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Postnatal > Breastfeeding > Flashcards

Breastfeeding Flashcards

1
Q

The breasts are

A

Secreting glands made of glandular tissue arranged in lobes

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2
Q

How many lobes in breast

A

7-10
Divide into lobules
Consist of alveoli an ducts

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3
Q

Cells in alveoli

A

Acini cells- produce milk

Myoepithelial cells - contract and expel

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4
Q

Lactoferous ducts

A

Carry milk from alveoli unite to form larger ducts (lactiferous sinus or ampulla) which is a temp reserve for milk

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5
Q

Weight of boobs

A

200 pre
400-600 Preg
600-800 lactation

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6
Q

Breast changes during Preg

A

Mammogenesis
1st tri
2nd tri
3rd tri

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7
Q

Mammogenesis

A

Phase of growth and proliferation
Puberty
Oestrogen and progesterone

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8
Q

1st tri breast changes

A

Oestrogen and progesterone promote rapid growth in ducts, lobes, alveoli system,
lactogen, prolactin aid changes

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9
Q

2nd tri Brest changes

A

Placental prolactin works primarily on alveolar dev

Maturation by wk 16 is being synthesised

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10
Q

3rd tri breast changes

A

May be leaking but most serotonin prevented by progesterone

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11
Q

Hormonal influences of breast changes (Preg)

A

Oestrogen- placenta and ovaries. AIDS growth of ducts
Progesterone- ovaries placenta. Inhibits effect of prolactin during Preg
HPL- helps alveoli produce lactose

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12
Q

Signs of let down reflex

A 
Pins and needles
Full
Temp
Relaxed
Leaking
Thirst
Contractions
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13
Q

Prolactin source

A

Adenohypophysis of Anterior pituitary

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14
Q

Oxytocin source

A

Neurohypophysis of Posterior pituitary

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15
Q

Prolactin peak response

A

30 mins

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16
Q

Oxytocin peak response

A

30 secs

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17
Q

Prolactin stimulus

A

Sucking

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18
Q

Oxytocin stimulus

A

Thoughts and feelings

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19
Q

Prolactin Target cells

A

Alveolar

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20
Q

Oxytocin target cells

A

Myoepithelial cells

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21
Q

Prolactin effect

A

Milk synthesis / production
Stimulates initial alveolar milk production
But does not regulate milk synthesis
Continue production of prolactin get stimulated by baby feeding at breast
Contraceptive effect

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22
Q

Oxytocin effect

A 
Milk ejection 
Nipple erection 
Increases bf to breast 
Drives let down 
Stimulates vagus nerve to release hormones 
Sedative / euphoric effect 
Dec BP
Increases pain threshold 
Increases appetite
Red heat production 
Enhances bonding- horm of love
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23
Q

Stages of lactation

A

Mammogenesis - puberty
Lactogenesis stage 1- late Preg 16-23
Lactogenesis stage 2- day2/3-8 after 3rd stage birth
Lactogenesis stage 3- day 9+

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24
Q

Lactogenesis stage 3 aka

A

Galactppoesis

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25
Q

Lactogenesis involves

A

Establishment and maintenance of milk production

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26
Q

Decreased oestrogen and progesterone

A

Releases alveoli in breast from inhibitory state

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27
Q

L1

A

Levels of progesterone high.
Endocrine control- supply is hormonal my driven
Makes colostrum
But progesterone inhibits secretion

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28
Q

L2

A

Triggered by placenta del progesterone drops, prolactin increase which initiates l2
Also influenced by rapid cvs changes which increase blood supply to breasts
Still under autocrine control
Milk will increase in volume around 30-40 hrs after birth

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29
Q

L3

A

Autocrine (local control) (supply and demand of milk)
Maintenance
Involves the maintenance of established bf through milk production an removal of milk by baby
Removal is primary control mega ism for supply

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30
Q

Mothers don’t typically feel increased fullness (coming in sensation) till

A

48-72 hrs 2-3 days

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31
Q

Hormonal influences of lactation

A

Prolactin
Oxytocin
To some extent oestrogen and progesterone

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32
Q

Anatomy of breast

A 
Nipple 
Areola
Montgomery glands 
Montgomery tubicles 
Lactiferous sinuses- milk flows from
Lobes
Alveoli
Myoepithelial cells
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33
Q

Progesterone

A

Produced by placenta
High levels inhibits prolactin
Withdrawal after placenta
Trigger for L2

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34
Q

Let down reflex aka

A

Neuro endocrine mechanism

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35
Q

Hormonal response to sucking

A

Baby sucks, sends message to hypothalamus to APG to produce prolactin
Prolactin sent down to alveoli/acini cells to produce milk. Baby gets milk
PPG produces oxytocin which caused let down reflex and myoepothelial cells are contracting to release milk

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36
Q

Three types of milk

A

Colostrum
Transitional
Mature

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37
Q

Colostrum

A 
Concentrated yellow liquid 
From 20 was Preg 
High in protein sodium and minerals
Low in fat carbs and vitamins 
Easy to digest 
Low volume 
Laxative effect
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38
Q

Colostrum

Volume

A

7ml- 123ml in 24-48 he period
Average 37ml
2-10 ml per feed

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39
Q

Transitional milk

A

Mix of colostrum and mature
Day 3-10
Rick source of nutrients

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40
Q

Mature milk

A

Formilk and hindmilk

Changes during feed, throughout the day and bf time

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41
Q

Hindmilk

A

Produced during feeding
Higher in fat
Why we need to completely empty the breast
Creamy

42
Q

Foremilk

A

Bluish white
Produced between feedings
More watery

43
Q

Mature milk composition

A 
90% water
10%solids 
Energy 65cal/ 100ml
Lipids 38g per 1L
Casein 2.5 g per 1 40% protein 
Whey 6.4 g 60% soluble liquid protein 
Lactose 70g 
Non protein nitrogen is used in amino acid synthesis 
Vita ADEK
44
Q

Lactose

A

Major carb in milk
Provides 40-50% energy
Promotes growth of lactobacillus bifidus- gut protection
Enhances ca absorption

45
Q

Why empty breast completely

A

Fat and lipids in hindmilk high at end of feeding

46
Q

Fat

A 
Pre term milk is higher fat than term
Hindmilk higher in fat
Doubles at end of feed 
Essential fatty acids - omega 3 to promote neuro dev
Higher cholesterol
47
Q

Protein

A

Immunological purposes
Casein -whey ratio 40:60
Casein req high energy expenditure in digestion
Whey composed of alpha lactalbumin, serum albumin, lactoferrin, immunoglobulin, lysozymes

48
Q

Nitrogen

A

Used in amino acid synthesis
3 essential amino acids must be gained by diet
All 10 present in colostrum
Nucleotides (nitrogenous based compounds) necessary for energy metabolism, enzymatic reactions, growth of git and immune function

49
Q

Immune factors in milk

A

Phagocytes
Lymphocytes
Antibodies - iga igM
Non antibody antibacterial agents- lactoferrin bifidus factor

50
Q

Vitamins

A

ADKE
Influences by maternal diet
Vitamins are water soluble
Vegan mother - vita b12 def

51
Q

Minerals

A

Highly bio available for infant
Iron absorbed rate 49%
Calcium 67%

52
Q

Protective effect of milk

A 
Resp infections 
Ototitis media 
Git infections 
SIDS 
Allergies
53
Q

Advantages bf for baby

A 
Well balanced didt
Ever changing blend
AIDS absorption of nutrients 
Immune system 
Reduces risk of disease 
Decrease risk sids 
Brain dev 
Teeth
54
Q

Infant oral dev

A

Fetus can swallow 11wks g
Suck reflex 24 was
Rooting response 32
Combination of sick swallow and breathing not coordinated till 37

55
Q

Infant oral structures

A 
Ideal for bf 
Short oral cavity 
Large tongue in contact with palate 
Lower jaw is small and receded
Lips everted
Frenulum important for tongue movement
56
Q

Infant sucking pattern

A

Sucks till milk flow
Deep rhythmic sucks in suck swallow breath cycle
Sucking bursts and rest periods
Faster suckling and less swallowing during milk transfer

57
Q

Effects of analgesia during labour on bf

A

Sucking reflex stronger in first half hr after birth
Synt may make breast unresponsive
Pethidine and epidural so may depress infants natural reflexes causing difficulties

58
Q

Readiness to feed

A

Quiet and alert
Hand to mouth
Licking seeking
Self latch

59
Q

Wet and dirty in first 24 hrs

A

One wet one mec

60
Q

Bf education

A 
Drugs can effect 
Drink fluids 
Rest 
Care of nipples 
Relax
61
Q

Correct be position

A 
Baby close to mum
Head and shoulders facing breast 
Nipple to nose 
Chest to chest
Skin unwrap 
Head free to move 
Wait for wide open mouth 
Bring baby to breast 
Arellano well covers
62
Q

Principles of correct attachment

A 
Position close 
Mouth and nipple aligned 
Mouth is gaping with tongue down and forward 
No pain after let down 
Suck and swallow 
Thirsty 
Uterine cramping 
Sleepy 
Baby self detaches 
Entire areola 
Whole lower jaw raised and lowered in rocking motion 
Lips form seal 
Peristalsic rolling motion of tongue 
As jaw lowered tongue overs down and forward forming low pressure on oral cavity to draw milk into mouth
63
Q

What junction in mouth needs to be pressed by nipple

A

Passed hard palette into soft palate

64
Q

What sounds should not be heard

A

Slurping
Slushing
Sloshing

65
Q

Poor attachment

A 
Breast movement 
Chin out too far from chest
Shoulders hunched 
dumplings of cheeks 
Clicking 
Nipple pain continues
No swallowing heard
66
Q

Signs from baby poor attachment

A 
Intermittent or no sucking
Infreq swallowing 
Tense 
Dry mouth 
Unsettled between feeds 
Poor urinary output
67
Q

Signs of poor attachment : mother

A 
Pinching nip
Painful
Thirst not increased 
No bleeding changed 
Tense or anxious 
Full breast doesn't soften with feed 
Nipple appears pinched or blanched
68
Q

Signs of good milk transfer : baby

A 
Sustained/ Rhythmic suck 
Audible/ visual swallowing 
Relaxed 
Moist mouth 
Urinary output increase
69
Q

Signs of good milk transfer : mum

A 
Not painful 
Thirsty 
Contractions 
Bleeding 
Relaxed
Opp breast leak 
Full breast softens with feed 
Nipple shape unchanged
70
Q

Hands of technique

A 
Teach them to breastfeed independently
Empowers /
Confidence 
Avoids staff injury
Attach independently 
Videos posters 
Demonstrate with doll 
Teach to recognise feeding cues
71
Q

Aims of HOT: mum

A

Empower
Min intervention
Max care

72
Q

Aims of HOT: midwife

A

Increase Awareness
Increase Knowledge
Confidence to teach

73
Q

On demand feeding

A 
Healthy baby feeds whenever hungry encourage keep suckling and finish feeding on one ready before starting other 
Start on second breast next feed 
8-12 feeds in 24hrs 
Cluster feeds 
Not be woken for feeds 
Don't restrict length of feeds 
More likely to wake ready for feed and will suck more vigorously
Less risk of engorgement
74
Q

Innocenti declaration 1990

A

WHO Guidelines for bf
Recognises uniqueness of bf
Need for reinforcement of bf culture practice exclusive bf for 4-6 months

75
Q

Australian national bf strategy 2010-2015

A

Supports WHO guidelines

Baby friendly hospital initiative - 10 steps

76
Q

10 steps bf about

A

1991 WHO and UNICEF to encourage hospitals to promote practices that are supportive of bf
10 steps
To achieve ‘baby friendly status’ must comply with 10 steps

77
Q

Baby friendly hospital can expect to

A 
Choice 
Full disclosure 
Informed choices 
Hold skin to skin 
Offered help
78
Q

BF education

A 
How to hold
Position 
How to help baby latch 
Sensations 
Accurate and consistent advice 
How to express
Where to get more info and support
79
Q

The 10 steps

A 
Policy 
Train skills 
Inform women about benefits & mx 
How to initiate 
Show how to bf and maintain 
Give baby no other but milk 
Stay together at all times 
Encourage on demand 
No artificial teets 
Bf support
80
Q

Advantages of bf for mother

A 
Convenient 
Less expensive 
enviro friendly 
Bonding 
faster to pre Preg state 
Less post partum bleeding 
Decreased risk of ovarian cancer
Promotes child spacing
81
Q

Barriers to bf

A 
Lack of confidence 
Embarrassment 
Loss of freedom 
Influence of fam or friends 
Medical reason
82
Q

How can we promote bf antenatally

A 
Culture sensitive 
Positive talk 
Informed 
Benefits
Literature
83
Q

Breastfeeding challenges / concerns

A 
Inverted nipples 
Sore cracked nipples  
Low milk supply 
Engorgement 
Blocked ducts mastitis 
Sleep baby 
Tongue tie
84
Q

Inverted or flat nipples

A

May protract more with bf
Can’t latch
More support
Nipple shield

85
Q

Sore cracked nipples

A 
Tenderness common 
Supervise feeds to endure correct attachment 
Expressing milk onto nipples to heal 
Cream 
Feed on unaffected side
86
Q

Low milk supply

A

Insufficient amounts of milk to meet baby’s growth requirements
Mismanagement- rt restriction of freq and or duration of feeds or poor attachment - leads to sore nipples or engorgement
Lose confidence

87
Q

Enorgement

A 
May occur in first 2-4 days 
Full pain and hot 
Prevention- correct positioning 
Demand feed 
Analgesia 
Express 
Cool face washer
88
Q

Blocked ducts

A 
Red 
Tender 
Swollen 
May develop into mastitis 
Mx- feed from both sides, good positioning and complete emptying gentle massage
89
Q

Mastitis

A 
If milk duct isn't cleared 
Infective or non infective 
Non- obstructed milk flow
Infective- bacteria (cracked)
S&s flu like 
Red swollen 
Lumps shiny
90
Q

Mastitis management

A 
Correct positioning 
Complete emptying 
Massage 
Analgesia 
ABs if infective
91
Q

Breast abbess

A 
If mastitis untreated 
Similar S&S flu like 
High temp 
Red oedema 
Tx - surgical incision and drainage 
ABs
92
Q

Thrush in lactation

A

The over growth of canadida albicans in nipples and ducts - pain
Diagnosed symptomatically

93
Q

S&s thrush in lactation

A

Nipple- burning urging during and after feed, areola red dry flakey
Breast- shooting stabbing pain radiating to back, pain usually after feed or express, localised or bilateral pain

94
Q

Mx of thrush in lactation

A

Baby and mum tx at same time to prevent re infection
Miconazole oral gel cream
Nystatin cream to nipples

95
Q

Tongue tie

A

Aka ankyloglossia

Congenital condition where lingual frenulum is short and may restrict mobility of tongue

96
Q

Indications of tongue tie

A 
Nipple pain 
Odd shaped nipple 
Strike mark on nipple 
Looses suction sucks air 
Unable to grip 
Clicking sound 
Fails to gain weight 
Tongue can't pass lips 
Can't touch roof of mouth 
Looks flat or square 
Notched heart -s
97
Q

Sleepy baby mx

A 
Rouse at certain intervals
Change nappy offer breast 
Undress to nappy 
Skin to skin 
Hand express colostrum and let baby smell
98
Q

Complementary feeds

A

In addition to bf

99
Q

Supplementary feed

A

Instead of bf

100
Q

Complications of supp/ complementary feeds -

A

Nipple confusion
Inadequate drainage - mastitis
Confidence dec

Postnatal (3 decks)

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