3. Breastfeeding Flashcards by Megan Hamilton

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

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Negative impact on suckling

Anesthesia / Analgesia

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Enhanced breastfeeding 2/2…

continuous support through labor

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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

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General guidelines for breastfeeding

Exclusive up to 6 months

* Continue until 1st birthday

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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

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Whenv does mature milk happen?

Day 10

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How many calories per ounce in mature breast milk?

20 cal / oz

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Mature milk:
• % Fat
• % Carbs

Fat (58%)

* Carbs (30-40%) in form of lactose

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Composition of breastmilk (7 components)

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

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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

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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

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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

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When does breast development begin?

5th week of embryonic life

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Where does breast development begin?

From the milk lines, a line of glandular tissue

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Major divisions of breast tissue (2)

1) Parenchyma

2) Stroma

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Parenchyma components

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

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Stroma components (4)

CT
Fat
Blood vessels
Lymphatics

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Alveolar cell Funciton

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

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What carries milk from the alveolus to nipple pore?

Ductules and ducts

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

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

Breast changes: 1st trimester

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

Breast changes in 3rd month of pregnancy

Secretory material, colostrum begin to appear due to prolactin

Breast changes by 16th week of pregnancy

Breast is fully prepared for lactation - physiologic completion of cycle

Breast changes in last timester

Alveoli filled with colostrum

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

* Nervous | * Endocrine

Hormones responsible for breast development (2)

* Luteal | * Placental

Hormones responsible for continued and developed breast growth (5)

* Lactogen * Prolactin * Chorionic Gonadotropin * Estrogen * Prolactin

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

Negative control of prolactin | & Where is it secreted from?

Prolactin inhibiting factor from hypothalamus

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)

What maintains prolactin?

o Suckling → Initiates milk secretion → Prolactin maintained

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

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

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.

Fancy term for weaning

Breast involution

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

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

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

Optimal # of daily feednigs

8-12

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

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

What is engorgement?

Excessive fullness in early postpartum period

What is the treatment for engorgement (5)

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

Babies cry for four reasons:

Burp Feed Change Pick up

Breastfeeding: 3 immunological benefits to baby

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

Functional unit of milk making

Alveolar cell