R14 - Breastfeeding

Question 1

Prolactin and Milk Secretion

Answer 1

1. Hypothalamus releases dopamine
2. Dopamine DECREASES prolactin secretion from the anterior pituitary
3. When negative feedback from dopamine is released…
4. Prolactin causes alveolar cells to secrete milk

Question 2

Oxytocin and Milk Ejection

Answer 2

1. Hypothalamus releases dopamine
2. Dopamine DECREASES oxytocin secretion from posterior pituitary
3. When negative feedback from dopamine is released…
4. Oxytocin causes my-epithelial cells to contract and push the milk from the alveoli to the ducts

Question 3

Women who are lactating may have _____ and symptoms of ____

Answer 3

lactational amenorrhea, hypoestrogenemia

Question 4

Lactation Induction

Answer 4

1. Start continuous combined oral contraceptive pills (cOCPs)
2. Add domperidone
   * Domperidone blocks dopamine receptors
   * Not FDA approved in the US
3. Stop cOCPs but continue domperidone (mimic birth)
4. Start pumping (mimic suckling)

Question 5

Domperidone ____ dompamine receptors, releasing negative control

Answer 5

blocks

Question 6

What is in milk that makes it special?

Answer 6

Lactoferrin Oligosaccharides Neutrophils, macrophages, lymphocytes, IgA

Question 7

How long a mother breastfeeds her baby (duration) is influenced by many factors including:

Answer 7

• Issues with lactation and latching.
• Concerns about infant nutrition and weight.
• Mother’s concern about taking medications while breastfeeding.
• Unsupportive work policies and lack of parental leave.
• Cultural norms and/or lack of family support.
• Unsupportive hospital practices and policies.

Question 8

Pumping Barriers at Work

Answer 8

Legally, lactating individuals are supposed to have:
* Private location with lock on door
* Access to sink and refrigerator
* Breaks to pump

In reality, hard to come by this in many workplaces
* Lactation room far away
* Required to ”make up” time spent pumping→extending work day
* Effective pay cut

Question 9

• Absolute contraindications:

Answer 9

• Active HSV of breasts
• Untreated ACTIVE TB
• HIV
• Drugs of abuse
• Radioactive drugs

Question 10

Coffee / wine amount that is OK

Answer 10

1-3 cups of coffee or one glass of wine will not affect baby

Question 11

CDC and AAP recommend considering:

Answer 11

• Need for the drug by the mother.
• Potential effects of the drug on
  milk production.
• Amount of the drug excreted into human milk.
• Extent of oral absorption by the breastfeeding infant.
• Potential adverse effects on the breastfeeding infant.
• Age of the infant.
• Proportion of feedings that are breast milk.