Breastfeeding Flashcards
When does colostrum start being produced?
- 16/40
- Caused by prolactin and hPL
What causes milk ejection?
Nipple stimulation, which stimulates the hypothalamus to release oxytocin from the posterior pituitary gland
What happens if the lactocytes become too full?
The shape distorts so the prolactin receptor sites do not work and milk synthesis decreases
What occurs in Lactogenesis I?
- Production of colostrum at 16/40
- Prolactin is inhibited by pregnancy hormones so milk production is suppressed
What pregnancy hormones inhibit prolactin in Lactogenesis I?
- Progesterone
- Oestrogen
- hPL
- PIF
What occurs in Lactogenesis II?
- 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
What effect does skin to skin have?
Stimulates production of prolactin and oxytocin
Why is early and regular breastfeeding good?
Inhibits production of PIF and stimulates production of prolactin
Describe prolactin
- Released from the anterior PG
- Primes and stimulates prolactin receptor sites
- Prolactin levels peak at night
Describe oxytocin
- Released from the posterior PG
- Causes the ‘let-down reflex’ (stimulates contraction of myoepithelial cells to eject milk through lactiferous ducts)
- Reduces cortisol levels
What does a decreased cortisol level result in?
- Relaxation
- Decreases anxiety and BP
- Promotes maternal behaviour
What is the Feedback Inhibitor of Lactation?
- 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
What is the use of fat in breast milk?
Provides energy and calories
What is the use of protein in breast milk?
- Contain anti-infective properties
- Carry calcium and phosphate
- Inhibit harmful bacteria by promoting the growth of good bacteria
What is the use of carbohydrates in breast milk?
Lactose is important for brain growth
Why is only a small volume of colostrum needed?
- Encourages the coordination of sucking, breathing and swallowing
- Means they have to feed often so blood glucose levels are maintained
What are some signs of poor attachment?
- The top lip being flanged out as well as the bottom lip
- Dimples in cheeks
- Sore nipples
- Engorgement
- Unsatisfied baby
What does CHIN stand for?
C - close
H - head free
I - in line
N - nose to nipple
What does nipple sucking cause?
- Pain
- Ineffective milk removal = reduced milk supply
What are some indications to hand express?
- Sick infant
- Unable to breastfeed well
- Separation (e.g. NICU)
- Inverted nipples
- Engorgement
What are some common signs of breast refusal?
- Arched back
- Stiffened body
- Pushing breast away
- Crying
- Turning head away
How should breast refusal be managed?
- Encourage skin to skin
- Observe for feeding cues
- If infant is distressed, calm them before BF
- Hand express if cant BF
What are the feeding cues?
- Hands in mouth
- Clicking sounds
- Rooting
- Crying
What are some causes of nipple pain?
- Poor attachment
- Thrush
- Eczema
- Infection (if open wound)
How should nipple pain be managed?
- Nipple shields??
- Assess positioning and attachment
- Hand expression
- Warm compress
What are some causes of insufficient milk supply?
- Hormonal imbalance (caused by Diabetes, Hypothyroidism, Obesity)
- Premature birth
- CS
- Breast trauma/ surgery
- Lack of skin to skin
What are the signs of insufficient milk supply?
- Fewer than 3 wet nappies by day 3
- Stools not changing by day 3/4
- Weight loss
- Soft breasts
- Jaundice
How should insufficient milk supply be managed?
- Skin to skin
- Increase frequency of feeds
- Switch feeding
- Assess positioning and attachment
- Check for tongue tie
What is switch feeding?
Keep changing between breasts each feed
What causes engorgement?
Delayed/ infrequent feeding, causing build up of FIL so milk production is suppressed
How should engorgement be managed?
- Encourage frequent feeding
- Skin to skin
- Nipple shields?
- Assess positioning and attachment
- Warm/cold compress
What are the signs of full breasts?
- Warm
- Tender
- Full
- Milk still flows
What are the signs of engorged breasts?
- Hot
- Painful
- Full
- Shiny, possibly inflamed
- Milk does not flow easily
What is Mastitis?
Inflammation of the mammary gland
What causes Mastitis?
- Prolonged engorgement
- Infrequent feeding
- Sore/cracked nipples (= infection)
- Thrush
What are the signs of Mastitis?
- Inflamed, hot, swollen area on the breast
- Pain
- Flu-like symptoms
How should Mastitis be managed?
- Continue breastfeeding if possible
- Assess positioning and attachment
- Pain relief
- Warm compress/shower before feeding
- Anti-inflammatory medication (e.g. ibuprofen)
- Antibiotics
What medication should not be given to a breastfeeding mother?
Aspirin
What antibiotics are commonly given for Mastitis?
500mg Flucloxacillin
or
500mg Erythromycin
How is an abscess diagnosed and how should it be managed?
- Diagnosed by USS, showing as a fluid-filled sac
- Drained surgically
- Antibiotics
What are some ways to prevent an abscess?
- Effective milk removal
- Treatment of breast inflammation and infection
- Education regarding positioning and attachment and responsive feeding
What causes thrush?
- Mother had vaginal thrush at time of birth
- Mother or infant on antibiotics
- Trauma to the nipple
What are the symptoms of thrush in the mother?
- Shooting pain through the breast
- Pain in both breasts
- Nipple red, itchy and swollen
What are the symptoms of thrush in the infant?
- Oral thrush (white tongue)
- Nappy rash
- Keep pulling away from breast
- Windy and unsettled after feeding
What is the treatment for thrush for the mother?
Anti-fungal cream:
- Miconazole 2% gel
- Miconazole 2% gel and Hydrocortisone 1% cream (if nipple is inflamed)
What is the treatment for thrush for the infant?
Miconazole gel applied inside the mouth 4 times a day
What are some other ways to get rid of thrush?
- 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
Can women with HIV breastfeed?
- Recommend against it
- If they do, should exclusively breastfeed for first 2 months and treat the infant with an antiretroviral drug
Can women with Hepatitis breastfeed?
Hep B = if the infant is immunised
Hep C = yes, it is not transmitted in breast milk
Can women with Herpes breastfeed?
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
Can women with TB breastfeed?
Yes
Can women with substance misuse breastfeed?
Yes if benefits outweigh risks
- Encourage women to stop taking drugs if possible
- Only small amounts of the drug are passed through breastmilk
Can women who smoke/ drink alcohol breastfeed
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
What is the effect of Diabetes on breastfeeding?
- Delays milk coming in
- Breastfeeding = lose weight more quickly and have more stable blood glucose levels
What is the effect of obesity on breastfeeding?
- More at risk of Diabetes, CS, Hypertension baby in NNU
- Delays milk coming in
What is the effect of PCOS on breastfeeding?
- Low oestrogen = poor development in puberty
- Inhibits prolactin
- Increased risk of diabetes and obesity
What is the effect of PPH on breastfeeding?
- Can delay release of prolactin
- Increased cortisol levels
What are the effects of Kangaroo care on infants?
- Reduces HR and BP
- Reduces cortisol levels
- Thermoregulation
- Increases oxytocin levels
- Encourages bonding
Why do preterm babies struggle to breastfeed?
- Poor/absent suck-swallow-breathe coordination
- Weak suck
- Nasal prongs, feeding tubes etc
- Lung disease
- Lack energy
What is it called when HCPs give dummies to teach babies sucking reflex?
Non-nutritive sucking
When is cup feeding effective?
30-34 weeks
When should an infant be able to effectively breastfeed?
36 weeks
What effect does hypoxia have on breastfeeding?
- GI tract may have been affected = breastmilk good
- Poor suck-swallow-breathe coordination
