Course notes Flashcards
What is exclusive breastfeeding?
Baby is receiving solely mother’s milk as their food source.
What to do for babies with Galactosemia?
May not breastfeed or receive expressed breast milk.
Must be fed a special formula.
What to do for babies with babies diagnosed with Phenylketonuria (PKU)?
May partially breastfeed but also receive a special formula. Amount of breastfeeding allowed is determined by monitoring and infant blood levels.
What is predominant breastfeeding?
Baby is receiving mother’s milk as well as water, water based drinks, ritual foods, oral rehydration solution, vitamins, minerals and oral medications.
They are not receiving any other foods or drinks including formula and other animal milk.
What is complimentary feeding?
Child is between 6 and 23 months and is receiving human milk and solid or semi solid food.
What are the reasons women stop breastfeeding before they wanted?
Concerns about milk quality/quantity.
Feeding problems during the first week.
Problems with their infant latching on or sucking.
Lack of appropriate information and support.
What are the 9 stages that newborns go through after birth?
Birth Cry Relaxation Awakening Activity Rest Crawling/sliding Familiarization Suckling Sleeping
What are the feeding cues?
Rooting - turning the head and searching movements.
Increasing alertness especially REM.
Flexing of the arms and legs and mouthing with little sucking motions.
Attempting to bring hand to mouth.
Sucking on fist or finger.
Mouthing motions of the lips and tongue.
Crying is a late feeding cue.
What are the 10 steps to successful breastfeeding? For BFHI
1) Have a written breastfeeding policy that is routinely communicated to all staff.
2) Train all healthcare staff in the skills necessary to implement the policy.
3) Informal all pregnant women abut the benefits and management of breastfeeding.
4) Help mothers initiate breastfeeding within 1 hour of birth.
5) Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6) Give infants no food or drink other than breastmilk, unless medically indicated.
7) Practice rooming in.
8) Encourage breastfeeding on demand.
9) Give no pacifiers or artificial nipples to breastfeeding infants.
10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge.
What are factors that discourage women from breastfeeding?
Coupons, bags and other free gifts.
Breastmilk substitutes advertisements.
Family members and peers who may discourage women from breastfeeding.
Fear of pain and embarrassment.
Fears about the adequacy of milk supply.
Fears about inadequacy of breast size or appearance.
What are factors that affect the duration of breastfeeding?
Scheduled, delayed or timed feedings.
Inadequate number of feedings.
Inadequate transfer of breastmilk to the baby.
Inverted nipple that does not evert during suckling.
Mother’s fear that she doesn’t have enough milk.
Breast surgery that has damaged lactiferous ducts and/or breast/nipple innervation and circulation.
Infants with an adequate suck (e.g. premies, facial or other anomalies).
What should postpartum community support do?
Include both professional and lay breastfeeding education and support. and follow up
Be communicated to both pregnant women and new mother’s prior to discharge.
Include assessment of an entire breastfeed including pre feeding behaviors.
Include prompt referral to primary healthcare provider.
When is breastfeeding not advisable?
Galactosemia
Mother has been infected by Human Immunodeficiency Virus (HIV).
Mother is taking antiretroviral medications.
Mother has untreated active tuberculosis.
Mother is infected with human t cell lymphotropic virus type 1 and 2.
IS using is is dependent on illicit drugs.
Is taking prescribed cancer chemotherapy agents e.g. antimetabolites that interfere with DNA replication and cell division.
Is undergoing radiation therapies.
Mother has suspected or confirmed Ebola virus.
Women who do not breastfeed are at a greater risk of what?
Myocardial infarction and aspects of metabolic syndrome.
breast, endometrial and ovarian cancer.
Nursing a baby for a year or more decreases the risk of what by 10-15% for women?
Hypertension diabetes hyperlipidemia cardiovascular disease when post menopausal
What is the WHO and UNICEF Breastfeeding Promotion Strategy?
Focus on the advantages of breastfeeding on a personal, community, country or global level.
What is the WHO and UNICEF Breastfeeding Protection Strategy?
Focuses on government, manufacturer and social responsibility to assure breastfeeding’s ability to compete with commercial interests.
Addressing improper marketing practices.
Addresses breastfeeding in public, employment issues, jury duty family law, mothers in prison etc.
What is the WHO and UNICEF Breastfeeding Support Strategy?
Focuses on the interaction of helpers as well as program development and implementation.
Breastfeeding a child for 6 months is associated with what?
A decrease in breast cancer morbility.
When is there the greatest risk of women giving up breastfeeding?
3-7 days postpartum.
Fastest from off is the 10 days following discharge from hospital when you are alone with the baby.
Describe the Alveolar cells?
Single layer structure - 1 layer of cells with space inside.
Make milk.
When space inside fills up breasts go from soft to hard.
What are the myoepithelial cells?
Smooth muscle cells.
Squeeze the alveolar cells and squeeze the milk out of the space and into the ducts.
What is the capillary layer?
Surrounds the myoepithelial cells and alveolar cells.
What does the capillary system do?
Brings all the nutrients that the cells need to make mil and also brings the hormones that are needed to make the milk and deliver the milk.
What is the Alveolus?
The entire structure of milk cells.
What is the Lumen?
The space in the middle where the milk collects.
What are the ducts?
What brings the milk down to the nipple.
Where are the receptor sites and what do they do?
On the outer edge of cells. They are how our components are collected from the blood and are brought into the milk cells in order to produce milk.
How many functioning nipple pores are there per breast for each lactation?
3-5
Where is oxytocin secreted from?
Posterior pituitary.
Where is prolactin secreted from?
Anterior pituitary.
What does prolactin do?
Responsible for milk production.
Baby suckles and that gives the message to the thoracic nerves to have the pituitary secrete prolactin intro the blood then it moves through the mother’s body including the milk cells where milk is produced.
What happens when you lengthen the time between feeding?
You decrease the amount of prolactin that made at the next feeding.
What are mechanisms that can trigger oxytocin?
Conditioned response (letdown reflex).
Nipple stretching - happens with a proper latch
Baby hand massage.
When does breastmilk composition change?
Over the course of lactation Preterm vs term milk After 1 year of lactation Within the day - diurnal variations Within a feeding By way it is taken.
How is preterm milk different?
For 5-7 weeks after delivery it has higher protein, fat and electrolytes
What are the mechanisms by which exclusive breastfeeding protects babies from diarrhea?
1) pH of the gut breastfeed babies gut is more acidic.
2) Low iron in the gut.
3) Presence of bifidus factor which promotes the intestinal presence of lactobacillus bifidus that maintain low pH and crowd out pathogenic organisms.
4) Presence of hormones, hormone like factors and growth factors that stimulate growth and development of the GI tract and Gi Motility.
5) Antibodies such as SIgA bind to microbes in the bab’y intestinal tract and prevent them from being absorbed into the rest of the body.
6) White blood cells.
7) Cell wall disruptors kill microbes by destroying the cell walls.
8) B12 Binding factor reduces the amount of B12 in the intestines available to microbes.
9) Lactoferrin - deprives bacteria of iron, disrupts integrity of the outer membranes of bacteria, assists in intestinal maturation and the recovery of the intestine from injury.
10) Antimicrobial activity boosters such as fibronectin and gamma interferon.
11) Mucosal wall protectors such as mucins and oligosaccharides.
12) Microbes from the mother’s skin and bacteria in the mother’s milk.
13) Absence of exposure to contaminants.
14) When mother is exposed to organisms she makes antibodies and secretes them into her milk and cells from the baby’s mouth go into the breast.
If a baby loses more than 7% of birth weight and has further weight loss after 5 days what should happen?
Assess feeding and consider frequent follow up.
When should babies regain birth rate.
by 2 weeks postpartum at the latest.
When do infants lose more weight in the first postpartum days?
When labor meds are used.
When more intrapartum fluids have been given.
When there is no labor prior to c-section.
How to prevent breastfeeding associated hypernatremia?
Ensure formal evaluation and documentation of breastfeeding by trained caregivers at least once per nursing shift.
Breastfeeding newborns should be seen by a pediatrician at 3-5 days of age (48-72 hours after discharge). Evaluate hydration (elimination patterns), body weight gain, discuss maternal/infant issues and observe feeding.
What is lactogenisis stage 1?
Secretory differentiation.
Production of colostrum.
Under the influence of placental hormones.
What is lactogenesis stage 2?
Secretory Activation
Requires complete delivery of the placenta.
Rapid drop of progesterone and prolactin going into cells.
Production of colostrum slows down and the production of mature milk ramps up. Therefore is a mix of both milks.
What is lactogenesis stage 3?
Lactation/Galactopoesis
The longterm production of mature milk.
Need frequent removal of milk and frequent nipple stimulation to cause prolactin production.
How much milk are women expected to make a day?
750-1000ml
What are negative influences on milk production?
Long spaces between feedings.
Long, slow feedings.
Excessive pressure on the breast.
Breast surgery or injury
What can pressure result from?
Too much milk left in the breast Missed feedings Restrictive bras and clothing Breast implants Suboptimal breast anatomy Suboptimal or altered physiology physical objects e.g. pacifiers Secretory activation (Lactogenesis 2)
What is normal breast fullness like?
Breast soft to touch Body temp normal Mother feels well Breast may be hot Baby can grasp nipple
What is engorgement like?
Breast hard temp normal Mother feels discomfort Breast is hot and shiny Nipple is difficult to grasp - baby can't latch
When do women who have c-sections experience peak engorgement?
24-48 hrs later
Why is breast surgery or injury a concern with breast feeding?
Concern about:
- damage to nerves control the passage of the message that baby is feeding to the brain.
- damage to the ducts
- damage to the milk making tissue
- damage to the circulatory system coming to that area.
What are examples of suboptimal breast anatomy?
anatomical concerns
Absence of breast changes - in pregnancy or early days postpartum
No postpartum breast fullness or signs of abundant milk production
hypoplastic breasts
discrepant breast size
What are the grades of inverted nipples?
Grade 1 - easily pulled out with a breast pump or nursing
Grade 2 - can be pulled out but don’t maintain projection
Grade 3 - difficult or impossible to pull out
What are the symptoms of Sheehan’s Syndrome?
low blood pressure, anemia, fatigue, profound hair loss, dry dull hair.
What drugs can alter physiology?
Pseudoephedrine - a single 60mg dose decreased 24hr milk production by 24% probably by decreasing prolactin levels.
Corticosteroids - temporary suppression of lactation for 24-48hrs after a local injection of 24mg prednisolone.
How does smoking affect breastfeeding?
make less milk
may have lower prolactin levels
may wean earlier
babies may nap less
How does cannabis affect pregnancy?
no safe threshold for use in pregnancy
significantly associated with an increased risk of preterm birth and low birth weight
How do pacifiers help premies?
May have earlier hospital discharge.
Tube fed babies may gain faster and have improved physiologic and behavioral responses.
Reduced the time to full oral feeds.
How does depression affect breastfeeding?
more likely to discontinue by 4-12 weeks.
be unsatisfied with their infant feeding method
experience significant breastfeeding problems
report lower levels of breastfeeding confidence.
Why are implants a concern?
Storage capacity.
When you put implants into the breast there is less room for milk cells.
What is the worst sort of breast implant surgery?
When there is an incision around the areolar as it is most significantly associated with milk insufficiency.
How does iron deficiency anemia affect milk supply?
Poor oxygen to milk making cells.
Due to exhaustion or depression altering coping behavior.
Why is pacifier use a problem?
Why is it used? sore nipples hunger crying sleep problems
Why are nipple shields a concern?
Cover the nerve endings on the nipple.
Uncertain effect on milk supply
3x the risk of not exclusively breast feeding
Increased risk of readmission for weight loss and hypernatremic dehydration
Fungal biofilm on the surface of the shields.
Can be difficult to wean a baby from.
higher risk of early weaning.
How do you wean from a nipple shield?
Spend a lot of time skin to skin.
Start to feed with a shield, distract baby, slip off shield and re-latch.
How is formula susceptible to contamination?
The formula itself Water used Additives such as melamine Bottles - improper cleaning, BPA and other chemicals in bottles Bottle nipples
How do you prepare formula?
Mix formula with water heated to a temperature of at least 70 degrees celsius (158F) to kill Enterobacter sakazakii
Why do formula fed babies gain more weight?
Production of insulin that does not move glucose into the cells.
Receptor sites on cells seem to be blocked so the function to move glucose out of the blood and into the cells can’t occur efficiently.
Excess insulin in the blood is used to make and lay down fat.
Cells send out repeat signals to secrete more insulin because of lack of glucose in cells.
When should mothers temporarily not breastfeed?
Mother is infected with untreated brucellosis.
Mother is taking certain medications.
Mother is undergoing diagnostic imaging with radiopharmaceuticals.
Mother has an active herpes simplex virus infection with lesions on the breast.
When can mothers temporarily not breastfeed but can feed expressed breast milk?
Mother has untreated active tuberculosis.
Mother has active varicella (chicken pox) that developed within 5 days prior to the 2 days following delivery.
What causes reflux?
Laying down while feeding.
Nature of food itself.
Physiological immaturity.
Cows milk allergy
When can allergy be provoked?
After diarrhea. During times of mucosal damage there is increased permeability to food antigen - cow milk or soy.
What is galactosemia?
A rare congenital inability of the body to metabolize the simple sugar, galactose, causing damage to the liver, cns and other body symptoms.
What does galactosemia cause?
brain damage, cataracts, jaundice, enlarged liver, kidney damage.
Why is smell important for newborns?
Exposure to the mother’s odor may facilitate adaption to the early postnatal environment.
Mother’s areolae and milk odor may attract and guide the baby to the breast.
Maternal breast milk odor calms newborns during painful procedures.
What are the benefits of skin to skin?
Decreased rate of postpartum hemorrhage. Faster Expulsion of the placenta. Correct suckling. Less crying. skin to skin babies are warmer.
Benefits of rooming in?
Families can observe feeding cues. Babies can be held skin to skin. Babies can smell the milk. Babies can be fed at their best time. Learning happens together.
What are the risks of delayed breastfeeding on the mother?
Decreased prolactin receptors activated. Decreased oxytocin/uterine contractions Decreased milk volume Less opportunities to practice with colostrum. Decreased confidence. Increased risk of supplementation.
What are the risks of delayed breastfeeding on the baby?
Increased risk of jaundice, sleepiness and lethargy.
Increased risk of hypoglycemia
Less opportunities to practice with colostrum.
Increased risk of supplementation.
Increased pH and opportunistic Microorganisms in the gut.
When are good times to attempt feedings?
Light state sleep (REM)
quiet alert (still body, fixed focus eyes)
Active alert
Growing restless with hand to mouth activities
Open eyed rooting
Signs of oversupply?
Rapid weight gain Unsettled baby especially after feeding Recurrent plugged ducts and mastitis Painful feedings Voluminous stools - often green and shiny.
What to consider with green, shiny stool?
Is there a deep latch and nipple stretching? (if not stretched less oxytocin flows and therefore less fat)
Is there either overactive letdown or overproduction of milk?
If there is a lot of milk at once the production of lactose may not keep up with the amount of lactose.
How do you handle oversupply?
Decrease additional stimulation/milk removal if possible.
Consider block feeding (nurse 1 side per feeding).
Try Australian posture.
Watch for mastitis.
Consider donating to a milk bank.
What are the signs of Candida Albicans (Yeast/Thrush)?
Mother usually has itchy, flaky and shiny skin.
What are the treatments for Candida Albicans?
Pharmacological treatment (Nystatin first then Fluconazole). Clean/replace yeast vectors e.g. toys, pacifiers, pump parts etc.
What are the symptoms of Reynaud’s Syndrome?
Vasospasm of the nipple.
Triple color sign - white - blue - raspberry
Bi color sign - white - raspberry
Pain is extreme and spasmodic
What is the treatment for Reynaud’s Syndrome?
Preventing or decreasing cold exposure.
Avoiding vasoconstrictive drugs (including some hypertensive drugs).
Avoid caffeine/nicotine.
Nifedipine - a calcium channel blocker.
What are plugs, clogs or cakes?
Palpable lumps of milk within the lumen or duct system/
What are symptoms of blebs?
white spots on the face of the nipple that look like milk filled blisters.
One duct is usually covered.
Pinpoint pain.
What factors are commonly associated with mastitis?
Blocked ducts from engorgement, hurried feedings or use of a nipple shield. Attachment difficulties. Tight bra. Use of breast shell. Nipple pain. Anemia in the mother. Tongue Tie.
What is Goldsmith sign?
Persistent refusal to latch onto same breast.
A sign of potential breast cancer.
What is the cut off for treating SYMPTOMATIC neonatal hypoglycemia?
40 mg/DL
What are the symptoms of Neonatal Hypoglycemia?
Jitteriness Cyanosis (blue covering) apnea hypothermia (low body temp) poor body tone Poor feeding/lethargy Seizures
What is Jaundice?
yellow coloration of the skin and sclera (whites of eyes).
What causes the yellow coloring with jaundice?
Unconjugated bilirubin
What is pathologic jaundice?
occurs before 24hrs of age, usually due to sepsis, blood incompatabiliy.
What is early onset jaundice?
peaks between 72-96 hrs frequently related to underfeeding
What is late onset jaundice?
May be related to metabolic or other issues with baby.
presents in 2nd week and can persist for 12 weeks
What is kernicterus
when unconjugated bilirubin crosses the blood brain barrier and becomes too high, causing damage to the brain, spinal cord and nerve cells.
What are the warning signs of kernicterus?
jaundice advancing from the upper body to the lower body fussiness lethargy feeding difficulties fewer than 4 wet or dirty diapers/24 hrs
What is Kangaroo Mother Care (KMC)?
A special kind of skin to skin holding for premature and fragile babies that has been shown to decrease mortality by 36% as well as sepsis, hypoglycemia, hypothermia and hospital admission.
What are the benefits of skin to skin?
Better long term physiological organization and cognitive control.
Improved cerebral blood flow.
Improved weight gain.
May have nostrils decolonized that have been colonized by MRSA?MRSE organisms.
Have more mature sleep patterns./
Are warmer and more physiologically stable.
May have better breastfeeding outcomes.
How to treat plugs, cakes and blebs?
Find out the cause (eg. bra cutting into breast and slowing milk flow).
Use massage (side of hand down breast).
Warmth
double nursing (start side of cloth, then other breast , then back again)
Try different feeding posture.
See health care provider of systemic symptoms occur
Symptoms of MRSA (methillicillin resistant staphylococus aureus)?
peeling skin
pitting
feel deathly ill
can cause lesions or abcess
What are the reasons for difficulty sustaining a feed?
wrong state poor positioning not hungry prematurity dehydration/malnutrition oral/facial anatomy (e.g. cleft) cardiac anomaly neuro inadequacy (hyper/hypotonic) neonatal abstinence syndrome meds (through mom's milk) undiagnosed breast cancer low milk supply low milk volume Full stomach torticollis birth injury birth trauma maternal discomfort Oral aversion behavior
How to check for goldsmith sign?
feed on non refused breast then without moving baby turn and offer the other breast.
Why do babies with down syndrome struggle with breast feeding?
Low tone - cues
Depressed reflexes - hard to latch on - gape
Hypotonic perioral muscles - weak suck
Deficiency in the smooth muscle movement
Skeletal abnormalities of the mouth and skull will decrease the volume of the oral cavity
Why should mothers not use fenugreek?
May cause reduced absorption of all medications used concurrently.
Worsening of asthma, diarrhea, maple smelling urine and perspiration.
Cross reaction is possible if there is an allergy to chickpeas, peanuts and other legumes.
Decrease in blood coagulation and decreased serum glucose.
Doesn’t improve milk production.
Does reglan increase milk supply?
No. Side effect of tardive dyskenesia (hand shaking).
Does domperidone increase milk volume?
No improvement.
Is illegal in US.
Risk of cardiac arrythmia, cardiac arrest and sudden death.
What are the benefits of cup feeding?
less increase in heart rate.
better oxygenation.
ability to pace own feeding.
How much alcohol can a women drink?
limit intake to no more than 0.5g of alcohol per kg of maternal body weight per day.
What are the most important modifiable risk factors for child allergies?
maternal smoking
breastfeeding
avoid c-section
What are the 3 strategies for weaning?
Parent led
baby led
society led
What is parent led weaning?
choose least favorite nursing
substitute for something equally good in eyes of the child
watch for reaction - physical and emotional
wait and repeat
What is baby led weaning?
Babies older than 12 months - stop offering to nurse and change to on request only.
What is society led weaning?
Historical way of weaning
Same for everyone in society
Everyone knows and expects
Ritual and celebration
What are reasons for a nursing strike?
stuffy nose teething ear infection prefers bottle biting and yelling reaction to being left to CIO family stress separation
How to end a nursing strike?
Identify and resolve the problem lots of support lots of skin contact don't force it avoid the bottle offer breast to sleeping baby try peer pressure
What were the 1970s goals for the nation?
75% initiation
35% continuing to 6 months
What were the goals for the nation for year 2000?
75% initiation
50% continuing to 6 months
What are the heathy people 2020 goals?
Ever breastfed 81.9% Breastfed at 6 months 60.6% Breastfed at 12 months 34.1% Exclusively through 3 months 46.2% Exclusively through 6 months 25.5%
What are the breastfeeding 2020 targets?
Increase the proportion of employers with worksite lactation programs to 38%.
Reduce the percentage of breastfed infants who receive formula before 2 days of age to 14.2%.
Increase the proportion of live births in facilities that provide recommended care for lactating mothers and babies to 8.1%.
What makes a difference to childhood deaths?
Vitamin A supplements Zinc supplementation Increase breastfeeding Insecticide treated materials Increase complimentary feeding around 6 months with nutritious/diverse foods.
What are the first 1000 days?
3 stages
1) pregnancy 270 days
2) Infancy 180 days
3) Toddler years 550 days
What is important during the 270 days of pregnancy?
Good balanced nutrition
Take iron and folate to prevent anemia and birth defects.
Consume adequately iodized salt.
Which thoracic cells innervate the breast area?
T1-6
What do T3 & T5 do?
affect the size of the breast.
What do T4 do?
innervates the nipple
When are maximum fat levels obtained?
30 mins post feeding
What do Gastrin and Cholecystokinin do?
promote induced insulin release and growth promoting effects in the gut.
What does Somatastatin do?
inhibits GI secretion
inhibits GI motility in the GI tract
inhibits the secretion of HGH from the pituitary
inhibits cellular growth and proliferation in the gut
What increases gastrin and decreases somatostatin in babies?
Sucking species own milk decreased stress wellness touch
How much protein is in human milk?
1.2
How much fat is in human milk?
3.8
How much carbs is in human milk?
7.0
How much water is in human milk?
87.6
Why is there more iron in formula?
Because you need a higher amount in formula in order to have the amount that is bio available in breast milk
black/brown poop means?
meconium
greenish brown poop means?
meconium being worked out
Bright yellow liquid poop means?
breastfed stool
How does cadmium exposure effect babies?
affects the kidney, liver, nerves, as well as other body systems
Causes a problem with sequencing
Why are breast implants a concern?
Storage capacity reduction - less room for milk cells
Skin isn’t going to stretch as it is already stretched enough from the implants and milk cells have no place to go
What is a free nipple graft?
nipple and areola are removed and sown back on
super red flag
What is the purse string reduction?
cut out and remove the areolar and nipple
then cut out a larger circle around it
pull together and re stitch
what is the pedicle technique?
excise the surface around the areola, but they keep the nipple intact with the skin that’s underneath
Then cut a wedge underneath and then sow back together
What are women in silence like?
voiceless, powerless, and mindless
afraid of words
see themselves as powerless and dependent on others for their survival
Don’t trust their ability to answer and remember
have little awareness of their intellectual capabilities
live at the behest of others
How do you develop a relationship with women in silence?
few words
familiar words (not areolar or alveoli)
nothing to remember
you may need to be an advocate
What are receivers of knowledge like?
believe that all authorities tell the truth
like to learn the right answer and repeat it to the teacher
can’t tolerate ambiguity
submit to the command of authority
sense of self is embedded in external definitions and roles
believe that all authorities tell the truth
How do you develop a relationship with receivers of knowledge?
teacher must project authority
never be ambiguous
advantages must be concrete and appropriate for her
teaching should center on the right way and include a return demo
What are subjective knowers like?
believe knowing is personal, private and based on intuition
trust their own intuition
inner voice helps guide them
experts don’t know what they are talking about
find female support groups helpful
How do you develop a relationship with subjective knowers?
create time for them to talk about themselves and what they think about breastfeeding
offer help with possible misconceptions about breast feeding
offer to make contacts and referrals
What are procedural knowers like?
invested in learning
interested in obtaining and applying knowledge
want to understand other’s point of view
assume everyone can be wrong
read a variety of books for different points of view
may want very technical information about breastfeeding
How do you develop a relationship with procedural knowers?
be prepared to back up statements with evidence
be knowledgeable about multiple sources of evidence
limit personal stories
understand that options and change are part of the process
What are constructed knowers like?
have abandoned either or thinking
Have learnt to live with conflict and have a high tolerance for ambiguity
believe all knowledge is constructed and the knower an intimate part of the known
want to avoid compartmentalizing
aspire to work that contributes to the empowerment and improvement in the QOL of others
believe that ideas and values must be nurtured
What are montgomery glands and what do they do?
The Montgomery glands are sebaceous glands within the areola that secrete a fatty substance which protects the breast during breastfeeding.
What happens when a baby suckles?
Messages are sent through the thoracic nerves and prolactin increases.
What happens to milk content when lactose and volume is high?
Fat decreases
Mothers of males produce milk with _____% greater or less energy content?
25% greater
men with high _____ levels make milk
prolactin
