UNICEF AUDIT Flashcards
What are the 3 breastfeeding hormones, and what do they do?
Prolactin = switches on milk producing cells.
Oxytocin = works on muscle cells, causing them to contract , producing the “let down reflex”.
Feedback inhibitor of Lactation (FIL) = protein in milk which alerts milk producing cells to stop producing milk when breasts are full.
How can a women optimise breastfeeding physiology when expressing milk?
Frequent, regular expressing helps to increase production and remove FIL (prolactin/FIL)
Quiet and private place where the woman can relax (oxytocin)
Visit baby/initiate kangaroo care ASAP promoting bonding (oxytocin)
Pictures/smells of baby when expressing releases oxytocin, facilitating the “let down reflex”
What is responsive bottle feeding?
waiting for cues to feed
holding baby close/eye contact
limit number of people feeding baby
pace feeds, let baby control flow and volume
dont force baby to complete feed
Name some of the breastfeeding positions
Cradle
Football/rugby hold
laid back
sidelying
How do you attach baby to the breast?
Wide open mouth
chin leads
bottom lip touches breast, well away from base of nipple
nipple towards rear of roof of baby’s mouth
What practical measures can be taken to get breastfeeding off to a good start?
unhurried skin to skin contact at birth, resulting in a breastfeed (Oxytocin)
early, frequent, effective feeds (prolactin, removal of FIL)
Keep baby close (oxytocin)
Talking to mum about feeding cues and how to be responsive to needs (oxytocin and prolatin)
Avoiding unnecessary supplementation
What are the benefits of skin to skin?
Keeps baby warm
good start to breastfeeding
bonding
calms both mother and baby
regulates heartrate and breathing
What are the signs of ineffective attachment?
Painful for mother
mouth not widely open
chin away from breast, nose indenting breast
cheeks sucked in
areola visible below babies bottom lip
baby is fussy - coming on and off the breast
When would hand expressing be beneficial?
To get some colostrum to tempt a sleepy baby
to soften full breasts and enable baby to attach
to help clear a blocked duct
when separated from baby
Which hormones regulate breastfeeding and how to they work?
Prolactin is produced in the pituitary gland and produces the milk when baby sucks on breast frequently
Oxytocin is produced by the hypothalamus and helps milk ejection and bonding. Triggered by skin to skin, smell/vision of baby and thoughts of baby.
FIL - produced by alveoli, regulates milk, triggered by lack of milk drainage.
In breast milk, what benefit do transfer factors have?
Absorption
In breastmilk, what benefit do growth factors have?
growth and development of the gut
in breastmilk, what benefits do enzymes have?
they aid digestion and destroy bacteria
In breastmilk, what benefits do oligosaccarides have?
the prevent bacteria in the gut.
In breastmilk what benefits do bifidus factor have?
create an acid PH in the gut
in breastmilk, what benefits do lactoferrin have?
absorption of iron
in breastmilk, what benefits do IgA antibodies have?
protection and immunity
In breastmilk, what benefits do white cells have?
they destroy bacteria
in breastmilk, what benefits do nucleotides have?
cell repair
What is lactogenesis 1?
during pregnancy, the alveoli in the breasts develop and prepare. Colostrum may be present.
What is lactogenesis 2?
after birth, hormones increase to produce copious amounts of milk in the first 32-92 hours.
What is lactogenesis 3?
Feeding frequently over the first few weeks ensure development of the receptors on the breast to ensure long term milk production.
Why is feeding overnight important?
Prolactin produced at night time produces milk for the next feed. skipped feeds at night may reduce levels of milk the following day. If breasts don’t empty at night, FIL builds up resulting in reduced milk production.
How can loving relationships and bonding be encouraged?
Talking to baby in pregnancy
Skin to skin contact
Looking into babies eyes
being responsive to cues, soothing and comforting baby when they are distressed
not leaving baby to cry for long periods
not possible to spoil baby
9 Signs of effective feeding
appropriate wet nappies
appropriate soiled nappies
active/alert and no jaundice
at least 8-10 feeds in 24H
baby feeds for 5-30 mins at most feeds
nipple shape normal after a feed
signs of effective attachment present
no dummies or formula used
weight loss and weight gain normal
How many soiled nappies for newborn per day?
within 24 hours - meconium
day 3-4 - 2 x green stools
day 5 - 2 or more yellow runny stools
How many wet nappies per day for newborn?
Increase with days of age of life until day 6, then x6 per day
8 signs of ineffective feeding?
less than recommended wet nappies or none at all
still passing meconium after day 3 or no stools
sleepy, difficult to wake and unsettled (jaundice)
less than 8 feeds in 24 hours or constant feeding
consistently feeding for less than 5 mins or more than 40 mins
sore/damaged/misshapen nipples after a feed
engorged breasts or early signs of mastitis
use of bottles or dummies
What is responsive breastfeeding?
Responding to feeding cues (rooting, opening mouth, rapid eye movement)
Feeding when baby in distress or in need of comfort
When breasts are full/engorged (mothers comfort)
for mums emotional comfort/relaxation
for mums convenience, to fit around lifestyle
What are 6 reasons that loving relationships between parents and baby are important?
Encourage high levels of oxytocin
encourage low levels of cortisol
optimises brain development
supports secure attachment
helps mum and babies emotional development
improving short and long term outcomes
What are 6 signs of good attachment at the breast?
pain free for mother
mouth wide open
chin indents breast, nose away from breast
cheeks full and round
more areola visible above baby top lip
content baby, stays on breast
How to formula feed safely?
Hold baby semi-upright
place teat gently around lips
hold bottle horizontally, slightly tipped ensuring milk fills teat
5 signs that baby has had enough formula?
splaying fingers and toes
milk spilling out of mouth
pushing teat away
stopped sucking
turning head
How to prepare bottle feeds safely?
wash bottles and sterlise
make feeds as needed
boil tap water, let it cool to 70 before adding scoops
don’t overfill scoop
check temperature of milk before feeding, cool down by running under cold water
discard leftovers
avoid use of prep machine
Why is skin to skin contact important at birth?
stimulates earlier birth of placenta
reduces bleeding
increases milk ejection reflex
lowers mum and babies stress levels
initiates bonding
keeps baby warm
regulates mum and baby heart rates/breathing rates
encourages feeding behaviours
What are the breastfeeding rates in the UK?
some of the lowest in the world.
81% initiate breastfeeding
8/10 stop before planned
there has been an increase in babies being exclusively breast fed at age 6 months
last survey in scotland in 2017
What is the Code?
it is the code of marketing, which regulates the marketing of breastmilk substitutes to protect breastfeeding. publishing 1981.
How would you support a mother whose baby is reluctant to feed?
Gently handing/patience
revisit position and attachment
check for illness or underlying causes
keep baby close so cues can be responded to timely
suggest switching breasts
breast compressions
why should supplements be avoided?
supplements interfere with physiology of breastfeeding
formula changes gut flora in baby
undermines mothers confidence to feed
nipple/teat confusion
How can you support a baby at risk of hypoglycaemia?
skin to skin and encourage breastfeeds
frequent feeds using a cup or syringe if required
keep baby warm
complete obs regularly
check blood glucose levels regularly
How can engorgement be prevented?
good positioning and attachment
frequent feeding
avoid formula feeds
avoid dummies
Best communication skills when talking to mothers
opened ended questions
sensitive/compassion in discussion
validate points raised by mum
seek consent
reflect back
build on mums current knowledge
non judgement
non biased
