Podcast
Questions and Answers
What is the main role of Oxytocin in lactation?
What is the main role of Oxytocin in lactation?
Which of the following hormones is primarily responsible for the development of the ductal system in the mammary glands?
Which of the following hormones is primarily responsible for the development of the ductal system in the mammary glands?
Which stage of lactogenesis is characterized by the production of colostrum?
Which stage of lactogenesis is characterized by the production of colostrum?
Which of the following is NOT a characteristic of colostrum?
Which of the following is NOT a characteristic of colostrum?
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Which of the following statements correctly describes the role of Human Placental Lactogen (hPL) in lactation?
Which of the following statements correctly describes the role of Human Placental Lactogen (hPL) in lactation?
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Which of the following benefits of breastfeeding is not related to the mother's health?
Which of the following benefits of breastfeeding is not related to the mother's health?
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Based on the UNICEF data provided, which country has the highest rate of breastfeeding for the first 6 months of life?
Based on the UNICEF data provided, which country has the highest rate of breastfeeding for the first 6 months of life?
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What is a potential negative consequence of the frequent and relatively high levels of progesterone during pregnancy?
What is a potential negative consequence of the frequent and relatively high levels of progesterone during pregnancy?
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Which of the following structures is directly responsible for producing milk?
Which of the following structures is directly responsible for producing milk?
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According to the content provided, which environmental benefit is associated with breastfeeding?
According to the content provided, which environmental benefit is associated with breastfeeding?
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Based on the information provided, which hormone is directly involved in the release of milk from the alveoli into the lactiferous duct?
Based on the information provided, which hormone is directly involved in the release of milk from the alveoli into the lactiferous duct?
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What is the most likely explanation for the higher rates of breastfeeding in the developing world compared to developed countries?
What is the most likely explanation for the higher rates of breastfeeding in the developing world compared to developed countries?
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Based on the information provided, what can we conclude about the effects of breastfeeding on the mother's uterus?
Based on the information provided, what can we conclude about the effects of breastfeeding on the mother's uterus?
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Which of the following is NOT a benefit of breastfeeding for the infant, as mentioned in the information provided?
Which of the following is NOT a benefit of breastfeeding for the infant, as mentioned in the information provided?
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Based on the given information, what is the primary function of prolactin in relation to breastfeeding?
Based on the given information, what is the primary function of prolactin in relation to breastfeeding?
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What is the primary condition under which breastfeeding is contraindicated?
What is the primary condition under which breastfeeding is contraindicated?
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What is breastmilk jaundice primarily associated with?
What is breastmilk jaundice primarily associated with?
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Which of the following conditions may necessitate supplementation of breastfeeding?
Which of the following conditions may necessitate supplementation of breastfeeding?
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What guidance is provided regarding medications during breastfeeding?
What guidance is provided regarding medications during breastfeeding?
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What is an indication for a frenulotomy in a baby with tongue tie?
What is an indication for a frenulotomy in a baby with tongue tie?
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What duration can breastmilk jaundice typically last?
What duration can breastmilk jaundice typically last?
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Which of the following is NOT recommended for a mother on chemotherapy?
Which of the following is NOT recommended for a mother on chemotherapy?
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What assessment is suggested for infants presenting feeding difficulties associated with tongue tie?
What assessment is suggested for infants presenting feeding difficulties associated with tongue tie?
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What is a key benefit of allowing mothers and infants to remain together 24 hours a day after childbirth?
What is a key benefit of allowing mothers and infants to remain together 24 hours a day after childbirth?
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What should be avoided when feeding breastfeeding infants to ensure better breastfeeding practices?
What should be avoided when feeding breastfeeding infants to ensure better breastfeeding practices?
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Which practice is essential for promoting breastfeeding initiation shortly after birth?
Which practice is essential for promoting breastfeeding initiation shortly after birth?
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Which of the following statements best reflects the goals of a breastfeeding policy in healthcare?
Which of the following statements best reflects the goals of a breastfeeding policy in healthcare?
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What is one of the important roles of lactation consultants in supporting breastfeeding mothers?
What is one of the important roles of lactation consultants in supporting breastfeeding mothers?
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In terms of environmental factors, what is recommended to reduce maternal stress for breastfeeding mothers?
In terms of environmental factors, what is recommended to reduce maternal stress for breastfeeding mothers?
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What is the purpose of breastfeeding support groups after mothers are discharged from the hospital?
What is the purpose of breastfeeding support groups after mothers are discharged from the hospital?
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What is the recommended practice regarding the use of supplementary food for newborns in a breastfeeding-promoting environment?
What is the recommended practice regarding the use of supplementary food for newborns in a breastfeeding-promoting environment?
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Which of these techniques can be used to support breastfeeding in the NICU?
Which of these techniques can be used to support breastfeeding in the NICU?
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Nipple pain during the first few days of breastfeeding is:
Nipple pain during the first few days of breastfeeding is:
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Which of the following is NOT a recommended way to treat cracked nipples?
Which of the following is NOT a recommended way to treat cracked nipples?
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Mastitis is a condition that causes inflammation of the breast and is most common:
Mastitis is a condition that causes inflammation of the breast and is most common:
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Which of these is a potential cause of prolonged jaundice in infants?
Which of these is a potential cause of prolonged jaundice in infants?
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What is the primary reason for recommending regular milk expression with a breast pump?
What is the primary reason for recommending regular milk expression with a breast pump?
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Why is it important to make sure the baby’s nose is positioned to the nipple when latching?
Why is it important to make sure the baby’s nose is positioned to the nipple when latching?
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Which of the following is NOT a common symptom of mastitis?
Which of the following is NOT a common symptom of mastitis?
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Which of the following is LEAST likely to delay lactation after delivery?
Which of the following is LEAST likely to delay lactation after delivery?
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Which of the following is NOT a characteristic of foremilk?
Which of the following is NOT a characteristic of foremilk?
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What is the primary reason for a mother’s prolactin levels to be higher at night?
What is the primary reason for a mother’s prolactin levels to be higher at night?
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Which of the following is a common breastfeeding pattern observed in infants between Day 2 and Day 3?
Which of the following is a common breastfeeding pattern observed in infants between Day 2 and Day 3?
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Which of the following factors could potentially interfere with an infant's ability to suckle effectively?
Which of the following factors could potentially interfere with an infant's ability to suckle effectively?
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Which of the following statements best describes the difference between colostrum and mature milk?
Which of the following statements best describes the difference between colostrum and mature milk?
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What is the primary indicator of adequate breast milk intake in an infant?
What is the primary indicator of adequate breast milk intake in an infant?
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When should a mother start supplementing her infant with Vitamin D?
When should a mother start supplementing her infant with Vitamin D?
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Flashcards
Oestrogen
Oestrogen
A hormone that develops mammary glands and inhibits lactation during pregnancy.
Oxytocin
Oxytocin
Hormone secreted from the posterior pituitary that promotes milk let down and contraction of smooth muscle.
Human placental lactogen
Human placental lactogen
Hormone produced by the placenta that promotes breast growth and has a Prolactin-like effect.
Stages of Lactogenesis
Stages of Lactogenesis
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Colostrum
Colostrum
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Mature milk
Mature milk
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Foremilk
Foremilk
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Hindmilk
Hindmilk
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Delays to lactation
Delays to lactation
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Maternal risk factors
Maternal risk factors
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Neonatal feeding patterns
Neonatal feeding patterns
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Assessing breast milk intake
Assessing breast milk intake
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Deep latch
Deep latch
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Skin to skin contact
Skin to skin contact
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Regular milk expression
Regular milk expression
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Nipple pain
Nipple pain
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Mastitis
Mastitis
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Cracked nipples
Cracked nipples
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Nipple shields
Nipple shields
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Breastmilk jaundice
Breastmilk jaundice
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Breastfeeding policy
Breastfeeding policy
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Staff training
Staff training
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Breastfeeding initiation
Breastfeeding initiation
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Rooming in
Rooming in
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On-demand breastfeeding
On-demand breastfeeding
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No artificial nipples
No artificial nipples
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Postnatal support
Postnatal support
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Breastfeeding Benefits to Baby
Breastfeeding Benefits to Baby
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Reduce Sudden Infant Death Syndrome
Reduce Sudden Infant Death Syndrome
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Breastfeeding Benefits to Mother
Breastfeeding Benefits to Mother
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Lactation Physiology
Lactation Physiology
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Role of Prolactin
Role of Prolactin
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Environmental Benefits of Breastfeeding
Environmental Benefits of Breastfeeding
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Alveoli Function
Alveoli Function
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Cardiovascular Health Link
Cardiovascular Health Link
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WHO Recommendation
WHO Recommendation
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Breast Anatomy Components
Breast Anatomy Components
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Biliary atresia
Biliary atresia
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Contraindications to breastfeeding
Contraindications to breastfeeding
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Supplementing breastfeeding
Supplementing breastfeeding
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Tongue tie (ankyloglossia)
Tongue tie (ankyloglossia)
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Medications during lactation
Medications during lactation
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Assessment for breast feeding
Assessment for breast feeding
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Frenulotomy
Frenulotomy
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Study Notes
Breastfeeding Overview
- Breastfeeding is beneficial for both mother and baby
- WHO recommends exclusive breastfeeding for the first six months of life
- All healthcare professionals involved with newborns have a responsibility to promote and support breastfeeding
Learning Outcomes
- Describe the benefits of breastfeeding for the baby and the mother
- Explain the anatomy and physiology of breast milk production
- Describe the hormonal mechanisms involved in breast milk production
- Describe normal infant feeding patterns and intake assessment
- Perform an assessment of infant feeding
- Identify common breastfeeding challenges and their management
- Identify information sources for breastfeeding mothers and clinicians
- Apply knowledge to a clinical case study
Why Breastfeed?
- Benefits to Baby:
- Nutritionally complete and the composition changes over time, adapting to the baby's needs
- Prevents necrotizing enterocolitis (NEC) in preterm infants
- Reduces risk of:
- Sudden infant death syndrome (SIDS)
- Gastroenteritis
- Ear and respiratory infections
- Obesity
- Allergies and eczema
- Cardiovascular disease in adulthood
- Facilitates maternal-infant bonding
- Benefits to Mother:
- Reduces risk of:
- Breast cancer
- Ovarian cancer
- Type 2 diabetes
- Osteoporosis
- Increases calorie consumption and assists weight loss
- Uterus returns to pre-pregnancy size more quickly
- Relative infertility during lactation facilitates pregnancy spacing in developing countries
- Financial benefit (free)
- No need for formula powder, bottles, or sterilizers
- Reduces risk of:
Breastfeeding Rates
- UNICEF 2018 data shows variations in "ever breastfed" rates across countries
- Examples include: Canada (89%), Sweden (98%), USA (74.4%), Cuba (96.2%), Russia (92%), China (96.1%). Data varying by country
WHO Recommendations
- Globally, 41% of infants receive at least some breast milk
- In Ireland (2016), 56.9% of infants received any breast milk and 46.3% received exclusive breastfeeding
- Only 15% of infants globally receive exclusive breastfeeding for the first 6 months .
Lactation
- A period of milk production
- Breasts contain:
- Areola
- Nipple
- Ducts
- Glandular tissue (alveoli lined with lactocytes)
Breast Anatomy
- Alveoli produce milk, which is released into the alveolus
- Alveoli enclosed by smooth muscle cells which contract in response to oxytocin, secreting milk into lactiferous ducts
- Lactiferous ducts flow into sinuses that open on the nipple
Physiology of Lactogenesis
- Inhibitors: Progesterone, Estrogen, Human Placental Lactogen
- Stimulators: Prolactin, Oxytocin
- Prolactin is produced in the anterior pituitary & stimulates mammary gland growth and milk production
- Oxytocin is produced in the posterior pituitary & stimulates milk ejection (let-down) in response to suckling
Stages of Lactogenesis
- Stage I: Colostrum production (initial few days) - small volumes, high protein content
- Stage II: Milk production (after colostrum) - dependent on breast emptying and infant suckling- average of 500-600mls/day
What's in Breast Milk?
- Composition: Approximately 86-88% water, remaining components including: Fat (4%), Carbohydrates (7%), Protein (1%), Vitamins & Minerals (0.2%) and Prebiotics (0.5-2%)
- Colostrum: Rich in protein and immunoglobulins, secreted first and in limited volumes
- Mature Milk: Transitions over 72 hours, contains varying lactose and protein amounts (fats high in hindmilk)
Delays to Lactation
- Caesarean Section: milk production may be delayed by 24 hours
- Postpartum hemorrhage
- Retained placenta
- Maternal risk factors: gestational diabetes, PCOS
- Infant unable to suckle effectively: unwell infant, premature infant, congenital malformation (e.g., cleft palate), neurological problems
- Breast reduction or augmentation may interfere with breast tissue, particularly if nipple placement is disrupted
Early Neonatal Feeding Patterns
- Latch within the first hour of life (hand expression if needed)
- Infant will find the breast based on smell and color
- 4-6 hours: alert with strong suck
- 18-24 hours: sleepy
- Day 2-3: cluster feeding overnight (prolactin levels higher), constant feeding
How to Tell When a Baby Wants to be Fed
- Early cues: stirring, mouth opening, mouth searching/rooting
- Mid cues: stretching, increased movement, hand-to-mouth
- Late cues: crying, agitated body movements, reddening skin
How to Know if a Baby is Getting Enough Breast Milk
- Observe baby feeding cues
- Monitor urine and stool output
- Monitor weight gain
Assessment of Breast Milk Intake
- Urine: Should pass at least 1 wet nappy in the first 24 hours, 2-3 wet nappies by day 2 and 3-4 wet nappies by day 3 or more with daily increases; 6-8 or more per day from day 5
- Stool: Meconium in first 24 hours, should transition to seedy, by days 2-4 and should continue with normal stools daily
- Weight: Infants lose around 10% of birth weight after delivery, recovering to near birth weight within 2 weeks
Common Breastfeeding Challenges
- Nipple pain (and cracked nipples)
- Mastitis (inflammation of the breast)
- Breastmilk jaundice (prolonged jaundice > 2 weeks)
When is Breastfeeding Contraindicated?
- Maternal HIV infection (developed world)
- Galactosemia
- Mother receiving chemotherapy
Medications and Breastfeeding
- Most maternal medications can be taken while breastfeeding
- Check drug-specific information from resources like Hale's Medications and Mothers' Milk or the LactMed database
Tongue Tie and Breastfeeding
- Most babies with tongue ties can breastfeed successfully
- Tongue tie (ankyloglossia) can make feeding difficult if assessment shows it as problematic- may need surgery at 2-3 weeks old
Supporting Breastfeeding Mothers
- Antenatal: Breastfeeding/antenatal classes
- In Hospital: Midwife, Doctor, Lactation Consultant, Health Care Assistant
- Post Discharge: Partner, Community Breastfeeding Groups, Public Health Nurse, Lactation Consultant, Hospital breastfeeding support classes
Environment
- Baby should room in with their mother
- Limit visitors during early postnatal period
- Reduce maternal stress
- Comfortable positions, feeding pillows, skin-to-skin contact
Methods to help latch the baby
- Bring the baby to the breast
- Position baby's stomach facing to mum's stomach
- Baby's nose to nipple, ears, shoulders, and hips in line
- Lead with Chin
- Nipple at soft palate (deep latch)
Breastfeeding Positions
- Cradle position
- Cross-cradle position
- Football hold
- Laid-back position
- Side-lying position
Breastfeeding in the NICU
- Skin-to-skin contact between mum and baby
- Lactation consultant advice and support
- Regular milk expression using breast pump (every 3 hours, including overnight)
- Latching infants to the breast as quickly as possible.
- Maternal support groups
Case Vignette
- Mary brings her baby for a bloodspot screen and is worried about insufficient milk production as he feeds all the time.
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Description
This quiz covers the essential aspects of breastfeeding, including its benefits for both mother and baby, and the recommendations by WHO. Participants will learn about the anatomy of breast milk production, hormonal mechanisms involved, and common breastfeeding challenges. You'll also gain practical insights through case studies and assessments.