LactationandBreastfeeding

1、Lactation and BreastfeedingObstetrics and Gynecology 1BreastfeedingInfant Health BenefitsCOLOSTRUM Small amount for the immature digestive systempaints the digestive tractLow fat for easy digestionContains mothers antibodies which boost infants immune systemActs as a laxative to ease passage of meco

2、nium2BreastfeedingInfant Health BenefitsThe milk comes inTransitional milk for up to 2 weeksMay still have yellow appearanceAmounts increase quickly as infant hungers and digestive system maturesMothers milk making” changes from endocrine to autocrine systemMature milkSupply/demand system engorgemen

3、t decreasesProperties of fore milk and hind milk present3BreastfeedingInfant Health BenefitsLower risk ofDiarrheaConstipationInfectionsEar, respiratory, meningitis, urinary tractSIDSAllergic diseasesChronic digestive diseasesJuvenile onset diabetesAcute leukemiaAdult obesity4BreastfeedingInfant Heal

4、th BenefitsProvides immunologic protection while the infants immune system is maturingAntimicrobial agentsAnti-inflammatory agentsImmunomodulating agents5BreastfeedingInfant Health BenefitsPreterm InfantsDecreased necrotizing enterocolitisDecreased ROPDecreased infection ratesBetter able to tolerate

5、 feedingsIncreased IQ ratesContains long chain polyunsaturated fatty acids that help the infants brain develop these are normally provided by the mother in late pregnancy, therefore preterm infants miss this6BreastfeedingMother Health BenefitsLess postpartum bleedingMore rapid uterine involutionWeig

6、ht lossDecreased premenopausal breast cancer ratesDecreased ovarian cancer ratesLactational amenorrheaShould still use progesterone only contraceptivesCombined contraceptives dry up milk7BreastfeedingParent BenefitsSaves moneySaves timeBabies love it8LactationAnatomy and PhysiologyBreast enlargement

7、During pregnancy and lactation indicates the mammary glands are becoming functionalBreast size before pregnancy does not determine the amount of milk a woman will produce9LactationAnatomy and PhysiologyHormones during pregnancyEstrogen stimulates the ductile systems to grow, then estrogen levels dro

8、p after birthProgesterone increases the size of alveoli and lobesProlactin contributes to increasing the breast tissue during pregnancy10LactationAnatomy and PhysiologyAlveoli secrete milk and contract when stimulatedOxytocin stimulates milk secretion and is released during the let down or milk ejec

9、tion reflexAfter let down, milk travels into the ductules, then to the larger lactiferous or mammary ducts11LactationAnatomy and PhysiologyHormones during breastfeedingProlactin levels rise with nipple stimulationAlveolar cells make milk in response to prolactin when the baby sucksOxytocin causes th

10、e alveoli to squeeze the newly produced milk into the duct system12LactationAnatomy and PhysiologyLatch On and suckingOxytocin ReleaseReleases MilkInfant Empties BreastProduction IncreasesMilk Production OccursInterference with this cycle decreases the milk supply.13BreastfeedingBarriersEarly breast

11、feeding failures deprive infants of the benefits, and leave many mothers disappointedIt is a natural process, but many mothers need a lot of help14BreastfeedingBarriersMust educate mothers regarding:Positioning the babyLatching onNormal nipple sorenessCramping with breastfeedingHow often to feed the

12、 babyNeed to wake the babyAlerting techniquesRootingSuckingListening for swallowsPreventing engorgementNutritionSupply and demandInfant cues15Breastfeeding BarriersBreast PathologyFlat/inverted nipples, breast reduction surgery that severed milk ducts, previous breast abscess, extremely sore nipples

13、 (cracked, bleeding, blisters, abrasions)Hormonal pathologyFailure of lactogenesis, hypothyroidismOverall healthSmoking, anemia, poor nutrition, depressionPsychosocialRestrictive feeding schedules, mother without support system, not rooming in with baby, bottle supplementing when not medically requi

14、redOtherPrevious breastfed infant who failed to gain weight well, perinatal complication (hemorrhage, htn, infection16BreastfeedingTeaching methodsWith infant in mothers armsConsistent informationRepeat information in a variety of waysWatch the mother feed the baby and helpLet the mother know she ma

15、y have difficulties at firstRemind mom that baby is learning with herPraise the mothers progress, help build confidenceProvide discharge support17BreastfeedingThe ResultsBaby gains weightNo more than 7% weight lossBack to birth weight in 2 weeks1oz per day weight gain for the first three monthsMothe

16、r is comfortable and satisfiedIf baby is still loosing weight on the 4th day of life:Get feeding evaluationRemember to:1. fed the baby2. maintain the milk supply3. continue breastfeeding18BreastfeedingComplicationsInfants at risk for poor weight gainPremature (less than 38 weeks)Difficulty latching

17、onIneffective or unsustained suckingOral anatomic abnormalities (cleft lip/palate, short frenulum, receding chin)MultiplesJaundiceCystic fibrosisInfectionCardiac disordersNeurologic problems downs, hypo or hypertoniaPoor apgarsLong laborSleepy, nondemanding, passive temperamentSeparation from mother

18、 early after deliveryInfants less than 5 lbs19BreastfeedingHospital Discharge SupportMother breastfeed longer if they:Are confident at hospital dischargeHave a good support system after dischargeReceive follow up after dischargeUpon dischargeGive written informationRecommend mom to keep breastfeedin

19、g recordGive mom phone number for a telephone helplineLactation consultant follow-up20BreastfeedingHospital discharge supportSupport the mothers breastfeeding effortsProvide accurate current breastfeeding information21BreastfeedingResources for MothersBooks:The Womanly Art of Breastfeeding LeLeche L

20、eagueSo thats what theyre for! Breastfeeding Basic by Janet TamaroThe Breastfeeding Book by Martha and William SearsNursing Mother Companion - Huggins Howard Common PressThe Breastfeeding Answer Book LeLeche LegueMedication and Mothers Milk Thomas Gele PhD., a manual of lactational pharmacology 9th

21、Ed.Breastfeeding and Human Lacation 2nd Ed. Jan Rioden and Kathleen G. AuerbachBreastfeeding Triage Tool - Sanie Jollay and Ellen Phillips-Angeles, M.S. Ches 4th Ed.WebsitesLeLecheLMP GroupsLeLeche LeagueWIC Public Health DepartmentCarles Breast Feeding ClinicTwin clubs22ReferencesSlusser W

22、ndelin, Ms, MD and Powers Nancy G MD; Breastfeeding Update 1: Immunology, Nutrition and Advocacy; Pediatrics Review Vol 18 No. 4Neifert, Marianne M.D., Early Assessment of Breastfeeding Infant, Contemporary Pediatrics Oct. 1996The Breastfeeding Answer Book, LeLeche League InternationalAWHONN Associa

23、tion of Womens Health, Obstetric and Neonatal Nurses Independent Study Module for the Clinical Management of Breastfeeding for Health Professionals 199923Clinical CaseYou are seeing a 22 yo G1 P0 woman in your office for her first prenatal visit at 12 weeks gestation. When you ask her if she intends

24、 to breastfeed her baby, she replies that she is concerned that she will not be able to due to the fact she is a chronic Hepatitis B carrier. She is also concerned about the fact that her friend told her that, if she breastfeeds, she will need to do so every hour and thus will be unable to do anythi

25、ng else.24Clinical CasePrenatal LabsHct 33%WBC 5600/cmm (normal differential)Plt 224,000/cmmBlood type A +Antibody screen: negativeRubella titer: immuneUA and Cx negativeVaricella-zoster titer: immuneVDRL test: negativeHBsAg: positive25Clinical CaseHow would you counsel this patient?What infant and

26、maternal benefits are there to breastfeeding.26Clinical CaseCounseling the patient:Prevalence of HBV infection in pregnancySymptomatic 1 to 1:1000Asymptomatic 5 to 15:1000Perinatal transmission of HBV without interventionSeropositive for HBsAg only 15-20% riskSeropositive for HBsAg and HBeAg 85-90%

27、risk27Clinical CaseCounseling the patient:Immunoprophylaxis for prevention of perinatal transmission of HBVTreat neonates immediately after birth with HBIG and HBV vaccine (must give HBIG within 12 hrs of birth)Reduces the risk of transmission to 5%First dose of HBV vaccine prior to hospital dischar

28、ge, 2nd and 3rd doses administered at 1 and 6 months of ageCDC recommends universal vaccination of all infants28Clinical CaseCounseling the patient:Breastfeeding is not contraindicated in chronic Hep-B carriers if the infant receives the HBIG and is vaccinated29Clinical CaseBased on your advice, the

29、 pt decides to breastfeed. She and her infant have now been successfully nursing for over 3 weeks. One morning she wakes to discover a red, wedge-shaped area in her right breast. She also has a fever to 101 degrees.What is the most likely diagnoses?How would you treat her?30Clinical CaseTreating the

30、 patient:Most likely diagnosis = MastitisGive antibiotics that cover S. aureus antistaphylococcal penicillin or first-generation cephalosporin, continue treatment for 10 daysPatient should continue breastfeeding31Review Question #11. How many calories should a lactating woman increase above her non-

31、pregnant baseline calorie consumption?32Answer #1400 calories33Review Question #2Match the following response associated with the following conditionsi. May breast feedii. Breastfeeding not encouragediii. Breastfeeding contraindicatedA. Acute mastitisB. HSV infectionC. CMV infectionD. two alcoholic

32、beverages consumed per dayE. TetracyclineF. ClindamycinG. Smoking two packs of cigarettes per dayH. Use of sub 50mg oral contraceptivesi. HTLV 1 infectionJ. HBeAg + hepatitis34Answer #2A iB iC iD iE iiiF iG iH iI iiiJ - ii35Answer #2Breastfeeding is contraindicated in very few situations. Most viral

33、 infections are not considered contraindications. CMV has been transmitted in breast milk, but the effect on the healthy term neonate is relatively minor if breastfeeding is allowed to continue. Active acute hepatitis B (particularly if the E antigen is present), HIV, HTLV 1, cyclophosphamide, tetra

34、cycline, oral metronidizole, lithium carbonate, and radioactive agents are considered to be contraindicated during pregnancy. Puerperal mastitis is not a contraindication to breastfeeding.36Review Question #3Select the 3 correct statements comparing human mature breast milk to cows milki. Calories are increasedii. Proteins are decreasediii. Fat is increasediv. Carbohydrate is increasedv. Iron is increased37Answer #3i, iii, ivHuman milk is significantly different from both cows milk and formula