Lactation & Breastfeeding Flashcards
Sir Ashley Cooper was wrong about the presence of….
Lactiferous sinuses (they do NOT exist)
The functional component of the breast
glandular tissue
It is possible for milk to be drained from behind a clog because….
it is UNLIKELY that the problematic lobe is drained by a single duct
Ducts and glands of the breast are both types of _____ tissue in the breast
glandular
Fibroblasts, adipocytes, blood vessels, plasma cells, and nerve are all types of ______ tissue in the breast
stromal
In the third trimester, the epithelial cells lining the breast alveoli differentiate into….
secretory cells, capable of milk production
Milk is stored in the alveoli until it can be expressed through the….
ducts (branching ducts > terminal ducts), which deliver milk from the alveoli to the nipple
Majority of milk is produced while…..
the infant is feeding
Each duct directly connects to around _______ lobes
10-15 lobes
Each lobe contains ~ _____ alveoli
10-100 alveoli
All lactational structures are [deep vs. superficial] to the pectoralis muscles
superficial
Support the breast by connecting the chest wall to the skin surface
Cooper’s ligaments
(2) hormones responsible for relaxation and stretching of the Cooper’s ligaments during pregnancy
relaxin, progesterone
Artery that feeds the blood supply of the breast
internal mammary artery (internal thoracic artery)
Sebaceous and lactiferous glands opening on and around the areolas
Montgomery tubercles
Proteins in human milk (3)
casein, whey, IgA
Type of sugar in human milk
lactose (native species lactose intolerance is rare)
Prolactin is produced by the….
anterior pituitary gland
Embryogenesis of breast development
4 weeks - breast ridge
18 weeks - buds appear
Secondary buds elongate, eventually canalize, forming a rudimentary duct system. As the fetus lays down more subcutaneous fat, the stored fat plays a critical role in allowing the ducts to extend and elongate.
Congenital condition in which infant is born with extra nipples along the original mammary ridge
supernumerary nipples
Why may infants have transient secretions from their nipples in first few days of life
r/t exposure to circulating maternal hormones like prolactin around the time of birth
After birth, the development of breasts is called…
mammogenesis
Mammogenesis during prepubescence is largely limited to….
fat deposition (no duct development)
Changes to the breast during puberty
fatty tissue growth, increase in mammary tissue volume/size, maturation of the terminal duct-lobe units (lobuloalveolar development)
Changes to the breast during puberty are driven by the influence of (3)
progesterone, estrogen, prolactin
______ marks the final phase of mammogenesis
pregnancy
Estrogen and progesterone are not directly involved in lactation, but contribute to lactation by…..
helping proliferate the cells needed for milk production
Changes to the external breast structures during pregnancy (3)
areolar pigmentation, enlarged montgomery tubercles, skin appears thinner with vessels more prominent
Changes to the internal breast structures during pregnancy (3)
ductal system proliferates, lobules increase in size, epithelium transforms
Stage of breast development that begins in embryo and is completed during pregnancy
mammogenesis
Stage of breast development that begins mid-pregnancy and is completed by day 8 postpartum
Lactogenesis Stage 1 - 2
Stage of breast development that begins day 9 postpartum and continues until weaning
Lactogenesis stage 3 (galactopoiesis)
Stage of breast development from commencement of weaning
involution
Lactogenesis I occurs…..
mid-to-late pregnancy
Lactogenesis II occurs…..
postpartum
Stage of lactogenesis marked by differentiation of the alveolar cells from secretory cells, producing colostrum
Lactogenesis I
During Lactogenesis I, the role of prolactin is ….
limited (priming the cells, but not producing milk)
In the absence of _____ after expulsion of the placenta, prolactin dominates and causes milk production
estrogen and progesterone
After the first 2-4 days, milk production switches from endocrine control (hormonal) to…
autocrine, meaning that the feeding behavior of the infant takes precedence over hormonal influence
Colostrum is made in the breasts as early as…..
16 weeks gestation
Lactogenesis III is also known as….
galactopoiesis
(3) hormones influencing lactogenesis III
prolactin, oxytocin, prolactin-inhibiting factor
Initiation of milk production occurs during…..
lactogenesis
Ongoing maintenance of milk production occurs during…
galactopoiesis
True or false: Pain is normal in the first 2 weeks of breastfeeding
FALSE! Pain is not normal
Which is more responsible for postpartum breast “droopiness” : the pregnancy or breastfeeding?
pregnancy
Prolactin is highest at….
night
Oxytocin is released from the ….
posterior pituitary
oxytocin role in breastfeeding
causes smooth muscle contraction of the cells of the breast alveoli
If the infant is working hard and feeding well, that may be an indication of intact….
cranial nerves
Required for lactogenesis II initiation
“letdown”, or milk ejection reflex
Non-pharm methods to facilitate letdown reflex (2)
gentle massage to breast and nipple before latch, moist heat to the breast and nipple x2-5 minutes before latch
Inhibitors of letdown reflex (5)
fear, anxiety, pain, fatigue, poor latch
Milk letdown reflex is stimulated by….
oxytocin
Maternal signs of the milk ejection reflex (5)
breast tingling, hot flash, cramps, thirst, sleepiness
Infant signs of the milk ejection reflex (2)
increased swallows, increased gulps
Characteristics of the foremilk
watery to quench thirst, high in protein
Characteristics of the hindmilk
fat-rich for satiety
Colostrum lasts from…..
16 weeks to 2-4 days pp
Transitional milk lasts from….
2-4 days pp to 2 weeks pp
Mature milk comes in at….
~2 weeks pp
Immune system components in breastmilk (4)
antibodies, immunoglobulins (IgA), lymphocytes, macrophages
Breast fed babies have lower incidence of (6) compared to formula-fed
otitis media, asthma, allergies, diabetes, SIDs, gastroenteritis
Breastfeeding uses about ____ extra calories per day
500 (helps with pp weight loss)
Should your tobacco-smoking pt still breastfeed?
Yes
Reduce or avoid these substances in the diet while breastfeeding (4)
caffeine (including in chocolate), alcohol, drugs, nicotine
Characteristics of a medication that would be more likely to get into the breastmilk in higher amounts
lipid soluble, low-molecular weight, long half life, low protein binding, large doses, chronic use
With perfect use, how effective is lactational amenorrhea/
98% effective for 3-6 months
An infant’s first visit to a pediatrician should be at….
2-3 days after she goes home
Breastfeeding decreases the risk of these cancers (2)
breast and ovarian cancer
Compared with cow milk, human milk has more _____ than _____
more WHEY than curd
Most infants regain their birth weight by ….
7-10 days pp
Colostrum has higher _____ but lower ____(2) than mature milk
higher protein, lower lactose and fat
Your pt is a strict vegan and is 8 months pregnant. She plans to breastfeed. What supplement should you address with her?
B12 supplement
Engorgement is best treated by….
allowing baby to attach and feed
The most important criterion for assessing milk transfer during a feeding is…
audible swallow
Roughly how many times per day should an infant feed?
8-10x (Q2-3 hours)
What is the next best thing to use for a newborn less than 2 weeks old when breastfeeding is temporarily unavailable?
a cup with expressed breastmilk
The addition of complementary foods to breastfed infants is recommended at about….
6 months
How is an obstructed duct best treated?
Change the baby’s positioning with each feed
Pain during breastfeeding may indicate…
a problem with latch
Why does the milk supply come in within a few days instead of being at sufficient levels at birth?
Progesterone and estrogen levels decrease with the loss of the placenta, leaving a relative elevation of prolactin
The average capacity of the stomach of a full term newborn on day 1 is….
20mL
A breastfeeding mother with a 3 month old infant has a red, tender, wedge-shaped area on the outer quadrant of one breast. She has flu-like symptoms and a fever. Your management includes (4)
extra rest, moist heat to the region, antibiotics for 10-14 days, continue breastfeeding
Why is vitamin D supplementation required for exclusively breast-fed infants?
vitamin D supplementation is required, not due to inherent deficiency of breast milk, but because our modern lifestyle [maternal vit D deficiency, not enough time in the sun, living in northern latitudes] makes our breastmilk deficient in vitamin D
Human milk is considered mature by….
2 weeks pp
Contraindication to breastfeeding (5)
galactosemia, active TB, HIV in the US, abusing drugs, receiving chemo
Yellow color of the colostrum is due to….
beta carotene
formula contains little to no ______ which is important for the development of the myelin sheath and nerve conduction in the brain
cholesterol
Feedings lasting 30 minutes or longer may be a sign of…..
baby not feeding well
