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OB > lactation > Flashcards

lactation Flashcards

1
Q

three stages of lactation n

A
  1. Mammogenesis
  2. Lactogenesis
  3. Galactopoiesis
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2
Q

Mammogenesis requires what hormone

A

mammary growth development

Requires estrogen and progesterone

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3
Q

lactogenesis -requries

A

initiation of milk secretion

a. Requires prolactin

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4
Q

galactopoiesis what is it and what does it require

A

maintenance of milk secretion

Requires prolactin, oxytocin (released during suckling)

The more baby suckles, the more milk production

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5
Q

Involution

A

– when mom stops breastfeeding

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6
Q

typical breast increase

A

Increase in breast size (gain 400g each)

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7
Q

physiological breast changes

cell types, ducts, lobes

A

Formation of new mammary ducts

Development of lobular architecture

Epithelium differentiates for secretory activity

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8
Q

lactations is initiated when …

A

Lactation is initiated when plasma estrogens, progesterones, and human placental lactogen levels fall after delivery

may be delayed during c section

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9
Q

prolactin levels will return to nonpregnant level in the absence of suckling in __

A

e. Prolactin levels will return to nonpregnant level in the absence of suckling 2-3 weeks postpartum

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10
Q

Maintenance of established milk secretion requires suckling and the emptying of mammary ducts and alveoli

A

Takes a few days for the milk to “come in”

Newborns can suckle almost every 30 mins

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11
Q

Premilk secretion present in the first ___ postpartum

A

Premilk secretion present in the first 2-3 days postpartum before milk comes in

may begin in the last week sof pregancny

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12
Q

normal weight loss and when do they get it back

A

babies can lose 10% in the first week

and should gain back normal birthweight in two weeks

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13
Q

“liquid gold”

A

collostrum
Yellowish alkaline secretion

super concentrated
high in protein, vitamins, immuno globulins

lower carb, K, and fat than breast milk

normal laxative action for meconium

moves through the gut quicker

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14
Q

what drives milk production

A

Prolactin drives milk production

Other hormones involved (insulin, cortisol, etc)

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15
Q

Substrates for milk are derived from the ___ and ____

A

ii. Substrates for milk are derived from the maternal gut and liver

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16
Q

calorie intake during lactation needs to be around____

A

500 calories to sustain milk production

needs to be fat and protein rich

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17
Q

what is the nutrition make up of breast milk

how many calories

A

Mature human milk contains 7% CHO as lactose, 3-5% fat, 0.9% protein, minerals, vitamins, enzymes, and water

  1. 60-75 kcal/dL provided to the infant
  2. In a healthy mom producing breast milk, breast milk should be the only thing the baby needs for the first 6 months of life
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18
Q

transfer of immunoglobulins

is highest when…
what type of immunoglobulins are most common

A

Maternal transfer of immunoglobulins through breast milk provides immunologic defense for the newborn as the immune system develops

  1. Highest output during the first week
  2. All classes of immunoglobulins in breast milk
    a. 90% IgA
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19
Q

what is meant by highly anti-infective

A

Breast milk is also highly anti-infective

a. Primarily leukocytes
b. If mom is sick and is producing antibodies, those antibodies will be transferred to the baby as well

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20
Q

average milk production

A

Average milk production in a breastfeeding mother is 120 mL by the second postpartum day and increases to 300 mL/d by postpartum days 10-14

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21
Q

how does the CNS improve milk output

A

increases oxytocin with support

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22
Q

ways to increase milk production

A

Nurse more often (the best way)

Pump between feedings
(pumping is not as efficient as suckling)

Herbal supplements
Metoclopramide (Reglan) 10mg BID off-label use

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23
Q

best supplements for milk production

A

fenugreek (best evidence)

Fenugreek 610mg capsules, Take 3-4 caps TID-QID for effectiveness

goat’s rue

brewer’s yeast

oats

teas

24
Q

SE of metoclopramide (Reglan)

A

nausea, significant headaches

25
Q

recommendations around breast feeding

A

Exclusive breastfeeding up to 6 months of age, partial breastfeeding 6-12 months or longe

WHO – up to 2 years or beyond (looking at food/water shortages)

Start to drink cow’s milk at 12 months (not before that b/c can cause IDA)

Currently 70% of women initiate breastfeeding and only 1/3 are still breastfeeding at 6 months

26
Q

advantages of breast feeding

A

f. Maternal advantages of breastfeeding
i. Convenient, economical
ii. Emotionally satisfying / bond with infant
iii. Aids in uterine involution (uterine cramping noted which is good b/c it prevents post partum hemorrhage)
iv. Improves GI motility and absorption
v. Delays ovulation
vi. May protect against ovarian cancer
vii. Increased weight loss postpartum

27
Q

Disadvantages of breastfeeding

A
  • May be inconvenient for some mothers

Yield may decrease if pumping a lot (eg: working mom)

  • ## Nipple tenderness, mastitis may develop
28
Q

Contraindications to breastfeeding:

A

Use of illicit drugs or excess alcohol
Human T-cell leukemia virus type 1 and HIV
Breast cancer (active)
Active pulmonary TB or varicella infection
Galactosemia of the newborn
Maternal intake of some medications

29
Q

Advantages of breastfeeding to infants

A

i. Easily digestible, ideal composition & temp
ii. Free of contamination; good source of Ig
iii. Decreased incidence of diarrhea, lower RTIs, necrotizing enterocolitis, invasive bacterial infections, SIDS, obesity, childhood allergies, Type 1 DM, Crohn’s disease, UC, and lymphoma
iv. Improved cognitive development and intelligence

30
Q

Disadvantages of breastfeeding to infants

A

Slightly increased risk of neonatal jaundice in the first few weeks

Not usually possible for infants that are weak, ill, or very premature

Mothers with CF have high Na content in milk

31
Q

what are some baby complications that can interfere with breast feeding

A
  1. Cleft palate, choanal atresia, PKU

2. May be fed expressed breast milk – mom can pump and express her own breast milk

32
Q

deal to begin breastfeeding within

A

Ideal to begin breastfeeding within 1-2 hours of delivery

Milk usually comes in on the 3rd or 4th postpartum day

33
Q

initial discomfort due to engorgement

A

Expressed breast milk or lanolin on the nipples after feeding

soothies gel pads by Lansinoh or Cool cabbage leaves on the nipples between feeds

Warm shower can help with engorgement but will cause milk let down

34
Q

most common cause of nipple pain

A

Baby must latch on correctly to suckle effectively with the mouth entirely covering the areola; the tongue will milk to nipple to express the colostrum

35
Q

Best to avoid supplementing breast milk in the first

A

Best to avoid supplementing breast milk in the first 6-8 weeks unless absolutely necessary

36
Q

Avoid using artificial nipples until

A

Avoid using artificial nipples, which will weaken the infant’s suckling reflex; avoid pacifiers until breastfeeding is well established (3-4 weeks)

37
Q

how to prepare to breastfeed

A

i. Wash the hands with soap and water
ii. Clean the nipples and breasts with water
iii. Assume a comfortable position

change positions and boobs

38
Q

breastfeed baby every …..

A

Allow infant to feed on demand q 3-4 hrs
1. Newborns want to feed every 60-90 mins

Always breastfeed on both breasts

Start with 5 minutes each breast per feeding, working up to 10-15 minutes per side per feeding

39
Q

Breastfeeding technique

A

make C hand with neck and chin at areola
place the entire nipple and areola in the infant’s mouth; gently express some milk into the mouth if needed to start suckling

40
Q

how long should babies breastfeed

when should you wake up infants

A

May be every hour, 8-12 times per day in the first few weeks

Typically 10-15 min each breast at each feed

usually NEVER unless baby is losing weight
Should wake newborns up to feed at least every 4 hrs
ii. Feedings initiated based on infant cues

41
Q

Signs of infant satiety

A
  1. Release of the nipple; relaxation of facial muscles, hands; falling asleep while feeding
42
Q

whens should a lactation consultant be utilized

A

most women should have one consultation

Ideally a lactation consultant will follow up with the family 48 hrs after discharge

43
Q

baby markers of adequate breast feeding

A 
Urine output
•	6 wet diapers/day
-Stools
•	>4 soft stools/day
-Weight gain/loss
•	Expect 5-7% loss initially
•	Regain birth wt @ 2 wks
-Jaundice
44
Q

mother markers of adequate nursing

A

Mother

  • Supplementation
  • Painful nipples
  • Engorgement
  • Mastitis
45
Q

painful nipples usually occur during___

A

i. Tender nipples are common! (Get a good latch)

ii. Usually occur the first few weeks of breastfeeding

46
Q

management of painful nipples

A

Dry heat or application of expressed milk to the nipples between feeds may help

iv. Vaseline, Lanolin, Vitamin A&D ointment, Soothies gel pads
v. Treatment of Candida infection if present (baby will get thrush so baby will need to be treated as well)
vi. Nipple shields only as a last resort (can decrease milk yield)

47
Q

when does engorgement occur and what causes it

A

Occurs in the first week postpartum

48
Q

best management of engorged breast

A

Breast massage and around-the-clock feedings help and prevent engorgement

Oral analgesics (Tylenol), cool compresses, partial expression of milk before feedings will help relieve discomfort and engorgement

49
Q

mastitis occurs usually when?

A

Painful, erythematous lobule in an outer quadrant of one breast during the 2nd or 3rd week postpartum

50
Q

what causes mastitis and what population do we see it in most commonly

A

i. Occurs most frequently in primiparas mother (first time mom)

Caused by coagulase-positive Staph aureus

51
Q

most common pathogen and what to do if mastitis occurs <4 weeks pospartum

A

neonatal Strep infection suspected if recurrent or bilateral mastitis

Antibody-coated bacteria in the milk

52
Q

management of mastitis

A

Local heat, well fitted bra, start antibiotics

  1. Cephalosporins, dicloxacillin, methicillin
53
Q

complications of mastitis

A

Breast abscess may develop if not treated

  1. Pitting edema & fluctuance over the inflamed area
  2. I&D abscess, start antibiotics
  3. Discontinue breastfeeding
54
Q

Indications for suppression of lactation:

A

Women who do not desire breastfeeding

  • Women who cannot breastfeed
  • Failure of attempted breastfeeding
  • Fetal or neonatal death
55
Q

Methods of suppression of lactation:

A

Stop or do not begin breastfeeding, milk expression, or pumping

  • Avoid nipple stimulation
  • Wear a supportive bra
  • Medical suppression with bromocriptine or estrogens is not recommended b/c of SE

can pump but only enough for engorgement to go away

56
Q

sxs of lactation will improve within

A

Symptoms will generally improve in 2-3 weeks

Oral analgesics are helpful (NSAIDS or Tylenol)

OB (14 decks)

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