breastfeeding Flashcards
what glands do the breasts contain
mammary glands
what do mammary glands contain
clusters of alveoli that contain mammary secretory epithelial cells
what type of cells produce milk
mammary secretory epithelial cells
what ducts connect the alveoli, lobules and lobes
the lactiferous ducts
what is the function of the lactiferous duct
where milk is drained from the areola during lactation
what is the lactiferous sinus
where the milk is expelled from during breastfeeding
what hormones work together during breastfeeding
progesterone, oestrogen, human placental lactogen, prolactin
what does prolactin stimulate
milk production
what does oestrogen promote
the development of milk ducts - which are responsible for milk storage/ delivery
what does progesterone stimulate
alveolar-lobular formation - which is responsible ultimately for milk production
what changes can happen to the breast during pregnancy
- increase in size
- appearance of montgomery glands
- darkening of areola
- veins become more prominent
what are montgomery glands
small, raised bumps on the areola responsible for nipple lubrication and antibacterial properties
why do breasts increase in size typically in pregnancy
due to alveolar-lobular formation
what does progesterone trigger the production of during the second half of pregnancy
cholostrum - lactogenesis 1
why isn’t there significant lactation during pregnancy
levels of oestrogen and progesterone are high enough to prevent significant lactation
what stimulates the onset of lactogenesis 2
the delivery of the placenta which triggers a sudden drop in oestrogen and progesterone levels
what hormones are responsible for maintaining milk production and release
oxytocin and prolactin
what does nipple stimulation cause
a surge in oxytocin causing a milk ejection relflex and the movement of milk from alveoli into the milk ducts
what does the emptying of the alveoli enable
prolactin to active prolactin recepor sites on the walls of lactocytes triggering further milk production
what does breastmilk contain (16)
water
triglycerides
fatty acids
lactose
proteins
vitamins
calcium
phosphates
b = t lymphocytes
neutrophils
macrophages
stem cells
enzymes
hormones
growth factors
oligosaccharides
what does cholostrum contain
high concentration of immune components, sodium and chloride, but less lactose and triglycerides
what are the 3 stages of lactation
lactogenesis 1
lactogenesis 2
lactogenesis 3
what happens in lactogenesis 1
breast development and colostrum production
when does lactogenesis start
16/40
what happens in lactogenesis 2
onset of copious milk secretion
when does lactogenesis 2 occur
between 32 and 96 hours after birth
what is lactogenesis 3
maintenance of milk production
what changes to hormones occur after birth
oestrogen and progesterone levels drop
prolactin and oxytocin levels rise
why do prolactin and oxytocin levels increase after birth
in response to touch, smell + sight of baby
when are prolactin levels highest
at night
what is prolactin responsible for
milk production
what is oxytocin responsible for
milk delivery
what does oxytocin act on
muscle cells in pulsatile action
when are oxytocin levels highest
when baby is near
what can impact oxytocin production
stress - can temporarily delay it
what is FIL
feedback inhibitor of lactation
describe feedback inhibitor of lactation
milk removal = milk production so when ineffective removal there is reduced production
what does formula contain (5)
- vitamins and minerals
- fats
- carbohydrates
- protein
- water
what does colostrum stimulate
gut growth
name some risks of not breastfeeding for baby
-gastroenteritis
- respiratory infections
- allergies
- obesity
- diabetes
- SIDS
- NEC
what are the risks of not breastfeeding for mothers
- breast cancer
- ovarian cancer
- hip fractures
- heart disease
what is gut dysbiosis
an imbalance in the baby’s gut which can have a long term impact on health and well-being
define attachment
how the baby takes the breast into their mouth to enable him to feed
define positioning
how the mother holds her baby to help them to attach effectively to breast
what does CHINS stand for
close
head free
inline
nose to nipple
sustainable
what is the impact of ineffective attachment for mother
- sore nipples
- engorgement
- mastisis
- low milk production
- loss of confidence
what is the impact of ineffective attachment for baby
- feeding very frequently
- frustration
- poor weight gain
- jaundice
-hypernatraemia
name 4 things used to recognise effective feeding
- input
- output
- weight
- mother
what long-term benefits can expressing breastmilk have
- prevent problems such as blocked ducts or mastisis
- social reasons
what benefits can expressing breastmilk have short term
- tempt baby to feed if sleepy
- provide colostrum for at risk baby
- kick-start milk production
- relieve engorgement
- show mother she has milk
- obtain milk for a baby who cannot feed
why do we teach hand expression
- convenient
- if baby admitted to neonatal unit, mother can express immediately
- better hormonal response
- best method for obtaining colostrum
- can target a specific area of the breast
describe key points of hand expression
- stimulate breast - massage
- c-shape around2.5 cm from nipple
- compress in steady rhythm
- milk may take a few minutes to flow
- if milk doesn’t flow, move fingers slightly up or down and try again
- when milk flow slows/ceases express the other breast
what advise can you give to someone to keep expressing breast milk going
- spend time with baby
- skin contact
- breast massage
- high quality breast pump
- double pumping
- funnel size
describe how to use a breast pump
- massage breast
- centre nipple ensuring good fit
- increase vacuum slowly until slightly uncomfortable and then back to 10%
- pump until milk flow decreases
- massage and pump again
- double pumping can be more effective, improving volumes expressed and saving time
how many days can breastmilk be stored in a fridge
for up to 5 days at 4 degrees or lower
how many days can breastmilk be stored in a freezer
up to 6 months
what differences are there in full breasts compared to engorged
full:
- warm
- firm
- heavy
- readily flowing milk
- mother feels well
engorgement:
- hot
-hard/tight
-painful
-shiny
-may be inflamed
- milk doesn’t flow well
- mother may have a fever
how does mastisis develop
from a blocked duct, which causes inflammation locally. then develops to a systemic response - fever, flu-like
what are the treatments for mastisis
- effective breast drainage
- hand expression
- anti-inflammatory therapy
- analgesics
- fluids
- rest
- antibiotics
describe ways to increase milk supply
- skin to skin
- frequent feeds
- expressing after feeds
- switch feed if baby sleepy
- breast compression
what do babies use as their energy source
glucose from milk
ketones from fat stores
what would you recommend for a baby who is reluctant or slow to feed
- rouse baby
- place in skin contact
- let baby lick and nuzzle at breast
- repeat every 2-3 hours
- leave baby in skin contact with mum
- be patient
- be reassuring
what are signs of insufficient milk intake
- low urine output
- abnormal stool pattern
- suck: swallow ratio greater than 2:1
- persistent jaundice
- excessive weight loss
what impact does feeding have on neonatal jaundice
if baby isn’t feeding, then it can linger or worsen. babies with jaundice tend to be sleepy and reluctant to feed
describe methods of helping a mother learn to feed
- explain reasons
- keep messages simple
- emphasise principles
- check understanding
- build confidence and support instinct
- use props to reinforce learning
