Breastfeeding Flashcards
what comprises a glandular unit?
alveolus: cluster of epithelial secretory cells around a lumen
ductules terminate in lumen of alveoli
myoepithelial cells surround each alveoli and eject milk into ductules
one duct has how many lobes? each lobe has how many lobules? each lobule has how many alveoli?
one duct has 15-20 lobes
each lobe has 20-40 lobules
each lobule has 10-100 alveoli
five phases of lactation?
embryogenesis mammogenesis: begins in childhood, accelerates in puberty, PG is final stage lactogenesis galactopoiesis involution
when does mammogenesis start? when is the breast capable of producing milk? what hormones have to do with milk production?
mammogenesis starts right after conception
breast is capable of producing milk at 16-20 wks
estrogen, progesterone, placental lactogen, prolactin and oxytocin all have to do with milk production
what does estrogen have to do with mammogenesis?
increases sensitivity to prolactin and PL
stimulates mammary growth and development
promotes lactation secretion by anterior pituitary
what does progesterone have to do with mammogenesis?
enhances lobuloalveolar development
inhibits milk secretion during PG
what does placental lactogen have to do with mammogenesis?
glandular tissue of alveoli
what does prolactin have to do with mammogenesis?
acts w/other hormones to stimulate development of alveoli and ductal system
effects of oxytocin on mammogenesis?
no effect on mammary development
sensitivity of myoepithelial cells in PG
enzyme from placenta keeps levels low
what is lactogenesis? when does it begin? suppressed by what hormones? triggered by fall of what 2 hormones? how many days to complete? predominate hormone to trigger it?
initiation of milk production begins before birth, secretion suppressed by progesterone triggered by fall of E and P 4 days to complete prolactin predominating hormone
what causes milk production and release?
controlled by suckling
what does suckling cause?
prolactin release from anterior pituitary and stimulates nipple/areola which sends impulses to hypothalamus
role of hypothalamus in lactogenesis?
decrease prolactin inhibiting factor
what happens to prolactin levels at the end of feeding?
increase at end of feed which increases milk volume, fat and protein in next feeding
what are levels of prolactin at during week 1? week 2-3 mos? after 3 mos?
week 1: base levels high, slight increase with suckling
week 2-3 mos: base levels 2-3x higher and suckling levels 10-20x higher
after 3 mos: base levels similar to non-lactating and do not rise much with suckling
is volume of milk related to prolactin?
nope
how does feedback inhibitor of lactation work?
when milk is left in breast there is activation of milk protein feedback inhibition of lactation
possibly decrease breast sensitivity to prolactin
stretch response
what is galactopoiesis? what is it dependent on?
maintenance of lactation
dependent on periodic suckling, removal of milk, intact hypothalamus/pituitary
oxytocin
what is the purpose of oxytocin?
milk ejection reflex or let down reflex via contraction of myoepithelial cells of alveoli
what causes the release of oxytocin?
sucking response triggers the hypothalamus to trigger the posterior pituitary to release oxytocin
what is oxytocin release stimulated by? what is oxytocin release reduced by?
oxytocin release stimulated by: thinking of the infant, hearing a crying baby, suckling, orgasm
oxytocin release reduced by: anxiety, stress, pain, fatigue, alcohol
5 mechanisms of milk production?
4 unidirectional (blood to milk), one paracellular/bidirectional (plasma, intact proteins, WBCs, degraded cells)
what is colostrum? what is it made up of? when does it appear and how long does it last?
colostrum- appears in 2nd TM, last 2-3 days PP, higher in protein 3x (AA, IgA, lactoferrin)
lower in CHOs, fat, calories
3 “types” of milk?
colostrum
transitional milk
mature milk replaces transitional 1-2 wks
how many calories are in an ounce of milk?
20 kcal in 1 ounce
protein characteristics of milk?
lower protein than cow’s milk so less load on the KDs
casein: whey 40:60
enzymes: anti-infective, digestive enzymes
high in immunoglobulins: sIgA is the highest then IgG, then IgM, no IgE in human milk
carbohydrate concentration in milk?
lactose: 6.8 g/dL
glucose: 14 mg/ 100 mL
galactose: 12mg/ 100 mL
fructose: important in establishing fibidus
nucleotides in milk?
cytidine, adenine, uridine
fat content of milk? factors which can affect fat content of milk?
3.5-4.5 g/100 mL
factors which affect content include: prenatal wt gain, length of gestation, parity, volume of milk, timing of feeding
higher linoleic acid than cow’s milk
amount of fat minorly influenced by diet but type of fatty acids can be affected
where is the majority of calcium from in milk?
maternal blood mostly from bone stores
cannot be raised by nutritional intake but can preserve bone stores in mom
how do breastfed babies iron stores compare to those that are not breastfed? purpose of ferritin in a baby?
breastfed babies have higher ferritin
lactoferrin inhibits bacterial growth in baby GI
mineral composition of human milk?
potassium and sodium levels are lower than cow’s milk
what vitamin is most likely to be deficient in milk?
B-6
excess levels suppress prolactin
what hormones are in milk?
prostaglandins
insulin-like growth factor
cholecystokinin (promotes satiety)
cortisol (highest in colostrum; matures lungs, intestines, pancreas)
two growth factors in milk?
epidermal growth factor
human growth factor
how many extra calories does mom need to intake for adequate milk production? absolute minimum?
need to intake at least 900 kcal/1 liter of milk
750 kcal/day minimum
how many g of prot/day?
65 g/day
what factors make a mom more likely to continue feeding past 6 mos?
if mom exclusively breast fed for first month non-smoking moms higher parity prenatal intent participation in childbirth class delay in return to work
different presentations of nipples when with thumb and forefinger, compressing areola at base?
inverted: nipple retracts
flat: nipple doesn’t evert or retract
everted: nipple everts
what may a mom need to do if she has inverted and/or flat nipples?
may need preparation
Hoffman exercises: stretch 2x daily during last 6 wks
Medela breast shell: wear 1-2 h qd increase as tolerated
Avent niplette, Lansinoh
immunological benefits of breastfeeding?
decreased: asthma, cow’s milk allergy, food allergy, GI and respiratory infxns, necrotizing entercolitis, DM, some immune disorders
WBC make up of colostrum (%age of each)?
WBCs: 40-50% MOs, 40-50% PMN, 5-10% lymphs
lactoferrin benefits?
antiviral, restrict iron for bacteria including E. coli
lactoperidase benefit?
inhibits bacterial growth
interferon benefit?
prevents viral replication
lipase benefit?
increase FFAs which act against virus
oligosaccharide benefit?
prevent attachment of bac and other antigens to gut
breastfeeding basics?
begin ASAP make sure you have proper positioning on cues from baby do not supplement or take supplements delay the use of artificial nipples
what is the key to successful breastfeeding?
proper positioning! of mom, of baby and suckling position as well
positions of mom?
can be sitting with support: cradle, cross cradle, football
side lying
how can baby be positioned to breast feed?
belly to belly
baby’s head faces breast, not tipped
ear, shoulder and hip are all in the same line
align nose to level of nipple
how to position the breast for breast feeding?
hand in relation to baby’s mouth
cup breast w/thumb on top in direction of nose and fingers underneath in direction of baby’s chin
keep fingers behind the areola
palm of hand supporting weight of breast
press fingers towards back and together to narrow area where baby will latch
how to encourage latching?
stroke baby’s lips
wait for wide open mouth and tongue extending over mandible
bring baby to breast- lower jaw and lips touch first, lips and gums grasp areola behind nipple, lips turned out, tongue under nipple
how might an asymmetrical latch happen?
not letting baby instinctively latch forcefully guiding baby can disrupt head tilting back chin leading lower jaw not covering areola
signs of good nursing?
long rhythmic suck/swallow jaw movement to baby's ears rounded cheeks hearing swallowing- not clicking feeling of gentle tugging or drawing not pinching or biting
things to avoid with breastfeeding?
chasing the baby with the breast holding breast w/scissor grip not supporting breast pulling chin down to open mouth flexing baby's head not bringing baby on quickly enough aiming breast to center of mouth
what are the different types of nursers?
barracuda: grabs nipple and sucks energetically for 10-20 mins
excited ineffective: very eager and active at breast, frustrated and crying when no milk appears
procrastinator: waits until milk appears before sucking, does well once started
gourmet: licks and tastes little drops of milk before latch-on, attempts to hurry are met with vigorous infant protest
rester: prefers to breastfeed for a few minutes, then rest a few minutes, resulting in a longer than usual nursing time
pumping regiment?
pump every 2-3 h, 8-12x/24 hr during first 2 weeks, even at night for 10-15 mins
after 2 wks pump q2-3 hrs, q6hrs at night
begin skin to skin contact immediately
relax, warm packs, massage, photos of baby
center pump funnels over nipple
after 15 min if still flowing then cont for 2 mins after milk slows
how long can you store pumped milk?
in the fridge: 24-72 hrs freezer in fridge: 2-3 wks separate door freezer: 2-3 mos deep freeze: 6-12 mos no combining methods! thaw in very warm water use w/in 24 hrs, NEVER REFREEZE
by day 10 PP, how much milk might there be?
ideally greater than 750 mL/d
borderline vol 350-500 mL/d
low volume is less than 340 mL/d
in regards to returning to work what is recommended as far as breast feeding?
establish breastfeeding first
begin occasional bottle feeding at 2-6 wks w/pumped milk
become a proficient pumper before returning to work
use an electric pump
consider alternatives
taking rxs during breastfeeding?
breast is not a sieve consider is drug safe for infant? choose the safest drug when in doubt look it up is it a necessary rx to be taking? take immediately after nursing possibly measure baby's blood levels?
9 acceptable drugs to take while breast feeding?
acetaminophen, ibuprofen most abx antiepileptics antihistamines anti-HTN codeine decongestants insulin thyroid
7 drugs to NEVER USE?
bromocriptine chemo ergotamine lithium methotrexate drugs w/potential for abuse tobacco
parameters of infant wellbeing?
wt gain urination stools frequency of nursing duration of feeding contentment of baby
wt gain markers for infant?
shouldn’t lose more than 10%
should regain birth wt by 2nd wk and should gain 4-8 oz/wk from then on
urination pattern? sign of dehydration?
1 on day 1, 2 on day 2, 3 on day 3, up to 6 a d from then on
brickdust urine: gritty, reddish orange –> sign of dehydration
what should stool look like?
meconium: thick, tarry, have until mature milk comes in
after meconium: loose, curdy, yellow-orange
3-6 qd for first 6 wks
when should nursing occur?
on baby’s cues, at least 8-10 q in 24 hr period during first 6-8 wks
feeding should last 20-60 mins
questions mom should ask if she’s wondering if her baby is getting enough food?
how many wet diapers/day? how many stools? how often is baby nursing? how long is baby at breast? are you hearing/seeing swallowing tell me about baby's sleep? is baby content?
why might a mom believe her milk supply is inadequate?
lack of education about normal breastfeeding patterns
soft breasts
growth spurts that mean need for frequent nursing
ease with which the infant eats from a bottle
inability to express large volumes of milk
does not experience let-down
what does it take to have a good milk supply?
sufficient mammary gland tissue
intact nerve pathways and ducts
adequate hormones and hormone receptors
adequate, frequent, effective milk removal and stimulation
what are some reasons to seek lactation consultation?
low supply previous low supply PCOS hormonal imbalance gestational diabetes lack of breast changes in PG asymmetry, wide spacing, tubular shape
what are some causes of a low milk supply?
scheduling feedings infrequent feedings nicotine, alcohol, medication or herb use PCOS thyroid dysfxn diabetes Sheehan's syndrome
signs baby might have a tongue tie?
baby comes off breast repeatedly baby who tires at the breast baby who resists latching/arches baby who clicks, chomps, slurps mother is in pain misshapen, flattened, creased nipple inadequate wt gain of baby
what medications can decrease milk supply?
pseudophedrine (decongestant) progestins estrogens bupropion bromocriptine ergotamine antiestrogens clomiphene
ways to increase milk supply?
prenatal pumping
traditional pumping: pump after breastfeeding for 10 mins
“power pumping”: pump 10 mins of each waking hour or pump 5-10 mins every 20-45 mins for 1-6 hrs
what is the #1 cause of sore nipples usually? what can help with soreness?
poor positioning!!
relief via: breastmilk topically, saline dips, dressings, ointments
