day 5 Flashcards
advantages of BF for mom
- Helps control bleeding after delivery and uterine involution.
- Helps body return to pre-pregnancy state (more rapid pp weight loss)
- Reduces risk of diseases.
- Decreased risk of PMD when BF difficulties are appropriately addressed
- Baby will always have food in case of disaster.
Contraindications to BF
- HIV (maternal)
- Active TB (maternal) - not in treatment
- Herpes lesion(s) on breast (maternal)
- Cancer therapy (maternal)
- Diagnostic and therapeutic radioactive isotopes (maternal)
- Human T-cell leukemia virus type 1 (maternal)
- Galactosemia-classic- (infant can’t process galactose)
- Maternal substance use
non contraindications to BF
- Cytomegalovirus (CMV)
- Hepatitis A or C (maternal)
- Hepatitis B (maternal)
- Fever (maternal)
basic breast anatomy
fatty tissue, alveoli, lobules, ducts, montgomery glands
- Fatty tissue: fills the space around the ducts and lobules
- Alveoli: produce milk
- Lobules: contain many alveoli
- Ducts: carry breast milk to the nipple –> There are 15-25 lactiferous ducts
- Montgomery glands: small raised bumps on the areola that lubricate nearby tissue
stages of milk production
lactogenesis 1
Lactogenesis I – Secretory differentiation
- (2nd half of pregnancy to ~48-36 hrs PP):
- 1st stage of milk production,
- epithelial cells change into milk producing cells (lactocytes)
- production of colostrum begins around 16 weeks gestation
- By birth, colostrum is produced in small but suitable quantities (2-20ml/feed)
stages of milk production
lactogenesis 2
Lactogenesis II – secretory activation
- (48-72hhrs PP to 8 days):
- Triggered by drop in Progesterone & Estrogen levels after delivery of placenta.
- Prolactin levels rise (no longer inhibited by PIF, Progesterone & Estrogen) –> stimulates the alveoli to produce and secrete milk.
- Rapid increase in milk volume that then levels off –> Referred to as “milk coming in”
stages of milk production
Lactogenesis III or Galactopoesis
Lactogenesis III or Galactopoesis
- (~9 days PP ):
- Maintenance stage
- Shift from endocrine to autocrine control
- Supply driven by demand
- Milk production regulated by: FIL (Feedback Inhibitor of Lactation)
- Frequent milk removal is essential for lactation maintenance and adequate milk supply to meet the infant’s needs.
- Prolactin peak at night
stages of milk production
9 days onward
volumeof milk? how many feeds?
- First 2 weeks after birth is a time of rapid increase in milk volume, from drops of colostrum to appox. 750ml/24 hours.
- Can take up to 6 weeks to establish and stabilize milk supply
- 8-12 feeds/24 hours (until start of complementary solids at 6 months)
- On average every 2-4 hrs (huge variation in what’s normal) + cluster feeding
stages of milk supplu
(lactogensis) stage 4
Stage IV - Involution
- Gradual apoptosis of milk-producing cells in the mammary gland occurs when weaning begins.
- Cell death begins within 2 days.
- The mammary gland returns to a pre-pregnancy state.
- The breast returns to being influenced by hormonal changes of the menstrual cycle
- Usually a gradual process around 6 months (solid food)
- Involution occurs approx. 40 days after last breastfeed
- Cessation of milk secretion.
types of milk
colostrum and transitional milk
Colostrum
- Thick, small amount
- Helps build immune system and establish a healthy microbiome
- helps clear meconium which has a high concentration of bile (reduces risk of jaundice)
- Contains essential nutrients
Transitional Milk
- Milk volume gradually increases
- Concentration of fat, lactose and the amount of calories gradually increases
- Concentration of immunoglobulins gradually decreases
- Gradually transitions to mature milk
types of milk
mature milk and teaching implications
Mature Milk
- Always changing to meet infant/child’s needs
- Foremilk: Higher concentration of protein, lactose, and water
- Hindmilk: Higher concentration of fats- happens gradually throughout the feed
- Immunological benefits continue
Teaching implication:
- For baby to receive foremilk and hindmilk, encourage mothers to let baby drain first breast before offering
- the second breast then next feed start on the second breast so it gets both
horomones
prolactin
Prolactin
- Hormone that stimulates the mammary glands to produce milk
- Released from the anterior pituitary gland
- Inhibited during pregnancy by Progesterone, Estrogen and Prolactin-inhibiting factor (dopamine) (PIF)
- Levels rise with delivery of the placenta (P&E and PIF levels drop- Prolactin levels rise)
horomones
oxytocin
Oxytocin
- Hormone for milk ejection reflex
- Sends messages to the alveoli to release milk into ducts (milk ejection reflex {MER}
- Released from posterior pituitary during labour, BF, skin to skin, orgasm, when thinking about baby, etc.
- Sends messages to uterus to contract
- Decreases cortisol levels
Golden hour -> 9 stages of readiness to feed
if mom is seperated?
- Birth Cry
- Relaxation
- Awakening
- Active
- Resting
- Crawling
- Familiarization
- Suckling
- Sleeping
if mom seperared
- hand expression pumping to save ebm
baby led vs mother led BF
Baby led
- Hold baby skin to skin, tummy to tummy with you, with their head between your breasts.
- Support baby’s back and bottom.
- Allow baby to move towards the breast.
- Support the breast with one hand as needed, fingers away from the areola.
mother led
- Hold baby tummy to tummy, nose to nipple
- Use a sandwich hold and tickle baby’s upper lip with your nipple
- Bring baby towards the breast (not the breast towards baby)
- Continue to hold your breast in the sandwich hold until you feel baby suckling rhythmically.
