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Women's health > Care of lactating woman > Flashcards

Care of lactating woman Flashcards

1
Q

Why we should breastfeed infants?

A

We should breastfeed infants for the child’s first six months to achieve optimal growth, development and health

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2
Q

When they should they stop breastfeeding?

A

Up to the age of 2 years or beyond

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3
Q

When should we initiate breastfeeding?

A

First hour of life

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4
Q

What is exclusive breastfeeding?

A

Infant only receives breast milk without additional food or drink, not even water

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5
Q

Breastfeeding on demand

A

as often as the child wants, day and night

no use of bottles, teats or pacifiers

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6
Q

What is partial breastfeeding?

A

It means giving a baby some breastfeeds, and some artificial feeds, either milk or cereal or other food

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7
Q

What is bottle feeding?

A

feeding from a bottle, whatever is in the bottle, including expressed breastmilk

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8
Q

What is artifical feeding?

A

feeding a baby on artificial needs, not breastfeeding at all

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9
Q

What is rooming in?

A

It refers to the practice of nursing babies with their mothers rather than keeping them in a separate nursery.

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10
Q

What are the advantages of rooming in?

A
  • promotes bonding
  • makes exclusive breastfeeding easy
  • early exposure of baby to maternal bacterial flora
  • reduces risk of nosocomial infections
  • mother is able to keep a close watch on her infant.
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11
Q

What hormones induces alveolar and ductal growth?

A

oestrogen and progesterone

It also stimulates the secretion of colostrum

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12
Q

When does the production of milk begin ?

A

When oestrogen falls and prolactin rises

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13
Q

Where is breast milk formed?

A

The alveolar / acinar cells of the mammary glands

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14
Q

Which hormone will stimulate the production of milk?

A

Prolactin acts on the acinar cells to stimulate production of milk

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15
Q

which part of the pituitary gland releases prolactin?

A

Anterior part

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16
Q

What does prolactin do other than production of milk?

A

It suppresses ovulation and has an effect on some women to remain anovulatory until lactation ceases

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17
Q

What control is milk release under?

A

neuro-endocrine control

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18
Q

what is the mechanism of breast milk secretion?

A

The suckling of nipple -> Stimulation of pituitary gland -> Produce prolactin and oxytocin

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19
Q

What is the role and oxytocin?

A

Prolactin initiates copious milk production and oxytocin operates to push out the breastmilk that accumulates in the breast ducts

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20
Q

Where is the breastmilk produced?

A

The acinar is composed of a large number of acinar cells.

Breastmilk is produced in acinar cells and secreted inside the acinar. It is released from the body through breast ducts. Myoepithelial cells around the acinar contract like a pump to discharge the breastmilk

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21
Q

What is colostrum?

A

It is thin watery, yellow fluid.

It consists of protein, sugar, fat, water, minerals, vitamins, maternal antibodies

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22
Q

Fore milk?

A

It is white, thinner in consistency

Protein, sugar, fat, water, minerals, vitamins

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23
Q

What is the difference between colostrum and fore milk?

A

Fore milk has no antibodies

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24
Q

What is hind milk?

A

Hind milk is creamy

It is higher in fat than fore milk

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25
Q

When is colostrum produced?

A

Pregnancy ( 2nd & 3rd trimester )

Birth ( at birth of baby )

Postpartum ( days 2-4 )

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26
Q

When is transitional milk produced ?

A

Postpartum
( days 2 - 4 )
( days 5 - 14 )

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27
Q

When is mature milk produced?

A

Postpartum

day 14 and above

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28
Q

LATCH

A 
L : Latch
A : Audible swallowing
T : Type of nipple
C : Comfort ( breast / nipple )
H : Hold ( positioning )
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29
Q

Average reported intake of colostrum of healthy breastfeed infants ( 1st 24 hours )

A

2-10ml/feed

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30
Q

Average reported intake of colostrum of healthy breastfeed infants ( 24-48 )

A

5-15ml/feed

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31
Q

Average reported intake of colostrum of healthy breastfeed infants ( 48-72 )

A

15-30ml/feed

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32
Q

Average reported intake of colostrum of healthy breastfeed infants ( 72-96 )

A

30 - 60ml /feed

33
Q

What are the feeding cues if your baby is ready for a breastfeed? ( early cues )

” I am interested in feeding”

A

Stirring
Mouth opening
Turning head / rooting

34
Q

What are the feeding cues if your baby is ready for a breastfeed? ( mild cues )

” I am really interested in feeding now”

A

Licking
Increasing movement
Hand to mouth

35
Q

What are the feeding cues if your baby is ready for a breastfeed? ( late cues )

” Calm me then feed me”

A

Crying
Agitated movements
Face turning red

36
Q

What are the breastfeeding positions?

A
  1. side lying
  2. cross-cradle
  3. cradle
  4. football
37
Q

What are the four key points on breastfeeding positions?

A
  1. The baby’s head and body should be in a straight line. A baby
    cannot suckle or swallow easily if his head is twisted or bent.
  2. His mouth should face the breast, with his top lip opposite the nipple.
    The baby’s whole body should almost face his mother’s body.
  3. His mother should hold his body close to hers.
  4. If her baby is newborn, she should support his whole body, and not
    just his head and shoulders.
38
Q

How to help a mother to position her baby for breastfeeding?

A
  1. Make the mother comfortable and relaxed
  2. Sit down yourself in a comfortable and convenient position
  3. Show or tell the mother how to hold her baby with his head and body
    straight, With his body almost facing her, and close to her, With his
    upper lip opposite the nipple — not too high, too low or too far away,
    Supporting his whole body with her hand and arm.
  4. Show or tell her how to support her breast if necessary, with her fingers
    against her chest wall under her breast, and with her thumb at right
    angles along the side of her breast.
  5. Show or tell her how to touch or tease her baby’s lips with her nipple (by
    gently moving the nipple against the baby’s lips)
39
Q

How to help a mother to position her baby for breastfeeding?

A
  1. Explain that she should wait until the baby’s mouth is wide open.
  2. She should then move the baby quickly onto the breast with his head
    slightly extended, aiming his top lip towards her nipple so that his lower
    lip is in contact with the underside c the areola.
  3. Ask her how this feels and notice how she responds.
  4. Look for the signs of good attachment.
  5. Try again if necessary (the mother can take the baby off the breast by
    inserting her little finger into the side of his mouth to break the seal —
    thus avoiding any damage to the breast tissue).
40
Q

What is a good latch?

A

Effective suckling

  • Rhythmic, deep sucks
  • Mother has no pain
  • Swallowing is heard after milk has “come in”
41
Q

GOOD LATCH ( “CALM” )

A

C : Chin and Cheek close to breast
A : Areola covered as much as possible
L : Upper and lower lips flanged out
M : Mouth is wide open

42
Q

What are the possible causes of low supply?

A

Low supply can often be traced to:
• not feeding or pumping often enough
– inability of the infant to transfer milk effectively caused by, among other things:
jaw or mouth structure deficits
– poor latching technique
• rare maternal endocrine disorders
• hypoplastic (insufficient glandular tissue) breast tissue
• a metabolic or digestive inability in the infant, rendering it unable to utilise
the milk it receives
• inadequate calorie intake or malnutrition of the mother

43
Q

What is a let down reflex?

A

• The let-down reflex, also known as the milk ejection reflex, is caused by the
release of the hormone, oxytocin.
• Oxytocin stimulates the muscles of the breast to squeeze out the milk.
• Breastfeeding mothers describe the sensation differently, with some feeling
a slight tingling , some feeling immense amounts of pressure, some feeling
slight pain/discomfort, and still others not feeling anything different.
• The reflex is not always consistent, especially at first.

• The thought of nursing or the sound of any baby can stimulate the let-
down reflex, causing unwanted leakage, or both breasts giving out milk

when one infant is feeding.

44
Q

Causes of let down reflex

A
  • Stress and anxiety
  • Sore or cracked nipples
  • Separation from the infant
  • A history of breast surgery
45
Q

Assisting the let-down reflex

A

If a mother has trouble breastfeeding she can
try different methods of assisting the let-down
reflex.
These include:
• Feeding in a familiar and comfortable
location
• Massage of the breast or back
• Warming the breast with a cloth or shower

46
Q

What are the benefits of breastfeeding for mother?

A

• Breastfeeding also benefits the mother. It releases hormones that have
been found to relax the mother and cause her to experience nurturing
feelings toward her infant.

• Breastfeeding as soon as possible after giving birth increases levels of
oxytocin which encourages the uterus to contract more quickly. This helps
to decrease bleeding after the birth.

• Mothers can find breastfeeding helps them return to their previous weights as the fat accumulated during pregnancy is used in milk production.

• Frequent and exclusive breastfeeding delays the return of menstruation
and fertility known as lactational amenorrhoea. This allows for improved
iron stores and the possibility of natural child spacing.

47
Q

What are the benefits of breastfeeding for mother?

A

• Reduced Risk of Breast Cancer
• Reduced Risk of Ovarian Cancer
• Decreased Insulin Requirements in Diabetic Mothers
• Stabilization of Maternal Endometriosis
• Reduced Risk of Post-partum Hemorrhage
• Reduced Risk of Endometrial Cancer
• Reduced Risk of Osteoporosis
• Beneficial Effects on Insulin Levels of Mothers with PCOS (Polycystic ovary
syndrome)
• Reduced risk for both ovarian and breast cancer both before and after
menopause.

48
Q

What are the benefits of breastfeeding for infant?

A

• Due to the anti-infective properties of breastmilk, breastfed babies tend
to have less incidence of or less pronounced symptoms of ear infections,
respiratory illness, allergies, diarrhoea, and vomiting.
• SIDS (Sudden Infant Death Syndrome) is less common in breastfed
babies.
• Breastmilk is constantly changing in its composition to meet the changing needs of the baby. It has the exact combination of protein,
fats, vitamins, minerals, enzymes, and sugars needed for the human
infant at various stages of his growth.

49
Q

What are the benefits of breastfeeding for infant?

A

• Breastfed children are at less risk for Chrohn’s disease and juvenile
diabetes.
• Better overall dental health than formula-fed children.
• IQ levels are an average of 8 points higher in children who were breastfed.
• Adult daughters who were breastfed are at less risk for breast cancer.
• Adults who were breastfed have a lower risk for high cholesterol and
asthma.
• The bond between mother and child seems to be enhanced with
breastfeeding.

50
Q

What are some signs of breast overproduction?

A

• Baby gets uncomfortable, cries incessantly, is windy and has frequent green stools
(maybe with mucus)
• When feeding on one side, other breast leaks a lot of milk (beyond the first few
weeks)
• When baby pulls off of the nipple, milk squirts some distance
• During feeding, mother hears a ‘milk hitting the bottom of the stomach’ sound
• Baby seemingly in pain, for feeding stimulates bowel movements
• Baby ‘head-bangs’ during feeds, arching its back, and pulling off the breast to
protect its airway, perhaps dragging the nipple with it, then maybe refusing to
feed
• NOTE: With the fast rush of milk, the baby can swallow a lot of air as well as milk,
which can make the baby think he/she is full

51
Q

What are the causes of breast refusal?

A

• Formula feeding, sometimes without the knowledge of the mother.
• The use of artificial teats (nipples) or dummies leading to “nipple confusion” (it difficult to latch on and breastfeed because baby’s previously had a dummy or a bottle teat to
suck on)
• Poor feeding technique
• Over-handling after birth
• Thrush in the baby’s mouth
• Distractions or interruptions during feeds
• Long separations from the mother
• Breathing difficulties, often caused by a common cold
• Swallowing difficulties, sometimes the painful result of ear or throat infections
• Pain from surgery (most commonly circumcision), blood tests, vaccinations, and other

52
Q

What are the contradictions for breast feeding?

A

• HIV positive mother
• is taking certain medications that suppress the immune system such as
corticosteroids
• is taking certain medications which may be passed onto the child through the milk.
• The vast majority of medications are compatible with breastfeeding
• has had excessive exposure to heavy metals such as mercury
• uses potentially harmful substances such as cocaine, heroin and
amphetamines.
• Substances such as caffeine, tobacco, and alcohol, while possibly harmful
to the nursling if consumed in large quantities, are safe to use in moderation
while breastfeeding

53
Q

What are the common breastfeeding problems?

A
  1. Signs of * well-fed to babies
  2. Collection & storage of Expressed Breast Milk
    (EBM)
  3. Insufficient milk supply
  4. Breast engorgement
  5. Sore nipples
54
Q

What are the signs of an underfed baby?

A
  • Continues to lose weight after day-5
  • Below birth weight at day-14
  • Gains less than 120g per week after the first week, or less than 500g per month
  • Fewer than six wet nappies daily
  • Urine that is yellow and strong smelling
  • Infrequent dry, hard, green stools
  • Worried-looking face
  • Not alert or active for some periods daily
  • Unusually lethargic and sleepy
  • Weak cry
55
Q

What are signs of a well-fed newborn?

A

• At least 8 breastfeeds every 24 hours (10-12 in 24 hours is more common in newborns)
• Baby is allowed to determine the length of the feeding, which may be 10 to 20 minutes or longer, on one breast or two
• No meconium faeces by day-5.
• “The normal breastmilk stool is pasty to watery, mustard, coloured, and usually has little odour.
• However, bowel movements may vary considerably from this description.
• They may be green or orange, may contain curds, or mucus, or may
resemble shaving cream in consistency (from air bubbles).

56
Q

What are the signs of a well-fed newborn?

A

• The variations in colour do not mean something is wrong.
• A baby who is breastfeeding only, and is starting to have bowel
movements that are becoming lighter by day 3 of life, is doing well.”
• Day 1- at least three soiled nappies (diapers) in 24 hours
• Day 5 onwards - Five (5) to six (6) wet disposable diapers in 24 hours, or six
(6) to eight (8) wet cloth diapers in 24 hours.
• Baby should be gaining at least 140-250 grams (4-7 ounces) per week after
the fourth day of life. (Most infants lose 7 to 10 percent of their birth weight
during the first week of life, and regain it again by the second week)
• Thereafter gaining 100-200 grams per week

57
Q

How often should you breastfeed per day?

A

At least 8 feeds per day
( Your baby is suckling strongly, slowly, steadily and swallowing )

1 day to 3 weeks

58
Q

How’s your baby’s tummy size should be?

A

1-2 days : Size of a cheery ( 5-7ml )
3-4 days : Size of a walnut ( 22 - 27ml )
5-6 days : Size of an apricot ( 45-60ml )
7 days - 3 weeks : Size of an large egg ( 80ml - 150ml )

59
Q

How many wet diapers per day?

A 
1st day : At least 1 wet diaper
2nd day : at least 2 wet diapers
3rd day : at least 3 wet diapers
4th day  at least 4 wet diapers
5 days - 3 weeks : at least 6 ( heavy wet with pale yellow or clear urine )
60
Q

Soiled diaper :

Number and colour of stools

A

1-2 days : at least 1 to 2 black or dark green meconium

3-4 days : at least 3 brown, green or yellow

5 days - 3 weeks : at least 3 large soft and seedy yellow

61
Q

What’s the baby weight?

A

1-3 day : baby will lose an average of 7% of their birth weight in the first 3 days after birth

Day 4 onwards : baby should gain 20-35g per day and regain birth weight by 10-14 days

62
Q

what’s the growth spurt?

A

baby often experience a sudden burst in growth ~ also known as growth spurt ~
at around 2 weeks, 6 weeks and 3 months.

During these growth spurts, your baby may want to nurse more than usual
‘

63
Q

Other signs

A

Your baby should have a strong cry, move actively and wake easily.
Your breasts feel softer and less full after breastfeeding.

64
Q

What is the colour of the baby’s poo should be like?

A

The baby’s poop should change colour from black to yellow during the first 5 days of birth

The baby’s first poop is black and sticky

The poop will turn green by day 3 and 4

The poop should turn yellow by day 4 or 5

65
Q

How should the expressed breast milk be stored?

A

at 25 degree - 4 hours
at 4 degree ( fridge ) - 2 days
at -20 degree ( freezer ) - 3 to 6 months

66
Q

What are common causes of insufficient milk supply?

A
  • Lack of breast stimulation
  • Incorrect positioning
  • Maternal fatigue
67
Q

What are the interventions towards insufficient milk supply?

A
  1. Review feeding pattern
  2. Assess the mother’s breastfeeding
  3. Observe the baby’s feeding behaviour
  4. Educate and support mother
  5. Ensure sufficient rest.
68
Q

What are the common breastfeeding problems

( Breast engorgment ) ?

A
  1. Breast engorgement

Causes :

  • Physiological ( 3-4th postpartum )
  • Ineffective/ inadequate removal of milk
69
Q

What are the interventions towards common breastfeeding problems
( Breast engorgement )?

A

Before feeds : hot compress ; express milk
During feeds : ensure correct positioning
After feeds : express milk ; cold compress ; supportive

70
Q

What are the common breastfeeding problems ( Sore nipples ) ?

A

Cause : incorrect positioning

71
Q

What are the prevention towards breastfeeding problems ( breast engorgement )?

A
  • Frequent, unrestricted feeding

- Proper attachment

72
Q

What are the interventions for sore nipples?

A
  1. Rest affected nipple if necessary (express)
  2. Feed from the unaffected side first
  3. Review technique of latching on & removal from nipple
  4. Emphasize importance of “correct positioning”
  5. Massage nipples with breast milk after feeds & expose them
73
Q

What are the alternative method to breastfeeding?

A
  1. cup feeding
  2. Finger feeding
  3. Syringe feeding
74
Q

What are the reasons to cup feed?

A

For a full-term baby, cup-feeding can be used when:

  • the baby and mother are not together for some reason
  • a mother needs to rest painful nipples to give them time to heal
  • a baby is refusing to breastfeed
  • a baby has a minor cleft of lip and/or palate.
75
Q

What does cup feeding help the premature babies?

A
  • helps to avoid ‘nipple confusion’
  • encourages the baby to take an active role in feeding.
  • improves the baby’s digestion of the breastmilk by involving the baby’s
    saliva.
  • reduces the need for nasogastric tubes, which some babies find distressing.
  • provides extra breastmilk while a baby is learning to breastfeed well.
     allows more eye contact and interaction during feeding.
76
Q

What is finger feeding?

A

Finger feeding is very similar to breastfeeding and is
sometimes used for a few minutes before
breastfeeding to prepare baby to take the breast.

The sucking needed is very similar to that needed
while breastfeeding

77
Q

What are the reasons of finger feeding?

A

• Baby is unable to latch on properly due to cleft plate /lip or other sucking
• Baby is very sleepy at the breast and need to be woken up. The increased
flow of milk usually wakes baby
• Sore cracked nipples need a break for healing
• Baby is separated from mom for some reason
• Temporary weaning from breastfeeding
• Breast refusal
• Feeding premature babies

78
Q

What are the steps to syringe feeding?

A

Step 1
• Fill a feeding syringe with breast milk or formula.
Step 2
• Place the baby on lap and hold baby upright.
Step 3
• Place the tip of the syringe into the baby’s mouth. Once baby’s latched on, press the plunger down slowly (0.5ml per each) to give
the baby milk once she starts to suck.

Women's health (9 decks)

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