Breastfeeding in Difficult Circumstances

Question 1

Define Lactogenesis II and III

Answer 1

Lactogenesis II (endocrine) occurs after the expulsion of the placenta and membranes due to the drop in progesterone and oestrogen. Prolactin levels increase and bind with prolactin receptors in the walls of lactocytes to begin milk synthesis (Lawrence and Lawrence, 2005). 
Lactogenesis III is an autocrine response which women begin to notice on day 2 and 3 when mil comes in.  It involves feedback inhibitor of lactation which is a whey protein.  If milk is not removed, FIL will build up and milk will not be synthesised.

Question 2

Describe 11 points of BF advice (important to know!)

Answer 2

P&A
Avoid separation
Rooming in
Regular feeding, particularly at night
Monitor urine and stool output
Monitor general wellbeing
Express
Monitor jaundice
Avoid Dummies
Relaxed atmosphere for BF
Skin to Skin

Question 3

When does the suck, swallow breathe reflex come in?

Answer 3

36 weeks

Question 4

What factors can delay lactogenesis II?

Answer 4

Inefficient milk removal
Obesity
LSCS
Retained products
Anxiety
Preterm birth

Question 5

Why does LSCS delay lactogenesis II, what is the reference and what care should be given?

Answer 5

May have had a PPH or traumatic delivery.
Dewey et al., 2005 states it is harder to BF
Women will need more support with P&A due to scar, regular expression. Lying down position or under arm position may be more suitable (Pollard, 2011).

Question 6

What care should diabetic mothers receive with regards to feeding and why?

Answer 6

Babies of diabetic mothers are more likely to be hypoglycemic so it is very important that they feed regularly. They will need support doing this. BF helps blood glucose levels stabilize in diabetic mothers. As BF burns more energy, mothers should watch their blood glucose levels.

Question 7

What extra care should be given to obese mothers in terms of BF?

Answer 7

P&A support due to large breasts and lack of mobility

Encourage regular feeding as obese mothers are more likely to have hypoglycemia

Question 8

What extra care should be given for mothers with PPH?

Answer 8

Loss of fluid inhibits lactogenesis II and leads increased cortisol which can impede lactogenesis III. Encouraging early BF (within 30 minutes) and regular feeds. Additionally a relaxed BF environment will enable oxytocin levels to increase and cortisol levels to decrease.

Question 9

Describe tongue tie and the care you would give to a mother and baby feeding?

Answer 9

Tongue tie is an excessively thick or short frenulum which makes it harder for babies to open their mouth wide enough to get a mouth full of breast tissue. It is graded, 1 being the most severe.
The baby may have poor weight gain and mother may have sore nipples. Frenulotomy may be needed if P&A have been looked at and adjusted.

Question 10

How long should does expressed BM last?

Answer 10

12 hours at room temperature, 7 days in the fridge, 6 months in freezer