Sensitive Midwifery - Issue 43 - July2019

We know that human beings are mammals, and that mammals feed their young with their own milk and yet, nowadays, it has become ‘normal’ to feed our babies with another species’ milk. We are the only mammals to do so. The reasons for this are complex, but I personally believe that the increased normalisation of formula and cow’s milk for human babies, particularly in the past century, has been indirectly influenced by the medicalisation of birth, and with this, poor feeding advice and ‘rules’ that mothers follow from early on. These rules and regulations by institutions interfere with the intuitive process of breastfeeding. While breastfeeding can come with challenges, babies are hardwired to breastfeed and moms are hardwired to respond to their babies’ cries. I do believe that if we did fewer interventions, we would have more breastfeeding mothers. Surprise! No lactiferous sinus It is a human trait to believe what we believe, to accept what we’ve been taught. At times, it can be difficult to change our minds – even with new evidence that what we thought we knew is wrong. According to Merriam Webster dictionary, a lactiferous sinus is ‘an expansion in a lactiferous duct at the base of the nipple in which milk accumulates’. The Dictionary.com definition is ‘a circumscribed spindle-shaped dilation of the lactiferous duct just before it enters the nipple of the breast’. In the past, many healthcare professions being taught about the anatomy and the physiology of breastfeeding were told that the milk is stored in the lactiferous sinuses under the areola. Anatomy of the normal breast did not receive a lot of attention since Sir Astley Cooper performed dissections of the breast about 180 years ago. These anatomical drawings only changed slightly over the years as more publications were printed, and so we continued to believe that lactiferous sinuses do exist. But with technology comes change and though surprising, we need to acknowledge now that not only are there are no lactiferous sinuses, but that this must have an impact on how we advise mothers about breastfeeding. The long and short of it is simple: our breasts have not mutated; rather, it is our knowledge that has changed. New research means re-learning In the late 1990s and early 2000s, more research on the anatomy of the breasts emerged as technology developed. In 2005, researchers viewed new dimensions using ultrasound – a non- invasive, relatively cheap approach to re-examine the anatomy of the breast. This led to ground- breaking discoveries and changed our whole outlook on the anatomy of the lactating breast. Some of the findings from this research were mind blowing: • No lactiferous sinuses exist • The ductal system is comprised of fewer numbers of main ducts than previously thought – the actual number of openings is between four and 18 (previously, we believed it was 15 to 20) • The ducts branch much closer to the nipple than what we thought • Some ducts are very close to the skin surface and therefore they are easily compressible • Compressible ducts do not contain large amounts of milk • The amount of fatty tissue in the breast is variable; a proportion is situated within the glandular tissue • Most of the glandular tissue is within 3cm of the nipple Since medical professionals need to know the normal to be able to depict the abnormal, these findings not only add to our understanding of the physiology but also the pathology of the lactating breast. As a breastfeeding consultant, this research changed my whole outlook on breastfeeding. You think you know it all and then realise you’ve only seen the tip of the iceberg. Now, 14 years later, I continue to be amazed by the world of breastfeeding and how little we know. Updating our advice With any new information, we, as midwives and healthcare workers, need to really look at our practices. If, as the evidence now shows, there are no lactiferous sinuses, we need to revisit our understanding of a good latch and where the nipple should be in the baby’s mouth to ensure a rapid first milk ejection for optimal drainage of milk. We now know that very little milk is removed before the first milk ejection reflex as the breast doesn’t store milk. Rather, rapid initial sucking action from the baby stimulates milk ejection, which will lead to subsequent milk ejections. The implication of this is that a sleepy baby may not have this rapid sucking action, and the healthcare worker needs to help the mom to establish a good, effective latch as soon as possible to stimulate milk ejection. Breast assurance Continued on page 26 25 eSensitive Midwifery Magazine Issue 43