Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
 Objective 6:
Social,
institutional,
and community
benefits
 Objective 7:
Anatomy and
physiology
Section 3
Section Three Contents:
 Objectives 6-7
 Topics
Social, institutional, and community
benefits of breastfeeding
Anatomy and physiology of lactation
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Objective 6
 Examine the
social,
institutional,
and
community
benefits of
breastfeeding
Image taken by Jennifer DeJong; Breckenridge,
Colorado – Walking Down Main Street (restaurant
decoration), Summer 2012.
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Social, Institutional, and Community
Benefits (Mesosystem)
 Increased cost savings for mothers
and families.
 Decreased costs for hospitals and
public health programs.
 Decreased absenteeism and loss of
income for employers.
 Decreased environmental burden.
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Increased Cost Savings for Families
 Breastfeeding women and
their infants have lower
healthcare costs compared
with those who formula
feed (Pugh et al., 2002).
 According to Ball and
Wright (1999), infants who
are not breastfed incur up
to $471 more health costs in
the first year compared with
infants who are exclusively
breastfed for three months
($671 in 2008 dollars) (U.S.
Bureau of Labor Statistics. Inflation
calculator, 2009).
Image taken by Jennifer DeJong, November 2011.
People in photo: Brad DeJong; children: Christian,
Joseph, John, and Carolyn DeJong.
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Pre-Class Team Work
 An exclusively
formula fed infant
uses 150 cans of
formula powder in
the first 6 months of
life (Riordan, 2005).
 What does that mean
to a caregiver’s
pocketbook?
Image taken by Jennifer DeJong; Carolyn feeding panda
bear with bottle, Summer 2011.
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Decreased Costs for Hospitals
and Public Health Programs
 Tuttle and Dewey (1996) compared
breastfeeding to formula feeding from the
perspective of the U.S. WIC program among
low-income Hmong women in California
(n = 838); they projected increased cost
savings of approximately $3 million to $5
million for WIC programs in just one
California county if women were to
breastfeed their children at least six months.
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For Every Infant Not
Breastfed…
 Likewise, in medical insurance organizations
(Medicaid) and health maintenance
organizations (HMOs), Ball and Wright (1999)
concluded that
 for every 1000 infants never breastfed, there
were 2033 surplus office visits, 212 additional
hospitalization days, and 609 excess
prescriptions written that were ascribed to lower
respiratory tract illness, diarrhea, and otitis media
among never-breastfed infants when contrasted
to breastfed infants.
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Billions of Dollars in Savings
 It has been speculated that in the near future,
endorsement of breastfeeding may arise from
entire HMOs, the U.S. government, and
insurance companies, who are likely to
increasingly distinguish the costs of women not
breastfeeding to their institutions (Wright, 2001).
 According to the AAP (2005), increasing the
percentage of children breastfed in the early
postpartum period from 64% in 2000 to the
HP2010 goal of 75% would save an estimated
$3.6 billion in health-care costs annually.
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The Joint Commission



This economic point is further emphasized by Bartick, Stuebe,
Shealy, Walker, and Grummer-Strawn (2009) when they
discussed the leverage accrediting organizations have in
modifying hospital practice. For example, the Joint Commission,
which accredits most U.S. hospitals, has set quality measures in
many areas over the last decade.
These measures are publicly reported and the subject of
considerable attention by hospital staff and administrators
across the U.S.
Until recently, the Joint Commission did not have quality metrics
relating to lactation. However, on July 20, 2009, the Commission
made the announcement that it was adding “Exclusive breast
milk feeding” as a new hospital Core Measure for prenatal
care, effective April 2010 (The Joint Commission, 2009).
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Decreased Absenteeism and Loss of Income
for Employers (Mesosystem and Exosystem)
 Lactating workers
have lower rates of
absenteeism as a
result of an ill child
(AAP, 2005; Association of Women’s
Health, Obstetric, and Neonatal
Nurses, 2008; Brown, Poag, &
Kasprzycki, 2001; Dunn et al., 2004;
Libbus & Bullock, 2002; USDHHS, 2008;
Witters-Green, 2003).
Image taken by Jennifer DeJong; Vietnam, May 2011.
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Decreased
Absenteeism and
Loss of Income for
Employers
(Mesosystem and
Exosystem)
 Mothers who
continue to
breastfeed while
working report fewer
lost work days due to
infant illness, even if
the infant is in
daycare (Visness,
Kenendy, & Labbok, 1995).
Image taken by Jennifer DeJong; Vietnam, Summer 2011.
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Supported Mothers have
Increased Productivity
 Supported mothers have improved
morale, decreased stress, and
increased productivity which
increases the financial benefits to
employers (Brown et al., Dunn et al., Lippus &
Bullock; Ortiz, McGilligan, & Kelly, 2004).
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Decreased Environmental
Burden
 What do you think is required to
manufacture artificial feeding
products?
 Human milk is a RENEWABLE resource!
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Breastfeeding Protects the
Environment
 Breastfeeding, by its very nature, protects
society and the environment from pollution
and disposal problems, eliminating the need
for discarding tin, paper, and plastic cans
and bottles, as well as diminishing the energy
demands and expenditures for preparing,
packaging, and transporting artificial
feeding products (Baby Friendly U.S.A, 2009).
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Objective 7
 Develop a
thorough
understanding
of the anatomy
and
physiology of
lactation.
Image taken by Jennifer DeJong; Breckenridge,
Colorado – Walking Down Main Street (restaurant
decoration), Summer 2012.
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“In the Beginning” Lactogenesis I
 Starts mid pregnancy and occurs to
day 2 postpartum.
 Alveolar cells differentiate to secretory
cells.
 Mammary secretory cells are
stimulated to produce milk by
prolactin.
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Prolactin = Production
 When progesterone levels fall (after
delivery), prolactin secretion increases
10-fold!
 Its major responsibility is MILK
PRODUCTION!
 Think P for Prolactin and P for
Production.
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Did you Know?
 Breast size is not an indicator of milk
production.
 In a healthy, normally lactating
woman, breast milk production
reflects the infant’s appetite and not
the mother’s ability to produce milk.
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Oxytocin
– Produced in the _____________________________.
– Ejection of oxytocin is stimulated by the infant
sucking at breast.
– Oxytocin is released in _______ and sent through
the blood stream to the breast tissue.
– Major responsibility is to get the milk _____ of the
breast
– Oxytocin also aids in uterine ________________
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Strong Surges
When Baby
Touches the
Breast
Image used by DeJong with permission from Justine
MacAurthur on 7/24/2012 via email.
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Oxytocin Leads to Contentment
 Results in the opposite
of “fight or flight”
 BP drops
 Brain activity becomes
calm and introverted
 Mom and Baby go to
their “happy place”
(DeJong, 2012)
Image taken by Jennifer DeJong; Florida, Spring 2012.
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Mnemonic Device
 Hormones
–Prolactin = Production
–Oxytocin = Out of the breast
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Lactogenesis II: Secretory
Activation
 Occurs from Day 3 to Day 8
postpartum
 Onset of copious milk production
 Breasts become full and firm
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Breast milk Characteristics
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If Milk is Not Removed…
 The secretory cells become flattened
 The prolactin can not enter the flattened
cells
 Cells are signaled to stop producing milk,
and milk is eventually reabsorbed
 INVOLUTION occurs – “apoptosis” – which
is planned cell death
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How Much Intake Should I
Expect in a Breastfed Infant?
Day 1:
Day 2:
Day 3:
Day 4:
Day 5:
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How to Measure Intake and
Output in a Breastfed Infant
Intake (Once milk supply is established)
 Breastfed infants feed on average 8 – 12
times per day.
 Audible swallowing, and quantity of stools
and wet diapers, are the best indicators of
adequate intake at breast.
 Pre- and Post-feeding weights (in grams)
may also be necessary.
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How Much Output Should I
Expect in a Breastfed Infant?
Day 1:
Day 2:
Day 3:
Day 4:
Day 5:
Day 6:
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End of:
 Objective 6: Social,
institutional, and
community benefits
 Objective 7:
Anatomy and
physiology
Next:
 Objective 8:
Nurses’ role
 Objective 9:
Positions
 Objective10:
History and trends
Image taken by Jennifer DeJong,
November 2011. People in photo: My
husband, Brad, and our children:
Christian, Joseph, John, and Carolyn
DeJong.
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