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Breastfeeding Flashcards

(100 cards)

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1
Q

The breasts are

A

Secreting glands made of glandular tissue arranged in lobes

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2
Q

How many lobes in breast

A

7-10
Divide into lobules
Consist of alveoli an ducts

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3
Q

Cells in alveoli

A

Acini cells- produce milk

Myoepithelial cells - contract and expel

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4
Q

Lactoferous ducts

A

Carry milk from alveoli unite to form larger ducts (lactiferous sinus or ampulla) which is a temp reserve for milk

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5
Q

Weight of boobs

A

200 pre
400-600 Preg
600-800 lactation

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6
Q

Breast changes during Preg

A

Mammogenesis
1st tri
2nd tri
3rd tri

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7
Q

Mammogenesis

A

Phase of growth and proliferation
Puberty
Oestrogen and progesterone

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8
Q

1st tri breast changes

A

Oestrogen and progesterone promote rapid growth in ducts, lobes, alveoli system,
lactogen, prolactin aid changes

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9
Q

2nd tri Brest changes

A

Placental prolactin works primarily on alveolar dev

Maturation by wk 16 is being synthesised

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10
Q

3rd tri breast changes

A

May be leaking but most serotonin prevented by progesterone

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11
Q

Hormonal influences of breast changes (Preg)

A

Oestrogen- placenta and ovaries. AIDS growth of ducts
Progesterone- ovaries placenta. Inhibits effect of prolactin during Preg
HPL- helps alveoli produce lactose

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12
Q

Signs of let down reflex

A 
Pins and needles
Full
Temp
Relaxed
Leaking
Thirst
Contractions
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13
Q

Prolactin source

A

Adenohypophysis of Anterior pituitary

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14
Q

Oxytocin source

A

Neurohypophysis of Posterior pituitary

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15
Q

Prolactin peak response

A

30 mins

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16
Q

Oxytocin peak response

A

30 secs

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17
Q

Prolactin stimulus

A

Sucking

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18
Q

Oxytocin stimulus

A

Thoughts and feelings

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19
Q

Prolactin Target cells

A

Alveolar

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20
Q

Oxytocin target cells

A

Myoepithelial cells

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21
Q

Prolactin effect

A

Milk synthesis / production
Stimulates initial alveolar milk production
But does not regulate milk synthesis
Continue production of prolactin get stimulated by baby feeding at breast
Contraceptive effect

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22
Q

Oxytocin effect

A 
Milk ejection 
Nipple erection 
Increases bf to breast 
Drives let down 
Stimulates vagus nerve to release hormones 
Sedative / euphoric effect 
Dec BP
Increases pain threshold 
Increases appetite
Red heat production 
Enhances bonding- horm of love
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23
Q

Stages of lactation

A

Mammogenesis - puberty
Lactogenesis stage 1- late Preg 16-23
Lactogenesis stage 2- day2/3-8 after 3rd stage birth
Lactogenesis stage 3- day 9+

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24
Q

Lactogenesis stage 3 aka

A

Galactppoesis

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25
Lactogenesis involves
Establishment and maintenance of milk production
26
Decreased oestrogen and progesterone
Releases alveoli in breast from inhibitory state
27
L1
Levels of progesterone high. Endocrine control- supply is hormonal my driven Makes colostrum But progesterone inhibits secretion
28
L2
Triggered by placenta del progesterone drops, prolactin increase which initiates l2 Also influenced by rapid cvs changes which increase blood supply to breasts Still under autocrine control Milk will increase in volume around 30-40 hrs after birth
29
L3
Autocrine (local control) (supply and demand of milk) Maintenance Involves the maintenance of established bf through milk production an removal of milk by baby Removal is primary control mega ism for supply
30
Mothers don't typically feel increased fullness (coming in sensation) till
48-72 hrs 2-3 days
31
Hormonal influences of lactation
Prolactin Oxytocin To some extent oestrogen and progesterone
32
Anatomy of breast
``` Nipple Areola Montgomery glands Montgomery tubicles Lactiferous sinuses- milk flows from Lobes Alveoli Myoepithelial cells ```
33
Progesterone
Produced by placenta High levels inhibits prolactin Withdrawal after placenta Trigger for L2
34
Let down reflex aka
Neuro endocrine mechanism
35
Hormonal response to sucking
Baby sucks, sends message to hypothalamus to APG to produce prolactin Prolactin sent down to alveoli/acini cells to produce milk. Baby gets milk PPG produces oxytocin which caused let down reflex and myoepothelial cells are contracting to release milk
36
Three types of milk
Colostrum Transitional Mature
37
Colostrum
``` Concentrated yellow liquid From 20 was Preg High in protein sodium and minerals Low in fat carbs and vitamins Easy to digest Low volume Laxative effect ```
38
Colostrum | Volume
7ml- 123ml in 24-48 he period Average 37ml 2-10 ml per feed
39
Transitional milk
Mix of colostrum and mature Day 3-10 Rick source of nutrients
40
Mature milk
Formilk and hindmilk | Changes during feed, throughout the day and bf time
41
Hindmilk
Produced during feeding Higher in fat Why we need to completely empty the breast Creamy
42
Foremilk
Bluish white Produced between feedings More watery
43
Mature milk composition
``` 90% water 10%solids Energy 65cal/ 100ml Lipids 38g per 1L Casein 2.5 g per 1 40% protein Whey 6.4 g 60% soluble liquid protein Lactose 70g Non protein nitrogen is used in amino acid synthesis Vita ADEK ```
44
Lactose
Major carb in milk Provides 40-50% energy Promotes growth of lactobacillus bifidus- gut protection Enhances ca absorption
45
Why empty breast completely
Fat and lipids in hindmilk high at end of feeding
46
Fat
``` Pre term milk is higher fat than term Hindmilk higher in fat Doubles at end of feed Essential fatty acids - omega 3 to promote neuro dev Higher cholesterol ```
47
Protein
Immunological purposes Casein -whey ratio 40:60 Casein req high energy expenditure in digestion Whey composed of alpha lactalbumin, serum albumin, lactoferrin, immunoglobulin, lysozymes
48
Nitrogen
Used in amino acid synthesis 3 essential amino acids must be gained by diet All 10 present in colostrum Nucleotides (nitrogenous based compounds) necessary for energy metabolism, enzymatic reactions, growth of git and immune function
49
Immune factors in milk
Phagocytes Lymphocytes Antibodies - iga igM Non antibody antibacterial agents- lactoferrin bifidus factor
50
Vitamins
ADKE Influences by maternal diet Vitamins are water soluble Vegan mother - vita b12 def
51
Minerals
Highly bio available for infant Iron absorbed rate 49% Calcium 67%
52
Protective effect of milk
``` Resp infections Ototitis media Git infections SIDS Allergies ```
53
Advantages bf for baby
``` Well balanced didt Ever changing blend AIDS absorption of nutrients Immune system Reduces risk of disease Decrease risk sids Brain dev Teeth ```
54
Infant oral dev
Fetus can swallow 11wks g Suck reflex 24 was Rooting response 32 Combination of sick swallow and breathing not coordinated till 37
55
Infant oral structures
``` Ideal for bf Short oral cavity Large tongue in contact with palate Lower jaw is small and receded Lips everted Frenulum important for tongue movement ```
56
Infant sucking pattern
Sucks till milk flow Deep rhythmic sucks in suck swallow breath cycle Sucking bursts and rest periods Faster suckling and less swallowing during milk transfer
57
Effects of analgesia during labour on bf
Sucking reflex stronger in first half hr after birth Synt may make breast unresponsive Pethidine and epidural so may depress infants natural reflexes causing difficulties
58
Readiness to feed
Quiet and alert Hand to mouth Licking seeking Self latch
59
Wet and dirty in first 24 hrs
One wet one mec
60
Bf education
``` Drugs can effect Drink fluids Rest Care of nipples Relax ```
61
Correct be position
``` Baby close to mum Head and shoulders facing breast Nipple to nose Chest to chest Skin unwrap Head free to move Wait for wide open mouth Bring baby to breast Arellano well covers ```
62
Principles of correct attachment
``` Position close Mouth and nipple aligned Mouth is gaping with tongue down and forward No pain after let down Suck and swallow Thirsty Uterine cramping Sleepy Baby self detaches Entire areola Whole lower jaw raised and lowered in rocking motion Lips form seal Peristalsic rolling motion of tongue As jaw lowered tongue overs down and forward forming low pressure on oral cavity to draw milk into mouth ```
63
What junction in mouth needs to be pressed by nipple
Passed hard palette into soft palate
64
What sounds should not be heard
Slurping Slushing Sloshing
65
Poor attachment
``` Breast movement Chin out too far from chest Shoulders hunched dumplings of cheeks Clicking Nipple pain continues No swallowing heard ```
66
Signs from baby poor attachment
``` Intermittent or no sucking Infreq swallowing Tense Dry mouth Unsettled between feeds Poor urinary output ```
67
Signs of poor attachment : mother
``` Pinching nip Painful Thirst not increased No bleeding changed Tense or anxious Full breast doesn't soften with feed Nipple appears pinched or blanched ```
68
Signs of good milk transfer : baby
``` Sustained/ Rhythmic suck Audible/ visual swallowing Relaxed Moist mouth Urinary output increase ```
69
Signs of good milk transfer : mum
``` Not painful Thirsty Contractions Bleeding Relaxed Opp breast leak Full breast softens with feed Nipple shape unchanged ```
70
Hands of technique
``` Teach them to breastfeed independently Empowers / Confidence Avoids staff injury Attach independently Videos posters Demonstrate with doll Teach to recognise feeding cues ```
71
Aims of HOT: mum
Empower Min intervention Max care
72
Aims of HOT: midwife
Increase Awareness Increase Knowledge Confidence to teach
73
On demand feeding
``` Healthy baby feeds whenever hungry encourage keep suckling and finish feeding on one ready before starting other Start on second breast next feed 8-12 feeds in 24hrs Cluster feeds Not be woken for feeds Don't restrict length of feeds More likely to wake ready for feed and will suck more vigorously Less risk of engorgement ```
74
Innocenti declaration 1990
WHO Guidelines for bf Recognises uniqueness of bf Need for reinforcement of bf culture practice exclusive bf for 4-6 months
75
Australian national bf strategy 2010-2015
Supports WHO guidelines | Baby friendly hospital initiative - 10 steps
76
10 steps bf about
1991 WHO and UNICEF to encourage hospitals to promote practices that are supportive of bf 10 steps To achieve 'baby friendly status' must comply with 10 steps
77
Baby friendly hospital can expect to
``` Choice Full disclosure Informed choices Hold skin to skin Offered help ```
78
BF education
``` How to hold Position How to help baby latch Sensations Accurate and consistent advice How to express Where to get more info and support ```
79
The 10 steps
``` Policy Train skills Inform women about benefits & mx How to initiate Show how to bf and maintain Give baby no other but milk Stay together at all times Encourage on demand No artificial teets Bf support ```
80
Advantages of bf for mother
``` Convenient Less expensive enviro friendly Bonding faster to pre Preg state Less post partum bleeding Decreased risk of ovarian cancer Promotes child spacing ```
81
Barriers to bf
``` Lack of confidence Embarrassment Loss of freedom Influence of fam or friends Medical reason ```
82
How can we promote bf antenatally
``` Culture sensitive Positive talk Informed Benefits Literature ```
83
Breastfeeding challenges / concerns
``` Inverted nipples Sore cracked nipples Low milk supply Engorgement Blocked ducts mastitis Sleep baby Tongue tie ```
84
Inverted or flat nipples
May protract more with bf Can't latch More support Nipple shield
85
Sore cracked nipples
``` Tenderness common Supervise feeds to endure correct attachment Expressing milk onto nipples to heal Cream Feed on unaffected side ```
86
Low milk supply
Insufficient amounts of milk to meet baby's growth requirements Mismanagement- rt restriction of freq and or duration of feeds or poor attachment - leads to sore nipples or engorgement Lose confidence
87
Enorgement
``` May occur in first 2-4 days Full pain and hot Prevention- correct positioning Demand feed Analgesia Express Cool face washer ```
88
Blocked ducts
``` Red Tender Swollen May develop into mastitis Mx- feed from both sides, good positioning and complete emptying gentle massage ```
89
Mastitis
``` If milk duct isn't cleared Infective or non infective Non- obstructed milk flow Infective- bacteria (cracked) S&s flu like Red swollen Lumps shiny ```
90
Mastitis management
``` Correct positioning Complete emptying Massage Analgesia ABs if infective ```
91
Breast abbess
``` If mastitis untreated Similar S&S flu like High temp Red oedema Tx - surgical incision and drainage ABs ```
92
Thrush in lactation
The over growth of canadida albicans in nipples and ducts - pain Diagnosed symptomatically
93
S&s thrush in lactation
Nipple- burning urging during and after feed, areola red dry flakey Breast- shooting stabbing pain radiating to back, pain usually after feed or express, localised or bilateral pain
94
Mx of thrush in lactation
Baby and mum tx at same time to prevent re infection Miconazole oral gel cream Nystatin cream to nipples
95
Tongue tie
Aka ankyloglossia | Congenital condition where lingual frenulum is short and may restrict mobility of tongue
96
Indications of tongue tie
``` Nipple pain Odd shaped nipple Strike mark on nipple Looses suction sucks air Unable to grip Clicking sound Fails to gain weight Tongue can't pass lips Can't touch roof of mouth Looks flat or square Notched heart -s ```
97
Sleepy baby mx
``` Rouse at certain intervals Change nappy offer breast Undress to nappy Skin to skin Hand express colostrum and let baby smell ```
98
Complementary feeds
In addition to bf
99
Supplementary feed
Instead of bf
100
Complications of supp/ complementary feeds -
Nipple confusion Inadequate drainage - mastitis Confidence dec

Postnatal (3 decks)

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