Lactation & Breastfeeding

Question 1

Stages of lactation

Answer 1

Mammogenesis

Lacto génesis

Galactopoiesis

Question 2

Mammogenesis

Answer 2

Mammary growth & development

• requires estrogen & progesterone

Question 3

Lactogenesis

Answer 3

Requires prolactin

Initiates milk secretion

Question 4

Galactopoiesis

Answer 4

• requires prolactin & oxytocin (suckling)

Maintaining milk secretion

Question 5

When is lactación initiated

Answer 5

Estrogen, progesterone & lactogen levels fall after delivery

Question 6

Prolactin levels return to non preg levels (without suckling)

Answer 6

2-3wks

Ex) women who got C-sections

Question 7

Colostrum

• liquid gold

Answer 7

First 2-3days after birth, before milk

• high protein
• vit A
• Na, Cl
• Ig

Lower carbs, K, and fat content

(Laxative action)

Question 8

What drives milk production

Answer 8

Prolactin

Question 9

Substrates from milk derived from maternal

Answer 9

Gut & liver

Question 10

Principal carb in breastmilk is

Answer 10

Lactose

Question 11

When is the highest output of Ig

Answer 11

First wk when baby’s immune system is weakest

90% IgA + primary leukocytes (anti infective)

• formula doesn’t have Ig

Question 12

Milk production

Answer 12

Avg:

120ml - day#2
300ml - day #10-14

Question 13

Increases milk yield

Answer 13

Crying baby (oxytocin)
Orgasms (oxytocin)
Anticipation
Water

Question 14

Ways to increase milk production

Answer 14

Nurse more often
Pump b/w feedings
Fenugreek***
Goat’s rue
Brewers yeast oats
Teas
Metoclopromide (Reglan)- causes HAs

Question 15

Recommendations

Answer 15

Exclusive breastfeeding: until 6mo

Partial breast feeding: 6-12mo or longer

• WHO - up to 2yo

Question 16

What increases number of moms that breastfeed

Answer 16

Provider support

Question 17

Maternal advantages

Answer 17

Convenient, free
Emotionally satisfying/bonding
Helps uterine involution
Improves GI motility (mom & baby)
Delays ovulation
Weight loss
Ovarian CA protection

Question 18

Maternal disadvantages

Answer 18

Inconvenient

Nipple tenderness/mastitis

Question 19

Contraindications of breastfeeding

Answer 19

• drugs/alcohol
• Human T cell leukemia #1 or HIV
• Breast cancer (active)
• active pulmonary TB or Varicella infxn
• galactosemia
• maternal intake of certain meds

Question 20

Advantages for the infant

Answer 20

Easy to digest, ideal temp/composition
Not contaminated
Ig source
Improved cognitive development & intelligence
Decreased:
- diarrhea
- lower RTIs
- Necrotizing enterocolitis
- Invasive bacterial infxns
- Crohn’s/UC
- lymphoma 
- allergies
- type I DM
- SIDS
- obesity

Question 21

Disadvantages for baby

Answer 21

Increased risk of neonatal jaundice
Cleft palate, choanal atresia, PKU
Moms w/ CF have high salt content

Question 22

When should you start breastfeeding

Answer 22

1-2hrs after delivery

Question 23

When does milk let dwn

Answer 23

3-4days

Question 24

What helps the discomfort

Answer 24

Lanolin or extra milk on the nipples
Warm shower
Cool cabbage leaves
Soothies gel pads

Question 25

Avoid

Answer 25

Supplementing in first 6-8wks

Pacifiers until established 3-4wks

• leads to nipple confusion
• weakens suck reflex

Question 26

When should you supplement breast milk

Answer 26

Baby losing wt
Severe nipple/breast lesion
Pregnant mom
Mom Very ill

Question 27

Prep

Answer 27

Wash hands
Clean nipples w/ water
Position
- lying on side
- upright in chair
- pillow

Question 28

Technique

Answer 28

Feed baby q 3-4hrs, maybe q90min in the beginning
Use both breasts
Start w/ 5min per breast during feeding
- work up to 10-15min per side

Keep baby awake

Question 29

More technique

Answer 29

Entire nipple & areola in the mouth

Break suction- finger in mouth

Keep nipples moist w/ water or lanolin

Question 30

Baby is full

Answer 30

Nipple release
Relaxation of facial muscles, hands
Falls asleep

Question 31

Postpartum care

Answer 31

Eval before discharge

Lactation consultant 48hrs after discharge