Lactation and breastfeeding

Question 1

What is mamogenesis?

Answer 1

Begins when the mammary gland is exposed to oestrogen at puberty and is completed during the third trimester of pregnancy - marked hyperplasia of ductal, alveolar and myoepithelial elements in preparation for lactation

Question 2

Why isn’t milk produced during pregnancy?

Answer 2

The high plasma concentrations of oestrogen and progesterone present before delivery inhibit the active secretory effects of prolactin on mammary alveolar epithelium

Question 3

What is colostrum?

Answer 3

First milk appearing in acinar glands (during 2nd trimester)
Yellow, viscous fluid, highin carbohydrates, protein, antibodies, and low in fat
Also has immunologically active lymphocytes and monocytes
Contains interferon, which facilitates the removal of intestinal meconium, and is a factor for stimulation of the beneficialLactobacillus bifidus in the intestinal tract.

Question 4

What changes occur post delivery allowing active secretion of colostrum?

Answer 4

Removal of the inhibitory influence of oestrogen and progesterone, prolactin stimulates the alveolar epithelial cells to begin active secretion of colostrum

Question 5

What is lactogenesis?

Answer 5

Milk production

Question 6

How does mammary epithelium change predelivery to enable milk production?

Answer 6

Mature from non-secretory to secretory cells to allow prolactin to exert its effects

Question 7

How does the let down reflex occur?

Answer 7

1. Oxytocin is released after sucking stimulates sensory fibers in the nipple.
2. The release of oxytocin becomes a conditioned response in the lactating woman, requiring only visual stimulation or conscious thought.
3. Oxytocin causes the myoepithelial cells to contract, which results in release of milk into the lactiferous ducts and sinuses

Question 8

What are the dietary requirements for lactation?

Answer 8

Requires significant increases in protein, carbohydrate, lipid, minerals, and calories to maintain adequate volumes of milk produced

Question 9

When do breastfeeding mothers produce transitional milk?

Answer 9

Approx. weeks 1-3 postpartum (after initiation of breastfeeding) - then becomes mature milk

Question 10

What is Casein and what action does it have for baby when breastfeeding?

Answer 10

Low casein content which aids formation of Curd in the infant’s intestinal tract (increasing digestibility of milk)
Keeps the gastric acidity high leading to increased antimicrobial action

Question 11

What is galactopoiesis?

Answer 11

Maintenance of milk production - requires regular and frequent milk removal from the mammary gland

Question 12

What are the 3 important mechanisms to enable breastfeeding?

Answer 12

Regular sucking (promotes synthesis and release of prolactin and oxytocin)
Regular emptying (storage begins to decrease production due to diminished stimulation of glandular epithelium)
Demand feeding (milk production related to demand of baby)

Question 13

What happens if breasts are not regular emptied?

Answer 13

Substantial decrease in milk production after approx. 48 hours
Diminished stimulation of glandular epithelium by prolactin
Vascular stasis caused by increased intra-mammary pressure
Distended mammary ducts and alveoli

Question 14

What are the advantages of breastfeeding for baby?

Answer 14

Lowers risk of:
Infection
SIDS 
Obesity 
Childhood leukaemia 
Atopic conditions

Question 15

What are the advantages of breastfeeding for mother?

Answer 15

Increased skin to skin contact with baby (promoting bonding) 
Involution of uterus
Lower risk of breast and ovarian cancer
Lower risk of hip fractures
Prevention of rheumatoid arthritis

Question 16

What is uterine involution?

Answer 16

Return of the gravid uterus to it’s original size and shape (never completely returns to nulliparous state)
Measurements not routine unless risk factors present

Question 17

How can lactation be suppressed?

Answer 17

Stop sucking
Prolactin falls
Breast binding – wear a supportive bra
Pharmacological methods – Bromocriptine (no longer recommended)

Question 18

What is breast involution?

Answer 18

Begins with diminished frequency of sucking as this increases amount of milk retained resulting in vascular stasis and alveolar atrophy (decrease in size not number)
Decrease in prolactin production due to decreased sucking further decreasing milk synthesis

Question 19

What is ankyloglossia?

Answer 19

Tongue tie (can affect breastfeeding dependence on severity)

Question 20

When is breastfeeding not advised?

Answer 20

Alcohol misuse
Active TB
Certain drugs (e.g. methotrexate, lithium)
Infants with galactosemia/ rare amino acidurias/ PKU

Question 21

How long does a full term baby’s iron store last for?

Answer 21

6 months

Question 22

What are the UK guidelines for preventing childhood obesity?

Answer 22

Recommended that children under 5 years should be physically active for 180 minutes throughout the day