Breastfeeding Flashcards
1
Q
What is the WHO breastfeeding recommendations (2)
A
Recommend exclusive breast feeding for 6 months
Recommend supplemental breast feeding for 2 years
2
Q
Discuss the physiology of milk production (9 steps)
A
- During pregnancy HCG stimulates the development of terminal acini
- Late in pregnancy these become distended with colostrum
- Lactation is inhibited by oestrogen and progesterone
- Once placenta delivered progesterone and oestrogen levels drop and their inhibitory effects are lost
- Prolactin then stimulates milk production
- Nipple stimulation triggers oxytocin release which causes contraction of the myoepithelial cells and milk is released into the lactiferous ducts
- Oxytocin also triggers prolactin to produce more milk for subsequent feed.
- To avoid gland distension and atrophy regular complete emptying is required for ongoing milk production
- Fully established breastfeeding women make about 800mL a day
3
Q
Discuss the components of
-colostrum (4)
-breastmilk (8)
A
- Colostrum
-High in fat and protein
-Low in water content
-High in immunoglobulin content
-High in vitamin content (BADE) - Breast milk
-5% fat
-7% lactose
-1% protein
-Forewater high in water content
-Hindwater high in fat and Fe
-Non-pathogenic bacteria to colonise neonatal gut
-Immunoglobulins - IgA
-Cell mediated immune cells
4
Q
Discuss the benefits of breast feeding for the neonate (8)
A
- Decreased infant mortality by 21%
- Increased immunity and decreased risk and severity of infections
- Decreased risk of atopic illness (asthma, eczema)
- Decreased risk of SIDS
- Decreased risk of obesity, diabetes, hypercholesterolemia
- Increased IQ and educational achievement
- Decreased childhood cancers
- Decreased risk of inflammatory bowel disease, coeliacs, juvenille rheumatoid
5
Q
What are the maternal advantages for breastfeeding (7)
A
- Enhanced psychological bonding due to oxytocin release during breastfeeding
- Decreased PPH and rapid uterine involution
- Decreased risk of breast, ovarian and uterine cancer
- Earlier return to pre-pregnancy weight
- Lactational amenorrhoea for contraception
- Lower prevalence of postmenopausal HTN, DM, CVD, hyperlipidemia
- Free and portable
6
Q
What are the WHO 10 steps to successful breastfeeding
A
- Hospital policies which support mothers breastfeeding
- Ensure staff competency
-Train staff on supporting mother to breast feed - Discuss BF benefits
- Support rapid breast feeding after birth by skin to skin and putting baby to breast
- Give practical feeding support and education to mothers
- Give only breastmilk unless there are medical reasons. Use donor milk over formula
- Support rooming in so mothers and babies together all time as able
- Help mothers recognise responsive feeding
-Knowing when their baby in hungry
-Not limiting feeding times - Educate mothers of the risks of bottles, teats and pacifiers
- Continue support in community by referral to support groups upon DC
7
Q
Discuss breast engorgement
-Pathophysiology (2)
-Treatment (3)
A
- Pathophysiology
-Milk production exceeds extraction
-As milk comes in (day 3) may be associated with fever - Treatment
-Unlimited frequent prolonged feeds
-Massage and hand expressing
-Analgesia with paracetamol and NSAIDS
8
Q
Discuss mastitis
-Presentation (4)
-Pathophysiology (3)
-Treatment (4)
A
- Presentation
-Flu-like symptoms
-Rigors
-Tender red breasts
-Often upper outer quadrant - Pathophysiology
-Inadequate milk removal resulting in inflammatory reaction
-Galactocele (Blocked milk duct)
-Usually sterile but can become infected (4%) by retrograde spread of commensals through lactiferous ducts - Treatment
-Frequent feeds and hand expressing
-Analgesia
-Increase fluid intake
-Consider antibiotics (Fluclox)
9
Q
Discuss nipple pain
-Causes (4)
-Management for each cause (4)
-Expected course (1)
A
- Causes
Poor positioning: Lactation consultant
Candidiasis: Oral antifungals to mother and baby
Nipple cracking: Nipple shields
Nipple vasospasm: Avoid cold, consider fish oil, evening primrose oil, Mg supplementation, Nifedipine - Expected course
Usually subsides in 7-10 days
10
Q
Discuss poor breast milk supply
-Incidence (1)
-Medical reasons for poor supply (3)
-Non-pharmacological treatments (4)
-Pharmacological treatment (1)
A
- Incidence
-95% of women produce enough milk - Medical reasons for poor supply
-Primary mammary gland insufficiency
-Hypothyroidism
-PCOS - Non-pharmacological treatments
-Breast feed often and offer top up feeds
-Completely empty first breast before switching to second breast
-Massage breasts as baby feeds
-Correct positioning and attachment - Pharmacological treatment
-Domperidone
11
Q
Discuss domperidone to increase breast milk supply
-Mode of action (1)
-Neonatal risks (1)
-Maternal risks (4)
-Efficacy (1)
-Principles of prescribing (3)
A
- Mode of action
-Dopamine antagonist (dopamine suppresses prolactin) - Neonatal risks - minimal exposure
- Maternal risks
-If taking QT prolonging meds be careful
-Headache, nausea, dry mouth - Efficacy
-No evidence it effects proportion of mothers who continue to breast feed (2020 Cochrane) - Principles of prescribing
-Prescribe lowest dose and titrate up
-Ensure regular follow-up to monitor efficacy and side effects
-Ensure treatment is for limited time only
12
Q
Discuss breast feeding and medication
-Antibiotics to avoid (2)
-Analgesia to avoid (1)
-Anticoagulants to avoid (2)
-Image contrast (2)
A
- Antibiotics to avoid
-Ciprofloxicin
-Nitrofurantoin - Analgesia
-Codeine - Anticoagulants
-Rivaroxiban and dabigatran - Image contrast
-Safe
-VQ scans avoid breast feeding 12-24hrs
13
Q
Discuss lactational amenorrhoea
-Pathophysiology (3)
-Failure rates (1)
-Requirements (4)
A
- Pathophysiology
-Suckling disrupts the pulsitile action of GnRH
FSH and LH are not released from the pituitary
-Ovulation doesn’t occur - Failure rate - 2%
- Requirements
< 6 months PP
Amenorrhoeic
Exclusively breast feeding
Feeding 4 hourly in the day and 6 hourly at night
14
Q
Discuss suppression of lactation
-Non pharmacological options (2)
-Pharmacological options (3)
A
- Non pharmacological options
-Cessation of breast feeding - gland distension leads to atrophy and reduced supply
-Tight fitting bras - Pharmacological
-Carbergolin - dopamine receptor agonist
-1mg PO Stat D1 PP
-70-90% effective
15
Q
Discuss mastitis
-Incidence (3)
-Risk factors (6)
-Common pathogens (3)
-Complications (3)
A
- Incidence
2-3% of PP women
10-30% lactational mastitis (non infective)
3% Breast abscess - Risk factors
-Incomplete emptying of breasts
-Past Hx of mastitis
-Failure to alternate breasts between feeds
-Poor feeding technique
-Poorly fitting bra
-Abrupt discontinuation of breast feeding - Common pathogens
-Staph aureus
-Staph epidermidis
-Streptococcus - Complications
-Abscess
-Toxic shock
-Nec fasciitis
