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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
how many calories are in an ounce of milk?
20 kcal in 1 ounce
26
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
27
carbohydrate concentration in milk?
lactose: 6.8 g/dL glucose: 14 mg/ 100 mL galactose: 12mg/ 100 mL fructose: important in establishing fibidus
28
nucleotides in milk?
cytidine, adenine, uridine
29
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
30
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
31
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
32
mineral composition of human milk?
potassium and sodium levels are lower than cow's milk
33
what vitamin is most likely to be deficient in milk?
B-6 | excess levels suppress prolactin
34
what hormones are in milk?
prostaglandins insulin-like growth factor cholecystokinin (promotes satiety) cortisol (highest in colostrum; matures lungs, intestines, pancreas)
35
two growth factors in milk?
epidermal growth factor | human growth factor
36
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
37
how many g of prot/day?
65 g/day
38
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 ```
39
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
40
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
41
immunological benefits of breastfeeding?
decreased: asthma, cow's milk allergy, food allergy, GI and respiratory infxns, necrotizing entercolitis, DM, some immune disorders
42
WBC make up of colostrum (%age of each)?
WBCs: 40-50% MOs, 40-50% PMN, 5-10% lymphs
43
lactoferrin benefits?
antiviral, restrict iron for bacteria including E. coli
44
lactoperidase benefit?
inhibits bacterial growth
45
interferon benefit?
prevents viral replication
46
lipase benefit?
increase FFAs which act against virus
47
oligosaccharide benefit?
prevent attachment of bac and other antigens to gut
48
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 ```
49
what is the key to successful breastfeeding?
proper positioning! of mom, of baby and suckling position as well
50
positions of mom?
can be sitting with support: cradle, cross cradle, football | side lying
51
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
52
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
53
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
54
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 ```
55
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 ```
56
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 ```
57
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
58
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
59
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 ```
60
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
61
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
62
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? ```
63
9 acceptable drugs to take while breast feeding?
``` acetaminophen, ibuprofen most abx antiepileptics antihistamines anti-HTN codeine decongestants insulin thyroid ```
64
7 drugs to NEVER USE?
``` bromocriptine chemo ergotamine lithium methotrexate drugs w/potential for abuse tobacco ```
65
parameters of infant wellbeing?
``` wt gain urination stools frequency of nursing duration of feeding contentment of baby ```
66
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
67
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
68
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
69
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
70
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? ```
71
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
72
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
73
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 ```
74
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 ```
75
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 ```
76
what medications can decrease milk supply?
``` pseudophedrine (decongestant) progestins estrogens bupropion bromocriptine ergotamine antiestrogens clomiphene ```
77
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
78
what is the #1 cause of sore nipples usually? what can help with soreness?
poor positioning!! | relief via: breastmilk topically, saline dips, dressings, ointments

Natural Childbirth IV (15 decks)

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