Positioning and Attaching

Question 1

1. Identify structures of breast and their functions? 4 max

Answer 1

Made of adipose & connective tissue - gives breast shape.
OUTSIDE
1. Nipple - erectile tissue - delivers milk.
2. Areola (darker pigmented area) - small bumps called Montgomery tubucles release sebum to keep area soft and supple.
INSIDE
3. Alveoli - contain LACTOCYTES - milk producing cells
MYOEPITHELIAL CELLS surrounding alveoli - contract to expel milk.
4. Lactiferous ducts - milk travels to and is propelled to milk ducts in nipple.

Question 2

2. Name hormone that stimulates milk production and identify its source and target cell. 3 max.

Answer 2

Prolactin- produced in Anterior Pituitary Gland

Levels rise after delivery of placenta - in coordination with a drop in oestrogen and progesterone.

Acts on lactocytes (milk producing cells).

Question 3

2. 3 examples of how effective milk production can be achieved? 3 max.

Answer 3

1. Effective emptying of the breast.
2. Early feeding/ASAP
3. Good positioning and attachment.

Question 4

3. Name hormone responsible for the “let down reflex?

Where is it released from?

What cells does it act on?

Factors that help or hinder release of this hormone? 6.5 max.

Answer 4

Oxytocin

Posterior pituitary gland

Myoepithelial cells- contracts cells- pushes milk along lactiferious ducts.

HELP - being close to baby, seeing/smelling/thinking of baby.
HINDER - stress, lack of sleep, separation from baby or pain.

Question 5

4. Name protein involved in the autocrine production and maintenance of breast milk?

How does this work? 2 max

Answer 5

FIL (feedback inhibitor of lactation)

Accumulation of breast milk causes a negative feedback mechanism - release of protein FIL

More FIL less milk. To prevent this increased breast emptying stop’s production of FIL and production of milk. Less emptying of breasts causes increase in FIL and lack of breast milk.

Question 6

How should Robyn prepare for a feed? 4 max

Answer 6

1. Go toilet
2. Get everything she might need for example snacks, water or her phone.
3. Get into a comfortable sustainable position.
   4, if midwife is helping make sure guidance is clear and easy to follow and she understands it.

Question 7

6. Demonstrate suitable positions Robyn can adopt prior to attaching baby to her breast? Give reasons. 2.5 max

Answer 7

1. Cross chest/abdomen- head and neck in-line and supporting baby with arm, supporting head and neck with hand.
2. Rugby hold- support baby body with crook of arm, head is free, hand supporting head and neck, baby is free to come off.
3. Lying down position- place baby where nipple naturally falls.

Question 8

7. Using CHINS demonstrate good positioning of baby zac prior to attachment. 5 max.

Answer 8

1. Close
2. Head free - allow to stop
3. Inline - head, neck and spine all aligned- allow to get as much tissue into mouth as possible.
4. Nose to nipple. - bringing baby on
5. Sustainable

Question 9

8. Detail steps to attach baby to breast. 6 max

Answer 9

1. Baby to breast not other way.
2. Wide/full mouth
3. Chin leading
4. Nipple to roof of mouth, sitting at soft palate (avoid trauma).
5. Bottom lip turned away from nipple.

Question 10

9. Good signed of attachment? 8 max

Answer 10

1. Chin indenting breast
2. More areola on bottom than top
3. Large, wide mouth
4. Full rounded cheeks
5. Pain free
6. Change in sucking patterns
   - rapid (to signal oxytocin - let down
   - slow rhythmic suck suck pause
   - flutter sucking to receive high fat milk at end

Question 11

10. How you will know baby has enough? Max 3

Answer 11

1. Happy settled baby - sleeps
2. Regular wet and dirty nappies
3. Let baby come off on their own
4. Observe sucking patterns - get to know them
5. 8-12 feeds in 24 hours