Module 8: Breastfeeding Flashcards
National Guidelines for Breastfeeding
- 6 months of continuous breastfeeding is recommended by the ACOG
- American academy of Pediatrics and AAFP
—Continue breastfeeding for 6 months and CONTINUE breastfeeding while introducing complimentary foods until 12 months or longer
Stats on Breastfeeding
- Only 75% of all infants are breastfed after delivery
- 31.5% are exclusively breastfed for 3 months
- 12 % are exclusively breastfed for 6 months
Variations in rates are closely tied to provider and hospital messaging
Lactation Physiology
- Estrogen and progesterone promote increase in breast tissue early in pregnancy
- Prolactin and Oxytocin stimulate milk production
- Women begin secreting colostrum between 12-16 hours after birth
- Arrival of milk occurs 2-5 days postpartum
Causes of Low Milk Supply
- Introducing Formula/Bottle Feeding — Nipple confusion
- Estrogen - Best to avoid oral contraceptives if breastfeeding
- Stress - Can interrupt “let down”
- Lack of scheduled feedings
Improved Health Outcomes for Infants
- Otitis media — Cut in half with breastfeeding
- 3-6x increase in respiratory tract infection if NOT breastfed
- GI infections
- Necrotizing enterocolitis
- Asthma
- Atopic Dermatitis
- Obesity and metabolic disease
Improved Maternal Outcomes For Breastfeeding
- Ovarian Cancer
- Breast Cancer
- Postpartum Weight loss
- Blood Pressure
- Lipid metabolism
Points to Remember as FNPs
- Promote breastfeeding
2. Offer Education and conseling during preconception and prenatal periods
DRUGS IN BREASTFEEDING
DRUGS IN BREASTFEEDING
Mother’s Who Should NOT breastfeed
- Infant is diagnosed with Galactosemia
- HIV infection
- Human T-cell lymphotropic Virus Type 1 or 2
- Mother using illicit drugs —PCP or cocaine
- Ebola virus
Mothers Who should TEMPORARILY NOT breastfeed
- Infection with Brucellosis
- DIagnostic imagine w/ radiopharmaceuticals
- Active HSV w/ lesions on the breast
Temporarily should NOT breastfeed but CAN express milk
- Untreated, active TB
2. Varicella infection that developed w/in 5 days prior to delivery or up to 2 days following delivery
What Affects Concentration of Drugs in Milk?
- Maternal Plasma Concentration
- Maternal Plasma Protein Binding
- Size of Drug Molecule
- Degree of Ionization
- Lipid Solubility
- Maternal Pharmacogenomics
What Influences The Effects of Drugs on The Baby
- Timing of Dose
- Toxicity
- Oral Bioavailability
- Volume of Breastmilk
- Relative Infant Dose
Contraindicated Drugs in Breastfeeding
- Amiodarone
- Antineoplastics
- Gold Salts
- Iodine
- Lithium
- Radiopharmaceuticals
- Retinoids (oral)
BREASTFEEDING COMPLICATIONS
BREASTFEEDING COMPLICATIONS
Complications of Breastfeeding
-Breast Engorgement
- Usually 3-7 days following birth, more likely in first time mothers
- Increased blood supply, accumulated milk and swelling - Pain and tissue damange
- Caused by not getting enough milk out — Treat with regular feeding or pumping
- Gentle massage and warm compress before feeding — Cool compress and tylenol between feedings
Complications of Breastfeeding
-Low Milk Supply
- Most often supply is normal
- Caused by decrasing emptying of breast milk
- Caused by poor latch, engorgment use of formula and pacifiers, timed vs on-demand feeeding, changes in growth/feeding of infant
- Treatment — Increase skin-to-skin time, increased feeding w/ pumping right after, increased nipple stimulation, treat nipple pain, massage
- Galactagogues - Domperiodone - Dopamine D2 receptor antagonist
- Herbal - Fenugreek, and milk thistle
Complications of Breastfeeding
-Oversupply of Milk
- Increased risk of engorgement, blocked ducts and mastitis
- More foremilk (watery, high in lactose, low in fat) Vs hindmilk (thicker, high fat) - unsatisfied baby and less weight gain
- Treat by breastfeeding on only one side for a 2 hour block period - gets to the hind milk
- Pump foremilk prior to breastfeeding
Complications of Breastfeeding
-Overactive Milk Letdown
- Forceful ejection of breast milk - difficulty feeding, ingestion of air, colicky baby
- Caused by increased sensitivity of myoepithelial cells to oxytocin
- Treatm w/ hand expression/pumping nprior to infant latch - compression of either side of nipple to decrease flow after latch
- Avoid engorgement
- Positions that reduce gravity to the nipple help
Complications of Breastfeeding
-Nipple Pain
- Common in the first few days — Should reslove in the first 7 days
- Caused by poor latch or improper release
- Can lead to cracking, bleeding, cellulitis, mastitis
- Treat with good latch = areola > nipple
- Massage breast milk/ lanolin cream following feeding
- Allow complete drying following feeding, change breast pads regularly
- Avoid tight fitting bras, clothes, harsh soaps, fragrances
Complications of Breastfeeding
-Blocked Milk Duct
- Presents as a tender or sore lump in teh breast W/OUT signs of infection
- Treat w/ frequent feeding and massage from behind mass toward nipple
- Use heat and avoid underwire or tight fitting bra
- Galactocele — Retention cyst filled with milk - Can be during or after breastfeeding - Can self-resolve, or need aspiration/excision as it can lead to secondary infenction or rupture
Complications of Breastfeeding
-Mastitis
- Fever, Pain, Redness — 2-3 wks postpartum and associated w/ milk stasis
- Infection commonly wit hStaph, strep and E. Coli
- CONTINUED breastfeeding and pumping of breast is IMPORTANT — It’s OKAY for the baby
- Massage toward the nipple
- Broad spectrum antibiotic - Dicloxacilin
- CLOSE follow up to prevent abscess
Complications of Breastfeeding
-Breast Abscess
- RARE — Painful swelling and persistent systemic Sx’s despite antibiotics
- Palpable fluctuant mass vs US
- Treated w/ aspiration or I&D
- Antibiotic treatment is important
Complications of Breastfeeding
-Fungal Infection
- Sore Nipples despite good latch
- Flaky, shiny, itchy nipples or blisters
- Caused by Candida species in warm and wet environment
- Treat w/ topical antifungal cream — SAFE for baby
- Keep breasts DRY
- Use new clean and dry bra daily
- Wash clothing and pumping supplies
Complications of Breastfeeding
-Inverted, Flat, or Enlarged Nipples
- Nipple massage, stimulation, stretching can draw nipple out
- Infants can often latch on areola w/ good effect
- Suction devices and nipple shields — hand expression and pumping
Complications of Breastfeeding
-Raynaud’s of the Nipple
- Vasospasm leading to decreased blood supply to nipple
- Intense nipple pain w/ latch and nipple blanching in between feedings
- Caused by early trauma to nipple from breastfeeding and Candida Infection
- Treat w/ nipple massage, avoid cold and in some cases it is treated with nifedipine**
