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.
