Breastfeeding Flashcards
The breasts are
Secreting glands made of glandular tissue arranged in lobes
How many lobes in breast
7-10
Divide into lobules
Consist of alveoli an ducts
Cells in alveoli
Acini cells- produce milk
Myoepithelial cells - contract and expel
Lactoferous ducts
Carry milk from alveoli unite to form larger ducts (lactiferous sinus or ampulla) which is a temp reserve for milk
Weight of boobs
200 pre
400-600 Preg
600-800 lactation
Breast changes during Preg
Mammogenesis
1st tri
2nd tri
3rd tri
Mammogenesis
Phase of growth and proliferation
Puberty
Oestrogen and progesterone
1st tri breast changes
Oestrogen and progesterone promote rapid growth in ducts, lobes, alveoli system,
lactogen, prolactin aid changes
2nd tri Brest changes
Placental prolactin works primarily on alveolar dev
Maturation by wk 16 is being synthesised
3rd tri breast changes
May be leaking but most serotonin prevented by progesterone
Hormonal influences of breast changes (Preg)
Oestrogen- placenta and ovaries. AIDS growth of ducts
Progesterone- ovaries placenta. Inhibits effect of prolactin during Preg
HPL- helps alveoli produce lactose
Signs of let down reflex
Pins and needles Full Temp Relaxed Leaking Thirst Contractions
Prolactin source
Adenohypophysis of Anterior pituitary
Oxytocin source
Neurohypophysis of Posterior pituitary
Prolactin peak response
30 mins
Oxytocin peak response
30 secs
Prolactin stimulus
Sucking
Oxytocin stimulus
Thoughts and feelings
Prolactin Target cells
Alveolar
Oxytocin target cells
Myoepithelial cells
Prolactin effect
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
Oxytocin effect
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
Stages of lactation
Mammogenesis - puberty
Lactogenesis stage 1- late Preg 16-23
Lactogenesis stage 2- day2/3-8 after 3rd stage birth
Lactogenesis stage 3- day 9+
Lactogenesis stage 3 aka
Galactppoesis
Lactogenesis involves
Establishment and maintenance of milk production
Decreased oestrogen and progesterone
Releases alveoli in breast from inhibitory state
L1
Levels of progesterone high.
Endocrine control- supply is hormonal my driven
Makes colostrum
But progesterone inhibits secretion
L2
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
L3
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
Mothers don’t typically feel increased fullness (coming in sensation) till
48-72 hrs 2-3 days
Hormonal influences of lactation
Prolactin
Oxytocin
To some extent oestrogen and progesterone
Anatomy of breast
Nipple Areola Montgomery glands Montgomery tubicles Lactiferous sinuses- milk flows from Lobes Alveoli Myoepithelial cells
Progesterone
Produced by placenta
High levels inhibits prolactin
Withdrawal after placenta
Trigger for L2
Let down reflex aka
Neuro endocrine mechanism
Hormonal response to sucking
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
Three types of milk
Colostrum
Transitional
Mature
Colostrum
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
Colostrum
Volume
7ml- 123ml in 24-48 he period
Average 37ml
2-10 ml per feed
Transitional milk
Mix of colostrum and mature
Day 3-10
Rick source of nutrients
Mature milk
Formilk and hindmilk
Changes during feed, throughout the day and bf time
Hindmilk
Produced during feeding
Higher in fat
Why we need to completely empty the breast
Creamy
Foremilk
Bluish white
Produced between feedings
More watery
Mature milk composition
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
Lactose
Major carb in milk
Provides 40-50% energy
Promotes growth of lactobacillus bifidus- gut protection
Enhances ca absorption
Why empty breast completely
Fat and lipids in hindmilk high at end of feeding
Fat
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
Protein
Immunological purposes
Casein -whey ratio 40:60
Casein req high energy expenditure in digestion
Whey composed of alpha lactalbumin, serum albumin, lactoferrin, immunoglobulin, lysozymes
Nitrogen
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
Immune factors in milk
Phagocytes
Lymphocytes
Antibodies - iga igM
Non antibody antibacterial agents- lactoferrin bifidus factor
Vitamins
ADKE
Influences by maternal diet
Vitamins are water soluble
Vegan mother - vita b12 def
Minerals
Highly bio available for infant
Iron absorbed rate 49%
Calcium 67%
Protective effect of milk
Resp infections Ototitis media Git infections SIDS Allergies
Advantages bf for baby
Well balanced didt Ever changing blend AIDS absorption of nutrients Immune system Reduces risk of disease Decrease risk sids Brain dev Teeth
Infant oral dev
Fetus can swallow 11wks g
Suck reflex 24 was
Rooting response 32
Combination of sick swallow and breathing not coordinated till 37
Infant oral structures
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
Infant sucking pattern
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
Effects of analgesia during labour on bf
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
Readiness to feed
Quiet and alert
Hand to mouth
Licking seeking
Self latch
Wet and dirty in first 24 hrs
One wet one mec
Bf education
Drugs can effect Drink fluids Rest Care of nipples Relax
Correct be position
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
Principles of correct attachment
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
What junction in mouth needs to be pressed by nipple
Passed hard palette into soft palate
What sounds should not be heard
Slurping
Slushing
Sloshing
Poor attachment
Breast movement Chin out too far from chest Shoulders hunched dumplings of cheeks Clicking Nipple pain continues No swallowing heard
Signs from baby poor attachment
Intermittent or no sucking Infreq swallowing Tense Dry mouth Unsettled between feeds Poor urinary output
Signs of poor attachment : mother
Pinching nip Painful Thirst not increased No bleeding changed Tense or anxious Full breast doesn't soften with feed Nipple appears pinched or blanched
Signs of good milk transfer : baby
Sustained/ Rhythmic suck Audible/ visual swallowing Relaxed Moist mouth Urinary output increase
Signs of good milk transfer : mum
Not painful Thirsty Contractions Bleeding Relaxed Opp breast leak Full breast softens with feed Nipple shape unchanged
Hands of technique
Teach them to breastfeed independently Empowers / Confidence Avoids staff injury Attach independently Videos posters Demonstrate with doll Teach to recognise feeding cues
Aims of HOT: mum
Empower
Min intervention
Max care
Aims of HOT: midwife
Increase Awareness
Increase Knowledge
Confidence to teach
On demand feeding
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
Innocenti declaration 1990
WHO Guidelines for bf
Recognises uniqueness of bf
Need for reinforcement of bf culture practice exclusive bf for 4-6 months
Australian national bf strategy 2010-2015
Supports WHO guidelines
Baby friendly hospital initiative - 10 steps
10 steps bf about
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
Baby friendly hospital can expect to
Choice Full disclosure Informed choices Hold skin to skin Offered help
BF education
How to hold Position How to help baby latch Sensations Accurate and consistent advice How to express Where to get more info and support
The 10 steps
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
Advantages of bf for mother
Convenient Less expensive enviro friendly Bonding faster to pre Preg state Less post partum bleeding Decreased risk of ovarian cancer Promotes child spacing
Barriers to bf
Lack of confidence Embarrassment Loss of freedom Influence of fam or friends Medical reason
How can we promote bf antenatally
Culture sensitive Positive talk Informed Benefits Literature
Breastfeeding challenges / concerns
Inverted nipples Sore cracked nipples Low milk supply Engorgement Blocked ducts mastitis Sleep baby Tongue tie
Inverted or flat nipples
May protract more with bf
Can’t latch
More support
Nipple shield
Sore cracked nipples
Tenderness common Supervise feeds to endure correct attachment Expressing milk onto nipples to heal Cream Feed on unaffected side
Low milk supply
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
Enorgement
May occur in first 2-4 days Full pain and hot Prevention- correct positioning Demand feed Analgesia Express Cool face washer
Blocked ducts
Red Tender Swollen May develop into mastitis Mx- feed from both sides, good positioning and complete emptying gentle massage
Mastitis
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
Mastitis management
Correct positioning Complete emptying Massage Analgesia ABs if infective
Breast abbess
If mastitis untreated Similar S&S flu like High temp Red oedema Tx - surgical incision and drainage ABs
Thrush in lactation
The over growth of canadida albicans in nipples and ducts - pain
Diagnosed symptomatically
S&s thrush in lactation
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
Mx of thrush in lactation
Baby and mum tx at same time to prevent re infection
Miconazole oral gel cream
Nystatin cream to nipples
Tongue tie
Aka ankyloglossia
Congenital condition where lingual frenulum is short and may restrict mobility of tongue
Indications of tongue tie
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
Sleepy baby mx
Rouse at certain intervals Change nappy offer breast Undress to nappy Skin to skin Hand express colostrum and let baby smell
Complementary feeds
In addition to bf
Supplementary feed
Instead of bf
Complications of supp/ complementary feeds -
Nipple confusion
Inadequate drainage - mastitis
Confidence dec
