Module 5 BBB Flashcards
What is the alveolus? Why is it important?
The functional unit of the breast that is responsible for secreting milk.
(P&P p423)
What is colostrum?
The first milk that comes in. It is high in protein and fat. Has antibodies; especially IgA, that helps with gut closure. Has an immunologic effect.
(P&P p423)
What are the coopers ligaments?
Connects the breast tissue to the chest
(P&P p423)
What are the lactiferous duct/ule?
Transports milk from the alveolus to the nipple
(P&P p423)
What is lactogenesis 1? When does it occur?
Milk production is related to the high production of progesterone in pregnancy. Starts around 16 weeks and continues until postpertum.
(P&P p423)
What is lactogenesis 2? When does it occur?
Begins with the drop in progesterone from the delivery of the placenta. Begins around day 2-4 postpartum. This is when the “milk comes in.”
(P&P p423)
What is lactogenesis 3? When does it occur?
This is the maintenance/galactopoietic of milk production. It is baby driven and autocrine-controlled (aka locally controlled-**NOT via the blood stream)
(P&P p423)
What is mammary hypoplasia?
(P&P p423)
What is the milk ejection reflex?
(P&P p423)
What are the montogomary glands?
These are the small bumps on the areola that secrete oil to protect the nipples from trauma.
(P&P p423)
What is the tail of spense?
This is the area of the breast that goes out toward the armpits. Some people can get swelling in that area during let down.
(P&P p423)
What is galactopoesis?
(P&P p423)
What could delay lactogenesis 2?
Retained placenta or products, C/S, PCOS, premies, GDM
What sensation can mom’s feel with letdown?
Tingly
What sensation can mom’s feel with letdown?
Tingly
What are the benefits for baby with breastfeeding?
-Protect baby by passing antibodies (esp. IgA causes gut closure and prevents antigens from entering the baby’s system)
-Is a laxative-helps pass bilirubin through the meconium
-Can increase test scores by a small amount
-Passes hormone of calm and peacefulness (oxytocin)
What supplements should we recommend for a breastfeeding person?
-Vit D supplement/drops to baby 400 IU
OR
-Vit D supplement for mom 6400 IU
If she is vegan-recommend B12
What is the recommended duration for breastfeeding?
Exclusive for 6 months and then continue nonexclusive for 2 years
What does breastfeeding lower the medical risk of for baby?
-Asthma
-Obesity
-AOM
-GI complications (NEC)
-Allergies
-Resp. Infections
-DM
-SIDS
What does breastfeeding lower the medical risk of for mom?
-PP Bleeding
-Breast CA
-Ovarian CA
-DM
-HTN/Cardiovascular disease
What are some contraindications to BF?
-Galactosemia
-Active untreated TB
-Radioactive isotopes/chemo
-Drugs of abuse/anything that affects cognition
-Active HSV on breast (can pump)
-HIV if there is access to clean water (in underdeveloped countries the risk of unsafe water is higher than risk of HIV)
What positions can be used with breastfeeding?
-Cradle
-Cross cradle
-Football
-Laid back/ventral
-Side lying
Describe a “good” latch.
-Nose at the level of the nipple, chin touching breast
-Mouth wide open-corner angle 160
-Lips flanges
-Complete seal-no popping/dimples/clicking
-Document swallowing
What may happen to the BF person and infant if there is an improper latch?
Baby: can get dehydrated, lose weight/obstructed milk transfer
Mom: Nipple trauma (cracked/bleeding/blisters), pain, stop BF, risk for mastitis, yeast infection
Why is it important to know different BF positions?
It allows the baby to drain the breast from different angles
What are things the patient can do to help with painful BF?
Pay attention to baby’s hunger cues and feed before the baby is hangry, try different positions, and start feeding on the non-painful side
What are the 5 components of the LATCH tool?
Latch, Audible swallow, Type of nipple, Comfort, Hold
What output is normal for each day of the first week of baby’s life?
1-2 days: 2 wet, 3 stool (mec)
3 days: 3 wet, 3 stool (green/brown)
4 days: 5 wet, 4 stool (green/brown)
5 days: 6 wet, 4-5 stool (loose yellow seedy-BF)
6-7 days: 7 wet, 6 stool
How much weight loss in baby is normal PP?
5-7%
When does baby begin to regain weight? When should they be back to birth weight?
-4 days (this is when milk comes in)
-2 weeks
What percent of babies void in the first 24 hours?
95%
What are warning signs of voiding and stooling in the first week of life?
-No void in 24 hours of life
-<4 stools on day 4 indicates delayed lactogenesis
-<3-5 stools by day 5-7 or if stools are still green/brown
What is the difference between fore-milk and hind-milk?
Fore-milk is higher in water and hind milk is higher in fat
What do we think causes cluster feedings?
Growth spurt
How long can a patient experience pain with BF and it be normal?
First two weeks for 30-60 seconds of latching. This is the baby elongating the nipple.
When we are getting affective milk transfer, what will we observe?
Swallowing
How often should a baby feed?
8-12 feeds in 24 hours for 20-30 minutes
What are warning signs we should teach the BF PP mom to report about herself?
Fever, flu like symptoms, red/sore breasts, hard lumps on breast, inability to feed
What are warning signs we should teach the BF PP mom to report about baby?
lethary, crying >2-3hours, signs of jaundice, not meeting diaper counts, sunken fontanels, red stained diaper
How long is milk good for once it has been exposed to baby’s mouth?
1-2 hours. Anything left over should be discarded due to the risk of infection to the baby
Does nutrition significantly effect breast milk content?
No, the mother would have to be significantly malnourished. Differences in cultural diets do not make a difference.
How does exercise affect BF?
Moderate exercise is ok. 150m/week of exercise is ok and will not affect milk production
What aspects of BF affect amenorrhea? Aka: if these factors are present, they are likely not ovulating
BF around the clock, less than 6 months PP and have not had a menstrual cycle.
How can we advise patients that would like to drink alcohol while BF?
**Feed baby before drinking. Alcohol peaks in milk at about 2 hours, 1 glass/hour, can pump and dump
If a patient is smoking, how can it affect the breastmilk?
Nicotine is 3 times higher in milk circulation than maternal, can affect the taste, can cause babies to sleep less, and can lower milk supply.
**What aspects of medications are preferred for patients who are BF?
Shorter half-life, high molecular weight, bound to protein, lower bioavailability, drugs enter CNS with difficulty
How would you counsel your client if they want to continue to BF and return to work?
The law requires the employer must supply a clean space for patients to pump/feed. Recommend pumping beginning at 4 weeks, should still pump every 2-3 hours.
What are the signs of inadequate milk supply?
If the baby is not gaining weight, having more hunger cues, and breasts are not feeling full
