Describe the hormonal pathway for milk production
Milk production and release is stimulated by 2 stimuli:
- Baby suckling
- Sound of child's cry
- Baby suckling stimulates mechanoreceptors in the nipple which in turn stimulate higher brain centres
- Sound of babys cry directly stimulates higher brain centres
- The higher brain centres act on the hypothalamus to decrease Prolactin inhibiting hormone production (PIH) this then allows prolactin to be released from anterior pituitary
- Higher brain centres also act on post. pituitary to stimulate oxytocin release
- Prolcatin promotes milk secretion
- Oxytocin promotes smooth muscle contraction
- Both effects aid in milk ejection
In the early days when lactation is being established what are the important factors important for stimulation and continuation of milk production?
frequent feeding or expression of milk (i.e. milk removal promtes production)
Baseline levels of another key hormone, oxytocin, are higher when the mother and baby are in contact supporting lactation
What happens to milk production if areas of the breast are not being adequately drained ?
Levels of lactation inhibitory factor (LIF) rise and signal to breast tissue to stop milk production. This, plus pressure feedback from over-distended breasts, can cause milk volume to fall.
What is essential for effective, pain free breastfeeding?
Good attachment and positioning
Define attachment of breast feeding
Refers to how the infant takes the breast into his mouth for breastfeeding
What are the potential consequences of poor attachment in breastfeeding ?
- painful nipples
- low milk supply
- unsettled baby
- very frequent feeding
- failure to gain weight.
Define positioning for breast feeding
How the mother holds the infant to enable breastfeeding.
What are the principles of good positioning during breastfeeding ?
- Baby is held close to the mother and turned towards the mother’s body
- The baby’s head, neck and back are in a straight line with the head slightly tilted back
- The baby’s nose is lined up with the nipple and the mouth is just below the nipple
What are the key points to help women establish and continue breastfeeding?
- Provide all women with antenatal information on the health outcomes of breastfeeding
- Early (preferably within the first hour of birth) and frequent baby-led (on demand) feeding
- Mother and infant in close proximity as much as possible, including skin-to-skin contact
- Inform mothers on attachment, positioning and how to maintain lactation
- Avoid giving breast-fed infants any food or drink other than breast milk unless medically indicated
- Consistent messages and support from health practitioners tailored to women’s individual needs
- Provide accessible, proactive and culturally sensitive professional and peer support for breastfeeding women
What are the principles of good attachment during breast feeding ?
- Nose is not digging into the breast
- Cheeks are full and rounded
- Pattern of deep rhythmic sucking; swallowing and pauses
- Mouth is wide open with chin indenting the breast
- No pain but may be uncomfortable at start
- More areola visible above top lip than below the bottom lip
Describe what is meant by expressing breast milk and how it can be done
- Expressing breastmilk refers to the process by which a woman expels milk from her breast.
- The breastmilk can then be stored and fed to her baby at a later point in time. Milk may be expelled manually using the hands or with a pump especially designed for expressing breastmilk.
What are some of the reasons for expressing breast milk?
- The breasts feel full and uncomfortable prior to attaching the infant to the breast
- The infant is too small or sick to breastfeed.
- Hospitalisation of the mother where it is not possible to keep mother and infant together
- If the mother is going to be away from the infant for more than a couple of hours
- The mother may be returning to work where there are no facilities or opportunity to breastfeed
- Some women choose to feed their infants expressed breast milk rather than breastfeeding
What are some of the ways you can encourage milk flow prior to expressing breast milk?
- The mother should be comfortable and relaxed in a quiet, private environment
- Close contact with her infant, preferably skin-to-skin contact or, if this is not possible, a photo of the infant may help
- A warm bath or shower or applying warm flannels to the breast
- Gently massaging or stroking the breast towards the nipple for a few minutes may help the milk flow more easily
After expressing into a sterilised container, the container should be covered with a tight fitting lid and labelled with the date. How long can expressed breast milk be stored for ?
Up to 5 days in a fridge
Up to 2 weeks in the freezer section of a fridge
Up to 6 months in a freezer - should then be defrosted in a fridge not a microwave and used within 24hrs
What are the most common problems experienced in breast feeding ?
- Painful nipples – due to poor attachment
- Engorgement - painful swelling of the breasts
- Mastitis - red inflamed breasts
- Concerns about not having enough milk
What is thrush and how can it affect the breast feeding mother and baby ?
It is a fungal infection caused by candida albicans - it can develop on the nipples and in the babys mouth
What are the signs/symptoms of thrush on the nipple and in the babys mouth ?
- Cracked nipples that don’t heal, even though your baby is latching on well.
- Nipples that are pink, or red and shiny.
- Nipples that become sore after a period of pain-free breastfeeding. The pain often becomes more intense as your baby feeds, and can last for up to an hour after a feed.
- Itchy nipples, which may be extremely sensitive to touch. You may even find wearing a loose top is uncomfortable.
- A burning sensation in your breast.
- If your baby has thrush, white patches that look like milk curds or cottage cheese in their mouth
What is the treatment of thursh in breastfeeding ?
- For mother - miconazole cream applied after feeds, fluconazole 2nd line
- For infant oral miconazole gel, followed by nystatin oral suspension after symptoms have cleared
What is mastitis and what is breast engorgement ?
Mastitis = Mastitis is red inflammed breasts. (also painful) The inflammation may quickly become infected
Breast engorgement = When your breasts are engorged, they are very full of milk, and may feel big, hard, heavy and tender. (can lead to masitis) think painful swelling
What are the signs of mastitis ?
- Flu like symptoms - chills, headache, temp
What is the most common organism to cause infected mastitis ?
What is the treatment of infected masitis ?
Mastitis is more likely to be infective in the presence of skin trauma. Women can become ill quickly if mastitis is left unresolved. If symptoms of mastitis are not resolving within 12 hours with these measures, treat with suitable antibiotics and encourage continued breastfeeding.
- 1st line = Flucloaxcillin
- 2nd line = clyndamicin
What can be done to help alleviate the symptoms of breast encourgement/mastitis ?
- Breastmilk expression and frequent feeding
- Analgesia - ibuprofen or paracetamol
- Ensure correct attachment
Should breastfeeding be stopped in mastitis,engorgement or thrush?
No continue breast-feeding but ensure correctly done
What should you do if a mother comes in worried that her baby is not feeding well?
Assess the baby to see if its well signs indicating it is include:
- Appropriate assessment of weight (important to assess this over a period of time or compare to previous measurement)
- Several (six or more) wet nappies in 24 hours
- At least three dirty nappies per 24 hours
If an infant appears well but is feeding poorly what should be done ?
Go over how to feedeffectively
measures such as breastmilk expression etc
What is the normal weight loss for babies in the short period following birth ?
up to 10%