Breastfeeding and Lactation Quiz

Lactation-Breastfeeding and Nursing Care

• The presentation covers the benefits, physiology, and biospecificity of human milk, along with management techniques, common problems, and economic benefits.

Content of Presentation

• Benefits of breastfeeding
• Physiology of milk production
• Biospecificity of human milk
• Appearance and amount of breast milk
• Ten steps to successful breastfeeding
• Breastfeeding management and technique
• Milk expression and breast pumps
• Common problems encountered with breastfeeding

Purpose of Presentation

• To provide knowledge and skills about lactation and breastfeeding.

Breastfeeding Statistics in the World

• Statistics for exclusive breastfeeding for the first 6 months (2005-2012) are presented in a bar graph, showing the percentage of infants exclusively breastfed in various countries.
• Data for some countries isn't available in WHO's nutrition database but is from the country's latest survey of 2005.

Benefits of Breastfeeding

• Human milk is dynamic food that meets infant needs by building immune system, growing and developing the brain, and forming attachments with other human beings.
• Research shows compelling short- and long-term health benefits for both mother and newborn.

Newborn Health Benefits

• Exclusively breastfed infants in the first six months are less prone to disease and allergies compared to formula-fed infants.
• Breast milk contains many antibodies against disease agents.
• It's easily digestible, and its composition is adapted to the child's age and needs.
• Infants face less risk of asthma, allergies, sudden infant death syndrome, otitis media, cardiovascular disease, gastrointestinal (GI) infection, respiratory conditions, childhood leukemia, and lymphomas and benefit more from cognitive development.

Maternal Health Benefits

• Breastfeeding stimulates uterine involution, resulting in less blood loss.
• It enhances mother-infant attachment.
• It reduces the risk of breast cancer, ovarian cancer, and type II diabetes.
• It reduces the risk of metabolic syndrome, hypertension, hyperlipidemia, and cardiovascular disease.

Economic Benefits

• Breast milk is always available, sterile, and has the optimal temperature. This saves time, money, and work.
• Exclusive use of formula leads to increased neonatal morbidity and substantial healthcare expenditures.

Incidence of Breastfeeding Healthy People Goals

• The World Health Organization (WHO, 2011) recommends breastfeeding for 2 years or longer.

Physiology of Milk Production

• Perinatal nurses need to understand milk production science to help women breastfeed successfully.

Mammogenesis

• Mammogenesis refers to the growth of mammary glands.
• During pregnancy, estrogen and progesterone prepare breasts for lactation.
• External changes during pregnancy include breast enlargement and thinner skin, making veins more visible.
• Nipples enlarge, and Montgomery glands become prominent, secreting a substance to lubricate and protect the nipples and areola.
• Areola grows in diameter and darkens.
• Internal changes occur involving developing mammary ducts, lobules, and alveoli.

Lactogenesis I

• Lactogenesis I begins around midpregnancy and lasts until 1–2 days postpartum.
• Prolactin levels increase during pregnancy and stimulate colostrum production.
• Colostrum is present from midpregnancy onward.

Lactogenesis II

• Lactogenesis II is the onset of copious milk production 48–72 hours after birth.
• Higher prolactin levels, along with infant suckling, stimulate breast milk synthesis and secretion.

Common Risk Factors for Delayed Onset of Lactogenesis II

• Primiparity
• Maternal age 30 years
• Cesarean birth
• Prolonged labor
• Obesity
• High levels of stress during the birth
• Premature delivery (including late preterm)
• Insulin-dependent diabetes mellitus

Prolactin "Milk Secretion" Reflex

• Factors enhancing milk secretion include early initiation of breastfeeding, good attachment and effective suckling, frequent feeds (including night feeds), and emptying of the breast.
• Factors hindering milk secretion include delayed initiation of breastfeeding, pre-lacteal feeds, bottle feeding, incorrect positioning, and painful breasts.

Lactogenesis III

• Lactogenesis III is the phase when a woman has established a mature milk supply.
• Prolactin continues to be produced in response to infant suckling and breast emptying.
• Oxytocin is released in response to suckling, occurring repeatedly during feedings.
• This is felt as a heaviness or tingling sensation in the breast by some mothers.
• Oxytocin also stimulates uterine contractions controlling postpartum bleeding and promoting involution.

Breastfeeding Technique Video

• There is a linked video demonstrating techniques for breastfeeding.

Feeding Reflexes in the Baby

• Rooting, sucking, and swallowing reflexes are necessary physical actions for infant to consume milk.

Breastfeeding Technique

• Initiate breastfeeding as soon as possible after birth.
• Support the mother's back and arms to ensure comfort.
• Assist the mother in finding a comfortable position for breastfeeding.
• Common breastfeeding positions include cradle hold, cross-cradle/transitional hold, clutch/football hold, and side-lying positions.
• Mothers can wear simpler clothes which allow for ease of feeding in public.
• Using a light cloth over the breast can be helpful.
• Cup feeding and instruct the mother to hold the breast, stroke the baby's lower lip, and ensure the baby's mouth is fully open.
• Ensure the baby's mouth is properly latched to the areola, not just nipple to avoid injury.
• Help the infant escape air swallowed during feed by gently tapping the baby's back.

Observations Indicating Correct Latch On

• Flared lips
• Absent clicking or smacking sounds
• Absence of dimpled cheeks
• Movement of muscles above and in front of the ear
• Both cheeks close to the breast
• Chin and nose touching the breast
• All of the nipple and part of the areola covered by the newborn’s mouth
• More areola visible above the upper lip than below it
• Wide angle at the corner of the mouth
• Visible tongue over the lower gum line when gently opening the lower lip.

Good and Poor Attachment

• Illustrations of good and poor attachment are provided.

Signs of Adequate Intake

• Evaluating newborn intake involves assessing hydration, bowel movements, urine color and consistency and stool color and consistency.
• Wet diapers and the number of bowel movements provide evidence of milk transfer.
• Urine should be clear and pale yellow.
• Stools should change from meconium to transitional and yellow/seedy liquid.
• Moist mucous membranes and skin that doesn’t remain tented when lightly pinched indicate sufficient hydration.

The Perfect Match

• The quantity of colostrum per feed matches the newborn's stomach capacity.

Milk Expression and Breast Pumps

• Women may not be able to breastfeed early enough to stimulate and sustain lactation.
• Perinatal nurses should teach hand expression and advise the use of a breast pump in situations of delay.
• Correct sizing of breast pump shields and flanges is important to avoid nipple soreness, cracks, and excoriation.
• Aseptic techniques are crucial in expressing and storing breast milk.
• Women can massage breasts to stimulate letdown.
• Pumping at least 8-12 times every 24 hours, even with high milk volume, is essential to stimulate lactation.
• A mother may pump between feedings, or at the end of feed, instead of missing a feeding.

Safe Preparation and Storage of Expressed Breast Milk

• Handwashing is vital before expressing or handling breast milk.
• Use clean, closable containers to collect and store milk.
• Label containers and use oldest milk first.
• Do not mix fresh milk with already frozen milk.
• Do not save milk from one used container for another feeding.

Milk Storage Guidelines

• Guidelines regarding the duration and temperature of storage for breast milk are presented.
• Room temperature storage is only good for a 6 to 8 hour period.
• Insulated cooler bags are safe for 24 hours at temperatures rangeing from 5 to 39 degrees fahrenheit.
• Refrigerator storage can be good for 5 days at 39 degrees F.
• Freezer storage, inside a cooler bag or a deeper freezer, is good for 2 weeks at or below zero degrees fahrenheit, or 3 to 6 month storage at or below 18 degrees or -18 degrees Celsius.
• Deep freezers are safe for storing breast milk for 6 to 12 months.

Cup-feeding a Baby

• Information about cup feeding a baby is provided.

Safely Thawing Breast Milk

• Avoid thawing breast milk using microwaves due to uneven heating and potential nutrient damage.
• Warm water or room temperature water are safer thawing methods.
• Never refreeze thawed breast milk.

Common Problems Encountered With Breastfeeding

• Common breastfeeding problems include nipple soreness, engorgement, plugged ducts, mastitis, inverted nipples, and Candida albicans.

Sore Nipple

• Sore nipples are a common complaint in initiating breastfeeding.
• Common causes involve incorrect breastfeeding latch and improper breastfeeding positions resulting from ineffective sucking.
• Instruct mothers to break suction, reposition the infant, and reattempt latching the baby.
• Applying breast milk or ultra-purified lanolin to nipples after breastfeeding may soothe sore nipples.
• Encouraging mothers to air-dry nipples after feeding, and frequent changing of nursing pads, may help resolve sore nipples.

Breast Engorgement

• Between days two and six after delivery, mothers may begin producing a larger amount of milk.
• Naturally, breasts may feel full, larger, heavier, and possibly tender.
• The fullness may become engorgement, when breasts feel hard, painful, warm, and throbbing, with flattening of the nipples.

Engorgement

• Engorgement happens when milk build-up occurs due to irregular emptying of the breast because of poor latching, incorrect positioning, frequent feedings, supplementation, nipple damage, or fatigue.
• Minimizing engorgement involves avoidance of supplementation and pacifier overuse.
• Encourage hand expression of milk to soften the breasts before feeding.
• Assist the mother to understand correct latching and positioning techniques.
• Alternative treatments may include alteration of feeding position and avoidance of constrictive clothing.

Inverted Nipple

• Describe the inverted nipple and the treatment using a syringe.

Plugged Duct

• Breast engorgement can lead to plugged ducts in the breast.
• Plugged ducts are small, tender lumps the size of a pea. This isn't usually an infectious state unless a fever occurs with the lump or duct.
• Symptoms include tenderness, heat, or possible redness, and a palpable lump.
• Treat using hot packs and massaging the lump while the baby is feeding.
• Alter feeding position of infant and avoid tight clothing.

Mastitis

• Mastitis is an inflammatory condition of the breast, that may or may not be accompanied with infection.
• Inflammation tends to be unilateral.
• Symptoms include fever, aching, chills, swelling, redness, tenderness under the arm, and red streaks from the lump toward the axilla.
• Treat with frequent breastfeeding on both breasts, especially the affected side, enough rest, adequate nutrition.
• If symptoms become severe, antibiotics are prescribed.
• Antibiotics may help treat the infection, but they don't necessarily treat the underlying cause of the mastitis.

Candida Albicans

• If the mother complains of burning pain on the nipple, or burning and shooting pain in the breast, there may be Candida infection (thrush).
• Positive predictive symptoms of Candida infection in the breast include pain on the nipple/areola, non-stabbing pain in the breast, stabbing pain in the breast, and skin changes that look shiny and flaky.
• Treatment should be topical or systemic and involve both the mother and infant.
• Early diagnosis of Candida infection is critical to sustain breastfeeding.

Lactation Suppression

• In women not breastfeeding, milk leakage and breast pain may start 1-3 days postpartum.
• Engorgement usually begins within 1-4 days of delivery.
• Wear a well-fitting bra for 24 hours daily to reduce discomfort.
• Apply cold packs to the breasts to reduce swelling.
• Mild analgesics are recommended for comfort, as advised on the product's guidelines.
• Avoiding nipple or breast stimulation, or expressing milk, will not help in the long term. Restricting fluids is unnecessary.
• Breasts return to normal without treatment within 48-72 hours of engorgement onset.

Test your knowledge about breastfeeding and the lactation process. This quiz covers key concepts like lactogenesis, mammogenesis, and the benefits of breastfeeding as recommended by the World Health Organization. Match functions of breast components and identify factors affecting milk production.