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Natural Childbirth IV > Breastfeeding > Flashcards

Breastfeeding Flashcards

1
Q

what comprises a glandular unit?

A

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

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2
Q

one duct has how many lobes? each lobe has how many lobules? each lobule has how many alveoli?

A

one duct has 15-20 lobes
each lobe has 20-40 lobules
each lobule has 10-100 alveoli

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3
Q

five phases of lactation?

A 
embryogenesis
mammogenesis: begins in childhood, accelerates in puberty, PG is final stage
lactogenesis
galactopoiesis
involution
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4
Q

when does mammogenesis start? when is the breast capable of producing milk? what hormones have to do with milk production?

A

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

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5
Q

what does estrogen have to do with mammogenesis?

A

increases sensitivity to prolactin and PL
stimulates mammary growth and development
promotes lactation secretion by anterior pituitary

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6
Q

what does progesterone have to do with mammogenesis?

A

enhances lobuloalveolar development

inhibits milk secretion during PG

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7
Q

what does placental lactogen have to do with mammogenesis?

A

glandular tissue of alveoli

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8
Q

what does prolactin have to do with mammogenesis?

A

acts w/other hormones to stimulate development of alveoli and ductal system

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9
Q

effects of oxytocin on mammogenesis?

A

no effect on mammary development
sensitivity of myoepithelial cells in PG
enzyme from placenta keeps levels low

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10
Q

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?

A 
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
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11
Q

what causes milk production and release?

A

controlled by suckling

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12
Q

what does suckling cause?

A

prolactin release from anterior pituitary and stimulates nipple/areola which sends impulses to hypothalamus

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13
Q

role of hypothalamus in lactogenesis?

A

decrease prolactin inhibiting factor

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14
Q

what happens to prolactin levels at the end of feeding?

A

increase at end of feed which increases milk volume, fat and protein in next feeding

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15
Q

what are levels of prolactin at during week 1? week 2-3 mos? after 3 mos?

A

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

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16
Q

is volume of milk related to prolactin?

A

nope

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17
Q

how does feedback inhibitor of lactation work?

A

when milk is left in breast there is activation of milk protein feedback inhibition of lactation
possibly decrease breast sensitivity to prolactin
stretch response

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18
Q

what is galactopoiesis? what is it dependent on?

A

maintenance of lactation
dependent on periodic suckling, removal of milk, intact hypothalamus/pituitary
oxytocin

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19
Q

what is the purpose of oxytocin?

A

milk ejection reflex or let down reflex via contraction of myoepithelial cells of alveoli

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20
Q

what causes the release of oxytocin?

A

sucking response triggers the hypothalamus to trigger the posterior pituitary to release oxytocin

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21
Q

what is oxytocin release stimulated by? what is oxytocin release reduced by?

A

oxytocin release stimulated by: thinking of the infant, hearing a crying baby, suckling, orgasm
oxytocin release reduced by: anxiety, stress, pain, fatigue, alcohol

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22
Q

5 mechanisms of milk production?

A

4 unidirectional (blood to milk), one paracellular/bidirectional (plasma, intact proteins, WBCs, degraded cells)

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23
Q

what is colostrum? what is it made up of? when does it appear and how long does it last?

A

colostrum- appears in 2nd TM, last 2-3 days PP, higher in protein 3x (AA, IgA, lactoferrin)
lower in CHOs, fat, calories

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24
Q

3 “types” of milk?

A

colostrum
transitional milk
mature milk replaces transitional 1-2 wks

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25
Q

how many calories are in an ounce of milk?

A

20 kcal in 1 ounce

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26
Q

protein characteristics of milk?

A

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

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27
Q

carbohydrate concentration in milk?

A

lactose: 6.8 g/dL
glucose: 14 mg/ 100 mL
galactose: 12mg/ 100 mL
fructose: important in establishing fibidus

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28
Q

nucleotides in milk?

A

cytidine, adenine, uridine

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29
Q

fat content of milk? factors which can affect fat content of milk?

A

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

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30
Q

where is the majority of calcium from in milk?

A

maternal blood mostly from bone stores

cannot be raised by nutritional intake but can preserve bone stores in mom

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31
Q

how do breastfed babies iron stores compare to those that are not breastfed? purpose of ferritin in a baby?

A

breastfed babies have higher ferritin

lactoferrin inhibits bacterial growth in baby GI

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32
Q

mineral composition of human milk?

A

potassium and sodium levels are lower than cow’s milk

33
Q

what vitamin is most likely to be deficient in milk?

A

B-6

excess levels suppress prolactin

34
Q

what hormones are in milk?

A

prostaglandins
insulin-like growth factor
cholecystokinin (promotes satiety)
cortisol (highest in colostrum; matures lungs, intestines, pancreas)

35
Q

two growth factors in milk?

A

epidermal growth factor

human growth factor

36
Q

how many extra calories does mom need to intake for adequate milk production? absolute minimum?

A

need to intake at least 900 kcal/1 liter of milk

750 kcal/day minimum

37
Q

how many g of prot/day?

A

65 g/day

38
Q

what factors make a mom more likely to continue feeding past 6 mos?

A 
if mom exclusively breast fed for first month 
non-smoking moms
higher parity
prenatal intent
participation in childbirth class
delay in return to work
39
Q

different presentations of nipples when with thumb and forefinger, compressing areola at base?

A

inverted: nipple retracts
flat: nipple doesn’t evert or retract
everted: nipple everts

40
Q

what may a mom need to do if she has inverted and/or flat nipples?

A

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

41
Q

immunological benefits of breastfeeding?

A

decreased: asthma, cow’s milk allergy, food allergy, GI and respiratory infxns, necrotizing entercolitis, DM, some immune disorders

42
Q

WBC make up of colostrum (%age of each)?

A

WBCs: 40-50% MOs, 40-50% PMN, 5-10% lymphs

43
Q

lactoferrin benefits?

A

antiviral, restrict iron for bacteria including E. coli

44
Q

lactoperidase benefit?

A

inhibits bacterial growth

45
Q

interferon benefit?

A

prevents viral replication

46
Q

lipase benefit?

A

increase FFAs which act against virus

47
Q

oligosaccharide benefit?

A

prevent attachment of bac and other antigens to gut

48
Q

breastfeeding basics?

A 
begin ASAP
make sure you have proper positioning
on cues from baby
do not supplement or take supplements
delay the use of artificial nipples
49
Q

what is the key to successful breastfeeding?

A

proper positioning! of mom, of baby and suckling position as well

50
Q

positions of mom?

A

can be sitting with support: cradle, cross cradle, football

side lying

51
Q

how can baby be positioned to breast feed?

A

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

52
Q

how to position the breast for breast feeding?

A

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

53
Q

how to encourage latching?

A

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

54
Q

how might an asymmetrical latch happen?

A 
not letting baby instinctively latch
forcefully guiding baby can disrupt
head tilting back
chin leading
lower jaw not covering areola
55
Q

signs of good nursing?

A 
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
56
Q

things to avoid with breastfeeding?

A 
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
57
Q

what are the different types of nursers?

A

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

58
Q

pumping regiment?

A

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

59
Q

how long can you store pumped milk?

A 
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
60
Q

by day 10 PP, how much milk might there be?

A

ideally greater than 750 mL/d
borderline vol 350-500 mL/d
low volume is less than 340 mL/d

61
Q

in regards to returning to work what is recommended as far as breast feeding?

A

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

62
Q

taking rxs during breastfeeding?

A 
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?
63
Q

9 acceptable drugs to take while breast feeding?

A 
acetaminophen, ibuprofen
most abx
antiepileptics
antihistamines
anti-HTN
codeine
decongestants
insulin
thyroid
64
Q

7 drugs to NEVER USE?

A 
bromocriptine
chemo
ergotamine
lithium
methotrexate
drugs w/potential for abuse
tobacco
65
Q

parameters of infant wellbeing?

A 
wt gain
urination
stools
frequency of nursing 
duration of feeding
contentment of baby
66
Q

wt gain markers for infant?

A

shouldn’t lose more than 10%

should regain birth wt by 2nd wk and should gain 4-8 oz/wk from then on

67
Q

urination pattern? sign of dehydration?

A

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

68
Q

what should stool look like?

A

meconium: thick, tarry, have until mature milk comes in
after meconium: loose, curdy, yellow-orange
3-6 qd for first 6 wks

69
Q

when should nursing occur?

A

on baby’s cues, at least 8-10 q in 24 hr period during first 6-8 wks
feeding should last 20-60 mins

70
Q

questions mom should ask if she’s wondering if her baby is getting enough food?

A 
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?
71
Q

why might a mom believe her milk supply is inadequate?

A

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

72
Q

what does it take to have a good milk supply?

A

sufficient mammary gland tissue
intact nerve pathways and ducts
adequate hormones and hormone receptors
adequate, frequent, effective milk removal and stimulation

73
Q

what are some reasons to seek lactation consultation?

A 
low supply 
previous low supply
PCOS
hormonal imbalance
gestational diabetes
lack of breast changes in PG
asymmetry, wide spacing, tubular shape
74
Q

what are some causes of a low milk supply?

A 
scheduling feedings
infrequent feedings
nicotine, alcohol, medication or herb use
PCOS
thyroid dysfxn
diabetes
Sheehan's syndrome
75
Q

signs baby might have a tongue tie?

A 
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
76
Q

what medications can decrease milk supply?

A 
pseudophedrine (decongestant)
progestins
estrogens
bupropion
bromocriptine
ergotamine
antiestrogens
clomiphene
77
Q

ways to increase milk supply?

A

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

78
Q

what is the #1 cause of sore nipples usually? what can help with soreness?

A

poor positioning!!

relief via: breastmilk topically, saline dips, dressings, ointments

Natural Childbirth IV (15 decks)

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