Tanta University

Faculty of Nursing
Maternal and Neonatal Health Nursing Dep
Bachelor of Science in Nursing Program (Specialist)
2nd level, 3rd Semester, 2024- 2025

Breast Feeding
Prepared by
‫فاطمة السيد سالمه على بدوي‬ ‫محمد مهدي محمد الشين‬
‫فاطمة عبداللطيف السيد احمد خليفه‬ ‫محمود احمد عامر جبر‬
‫فاطمة محمود محمود صقر‬ ‫محمود السيد محمد السيد غازي‬

Under Supervision of :-
Prof.Dr / Manal Gaheen
Dr/ Eman Elkholy
Demonstrator/ Amina Yehia

Group (B 3 )

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 ‫رؤية البرنامج‪- :‬‬
‫تحقيق التميز في التعليم التمريضي لكي يواكب التقدم في العلوم الحديثة وتحقيق احتياجات المجتمع ومتطلبات سوق‬
‫العمل المحلية واإلقليمية والدولية‪.‬‬

‫رسالة البرنامج‪- :‬‬

‫يهدف البرنامج إلى تخريج أخصائي تمريض مؤهل بالكفاءات التمريضية التي تساعده على تقديم رعاية تمريضية شاملة‬
‫تلبى احتياجات المجتمع من خالل البحث العلمي والممارسة القائمة على دالئل األبحاث‪.‬‬

‫رؤية ورسالة قسم تمريض صحة األم وحديثي الوالدة للعام الجامعي ‪2025-2024‬‬

‫رؤية القسم‪:‬‬

‫يتطلع قسم تمريض امراض النساء والتوليد الى ان يكون من االقسام العلمية المتميزة على مستوى الكلية من خالل اعداد‬
‫ممرض وممرضة متميزين قادرين على المنافسة الفعالة في عصر تكنولوجيا المعلومات‪.‬‬

‫رسالة القسم‪:‬‬

‫التطلع إلى أن يكون قسم تمريض صحة األم وحديثي الوالدة من األقسام العلمية المتميزة على مستوى الكلية من خالل‬
‫إعداد ممرض وممرضة متميزين قادرين على المنافسة الفعالة في عصر تكنولوجيا المعلومات‪.‬‬

‫اهداف القسم‬

‫يهدف القسم الى تقديم برامج تعليمية من شانها اعداد كوادر من الطالب قادرة على تقديم رعاية تمريضية شاملة للمرأة‬
‫بمختلف المراحل العمرية وعلى جميع مستويات الصحة والمرض مبنية على تحليل وتحديد االحتياجات الجسمانية‬
‫والنفسية والبيئية للمرأة واالسرة والمجتمع‪ .‬وذلك باستخدام المعلومات والتقنية الحديثة وتطبيق نظريات وابحاث علوم‬
‫التمريض والعلوم االساسية واالجتماعية واالنسانية كأساس للممارسة التمريضية المهنية‪.‬‬

‫تتلخص اهداف القسم فيما يلي‪- :‬‬

‫دراسة الجوانب الجسدية والنفسية واالجتماعية المؤثرة في حياة المرأة من خالل‪-:‬‬

‫▪ دراسة محتوى التشريح للجهاز التناسلي الداخلي والخارجي وعلم وظائف االعضاء‪.‬‬
‫▪ دراسة الحالة الصحية للمرأة خالل فترات اإلنجاب والتي تشتمل على الحمل‪ ،‬الوالدة‪ ،‬النفاس واألمراض النسائية‬
‫ورعاية حديثي الوالدة ويتم التركيز على الرعاية الصحية من خالل تطبيق العملية التمريضية‪.‬‬

‫‪2‬‬
 Objectives
General objectives: At the end of this session the student will able to discuss in
details breast feeding.

Specific objectives:

At the end of session, the student will able to:

1) Define breastfeeding, exclusive breastfeeding and complementary

feeding.
2) Describe physiology of lactation.
3) List types of breast milk.
4) Discuss benefits of breastfeeding.
5) Describe technique of breastfeeding:
6) Discuss criteria of adequate breastfeeding.
7) Discuss criteria of feeding in breastfeeding.
8) Discuss criteria of over feeding in breastfeeding.
9) List contraindications of breastfeeding.

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 Outlines:

1. Introduction.
2. Definition of: -

✓ Breastfeeding.
✓ Exclusive breastfeeding.
✓ Complementary feeding.

3. Physiology of lactation.
4. Types of breast milk.
5. Benefits of breast-feeding.
6. Technique of breast-feeding:

✓ Steps of breast feeding.

✓ Position of breast feeding.

7. Criteria of adequate breast-feeding.

8. Criteria of under feeding in breast-feeding.
9. Criteria of over feeding in breast-feeding.
10. Contraindications of breast-feeding.
11. References.

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 Introduction
Breastfeeding should be started as early as possible. Breastfeeding gives the baby
all the nutrients it needs for the first six months of life, and continues to benefit the baby
along with solid foods for many months. It helps to protect the baby from infection and
other diseases. Breast feeding reduces the chances of getting related illnesses later in
life. Breastfeeding also strengthens mother and their baby’s bond both physically and
emotionally.

Breast milk is easy for baby to absorb and is the perfect food to help grow and
develop. Bottle feeding does not give the baby the same ingredients as breast milk. And
infant formula milk doesn’t provide protection against infections and other diseases.
Breastfeeding also has many benefits for mothers. Not only is it convenient, cheap, and
always available, it also: reduces the risk of hemorrhage immediately after delivery,
reduces the risk of breast and ovarian cancer and prolongs the amount of time before
mother get her period again.

https://www.moneycrashers.com/benefits-breastfeeding-mother-baby-tips

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Definition of breastfeeding: -
It is method of feeding an infant or young child with breast milk directly from
mother breasts from first hour after birth.
Definition of exclusive breastfeeding: -
It means that an infant receives only breast milk from his / her mother for first 6
months after delivery no other liquids or solids, not even water, with the exception of
oral rehydration solution, drops or syrups consisting of vitamins, minerals supplements
or medicines
Definition of complementary feeding: -
It is defined as the process starting when breast milk is no longer sufficient to
meet the nutritional requirements of infants, and therefore other foods and liquids
are needed, along with breast milk.

/https://www.who.int/nutrition/topics/complementary_feeding/en

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Physiology of lactation: -
There are 4 hormones that affect lactation process.
Estrogen and progesterone
• They prepare breasts to make milk. The placenta releases these hormones during
pregnancy. They have two major roles: -
1) They increase the size and number of milk ducts in breasts.
2) They also keep body from making large amounts of breast milk until
after baby is born.
• Once baby is born and the placenta delivered, these hormones decrease; this
decrease signals body that it is time to make milk.
Prolactin
Prolactin responsible about milk production and the development of mammary glands
within breast tissues and promotes the growth of mammary alveoli where the actual
production of milk occurs. After the birth of baby, prolactin levels increase. Every time
breastfeed or pump, body releases prolactin. With each release, body makes and stores
more milk in the breast alveoli.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fmedical-

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 Oxytocin:

When baby (or breast pump) begins to suck and draw nipple into his mouth, Oxytocin is
released and contracts the smooth muscle layer of band-like cells surrounding the alveoli
and causes milk to be squeezed out of the alveoli, into the ducts and out of nipple, into
baby’s mouth. This process is called letdown or milk ejection reflex (MER).

https://www.google.com/url?sa=i&url=https%3A%2F%2Fnursekey.com%2Fnewborn-nutrition-and-feeding-

Types of Breast milk:

1) Colostrum: -
➢ Colostrum is the first stage of breast milk.
➢ Begins around 16 to 18 weeks’ gestation and lasts for first three days after the
birth of the baby.
➢ It is either yellowish or creamy in color.
➢ Thick and sticky is often called "liquid gold".
➢ The volume varies from 2 to 20 ml per feeding
➢ Colostrum is high in protein, fat-soluble vitamins, minerals, and
immunoglobulins.
➢ Immunoglobulins are antibodies that pass from the mother to the baby and
provide passive immunity for the baby. Passive immunity protects the baby from

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 a wide variety of bacterial and viral illnesses. Three days after birth, colostrum
will be replaced by transitional milk.
➢ It is called Lactogenesis I.
2) Transitional milk: -
➢ Transitional milk occurs after colostrum and produced from the fourth to the ten
day.
➢ The content of transitional milk includes high levels of fat, lactose, and water-
soluble vitamins.
➢ It contains more calories than colostrum and is lower in protein in comparison to
colostrum.
➢ It is called Lactogenesis II.
3) Mature milk: -
➢ Mature milk is the final milk that is produced. 90% of it is water, which is
necessary to keep the infant hydrated. The other 10% is comprised of
carbohydrates, proteins, fats and bioactive components – such as growth factors,
enzymes and live cells – to support baby’s growth and development
➢ It is produced from approximately ten days after delivery up until the termination
of the breast-feeding.
➢ It is called Lactogenesis III (Galactopoiesis).

https://upload.wikimedia.org/wikipedia/commons/e/e6/From_Colostrum_to_Breastmilk_-_4241.jpgv

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There are also two types of mature milk:
1) Foremilk
2) Hind milk
1. Foremilk: occurs at the beginning of the feeding and contains water, vitamins, protein.

➢ Immediate milk received in feeding.

➢ Satisfies infants initial thirst.

2. Hind milk: comes at the end of the feeding when the breast is nearly empty and contains
higher levels of fat.

➢ Later milk received in feeding.

➢ Higher in fat content (4 times higher than foremilk).
➢ Satisfies hunger and promotes infant weight gain.

NB: The mature milk stage will last until weaning the baby from the breast.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fexclusivepumping.com%2Ftypes-of-breast-

❖ Benefits of breastfeeding to the mother- :

For mother:

1. Economically: no need to buy formula.

2. Easy for the mother & no preparation and available at any time.

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3. Mothers who breastfeed are more likely to return to their pre pregnancy weight.
It burning about 500 extra calories a day to build and maintain a milk supply.
4. Reduce the risk of breast cancer, osteoporosis, heart disease, lower risk of type 2
diabetes& ovarian cancer.
5. Help involution of uterus. Stimulates the uterus to contract and return to normal
size.
6. Reduced risk of postpartum bleeding.
7. Help in birth spacing
8. Exclusive breastfeeding may reduce the risk of anemia by delaying the return of the
menstrual cycle for 20 to 30 weeks.
9. Breastfeeding contributes to feelings of attachment between a mother and her child
(Maternal and fetal bonding)
10.Reduce risk of postpartum depression and increased confidence and self-esteem
For baby

1. Provides the superior nutrition for optimum growth.

2. Provide baby with all minerals needed & Contain balanced amount of protein &
carbohydrates & fat and vitamins.
3. Protect baby from infection & increase baby immunity.
4. Breast milk protect baby from inflammatory bowel disease, rheumatoid arthritis
and sudden infant death syndrome (SIDS).
5. Easy in digestion and absorption.
6. No allergic reaction.
7. At proper temperature.
8. Provides adequate water for hydration.
9. Emotional satisfaction.
10.Promotes bonding and development.

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 For community: -

1. Reduce health care costs.

2. Reduce infant morbidity & mortality.
3. Reduce fertility.
❖ Technique of breast-feeding:
• Steps of breast feeding: -
1) Mother Breast should be cleansed every day when the mother takes a
shower otherwise breast is washed with plain water and dried thoroughly.
2) The mother should wash hands thoroughly before breastfeeding and wear
a clean clothes
3) The infant should be hungry, dry and warm.
4) The mother should be in comfortable position either sitting or lying, such
as in a chair, with ample room on the sides and back for pillows to support
the baby and the arms.
5) Make sure that feet are elevated at a comfortable level.
6) The mother gently supports her breast, she can cup her breast with her
hand from underneath using four fingers and well behind the areola.
7) Rub the nipple or a finger gently against infant cheeks or lips to stimulate
sucking reflex where the infant opens his mouth widely and thrusts the
tongue forward and hold the nipple.

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 https://www.google.com/url?sa=i&url=https%3A%2F%2Fsimple.wikipedia.org%2Fwiki%2FLatching_on

https://www.pinterest.com/pin/176907091586565229/

Position of breast feeding: -

✓ The infant must be held close to his mother body, tummy against tummy and
the infant facing the breast, so that he does not have to turn the head to feed.
✓ The infant nose should be at level of nipple and the head tilted slightly
backward.
✓ In some positions the infant bottom is supported with mother hand.

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❖ Types of position: -
1) Side-lying hold
2) Cradle hold
3) Cross cradle hold
4) Football hold
5) Twins hold
 Side lying hold: - Mother and infant bodies are parallel.

http://www.babycentre.co.uk/a8784/good-positions-for-breastfeeding#ixzz3GiPHkjY2

 Cradle hold: - Mother hold infant across her lap, supporting him with the same
arm as her breast.

https://www.clipartmax.com/middle/m2i8Z5Z5b1b1i8K9_illustration-of-cradle-breastfeeding-hold-breastfeeding-
positions-cradle-hold/

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 Cross cradle holds: - Mother hold infant across her lap, using the opposite arm
to the breast she is feeding from to support him.

https://googleweblight.com/i?u=https://www.babycenter.com/0_positions -a

 Football hold: - Mother hold infant underarm, like a football or handbag.

https://googleweblight.com/i?u=https://www.babycenter.com/0_positions -and-t

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 Twins hold: - Using a cushion under infants as mother gently supports them with
her hands on their upper backs.

https://googleweblight.com/i?u=https://www.babycenter.com/0_positions-

❖ Eructation:-
• Eructate the infant 1:2 times during and once at the end of the feeding.
• Regurgitation 5:15cc of milk when eructated or after feeding is normal.
Positions of the eructation: -
1. Upright position on mother shoulder.
2. Sitting position on mother lap.
3. Prone position on mother lap.

https://www.google.com.eg/url?sa=i&rct=j&q=&esrc=s&source=images&

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Criteria of adequate feeding during breastfeeding: -
1) Infant is clam and satisfied after feeding.
2) Infant sleep well 3-4 hours after feeding.
3) Normal bowel movement and no constipation (4-8 / 24 hrs).
4) Normal amount of urine (6 or more / 24 hrs).
5) Normal weight gain (150-210 / week).
6) Good skin color and muscle tone.

Criteria of under feeding Criteria of over feeding

Criteria 1) Baby always crying before, during 1) Vomiting and colic.
and after feeds. 2) Milk Regurgitation.
2) Infant stay on the breast for a long 3) Large bulky stools
period 1/2-3/4 hour. containing undigested
3) Sleeplessness or very short sleep. curds.
4) Air swallowing leading to colic. 4) Excessive sweating.
5) Oliguria. 5) Abdominal distention
6) Poor weight gain. and cramps.
7) Constipation. 6) Baby crying and
8) Anemia. discomfort.
9) Finger-sucking after feedings. 7) Diarrhea.
10) Always tired. 8) Polyuria.
11) Bulging eyes. 9) Over weight.
12) Dry, yellowish skin. 10) Irritability.
13) Dry eyes and mouth.
Management ❖ Give supplementary, complementary ❖ Increase the interval
formula feeding. between feeds (4hours).

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 ❖ If baby cries excessively,
give (anise, carwya)
before feeding.

Contraindication of breastfeeding
For mother
Temporary: -

1) Infection disease, mastitis.

2) Inverted nipples.
3) Exposure to environmental toxins
4) She taking antiretroviral medication.
5) Mother undergoing chemotherapy or radiation treatment.
6) Mother is abusing drug.
7) Sore nipple.
8) Fissures, abscess in breast.
9) Mother smoking or alcohol consumption.
Permanent: -
1) Breast cancer or mastectomy.
2) Severe maternal illness, psychological shock.
3) Active T.B.
4) Drug use such as tranquilizers.
5) Epilepsy and severe mental disease.
6) Mother is HIV positive.
7) Mother is Hepatitis B surface antigen positive.

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For infant
Temporary: -
1) Nasal catarrh.
2) Thrush stomatitis.
3) Weak sucking reflex.
4) Congenital malformation e.g.: - cleft lip and cleft palate.
Permanent: -

1) Allergy but rare occur.

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 References

➢ Ciampo L., & Ciampo R. Breastfeeding and the Benefits of Lactation for
Women's Health. The Brazilian Journal of Gynecology and Obstetrics, 2018;
40(6): 354-9.

➢ Green E. Is Breastfeeding Truly Best? Evolutionary, Physiological, & Cultural

Factors that Shape Breastfeeding Practices. Honor Scholar Theses, DePauw
University, 2019; 106:17.
➢ Hall J. Guyton and Hall Textbook of Medical Physiology. 14th ed., United
States of America, Elsevier Health Sciences Com., 2020:1056.
➢ Potts J. The Physiological and Psychological Effects of Breastfeeding on
Subsequent Mother-Infant Bonding. Master Degree, faculty of Charles E,
Florida Atlantic University, Boca Raton, Florida, 2019; 1-6.
➢ Potts J. The Physiological and Psychological Effects of Breastfeeding on
Subsequent Mother-Infant Bonding. Master Degree, faculty of Charles E,
Florida Atlantic University, Boca Raton, Florida, 2019; 1-6.
➢ Nagendra K., Shetty P., Rudrappa S., Jaganath S., & Nair R. Evaluation
of Breast Feeding Techniques among Postnatal Mothers and Effectiveness of
Intervention: Experience in A Tertiary Care Centre. Sri Lanka Journal of Child
Health, 2017; 46(1).39-43.

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