3. Breastfeeding Flashcards Preview

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Flashcards in 3. Breastfeeding Deck (48):
1

Detrimental peripartum experiences that influence breastfeeding (5)

• Late initiation of breastfeeding after birth
• Extended separation from infant
• Supplementation with formula
• Limited or no help with breastfeeding
• Gift packages with formula

2

Negative impact on suckling

Anesthesia / Analgesia

3

Enhanced breastfeeding 2/2...

continuous support through labor

4

HIV / AIDS policy with breastfeeding in the US

o Since HIV virus exists in breast milk, it is the current protocol to recommend exclusive bottle feeding for all HIV+ patients

5

General guidelines for breastfeeding

• Exclusive up to 6 months
• Continue until 1st birthday

6

What makes colostrum so great?
• Components (4)

• High in protein, minerals and fat soluble
• Rich in immunoglobulin’s (IgA) which help protect newborn’s GI tract

7

Whenv does mature milk happen?

Day 10

8

How many calories per ounce in mature breast milk?

20 cal / oz

9

Mature milk:
• % Fat
• % Carbs

• Fat (58%)
• Carbs (30-40%) in form of lactose

10

Composition of breastmilk (7 components)

• Protein (whey)
• Fat (58%)
• Carbs (30-40%) in form of lactose
• Water
• Minerals
• Vitamins
• Enzymes

11

Breastfeeding: 7 benefits to newborn - GI system

o Good GI bacteria
o Reduces incidence of stomach upset, diarrhea and colic
o Reduces risk of newborn constipation
o Provides easily tolerated and digestible formula that is sterile, at proper temperature and readily available with no artificial colorings, flavorings or preservatives
o Is less likely to result in overfeeding, leading to obesity
o Promotes better tooth and jaw development

12

8 maternal advantages to breastfeeding

o Weight loss
o Decreases uterine bleeding
o Promotes uterine involution as a result of release of oxytocin
o Lowers risk against breast cancer and osteroperosis
o Affords some contraceptive protection
o Economical
o Associated with avoidance of type 1 diabetes and heart disease
o Bonding benefits

13

8 contraindicated substances for breastfeeding

o Alcohol (in large amounts)
o Amphetamines
o Cocaine
o Cyclosporine (immunosuppressant)
o Heroin
o Lithium
o Methadone
o Antihistamines dry you up

14

When does breast development begin?

5th week of embryonic life

15

Where does breast development begin?

From the milk lines, a line of glandular tissue

16

Major divisions of breast tissue (2)

1) Parenchyma
2) Stroma

17

Parenchyma components

Includes orderly, tree-like lactiferous ducts that open onto the surface of the nipple and the lobular-alveolar structure

18

Stroma components (4)

• CT
• Fat
• Blood vessels
• Lymphatics

19

Alveolar cell Funciton

• Produces milk and excretes it into lumen of the alveolar sack

20

What carries milk from the alveolus to nipple pore?

Ductules and ducts

21

5 characteristics of the nipple

• Located slightly below midpoint of the breast
• Has 15-25 small openings that are endings: Endings of ducts that connect back to the lobular-alveoli system
• Elastic
• Contains smooth muscle fibers
• Enervated with both sensory and autonomic nerve endings

22

3 characteristics of the areola

• Surrounds the nipple
• Enlarges and darkens during pregnancy and lactation
• Montgomery’s tubercles (small pimples) secrete a substance that lubricates and provides antimicrobial protection

23

Breast changes: 1st trimester

Rapid ductular-lobular-alveolar growth due to changing levels of circulating hormones

24

Breast changes in 3rd month of pregnancy

Secretory material, colostrum begin to appear due to prolactin

25

Breast changes by 16th week of pregnancy

Breast is fully prepared for lactation - physiologic completion of cycle

26

Breast changes in last timester

Alveoli filled with colostrum

27

Functioning mammary gland responds to what type of signals in order to produce and deliver milk? (2)

• Nervous
• Endocrine

28

Hormones responsible for breast development (2)

• Luteal
• Placental

29

Hormones responsible for continued and developed breast growth (5)

• Lactogen
• Prolactin
• Chorionic Gonadotropin
• Estrogen
• Prolactin

30

Essential hormone for lobular-alveolar completion in pregnancy. Initiates milk secretion via secretion on alveolar walls
(& Where is it secreted from?)

Prolactin - secreted by anterior pituitary

31

Negative control of prolactin
(& Where is it secreted from?)

Prolactin inhibiting factor from hypothalamus

32

o Delivery of placenta → HORMONAL RESPONSE → HORMONAL RESPONSE

o Delivery of placenta → Estrogen and progesterone levels drop → Triggers release of high prolactin (from anterior pituitary gland)

33

What maintains prolactin?

o Suckling → Initiates milk secretion → Prolactin maintained

34

How long does it take prolactin levels to drop to those of a non-pregnant, non-lactating woman?

• Without nipple stimulation, prolactin levels drop to those of non-pregnant, non-lactating women within 2 weeks

35

Role of oxytocin in breastfeeding (3)

• Released during suckling 2/2 nipple stimulation and sensory pathways
• Causes myoepithelium to contract, ejecting milk from the alveoli and lobules
• Promotes mother-infant bonding as well as other maternal behaviors

36

Phases of milk production (3)

o Lactogenesis I: Initial synthesis of milk components (colostrum) that begins during pregnancy.

o Lactogenesis II: Begins after delivery of placeta with rapid fall levels of progesterone, resulting in copious secretion of milk 2-3 days postpartum

o Lactogenesis III: Galactopoiesis: Ongoing production of mature milk.

37

Fancy term for weaning

Breast involution

38

Mechanism of breast involution (2)

• 1) Secretory cells undergo apoptosis
• 2) Mammary gland’s basement B membrane undergoes proteolytic degeneration, with reabsorption of mammary epithelium

39

BFHI (2 characteristics)

"Baby Friendly hospital initiative"

• Created by UNICEF and WHO
• Recognizes maternity facilities internationally that create environment that promotes, protects and supports breastfeeding

40

Ten steps to successful breastfeeding (just read, don't memorize)

• 1) Establishment of facility-wide breastfeeding policy to guide practice
• 2) All staff must be oriented to facility’s breastfeeding policy and be knowledgeable of its content
• 3) Parental education must integrate knowledge about breastfeeding
• 4) Early mother-infant contact and early initiation of breast feeding
• 5) Positive and frequent breastfeeding teaching interactions between staff members and mothers (Breastfeeding is a learned behavior—not instinctive)
• 6) Discourage unnecessary supplementation of breastfed infants
• 7) Develop practice of rooming-in when possible
• 8) Offer breast milk according to infant cues, not clock timing
• 9) Avoid use of pacifiers, bottle nipples – unless medically indicated
• 10) Maternity faculty is responsible to assist mothers in finding postpartum support systems

41

Optimal # of daily feednigs

8-12

42

4 characteristics of an infant who is optimally breast fed

• Have a minimum of 3-4 bowel movements every 24 hours
• Wet diaper 6x daily
• Gain 15-30 grams daily
• Be at or above birth weight by 10 days of age

43

4 characteristics of nipple discomfort

• Most common reason for early weaning
• Usually caused by poor positioning / attachment of newborn
• Treat nipple fissures with air + breast milk
• Evaluation for Candidiasis and Rx with topical nystatin

44

What is engorgement?

Excessive fullness in early postpartum period

45

What is the treatment for engorgement (5)

• Unlimited access to feeding on baby's cue
• Comfortable positioning
• Warm shower
• Massage
• Red cabbage leaves

46

Babies cry for four reasons:

Burp
Feed
Change
Pick up

47

Breastfeeding: 3 immunological benefits to baby

o Lymphocytes and neutrophils in colostrum promotes optimal mother-infant bonding.
o Passive immunity
o Strong immune system

48

Functional unit of milk making

Alveolar cell