Lactation and Mammogenesis Quiz

Lactation and Breastfeeding Care

• The presentation covers the benefits, physiology, and management of breastfeeding.
• The goal is to provide knowledge and skills about lactation and breastfeeding.
• Global breastfeeding statistics (2005-2012) show high rates of exclusive breastfeeding in some regions but not others.

Benefits of Breastfeeding

• Human milk dynamically supports the infant's immune system, brain development, and attachment with other beings.
• Extensive research highlights both short- and long-term health benefits for mothers and newborns.

Newborn Health Benefits

• Exclusively breastfed infants in the first half-year are less prone to diseases and allergies.
• Human milk contains many antibodies against disease agents.
• It is easily digestible and its composition adapts to the baby's age and needs.
• Breastfeeding reduces the risk of asthma, allergies, sudden infant death syndrome, otitis media, cardiovascular disease, gastrointestinal infections, respiratory conditions, childhood leukemia and lymphomas, and improves cognitive development.

Maternal Health Benefits

• Breastfeeding stimulates uterine involution, reducing postpartum blood loss.
• It enhances mother-infant bonding.
• It reduces the risk of developing breast cancer, ovarian cancer, type II diabetes, metabolic syndrome, hypertension, hyperlipidemia, and cardiovascular disease.

Economic Benefits

• Breastfeeding is readily available, sterile, and has the optimal temperature (saving time, money, and effort).
• Exclusive use of formula leads to increased neonatal morbidity and substantial healthcare costs.

Incidence of Breastfeeding Healthy People Goals

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

Physiology of Milk Production

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

Mammogenesis

• Mammogenesis is the growth of mammary glands.
• During pregnancy, estrogen & progesterone prepare the breasts for lactation, causing enlargement and skin changes.
• Nipples enlarge and Montgomery glands secrete a lubricating substance to protect the nipples and areola, which darkens.
• Internal changes include developing mammary ducts, lobules, and alveoli.

Lactogenesis I

• Lactogenesis I starts around mid-pregnancy, lasting until 1-2 days postpartum.
• Rising prolactin levels during pregnancy trigger colostrum production, which is present from mid-pregnancy.

Lactogenesis II

• Lactogenesis II is the onset of copious milk production 48-72 hours after birth.
• Higher prolactin levels (along with infant suckling) stimulate the breasts for 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 birth
• Premature delivery (including late preterm)
• Insulin-dependent diabetes mellitus

Prolactin "Milk Secretion" Reflex

• Enhancing factors include early initiation, good attachment & effective suckling, and frequent feedings, including night feeds, emptying of breasts, etc
• Hindering factors include delay in initiation, pre-lacteal feeds, bottle feeding, incorrect positioning, painful breasts, Sensory impulse from nipple

Lactogenesis III

• Lactogenesis III is the phase when a woman has established a mature milk supply.
• With autocrine control, prolactin production continues in response to infant suckling & emptying of the breasts.
• Oxytocin is also released in response to suckling, leading to the "let down" or "milk ejection" reflex, numerous times during a feeding.

Oxytocin Reflex

• This reflex is stimulated by loving thoughts of the baby, sound and sight of the baby, and confidence in the mother.
• Inhibited by worry, stress, pain, and doubt.

Lactogenesis III - Additional notes

• Some women feel a heaviness or tingling in the breasts.
• Oxytocin promotes uterine contractions to control postpartum bleeding.
• Leaving milk in the breasts for prolonged periods can decrease milk production.

Summary of Lactation Anatomy and Physiology

• Latch-on and suckling trigger Oxytocin release.
• Milk release, emptying of the breasts, and increased production are all linked.
• Interference with this cycle can decrease milk supply.

Biospecificity of Human Milk

• Human milk is species-specific and changes over time, starting with colostrum (1-5 days postpartum).
• Colostrum evolves into transitional milk (6-13 days postpartum) and then mature milk (14 days and beyond).
• Colostrum is present in the breasts from 12-16 weeks of pregnancy.
• Colostrum, being low in volume, encourages frequent breastfeeding.
• Compared with mature milk, colostrum is higher in protein, sodium, chloride, potassium, and fat-soluble vitamins.
• It is rich in antioxidants, antibodies, interferons, fibronectin, and immunoglobulins (especially immunoglobulin A).
• Colostrum establishes normal bacterial flora in the newborn's gastrointestinal tract, promoting meconium expulsion and reducing bilirubin reabsorption.
• Mature milk composition varies during feeding: Foremilk, low in fat, is produced initially, while hindmilk, high in fat and calories, forms later.
• Hindmilk is critical for growth and brain development in infants.

Nutritional Components

• Human milk contains water, carbohydrates (lactose), protein, fat, and vitamins and minerals.

Barriers to Breastfeeding (Healthcare Professionals)

• Apathy
• Misinformation
• Lack of relevant breastfeeding information in professional training
• Outdated clinical practices

Barriers to Breastfeeding (Hospital Practices)

• Failing to provide sufficient skills-based support to breastfeeding mothers
• Routine separation of mother-infant dyads
• Delaying first feeding
• Formula/water supplementation
• Use of pacifiers
• Absence of adequate staff training
• Lack of breastfeeding policy
• Inappropriate interventions (e.g. supplemental feedings, improper use of pacifiers)

Barriers to Breastfeeding (Lack of Support)

• From partner, peers, and family
• From workplace
• From healthcare professionals

Barriers to Breastfeeding (Societal Attitudes)

• Media portrayals of bottle-feeding as normal
• Commercial pressures on mothers to use formula
• Availability of formula starter kits
• Formula advertising in various media outlets

Ten Steps to Successful Breastfeeding

• Written breastfeeding policy communicated to all healthcare staff
• Train staff in implementing this policy
• Inform all pregnant women about breastfeeding benefits & management

Ten Steps to Successful Breastfeeding (Continued)

• Assist mothers in initiating breastfeeding within an hour of birth
• Show mothers how to maintain lactation when separated from their newborns
• Offer babies only breast milk (unless medically indicated)
• Practice "rooming-in" (mothers & newborns together for 24 hours a day)
• Encourage exclusive breastfeeding
• Do NOT provide artificial nipples or pacifiers

Breastfeeding Management and Technique

• 95% of mothers can breastfeed.
• Breast size is not a determinant for breastfeeding success or milk production.
• Flat or retracted nipples are not a barrier as long as the baby is feeding from the breast.

Breastfeeding Management and Technique (Continued)

• Early & frequent breastfeeding along with skin-to-skin contact promotes optimal breastfeeding
• Breastfeeding should be initiated within an hour of birth.
• Infants demonstrate strong sucking movements immediately after birth, usually peaking at 45 minutes post-birth and then gradually decreasing over 2 hours.

Breastfeeding Management and Technique (Continued)

• Important nursing support from family, midwives, nurses, and doctors is key to successful breastfeeding.

Supporting the Breast

• Historically, mothers have used techniques like scissor holds or c-holds.
• The current emphasis is encouraging mothers to choose the method best for them.
• Even when holding the breast, techniques do not impede or compress the duct system, allowing for proper latching

Frequency and Duration of Breastfeeding

• Feeding frequency depends on the newborn's age, digestive capacity, and how much breast tissue can hold milk, which often vary.
• For the first few weeks, 8-12 feedings per 24 hours are normal,.
• Offer both breasts for at least 10-15 minutes on each session and allow the baby to stay on the breast as long as they desire.

Frequency and Duration of Breastfeeding (Continued)

• In a typical feeding, the baby should feed from the same breast until satisfied/the newborn comes off the breast.
• If unsure, manual expression can help.
• Breastfeeding frequency is important to ensure adequate milk supply. It minimizes soreness, encourages more milk, reduces jaundice, improves weight gain, and increases breastfeeding duration.

Hunger Cues

• These cues may indicate hunger, including rapid eye movements under the eyelids, mouth opening in response to stimulation, sucking movements and mouth/tongue movements, wide-open eyes/alert state, hand-to-mouth movements, and small sounds or sighing.

Common Problems Encountered with Breastfeeding

• Nipple soreness
• Breast engorgement
• Plugged duct
• Mastitis
• Inverted nipple
• Candida albicans

Sore Nipple

• Sore nipples are common when initiating breastfeeding.
• Incorrect latch or position can lead to sore nipples.
• Encourage mothers to air-dry their nipples, avoid tight bra wear, and change nursing pads frequently.

Breast Engorgement

• Breast engorgement occurs between the 2nd and 6th day after delivery, as milk production increases.
• Breasts become full, larger, heavier, and sometimes tender.
• To minimize discomfort, frequent nursing/pumping is beneficial, supplemented with hot packs and hand expression to ease the engorgement.

Plugged Duct

• Breast engorgement can lead to plugged ducts (small, tender breast lumps, pea-sized).
• Symptoms include tenderness, heat, and/or redness possible with/without fever.
• Massaging gently, applying hot packs during/before feedings, alternating the unaffected/affected breast, and thorough emptying, can ease the obstruction.

Mastitis

• Inflammation of the breast tissue (often unilateral); may or may not be due to an infection.
• Presenting symptoms can include fever, aching, chills, swelling, redness, tenderness under the arm, and possibly red streaks.
• Treatment primarily focuses on frequent breastfeeding (including the affected breast), rest, and adequate nutrition.

Candida Albicans

• Burning, shooting pains on the nipple or breasts, in addition to skin changes, like shiny/flaky nipple/areola, can suggest Candida albicans infection.
• Treatment may be topical or systemic and should include mother and child.

Lactation Suppression

• In non-breastfeeding mothers, leakage and breast pain can occur 1-3 days after birth.
• Engorgement occurs between 1-4 days post-birth
• Cold packs, breast binders, avoiding stimuli, and topical/systemic medication can aid in suppression.

Milk Expression and Breast Pumps

• Breast pumps and hand expression help stimulate and sustain lactation when spontaneous initiation is unsuccessful.
• Proper sizing of breast pump parts is essential to prevent nipple problems.
• An aseptic collection and storage technique is vital. (cleanliness is key).
• Frequent pumping (8-12 times per 24 hours), even when milk supply is high, is beneficial.

Safe Preparation and Storage of Expressed Breast Milk

• Proper handwashing before handling expressed breast milk.
• Clean storage containers with tight lids.
• Labeling and storing oldest to newest.

Milk Storage Guidelines

• Appropriate temperatures and safe durations for storage (refrigerator/freezer).

Cup Feeding a Baby

• Technique for feeding infants with cups.

Safely Thawing Breast Milk

• Avoid thawing milk in a microwave.
• Safely thaw in warm water

Breastfeeding Technique (initiation, position, correct latch on)

• Initiate breastfeeding soon after birth.
• Comfortable positions (cradle, cross-cradle, clutch/football, lying-down).
• Correct latch is key for successful breastfeeding – visible areola in the baby’s mouth is important.

Observations Indicating Correct Latch On

• Flared lips
• Absence of clicking or smacking sounds
• No dimpling of cheeks
• Visible movement of muscles above & in front of earlobe
• Equal cheek contact with breast
• Chin touching breast
• Full areola in mouth

Signs of Adequate Intake

• Assess the baby's weight gain, moist/swollen mucous membranes, and elimination pattern (urine color and bowel movements).

The perfect match: quantity of colostrum and newborn stomach capacity.

• Newborn stomach capacity is typically 20 mL, equivalent to 4 teaspoons.
• A 1-year-old, on the other hand, may accommodate 200 mL (40 teaspoons).

References

• List of references are provided.