3. Breastfeeding Flashcards
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
Negative impact on suckling
Anesthesia / Analgesia
Enhanced breastfeeding 2/2…
continuous support through labor
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
General guidelines for breastfeeding
- Exclusive up to 6 months
* Continue until 1st birthday
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
Whenv does mature milk happen?
Day 10
How many calories per ounce in mature breast milk?
20 cal / oz
Mature milk:
• % Fat
• % Carbs
- Fat (58%)
* Carbs (30-40%) in form of lactose
Composition of breastmilk (7 components)
- Protein (whey)
- Fat (58%)
- Carbs (30-40%) in form of lactose
- Water
- Minerals
- Vitamins
- Enzymes
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
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
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
When does breast development begin?
5th week of embryonic life
Where does breast development begin?
From the milk lines, a line of glandular tissue
Major divisions of breast tissue (2)
1) Parenchyma
2) Stroma
Parenchyma components
Includes orderly, tree-like lactiferous ducts that open onto the surface of the nipple and the lobular-alveolar structure
Stroma components (4)
- CT
- Fat
- Blood vessels
- Lymphatics
Alveolar cell Funciton
• Produces milk and excretes it into lumen of the alveolar sack
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
