3. Breast is the natural way of feeding an infant. Malnutrition and increased susceptibility to infectious diseases occur much more easily in artificially fed babies than in breast fed infants. Advantages of breast feeding is the natural food for an infant:  It is always clean,  Has right composition and right temperature.  Its composition is such that the ferments present in the infant's stomach can perfectly digest it.  Has less protein and more sugar than cow‘s milk, fat is present in approximately the same proportion and more easily digested than those of cow‘s milk.  Contains salts especially calcium and phosphorus which are necessary for bone formation and arranged to the rate of growth.

4.  Physiologically:  Breast feeding helps the mother to overcome more easily the sudden changes in her physical condition, the endocrine imbalance is responsible for some mental instability in many young mother and takes about six months to be restored to normal, breast feeding is the most valuable during this restorative period

5.  There are two glands formed from columnar epithelium, situated over the anterior part of the chest, one on each side.  At birth the gland consists of the nipple and few radiating ducts  At puberty the few ducts begin to branch and further glandular tissue develops.  During pregnancy the ducts branch further and the gland develops in the form of lobules which form lobes.  As early as 3-11 weeks of pregnancy unusual tenderness and tingling may be experienced in the breast and soon enlargement begins to be stimulated by the rising level of oestrogen, progesterone and relaxin.  This growth continues through pregnancy and results in an increase of local breast weight of 400 – 800 gram.

6.  The capacity to form milk depends on two main factors: 1)The amount of secreting glandular epithelium present. 2)The adequacy of the blood supply which brings the constituents to the secreting cells, from which in the early stages colostrum, and later milk is manufactured.  Improve blood supply occurs by: 1)Pectoral muscle exercises (muscle support the gland and sharing the same blood supply) 2)Alternate contraction and stretching of the fibers of these muscles

7. Important mechanisms for improving breast feeding  Elongation of nipple:  By firm pressure on the base of the areola by the thumb and finger to cause protrusion of the nipple.  A shield worn by woman during pregnancy will help to develop the protrusion action of the nipple.  Teach the mother  How to manipulate the nipple gently by pulling it between fingers (not finger tip)  Three simple breast massage manipulation.  An adequate capillary blood supply to the mammary glands:  By teaching the woman simple exercises to strength the supporting muscles (if the mother feels her breast is heavy)

8. Static arm exercises. Active arm exercises. Resistive arm exercises.

10. Lower extremity varicositiesLower extremity varicosities occur in 40% or more of pregnant women, at the sixth weeks before the enlargement of the uterus to fill the pelvis, the dilatation of vessels is due to the effect of estrogen on the smooth muscle and collagen cells in the veins. Uterus during pregnancyUterus during pregnancy leaves the pelvic and compress on the caval vein leading to reduction of the venous return and women complain of edema, tiredness of the leg and development of varicose vein. VaricositiesVaricosities may develop at any location in the superficial system, most often a portion of greater or lesser saphenous vein. The symptoms followThe symptoms follow may include swelling and discomfort, dull acing sensation, throbbing in the area of the larger veins, pain.

11. Conservative: Avoid : prolonged standing prolonged sitting obesity. Shower or bath in the evening Apply well fitted below the knee Support stocking (20-40mmHg before ambulation in the morning. Elevate the feet 10-15 minutes for 3-4 times daily. Physical therapy management To assist venous return and avoid venous stasis and its complications

12. Physical therapy management Positioning Bandaging Progression Burger‘s Exercises Intermittent compression

13. Positioning The patient should lie on bed with both lower limbs elevated on pillows or on wall. The patient should practice this method frequently for a period of 20 minutes at least twice daily. Resting in this position may reduce edema by removing the gravitational effect and reducing venous hypertension. This position with moderate elevation can be used during bandaging or stocking wear or release during massage, air compression and exercises.

14. Intermittent compression Pneumatic Unite (compression Pumps) are designed to reduce edema by giving controlled, alternating external pressure. It reduces edema by moving excess interstitial fluid to site of normal lymphatic or venous drainage. Pressure needs to be higher distally and lower proximally. Pressure may decrease pain and improve of motion (secondary by decreasing swelling).

15. Bandaging It is important in management of edema, improve muscle pump mechanism, and supporting distended veins. Pressure should be higher distally and lower proximally.

16. Progression Burger's Exercises 1 st progression1 st progression 1) The patient lies supine with the legs supported in elevation (at an angle of 45 o to 60 o to horizontal) until the occurrence of foot blanching (Normally from 1-2 min)  The aim is to help venous return and cause powerful effect of the arterial system to overcome the effect of the gravity on the arterial supply. 2) The patient sites up with leg dependent until the skin color is bright red (rubour).  The aim is to improve blood rushing to the extremities and to improve collaterals. 3) The patient lies with legs horizontal until the skin color returns to normal (pinky) for about 5 min. and skin warms occur  The aim is to control the fluid exchange between the capillary‘s wall and the extra vascular tissue and to judge the time needed for feeling of the rest

17. Indications of improvement are: Increase time for the appearance of blanching. Decrease time for rubour and filling of superficial veins Decrease time for normal coloration and warms.

18. 2 nd progression: Done after three successive sessions of performing the 1 st progression 1) The patient lies supine with legs supported as before, the therapist applies massage (effleurage – hand over hand stroke), this position with massage is maintained from 1-3 min or until blanching occurs.  The aim is to assess venous return and to stimulate histamine like substance release for its effect in dilatation of the skin capillaries. 2) The patient sites up with leg dependent until the skin color is bright red (rubour).  The aim is to improve blood rushing to the extremities and to improve collaterals by the effect of histamin like substance. 3) The patient lies with legs horizontal until the skin color returns to normal (pinky) for about 5 min. and skin warms occur.  The aim is to ensure that histamine released increases capillary permeability in skin and muscular tissue, to face further activities.