Breastfeeding Flashcards
Explain the control of lactation in pregnancy and postnatally
- Breast lobules and alveoli increase with oestrogen and progesterone in pregnancy
- The drop in progesterone following delivery allows prolactin to initiate milk production
- Continued milk removal stimulates the breast to continue milk production
How much of the maternal dose of drug is transmitted to the baby?
1%, GIT administration
Which drugs are of concern in breastfeeding?
Radioactive
Chemotherapy
When do you breast feed after radioactive drugs?
4-5 half-lives after absorption as 98% is eliminated
Which contraceptives are contraindicated and which are fine?
Contraindicated
- COCP until after 6 months
- ?DEPO due to systemic absorption of progesterone suppressing milk production
Fine
- Emergency contraception
- Mirena
- Non-hormonal
What are some true signs of poor milk supply?
- Weight gain less than 500g/month, less than 150g/week
- Baby less than birth weight at 2 weeks
- Passing small amounts of concentrated yellow, strong-smelling urine, less than 6/day
- Infrequent small amounts of hard, dry, green stool
- Lethargic, sleepy, weak cry
- Dry skin and mucous membranes, poor muscle tone
What are some misconceptions about poor supply?
- Breasts feel softer
- Baby feeds more often - human milk is meant to be like that
- Baby takes less time to feed - milk becomes more readily produced
- Baby is unsettled
- Baby settles better on formula - this is because it takes longer to digest
- Growth slows after 3 months
What are some factors that affect supply?
- Maternal health
○ Anaemia
○ PPH
○ Smoking
- Mammogenesis
○ Inadequate breast tissue
○ Breast surgery
- Lactogenesis
○ Retained placenta
○ Delayed breastfeeding
- Galactopoiesis
○ Inadequate breast drainage
○ Tongue tie
- Milk intake
○ Restriction of frequency or duration of feeds
- Infant growth
- Medical problemsWhat are some signs that breast are inadequate?
Large area between breasts
Concavity of bulge (normally convex)
What are some simple ways to increase supply?
- Improve positioning and attachment
- Increase number of feeds
- Increase duration of feeds
- Offer both breast at each feed
- Express after feeds
- Supplemental feeding lines - increase stimulation
What are some medications to help increase supply?
Metoclopramide 10mg tds
Domperidone 20mg tds
What are the ddx for breast pain while breastfeeding
Mastitis
Thrush
Vasospasm
Eczema
How does mastitis present?
Pain
Hard, red breast
Fever
Lethargy, headache, muscle aching
How is mastitis managed?
○ Breast emptying § Start feeding on affected side § Heat before feeds § Express afterwards ○ Rest ○ Analgesia § Paracetamol § Ibuprofen ○ Cold after feeds, no bra ○ Abx § If unwell or no improvement with above after 12-24 hours § Flucloxacillin or dicloxacillin, or cephalexin, or clindamycin
Which antibiotics are used in mastitis? When?
Flucloxacillin or dicloxacillin
Cephalexin if penicillin sensitive
Clindamycin if penicillin anaphylactic
