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Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. With reference to the World Health Organisation, breastfeeding, commonly known as nursing, is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure  and hormonal control on milk secretion. Besides the milk supply, adopting the correct approach during the breastfeeding process also helps build up the maternal bond, which in turn promotes breastfeeding as well. Not only is the mother-child relationship strengthened, but also that breastfed children usually gain benefits in intelligence and immunity while mothers will have a diminished risk of having ovarian and breast cancer.

After establishing breastfeeding, it is crucial to ensure a constant milk supply to infants. To maintain milk production, postpartum mothers are recommended to have various food and remedies, providing minerals and vitamins for infants’ growth development and mothers’ recovery. However, if mothers suffer from diseases, like  mastitis, that interfere with breastfeeding, it is suggested that they should seek professional medical assistance to see whether the situation can be ameliorated for the continuation of nursing.

Anatomical significance of breast
The composition of a breast is mainly the glandular and adipose (fatty) tissues which are linked together by ligaments. Concerning the structure of glandular tissue, it is composed of ducts and alveoli. These alveoli are small hollow cavities that cluster together to form lobules and these lobules further clump together to form lobes that are responsible for the production and storage of milk. The alveolar cells have their linings consisting of muscle cells, which plays a vital role in the ejection of milk by contracting the lobes during lactation. Subsequently, the already-made milk is drained outside through the ducts connecting the milk-secreting lobes and nipple.

Regarding the adipose tissue present between lobes, it is important for the alveolar growth and ductal development in the mammary gland. The maturation of alveolar cells is supported by white adipose tissue and brown adipose tissue in breast, preparing the alveoli for milk synthesis during lactation. The growth of ductal epithelium is stimulated by leptin, a hormone secreted by mature breast fatty tissue, to make the milk ducts ready for the passage of milk.

Apart from the internal structures, the external features of the breast are also involved in breastfeeding. A nipple is supplied with nine milk ducts on average, muscle and nerve fibres. The pigmented circular area surrounding the nipple is the areola containing Montgomery's glands that synthesized oily liquid. The function of this oily fluid is to protect the skin of the nipple and alveolar by reducing frictions during breastfeeding. Not only does the fluid lubricates and ensure a smooth feeding, but it also releases a special fragrance to entice the baby to approach the breast to initiate feeding.

Mechanism of breast milk supply
The mechanism of milk supply is mainly controlled by three 3 hormones, prolactin, oxytocin, and feedback inhibitor of lactation.

Prolactin
Prolactin, produced in the anterior lobe of the pituitary gland, is the major hormone responsible for milk production. During pregnancy, the level of prolactin rises to trigger the development of mammary tissue in the breast to prepare it for milk supply. Yet, due to high levels of progesterone and oestrogen which are female hormones released from the placenta, milk production is prohibited until the removal of the placenta after labour. When the inhibition from progesterone and oestrogen fades, rising levels of prolactin can stimulate the production of milk which is stored in the myoepithelium of the mammary gland. In addition, the suckling action of the baby stimulates the nipple, resulting in the secretion of prolactin. The prolactin hormone will reach its highest level in blood approximately 90 minutes after breastfeeding. The peak level of prolactin triggers milk supply in the alveoli and ducts for the next feeding.

Oxytocin
Oxytocin, released by the posterior lobe of the pituitary, is so-called the ‘let-down’ hormone that induces the ejection of milk stored in breast. This hormone is secreted depending on the thoughts or the sensations of mothers. For instance, the suckling action of a child and the crying of a baby can promote the rapid increase of maternal oxytocin. During breastfeeding, oxytocin triggers the ejection of milk by contracting the myoepithelial cells present surrounding alveoli in the mammary gland.

Feedback Inhibitor of Lactation (FIL)
In contrast to prolactin and oxytocin, FIL poses an inhibitory effect on milk synthesis. It gradually reduces the amount of milk produced by suspending the milk secretion when the mother wants to reduce the frequency of breastfeeding. This makes sure that a proper volume of milk is produced, thereby avoiding overfilling the breast with milk. Therefore, the level of FIL rises during the accumulation of milk to slow down milk secretion. While breast is emptier, FIL level drops to allow the milk production.

Before breastfeeding
Nipples can be pressed with sanitized hands to allow milk retained in the last feeding to come out and cleaned with warm water. To clear the blockage of mammary glands and further facilitate milk secretion, breasts can be kneaded or have their sides swept with a wooden comb.

During and after breastfeeding
During breastfeeding, babies should be hugged diagonally and fed with a constant middle speed to prevent overfeeding. After feeding, babies can be slightly lifted and have their back gently patted, preventing regurgitation of milk.

Infants should be fed every 3 hours and the milk-drinking pattern alters upon babies’ exposure to alcohol. More care should be provided to the preterm infants, who have immature coordination between sucking and swallowing. Thus, tube feeding is used to feed preterm infants breastmilk while preventing choking. The transition from tube-feeding to oral feeding, including breastfeeding, can be facilitated by oral motor interventions, which are oral and tongue exercises.

Mothers should express milk at least 3 times a day. If milk production is inadequate, formula milk and baby food should be added to the diet. On the contrary, milk not drunk should be expressed by either hand expression or pump and stored in a container with a lid in the refrigerator. Stored milk should be dated such that the quality of milk is maintained. Refrigerated milk has to be thawed at room temperature and mixed to have an even distribution of fat before intake.

Weaning
From the sixth month onward, mothers and their babies can decide when to switch from breast milk to semi-solid foods and this transition is called weaning. It is suggested by the World Health Organisation that 6 months old babies who are introduced to their first solid foods shall also be complementarily fed with breast milk or formula milk as the main drink until two years old or above. The reason for this practice is that breastfeeding not only helps with the digestive system with the breaking down of solid foods, but it also supplied balanced nutrition for the babies.

Apart from offering solid foods, the frequency of breastfeeding should be reduced gradually to avoid possible adverse events like overfull. It is easier to begin with cutting down the least favoured regular daily breastfeed. The pace of weaning is up to the mother and baby, but it is recommended to adopt a progressive reduction approach. When the mother wants to push forward the transition to weaning, she can further suspend another least favoured breastfeed after a couple of days. For babies below 1 year, it is better to substitute the dropped breastfeed with a bottle of infant formula to guarantee adequate nutrition. As for the babies above 1 year, they do not require this kind of replacement as they already gain nutrients from a wider range of food and drink such as whole milk.

Relationship establishment with baby through breastfeeding
Breastfeeding is an intimate physical contact between mother and baby, which allows the establishment of mutual trust, caring, and connectedness as the foundation of a close parent-child relationship. The reasons for the amelioration of mother-child bonding will be analysed from the viewpoints of the baby and the mother.

From the perspective of babies, breastfeeding is a special physical interaction that provides comforting, analgesic, and relaxing effects. During weaning, breastfeeding can be utilised as a means to comfort the babies when they cry at night. This makes some mothers keep on night feed. Additionally, even the toddler can be breastfed to ease their negative feelings and discomfort. These show the important role of consolation played by breastfeeding in strengthening the bonding between mothers and babies.

As for the mothers, the release of oxytocin during lactation does not only promote milk supply, but it also triggers the expression of maternal behaviour and maternal love. Although the mechanism of oxytocin-inducing maternal love has yet to be elucidated, various studies and evidence indicate that oxytocin enhances the mammalian motherly behaviours and provides anti-stress effects. It is generally believed that oxytocin-influencing motherhood can reinforce the attachment between the mother and baby.

Factors affecting quality of establishment breastfeeding
Health of postpartum mothers and infants determines the quality and effort spent in breastfeeding establishment. Establishment is aid by sufficient milk supply.

Foods recommendation for health of mothers and infants
Vitamins and minerals taken by mothers deliver into infants via breastfeeding.

Various vitamins are recommended for breastfeeding mothers, including vitamin A, vitamin D, vitamin C, and vitamin B. Maternal supplied vitamin A is delivered to infants to strengthen body development, especially lung. Vitamin D supplemented maintains the balance between calcium and phosphate level to promote infant skeleton and skeletal muscle formation. Vitamin C promotes absorption of iron for blood production. Vitamin B may improve cognitive function.

Minerals are also essential for infant growth, including calcium, which is responsible for rapid skeletal development. Increase in maternal calcium intake replenishes the calcium delivered to baby and prevent excessive reduction in body mineral density. Inadequate calcium intake of breastfeeding mothers leads to a higher chance of osteoporosis in the postmenopausal period. Moreover, iron should be taken to possibly maintain the hematological and neurological development progression of infant and mothers’ health.

Furthermore, a high intake of fruits and vegetables maintains diverse nutrients intake and nutrients-richness of milk. It might reduce the psychological distress of postpartum mothers and the risk of postpartum depression.

Food and activities which may harm health

 * Breastfeeding mothers should consult doctors before drug intake, otherwise, the drugs babies obtained from milk will affect infants’ metabolism.
 * Low dose intake of accumulative caffeine by mothers would not affect infants. However, with a continuous accumulation of caffeine by having more than 6 cups of caffeine-containing drinks, the sleeping pattern of hyperactive babies will be significantly affected.
 * Alcohol in breastmilk blocks release of oxytocin and release of milk . Moderate level of alcohol introduces a detrimental effect on motor development of breastfeeding infants.
 * Mothers should cease smoking so that nicotine would not be transferred to babies via milk and respiration, possibly harming their health and leading to death.

Western remedies
Natural galactagogue mix, including herbal tea, might increase milk secretion. Pharmacological galactagogues also show their ability in boosting milk production, e.g. Metoclopramide.

Chinese remedies
Chinese herbal medicine and tuina massage can improve milk production. Papaya fish soup increase production and nutrients of milk. Fish increases the protein composition of milk while fish oil increases the proportion of beneficial fatty acid in milk.

Massage
The following acupuncture points can be pressed or have acupuncture operated on them to promote milk excretion.


 * Danzhong (CV17)
 * Shaoshang (LU11)
 * Hegu (LI4)

Others
Milk production is higher at night due to active synthesis and release of prolactin.

Mastitis
Blockage of the mammary gland caused by missing feeding in an oversupply of milk and damaged nipple increase the chance for having mastitis, which is caused by infection of Staphylococcus aureus.

Due to inflammation, these mothers will have an ill feeling and lumps in breast. Their breasts will be swollen and red, sometimes painful after infection.

Apart from antibiotics prescription, commonly penicillinase-resistant penicillin, mastitis can be treated with effective milk removal by increasing feeding frequency, usage of pump, and massage on the blocked area on breast. Warming breasts may facilitate the clearance of blockage and relieve pain before massaging acupuncture points, such as Tianxi (SP18) and Shidou (SP17).