Breastfeeding: a multidisciplinary approach

Question 1

What is exclusive breastfeeding?

Answer 1

• baby fed 100% on breast milk

- can be expressed milk or directly from the breast

Question 2

When a baby stimulates the mothers breast, whether that be suckling by the baby, crying from the baby or other stimulus, what then happens?

Answer 2

• hypothalamus is stimulated
• hypothalamus releases oxytocin that is released from posterior pituitary gland
• hypothalamus releases prolactin that is released from anterior pituitary gland

Question 3

Once oxytocin has been released by the posterior pituitary gland, what effect does this have on breast tissue?

Answer 3

• stimulates myoepithelial cells to contract

- myoepithelial cells surround lobes and therefore push milk into ducts

Question 4

Once prolactin has been released by the anterior pituitary gland, what effect does this have on breast tissue?

Answer 4

• signals alveoli cells to synthesis and secrete breast milk

Question 5

If breast milk was able to be applied worldwide, what % mortality would be reduced?

1 - 100%
2 - 88%
3 - 50%
4 - 30%

Answer 5

2 - 88%

- reduction would be due to improved immunity

Question 6

What beneficial effects can breast feeding have on the mum?

Answer 6

• reduced risk of cancer (breast and cervical)
• improved bonding and thus oxytocin release
• reduced risk of CVD

Question 7

What ratio of women stop breastfeeding before they want to?

Answer 7

• 8 out of 10 women

Question 8

How long does the WHO recommend women should breast feed for?

1 - 12 weeks
2 - 3 months
3 - 6 months
4 - 12 months

Answer 8

3 - 6 months

- but some women will continue to the age of 2

Question 9

What are some of the basic reasons why breastfeeding rates are the lowest in the UK?

Answer 9

• socioeconomic status and deprivation
• misguided campaigns ‘Breast is best’ (could do half breast and half formula)
• industry pressure (somehow formula is better, but not)
• barriers to breastfeeding

Question 10

Should we provide information about breast feeding to women antenatally or postnatally?

Answer 10

• both

Question 11

When looking at a babies latch position, should the babies latch be:

1 - cover just the nipple
2 - cover areola and nipple
3 - partially cover areola and nipple
4 - partially cover the nipple

Answer 11

2 - cover areola and nipple

Question 12

What % of women cannot breast feed?

1 - 5%
2 - 15%
3 - 35%
4 - 55%

Answer 12

1 - 5%

Question 13

5% of women cannot breast feed. What are the 4 most common symptoms that may lead to a mother stopping to breastfeed?

Answer 13

• breast pain
• nipple pain
• low milk supply (true or perceived = baby is feeding a lot so maybe not getting enough) - MAIN CAUSE
• oversupply of milk

Question 14

5% of women cannot breast feed. The 2 most common symptoms that may lead to a mother stopping to breastfeed are:

1 - pain (breast and nipple)
2 - low milk supply

What is the main cause for both of these problems?

1 - lack of interest from baby
2 - stress and anxiety of the mother
3 - poor attachment
4 - no supportive partner

Answer 14

3 - poor attachment causes ineffective milk transfer

Question 15

One problem in breastfeeding is engorgement, which is where there is an over supply of milk in the breasts. How can this lead to not breast feeding and how can this be treated?

1 - baby is over fed, so need to feed more often
2 - pain in nipples and breast, feed more often
3 - pain in nipples and breast, express in between feeds
4 - pain in nipples and breast, express in between feeds and work on babies latch

Answer 15

4 - pain in nipples and breast, express in between feeds and work on babies latch

Question 16

What are some common causes of breast pain?

Answer 16

• engorgement
• blocked ducts and galactoceles (breast lesions)
• ductal infection
• mastitis (inflammed breast tissue) and breast abscess

Question 17

What are some common causes of nipple pain?

Answer 17

• physiological let-down
• nipple damage
• blocked duct
• nipple infection (thrush)
• vasospasm (narrowing of blood vessels)

Question 18

What are some common causes of low breast milk?

Answer 18

• insufficient access to breast (work, social restrictions, dummies)
• ineffective infant attachment (premature babies)
• prolactin deficiency

Question 19

What is responsive bottle feeding?

Answer 19

• responding to your baby’s needs
• no distraction when feeding time
• not forcing babies to finish bottles if they are full

Question 20

Even if a baby is bottle feeding, what can we do to encourage bonding between baby and parents?

Answer 20

• skin to skin when breastfeeding
• ensure parents do most of the feeds
• baby kept close to parent

Question 21

There are some occasions when women may not want to breast feed such as pregnancy loss, gender dysphoria etc..). In these instances we need to suppress lactation. How can we do this?

Answer 21

• dopaminergic agonists (inhibit prolactin release)

- don’t wean (baby is not on the breast to stimulate milk production)