Физиология грудного вскармливания

Физиология грудного вскармливания

Источник: Mamascom.ru

Как увеличить количество молока? Чем опасны бутылочки и пустышки? На эти и другие вопросы вы сможете ответить, понимая физиологию выработки грудного молока.

Грудное вскармливание – это естественный процесс кормления своего потомства для всех млекопитающих, который обычно не связан с какими-либо сложностями. Но на данный момент в обществе практически потеряна культура естественного вскармливания. В середине XX века широкое применение нашли заменители материнского молока, которые заметно вытеснили грудное вскармливание. В связи с этим современные мамы, родив ребенка, не могут опираться на опыт поколений. Они, зачастую, вообще первый раз держат новорожденного ребенка на руках уже будучи в роддоме. И большинство трудностей с грудным вскармливанием возникают из-за неверного представления и непонимания механизма выработки молока. Поэтому предлагаю вам, дорогие мамы, почувствовать себя на несколько лет моложе, оказаться в 9 классе школы, на уроке биологии и более подробно изучить физиологию лактации.

Анатомия груди

У всех женщин грудь устроена одинаково, единственная особенность, которая влияет на размер груди и ее форму – количество и расположение жировой ткани. Этот фактор никак не сказывается на способности кормить грудью.

Распространенное мнение о том, что женщины с маленькой грудью могут испытывать трудности с грудным вскармливанием – не более, чем вымысел.

Итак, женская грудь состоит из жировой ткани и молочных желез, в которых под воздействием гормона пролактин вырабатывается молоко. Молочные железы представляют собой миллионы альвеол – крошечных пузырьков, окруженных мышечными волокнами. Непосредственно в альвеолах и вырабатывается молоко. Мышечные волокна сокращаются под влиянием гормона окситоцин и выталкивают молоко в млечные протоки, откуда оно поступает в более крупные протоки – млечные синусы, где и хранится до момента кормления.

Снаружи груди расположен сосок, окруженный участком темной кожи, называемым ареолой. На поверхности ареолы вы заметите небольшие пузырьки – это, так называемые, железы Монтгомери. Они вырабатывают маслянистый секрет, который защищает кожу сосков от повреждений.

Подготовка груди к лактации

Подготовка груди к грудному вскармливанию начинается с первых дней беременности. Ткани молочных желез разрастаются, увеличивается количество альвеол. Именно поэтому женщина чувствует болезненные и неприятные ощущения в груди и отмечает ее увеличение.

Модная ранее «подготовка груди к кормлению» на данный момент доказала свою неэффективность. Не нужно специально стимулировать соски во время беременности, воздействовать на них с помощью грубой ткани или какими-либо иными способами.

Если у вас небольшие или втянутые соски, искусственное их вытягивание во время беременности не является эффективным.

У многих женщин еще во время беременности из груди может выделять молозиво – густая маслянистая жидкость, полупрозрачная, с желтоватым оттенком, которая будет являться первой пищей ребенка, пока не придет зрелое молоко. Выделение молозива во время беременности или его отсутствие не является показателем качества лактации в будущем. Поэтому, если выделения из груди вас не беспокоят – это не означает ничего, кроме того, что вам не придется заботиться о ношении впитывающих вкладышей. Если все же молозиво подтекает в тех или иных количествах – это не повод для волнения. Не пытайтесь его выдавливать, потому что в этом случае вы только усилите его секрецию.

Итак, сразу после родов ребенок в качестве первой пищи получит именно молозиво. Не стоит бояться того факта, что его может быть очень мало. Для новорожденного ребенка, пищеварительный тракт которого только начинает свою работу, даже нескольких капель молозива вполне достаточно.

Молозиво богато белками, противоинфекционными агентами, факторами роста. Содержание витаминов, в том числе и витамина А, значительно превышает показатели зрелого молока. Таким образом молозиво способствует развитию ЖКТ, предохраняет от развития аллергических реакций, защищает ребенка от инфекций, оказывает мягкое слабительное действие для скорейшего опорожнение кишечника от мекония (первородного кала), облегчает течение младенческой желтухи. Поэтому очень важно, чтобы ребенок в качестве первой пищи получил именно молозиво, а не воду или детскую смесь.

Физиология ГВ и зрелая лактация

В начале статьи мы уже вскользь упомянули о гормонах пролактин и окситоцин. Именно этот гормональный тандем обеспечит вашего малыша необходимым питанием в любое время дня и ночи.

С момента рождения ребенка гормональный фон женщины стремительно меняется. Прогестерон и эстроген уступают свои позиции пролактину. Именно он в течение долгого времени будет отвечать за выработку грудного молока и подавлять овуляцию, что будет способствовать плавному восстановлению организма после родов и препятствовать возникновению новой беременности.

Примерно на 3-7-ые стуки после родов (в зависимости от срока родов, способа родоразрешения и других факторов) у женщины приходит так называемое зрелое молоко. Которое и будет отныне являться пищей для малыша. Это результат не только естественной гормональной перестройки организма, но и активной стимуляции груди ребенком.

Грудное молоко вырабатывается однородным, но при перерывах между кормлениями более 2 часов, как любая многосоставная жидкость, молоко расслаивается на верхнее и нижнее. Верхнее молоко более водянистое, содержит меньше жиров, очень насыщено лактозой. Нижнее – более жирное и питательное.

Этой особенностью обусловлены рекомендации по смене груди во время кормлений: прежде чем дать ребенку вторую грудь, мама должна быть уверена, что он достаточно хорошо опорожнил первую. При этом женщина ориентируется на свои ощущения. В среднем, смена груди для кормлений происходит не реже, чем каждые 2-2,5 часа. То есть, при частых кормлениях (например каждые 40-60 минут) женщина может 2-3 кормления подряд покормить ребенка одной грудью, а потом перейти к другой. При кормлениях каждые 2-3 часа, как правило, женщины дают ребенку в одно кормление одну грудь, в следующее – другую. Однако часто бывает, что ребенок в каждое кормление опорожняет обе груди – все эти варианты абсолютно нормальны и имеют место быть при условии хорошего самочувствия мамы и ребенка.

Для успешного грудного вскармливания недостаточно одного лишь наличия молока в груди. Ребенок должен это самое молоко каким-то образом «достать». Поэтому в ответ на стимуляцию сосков вырабатывается гормон, сокращающий мускулатуру – окситоцин. Именно он «выталкивает» молоко из альвеол в млечные протоки, откуда его уже получает ребенок. Помимо этого в первые дни после родов окситоцин способствует сокращению матки. Поэтому мама во время кормления может ощущать схваткообразные боли, порой – очень сильные. И именно рефлекс окситоцина кормящие женщины ощущают, как «прилив молока». В такие моменты женщина может отмечать, что грудь налилась, стала тверже обычного, молоко может самопроизвольно вытекать из груди, а также могут чувствоваться болезненные покалывания в области молочных желез. Всё это связано с сокращением мышечных волокон вокруг альвеол и выталкиванием молока из желез в млечные протоки и синусы.

Количество грудного молока подчиняется только одному правилу: чем больше молока из груди уйдет – тем больше придет. Никакие лактогонные сборы, чай с молоком или таблетки для стимулирования лактации не усиливают выработку молока. Пока грудное молоко находится в груди, вступает в действие ингибитор грудного молока – вещество, приостанавливающее выработку молока. Это защитный механизм, защищающий от переполнения груди и сопутствующих осложнений (нагрубание, застой молока, мастит). Соответственно, чем реже и/или чем меньше грудь опорожняется – тем сильнее снижается выработка молока. Поэтому кормящей женщине важно понимать риски, связанные с использованием пустышек, бутылочек, включением в рацион ребенка первых 6 месяцев жизни дополнительного питания или не питательных жидкостей (вода, чаи, соки и т.д.). Все перечисленные факторы в той или иной степени могут заменять кормления грудью или увеличивать промежуток между ними, что часто приводит к уменьшению количества молока. Ту же опасность несет принудительное кормление по режиму, который противоречит потребностям ребенка или ограничение времени сосания.

Ночные кормления

Желание спать всю ночь и часто встречающееся заблуждение, что ребенок не должен есть в ночное время могут сыграть злую шутку. Пик выработки гормона пролактин приходится на подутренние часы – с 3 до 8 утра. В это время важно кормить ребенка именно грудью, так как с помощью ночных кормлений ребенок обеспечивает себе достаточное количество молока на следующий день. Также ночные кормления имеют наибольшее значение для подавления овуляции.

Если ребенок хорошо себя чувствует и нормально прибавляет вес – нет необходимости будить его на ночные кормления, придерживаясь какого-то четкого графика.

Как правило, дети, которые не получают никакого питания или жидкостей, кроме грудного молока и не сосут заменители материнской груди, самостоятельно обеспечивают себе два или больше кормлений в указанный промежуток времени. Например, ребенок лег спать в 10 часов вечера и проспал до 3 утра, поел, уснул и проснулся в 7 утра. В этом примере мы видим вполне удобную ситуацию, которая позволяет родителям неплохо выспаться, при этом с 3 до 8 утра ребенок выполняет «норму» по ночным кормлениям.

Значение правильного прикладывания к груди

Вопреки распространенному мнению ребенок не высасывает молоко из груди, а как бы выталкивает его. Ведь женский сосок сам по себе не содержит молока (в отличие от соски бутылочки, например). Для того чтобы добыть себе молоко, ребенок совершает определенные «доильные» движения языком, надавливая на область, находящуюся за соском. Именно поэтому размер и форма соска не имеют принципиального значения для успешности грудного вскармливания, ведь ребенок сосет не сосок, а грудь. По сути, сосок – просто точка, из которой вытекает молоко. Поэтому очень важным фактором в организации грудного вскармливания является правильное прикладывание ребенка к груди.

При правильном прикладывании ребенок наиболее эффективно опорожняет грудь, что позволяет ему получать питание в достаточном объёме, а у мамы поддерживается необходимое для питания ребенка количество молока.

Как понять, правильно ли малыш сосет грудь? Есть несколько вполне достоверных признаков:

  • рот ребенка широко открыт, нижняя губа вывернута наружу
  • головка слегка запрокинута назад
  • подбородок ребенка прижат к груди
  • ребенок захватывает ртом бОльшую часть ареолы
  • дыхание малыша не затруднено
  • иногда вы можете видеть язык ребенка над нижней губой
  • при сосании малыш делает сначала краткие быстрые движения, затем меняет ритм на более постоянное глубокое сосание. В ходе кормления ребенок делает паузы, которые становятся все дольше, по мере насыщения.
  • щеки ребенка округлены, иногда при сосании могут двигаться ушки
  • малыш не издает посторонних звуков (не чмокает, не чавкает. Только дыхание и глотание)

Как понять, что ребенок возможно испытывает трудности с правильным прикладыванием к груди?

  • мама испытывает боль при кормлении, которая длится более 10-15 секунд от момента начала кормления
  • возникают травмы сосков (трещины, ссадины)
  • часто повторяющиеся застои молока (лактостазы)
  • плохой набор веса у ребенка (менее 500 гр в месяц) и малое количество мочеиспусканий (менее 10-12 в сутки, при этом моча имеет желтый или даже оранжевый оттенок и резкий запах)
  • ребенок может очень часто прикладываться к груди, при этом быть беспокойным, брать грудь и тут же бросать ее, выгибаться, плакать и т.д.

Возникновение одного или нескольких из перечисленных факторов может свидетельствовать о том, что малыш неправильно захватывает грудь и, как следствие, испытывает нехватку грудного молока.

Что негативно влияет на лактацию?

Самый волнующий всех кормящих женщин вопрос – как сделать так, чтобы ребенку было достаточно молока? К счастью, случаи, когда женщина может испытывать необратимые трудности с грудным вскармливанием, встречаются достаточно редко. Как правило, такие состояния могут быть связаны с нарушением работы щитовидной железы, недоразвитостью тканей молочных желез (гипоплазия), хирургическими вмешательствами (пластика груди).

Есть ряд факторов, которые могут затруднять грудное вскармливание, но при правильной организации кормления, с учетом отягчающих обстоятельств, их удается достаточно быстро и успешно преодолеть:

  • кесарево сечение и другие хирургические вмешательства в роды (разрезы, разрывы)
  • преждевременные роды, недоношенный ребенок
  • разлука матери и ребенка из-за болезни или по другим причинам
  • некоторые особенности ребенка: синдром Дауна, расщелина нёба, «заячья губа», короткая уздечка и т.д.
  • прием матерью некоторых медикаментов

Что может сделать мама, при отсутствии осложняющих обстоятельств, чтобы свести к минимуму вероятность проблем с лактацией?

  • по возможности минимизировать различные вмешательства в естественный процесс родов. Побочными эффектами любых видов анестезии, а также искусственного окситоцина являются возможные трудности с лактацией, связанные как с нарушением естественного гормонального фона, присущего послеродовому периоду, так и с физиологическими и психологическими факторами. Для любого вмешательства в роды должны быть веские основания
  • обеспечить с ребенком контакт «кожа к коже» сразу же после рождения. При условии того, что ребенок и мама хорошо себя чувствуют. При этом все стандартные процедуры (взвешивание, измерение роста и т.д.) можно на некоторое время отложить.
  • осуществить первое прикладывание малыша к груди еще в родблоке, в течение первых 30-40 минут после рождения
  • при отсутствии противопоказаний, организовать совместное пребывание с ребенком
  • постараться избежать догрудного кормления. Иными словами, первой пищей, которую получит ребенок должно быть молозиво, а не адаптированная смесь, вода с глюкозой или другие жидкости
  • кормить малыша грудью по первому требованию, в любое время дня и ночи. При этом длительность и количество кормлений регулирует ребенок
  • не использовать бутылочки, пустышки и другие сосательные предметы. Если ребенку необходим докорм сцеженным молоком или смесью – его можно осуществлять из чайной ложки, чашки, шприца без иглы и т.д.
  • важным, но не основным условием достаточности молока является полноценное питание мамы, отдых и прогулки на свежем воздухе.

229 thoughts on “Физиология грудного вскармливания

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