Lactation, Breast-feeding (1.3) Flashcards
What are some of the roles that a pharmacist has in the promotion and support of breastfeeding?
- Be a accessible health professional
- Support and promote breasfeeding
- Do not promote breast milk substitutes in a manner that discourages breast feeding
- Recognise that a proportion of womnen do not breast feed: these women should be given support and advice
- Respect the rights of parents to make informed choices about the method of infant feeding
What are three reasons as to why breast feeding is considered the gold standard?
- Improved cognitive development of the baby
- Economic benefits to the family and society
- Antibodies from breast milk provide protection
- Perfect blend of protein, fat, CHO, vitamins and minerals
Provide three breast feeding health advantages for the infant and the mother
Infant
- Reduce incidence and duration of diarrhoea
- Higher IQ levels
- Decreased chance of resipratory infections and decreased prevalence of asthma
Mother
- Promotion of maternal recovery from childbirth
- Possible accelerated weight loss
- Reduce risk of ovarian and pre-menopausal breast cancer
What are some of the situations when a mother cant breastfeed (divide answers into permanent and temporary)?
Permanent avoidance of breastfeeding
- Mothers who are HIV positive
- Rare genetic metabolic disorders (galactosaemia)
Temp avoidance of breastfeeding
- Severe illness (eg sepsis, active TB)
- Certain medications (cytotoxics, cancer chemotherapy, high dose sex hormones)
A) What is the initial form of breast milk called? When is it secreted post partum?
B) When does milk ‘come’ in and what causes this?
A)
- Colostrum = small volume of first milk secreted day 3-5 post-partum
- High immune value
B)
- Milk comes in any time 48-72 hours post-partum
- Initiated by decrease in progestorone due to placenta removal
What are the two pituitary hormones that are involved in the production of breast milk? Outline their differences
Prolactin
- Secreted during and after feed to produce next feed
- More proclactin secreted at night
- Suppresses ovulation
Oxytocin
- Milk ejection reflex
- Works before or during feed to make milk flow
Gradual transition over 4-6 weeks to autocrine or demand and supply control: increase emptying = increase synthesis
What are some signs that a baby is getting enough breast milk?
- Gaining weight (doubles birth weight in 4-6 months)
- 5-6 wet nappies/ 24 hours
- Clear/pale urine
- Good skin tone
- Soft yellow bowel action
When to refer for breastfeeding mothers
- Unsettled infant and/or mother
- Infant failing to thrive/gain weight
- Mother in pain when breast-feeding (attachment? infection? need to rest nipples? temporary use of niple shield required?
List 7 common breastfeeding problems
- Sore nipples
- Engorged breasts
- Blocked milk ducts
- Inverted or flat nipples
- Mastitis
- Low milk supply
- Attachment problems
Why is good attachment essential and what are some results of poor attachment?
- Achieveing sufficient milk transfer
- Preventing nipple trauma
Results of poor attachment
- Damaged nipples
- Engorgement
- Baby feeding frequently and for extended periods
- Decreased milk production and baby fails to gain weight
What are some causes of sore nipples, give some general managment tips and discuss nipple thrush
Causes
- Attachment/positioning of baby + incorrect detachment
- Engorgement
- Thrush/candida infection
General Management
- Change breast pads often
- Begin feeding on less affected side
- Ensure proper latch on and positioning
- Consider a breast shield to protect from friction as the nipples are very tender
Nipple thrush
- Burning/shooting pain within the breast
- Nipples may be pinkier and shinier
- Check babys mouth for signs of thrush
- Mum and baby both require treatment (nystatin q3-4 hours 14/7)
What is engorgement? What are some of the causes? How to manage it?
- Breasts are swollen, firm-hard. uncomfortable but the pain is not severe
- Uni or bilateral
- Nipples flattened and taut
Causes
- Build up of fluid in the breast
- Normal when milk fluid first comes in
- Infrequent feeds, short feeds, poor management
Management
- Check correct positioning/attachment
- Do not restrict feeds
- Fluids and rest and analgesics prn
What are blocked milk ducts? How to manage them?
- Represents a lump that is tender or painful
- Result of milk build up behind the blockage in one of the milk ducts
- Rresults in localised redness/tenderness –> moderate to severe pain over affect area
Management
- Positioning and attachment, alter position during feed
- dont wear tight bra
- Frequent drainage of the breast
- Referral if not cleared in 24 hours
What is mastitis? How to manage it?
- Occurs when there is a blockage in a milk duct causing the milk in the duct to enter the surrounding tissues –> inflammation occurs
- Symptoms: breast has a sore red, hot, painful area. An aching flu-like feeling such as a fever, feeling shivery and generally unwell
Management
- Must drain the breast frequently (despite pain)
- Referral (if >6 hours for antibiotics)
- Analgesia
- Rest, fluids
What are inverted/flat nipples?
- Nipples that do not protrude - are retracted inwards, or flat with the areola
- Breast feed from early on to avoid bottles, teats
- Full breasts: soften nipple with hand to express assist with latch on
- Some nipples can be drawn out with suction; breast pump or syringe
