The National Nutrition Council MIMAROPA posted the second of a three-part video series (see: https://www.nnc.gov.ph/regional-offices/luzon/region-iv-b-mimaropa/4336-highlights-nnc-mimaropa-premiered-nutrition-sharing-session-part-1-of-3-unang-yakap-protocol-and-breastfeeding-benefits) on 21 November 2020 via NNC MIMAROPA Facebook page which focused on breast milk expression, breast milk storage, and cup feeding.

Guest resource person, Dr. Aurora Gloria I. Libadia, Clinical Associate Professor and Head, Lactation Unit and Human Milk Bank, University of the Philippines – Philippine General Hospital started the discussion by sharing on how milk is produced in the body.

The following are key points shared by Dr. Libadia:

• Breast milk production is stimulated through the release of hormone oxytocin, also known as the love hormone. Oxytocin reflex works before or during to make milk flow.

• An enabling environment helps a mother breastfeed. A mother should have positive thoughts and positive support system to help build her confidence in breastfeeding. Breastfeeding is not a one-man team.

• Stimulating factors include sight of the baby, sound of baby’s voice, and sensory impulses from nipple sucking help oxytocin reflex. Anxiety, pain, or doubts stops oxytocin reflex.

• Another hormone involved in breastfeeding is prolactin, which is also known as the relaxing hormone. Prolactin is secreted after the breasts are empty. More prolactin is secreted at night, and also has an effect on suppressing ovulation.

• Recommended practice is to empty the breast before transferring to the another. This enables more milk production.

• If the breast remains full of milk, secretion stops. If the mother will be away, it is recommended that milk is expressed every 2-3 hours.

• Early signs that the child is hungry include facial expressions and showing of rooting reflex. Mid signs include movement of hands and feet, or sucking of fingers or hands. Once unattended, late signs such as irritability will show.

• There are different breastfeeding positions a mother-baby dyad can try. Important points in breastfeeding - in-line, close, supported, and facing.

• Signs of good attachment include chin touching breast, mouth wide open, lower lip turned outwards, and the areola is more visible above than below the mouth.

• Results of poor attachment include: 1) pain and damage to nipples which result to sore nipples and nipple fissures; 2) breastmilk not removed effectively resulting to breast engorgement; 3) poor milk supply, and 4) less production of breast milk.

• Milk expression should start with proper handwashing. Breasts can be massaged beforehand. When expressing milk, use a C hand position in 6 and 12 o'clock or in 3 and 9 o’clock position. Compress posteriorly (patalikod), since ducts are located at the back. Press backward towards chest wall, relax and then repeat or 5 minutes. Possibly in the first 2 minutes of expressing, no milk comes out yet.
• Colostrum may come out in drops, as it is thick and a small amount. You may use a tuberculin syringe, remove the needle and aspirate the colostrum when first learning to express . This is very helpful when mother gives birth to a premature /sick baby. Milk expression can be done within 6 hours after delivery of her baby to stimulate the breast and increase milk supply. Later, the milk may spray out in streams after the oxytocin reflex works.
• Expressing breast milk will get better and easier with practice. It is important to note the volume expressed is not the volume of milk the baby is suckling.
• In storing breastmilk, put it in a thoroughly cleaned container with label and freeze. If refrigerator is not available, a cooler or jar with cold water may use.
• Practice the first in, first out method in using stored breastmilk. Never use hot water or putting in the microwave when thawing, instead, use warm/tap water bath or thaw inside the refrigerator.

Part 3 of the Nutrition Sharing Session video series will be aired on 28 November 2020 and will focus on Executive Order 51 (Milk Code), risks of milk formula, ensuring adequate milk supply, donor human milk bank and overview of the human milk banking system.