Lactation and Breastfeeding Flashcards
1
Q
lactation
A
- During pregnancy and the puerperium, mammary glands undergo dramatic changes
- Proliferation of alveolar epithelial cells
- Formation of new mammary ducts
- Development of lobular architecture
- Epithelium differentiates for secretory activity
- Increase in breast size (gain 400g each)
- Hypertrophy of blood vessels, myoepithelial cells, connective tissue
- 3 stages of lactation
- Mammogenesis – mammary growth & development
- Requires estrogen and progesterone
- Lactogenesis – initiation of milk secretion
- Requires prolactin
- Galactopoiesis – maintenance of milk secretion
- Requires prolactin, oxytocin (suckling)
- Mammogenesis – mammary growth & development
- Multiple, complicated hormonal interactions involved in lactation
- As soon as birth happens, your E levels drop to essentially nothing, you get a huge increase in Oxy and Prolactin
- Lactation is initiated when plasma estrogens, progesterones, and human placental lactogen levels fall after delivery
- Maintenance of established milk secretion requires suckling and the emptying of mammary ducts and alveoli
- Takes a few days for the milk to “come in”
- Prolactin levels will return to nonpregnant level in the absence of suckling 2-3 weeks postpartum
2
Q
colostrum
A
- Premilk secretion present in the first 2-3 days postpartum
- Yellowish alkaline secretion (“liquid gold”)
- May begin in the last months of pregnancy
- Higher specific gravity, protein, vitamin A, Ig, Na, Cl content than mature breast milk
- Lower carb, K, fat content than mature breast milk
- Normal laxative action
3
Q
human milk
A
- Prolactin drives milk production
- Other hormones involved (insulin, cortisol, etc)
- Substrates for milk are derived from the maternal gut and liver
- Maternal nutrition important in breastmilk concentration
- Principal carbohydrate is lactose – babies are not born lactose intolerant (rare that baby is born this way)
- Mature human milk contains 7% CHO as lactose, 3-5% fat, 0.9% protein, minerals, vitamins, enzymes, and water
- 60-75 kcal/dL provided to the infant
- Milk proteins: casein, alpha-lactalbumin, lactoferrin, secretory IgA
- Cells: macrophages, neutrophils, lymphocytes
- To sustain milk production, you need to have high fat content intake
- There is enough water in breast milk to sustain babies – they don’t need additional water
- Maternal transfer of immunoglobulins through breast milk provides immunologic defense for the newborn as the immune system develops
- Highest output during the first week
- All classes of immunoglobulins in breast milk
- 90% IgA
- Breast milk is also highly anti-infective
- Primarily leukocytes – provides protection and provides leukocytes to baby so that baby can fight off infection
- Other factors that help protect the infant from disease and develop a normal immune system
4
Q
milk yield
A
- Average milk production in a breastfeeding mother is 120 mL by the second postpartum day and increases to 300 mL/d by postpartum days 10-14
- Milk yield increases with a crying baby, positive family or provider support of breastfeeding, anticipation of nursing, or sexual stimuli
- CNS modulated release of oxytocin
- Ways to increase milk production
- Nurse more often: the more baby feeds, the more milk mama will make
- Pump between feedings: the more the breasts are stimulated, the more milk they will make
- Herbal supplements: fenugreek, goat’s rue, brewer’s yeast, oats; teas
- Fenugreek 610mg capsules, Take 3-4 caps TID-QID for effectiveness
- Metoclopramide (Reglan) off-label use – increases serum prolactin level
5
Q
Breastfeeding recommendations
A
- Exclusive breastfeeding up to 6 months of age, partial breastfeeding 6-12 months or longer
- WHO – up to 2 years or beyond
- Currently 70% of women initiate breastfeeding and only 1/3 are still breastfeeding at 6 months
- Healthy People 2010 set a goal of at least 75% of women initiating breastfeeding with 50% continuing to breastfeed at 6 months
- Ongoing practitioner support increases the proportion of mothers who breastfeed
- Giving formula to new mothers at discharge from the hospital has been shown to discourage breastfeeding
6
Q
Maternal advantages and disadvantages of breastfeeding
A
- Advantages
- Convenient, economical
- Emotionally satisfying / bond with infant
- Aids in uterine involution
- Improves GI motility and absorption
- Delays ovulation
- May protect against ovarian cancer
- Increased weight loss postpartum
- Disadvantages
- May be inconvenient for some mothers
- Yield may decrease if pumping a lot (eg: working mom)
- Nipple tenderness, mastitis may develop
- Contraindications to breastfeeding:
- Use of illicit drugs or excess alcohol
- Human T-cell leukemia virus type 1 and HIV
- Breast cancer (active)
- Active pulmonary TB or varicella infection
- Galactosemia of the newborn
- Maternal intake of some medications
- May be inconvenient for some mothers
7
Q
Advantages of breastfeeding to infants
A
- Easily digestible, ideal composition & temp
- Free of contamination; good source of Ig
- Decreased incidence of diarrhea, lower RTIs, necrotizing enterocolitis, invasive bacterial infections, SIDS, obesity, childhood allergies, Type 1 DM, Crohn’s disease, UC, and lymphoma
- Improved cognitive development and intelligence
8
Q
disadvantages of breastfeeding to infants
A
- Slightly increased risk of neonatal jaundice in the first few weeks
- Not usually possible for infants that are weak, ill, or very premature
- Cleft palate, choanal atresia, PKU
- May be fed expressed breast milk
- Mothers with CF have high Na content in milk
9
Q
breastfeeding
A
- Ideal to begin breastfeeding within 1-2 hours of delivery
- Milk usually comes in on the 3rd or 4th postpartum day
- Initial discomfort due to engorgement
- Expressed breast milk or lanolin on the nipples after feeding
- Soothies gel pads by Lansinoh or Cool cabbage leaves on the nipples between feeds
- Warm shower can help with engorgement but will cause milk let down
- Baby must latch on correctly to suckle effectively with the mouth entirely covering the areola; the tongue will milk to nipple to express the colostrum
- Best to avoid supplementing breast milk in the first 6-8 weeks unless absolutely necessary
- Baby is losing weight, severe nipple or breast lesions, pregnant mother, severely ill mother
- Avoid using artificial nipples, which will weaken the infant’s suckling reflex; avoid pacifiers until breastfeeding is well established (3-4 weeks)
- Instead may use a dropper or tube
10
Q
preparing to breastfeed
A
- Wash the hands with soap and water
- Clean the nipples and breasts with water
- Assume a comfortable position
- Upright or rocking chair with infant and mother chest to chest
- Mother lying on her side
- Using a pillow to prop the baby
11
Q
breastfeeding technique
A
- Allow infant to feed on demand q 3-4 hrs
- Always breastfeed on both breasts
- Start with 5 minutes each breast per feeding, working up to 10-15 minutes per side per feeding
- Stimulate the infant’s cheek or mouth to stimulate the suckling reflex (and keep the baby awake if falling asleep during feeds)
- Place the entire nipple and areola in the infant’s mouth; gently express some milk into the mouth if needed to start suckling
- Before removing the infant from the breast when finished, gently open its mouth by lifting the outer border of the upper lip to break suction
- Wipe the nipples with water and dry them - TANA DOESNT AGREE!!! actually keep some milk on there or apply lanolin
12
Q
initiation of breastfeeding
A
- Should begin about 1 hr post delivery
- Frequency and duration of feeds should be on demand
- May be every hour, 8-12 times per day in the first few weeks
- Typically 10-15 min each breast at each feed
- Depends on milk supply, efficiency of milk transfer, infant’s behavior
- Discourage supplementing with formula unless necessary (baby losing weight, premature)
13
Q
demand feeding
A
- Feedings initiated based on infant cues
- Sleeping infant making suckling motions of the lips; moving the mouth toward an object; sucking on the hands; irritation and crying
- Mom will feel milk let-down sensation
- Signs of infant satiety
- Release of the nipple; relaxation of facial muscles, hands; falling asleep while feeding
- Should wake newborns up to feed at least every 4 hrs if necessary - TANA DOESN’T agree!! But if baby is having trouble nursing or losing weight, then you can wake them up
14
Q
postpartum care
A
- Before discharge from the hospital, mother and baby should be evaluated for adequacy of latching on, suckling, milk production, and assessment of intake
- Maternal knowledge and resources should be discussed
- Ideally a lactation consultant will follow up with the family 48 hrs after discharge
- Check in with mom early & frequently – moms can get frustrated and give up, and the 2 week postpartum visit is usually too late to re-establish breastfeeding
15
Q
assessment of breastfeeding
A
- Infant
- Urine output
- 6 wet diapers/day
- Stools
- >4 soft stools/day
- Weight gain/loss
- Expect 5-7% loss initially
- Regain birth wt @ 2 wks
- Jaundice
- Satisfaction/behavior
- Urine output
- Mother
- Supplementation
- Support system
- Painful nipples
- Engorgement
- Mastitis
