lactation Flashcards
three stages of lactation n
- Mammogenesis
- Lactogenesis
- Galactopoiesis
Mammogenesis requires what hormone
mammary growth development
Requires estrogen and progesterone
lactogenesis -requries
initiation of milk secretion
a. Requires prolactin
galactopoiesis what is it and what does it require
maintenance of milk secretion
Requires prolactin, oxytocin (released during suckling)
The more baby suckles, the more milk production
Involution
– when mom stops breastfeeding
typical breast increase
Increase in breast size (gain 400g each)
physiological breast changes
cell types, ducts, lobes
Formation of new mammary ducts
Development of lobular architecture
Epithelium differentiates for secretory activity
lactations is initiated when …
Lactation is initiated when plasma estrogens, progesterones, and human placental lactogen levels fall after delivery
may be delayed during c section
prolactin levels will return to nonpregnant level in the absence of suckling in __
e. Prolactin levels will return to nonpregnant level in the absence of suckling 2-3 weeks postpartum
Maintenance of established milk secretion requires suckling and the emptying of mammary ducts and alveoli
Takes a few days for the milk to “come in”
Newborns can suckle almost every 30 mins
Premilk secretion present in the first ___ postpartum
Premilk secretion present in the first 2-3 days postpartum before milk comes in
may begin in the last week sof pregancny
normal weight loss and when do they get it back
babies can lose 10% in the first week
and should gain back normal birthweight in two weeks
“liquid gold”
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
what drives milk production
Prolactin drives milk production
Other hormones involved (insulin, cortisol, etc)
Substrates for milk are derived from the ___ and ____
ii. Substrates for milk are derived from the maternal gut and liver
calorie intake during lactation needs to be around____
500 calories to sustain milk production
needs to be fat and protein rich
what is the nutrition make up of breast milk
how many calories
Mature human milk contains 7% CHO as lactose, 3-5% fat, 0.9% protein, minerals, vitamins, enzymes, and water
- 60-75 kcal/dL provided to the infant
- In a healthy mom producing breast milk, breast milk should be the only thing the baby needs for the first 6 months of life
transfer of immunoglobulins
is highest when…
what type of immunoglobulins are most common
Maternal transfer of immunoglobulins through breast milk provides immunologic defense for the newborn as the immune system develops
- Highest output during the first week
- All classes of immunoglobulins in breast milk
a. 90% IgA
what is meant by highly anti-infective
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
average milk production
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
how does the CNS improve milk output
increases oxytocin with support
ways to increase milk production
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
best supplements for milk production
fenugreek (best evidence)
Fenugreek 610mg capsules, Take 3-4 caps TID-QID for effectiveness
goat’s rue
brewer’s yeast
oats
teas
SE of metoclopramide (Reglan)
nausea, significant headaches
recommendations around breast feeding
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
advantages of breast feeding
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
Disadvantages of breastfeeding
- May be inconvenient for some mothers
Yield may decrease if pumping a lot (eg: working mom)
- ## Nipple tenderness, mastitis may develop
Contraindications to breastfeeding:
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
Advantages of breastfeeding to infants
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
Disadvantages of breastfeeding to infants
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
what are some baby complications that can interfere with breast feeding
- Cleft palate, choanal atresia, PKU
2. May be fed expressed breast milk – mom can pump and express her own breast milk
deal to begin breastfeeding within
Ideal to begin breastfeeding within 1-2 hours of delivery
Milk usually comes in on the 3rd or 4th postpartum day
initial discomfort due to engorgement
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
most common cause of nipple pain
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
Best to avoid supplementing breast milk in the first
Best to avoid supplementing breast milk in the first 6-8 weeks unless absolutely necessary
Avoid using artificial nipples until
Avoid using artificial nipples, which will weaken the infant’s suckling reflex; avoid pacifiers until breastfeeding is well established (3-4 weeks)
how to prepare to breastfeed
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
breastfeed baby every …..
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
Breastfeeding technique
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
how long should babies breastfeed
when should you wake up infants
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
Signs of infant satiety
- Release of the nipple; relaxation of facial muscles, hands; falling asleep while feeding
whens should a lactation consultant be utilized
most women should have one consultation
Ideally a lactation consultant will follow up with the family 48 hrs after discharge
baby markers of adequate breast feeding
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
mother markers of adequate nursing
Mother
- Supplementation
- Painful nipples
- Engorgement
- Mastitis
painful nipples usually occur during___
i. Tender nipples are common! (Get a good latch)
ii. Usually occur the first few weeks of breastfeeding
management of painful nipples
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)
when does engorgement occur and what causes it
Occurs in the first week postpartum
best management of engorged breast
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
mastitis occurs usually when?
Painful, erythematous lobule in an outer quadrant of one breast during the 2nd or 3rd week postpartum
what causes mastitis and what population do we see it in most commonly
i. Occurs most frequently in primiparas mother (first time mom)
Caused by coagulase-positive Staph aureus
most common pathogen and what to do if mastitis occurs <4 weeks pospartum
neonatal Strep infection suspected if recurrent or bilateral mastitis
Antibody-coated bacteria in the milk
management of mastitis
Local heat, well fitted bra, start antibiotics
- Cephalosporins, dicloxacillin, methicillin
complications of mastitis
Breast abscess may develop if not treated
- Pitting edema & fluctuance over the inflamed area
- I&D abscess, start antibiotics
- Discontinue breastfeeding
Indications for suppression of lactation:
Women who do not desire breastfeeding
- Women who cannot breastfeed
- Failure of attempted breastfeeding
- Fetal or neonatal death
Methods of suppression of lactation:
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
sxs of lactation will improve within
Symptoms will generally improve in 2-3 weeks
Oral analgesics are helpful (NSAIDS or Tylenol)
