Normal Pregnancy: Breastfeeding

Question 1

How long should you breastfeed your baby?

Answer 1

Recommended to exclusively breastfeed for the first 6 months of life

From 6 months can breastfeed alongside solid foods

(NHS)

Question 2

What ways can women get help in preparing to breastfeed before birth?

Answer 2

Antenatal classes - cover positioning and attachment, expressing and common breastfeeding problems

• Midwife / health visitor advice
• Family / friends
• Helplines / websites e.g. National Breastfeeding Helpline
• Groups / drop in’s e.g. Baby cafe - a network of breastfeeding drop in centres

Question 3

What are some social benefits of breastfeeding?

Answer 3

Breast milk is free and available without preparation.

There is no need to buy a steriliser, bottles or formula milk.

It does not need to be pre-warmed.

Question 4

What are some medical advantages of breastfeeding for a child?

Answer 4

Immunity / infection protection, lower rates of and hospitalisation for:
- Otitis media
- LRTI
- gastroenteritis

• Protective effect for severe eczema
• may be protective for childhood asthma
• reduce risk of obesity
• protection form future type 2 diabetes and possibly type 1
• Intelligence
• A meta-analysis showed breastfeeding
  associated with a reduction in SIDS (sudden infant death syndrome) by 36%

Question 5

What are some medical advantages of breastfeeding for the mother ?

Answer 5

Reduced risk of :

• Invasive breast cancer (4.3 % for every 12 months)
• Diabetes - reduced chance of T2D by 1/3
• Ovarian cancer - longer periods of breastfeeding reduce risk by 18%
• Possible: Metabolic syndrome / cardiovascular disease
• Can be used as contraception ‘lactational amenorrhoea’ if child is up to 6 months old, mother is amenotrhoeaic and child exclusively breast fed.

Question 6

What are some medical risks / disadvantages in breastfeeding?

Answer 6

vertical transmission:
- HIV : in UK women not advised to breastfeed

Hep B:
- breastfeeding not risk factor for transmission if baby has received HBV immunoprophylaxis

Hep C:
- Hep C can be found in maternal milk but breastfeeding not contraindicated

Bacterial infections:
- some can be transmitted.
- Advice: temporarily stop for 24 hrs for Neisseria gonorrhoeae, Haemophilus influnenzae, Group B Strep and Staph
- stop for long for TB, syphilis (treponema pallidum)

Question 7

What are some problems women can experience with breastfeeding?

Answer 7

Cracked sore nipples
blocked duck and breast engorgement
Mastitis / abscess

Question 8

What can cause cracked / sore nipples?

Answer 8

• position of the baby: altering feeding positions may help to reduce soreness, providing good attachment is maintained.
• Improper feeding techniques: nipple soreness may be caused by incomplete suction release at the end of baby’s feeding. Gently inserting a finger into the side of the mouth to break the suction may help.
• nipple care: excessively dry (or excessively moist) skin can cause nipple soreness. e.g. moisture from bras made of synthetic fabrics. Try: ointments containing lanolin

Question 9

What causes block duct and breast engorgement?

Answer 9

• caused by poor drainage of the breast.

-swollen, hard and painful breasts +/-
redness / systemic symptoms.

• nipples cannot protrude to allow the baby to ‘latch on’, and feeding becomes difficult.

Common causes are: pressure on the breast (e.g. poorly fitting bra or a seatbelt) and prolonged gaps between feeds.

Question 10

What advice for a woman with blocked duct and breast engorgement?

Answer 10

• nurse eight 8 or more times in 24 hours, for at least 15 minutes. to prevent engorgement.

-To relieve engorgement, express milk manually or with a pump.

• warm showers followed by cold compresses may help to relieve the discomfort.

-If engorgement persists, mastitis may develop and milk or milk products can get into the bloodstream, leading to flu-like symptoms similar to those of incompatible blood transfusion.

Question 11

How many women get mastitis?

Answer 11

Mastitis affects around 1 in 10 breastfeeding women.

Question 12

What is the management of mastitis?

Answer 12

1st line: continue breastfeeding.

BNF: ‘if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal or if culture indicates infection’—–>

• 1st line antibiotic: flucloxacillin for 10-14 days
• Breastfeeding or expressing should continue during treatment

Question 13

What is the risk if mastitis is left untreated?

Answer 13

mastitis may develop into a breast abscess.

This generally requires aspiration, incision and drainage.

Question 14

What is the risk if mastitis is left untreated?

Answer 14

mastitis may develop into a breast abscess.

This generally requires aspiration, incision and drainage.

Question 15

What causes mastitis ?

Answer 15

Most often: Staphylococcus aureus

The infection takes place in the parenchymal (fatty) tissue of the breast and causes swelling which pushes on the milk ducts. This results in pain and swelling.

Question 16

What are risk factors for mastitis?

Answer 16

• nipple damage e.g. cracked nipple
• over-supply of milk
• use of nipple shields
• nipple carriage of Staphylococcus aureus

Question 17

What is the most common reason women give up breastfeeding?

Answer 17

common reason: not producing enough milk

However, usually there is adequate milk but the woman may lack confidence in her ability to maintain her milk supply.

(she may not be aware that her breasts will soften as feeding becomes established and that it is perfectly normal for some breast-fed babies to feed as often as 10 times per day).

Question 18

If a mum was worried about insufficient milk / hungry baby

1. what advice could you give her?
2. How could you empower her to check if baby is getting enough milk?

Answer 18

1. Frequent feedings, offering both breasts at each feed, adequate rest, good nutrition and adequate fluid intake, can help maintain a good milk supply. Expressing after feeds will increase milk supply.
2. Checking weight and growth will determine whether the baby is taking enough milk

Question 19

What does the WHO recommend for establishing breastfeeding after birth?

Answer 19

• Breastfeeding should begin within an hour of birth.
• Breastfeeding should be ‘on demand’, as often as the child wants day and night.
• Bottles or pacifiers should be avoided if possible

should be immediate support at delivery.

Question 20

Can pre-term infants be breastfed?

Answer 20

• Well infants >34 weeks are usually able to co-ordinate sucking, swallowing and breathing. They can usually establish breastfeeding or bottle-feeding.
• Extremely preterm babies, or those expected to have a prolonged stay in neonatal intensive care, may need total parenteral nutrition.

Question 21

Is preterm human breast milk better than artificial milk?

Answer 21

• Preterm human breast milk, compared with artificial formula milk, may not provide sufficient nutrition for preterm or low birth-weight infants and may need fortification.
• Multinutrient fortifiers can be added to human milk.
• Mother of preterm infants may struggle to achieve full milk production

Question 22

What formula feeding options for babies?

Answer 22

• Cow’s milk infant formulas ( alternative to breast milk) - given until the baby is at least 1 year old.
• Hydrolysed protein infant formulas can be prescribed if the baby has an allergy to cow’s milk
• Soya-based infant formulas can also be used; however, babies who are allergic to cow’s milk may also be allergic to soya

Question 23

When can you wean a child and introduce solids?

Answer 23

Around 6 months
(UK department of health)

• complementary feeding - solids and continue breastfeeding

Question 23

When can you wean a child and introduce solids?

Answer 23

Around 6 months
(UK department of health)

• complementary feeding - solids and continue breastfeeding

Question 24

What is colostrom?

Answer 24

-“first milk,” - gold or yellow liquid that is rich in nutrition and healthy antibodies tto protect baby from infections.

-quantity of colostrum is small, it provides all of the nutrition that the baby needs in the first few days as long as they are receiving it frequently.

Question 25

Outline the let down reflex

Answer 25

In response to suckling, oxytocin is released from the pituitary gland which stimulates myoepithelial cells that surround alveoli to contract thus squeezing milk out of the breast.

• The cry or sight of an infant and preparation of the breast for nursing may cause let-down as well, whereas pain, embarrassment or alcohol may inhibit it.

-The key to maintaining milk production is sufficient suckling stimulation at each feed to maintain prolactin secretion

Question 26

How often should you feed a baby?

Answer 26

As a very rough guide, your baby should feed at least 8 to 12 times, or more, every 24 hours during the first few weeks.

It’s fine to feed your baby whenever they are hungry, when your breasts feel full or if you just want to have a cuddle.

It’s not possible to overfeed a breastfed baby.

Question 27

What signs might a baby make if hungry?

Answer 27

• get restless
• suck their fist or fingers
• make murmuring sounds
• turn their head and open their mouth (rooting)