Breasts begin to develop at puberty. This is the most important organ where the hormones estrogen, progesterone and prolactin (link to glossary) play an important role. In pregnancy the glandular tissue matures completely for actual production of milk. The breasts lie over the pectoral muscles of the chest. It usually extends from the 2nd to 6th rib in mid–clavicular line. The size and shape of the breasts keeps on varying in women during different periods of life. It greatly depends upon each person’s constitution and genetic make–up. Breasts do not contain any muscles, they are made of glandular tissue and fat.

Various Parts of the Breasts are:
Nipples
The small muscular projection near the center of the breast. All the milk ducts join together at each nipple. While the mother is nursing the child, milk from the mammary glands reaches the nipple, allowing the baby to suckle. At other times, the nipple plays a sensitive role during love play. Breast is supplied with numerous nerve endings, which makes it very sensitive to touch. It is vascular hence becomes erect. It has 15–20 lactiferous ducts with their opening. There is no fat beneath the nipples.

Areola
It is placed in the center of the breast. It is a small ring of the colored pigmented area around each nipple. There are numerous sebaceous glands over it.

Milk Glands
Each breast is divided into 15–20 lobes which consists of fatty tissue. Inside each breast there are a number of milk–producing sacs. The milk production is same in every woman and does not depend upon the size of the breast.

Milk Ducts
These ducts (lactiferous duct) connect the milk glands to the nipple. The total number of ducts is anywhere between 10–100. They carry the milk to the nipples.

Breastfeeding is very vital for the infants’ well–being and for avoidance of infections. It should be avoided only in some rare serious conditions. Artificial feeding is safe only under good social environment, but if there is lack of hygiene the infant may suffer from gastroenteritis and malnutrition.

Advantages of Breastfeeding

• It is good for digestion: Fat is digested better. This milk is rich in protein, rich in lactalbumin and lactoglobulin but less casein hence easily digestible.
• Protection against infection and deficiency states.
• It contains water soluble vitamin D which protects the baby against rickets.
• It contains milk bacteria–lactobacilli which helps preventing gastroenteritis . It also make the stool acidic in reaction.
• The milk contains protective antibodies which gives passive immunity to the baby.
• Breast milk is sterile and readily available.
• It is given to the baby directly at body temperature.
• It is most convenient as it requires no preparation and costs nothing.
• Breastfeeding acts as a natural contraception.
• It has laxative action. There is no danger of allergy.
• It helps in establishing healthy mother–child relationship.
• The baby never suffers from diseases like scurvy and rarely from rickets.

Preparations for Breastfeeding

• The to–be–mothers should start the preparation for breast–feeding right when they are pregnant. If there is any abnormality in the nipples, like cracked or depressed or inverted nipples, it should be effectively treated.
• She should regularly massage her breast to express the colostrum.
• Cleanliness should be carried out during the last four weeks of pregnancy.
• Mothers should be told about the advantages of breastfeeding and should be encouraged.

Tips for Breastfeeding
First Feed
A healthy baby is put to the breast 1–2 hours following normal delivery.

• The breast should be washed once daily.
• A clean and supporting brassiere should be worn.
• The mother should wash her hands before feeding her baby.
• Any discharge through the nose and ears of the baby should be cleaned and the napkin must be changed.
• Mother and the baby should be in a comfortable position during feeding.

Frequency of Feeding

• Time schedule–During the first 24 hours, the mother can feed the baby at regular intervals not exceeding 5 hours. By the end of first week, the regularity is established at a 3–4 hour pattern.
• Demand feed–The baby is put to the breast as soon as the baby becomes hungry. There is no restriction of the number of feeds and duration of suckling time.

Time at The Breast
The initial feeding should last for 5 minutes at each breast. Thereafter, by the end of first week, about 15 minutes time is to be spent on both breasts. The baby should suckle for 10 minutes at the first breast and 5 minutes at the second one. The next feed should start with the second breast.

Night Feed
In the initial period, a night feed should be given at an interval of 5 hours. By doing this one can avoid excessive filling and hardening of the breasts and also ensures sound sleep for the baby. As the baby grows he gets set with the 3–4 hourly feed and has a good sleep at night without any feed.

Amount of Food
The average requirement of milk is about 100ml/kg of body weight for every 24 hours on the third day and is increased to 150ml/kg/24 hours on the 10th day. However, the baby can take as much as he wants.

Technique of Breastfeeding
The mother and the baby should be in a comfortable position. Feeding in the sitting position, the mother holds the baby in an inclined upright position on her lap, the baby’s head on her forearm on the same side as her breasts, the head being a little extended. The mother should bend slightly forward and then guide the nipple holding it between her first two fingers into the baby’s mouth. Feeding in side ways position either at night or during illness may be carried out by placing the baby along her side between the body and the arm.

Breaking The Wind
All babies swallow varied amount of air during suckling. To break up the wind, the baby should be held up right against the chest and the back should be gently patted till the baby belches out the air. It is better to break up the wind in the middle of suckling so as to enabling the baby to take more milk.

Difficulties in Breastfeeding
Due to Mother

• Reluctance to breastfeeding. The mother should be told the advantages of breastfeeding.
• Anxious mothers who fail to relax during feeding and due to which the baby refuses to suck.
• Previous history of failed lactation or elderly mother.
• After delivery such as Caesarean section or following prolonged and exhaustive labor.
• In illness such as severe anemia, pre–eclampsia (sudden high blood pressure), eclampsia (occurrence of one or more convulsions in women suffering from pre–eclampsia), organic heart diseases, diabetes, pulmonary tuberculosis etc.
• Milk secretion is inadequate either from the beginning or at a varying interval after the onset of lactation.
• Some sort of abnormality in breast such as engorgement of breast, breast lumps, cracked nipple, depressed nipple and mastitis.

Due to Infant

• Low birth weight baby–The baby is too small or feeble to suck.
• Imperfect suckling which can be due to temporary illness such as cerebral irritation, respiratory tract infection, nasal obstruction due to congestion, lethargy due to jaundice and oral thrush. As the baby could not suck, there is lack of proper nipple stimulus, which results in improper emptying of the breasts and drying of the milk.
• The baby swallows excessive air which leads to over–distension of the stomach. This could be tackled by breaking the wind several times while feeding.