Breastfeeding Overview and Benefits
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Questions and Answers

What is the main role of Oxytocin in lactation?

  • Promotes uterine contractions after delivery
  • Facilitates the release of milk from the breasts (correct)
  • Inhibits milk production during pregnancy
  • Stimulates the production of milk in the mammary glands
  • Which of the following hormones is primarily responsible for the development of the ductal system in the mammary glands?

  • Human placental lactogen
  • Progesterone
  • Oxytocin
  • Oestrogen (correct)
  • Which stage of lactogenesis is characterized by the production of colostrum?

  • Stage III
  • Stage I (correct)
  • Stage II
  • Stage IV
  • Which of the following is NOT a characteristic of colostrum?

    <p>High fat content (B)</p> Signup and view all the answers

    Which of the following statements correctly describes the role of Human Placental Lactogen (hPL) in lactation?

    <p>hPL has a prolactin-like effect on breast growth, contributing to the preparation for lactation (B)</p> Signup and view all the answers

    Which of the following benefits of breastfeeding is not related to the mother's health?

    <p>Reduces the risk of Sudden Infant Death Syndrome (A)</p> Signup and view all the answers

    Based on the UNICEF data provided, which country has the highest rate of breastfeeding for the first 6 months of life?

    <p>Guinea (D)</p> Signup and view all the answers

    What is a potential negative consequence of the frequent and relatively high levels of progesterone during pregnancy?

    <p>Inhibition of lactation (C)</p> Signup and view all the answers

    Which of the following structures is directly responsible for producing milk?

    <p>Alveoli (D)</p> Signup and view all the answers

    According to the content provided, which environmental benefit is associated with breastfeeding?

    <p>Reduced waste from formula production and packaging (A)</p> Signup and view all the answers

    Based on the information provided, which hormone is directly involved in the release of milk from the alveoli into the lactiferous duct?

    <p>Oxytocin (C)</p> Signup and view all the answers

    What is the most likely explanation for the higher rates of breastfeeding in the developing world compared to developed countries?

    <p>Developed countries have better access to infant formula (B)</p> Signup and view all the answers

    Based on the information provided, what can we conclude about the effects of breastfeeding on the mother's uterus?

    <p>It accelerates the return of the uterus to its pre-pregnancy size (B)</p> Signup and view all the answers

    Which of the following is NOT a benefit of breastfeeding for the infant, as mentioned in the information provided?

    <p>Increased risk of obesity (C)</p> Signup and view all the answers

    Based on the given information, what is the primary function of prolactin in relation to breastfeeding?

    <p>Stimulating the production of milk in the alveoli (A)</p> Signup and view all the answers

    What is the primary condition under which breastfeeding is contraindicated?

    <p>Maternal HIV infection (B)</p> Signup and view all the answers

    What is breastmilk jaundice primarily associated with?

    <p>Unknown substances in breast milk (C)</p> Signup and view all the answers

    Which of the following conditions may necessitate supplementation of breastfeeding?

    <p>Severe neonatal jaundice requiring treatment (B)</p> Signup and view all the answers

    What guidance is provided regarding medications during breastfeeding?

    <p>Most maternal medications can be taken (D)</p> Signup and view all the answers

    What is an indication for a frenulotomy in a baby with tongue tie?

    <p>Maternal nipple pain and infant's inability to maintain a latch (C)</p> Signup and view all the answers

    What duration can breastmilk jaundice typically last?

    <p>3 to 12 weeks (C)</p> Signup and view all the answers

    Which of the following is NOT recommended for a mother on chemotherapy?

    <p>Breastfeeding the infant (A)</p> Signup and view all the answers

    What assessment is suggested for infants presenting feeding difficulties associated with tongue tie?

    <p>Lactation assessment (A)</p> Signup and view all the answers

    What is a key benefit of allowing mothers and infants to remain together 24 hours a day after childbirth?

    <p>It promotes better bonding and breastfeeding success. (B)</p> Signup and view all the answers

    What should be avoided when feeding breastfeeding infants to ensure better breastfeeding practices?

    <p>Providing artificial teats or pacifiers. (A)</p> Signup and view all the answers

    Which practice is essential for promoting breastfeeding initiation shortly after birth?

    <p>Help mothers initiate breastfeeding within one half-hour of birth. (D)</p> Signup and view all the answers

    Which of the following statements best reflects the goals of a breastfeeding policy in healthcare?

    <p>To train healthcare staff to implement necessary breastfeeding practices. (C)</p> Signup and view all the answers

    What is one of the important roles of lactation consultants in supporting breastfeeding mothers?

    <p>To assist mothers in maintaining lactation even if separated from the infant. (B)</p> Signup and view all the answers

    In terms of environmental factors, what is recommended to reduce maternal stress for breastfeeding mothers?

    <p>Create a comfortable feeding environment. (B)</p> Signup and view all the answers

    What is the purpose of breastfeeding support groups after mothers are discharged from the hospital?

    <p>To offer emotional and practical support for breastfeeding. (C)</p> Signup and view all the answers

    What is the recommended practice regarding the use of supplementary food for newborns in a breastfeeding-promoting environment?

    <p>Only use breastmilk unless medically indicated. (D)</p> Signup and view all the answers

    Which of these techniques can be used to support breastfeeding in the NICU?

    <p>Using a breast pump to express milk regularly (D)</p> Signup and view all the answers

    Nipple pain during the first few days of breastfeeding is:

    <p>Usually harmless and resolves on its own (D)</p> Signup and view all the answers

    Which of the following is NOT a recommended way to treat cracked nipples?

    <p>Using nipple shields for all feedings (D)</p> Signup and view all the answers

    Mastitis is a condition that causes inflammation of the breast and is most common:

    <p>During the postpartum period, especially while breastfeeding (A)</p> Signup and view all the answers

    Which of these is a potential cause of prolonged jaundice in infants?

    <p>Breast milk jaundice (C)</p> Signup and view all the answers

    What is the primary reason for recommending regular milk expression with a breast pump?

    <p>To stimulate the mother's milk ducts (A)</p> Signup and view all the answers

    Why is it important to make sure the baby’s nose is positioned to the nipple when latching?

    <p>To ensure proper latching and maximize milk flow (C)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of mastitis?

    <p>Diarrhea (C)</p> Signup and view all the answers

    Which of the following is LEAST likely to delay lactation after delivery?

    <p>Gestational diabetes mellitus (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of foremilk?

    <p>Rich in fat (D)</p> Signup and view all the answers

    What is the primary reason for a mother’s prolactin levels to be higher at night?

    <p>To optimize milk production (D)</p> Signup and view all the answers

    Which of the following is a common breastfeeding pattern observed in infants between Day 2 and Day 3?

    <p>Infants cluster feed overnight. (A)</p> Signup and view all the answers

    Which of the following factors could potentially interfere with an infant's ability to suckle effectively?

    <p>An infant with a congenital malformation such as a cleft palate (B)</p> Signup and view all the answers

    Which of the following statements best describes the difference between colostrum and mature milk?

    <p>Colostrum is higher in protein and immunoglobulins, while mature milk is higher in fat. (B)</p> Signup and view all the answers

    What is the primary indicator of adequate breast milk intake in an infant?

    <p>Regular bowel movements and urination. (C)</p> Signup and view all the answers

    When should a mother start supplementing her infant with Vitamin D?

    <p>Until the infant is one year old. (D)</p> Signup and view all the answers

    Flashcards

    Oestrogen

    A hormone that develops mammary glands and inhibits lactation during pregnancy.

    Oxytocin

    Hormone secreted from the posterior pituitary that promotes milk let down and contraction of smooth muscle.

    Human placental lactogen

    Hormone produced by the placenta that promotes breast growth and has a Prolactin-like effect.

    Stages of Lactogenesis

    The process of milk production involving two key stages: colostrum production and mature milk production.

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    Colostrum

    The initial milk produced, rich in protein and low in volume, formed in Stage 1 of lactogenesis.

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    Mature milk

    Milk that transitions from colostrum after approximately 72 hours, providing essential nutrients and hydration.

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    Foremilk

    The watery milk delivered at the start of a feed, rich in lactose and protein, important for hydration.

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    Hindmilk

    The creamy, rich milk delivered at the end of a feed, high in fat and important for satiety.

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    Delays to lactation

    Factors that can delay milk production, including C-section and maternal health issues.

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    Maternal risk factors

    Conditions such as gestational diabetes or breast surgery that can impact milk production.

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    Neonatal feeding patterns

    Feeding behaviors of infants, including alertness and cluster feeding, especially at night.

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    Assessing breast milk intake

    Ways to determine if a baby is getting enough breast milk, including observing urine and stool output.

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    Deep latch

    Positioning where the nipple reaches the soft palate of the baby.

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    Skin to skin contact

    Holding the baby on the mother's chest to promote bonding and breastfeeding.

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    Regular milk expression

    Using a breast pump every 3 hours to stimulate milk production.

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    Nipple pain

    Common discomfort experienced by mothers in the early days of breastfeeding.

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    Mastitis

    Inflammation of the breast, can be infective or non-infective.

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    Cracked nipples

    Condition of broken skin on the nipple, often due to poor latch.

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    Nipple shields

    Devices that help breastfeeding for flat nipples, but can risk incomplete emptying.

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    Breastmilk jaundice

    Prolonged jaundice in infants due to breastmilk, lasting over 2 weeks.

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    Breastfeeding policy

    A formal guideline communicated to healthcare staff about breastfeeding practices.

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    Staff training

    Training provided to healthcare staff to equip them with the skills to support breastfeeding.

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    Breastfeeding initiation

    The action of helping mothers start breastfeeding within 30 minutes after birth.

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    Rooming in

    Practice of keeping mothers and infants together 24 hours a day.

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    On-demand breastfeeding

    Encouraging mothers to breastfeed whenever the baby shows hunger cues.

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    No artificial nipples

    Prohibition of using pacifiers or teats for breastfeeding infants.

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    Postnatal support

    Support provided to mothers after leaving the hospital, including groups and consultants.

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    Breastfeeding Benefits to Baby

    Nutritionally complete, prevents NEC, reduces various health risks.

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    Reduce Sudden Infant Death Syndrome

    Breastfeeding is linked to lower risk of SIDS in infants.

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    Breastfeeding Benefits to Mother

    Reduces cancer risks, aids in weight loss, helps uterus recovery.

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    Lactation Physiology

    Milk is produced in alveoli, released into ducts and out through the nipple.

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    Role of Prolactin

    Stimulates milk production in the breasts post-delivery.

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    Environmental Benefits of Breastfeeding

    No production waste; no packaging or transport needed.

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    Alveoli Function

    Structures where milk is produced and stored before secretion.

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    Cardiovascular Health Link

    Breastfeeding reduces the risk of heart disease in adulthood.

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    WHO Recommendation

    Exclusive breastfeeding recommended for the first six months.

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    Breast Anatomy Components

    Includes areola, nipple, ducts, and glandular tissue for milk production.

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    Biliary atresia

    A condition affecting the bile ducts that can lead to liver damage if untreated.

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    Contraindications to breastfeeding

    Situations where breastfeeding should not occur, such as maternal HIV or certain metabolic disorders.

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    Supplementing breastfeeding

    Using additional feeding methods when breastfeeding is inadequate, such as formula or donor milk.

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    Tongue tie (ankyloglossia)

    A condition where the lingual frenulum restricts tongue movement, potentially affecting breastfeeding.

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    Medications during lactation

    Most medications are safe to take during breastfeeding; evaluate risks and benefits individually.

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    Assessment for breast feeding

    Evaluating factors like tongue tie or maternal pain to ensure successful breastfeeding.

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    Frenulotomy

    A minor surgical procedure performed to correct a tongue tie in infants.

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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

    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.

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