Infant Feeding & Milk Production Flashcards
What does the BFI (Baby Friendly Initiative) offer?
support for breastfeeding and infant nutrition, helping parents develop close relationships and bonds with their babies
How does the BFI support maternity services?
- setting standards
- providing training
- assessing progress
What year was the Unicef BFI introduced?
1994
Define positioning
how a mother holds her baby to enable him/her to attach effectively
Name the 4 types of positioning for breast feeding
cradle,
rugby ball,
cross cradle,
lying down
Explain the acronym ‘CHIN’
C - close - baby needs to be close to mum to scoop enough breast into their mouth
H - heads free - to allow the the chin to lead to the breast and to allow the motion of swallowing
I - in line - alignment of the babies body enable feeding and swallowing to be easier
N - nose to nipple - enabling a wide mouth to engulf enough nipple to rest at the junction of the hard and soft palette in babies mouth
Define attachment
how a baby takes the breast into his mouth to feed
How does a baby ‘effectively attach’?
the baby takes a big mouthful of the breast tissue into his mouth and milk is released due to a combination of tongue compression and negative pressure within the baby’s mouth
Name the 5 signs of correct attachment
- no pain for mother
- chin is against the breast (navigate nose to nipple)
- more areola visible where the babies nose is than where their chin is
- full round cheeks
- rhythmic sucking with pauses
State the 4 parts of the breast anatomy
- nipple
- areola
- montgomerys tubercle
- lobule
Explain what is meant by ‘montgomery’s tubercle’, what’s their role?
hair follicles on areola that secrete an oil that gives off a smell that attracts babies to breast
Explain what the breast ‘lobules’ contain
lactiferous ducts (milk ducts) and alveoli which contain myoepithelial cells and lactocytes
Breast changes occur throughout pregnancy to prepare for lactation. What happens during weeks 4-8?
breast development
Breast changes occur throughout pregnancy to prepare for lactation. What happens during week 12?
pigmentation of areola (increased visibility for baby)
Breast changes occur throughout pregnancy to prepare for lactation. What happens during week 16?
secondary areola appears and colostrum present
Explain the physiology of lactation i.e. beginning milk production…
Milk production is triggered by the removal of placenta and membranes, and progesterone, prolactin and oxytocin
What does progesterone do to instigate milk production?
Maternal progesterone blood levels decline when the placenta and membranes are removed during ‘after birth’
What does prolactin do to instigate milk production?
stimulate acini cells/lactocytes to produce milk
What does oxytocin do to instigate milk production?
stimulates myoepthelial cells to contract to release milk
Describe acini cells/lactocytes?
Smallest functional unit of the breast. Hundreds of acini cells in each breast produce milk into a separate ducts. Milk is then funneled into the ductal system toward the nipple.
What is the function of myoepithelial cells in the breast?
contraction of the mammory gland ducts
What is prolactin?
Hormone that communicates to the body that breast milk is to be made during pregnancy and birth
Where is prolactin released from?
anterior part of the pituitary gland
What triggers prolactin to function?
Sucking of baby on nipple
What type of cells does the hormone Prolactin communicate with in order to produce milk?
Acini/lactocyes
Does prolactin only act during breastfeeding?
No, prolactin count remains high for up to 90 minutes post feed, stimulating the production of more milk
Why is breastfeeding referred to as a form of contraception?
Prolactin occurrence in the maternal body suppresses ovulation
When is the best time to begin breastfeeding and why?
Straight after birth because the sooner and more frequently prolactin is stimulated, the more likely it will remain effective long term
Explain the ‘prolactin receptor theory’
- surges of prolactin prime the receptor sites
- expulsion of placenta opens receptor sites
- unprimed/unfilled receptor sits shut down, reducing potential for milk production
What is oxytocin?
Peptide hormone that plays a role in social bonding, sexual reproduction, childbirth, and the period after childbirth. Known as the ‘love hormone’
Where is oxytocin produced?
Posterior part of pituitary gland
What type of cells does oxytocin act upon in the process of milk production?
Myoepithelial cells to eject milk
What triggers oxytocin?
Sucking of nipples and positive/loving thoughts
How is oxytocin increased between mother and baby?
Keeping them close together and skin to skin contact
When does oxytocin peak?
early in the feed, can be felt as a tingling in the breast
How do prolactin and oxytocin work together?
- trigger feelings of love and mothering behaviour
- induce calmness and a feeling of wellbeing
- enhance the mother-baby bond
What is the ‘feedback inhibitor’ of lactation (FIL)?
a protein secreted in breast milk
Explain the process of FIL
Removal of milk and the protein secreted from the breast ensures milk will continue to be production. If milk is not removed, milk production will diminish - the presence of FIL in receptor sites blocks further milk production
State the two systems of ‘Control of Lactation’ at work to regulate milk supply:
Endocrine control and Autocrine control
Explain the endocrine control system of lactation
Posterior pituitary gland produces oxytocin that ejects milk produced by prolactin - systemic aka. happen in both breasts when all succeeds during breastfeeding
Explain the autocrine control system of lactation
Build up of FIL (protein) lessens production of milk when breast feeding is not occurring regularly. Removal of milk stimulates production once again. This is ‘local’ - happens in one breast at a time, whichever breast baby chooses to feed from
What is the ideal way to control lactation using endocrine and autocrine systems?
Endocrine system drives early stages of lactation and is important for establishing ongoing potential for milk production, whereas continuing removal of the feedback inhibitor is the key to actual supply and longer-term maintenance of lactation
What is colostrum?
The breast fluid you produce in the first few days postnatally
Describe colostrum
yellowish fluid, high density, low volume
What is colostrum highly concentrated in compared to that of matured milk?
protein, mineral and fat-soluble vitamins (A and K)
What does colostrum have less of than matured milk?
less lactose, fats and water soluble vitamins
What is the golden ingredient to colostrum?
more anti-infective agents than mature milk - great for the immune system for infections as a baby and child
What are the feature of breast milk?
fat, lactose, protein, fat soluble vitamins, water soluble vitamins
Describe the function of ‘fat’ found in breast milk
provides 35-50% of energy, remainder from lactose metabolised into glucose
Describe the function of ‘lactose’ found in breast milk
provides energy of rapidly growing brain, enhances absorption of calcium and promotes growth of lactobacilli
What is the ‘protein’ found in breast milk?
Alpha-lactalbumin
What ‘fat soluble vitamins’ are found in breast milk?
A, D, E, K
What ‘water soluble vitamins’ are found in breast milk?
B complex and C
State five evidenced factors to make breastfeeding work
- keeping mother and baby together - oxytocin
- baby to breast asap after birth, skin to skin - sooner prolactin produced, more effective long term
- correct attachment
- responsive feeding - communication between mother and baby, recognising feeding cues
- no formula, teats or dummies given
State 6 feeding cues (baby ‘asking’ for food)
- moving eyes
- wriggling/waving
- rooting for breast
- sucking fists, blanket etc
- murmuring noises
- crying is last resort
