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Adv Practice Women’s Health 6032 Test 2 > Module 8: Breastfeeding > Flashcards

Module 8: Breastfeeding Flashcards

1
Q

National Guidelines for Breastfeeding

A
  1. 6 months of continuous breastfeeding is recommended by the ACOG
  2. American academy of Pediatrics and AAFP
    —Continue breastfeeding for 6 months and CONTINUE breastfeeding while introducing complimentary foods until 12 months or longer
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2
Q

Stats on Breastfeeding

A
  1. Only 75% of all infants are breastfed after delivery
  2. 31.5% are exclusively breastfed for 3 months
  3. 12 % are exclusively breastfed for 6 months

Variations in rates are closely tied to provider and hospital messaging

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3
Q

Lactation Physiology

A
  1. Estrogen and progesterone promote increase in breast tissue early in pregnancy
  2. Prolactin and Oxytocin stimulate milk production
  3. Women begin secreting colostrum between 12-16 hours after birth
  4. Arrival of milk occurs 2-5 days postpartum
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4
Q

Causes of Low Milk Supply

A
  1. Introducing Formula/Bottle Feeding — Nipple confusion
  2. Estrogen - Best to avoid oral contraceptives if breastfeeding
  3. Stress - Can interrupt “let down”
  4. Lack of scheduled feedings
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5
Q

Improved Health Outcomes for Infants

A
  1. Otitis media — Cut in half with breastfeeding
  2. 3-6x increase in respiratory tract infection if NOT breastfed
  3. GI infections
  4. Necrotizing enterocolitis
  5. Asthma
  6. Atopic Dermatitis
  7. Obesity and metabolic disease
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6
Q

Improved Maternal Outcomes For Breastfeeding

A
  1. Ovarian Cancer
  2. Breast Cancer
  3. Postpartum Weight loss
  4. Blood Pressure
  5. Lipid metabolism
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7
Q

Points to Remember as FNPs

A
  1. Promote breastfeeding

2. Offer Education and conseling during preconception and prenatal periods

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8
Q

DRUGS IN BREASTFEEDING

A

DRUGS IN BREASTFEEDING

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9
Q

Mother’s Who Should NOT breastfeed

A
  1. Infant is diagnosed with Galactosemia
  2. HIV infection
  3. Human T-cell lymphotropic Virus Type 1 or 2
  4. Mother using illicit drugs —PCP or cocaine
  5. Ebola virus
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10
Q

Mothers Who should TEMPORARILY NOT breastfeed

A
  1. Infection with Brucellosis
  2. DIagnostic imagine w/ radiopharmaceuticals
  3. Active HSV w/ lesions on the breast
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11
Q

Temporarily should NOT breastfeed but CAN express milk

A
  1. Untreated, active TB

2. Varicella infection that developed w/in 5 days prior to delivery or up to 2 days following delivery

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12
Q

What Affects Concentration of Drugs in Milk?

A
  1. Maternal Plasma Concentration
  2. Maternal Plasma Protein Binding
  3. Size of Drug Molecule
  4. Degree of Ionization
  5. Lipid Solubility
  6. Maternal Pharmacogenomics
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13
Q

What Influences The Effects of Drugs on The Baby

A
  1. Timing of Dose
  2. Toxicity
  3. Oral Bioavailability
  4. Volume of Breastmilk
  5. Relative Infant Dose
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14
Q

Contraindicated Drugs in Breastfeeding

A
  1. Amiodarone
  2. Antineoplastics
  3. Gold Salts
  4. Iodine
  5. Lithium
  6. Radiopharmaceuticals
  7. Retinoids (oral)
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15
Q

BREASTFEEDING COMPLICATIONS

A

BREASTFEEDING COMPLICATIONS

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16
Q

Complications of Breastfeeding

-Breast Engorgement

A
  1. Usually 3-7 days following birth, more likely in first time mothers
  2. Increased blood supply, accumulated milk and swelling - Pain and tissue damange
  3. Caused by not getting enough milk out — Treat with regular feeding or pumping
  4. Gentle massage and warm compress before feeding — Cool compress and tylenol between feedings
17
Q

Complications of Breastfeeding

-Low Milk Supply

A
  1. Most often supply is normal
  2. Caused by decrasing emptying of breast milk
  3. Caused by poor latch, engorgment use of formula and pacifiers, timed vs on-demand feeeding, changes in growth/feeding of infant
  4. Treatment — Increase skin-to-skin time, increased feeding w/ pumping right after, increased nipple stimulation, treat nipple pain, massage
  5. Galactagogues - Domperiodone - Dopamine D2 receptor antagonist
  6. Herbal - Fenugreek, and milk thistle
18
Q

Complications of Breastfeeding

-Oversupply of Milk

A
  1. Increased risk of engorgement, blocked ducts and mastitis
  2. More foremilk (watery, high in lactose, low in fat) Vs hindmilk (thicker, high fat) - unsatisfied baby and less weight gain
  3. Treat by breastfeeding on only one side for a 2 hour block period - gets to the hind milk
  4. Pump foremilk prior to breastfeeding
19
Q

Complications of Breastfeeding

-Overactive Milk Letdown

A
  1. Forceful ejection of breast milk - difficulty feeding, ingestion of air, colicky baby
  2. Caused by increased sensitivity of myoepithelial cells to oxytocin
  3. Treatm w/ hand expression/pumping nprior to infant latch - compression of either side of nipple to decrease flow after latch
  4. Avoid engorgement
  5. Positions that reduce gravity to the nipple help
20
Q

Complications of Breastfeeding

-Nipple Pain

A
  1. Common in the first few days — Should reslove in the first 7 days
  2. Caused by poor latch or improper release
  3. Can lead to cracking, bleeding, cellulitis, mastitis
  4. Treat with good latch = areola > nipple
  5. Massage breast milk/ lanolin cream following feeding
    - Allow complete drying following feeding, change breast pads regularly
    - Avoid tight fitting bras, clothes, harsh soaps, fragrances
21
Q

Complications of Breastfeeding

-Blocked Milk Duct

A
  1. Presents as a tender or sore lump in teh breast W/OUT signs of infection
  2. Treat w/ frequent feeding and massage from behind mass toward nipple
  3. Use heat and avoid underwire or tight fitting bra
  4. 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
22
Q

Complications of Breastfeeding

-Mastitis

A
  1. Fever, Pain, Redness — 2-3 wks postpartum and associated w/ milk stasis
  2. Infection commonly wit hStaph, strep and E. Coli
  3. CONTINUED breastfeeding and pumping of breast is IMPORTANT — It’s OKAY for the baby
  4. Massage toward the nipple
  5. Broad spectrum antibiotic - Dicloxacilin
    - CLOSE follow up to prevent abscess
23
Q

Complications of Breastfeeding

-Breast Abscess

A
  1. RARE — Painful swelling and persistent systemic Sx’s despite antibiotics
  2. Palpable fluctuant mass vs US
  3. Treated w/ aspiration or I&D
  4. Antibiotic treatment is important
24
Q

Complications of Breastfeeding

-Fungal Infection

A
  1. Sore Nipples despite good latch
  2. Flaky, shiny, itchy nipples or blisters
  3. Caused by Candida species in warm and wet environment
  4. Treat w/ topical antifungal cream — SAFE for baby
    - Keep breasts DRY
    - Use new clean and dry bra daily
    - Wash clothing and pumping supplies
25
Q

Complications of Breastfeeding

-Inverted, Flat, or Enlarged Nipples

A
  1. Nipple massage, stimulation, stretching can draw nipple out
  2. Infants can often latch on areola w/ good effect
  3. Suction devices and nipple shields — hand expression and pumping
26
Q

Complications of Breastfeeding

-Raynaud’s of the Nipple

A
  1. Vasospasm leading to decreased blood supply to nipple
  2. Intense nipple pain w/ latch and nipple blanching in between feedings
  3. Caused by early trauma to nipple from breastfeeding and Candida Infection
  4. Treat w/ nipple massage, avoid cold and in some cases it is treated with nifedipine**

Adv Practice Women’s Health 6032 Test 2 (6 decks)

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