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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
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
26
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
27
Disadvantages of breastfeeding
- May be inconvenient for some mothers Yield may decrease if pumping a lot (eg: working mom) - Nipple tenderness, mastitis may develop -
28
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
29
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
30
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
31
what are some baby complications that can interfere with breast feeding
1. Cleft palate, choanal atresia, PKU | 2. May be fed expressed breast milk – mom can pump and express her own breast milk
32
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
33
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
34
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
35
Best to avoid supplementing breast milk in the first
Best to avoid supplementing breast milk in the first 6-8 weeks unless absolutely necessary
36
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)
37
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
38
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
39
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
40
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
41
Signs of infant satiety
1. Release of the nipple; relaxation of facial muscles, hands; falling asleep while feeding
42
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
43
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 ```
44
mother markers of adequate nursing
Mother - Supplementation - Painful nipples - Engorgement - Mastitis
45
painful nipples usually occur during___
i. Tender nipples are common! (Get a good latch) | ii. Usually occur the first few weeks of breastfeeding
46
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)
47
when does engorgement occur and what causes it
Occurs in the first week postpartum
48
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
49
mastitis occurs usually when?
Painful, erythematous lobule in an outer quadrant of one breast during the 2nd or 3rd week postpartum
50
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
51
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
52
management of mastitis
Local heat, well fitted bra, start antibiotics 1. Cephalosporins, dicloxacillin, methicillin
53
complications of mastitis
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
Indications for suppression of lactation:
Women who do not desire breastfeeding - Women who cannot breastfeed - Failure of attempted breastfeeding - Fetal or neonatal death
55
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
56
sxs of lactation will improve within
Symptoms will generally improve in 2-3 weeks Oral analgesics are helpful (NSAIDS or Tylenol)

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