Podcast
Questions and Answers
What is the role of the Montgomery glands during mammogenesis?
What is the role of the Montgomery glands during mammogenesis?
At what stage does Lactogenesis I occur?
At what stage does Lactogenesis I occur?
What initiates the onset of Lactogenesis II?
What initiates the onset of Lactogenesis II?
Which of the following is NOT a common risk factor for delayed onset of Lactogenesis II?
Which of the following is NOT a common risk factor for delayed onset of Lactogenesis II?
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How long after birth does Lactogenesis II begin?
How long after birth does Lactogenesis II begin?
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What does colostrum provide during Lactogenesis I?
What does colostrum provide during Lactogenesis I?
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Which factor may NOT contribute to insufficient mammary tissue?
Which factor may NOT contribute to insufficient mammary tissue?
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What physiological changes define mammogenesis?
What physiological changes define mammogenesis?
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What is the primary benefit of the mother wearing uncomplicated clothes during breastfeeding?
What is the primary benefit of the mother wearing uncomplicated clothes during breastfeeding?
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Which position is described as the most widely used for breastfeeding?
Which position is described as the most widely used for breastfeeding?
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What should the mother do to help the infant properly latch during breastfeeding?
What should the mother do to help the infant properly latch during breastfeeding?
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What technique should the mother use to encourage the baby to open wide for latching?
What technique should the mother use to encourage the baby to open wide for latching?
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During breastfeeding, what should the mother avoid regarding the baby's latch?
During breastfeeding, what should the mother avoid regarding the baby's latch?
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What is one way a mother can ensure comfort for herself while breastfeeding in a sitting position?
What is one way a mother can ensure comfort for herself while breastfeeding in a sitting position?
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What is an important consideration for the comfort of both the mother and newborn during breastfeeding?
What is an important consideration for the comfort of both the mother and newborn during breastfeeding?
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What is the recommended number of feedings for a newborn during the first weeks?
What is the recommended number of feedings for a newborn during the first weeks?
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Which technique is NOT recommended to support breastfeeding?
Which technique is NOT recommended to support breastfeeding?
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What should a mother do if she is uncertain about the newborn's satisfaction after feeding?
What should a mother do if she is uncertain about the newborn's satisfaction after feeding?
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When should a feeding typically end for the newborn?
When should a feeding typically end for the newborn?
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What is the appropriate duration to offer each breast during feeding?
What is the appropriate duration to offer each breast during feeding?
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Why is it important for mothers to experience little stress during feeding?
Why is it important for mothers to experience little stress during feeding?
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What can be a sign that the infant's feeding may need to be adjusted?
What can be a sign that the infant's feeding may need to be adjusted?
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Which professional is NOT listed as a competent advisor for breastfeeding problems?
Which professional is NOT listed as a competent advisor for breastfeeding problems?
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What should be avoided when holding the breast during breastfeeding?
What should be avoided when holding the breast during breastfeeding?
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Breastfeeding patterns vary widely due to which factors?
Breastfeeding patterns vary widely due to which factors?
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What is the role of prolactin during lactogenesis III?
What is the role of prolactin during lactogenesis III?
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Which factor is a hindrance to effective breast feeding?
Which factor is a hindrance to effective breast feeding?
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How is oxytocin related to breastfeeding?
How is oxytocin related to breastfeeding?
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Which of the following describes the effect of stress on the oxytocin reflex?
Which of the following describes the effect of stress on the oxytocin reflex?
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What sensory stimuli can stimulate the oxytocin reflex?
What sensory stimuli can stimulate the oxytocin reflex?
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Lactogenesis III is primarily characterized by:
Lactogenesis III is primarily characterized by:
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What can some mothers feel due to the oxytocin reflex?
What can some mothers feel due to the oxytocin reflex?
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What is a common factor leading to delayed initiation of breastfeeding?
What is a common factor leading to delayed initiation of breastfeeding?
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Which of these statements about the sensory impulse from the nipple is true?
Which of these statements about the sensory impulse from the nipple is true?
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Which of the following is NOT a factor that enhances milk secretion during breastfeeding?
Which of the following is NOT a factor that enhances milk secretion during breastfeeding?
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What role does colostrum play in a newborn's gastrointestinal health?
What role does colostrum play in a newborn's gastrointestinal health?
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What is the primary difference between foremilk and hindmilk?
What is the primary difference between foremilk and hindmilk?
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What is the recommended practice to ensure infants receive adequate hindmilk?
What is the recommended practice to ensure infants receive adequate hindmilk?
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Which of the following components are primarily found in human milk during the first six months?
Which of the following components are primarily found in human milk during the first six months?
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What common barrier affects breastfeeding according to the information provided?
What common barrier affects breastfeeding according to the information provided?
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How does foremilk differ notably in composition compared to hindmilk?
How does foremilk differ notably in composition compared to hindmilk?
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What type of effect does colostrum have on the newborn's elimination process?
What type of effect does colostrum have on the newborn's elimination process?
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Which component is crucial for the growth and brain development of infants found in hindmilk?
Which component is crucial for the growth and brain development of infants found in hindmilk?
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Barriers to effective breastfeeding care can stem from healthcare professionals' lack of which of the following?
Barriers to effective breastfeeding care can stem from healthcare professionals' lack of which of the following?
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What is primarily emphasized in the first six months of breastfeeding regarding nutritional needs?
What is primarily emphasized in the first six months of breastfeeding regarding nutritional needs?
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Study Notes
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.
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Description
Test your knowledge on the processes of mammogenesis and lactogenesis, including the roles of various physiological factors during breastfeeding. This quiz covers important milestones and practical tips for breastfeeding mothers, ensuring a comprehensive understanding of lactation. Challenge yourself and discover more about this essential aspect of maternal health.
