Breast Feeding & Lactation Flashcards
What are the benefits of breast feeding to the mother?
- There is faster return to the prepregnancy states
- oxytocin encourages involution of the uterus, decreased blood loss, decrease in breast cancer, ovarian cancer, CVD<
- Can have a contraceptive effect
What are contraindications to breast feeding?
- anti-neoplastic agents
- ergotamine
- methotrexate
- cyclosporine
- radio-pharmaceuticals
- If HIV positive
How much should babies be fed?
Encourage demand feeding
What is the mechanism behind the indication of lactation?
- following delivery, the progesterone levels fall, and prolactin levels increase, prolactin and oxytocin is increased by feeding. Regular emptying and breast nipple stimulation required.
What is colostrum?
Thick small volume 05 - 5 ml, yellow, lipid and immunoglobilun rich
What are some problems associated with breast feeding? name 4 problems for the mother
Nipple problems Engorgement Low supply Blocked ducts, mastitis , abscess Cracked Grazed Nipples
What is the treatment of candida infection in the mother and in the bub?
- Mother: miconazole/ fluconazole
- Baby: Nystatin/ miconazole
What are some questions to ask on history, if you suspect poor supply?
- Does your breast feel softer
- Does your baby feel for a shorter time but more often
- Baby feeds better on formula
- Growth is slowed after 3 months
- Is the baby unsettled?
What are baby indicators of poor supply?
Weight gain which < 500 g per month
Baby becomes less than birth weight at 2 weeks
Small concentrated urine
Infrequent, high, dry, hard stools - green colour
Dry skin and mucus membranes, with poor muscle tone
What are some techniques to increase supply?
Improve the positioning and attachment
Increase the number of feeds, increase duration
Offer both breasts at each feed
Express following feeds
Supplemental feeding line (increases the breast stimulation)
Metoclopramide/ Domperidone
What are some clinical features of mastitis?
Fever
Indurated, painful area, erythematous
This may require admission but feeding should be continued
How is mastitis treated?
Treated with antibiotics - flucloxacillin
If it fails to address the issue, consider a breast abscess
In the vent of an abscess prompt surgical drainage is required.
What is the LOS post caesarian section?
4 nights
what is the hospital length of stay post primiparous vaginal delivery?
2 nights
What are the questions involved in an obstetrics review post natal?
- General wellbeing
- Vitals
- Uterus involution: Palpation, lochia (observation/ report)
- Wound appearance: Perineum, abdominal
- Ask about any pain
- How is urinary and bowel function
- Breast nipple symptoms and signs (supply)
- contraception
- Social worker, physiotherapy, dietician, pastoral care
What factors regarding psychosocial adjustment must be counselled?
- sleep deprivation
- Libido/ physical changes
- Cultural practices
- family income reduction/ role canges
- Attachment to baby and confidence in parenting
- Readjustment back to work
What is puerperal sepsis
maternal temperature > 38 degrees within 2 weeks of birth. The sources include UTI, endometrirtis, infected wounds, mastitis
Less common
- UTI
- URTI
- Surgical
- IV site
- Epidural site
What are indications of secondary post partum haemorrhage
Excess vaginal bleeding more than 24 hours post the delivery of the baby. Causes can be retained placenta/ contents of conception. They have fever, they are tachycardic, they have tender bulky uterus and offensive vginal los
What are some critical investigations for secondary post partum haemorrhage?
High vaginal swab, Ultrasound and blood culture
What is endometritis?
It is the inflammation of the endometrium or inner lining of the uterus
What are the polymicrobial causes of endometritis? What are anaerobes which cause it and aerobes?
aerobes: GAS, GBS, enterococcus, Ecoli, SAureus, klebsiella or Gardnerella
Anaerobes: peptostreptococcus, bacteroides, clostridum
Mycoplasma: ureplasma mycoplasma
What is the treatment for endometritis?
Fluid resuscitation
Outpatient: oral augmentin
Inpatient Mx: Ampicillin/ Gent/ Flagyl IV
+/- careful curettage after delay of antibiotics
What is post partum mood disorder?
Post partum blues which affects 80% of women, occurs third or fourth day after the delivery. It involves mood swings, tearfulness, insomnia, loss of concentration. you can get post partum depression and post partum psychosis.
What are the post partum contraception options?
If not breast feeding have normal range of contraception
- You get poor libido and vaginal dryness
- Ovulation: Occurs at 8 weeks in absence of prengnacy
choices
- Lactation amenorrhea (nocturnal prolactin prevents ovulation) - this is 97 % effective . If baby is less than 6 months, no formula or solid supplementary feeds, amenorrhea, 99% effective by adding the minipill
- Progestagen method
- Barrier methods
- irreversible
Inform a patient about the minipill, what would you say?
- Minipill is a form of contraception safe to use in breast feeding
- 30 microgram of levonogestrel
- It should be commenced on day 21, increased spotting in puerperium if earlier)
-
What are other Hormonal contraception available?
- Depo-Provera ( 150 mg of medroxyprogesterone)
- Implanon: 68 mg etonogesterel
What is surgical contraception?
Tubual ligation - must be appropriately counselled
Why is the combined oral contraceptive pill contraindicated in breast feeding?
- reduces the quality and quantity of milk, contraceptive steroids cross in breast milk
- If not breast feeding, ovulation may return within 25 days ( mean 45 days) therefore adivise commencement of OCP at 21 days