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Appreciating Complex Midwifery Care > Breastfeeding > Flashcards

Breastfeeding Flashcards

1
Q

When does colostrum start being produced?

A
  • 16/40

- Caused by prolactin and hPL

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2
Q

What causes milk ejection?

A

Nipple stimulation, which stimulates the hypothalamus to release oxytocin from the posterior pituitary gland

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3
Q

What happens if the lactocytes become too full?

A

The shape distorts so the prolactin receptor sites do not work and milk synthesis decreases

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4
Q

What occurs in Lactogenesis I?

A
  • Production of colostrum at 16/40

- Prolactin is inhibited by pregnancy hormones so milk production is suppressed

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5
Q

What pregnancy hormones inhibit prolactin in Lactogenesis I?

A
  • Progesterone
  • Oestrogen
  • hPL
  • PIF
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6
Q

What occurs in Lactogenesis II?

A
  • Onset of milk production following the delivery of placenta and membranes
  • Prolactin levels rise due to decreased levels of pregnancy hormones and bind to prolactin receptor sites
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7
Q

What effect does skin to skin have?

A

Stimulates production of prolactin and oxytocin

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8
Q

Why is early and regular breastfeeding good?

A

Inhibits production of PIF and stimulates production of prolactin

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9
Q

Describe prolactin

A
  • Released from the anterior PG
  • Primes and stimulates prolactin receptor sites
  • Prolactin levels peak at night
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10
Q

Describe oxytocin

A
  • Released from the posterior PG
  • Causes the ‘let-down reflex’ (stimulates contraction of myoepithelial cells to eject milk through lactiferous ducts)
  • Reduces cortisol levels
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11
Q

What does a decreased cortisol level result in?

A
  • Relaxation
  • Decreases anxiety and BP
  • Promotes maternal behaviour
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12
Q

What is the Feedback Inhibitor of Lactation?

A
  • Whey protein secreted by lactocytes
  • Build up as milk builds up and eventually inhibits milk production
  • When milk is drawn out of breast, FIL decreases so milk production resumes = supply and demand
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13
Q

What is the use of fat in breast milk?

A

Provides energy and calories

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14
Q

What is the use of protein in breast milk?

A
  • Contain anti-infective properties
  • Carry calcium and phosphate
  • Inhibit harmful bacteria by promoting the growth of good bacteria
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15
Q

What is the use of carbohydrates in breast milk?

A

Lactose is important for brain growth

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16
Q

Why is only a small volume of colostrum needed?

A
  • Encourages the coordination of sucking, breathing and swallowing
  • Means they have to feed often so blood glucose levels are maintained
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17
Q

What are some signs of poor attachment?

A
  • The top lip being flanged out as well as the bottom lip
  • Dimples in cheeks
  • Sore nipples
  • Engorgement
  • Unsatisfied baby
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18
Q

What does CHIN stand for?

A

C - close
H - head free
I - in line
N - nose to nipple

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19
Q

What does nipple sucking cause?

A
  • Pain

- Ineffective milk removal = reduced milk supply

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20
Q

What are some indications to hand express?

A
  • Sick infant
  • Unable to breastfeed well
  • Separation (e.g. NICU)
  • Inverted nipples
  • Engorgement
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21
Q

What are some common signs of breast refusal?

A
  • Arched back
  • Stiffened body
  • Pushing breast away
  • Crying
  • Turning head away
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22
Q

How should breast refusal be managed?

A
  • Encourage skin to skin
  • Observe for feeding cues
  • If infant is distressed, calm them before BF
  • Hand express if cant BF
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23
Q

What are the feeding cues?

A
  • Hands in mouth
  • Clicking sounds
  • Rooting
  • Crying
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24
Q

What are some causes of nipple pain?

A
  • Poor attachment
  • Thrush
  • Eczema
  • Infection (if open wound)
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25
Q

How should nipple pain be managed?

A
  • Nipple shields??
  • Assess positioning and attachment
  • Hand expression
  • Warm compress
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26
Q

What are some causes of insufficient milk supply?

A
  • Hormonal imbalance (caused by Diabetes, Hypothyroidism, Obesity)
  • Premature birth
  • CS
  • Breast trauma/ surgery
  • Lack of skin to skin
27
Q

What are the signs of insufficient milk supply?

A
  • Fewer than 3 wet nappies by day 3
  • Stools not changing by day 3/4
  • Weight loss
  • Soft breasts
  • Jaundice
28
Q

How should insufficient milk supply be managed?

A
  • Skin to skin
  • Increase frequency of feeds
  • Switch feeding
  • Assess positioning and attachment
  • Check for tongue tie
29
Q

What is switch feeding?

A

Keep changing between breasts each feed

30
Q

What causes engorgement?

A

Delayed/ infrequent feeding, causing build up of FIL so milk production is suppressed

31
Q

How should engorgement be managed?

A
  • Encourage frequent feeding
  • Skin to skin
  • Nipple shields?
  • Assess positioning and attachment
  • Warm/cold compress
32
Q

What are the signs of full breasts?

A
  • Warm
  • Tender
  • Full
  • Milk still flows
33
Q

What are the signs of engorged breasts?

A
  • Hot
  • Painful
  • Full
  • Shiny, possibly inflamed
  • Milk does not flow easily
34
Q

What is Mastitis?

A

Inflammation of the mammary gland

35
Q

What causes Mastitis?

A
  • Prolonged engorgement
  • Infrequent feeding
  • Sore/cracked nipples (= infection)
  • Thrush
36
Q

What are the signs of Mastitis?

A
  • Inflamed, hot, swollen area on the breast
  • Pain
  • Flu-like symptoms
37
Q

How should Mastitis be managed?

A
  • Continue breastfeeding if possible
  • Assess positioning and attachment
  • Pain relief
  • Warm compress/shower before feeding
  • Anti-inflammatory medication (e.g. ibuprofen)
  • Antibiotics
38
Q

What medication should not be given to a breastfeeding mother?

A

Aspirin

39
Q

What antibiotics are commonly given for Mastitis?

A

500mg Flucloxacillin
or
500mg Erythromycin

40
Q

How is an abscess diagnosed and how should it be managed?

A
  • Diagnosed by USS, showing as a fluid-filled sac
  • Drained surgically
  • Antibiotics
41
Q

What are some ways to prevent an abscess?

A
  • Effective milk removal
  • Treatment of breast inflammation and infection
  • Education regarding positioning and attachment and responsive feeding
42
Q

What causes thrush?

A
  • Mother had vaginal thrush at time of birth
  • Mother or infant on antibiotics
  • Trauma to the nipple
43
Q

What are the symptoms of thrush in the mother?

A
  • Shooting pain through the breast
  • Pain in both breasts
  • Nipple red, itchy and swollen
44
Q

What are the symptoms of thrush in the infant?

A
  • Oral thrush (white tongue)
  • Nappy rash
  • Keep pulling away from breast
  • Windy and unsettled after feeding
45
Q

What is the treatment for thrush for the mother?

A

Anti-fungal cream:

  • Miconazole 2% gel
  • Miconazole 2% gel and Hydrocortisone 1% cream (if nipple is inflamed)
46
Q

What is the treatment for thrush for the infant?

A

Miconazole gel applied inside the mouth 4 times a day

47
Q

What are some other ways to get rid of thrush?

A
  • Rinse breast with clean water after feed
  • Wash hands before feed and after nappy changes
  • Analgesia
  • Family members use different towels
  • Sterilise dummies, teats and nipple shields
48
Q

Can women with HIV breastfeed?

A
  • Recommend against it

- If they do, should exclusively breastfeed for first 2 months and treat the infant with an antiretroviral drug

49
Q

Can women with Hepatitis breastfeed?

A

Hep B = if the infant is immunised

Hep C = yes, it is not transmitted in breast milk

50
Q

Can women with Herpes breastfeed?

A

As long as the lesions are not in contact with the baby; if a breast has lesions on it, breastfeed from the other breast until it clears up

51
Q

Can women with TB breastfeed?

A

Yes

52
Q

Can women with substance misuse breastfeed?

A

Yes if benefits outweigh risks

  • Encourage women to stop taking drugs if possible
  • Only small amounts of the drug are passed through breastmilk
53
Q

Can women who smoke/ drink alcohol breastfeed

A

Smoking - yes as benefits outweigh risks but can cause reduced milk supply
Alcohol - 1-2 units 2-3 times a week is okay, drink at least 2 hours before feed, associated with reduced milk supply

54
Q

What is the effect of Diabetes on breastfeeding?

A
  • Delays milk coming in

- Breastfeeding = lose weight more quickly and have more stable blood glucose levels

55
Q

What is the effect of obesity on breastfeeding?

A
  • More at risk of Diabetes, CS, Hypertension baby in NNU

- Delays milk coming in

56
Q

What is the effect of PCOS on breastfeeding?

A
  • Low oestrogen = poor development in puberty
  • Inhibits prolactin
  • Increased risk of diabetes and obesity
57
Q

What is the effect of PPH on breastfeeding?

A
  • Can delay release of prolactin

- Increased cortisol levels

58
Q

What are the effects of Kangaroo care on infants?

A
  • Reduces HR and BP
  • Reduces cortisol levels
  • Thermoregulation
  • Increases oxytocin levels
  • Encourages bonding
59
Q

Why do preterm babies struggle to breastfeed?

A
  • Poor/absent suck-swallow-breathe coordination
  • Weak suck
  • Nasal prongs, feeding tubes etc
  • Lung disease
  • Lack energy
60
Q

What is it called when HCPs give dummies to teach babies sucking reflex?

A

Non-nutritive sucking

61
Q

When is cup feeding effective?

A

30-34 weeks

62
Q

When should an infant be able to effectively breastfeed?

A

36 weeks

63
Q

What effect does hypoxia have on breastfeeding?

A
  • GI tract may have been affected = breastmilk good

- Poor suck-swallow-breathe coordination

Appreciating Complex Midwifery Care (14 decks)

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