Hand Expression Flashcards
(13 cards)
SVB 18 hours ago
First time mum Abeje
How would you introduce yourself to her?
Hi I’m Chelsea, Student Midwife. I heard you needed some support with Hand expressing, are you okay if I help you with that?
Assets based approach - What do you already know about hand expressing?
As it’s your first time learning this I can start with the anatomy of the breast? Is that okay?
Using the model breast identify the structures and their functions
Nipple - central to the breast - made of erectile tissue - where milk is secreted during lactation
Areola - dark pigmented area around the nipple - small bumps & dimples around it call Montgomery’s Tubercles, these secret sebum oil to keep area moist and protected, and the scent emitted can help guide baby to the breast
Fatty tissue - makes up breast, gives it it’s shape and size and supports the structure of the breast inside as well.
Alveoli - hollow structure that contain lactocytes - milk producing cells
Lactiferous ducts - where the milk is transported through to the nipple
Myoepithelial cells - surround the alveoli and lactiferous ducts, and help contract milk down and out of the nipple.
1) Name the hormone that stimulates milk production and identify it’s source and target cell
2) explain the physiological process which stimulates the initiation of milk production
3) give three examples of how effective milk production can be achieved/ simulated
1) prolactin is the milk stimulating hormone, it is produced in the anterior pituitary gland, and it targets the lactocyte cells in the alveoli
2) you may or may not have produced small amounts of milk in pregnancy, but after the placenta is delivered, the hormones progesterone and oestrogen drop, which increases and ramps up prolactin to start producing milk
3) Effective milk production is achieved from early feeding, good skin to skin & positioning and attachment, and effective emptying of breasts after feeds and hand expressing
Identify the hormone responsible for the let down reflex
Where is it released from?
Name the cells this hormone acts on and the effect it has on them
Explain the factors which will help or hinder the release of this hormone
1) Oxytocin is responsible for the let down reflex
2) it’s released from the posterior pituitary gland
3) Oxytocin acts on the myoepithelial cells around the alveoli and helps them contract milk down and out through the nipple
4) factors that help - seeing your baby, smelling your baby, skin to skin, holding them
Hinder - being separated from them, anxiety, pain, stress
Name the whey protein involved in the autocrine production and maintenance of breast bilk. Explain how this works.
The feedback inhibitor of Lactation, aka FIL is the whey protein in volved in milk production and maintenance.
As your breasts fill and produce milk the FIL whey protein also increases and is at a high concentration. And when there’s a high concentration of FIL whey protein - sends a signal to your brain to stop producing milk, because they’re full and you have enough.
But when baby has a good feed or you hand express and you effectively empty the breast , more milk is produced.
FIL whey protein acts as a negative feedback loop for milk production. Does this make sense?
How soon should a woman be taught hand expression?
4 reasons why she will need to be able to hand express?
Can always learn it antenatally.
But it should definitely be taught 6-24 hours after birth and before discharge from hospital.
Four reasons:
Separated from baby (any point or going back to work)
Comfort
If you have a blocked duct
Improve effective milk production
How can Abeje be helped to prepare for hand expression?
Need to find a private space and be comfortable
Wash your hands
Have a sterile and clean recepticle/ syringes and bottles
Have any/ all information to hand to support you if needed
How many times a day would you advise Abeje to hand express if Tahir was unable to feed at breast and why?
8-12 times a day/ over 24 hours
Remember to express at least once over night as your prolactin levels increase at night - important not to skip
Reduced engorgement and to keep an effective cycle of good milk production (FIL whey protein).
Explain to Abeje how to stimulate the oxytocin reflex
If you can - see/touch/ hold baby skin to skin, but if you’re separated have some of their clothing or blanket / something that reminds you of them or smells like them to incite oxytocin.
Describe breast massage techniques
Feather strokes
Flutter touches
Knuckle/palm massage
(Gentle)
Remember to start at chest wall and work way towards nipple
Using a visual aid explain and demonstrate how Abeje should hand express
C-shape with finger and thumb - place 2-3 CM areola and use a squeeze and release effect
Clockwise around all ducts, not using any friction or sliding, and compress.
Small amounts/ drops will appear and can catch these.
Remember to change to the other breast.
Stop if painful - reassess technique
What advice would you give Abeje regarding storage of Breast milk?
Room temp
In a fridge
Freezer
UNICEF Breast Feeding Initiative Guidelines state
Can breast milk at room temp for up to 6 hours
3 days in a fridge if you don’t know the temperature
5 days of the fridge temp is below 4 degrees
And up to 6 months in a freezer when the temperature is -18 degrees.
What advice should be given to Abeje regarding defrosting stores breastmilk?
UNICEF Breast Feeding Initiative Guidelines state
12 hours in the fridge to use later
Room temperature or warm water for immediate use
Never microwave milk and it creates hot spots in it that can burn baby’s mouth.
