Lactation Education

What Does an IBCLC Do?

* An IBCLC is a healthcare professional trained to provide clinical expertise in management of lactation pregnancy through weaning * The IBCLC, like lactation educator, can provide women and their families with basic breastfeeding education on the normal course of breastfeeding * The IBCLC also has the clinical expertise to assist mother/baby dyads with more complex breastfeeding problems, including but not limited to assisting a mother/baby dyad when: - The mother has a low milk supply - The breastfed infant is not adequately gaining weight - The infant and/or mother has a medical problem

Some hand-held foods fed to infants included:

* Another mammals milk including: cow, goat, sheep, donkey, or camel (depended on the animal available and where you lived). * Pap, gruel and panada (foods prepared by using bread of cereal soaked in water or milk)

What is "Health Behavior"?

* Any behavior that can impact an individual's health status ⁃ so when we talk about behavior it's something we can observe ‣ Ex: so if I hate eating healthy that's not a behavior that's kind of an attitude of feeling we're talking more about behavior I can actually hate eating healthy but I may still do it. * What we're really focusing on when we talk about health behavior is observable actions that can impact someone's health status

Nipple Types: Babies can latch onto all types of nipples

* Everted * Flat * Inverted

Types of Nipples

* Everted * Flat * Pseudo-Inverted * Inverted * Retracted

What are the 10 steps to successful breastfeeding?

10 practices that are associated with longer exclusive and any breastfeeding durations rates

International Breastfeeding Promotion Efforts: 2010:

1000 Days Challenge

When was WIC established?

1972

Neural tube defects occur at day _____________.

21 - 28

What percent of U.S. births currently occur in "baby-friendly designated facilities?

28% of births

1998: US Breastfeeding Committee had a coalition of more than ___________________________________.

50 organizations that support efforts to create policies and practices that create a landscape of breastfeeding support across the United States.

Breastfeeding burns up to

500 calories a day - That's like 2 hours of aerobic exercise. So, while it's good for your baby breastfeeding is also great for your body.

What is a food check?

A food check that for someone who is on WIC and you can see that they would get it checked and it specifies doesn't really say the exact amount of money but it tells you what they can purchase

Which of the two scenarios described below would make a research study's findings stronger? - A research study that followed women over a 6-month period and measured breastfeeding by asking participants once a week about the frequency and amount of breastfeeding they were doing. - A research study that measured breastfeeding by asking women in their 60s about the frequency and duration of breastfeeding with their now adult child.

A research study that followed women over a 6-month period and measured breastfeeding by asking participants once a week about the frequency and amount of breastfeeding they were doing.

Cultural Competence

A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations

At this time, if a mother could not breastfeed her infant (e.g. maternal death, lactation failure, abandoned infant) what was the safest alternative to breastfeeding?

A wet nurse breastfed the infant

What is a wet nurse?

A wet nurse is a woman who breastfeeds a child who is not her own · Back in ancient times and particularly before the 19th century that was really the only safe alternative to breastfeeding. · If a mother couldn't feed her baby, chose not to feed her baby, we did not have formula, a wet nurse was used

The following is a list of major international breastfeeding initiatives, please match intiatve with the statement that best describes the main goal of the initiative A. The International Code of Marketing of Breast-Milk Substitutes B. Innocenti Declaration C. Baby-Friendly Hospital Initiative D. Global Strategy for Infant and Young Children Feeding E. 1000 Days Challenge To create guidelines for proper distribution of artificial baby milk.

A. The International Code of Marketing of Breast-Milk Substitutes

McClelland's Learned Needs Theory

Achievement, Affiliation, Power

The Three- Step Counseling Strategy: An Effective Tool for Communication about Breastfeeding Concerns Step 2:

Affirm feelings

The American Public Health Association's Recommendation

Affirm that exclusive breastfeeding for 6 months with continues breastfeeding for at least the first 1 to 2 years of life, is the biologic norm and that all alternative feeding methods carry health risks in comparison, with rare exceptions

The Impact of the Marketing of Infant Formula on Global Infant Health Outcomes & Breastfeeding Rates

Aggressive and inappropriate marketing strategies used by infant-formula companies had a significant negative impact on breastfeeding rates and infant morbidity and mortality globally. * ↓ Global breastfeeding rates * ↑ Global infant morbidity & mortality

What is the additional caloric requirement for the second trimester?

Approximately 340

What is the additional caloric requirement for the third trimester?

Approximately 450

How long should the mother feed the baby for?

As long as the baby wants to eat

How Do You Know When a Baby Is Full?

Babies tell you when they are satiated. ❖ Signs of a satiated baby: ▪︎ Baby ends the feeding on his own ▪︎ Baby's hands are relaxed ▪︎ Baby may drift off to sleep

How frequently do breastfed babies under 4 months eat in a 24-hour period?

Between 8 and 12 times

Please identify the health enhancing behavior listed below that is associated with a reduction in the risk of an infant developing sudden infant death syndrome.

Breastfeeding

One of the qualifications for becoming a __________________ is prior personal experience in breastfeeding. a) Public Health Educator b) Lactation Educator c) Breastfeeding Peer Counselor d) International Board Certified Lactation Consultant e) Pediatrician

Breastfeeding Peer Counselor

Currently under the Women Infant and Children (WIC) program,_______________ receive more benefits (e.g., food coupons). a) Formula feeding mothers b) Both formula feeding and breastfeeding mothers receive the same benefits c) Breastfeeding mothers

Breastfeeding mothers

INITIATIVES TO NORMALIZE BREASTFEEDING Goal:

By normalizing breastfeeding, women will no longer need to be embarrassed to breastfeed.

The following is a list of major international breastfeeding initiatives, please match intiatve with the statement that best describes the main goal of the initiative A. The International Code of Marketing of Breast-Milk Substitutes B. Innocenti Declaration C. Baby-Friendly Hospital Initiative D. Global Strategy for Infant and Young Children Feeding E. 1000 Days Challenge To promote the use of practices that promote breastfeeding in facilities where mothers give birth.

C. Baby-Friendly Hospital Initiative

HISTORICAL EVIDENCE Medical literature

Dating back all the way back to ancient Egyptian times such as a medical encyclopedia that has suggestions for how to increase milk supply

FAITH IN SCIENCE AND TECHNOLOGY · By the early decades of the 1900s many scientific and technological advances had results in improvements in the public's health (clean water, sanitation, safe food)

Decreased morbidity and mortality rates and improved life expectancy rates * Naturally the public held science and technology in high regards

What are opened ended questions?

Draw information from the mother as there are no right or wrong answers. ▪︎ Help mothers feel safe sharing thoughts and feelings. ▪︎ Avoid making clients feel interrogated. ▪︎ Build trust and openness.

The following is a list of major international breastfeeding initiatives, please match intiatve with the statement that best describes the main goal of the initiative A. The International Code of Marketing of Breast-Milk Substitutes B. Innocenti Declaration C. Baby-Friendly Hospital Initiative D. Global Strategy for Infant and Young Children Feeding E. 1000 Days Challenge To implement interventions that improve the nutrients a child receives from the time he or she is in utero through his or her second birthday.

E. 1000 Days Challenge

The Three- Step Counseling Strategy: An Effective Tool for Communication about Breastfeeding Concerns Step 3

Educate to target concerns

Vroom's Expectancy Theory

Effort, performance, outcome

HISTORICAL EVIDENCE Statues

Egyptian goddesses - on the slide is Isis who is breastfeeding her son Boris - the Egyptians believed that breast milk was something that would provide spiritual food and immortality

What is this mom's concern? I only want to breastfeed at home

Embarrassment of public breastfeeding

What is this mom's concern? I want to pump and put it in a bottle.

Embarrassment of public breastfeeding

A set of moral principles or values that defines right and wrong for a person or group are called: a) Ethics b) Professionalism c) Code of conduct d) Best practices

Ethics

What is ethnography?

Ethnography is the study of other cultures

Alderfer's ERG theory

Existence, relatedness, growth

T/F: Newborns' sleep patterns are the same as adults'.

FALSE. When newborns initially fall asleep, they go through light sleep. After about 30 minutes, they enter deep sleep. For adults it is the opposite. When adults fall asleep, they first go through deep sleep and then afterwards light sleep.

T/F: The only reason infants cry is to communicate that they are hungry.

FALSE. Infants cry to communicate a variety of needs, including hunger.

T/F: When a breastfed baby cluster feeds, it almost always means his or her mom is not producing enough milk.

FALSE. It is normal for the breastfed baby to cluster feed

Flat Nipple

Flat at rest and when touched

Hand-held foods:

Food other than breastmilk given to a baby using ones' hand or a hand-held device (i.e., ancient day bottle). - Hand-held foods were typically either fed with someone's hand or a horn repurposed as a baby feeding device

Which word describes "It is not what you say to someone, it is how you say it?" a) Framing b) Negotiating c) Collaborating d) Persuading

Framing

What is "Healthy People"?

Healthy People is a document that includes National health Objective - focused on improving the health of all Americans - Essentially these are the benchmarks for our nation to work towards and there is many many health objectives focused on a variety of health outcomes including breastfeeding

Turn the following closed ended questions into open ended questions "Have you talked to your mother about breastfeeding?"

How does your mother feel about breastfeeding?

Are the following tasks within the Lactation Educator's or the IBCLC's scope of practice? Helping a mother with a 2-week-old baby establish breastfeeding after her baby's pediatrician told her that the baby was not gaining enough weight:

IBCLC

In 2018, the WHO & UNICEF revised the implementation plan to help facilities that provide maternity and newborn services to implement the BFHI

Implementation guide called, "Protecting Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Service the Revised Baby Friendly Hospital Initiative".

Why Do Infants Cry?

Infants cry to communicate what they need.

THE CREATION OF THE ARTIFICIAL BABY MILK INDUSTRY · By 1883 there were 27 patented brands of artificial baby milk formulas

Initially these formulas lacked valuable nutrients such as protein, vitamins and minerals

International Breastfeeding Promotion Efforts: 1990:

Innocenti Declaration

Match the characteristics listed below, with the correction development phase of the mammary gland: Occurs approximately 40 days after the last breastfeeding

Involution

Galactopoessis

Is the establishment of lactation

The American Dietetic Association's Position Statement:

It is position of the American Dietetic Association that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of like and breastfeeding with complementary foods

The Healthy People 2020 breastfeeding objectives focus attention of tracking progress toward reducing major barriers to breastfeeding. Which barrier to breastfeeding listed below attempts to address the following Healthy People 2020 objective, "To increase the proportion of employers that have worksite lactation support programs to 38%?" a) Lack of employer support for lactation b) Formula supplementation before the mother has established her milk supply c) Hospital policies that hinder breastfeeding

Lack of employer support for lactation

What is this mom's concern? I don't know anyone in my family who hasever done that before.

Lack of support

The breast are also know as ___________.

Mammary gland (an endocrine organ)

Match the characteristics listed below, with the correction development phase of the mammary gland: Occurs during puberty

Mammogenesis:

"I've heard that breastfeeding hurts." Why do you think many women have this belief?

Many women have heard from their family members or friends that breastfeeding hurts

In the American College of Healthcare Code of Conduct all of the following entities are addressed EXCEPT? a) Patients b) Employees c) None of the above d) The Organization

None of the above

1998: US Breastfeeding Committee is a :

Nonprofit organization that formed in response to the Innocenti Declaration - called for breastfeeding coordinators in every country and so the Breastfeeding committee has a coordinator and this is focused on promoting and protecting breastfeeding throughout the US

When should you switch breasts?

Only after the baby stops breastfeeding on the first breast and wants to eat more

Which is a barrier to good communication? a) Feedback b) Clarity c) Perceptions d) Relationship established

Perceptions

Maslow's Hierarchy of Needs

Physiological, safety and security, belonging and friendship, esteem and recognition, self-actualization

Cultural competence is a set of behaviors, attitudes and ___________ that enables effective work in cross-cultural situations. a) skills b) procedures c) policies d) beliefs

Policies

How Affirmation Helps Build Connection

Reassures the client that his/her feelings are not unusual and that you are not shocked to hear them. ▪︎ Builds confidence and self-respect. ▪︎ Helps the client relax and feel safe, which builds trust in you and your information. ▪︎ Does not imply you are agreeing with her/his choices.

Biological variation includes all of the following EXCEPT: a) Religion b) Skin color c) Facial shape d) Stature

Religion

Which dimension is NOT included in practicing cultural humility? a) Self-critique b) Self-reflection c) Self-awareness d)Self-involvement

Self-involvement

Verbal communication: a) Relies on both language and emotion b) Used to inform, inquire, argue, and discuss topics c) Fosters better relationships d) Sets the tone of the conversation

Sets the tone of the conversation

Why Do Newborns Eat So Often? ❖ Developing brains requires regular and frequent caloric energy.

Since babies' main job is to grow, they need to eat frequently.

What is the impact of low intake of Vitamin B12 on breastmilk?

Since vitamin B12 crosses the placenta during pregnancy and is present in breast milk, exclusively breastfed infants of women who consume no animal products may have very limited reserves of vitamin B12, and possibly become deficient

Nipples vary in _________________________.

Size, shape and type

MARKETING OF ARTIFICIAL BABY MILK · (1981) In response, the World Health Organization (WHO) adopted the International Code of Marketing of Breast-Milk

Standards for appropriate marketing and distribution of human milk substitutes and formula

Everted Nipple:

Sticks out at rest, and more so when touched - if you were to stimulate the breast or if the mom got pulled, it would stick out a little bit more

HISTORICAL EVIDENCE Religious documents

Such as the Quran and the Talmud that advocate that women breastfeed their children for at least the first two years of life

True or false? Folates most well-known role is in the prevention of neural tube defects.

TRUE

Step 3: Educating, Using Carefully Targeted Messages that Address the Client's Concern

Target information to the client's concerns ‣ Feed information in small bites ‣ Give 2-3 simple options ‣ Provide the client with solutions that fit their lifestyle ‣ Reinforce the information

Turn the following closed ended questions into open ended questions "Are you going back to work or school after the baby is born?"

Tell me about your plans for after the baby is born?

International Breastfeeding Promotion Efforts: 1981

The International Code of Marketing of Breast-Milk Substitutes

During some periods of time, using a wet nurse was more popular than during other time:

The Middle Ages - It was not very popular to breastfeed The 17th century - It was much more popular to choose not to breastfeed and to hire a wet nurse

Blood Vessels

The breast is highly vascular - 60% of the blood in the breast is supplied by the internal mammary artery and another 30% by the lateral thoracic artery.

1981: THE INTERNATIONAL CODE OF MARKETING OFBREAST-MILK SUBSTITUTES

The first major international initiative focused on promoting, protecting and supporting breastfeeding.

What is the goal of the code?

The goal of the code is "to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeed, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution"

Lymphatics

The lymphatic system collects excess fluids and drains mostly to the axillary lymph nodes

In the United States during the 1950s _______________________played a significant role in women's renewed interest in breastfeeding. a) Advance in science and technology b) The natural childbirth movement c) The creation of infant formula d) Faith in science e) None of the options played a significant role in women's renewed interest in breastfeeding.

The natural childbirth movement

During the 1900s all of the following EXCEPT _______ led to the decline in breastfeeding prevalence rates. a) Women's interest in impacting society outside of their home. b) Marketing of artificial baby milk. c) The natural childbirth movement. e) The public's faith in science and technology. f) Creation

The natural childbirth movement.

Inverted

The nipple shown in the picture above is:

Why Are Professional Organizations Advocating for Mothers to Breastfeed?

There are a number of benefits for babies who are breastfed, as well as for mothers who breastfeed their babies

What is this mom's concern? I won't be able to go anywhere.

Time and social constraints

What is this mom's concern? Since I have to go back to work it won't be worth the bother.

Time and social constraints

THE GOAL OF THE "CODE":

To contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution"

The La Leche League International mission:

To help mothers breastfeed by providing mother-to-mother support and education

Lactogenesis 2: Right after delivery * Endocrine control (i.e., hormonally driven)

Triggered by the delivery of the baby and the placenta • Once the baby is born and the placenta have been delivered there are some changes in the hormones that let the body know the baby is here we need to start to produce mature milk • and some of those hormones that occur: ⁃is that the progesterone rapidly drops: is a hormone that helps with the maintenance of pregnancy. Once the baby is here the body doesn't need all that progesterone ⁃ prolactin rapidly increases ⁃ milk volume increases

True or false: In the documentary Formula Disaster, TV commercials make claims that infant formula can increase an infant's intelligence. a) True b) False

True

Mammogenesis: Childhood

Very limited development in males and females.

What does WIC provide?

WIC provides a variety of services for women and children.

The Reluctant/Sleepy Nurser

When you have a super sleepy baby you do need to wake the baby up and feed them and not wait for feeding them on demand.

When should a breastfeeding mother feed her baby?

Whenever the baby displays signs of hunger

What are the main differences between mother-led breastfeeding and baby-led breastfeeding (i.e., biological nurturing and laid- back breastfeeding)?

With mother-led breastfeeding, the mother is doing the leading and she is controlling the feeding. Not meaning she is telling the baby when to eat, but she is the one who is latching the baby on. Whereas baby led feeding, the mom is letting the baby latch on.

The breast are the only organ that is not fully developed _______________________________.

at birth that can potentially provide both nutrition and nurturing.

Cultural competency is the set of ________________________________.

attitudes, behaviors, and policies that allow a health system to work effectively in cross-cultural situations

Children who receive good nutrition during the "1000 days" have substantially ___________________________.

better health outcomes.

The reason that Cooper's ligaments are important to discuss is that one myth that prevents women from breastfeeding is the erroneous belief that_____________________________.

breastfeeding can make a woman's breasts sag and that's not true - research demonstrates that the Cooper's ligaments are actually what supports the breast. - and during pregnancy, those Cooper's ligaments will begin to stretch and it is the stretching that can cause the breasts to be less supportive and sag more - and so it's not breastfeeding that causes breasts to sag IT IS PREGNANCY

The "Healthy People 1990" document included _______________.

breastfeeding objectives

Unconscious bias contributes to ______________________.

disparities in health care * Can lead to medical errors, over utilization and underutilization of resources, and poor decisions made by patients/clients

Due diligence

do no harm

Health Behavior Change: Knowledge of health benefits linked to a particular health behavior often _________________________.

does not motivate health behavior change

Peer Review Journal Article

essentially means that peers, individuals who are experts in the same field are reviewing the article or manuscript

MARKETING OF ARTIFICIAL BABY MILK Early on the advertising for artificial baby milk made claims that_____________________________.

formula was a perfect substitute for breastmilk

Professionalism

habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served

About _________________________ are enrolled in WIC.

half of all infants born in U.S.

The Breastfeeding report card gathers:

national & state specific data on breastfeeding practices and support including: - Ever breastfed - Breastfeeding at 6 & 12 months - Exclusive breastfeeding at 3 & 6 months - Proportion of births occurring at baby friendly hospital. - Proportion of employers that have worksite lactation support programs - Proportion of breastfeed newborns who receive formula supplementation within the first 2 days of life

Nipple stimulation triggers the posterior pituitary gland to release ______________.

oxytocin

Vegan:

plant sources only

To be designated "baby friendly," hospitals must demonstrate to an external review board that they ______________________________.

practice each of the 10 steps to successful breastfeeding.

ROUTINE BIRTH PRACTICES IN THE 1950S The childbirth movement advocated a _________________________.

radical shift from birthing practices in the 1950s.

Which is NOT a skill associated with critical thinking? a) predict b) react c) explain d) evaluate

react

The code is a set of ________________________.

recommendations that each country must enforce within their own country

Involution: Breast returns to pre-pregnant state Once breastmilk is no longer removed from the breasts, results in _____________________________.

secretory epithelial cell apoptosis ( i.e., cell death).

Initially, all breastfeeding helpers were __________.

unpaid

What triggered a renewed interest in breastfeeding?

• The natural childbirth movement (Wright & Schanler, 2001) - in article the article you read the resurgence of breastfeeding at the end of the second millennium Wright and Schanler reviewed various social practices and breastfeeding data and found to suggest that the practice that most likely contributed to the rise in breastfeeding was the natural childbirth movement

A mom is asking if supplementation is really necessary. What would you tell her?

• While eating more food to meet energy needs and the increased absorption of nutrients that occurs during pregnancy are usually enough to meet the needs for moth nutrients when good food choices are made • However, vitamin and mineral supplementation is routine. Supplementation is helps cover the "nutrition gaps" • Many women consume less than the recommended amounts of calcium, magnesium, zinc, vitamin B6, and folate • It is important to emphasize that vitamin and mineral supplements cannot replace a healthy diet • overall even if a diet is lacking in certain nutrients the perfect milk is still breast milk even in the face of an inadequate diet

"I know breastfeeding is best for my baby, but I am embarrassed to breastfeed in public." How can this barrier influence a mother's decision toinitiate breastfeeding?

• as we talked about before, babies in the early period the first 3 to 4 months they typically eat anywhere from an hour and a half and 3 hours • Logistically, it's impossible for the mom to do anything without having to feed that baby. So, if you are embarrassed to go out in public and feed your baby, you're not going to be able to do anything

How Do You Know When The Link Between Breastfeeding and Health Outcomes Is Strong?

• sample size • meta-analysis • published in a peer review journal article • Study designs • How was breastfeeding measured? • How are back the participants asked to recall the breastfeeding dosage?

❖ What are the signs of hunger?

▪︎ Open mouth ▪︎ Sucking movements ▪︎ Hand to mouth ▪︎ Moving or fidgeting ▪︎ Rooting for a breast ▪︎ Crying (late sign)

On average, breastfeeding has a calorie cost of ______/day for a single baby.

❖ 500 calories/day (on average)

How long should the mother feed her baby for?

❖ Duration of each feeding is determined by the baby

Hindmilk

❖ is what your baby receives at the end of a feeding. ❖ contains more of the fat and calories that your baby needs

Determining When Help Is Needed During the Hospital Stay

❖Give the mom and baby some time to respond to each other. ‣ Remember, they are both learning how to breastfeed.

Breast Changes to Expect During the First Few Weeks of Breastfeeding

❖Normal transient nipple soreness ❖Normal breast fullness ❖Normal leaking

MARKETING OF ARTIFICIAL BABY MILK Aggressive marketing of infant formula contributed to _____________________________________.

declines in breastfeeding prevalence rates worldwide

The breast has many _____________________________.

different parts, each with specific functions that help a mother produce milk for her baby.

Malfeasance

doing something illegal

What are some health-enhancing behaviors that reduce the risk of developing the following health problems? Lung Cancer

smoking cessation: If i am a smoker and I quit I'm gonna reduce my chances of developing lung cancer. Even better if I had never started smoking.

When the breasts become full, the amount of FIL increases and _________________________________.

slows down the production of milk

____________ occurs postpartum day 3 -8

Lactogenesis II

Which is NOT a problem solving challenge? a) Problem defined incorrectly b) Lack of technical skills and knowledge c) Logical thought process d) Poor team participation

Logical thought process

Persistence of effort

concerned with the choices people make about how long they will put out effort

Morals

concerned with the principles or rules of right conduct or the distinction between right and wrong

Which thinking style builds and strengthens relationships? a) explorer b) energizers c) coach d) connectors

connectors

Managerial ethics

dealing with business practices and doing the right thing

Bioethics

dealing with medical issues and patient/client rights

The international Board Certified Lactation Consultant (IBCLC) credential in the field of __________________.

lactation

We used to think that right at the base of the nipple, the lactiferous ducts were enlarged or dilating and that anatomy was referred to as _________________________.

lactiferious sinuses - so the assumption was that the milk duct were slightly dilating right there at the tip so we refer to that as lactiferous. What we recently learned is that there are no lactiferous sinuses.

The Three- Step Counseling Strategy: An Effective Tool for Communication about Breastfeeding Concerns Information comes____________

last!

Anytime then a mother who is pregnant or breastfeeding is interacting with a healthcare professional and asks a question related to breastfeeding, if the healthcare professional doesn't have the accurate knowledge however responds to the mother with information that is not accurate this can ___________________________________.

make it much more challenging for mothers to be successful breastfeeding ⁃ especially since there is an added validity that the health care provider has when a healthcare provider shares health information - typically those who listen are more likely to believe that it's accurate than if the individual wasn't a healthcare provider

Breast surgery or injury can sever nerves and ____________________________.

may affect milk production. - Refer mothers with prior breast surgery to lactation consultant during pregnancy and recommend to mother to follow up with lactation consultant after birth of baby to monitor milk supply.

Galactopoessis Autocrine control

meaning driven by local control not hormones - supply & Demand: Supply is influenced by infant's demand.

Problem Solving in health care often involves the use of _____________________.

metrics and visual indicators

The nipple has many sensory nerve endings which trigger _________________________.

milk release when the baby suckles

As of 2007, WIC participants who breastfeed their infants, received _____________________________.

more benefits than, WIC participants who are formula fed their infants

The less barriers a pregnant woman and her family perceives to breastfeeding, the _______________________________.

more likely she is to initiate breastfeeding when her baby is born

The current breastfeeding recommendations are that

mothers exclusively breastfeed their infant for the first 6 months life and add complimentary foods at six months and continue to breastfeed for at least one year.

Main duct are located at the end of the ______________________.

nipple base • Between 4 and 18 milk duct openings or nipple pores at the end of the nipple from which the baby can receive milk.

Women with insufficient glandular tissue often report _______________________________.

no breast changes during pregnancy - No breast changes during pregnancy are a red flag that the mother may have problems with milk supply once her baby is born. - Refer to lactation consultant during pregnancy and recommend that mother follow up with the lactation consultant after the birth of her baby to monitor her milk supply.

Lactiferous Ducts

▪︎ Duct that lead to the openings in the nipple ▪︎ These ducts transport milk to baby

Which stage of problem solving comes next; Identify, Explore, Set goals...? a) Evaluate b) Implement c) Select the correct alternatives d) Look for alternatives

Look for alternatives

How can obesity affect breastfeeding? During Pregnancy:

- Spontaneous miscarriage - Birth defects - Limitations to ultrasound - Gestational dibetes - Hypertensive disease - Stillbirth - Fetal growth abnormalities

Steps to reducing barriers to breastfeeding include:

* Determining whether the woman and her family perceive any barriers to breastfeeding. * Providing the woman and her family with strategies to overcome barriers they perceives to breastfeeding. * Ensuring that the woman and her family have accurate knowledge about breastfeeding. * Dispel breastfeeding myths she and her family may believe.

Key factors influencing establishment and continued production of milk production

1. Breast stimulation and frequent and effective milk removal 2. Sufficient glandular tissue 3. Enough intact nerve pathways and milk ducts

World leaders including the Gates Foundation issued the ____________________.

"1000 Day Challenge".

To further strengthen world attention on infant feeding practices, the WHO and UNICEF collaborated to create the,

"Global Strategy for Infant and Young Child Feeding"

These "10 Steps" were first described in (1989) when the WHO and UNICEF issued a joint statement called,

"Protecting. Promoting, and Supporting." The special role of Maternity Service.

These "10 Steps" are the 10 practices that a ___________________________________.

"baby friendly hospital" must implement to earn this designation of a "Baby Friendly Hospital."

Healthcare and Cultural Competency * American Hospital Association launched a pledge campaign to eliminate health disparities

#123forEquity

In 2017, the WHO and UNICEF revised the 10 steps to successful breastfeeding

(2017) WHO Guidelines: Protecting Promoting and Supporting Breastfeeding in Facilitates Providing Maternity and Newborn Services

The La Leche League International Highlights about the inception of the group and leading to where we are today

* 1956, the founders of La Leche League International held their first meeting in a private home * Later, meetings expanded to churches parenting centers, and various other public venues that provided meeting spaces * Today, La Leche League International has branches all over the world

Cultural Competence Leadership Application(as it applies to patients)

* Differences in culture based on nationality/lineage impact health seeking behavior, diet, communication, and other relevant factors * These factors are necessary to understand how to provide optimal services * We need to understand different cultures to better serve them * There are many emerging majorities - In U.S. by 2050 minority populations will be 54%. Whites will be the minority. (US Census Bureau 2017) - Hispanics leading the increase

Race

* Different from ethnicity. It is biological variation which includes skin color, stature, facial shape, etc... * Hispanics for example identify as a ethnicity rather than a race * White or black are examples of racial identity

Few Key Initiative Implemented to Help Establish the Profession

* 1985: IBLCE administers its first exam: Individuals who pass this exam earn the designation of International Board Certified Lactation Consultant (IBLCE) * On the same year, the first year that the IBLCE exam was administered the group of leaders implemented two other initiatives to help establish a credible profession - 1985: They established an International Lactation Consultant Association (ILCA) is formed - they also began a peer review journal that publishes research in the field of lactation: The Journal of Human Lactation * Today, there are actually three journals that focus exclusively lactation-related research: 1. The Journal of Human Lactation 2. Breastfeeding Medicine 3. The International Breastfeeding Journal *Currently, there are approximately 30,000 professionals in 108 countries who hold the International Broad Certifies Lactation Consultant certification (IBCLC). * So as you can since 1985 when IBCLC exam was first administered the field grown quite substantially and we now have a new health care profession called the lactation consultant

How does the public feel about breastfeeding? Nationwide:

* 57.75% of Americans are comfortable when mothers breastfeed their babies near them in a public place, such as a shopping center, bus station, etc. * 63.74% of Americans believe that mothers should have the right to breastfeed in public places.

Is there a value in other health care professionals obtaining the knowledge, attitudes, and skills necessary to promote breastfeeding?

* ABSOULTELY! * There is a lack of minimal breastfeeding knowledge, attitudes, and skills among health care professionals, and this has been linked to low breastfeeding initiation and duration rates are what makes it difficult for breastfeeding families in the community to obtain the support they need breastfeed successfully

Health Enhancing Behaviors

* Actions that help prevent illness, disability, or injury - we're talking about observable actions that are linked with positive health outcomes.

The Parenchyma (functional Breast tissue)

* Alveoli * Myoepithelial Cells * Lobes * Lactiferous Ducts

STATEMENTS BY PROFESSIONAL HEALTH ORGANIZATIONS Professional health organizations recommend that mothers breastfeed their babies exclusively for the first six months of life, and for at least until 12 months with complementary foods:

* American Academy of Pediatrics * American Dietetic Association * American Public Health Association * American College of Obstetricians and Gynecologists * American College of Nurse-Midwives * Association of Women's Health Obstetric and Neonatal Nurses * National Association of Pediatric Nurse Practitioners * Academy of Breastfeeding Medicine

During pregnancy woman should notice a variety of changes to their breasts including:

* Areola may enlarge and darken * Montgomery glands more visible * Breast may feel tender to touch * Breast may enlarge 1-2 cup sizes * Veins on breast show more

What was The Promotion of Breastfeeding Intervention (PROBIT) key findings?

* At 3 months, 40% of the intervention group was exclusively breastfeeding, compared to 6% of the control group. * At 6 months, 7.9% of the intervention group weas exclusively breastfeeding, compared to 0.6% of the control group. * The impact on health outcomes of the intervention group, compared to the control group: When compared to the control group, the intervention group had: - Significantly higher IQs. - A significantly lower risk of developing diabetes and obesity.

What Are Health Behavior Models/Theories?

* Attempt to explain behavior * Serve as guides or plans for designing health behavior change interventions Examples: - Theory of Planned Behavior - Social Cognitive Theory - Transtheoretical Model

Pseudo- Inverted vs. True Inverted Nipple

* Both appear drawn inward and "dimpled" at rest. * After stimulation: - Pseudo-inverted becomes erect. - True inverted stays drawn inward.

What causes nipples to be inverted?

* Breast being to form in the fetus at five weeks of life * At weeks 15-25, the mammary pit forms, becomes elevated and forms the nipple and areola * In some cases, adhesions prevent the pit from elevating - it's these adhesions that are preventing the pit from elevating

Key factor influencing galactopoessis as well as continued milk production are:

* Breast stimulation * Frequent and effective milk removal

Mammogenesis: Puberty

* Breast tissue development in females only * Initial major changes in functional breast tissue are typically complete about 12 -18 months after the onset of menses.

What is the Areola?

* Circular, dark-pigmented area that surrounds the nipple * Size and color differ for every women *Consist of smooth muscle and collagenous elastic connective tissue fibers * Becomes larger and darker during pregnancy * Visual target for baby

#123forEquity Commit to increasing

* Collection of race, ethnicity, language preferences, and other socio-economic data * Cultural competency training * Diversity in leadership and governance

What are some health-enhancing behaviors that reduce the risk of developing the following health problems? Heart Disease

* Consuming a low fat diet * Regular physical activity

By the 1900's artificial feeding became a feasible substitute for wet nursing and the once highly organized wet-nursing profession was extinct · Some alternatives to breastmilk included:

* Cow's milk * Evaporated milk * Infant formula

"I know breastfeeding is best for my baby, but I am embarrassed to breastfeed in public." Why do you think many women have this belief?

* Current social norms including: - Lack of normalization regarding breastfeeding ‣ when we think about breastfeeding in public, a lot of people get a little uneasy with that. It's not something that people see a lot, and when they do see, they feel very uncomfortable. It's not normal * Sexualization of the Breast: Breasts are not seen as functional organ that are to be used to feed a baby. Instead, breasts are viewed as something sexual ‣ These social normals about the breast, what it's used for—its not used for, causes a lot of embarrassment for public breastfeeding

Prolactin's role in milk production: Tells body to make milk

* During pregnancy, prolactin stimulates aveolar growth * After birth, prolactin triggers lactogenisis II * Throughout the duration of lactation, prolactin is the hormone that tells the body to produce milk * Prolactin is a natural tranquilizer that relaxes the mother and is known to induce maternal behavior (e.g., yearning to be with the mother).

How do you think births moving from the home to hospitals might have contributed to declines in breastfeeding rates?

* During the 1900s childbirth moved from a midwife attended home birth to a doctor attended hospital birth * Women were separated from their families and attended by hospital staff * Birth was conducted under general anesthesia - The mom was half asleep during her birth * During the early postpartum period, mother and infant were separated. As mothers recovered from highly medicated births, their baby was fed formula. - Because she was essentially asleep and couldn't feed the baby * The use of formula and limited breastfeeding during the extended hospital stay (up to two weeks) led to compromised milk supply and a baby who had difficulty breastfeeding.

Common barriers to breastfeeding:

* Embarrassment of Public Breastfeeding * Fear of Pain * Time and Social Constraints * Lack of Support * Lack of Confidence Regarding Milk Production

Lactogenesis 2: Right after delivery

* Endocrine control (i.e., hormonally driven) * Occurs between postpartum day 3 to day 8 * Breasts begin to secrete large amount of milk resulting in full breasts

Lactogenesis 1: During pregnancy

* Endocrine control (i.e., hormonally driven) * Occurs mid-pregnancy to 2 days postpartum * Breast develops ability to secrete milk (colostrum).

What was the Innocent Declaration called for?

* Establishment of national breastfeeding coordinators in all countries * Implementation of the "code" * Implementation of legal protections for employed breastfeeding women * Implementation by birth centers of the 10 steps of successful breastfeeding by birth centers

Factors that can delay or impair lactogenesis II

* Extremely long Stage II of labor * Labor analgesia * Cesarean delivery * Excessive blood loss after birth * Retained placental fragments * Hypothyroidism * Obesity * Type 1 Diabetes * Breast surgery, especially breast reduction * Fluid volume overload in labor * Stressful vaginal birth with a long stage 2 labor: sometimes women may be in labor for a very long time and spend stage 2 (when the mother is pushing the baby out) so if it's very stressful or long that can delay lactogenesis II meaning the milk may not come in as quickly * History of reduction mammoplasty (i.e., breast reduction surgery) that can severe lot of milk ducts and can make impair lactogenesis II * Hypoplasia which is underdevelopment of breast tissue * Polycystic ovarian syndrome * Infertility * Thyroid dysfunction * Sheehan Syndrome: is a condition that mothers blood pressure may drop substantially right after birth and at that time blood does not get to the pituitary gland and then there is permanent damage to the pituitary gland. ⁃ the pituitary gland secretes two hormones that are critical for lactation and so if that pituitary gland is no longer functioning that will impair lactogenesis II significantly

Stroma (supporting tissue)

* Fatty Tissue * Connective Tissue * Blood Vessels * Nerves * Lyphatics

Fatty Tissue inside the breasts:

* Fatty tissue is found between and around the lobes and helps cushion the breast - one thing to know about fat in the breast is it has no functional purpose * Fat within the breasts determines breast size, not milk making capabilities

Ethnicity

* Group or individual's conception of cultural identity which includes learned behavior * Used to survive but can lead to cultural demarcation * Examples are social behavior, traditions, preferences

What were some health risks associated with using alternatives to breastmilk?

* Hard to clean hand-held devices - Didn't have clean water or brushes *Poor sanitary conditions *Lack of access to clean water * Animal milk would spoil easily - No way to refrigerate - No methods for pasteurization * All these things contributed to the buildup of bacteria and essentially very detrimental to the infant's health

How can a woman know what type of nipple she has?

* Have her do a pinch test - The pinch test can be used prenatally to assess a women's nipple for protrusion

How would you categorize breastfeeding?

* Health enhancing

What are the impacts of breastfeeding on infant health outcomes?

* Human milk protects infants against infections outside the GI tract, including: - Upper and lower respiratory infections (Lanari et al., 2013; Ujunwa & Ezeonu, 2014). - Respiratory syncytial virus (RSV) (Carbonell-Estrany et al., 2014; Schijf et al., 2012). Urinary tract infections (Levy et al., 2009; Mardi et al., 2004). * Human milk protects infants against the risk of childhood cancers including: - Leukemia and lymphoma (Lujano et al., 2009; Puumala et al., 2013). - Hodgkin's disease (Wang et al., 2013). - Rhabdomyosarcoma (Lupo et al., 2014). * Human milk protects infants against a variety of chronic and autoimmune diseases, including: - Allergies (De Koker et al., 2014; Vandenplas et al., 2014). - Asthma (Dogaru et al. 2014; Sonnenschein-van der Voort et al., 2012). - Atopic dermatitis (Kramer & Kakuma, 2012). - Celiac disease (Ivarsson et al., 2013; Schaart & Mearin, 2014). - Hypertension (Grezelak et al., 2014; Kelishadi & Farajian, 2014). - Inflammatory bowel disease, such as Crohns and ulcerative colitis (Dam et al., 2013; Hlavaty et al., 2013)

What scientific and technological advances do you think contributed to declines in breastfeeding?

* Improved sanitary conditions of diary barns * Cleaner water * Ability to pasteurize, preserve and refrigerate foods * Creation of easier to clean feeding devices

Breastfeeding Peer Counselors are mothers who:

* In order to be a peer counselor you need to be a mother who successfully breastfed her own child * Participated in formal training to provide them with the knowledge and skills they need to educate and support mothers with normal non-clinical breastfeeding concerns. * In addition to the breastfeeding peer counselor having her own personal experience of breasting she is required to have some additional formal trainings to augment her personal experience with breastfeeding * Have a background that is similar to the mothers they educate and support: - Similar SES, age, experiences they are going through etc.

Why is it Inappropriate to Market Infant Formula in Underdeveloped Countries? Conditions needed to safely prepare artificial baby milk include:

* Income⁃ to safely prepare infant formula one needs to have the funds to regularly purchase infant formula • Ability to read: individuals need to be able to read the instructions on how to prepare the formula, how much formula, what kind of water is needed, etc. in order to safely prepare infant formula * Access to clean water⁃ individuals also need access to clean water * Access to facilities to boil water: if we don't have clean water that's boiled, the product will not be safely prepared

Should moms do something to evert inverted nipples prenatally?

* It depends - first of all it depends if the mother is at risk for preterm labor or not. Theoretically speaking, there is a risk that nipple stimulation can trigger pre term labor.So if we go back to the hormones that impact lactation, prolactin and oxytocin. Oxytocin causes the milk ejection reflex. It cause the milk to come from the alveoli out to the baby. That oxytocin which causes the myoepithelial cells to contract also causes the uterus to contract. ⁃ and when moms are pregnant, does anyone know when they're in labor what causes their cervix to dial from zero to ten so that they can give birth? ‣ it's oxytocin. so theoretically, if we're stimulating a breast and oxytocin is release, that could tigger a contraction and if a mom is at risk for preterm labor the last thing we want to do is trigger her labor and have her end up with birthing a baby prematurely b/c premature babies have a lot more health problems than babies who are born at term. So if mom has that risk for giving birth prematurely she has risk factors, she definitely doesn't want to do anything to try to evert her nipples - However she is not at risk, then during the last trimester she may consider correction techniques ▪︎ During the last trimester of pregnancy the woman's skin on the nipples has increased elasticity and therefore may respond to correction techniques - the skin in the nipples particular towards the end of the pregnancy is much more elastic and it can respond to different correction techniques ▪︎ Past recommendations discourage the use of correction techniques during pregnancy ⁃ and that was based on some research that wearing breast shells, which is a device, and doing something called Hoffman maneuvers, which is kind of stretching the nipple were not effective at everting an inverted nipple ▪︎ New recommendations encourage some pregnant women to consider use of commercially available nipple everting products

Which of the following stages of breast development is triggered by the endocrine system ( i.e., hormones)?

* Lactatogenesis I * Lactatogenesis II

THE CREATION OF THE ARTIFICIAL BABY MILK INDUSTRY * (1865) first artificial baby milk formula created by a chemist, Jutus Von Liebig

* Liebig's formula consisted of cow's milk, wheat, malt, flour and potassium bicarbonate * It was considered the perfect infant food

Oxytocin's impact on mother includes:

* Lowers blood pressure * Reduces cortisol levels therefore reduces stress and anxiety * increases pain threshold * Induces maternal behavior

Diversity

* Make-up of the workforce of a given healthcare organization * Not just race, also age, socio-economic status, sexual orientation, etc... * Should celebrate diversity, it enhances our living environment

Policies that promote, protect, and support breasting: The State Level

* Many states throughout the U.S. have breastfeeding laws. * State breastfeeding laws include, but are not limited to, laws that: - Specifically allow women to breastfeed in any public or private location. - Exempt breastfeeding from public indecency laws. - Provide protections for breastfeeding in the workplace - Exempt breastfeeding mothers from jury duty or allow jury service to be postponed.

What birth practices were encouraged by proponents of the natural childbirth movement?

* Mothers their family members should take childbirth preparation classes to learn about the childbirth process and comfort measures, such as focused breathing, to reduce pain during labor. * Mothers could give birth un-medicated and be fully conscious during childbirth * During birth, mothers would be surrounded by both healthcare professionals taking care of her during the birthing process and their family members including the father of the baby * After the birth, mother and baby would stay together and breastfeed

The Nipple Areola Complex

* Nipple * Areola * Montgomery Glands

Oxytocin's role in milk production: Triggers milk ejection reflex

* Nipple stimulation triggers the posterior pituitary gland to release oxytocin. * Other stimuli that can trigger the release of oxytocin include: - Uterine contractions

A systematic review of on the impact of the BFHI on breastfeeding outcomes:

* Number of studies reviewed: 58 * Main Findings: - There is a dose -response relationship between the number of BFHI steps women were exposed to and the likelihood of improved breastfeeding outcomes * The more steps that are implemented the higher the: - Breastfeeding initiation rate - Exclusive breastfeeding at hospital discharge rates - Any breastfeeding duration rates - Exclusive breastfeeding duration rates

Healthcare providers who interact with pregnant and breastfeeding mothers include:

* Obstetricians: going to follow the mom during her pregnancy and also be there when the mom delivers their baby * Pediatricians * Midwives * Nurse Practitioners *Registered Dietitians: are likely to work with mothers and providing them with nutrition counseling when they're pregnant and perhaps when they're breastfeeding * Nurses * Pharmacists * Public Health Educators: a woman may come to a health education class not anything related to breastfeeding that public health educators teaching

Why might mothers lack confidence about their milk production?

* Often, a woman's belief, that they will not be able to milk enough milk to nourish their baby, is based on inaccurate knowledge about breastfeeding including: - How to establish and maintain a good milk supply - Normal breastfed baby's feeding patterns - Who can and can't successfully breastfeed

Training to become a lactation educator varies and includes:

* One week, 45 hour training courses were participants earn the designation of certified lactation counselors * University-based, for academic credit (3 units) lactation educators course which enables participants to earn the designation or Certificated Lactation Educator (CLC) * University- based academic program that prepares students for careers as lactation educators and enables students to earn a Minor in Human Lactation

Breast malformations include:

* Polythelia (Accessory or supernumerary nipple) * Hyperthelia (nipple without accompanying) mammary tissue) * Hypertrophy (abnormally large breast) * Hypomastia (abnormally small breast) * Hyperplasia (underdevelopment the breast)

Problem Solving challenges

- Management, impatient for a quick fix - lack procedures - poor team participation - no logical thought process - potential caused misidentifies as root cause - problem defined incorrectly - lack of technical skills/ knowledge - coaction taken to implement a permanent corrective action - problem solving steps skipped in order to obtain a quick solution - no priorities, resources, $, approvals

Why is it Inappropriate to Market Infant Formula in Underdeveloped Countries? Conditions in underdeveloped countries make it unsafe to feed infants artificial baby milk, for example:

* Poverty: which is prevalent in developing countries. Poverty results in the mother stretching the formula to last longer, she will dilute the formula, resulting in malnutrition of her child ⁃ malnourished babies are more susceptible to disease, dying young and also can result in lifelong developmental delays * High illiteracy rate: when parents can't read instructions on how to safely prepare formula, they don't know that diluting formula or mixing it with unclean water is harmful to their infants.. * Lack of access to clean water * Lack of access to facilities to boil water: this condition that makes feeding infant formula in underdeveloped countries extremely unsafe. ⁃ when moms mix formula with contaminated water, their infants likely to develop a variety of illnesses, including GI illnesses which can result in diarrhea, vomiting, and dehydration ⁃ infants who are dehydrated aren't going to get the nutrients or fluids they need and subsequently can become severely malnourished ⁃ also, formula strips the infant gut of good bacteria that helps them fight off infections prevalent in their countries

Problem Solving is Different than Decision Making

* Problem Solving 1. How to get to all the mothers you are assigned to educate 2. How to deal with low milk supply 3. What to do when the baby sleeps at the breast 4. What to tell a mother about her sick baby * Decision Making 1. Which client/patient to visit first 2. Which breast pump to recommend 3. Deciding how many minutes should you allow the baby to sleep before removing from the breast 4. When to tell the mother about her sick baby

What happens when there is frequent and effective milk removal?

* Prolactin receptor theory * Feedback inhibitor of lactation

What does a La Leche League Lay Leader do?

* Provide basic education and support to pregnant and/or breastfeeding mothers via phone, email, or in person. * Facilitate monthly breastfeeding support meetings ⁃ it is mother-to-mother support

What does a breastfeeding peer counselors do?

* Provide basic support and education to pregnant and/or breastfeeding mothers * Provide appropriate referrals when necessary (i.e., to a IBCLC lactation consultant, pediatrician or doctor).

What do Lactation Educators Do?

* Provide basic support and education to pregnant and/or breastfeeding mothers. * Provide appropriate referrals when necessary (i.e., to a lactation consultant, pediatrician, or doctor * Specific responsibilities include: - Teaching prenatal breastfeeding classes - Providing one-on-one breastfeeding education to new mothers during their hospital say - Answering calls on breastfeeding information lines - Renting and selling breast pumps

Oxytocin also affects mothers in the following ways:

* Reduces blood pressure * Reduces cortisol levels, thereby reducing stress and anxiety * Increases pain threshold * Induces maternal behavior * Often called "mothering hormone"

Mammogenesis: Adult

* Relatively inactive between event of puberty and pregnancy. * First trimester of pregnancy growth occurs (e.g. more ducts, enlarged and darkened areola).

A variety of historical evidence suggests that the evidence suggests that the norm for feeding infants was breastfeeding including:

* Religious documents * Medical literature * Statues

Cultural Humility To do so must practice:

* Self awareness * Self- reflection * Self- critique

Eligibility requirements for IBCLC certification exam include:

* Six units (i.e., 90 hours) of coursework in lactation * Coursework in 14 health science subjects (only for candidates who are not listed healthcare professionals) * Clinical hours assisting mother-baby dyads with breastfeeding

What are Montgomery Glands or Tubercles?

* Small bumps on areola, that have a pimply appearance. * Enlarge during pregnancy * Secrete a substance that lubricates and protects the nipple and areola from dryness * The scent secreted from the them helps baby find the breast

THE EMERGENCE OF VOLUNTARY BREASTFEEDING SUPPORT GROUPS

* So again we talked about how there was a renewed interest in breastfeeding ‣ Several women who were inspired by the natural childbirth movement began breastfeeding ‣ What these women found was that it was very challenging to breastfeed there was nowhere to access accurate breastfeeding knowledge or support for breastfeeding ‣ since most women at the weren't breastfeeding or hadn't breastfed their own children, most knew mothers, their own mother's, aunts, sisters, and friends were not able to answer any of their questions or concerns about breastfeeding ⁃ Believed there was no place for a new breastfeeding mother, touching accurate knowledge about breastfeeding or support to breastfeed * There was a great need for women in the community who were interested in breastfeeding to obtain accurate knowledge and support to enable them to successfully breastfeed. * Several women who were breastfeeding decided to start an establishment of voluntary breastfeeding support group to help mothers obtain knowledge and support for breastfeeding. - that voluntary breastfeeding support group was called the La Leche International

NATIONAL BREASTFEEDING PROMOTION EFFORTS include

* Statements by professional health organizations * Healthy People breastfeeding objectives * The Breastfeeding Report Card * The WIC Program * US Breastfeeding Committee * Policies that promote, protect & support breastfeeding

Prolactin Receptor Theory:

* Suggests that frequent and effective removal of milk from the breasts during the first few weeks postpartum are associated with the production of prolactin receptors in the breasts. * The more frequent and effective the milk removal the more prolactin receptors are created. * The more prolaction receptors in the breasts the greater breastmilk production potential the woman will have.

What are the Healthy People 2020 breastfeeding objectives?

* The Healthy People 2020 objectives are different than the 2010, 2000, 1990 in that in addition to focusing on getting higher breastfeeding rates *We also have objectives that focus on tackling the major barriers to breastfeeding * To increase the proportion of infants who are breastfed: - Ever breastfed to 81.9% - At 6 months to 60.6% - At 1 year to 34.1% - Exclusively through 3 months to 46.2% - Exclusively through 6 months to 25%

Parts of the Lactating Breasts

* The Nipple Areola Complex * The Parenchyma (Functional Breast Tissue) * Stroma (Supporting Tissue)

The 17th century it was much more popular to choose not to breast breastfeed and to hire a wet nurse because

* The aristocracy of the time chose not to breastfeed for social reasons - They didn't want to breastfeed because it prevented them from wearing socially desirable clothing - At that time they feared that it would ruin their figure and also it interfered with social activities such as playing cards or going to the theater * At the same time wives of merchants and doctors and lawyers chose not to breastfeed for economical reasons - It was actually more expensive to hire someone to run their husband's business than to hire a wet nurse - So what they would do was hire a wet nurse to take care of their child and feed their child and the mother's would run their husband's business

THE CREATION OF THE ARTIFICIAL BABY MILK INDUSTRY (1760) Jean Charles Des-Essartz published his treatise of physical upbringing of children

* The first chemical analysis of various mammal milk including human milk * Despite the fact that it concluded that human milk was best source of nutrition for babies, it resulted in attracting chemists to the area of infant feeding - These chemists believed that they could create a food equal to or better than breastmilk

Oxytocin triggers the following:

* The milk ejection reflex (let-down). As you may remember from the anatomy lecture the myoepithealial cells that contractile unit right around those alveoli are the milk making cells when oxytocin is released they compressed around that milk making cell and push milk down the ducts out the nipple into the baby. Milk ejection occurs in both breasts so even though the baby might be breastfeeding on the right breast when their oxytocin is released there will be a letdown in both breasts so the mom may experience leaking on the breast where the baby is not breastfeeding and it * also triggers uterine contraction which help shrink the uterus back to its pre pregnancy size and control postpartum bleeding * Other stimuli can also trigger the release of oxytocin, including: sight, smell, sound, and touch

Alveoli (also called Acini)

* The milk-making units of the breast that develop during pregnancy and where the milk is stored - like a grape, when you think about grape juice, the grape juice would be inside that little grape ⁃ Inside the alveoli is the milk * Lactocyes line the alveoli, and absorb nutrients, immunoglobins and hormone from the bloodstream to make breastmilk. * Prolactin receptor sites in the lactocyes, allow prolactin to be absorbed from the blood and enter into the alveoli to stimulate milk production

"If I breastfeed, I won't be able to work, go to school, or go out with my friends." Why do you think many women have this belief?

* They don't know anyone who was able to continue breastfeeding when they went back to work or school ‣ if you don't have a role model where you've seen them be successful, like combining work and school, or being able to go out with friends and manage maintaining their milk supply and having a life then it's going to be really difficult for you to even imagine that it's possible * They don't know how to be successful breastfeeding when separated from their baby (e.g. when working, going to school, etc.) ‣ meaning they don't actually know logistically what they need what they need to do. They don't know how a pump works. They don't know how frequently they need to pump. They don't know how to prepare breast milk that's been pumped, how to store it * They have the misperception that breastfeeding will result in their baby becoming overly dependent on them. ‣ meaning that if they don't give baby a bottle and they just breastfeed, that baby is never going to take a bottle and they'll never be able to do anything. The baby will be glued to their breasts for life ‣ This is actually not true! There is no research to suggest that a breastfed baby is more dependent than a bottle-fed baby. There are some babies who don't take bottles and under those circumstances, a lot of these babies do something called reverse cycle nursing. And what that is, is that they reverse their cycle of breastfeeding. Instead of eating a lot during the day, what they do is if their mom's away during the day, they eat a lot at night and what this would look like is mom goes to work, maybe she goes from 9-5, the baby eats once, maybe twice at most during the day and as soon as the mom comes home, maybe she's home at 5:30, that baby eats every two hours (5;30,7:30, 9:30, 11:30, 1:30 ... 7:30) and they get all of their feedings in the night time

MARKETING OF ARTIFICIAL BABY MILK Marketing played on parent's fear regarding their faith in modern science

* This time infant mortality rates were high, parents were scared that their baby wouldn't make it past their first birthday *So anything that would suggest, marketed as a product to make your baby healthier increase the chance of them living past the first year of life was held in high regard by parents

Cultural Humility How does one do this?

* Through challenging yet supportive discussions with knowledgeable people about specific cultures * Through understanding we gain acceptance and are then able help these patients/clients * This is a life-long, gradual, and transformational practice

What are some of the health benefits of breasting:

* To the breastfed baby: ⁃ protecting against a variety of chronic and autoimmune diseases * To the breastfeeding mother: ⁃ the mother will lose her pregnancy weight much quicker ⁃ reduces the risk of: breast cancer, ovarian cancer, cardiovascular disease and hyperlipidemia, hypertension, obesity, type 2 diabetes, postpartum blood loss and postpartum depression

Physical Characteristics of each breast type

* Type 1 : Round breasts, normal lower, medial and lateral quadrants * Type 2 Hypoplasia of the lower medial quadrant * Type 3: Hypoplasia of the lower and lateral quadrants * Type 4: Severe constrictions minimal breast base

A variety of factors occurring over a period of time led to declines in breastfeeding rate, including but not limited to:

* Women became interested in having an impact outside of their home * Scientific and technological advanced resulting in safer alternatives to breastmilk * Faith in science and technology * Changes in labor and delivery practices * Marketing of artificial infant milk

In order to be a La Leche League breastfeeding leader an individual must:

* be a mother who successfully breastfed her own child or children * she also needs to be a mother of the La Leche league Internation * Not required to participate in formal training. However, they are required to complete an application process ⁃ the application process includes reading a book on breastfeeding, completing some activities that help the leader develop some leadership, and support skills

What were routine birth practices in the 1950s?

- Mothers and their family members were not educated at the time about the childbirth process - Mothers were medicated during birth, resulting in an unconscious mother - During birth, mothers were surrounded by healthcare professionals and no family members. *not her mom, not her husband or any other family members - After birth the baby was separated from the mother, stayed in the nursery, and was taken care of by the nurse, who most likely was formula feeding the baby

How can obesity affect breastfeeding? Postpartum complications:

- Postpartum hemorrhage - Wound infection - obesity in offspring - Long-term health issues - Malnutrition (including vitamin and mineral deficiencies).

Decisional balance

* ex) Breastfeeding: if I perceive that there are tons of barriers to breastfeeding and very few benefits I'm not gonna be likely to want to initiate breastfeeding ⁃ if I have heard that breastfeeding is good for me and my baby that's a benefit but I've heard that it hurts that it's really embarrassing that I won't lose weight that my breasts will sag and it's gonna be really really hard I wouldn't be able to go anywhere I'll essentially be tied to my baby 24/7 I'm not gonna be all that motivated to breastfeed * so when we talk about decisional balance and motivating health behavior change it's really critical that we you know in trying to motivate someone to initiate breast feeding we need to reduce the barriers they perceive to breastfeeding we have to engage them in a conversation and find out what they think is gonna make breastfeeding difficult see if all those things are true and find ways that they can overcome them

How common is nipple inversion?

* it is not the common * Nipple inversion is found in only 3% of women * Typically it is bilateral- meaning on both breasts. It is not very common to see a women who has one nipple that's everted and one that's inverted * Of the 3% of women whose nipples are invert, only 4% are true inverted

Lactation Educators Qualifications:

* sometimes referred to as lactation specialists, counselors, and breastfeeding educators * Individuals are not required to have prior breastfeeding experience * They participated in formal training to provide them with the knowledge and skills they need to educate and support mothers with normal non-clinical breastfeeding concerns ⁃ typically the training that lactation educator completes involves more hours than that of a breastfeeding peer couselor * Currently there is no international or national certification exam that provides individuals with the opportunity to earn the designation of certified lactation educator ⁃ and that's why you'll find that there are a variety of courses and programs that focus on training lactation educators

Hyperplasia (underdevelopment of the breast) some physical characteristics of hyperplasia include:

* widely spaced breasts * Tubular, cone-shaped breasts * bulbous looking areola

Some physical characteristics of hypoplasia include:

* widely spaced breasts ( more than 1. 5 to 4 cm apart) * tubular, cone-shaped breasts * bulbous looking areolae.

Is it normal for infants to cry to communicate something other than hunger?

- ABSOLUTELY! Reasons infants cry include: ❖ Communicating the need for comfort ❖ Communicating too much external stimuli - too bright in a room ❖ Communicating body discomfort ‣Uncomfortable body temperature ‣ Gas or over-fullness ‣ Illness

Problem Solving

- Action steps are taken to resolve an issue - Involves diagnosing a problem and solving it through a set of decisions - May entail one or more solutions - Sometimes need conflict resolution when problem is between two or more people - A leadership strength could be creative problem solving (problem-led leaders)

Retracted Nipples

- Appear everted at rest - After stimulation, nipple retracts and becomes inverted

For healthcare leaders there are two types of ethics

- Bioethics - Managerial ethics

Why are Omega 3 fatty acids important to babies?

- Brain and nerve development - Immunity - Eye development

Name three sources of Omega 3 fatty acids?

- Catfish - Cod - Salmon - Sardines ▪︎ Supplements: Mercury-free fish oil - Algae oil ▪︎ Other Omega 3 sources: ▸ walnuts ▸ Flax seed ▸ Canola oil

How can obesity affect breastfeeding? During Labor & Delivery:

- Difficult fetal monitoring - Cesarean delivery - Decreased success of vaginal birth after cesarean delivery - Difficult anesthesia

Case Study 2 - ProfessionalismWhich group of people are more professional? Questions: 1. What do you do if you have a meeting to attend and you enter the room on the left? 2. If you act professional yet everyone else in the room is not acting professional what do you do? 3. Is there anything you can do to help prevent this from reoccurring?

- Do not make disparaging remarks like you all look horrible or did you all have too much partying last night? - Perhaps you comment on how the group seems to be low energy and ask what is up? - If they do not perk up and act better, do not go to their level of disengagement. Keep acting professional. - To prevent the same thing from occurring in the future, you can suggest the group design a code of conduct for the organization or even best practice guidelines to follow for meetings.

Ethics Defined

- Ethics provides a framework for understanding and interpreting what is right and wrong in society - Codes of conduct express relevant ethical standards for many professions - Ethics and morals are sometimes used interchangeably

Case Study: Three women from Kenya are breastfeeding their infants in the park and having a conversation about the night before. One woman relates that she had an argument with her husband about keeping their house clean. The women said that she did not breastfeed her baby that night since her mother told her to always avoid nursing after arguments to prevent "bad blood" from entering her milk and impacting the baby's health. This is a common cultural myth passed down by Kenyan woman who breastfeed as cited in Pickett, E. (2012). A Closer Look at Cultural Issues Surrounding Breastfeeding, October 30.

- First do not over react. Remain calm and do not negate her cultural belief as silly or impossible to believe. - Respect her belief and ask her more about her knowledge in this area. - Discuss with mom in a sensitive way. - It is actually not true that stress from an argument can result in bad breastmilk. - Let mom know that skipping a feeding because she thinks her milk is "bad" can result in engorgement, decreased milk supply and a hungry baby. - Encourage to always feed her baby when he or she is hungry. If mom is under stress for whatever reason, she should try some relaxation techniques. This will ensure optimal let down and sufficient milk to the baby

Based on our previous discussions, which of the nutrients below may be lacking in the diet of a vegetarian?

- Protein - Vitamin B 12 - Calcium - Iron

American College of Healthcare Executives (ACHE) Code of Ethics

- Recognized by healthcare leaders as a code of conduct to follow - It contains standards of ethical behavior for healthcare leaders in their professional relationships - These relationships include: - To the Professional - To Patients and Others Served - To the Organization - To the Employees - To the Community and Society - It is important that a leader reports violation to the code

I tend to get frequent colds, so I don't think it will be a good idea for me to breastfeed my baby.

- Hello, thank you for calling about your concern about breastfeeding while getting frequent colds. I am happy to inform you that breastfeeding can enhance a mother's health when she is sick (Mohrbracher et al., 2010). - When you are sick, your body's first response is to produce antibodies that pass into your milk designed to protect your baby from your cold (Mohrbracher et al., 2010). - When you are starting to feel sick, your baby has been exposed and is receiving protection through breastmilk (Mohrbracher et al., 2010). - If you continue to breastfeed during your cold, you continue to protect your baby because of the antibodies in the breastmilk (Mohrbracher et al., 2010). - If your baby does become sick, he/she will get a milder case than they would if that had been not breastfeeding (Mohrbracher et al., 2010). - Transmission of colds is through skin and nose or mouth secretions (Mohrbracher et al., 2010). It is important that you keep good personal hygiene. Having good personal hygiene means handwashing regularly as it decreases your baby's chances of catching your cold. - To lower your baby's chance of getting sick, you can try avoiding breathing on your baby by wearing a face mask whenever holding the baby. Wearing a mask can prevent transmission through breath or nose to mouth secretions (Mohrbracher et al., 2010). - If you are sick with the common cold, I encourage you to drink more fluids to stay well hydrated.

I am currently breastfeeding my six-month-old baby and just found out that I am pregnant. I heard that if I continue breastfeeding my older baby, I will harm my developing baby.

- Hello, thank you for calling about your concern about breastfeeding your six-month-old baby when you are currently pregnant. - When a mother is still breastfeeding and becomes pregnant, this may cause changes to the breastmilk, and their baby may wean during pregnancy (Mohrbracher et al., 2010). - As a mother becomes pregnant during breastfeeding, her nipples will change due to hormonal changes pregnancy causes. Since the nipple changes, mothers will experience nipple pain which causes them to breastfeed less often and shorten feeding times (Mohrbracher et al., 2010). - It is essential to know that your baby may wean during your pregnancy but then start breastfeeding again after the baby is born (Mohrbracher et al., 2010). - It is crucial that you keep an open mind and flexibility to changing needs to make breastfeeding during pregnancy a positive experience (Mohrbracher et al., 2010). - You should know if you are well-nourished; breastfeeding during pregnancy will not deprive your unborn child (Mohrbracher et al., 2010). - If you are malnourished, it is suggested that you take nutritional supplements during pregnancy (Mohrbracher et al., 2010). Being a malnourished pregnant, breastfeeding mother puts your child and unborn child at risk for low weight gain (Mohrbracher et al., 2010). Taking supplements during pregnancy is the best strategy to offset malnourishment (Mohrbracher et al., 2010). - If you are in high risk or complicated pregnancy, you may be asked to stop breastfeeding (Mohrbracher et al., 2010). - Breastfeeding during pregnancy will increase your nutritional requirements. It is essential that when you feel hungrier and thirstier, you increase your food and drink suitably (Mohrbracher et al., 2010). - An advantage to breastfeed during your pregnancy is it might make it easier for you to convince your baby or toddler to lie down and breastfeed when you want to rest (Mohrbracher et al., 2010). - If you do intend to breastfeed during your pregnancy, you may experience nausea. Experiencing nausea may be due to your body's heightened awareness during breastfeeding. To help with nausea, share frequent, small meals with your child to reduce your nausea (Mohrbracher et al., 2010). - It is also good to know that as you progress during your pregnancy, your lap disappears, and your abdomen grows, making it challenging to breastfeed. To help your child reach your nipple, try laying down and other positions while breastfeeding (Mohrbracher et al., 2010). - As you are breastfeeding while pregnant, you may experience feeling restless or irritable (Mohrbracher et al., 2010). It is suggested that you try distracting yourself with a book or watching TV to help with these feelings (Mohrbracher et al., 2010). - As you stated, your baby is six months old. If you continue to breastfeed, it is suggested that you monitor your baby's weight gain to make sure they continue to be well-nourished (Mohrbracher et al., 2010). It is crucial to monitor your baby's weight gain because as your milk taste changes due to pregnancy; it might cause your baby to wean. Again, if your baby does wean, don't worry. Your baby might want to resume breastfeeding after their sibling is born (Mohrbracher et al., 2010). Or your baby will continue to breastfeed despite the changes (Mohrbracher et al., 2010). - If your older child is still breastfeeding, they will not deprive the newborn of colostrum (Mohrbracher et al., 2010).

I heard that mothers who drink alcohol can't breastfeed.

- Hello, thank you for calling about your concern about drinking alcohol and breastfeeding. If you are breastfeeding and have an occasional alcoholic beverage, it is compatible with breastfeeding (Mohrbracher et al., 2010). It is only safe when the alcoholic drink is in small amounts. However, suppose you are going to drink alcohol and breastfeed. In that case, you should avoid breastfeeding for 2 hours after that drink was consumed (Mohrbracher et al., 2010). - If you want to breastfeed, it is discouraged to drink alcohol regularly (Mohrbracher et al., 2010). - If you drink a large amount of alcohol, that amount is secreted into the breastmilk (Mohrbracher et al., 2010). - It is highly suggested that no alcohol should be consumed during the first month of life (Mohrbracher et al., 2010). Once the first month has passed, limit your alcohol intake to one to two standard drinks (Mohrbracher et al., 2010). - If you want to drink more than one to two alcoholic beverages, express your milk, and consider skipping one breastfeeding (Mohrbracher et al., 2010). - If you do drink, ensure it is after you breastfeed your baby. - If a mother is 120 pounds, for one alcoholic beverage, it takes 2 to 3 hours for the alcohol to leave her body altogether (Mohrbracher et al., 2010). - Please keep in mind that the more you drink, the longer it takes to leave your body (Mohrbracher et al., 2010). - Also, you should know that eating a meal and expressing milk within an hour before drinking alcohol can decrease alcohol availability in your system (Mohrbracher et al., 2010). - If you decide to drink alcohol, it is essential to know that alcohol disrupts your hormonal balance and decreases the amount of milk your baby takes at the breast (Mohrbracher et al., 2010). - When you drink, it lowers your oxytocin which can impair your milk ejection (Mohrbracher et al., 2010). - You should also know that if your baby breastfeeds and there is still alcohol in your breastmilk, it can cause your baby to sleep less (Mohrbracher et al., 2010). - If you do drink a large amount of alcohol regularly over time and you breastfeed, your baby may experience side effects such as lower motor development (Mohrbracher et al., 2010).

I was just diagnosed with HIV. I heard that I can't breastfeed once my baby is born.

- Hello, thank you for calling about your concern about having HIV and breastfeeding. HIV is spread through the exchange of body fluids from mother to child during and birth, from sexual contact, sharing needles, blood transfusions, and some believe through breastfeeding. - Breastfeeding recommendations vary by area in which they live (Mohrbracher et al., 2010). - If you are HIV positive, living in a developed country, it is best to refrain from breastfeeding and donating your milk (Mohrbracher et al., 2010). - If you are living in a developing country, it is recommended that you breastfeed. Babies who are exclusively breastfeeding have lower transmission rates than those babies who are receiving liquids and foods other than breastmilk (Mohrbracher et al., 2010). - You should know there are alternatives to formula-feeding for mothers who are HIV positive. You can use donor milk and heat-treating your own expressed milk to kill HIV (Mohrbracher et al., 2010). - Also, taking antiretroviral drugs is considered compatible with breastfeeding (Mohrbracher et al., 2010). Many of these drugs are given to breastfeeding babies and children to prevent HIV infection (Mohrbracher et al., 2010).

I have a nipple ring and heard that I can't breastfeed.

- Hello, thank you for calling about your concern about how your piercing may affect your ability to breastfeed. Having a nipple ring can affect your milk transfer after birth (Mohrbracher et al., 2010). You should know that there are many cases of mothers being able to breastfeed successfully after their piercing. However, many cases of mothers stating problems from their piercing caused milk duct obstruction and reduced milk transfer during breastfeeding (Mohrbracher et al., 2010). - If you have nipple scar tissue from the piercing, it may complicate your baby's attachment to the breast and block milk ducts (Mohrbracher et al., 2010). - If you have one breast pierced, you may exclusively breastfeed on the breast that doesn't have a piercing (Mohrbracher et al., 2010). - I highly suggest removing your nipple ring before breastfeeding to prevent your baby from choking (Mohrbracher et al., 2010).

I don't have the perfect diet, so I am worried that my breastmilk will be poor in nutritional quality.

- Hello, thank you for calling about your concern about not having a perfect diet. A mother's diet is the only source of energy and nutrients she needs to make milk (Mohrbracher et al., 2010). However, a mother's diet is unlikely to affect their milk production unless it is extreme (Mohrbracher et al., 2010). - Mothers that are malnourished and live-in developing countries produce good quality milk for their babies (Mohrbracher et al., 2010). - If a mother changes her diet, that does not mean it will help milk production or improve the quality of the milk (Mohrbracher et al., 2010). - Suppose a mother is famine or living in near-famine conditions for weeks. In that case, her milk production and/or milk quality suffer (Mohrbracher et al., 2010).

My breasts are very small, so I am afraid I will not be able to produce enough milk to feed my baby (hint for finding information on this topic: look up "storage capacity").

- Hello, thank you for calling about your concern about producing enough milk to feed your baby. If you have small breasts, that does not impact how much milk you can produce to feed your baby (Mohrbracher et al., 2010). - If a mother does have a large capacity to hold milk in her breast, the baby may get full off one breast at most feeding and feed fewer times per day. (Mohrbracher et al., 2010). - If a mother has a small capacity to hold milk, to ensure her baby is getting enough milk, her baby may take both breasts at each feeding (Mohrbracher et al., 2010). Having a small capacity to hold milk means that the baby will feed more through the day and night (Mohrbracher et al., 2010). - A mother having a different storage capacity than other mothers does not mean it affects a mother's ability to produce milk. However, it will affect the feeding rhythm.

My work is very stressful, so I am afraid that my milk would be bad for my baby

- Hello, thank you for calling about your concern about stress from your work causing your milk to be bad for your baby. I am happy to inform you that breastfeeding provides stress relief (Mohrbracher et al., 2010). - When a mother breastfeeds, they have that skin-to-skin contact, and the hormone oxytocin is released (Mohrbracher et al., 2010). Oxytocin helps lower blood pressure and cortisol, a stress hormone (Mohrbracher et al., 2010). - Mothers who breastfeed report feeling calmer after breastfeeding than those who don't breastfeed (Mohrbracher et al., 2010). - If you are having difficulty expressing milk at work, look at a picture of your baby to help your let-down. Looking at a picture of your baby will allow you to release oxytocin, which will help you release milk.

I had prior breast surgery, so I am afraid that I will not be able to produce enough milk to feed my baby.

- Hello, thank you for calling about your concern about your fear that your past surgery may affect your ability to produce milk to feed your baby. You should know that some types of breast surgery, such as breast reduction, may put a mother at higher risk for insufficient milk production (Mohrbracher et al., 2010). This may not be a delay in milk increase, but rather a sign of low milk production (Mohrbracher et al., 2010). - Breast reduction surgery may involve removing some milk glands, which will likely affect the volume of milk a mother can produce. - The amount of breast tissue removed will not affect breastfeeding outcomes (Mohrbracher et al., 2010). - Suppose you have had a surgical incision near the areola. In that case, it may also cause nerve damage, hinder milk expulsion, and compromise milk transfer (Mohrbracher et al., 2010). - If you are unsure how your surgery was performed, I encourage you to contact your surgeon and ask (Mohrbracher et al., 2010). - If you are unsure if there were any complications, please get in touch with your healthcare provider (Mohrbracher et al., 2010). - A mother's nerves can grow back over time. So, the more time has passed since your surgery, the more sensitive your breasts and nipples become, and the minor nerve damage is likely to affect breastfeeding (Mohrbracher et al., 2010). - If your surgery caused injury to one breast only, breastfeeding may not be affected (Mohrbracher et al., 2010).

I have tuberculosis and heard that mothers with tuberculosis can't breastfeed.

- Hello, thank you for calling about your concern about your illness affecting your ability to breastfeed. If you are contagious with active tuberculosis, you will be separated from your baby until you and your baby start drug therapy (Mohrbracher et al., 2010). - When the baby starts on an antimicrobial, it has been shown to be effective in preventing TB infections and illness in the baby (Mohrbracher et al., 2010). - Once you and your baby start on drug therapy, separation is no longer necessary. - If you developed active TB during pregnancy and have received the appropriate drug therapy, you and your baby are unlikely to be separated after birth. - If you are worried that medication will not be compatible for breastfeeding, I am happy to inform you that anti-tubercular drugs including isoniazid, rifampin, and ethambutol are compatible with breastfeeding (Mohrbracher et al., 2010). - When you are feeling well enough to hold your baby, you can breastfeed.

I was just diagnosed with breast cancer and am scheduled to begin chemotherapy after the birth of my baby. I heard that I can't breastfeed.

- Hello, thank you for calling about your concern with starting chemotherapy and breastfeeding. Chemotherapy is used to treat mother's cancer. - As you start chemotherapy, you must wean because the drugs involved are not safe for breastfeeding (Mohrbracher et al., 2010). - It is best to provide your baby with supplements other than breastmilk while you are doing chemotherapy.

I am pregnant with twins and am concerned that my body will not make enough milk to feed both of my babies.

- Hello, thank you for calling about your concern. I am happy to inform you that a mother's body can produce enough milk for twins, triplets, and quadruplets (Mohrbracher et al., 2010). - For a mother of twins to breastfeed exclusively, she will need double the milk required by the mother of one baby (Mohrbracher et al., 2010). - A mother can expect each baby will need to breastfeed at least eight times every 24 hours (Mohrbracher et al., 2010). - As a mother of twins, it is essential to have support because it will help encourage you to breastfeed your babies longer (Mohrbracher et al., 2010). - The babies' feeding patterns may differ, with one baby feeding more often than the other (Mohrbracher et al., 2010). If you notice that one baby is not effectively feeding as their sibling, please try breastfeeding them together (Mohrbracher et al., 2010). Having the more effective baby breastfeed first can help stimulate milk to come out, and the fast flow of milk may help the less effective baby (Mohrbracher et al., 2010). - You may breastfeed your babies with no particular and feed the baby that seems the hungriest first to whichever breast seems the fullest. Or you may keep the baby on the same breast for the entire day while alternating breasts every day (Mohrbracher et al., 2010). It is good to know that letting your babies spend time at both breasts provides various stimulation, which also helps eye development (Mohrbracher et al., 2010). - Suppose one of your babies is feeding less effectively. In that case, it's good to offer both breasts to each baby to guarantee both breasts are well stimulated to continue milk production.

What role do Omega 3 fatty acids play in the diet of a breastfeeding mom?

- Human milk fatty acids are synthesized directly from the body's stores of omega-3 fatty acids, which are obtained through diet.

Case Study Ethics Filling out records The lactation consultant finished her rounds but was running late for her child's school performance due to a client's plugged duct. She decides to not give the details of the plugged duct to save time and instead charts as if there were nothing of a significantnature to report. Questions: 1. Is it e ver all right to abbreviate your record keeping in order to save time? 2. What could have been done to prevent this from happening? 3. If it is discovered by your supervisor can you go back and add to the chart?

- You should never compromise your record keeping due to time. - This is unethical behavior and unbecoming of a professional. - If there is a further problem with the mother's plugged duct, improper documentation can compromise further care. - One needs to practice good time management skills so they are not rushing to get their job done. - Late charting can be accomplished but the date and time it was entered must be noted.

Rationale for Each of the Code's KeyRecommendations NO gift or personal samples to health workers

- gifts can influence people. - It's human nature that if someone gives you something, particularly something you value, you're going be more inclined to help that person - if you scratch my back, I'll scratch yours.

You are a lactation educator who answers calls on a breastfeeding warmline. Jeni, a breastfeeding mother calls and tells you she is trying to lose weight and wants to know what is the recommended amount of weight loss per week. Which of the below answers is the best: a) 0.5-2 pounds b) 3-5 pounds c) 2-4 pounds d) It is not recommended that breastfeeding women lose weight e) 1-3 pounds

0.5-2 pounds

The Promotion of Breastfeeding Intervention (PROBIT): Three phases

1) at 12 months, 2) at 6.5 years, 3) at 11.5 years

4 Components to Cultural Competency

1. Awareness of one's own cultural world view 2. A positive attitude towards cultural differences 3. Knowledge of different cultural practices and world views 4. Developing skills to communicate and interact across cultures

Building Motivation - Coaching for Health

1. Find out person's values 2. Ask "what connections do you see about your values and your health?" 3. Need to establish trust and rapport to get client/patient to open up 4. Build specific goal(s) knowing the connection 5. When the client/patient is connected to values then they are more motivated to achieve their goal(s)

7 Steps for Effective Problem Solving

1. Identify the issues 2. Understand everyone's interest 3. List the possible solutions 4. Evaluate the options 5. Select the option or options 6. Document the agreement 7. Agree on contingencies and evaluations

In addition to the IBCLC, who are the professionals, paraprofessionals, or volunteers who specialize in supporting breastfeeding?

1. La Leche League Leaders 2. Breastfeeding Peer Counselors 3. Lactation Educators /Lactation Counselors/ Lactation Specialists

Four Developmental Phases of the mammary gland

1. Mammogenesis 2. Lactogenesis (I & II): 3. Glactopoiesis 4. Involution

IBCLC Code of Professional Conduct Principles

1. Provide services that protect, promote and support breastfeeding 2. Act in due diligence 3. Preserve the confidentiality of clients 4. Report accurately and completely to other members of the healthcare team 5. Exercise independent judgement and avoid conflicts of interest 6. Maintain personal integrity 7. Uphold the professional standards expected of an IBCLC 8. Comply with the IBLCE Examiners Disciplinary Procedures

Six Traits of a True Professional

1. Specialized knowledge 2. Competency 3. Honesty and integrity 4. Accountability 5. Self-regulation 6. Looking the part

By 1971 artificial baby milk was the norm with only __________________________.

24% of US women initiating breastfeeding

Involution: Breast returns to pre-pregnant state Occurs on average___________________________.

40 days after last breastfeeding.

If you think about breastfeeding for a moment and the frequency and duration that a baby breastfeeds, especially in the early day, how many times a say does a new baby breastfeed?

8 to 12 times

Health Damaging Behaviors

Actions that contribute to illness, disability, injury, or premature death

Which theory has the phases for existence, relatedness, and growth? a) Adam's Equity theory b) Herzberg's Two Factor theory c) Skinner's Reinforcement theory d) Alderfer's ERG theory

Alderfer's ERG theory

Which of the following are reasons given in the Baby Killer Report and/or the 1978 Senate Hearings why the marketing of formula in developing countries is inappropriate? A. Lack of access to clean water B. Lack of access to facilities to boil water C. High illiteracy rates D. Poverty E. All of the above

All of the above

All of the following are nutrients that may be lacking in the diet of a vegetarian EXCEPT: a) Iron b) Protein c) All of the choices are nutrients that may be lacking in the diet of a vegetarian d) Calcium e) Vitamin B12

All of the choices are nutrients that may be lacking in the diet of a vegetarian

During pregnancy, all of the following changes occur in the mammary glands EXCEPT: a) The montgomery glands become more visible. b) The breasts begin to produce colostrum. c) The mother's breasts may grow about 1-2 cup sizes. d) The areola may enlarge and darken. e) All of the listed changes occur during pregnancy.

All of the listed changes occur during pregnancy.

The "Baby Killer" report you read for this course highlights some reasons that the marketing of formula in developing countries can be inappropriate and detrimental to an infant's health. Those reasons include all of the following EXCEPT: a) Many families cannot afford formula and therefore dilute it. b) Many families are illiterate and cannot read instructions on how to properly prepare formula. c) All of the possible answers are reasons that the marketing of formula in developing countries can be inappropriate and detrimental to an infant's health d) Many families cannot afford formula and use substitutes that are not appropriate. e) Lack of access to clean water.

All of the possible answers are reasonsthat the marketing of formula in developing countries can be inappropriate and detrimental to an infant's health

Due to high mercury levels, what foods should be avoided during pregnancy, lactation and early childhood?

Avoided: • King mackerel • Marlin • Orange roughy • Shark • Swordfish • Tilefish • Bigeye tuna

International Breastfeeding Promotion Efforts: 1991:

Baby-Friendly Hospital Initiative

The main goal of the _______________________ is to promote the use of practices that promote breastfeeding in facilities where mothers give birth. a) International Code of Marketing of Breastmilk Substitutes b) Baby-Friendly Hospital Initiative c) Innocenti Declaration d) Global Strategy for Infant and Young Children Feeding e) 1000 Days Challenge

Baby-Friendly Hospital Initiative

What might be a barrier preventing this woman from breastfeeding? "If I breastfeed, I won't be able to work, go to school, or go out with my friends."

Barrier: Breastfeeding will result in time and social constraints- meaning that the mom won't be able to work, she can't go out with friends. Essentially, she just can't do anything

What might be a barrier preventing this woman from breastfeeding? "I know breastfeeding is best for my baby, but I am embarrassed to breastfeed in public."

Barrier: Embarrassed of public feeding

What might be a barrier preventing this woman from breastfeeding? "I've heard that breastfeeding hurts."

Barrier: Fear that breastfeeding will be painful

What might be a barrier preventing this woman from breastfeeding? I'm afraid I won't have any milk just like my mother."

Barrier: Lack of confidence regarding milk production

What might be a barrier preventing this woman from breastfeeding? "My partner said that he was not breastfed and he turned out fine."

Barrier: Lack of support for breastfeeding

▪︎ Locke's Goal-Setting Theory

Based on goals

▪︎ Skinner's Reinforcement Theory

Based on rewards and punishments

The Three- Step Counseling Strategy: An Effective Tool for Communication about Breastfeeding Concerns

Before you can educate you need to make a connection with the mother. ▪︎ "People don't care how much you know until they know how much you care." ▪︎ The 3-step counseling strategy is an effective tool for making connections needed to uncover breastfeeding concerns. ▪︎ Background: The three-step counseling strategy

What is NOT one of the 10 Communication skills of the best leaders? a) Listening for emotions behind the word b) Being authentic c) Being judgmental d) Being grounded and centered

Being judgmental

The Promotion of Breastfeeding Intervention (PROBIT): Setting

Belarus (located near Ukraine). Was selected because at the time it had similar conditions that were similar to other developed countries, including: * Hospital practices such as - Delayed onset of breastfeeding - Scheduled feedings - Routine separation of mothers and infants - Routine use of water, formula or other liquids - Early introduction of solids * Other conditions - Did not have contaminated water. - Immunization and adult literacy rates similar to other developed countries. - Similar breastfeed rates

CHANGE IN LABOR AND DELIVERY PRACTICES · In the 1900's, what change occurred in labor and delivery practices?

Births moved from the home to the hospital

What is breast milk storage capacity?

Breast storage capacity is the maximum volume of milk available to a baby when a woman's breast is at it's fullest and is unrelated to breast size.

The #123forEquity pledge is to have hospitals increase all of the following EXCEPT? a) Breastfeeding rates b) Cultural competency training c) Diversity in leadership and governance d)Collection of diversity data

Breastfeeding rates

Which is NOT one of the steps to problem solving? a) Listing possible solutions (alternatives) b) Close the cycle down if the problem is not solved c) Identify or defining the issue(s) d) Evaluate the options

Close the cycle down if the problem is not solved

Open or Closed? Did your mother breastfeed you?"

Closed

Open or Closed? "Do you plan to breastfeed your baby?"

Closed

The definition of professionalism includes all the following except? a) Communication b) Compromise c) Technical Skills d) Emotions

Compromise

Connective Tissue Inside the breast:

Cooper's Ligaments- Fibrous bands that provide support for the breast tissue (also called suspensory ligaments)

What is the impact of low intake of Vitamin B12 on breastmilk? On the baby?

Undetected and untreated vitamin B12 deficiency in infants can result in severe and permanent neurological damage

Myoepithelial Cells

Each alveoli surrounded by a myoepithelial cells which contracts in response to oxytocin and pushes milk into the milk ducts - Every time when a baby gets on the breast and they start to simulate the breast they're suckling and suckling, message is sent to the brain, "okay mom the baby is here, we need some milk, baby needs milk. - Oxytocin is released and when oxytocin releases, it does two things 1) causes the myoepithelial to contract and they are as you can see right around the milk making cell, alveoli

▪︎ Adam's Equity Theory

Fairness of outcomes relative to inputs

True or False: Many professional health organizations recommend that mothers breastfeed their babies exclusively for the first year of their baby's life. True False

False

True or false: The natural childbirth movement advocated that women giving birth in a hospital use pain medication and feed them baby formula. a) True b) False

False

What is this mom's concern? I quit last time because it hurt so bad.

Fear of pain

What is this mom's concern? My friend says it hurts.

Fear of pain

Match the characteristics listed below, with the correction development phase of the mammary gland: Occurs between 2-8 days postpartum

Lactogenesis II

The Healthy People 2020 breastfeeding objectives focus attention of tracking progress towards reducing major barriers to breastfeeding. Using the key of barriers to breastfeeding listed below, Match the barrier to breastfeeding that the objective attempts to reduce. A. Formula supplementation before the mother has established her milk supply B. Hospital policies that hinder breastfeeding C. Lack of employer support for lactation To reduce the proportion of breastfed newborns who receive formula supplementation within the first two days of life to 14.2%.

Formula supplementation before the mother has established her milk supply

Key strategies for establishing and maintaining a good milk supply:

Frequent and effective removal of breast milk from the breasts * Frequent feedings (8-12 every 24 hours) * Avoid artificial nipples (i.e., pacifiers and bottle nipples) * Avoid unnecessary supplements * Effective removal of breastmilk from the breasts A baby that is breastfeeding effectively ( i.e., effective latch & effective suckling & milk transfer) * If baby is not breastfeeding effectively, use of an effective breast pump * Frequent skin to skin contact with baby

Match the characteristics listed below, with the correction development phase of the mammary gland: Considered the phase that milk production is established

Galactopoiesis

Match the characteristics listed below, with the correction development phase of the mammary gland: Occurs approximately 9 days postpartum

Galactopoiesis

Which is NOT using powerful language? a) Here's what I learned... b) Generally speaking, I tend to think... c) I'm getting better d) I'm sorry. It was m responsibility

Generally speaking, I tend to think...

International Breastfeeding Promotion Efforts: 2003:

Global Strategy for Infant and Young Children Feeding

Mammogenesis

Growth and development of the mammary gland throughout fetal, adolescent and adult life

CSUN received a grant to develop a breastfeeding peer counselor program to promote breastfeeding among pregnant and breastfeeding CSUN students. You have been charged with the task of recruiting breastfeeding peer counselors for this program. Which of the following candidates would be most qualified for this position? a) Jodi, a junior majoring in Biology at CSUN who has two children. Her oldest child is two and her youngest is 7 months old. She tried to breastfeed both of her children. However, she ended up giving them formula because it seemed easier to her. b) Jeni, a mother who breastfed three of her children who are now all in college. Jeni was recently accepted to the BS in Public Health program. c) Hilary, a CSUN graduate student who is a breastfeeding mother of twins who are 4 months old. d) Mirna, a CSUN alumni who graduated from the MPH program at CSUN 10 years ago and is currently breastfeeding her first baby who is now 6 months old. e) John, a father of three breastfed children who is currently in his second year of the Masters in Human nutrition program at CSUN

Hilary, a CSUN graduate student who is a breastfeeding mother of twins who are 4 months old.

The Healthy People 2020 breastfeeding objectives focus attention of tracking progress towards reducing major barriers to breastfeeding. Using the key of barriers to breastfeeding listed below, Match the barrier to breastfeeding that the objective attempts to reduce. A. Formula supplementation before the mother has established her milk supply B. Hospital policies that hinder breastfeeding C. Lack of employer support for lactation To increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies to 8.1%.

Hospital policies that hinder breastfeeding

An individual earns the designation of IBCLC by passing the __________________________.

IBCLC certificate exam

"If I breastfeed, I won't be able to work, go to school, or go out with my friends." How can this barrier influence a mother's decision to initiate breastfeeding?

If I think that breastfeeding will prevent me from doing anything, I'm really unlikely to want to initiate breastfeeding

INNOCENTI DECLARATION

In 1990, The World Health Organization (WHO) and the UnitedNations International Children's Emergency Fund (UNICEF)reaffirmed their commitment to breastfeeding with the Innocenti Declaration.

Match the characteristics listed below, with the correction development phase of the mammary gland: Occurs mid-pregnancy through 2 days postpartum

Lactogenesis I

Match the characteristics listed below, with the correction development phase of the mammary gland: The body begins to make colostrum

Lactogenesis I

Match the characteristics listed below, with the correction development phase of the mammary gland: The body begins to secrete large amount of milk and isreferred to as "secretory activation."

Lactogenesis II

Match the characteristics listed below, with the correction development phase of the mammary gland: Secretory epithelial cells apoptosis (ie., cell death )

Involution

You are a lactation educator who answers phone calls made to a breastfeeding warmline. Julie, a pregnant vegetarian, has contacted you. She tells you she would like to breastfeed her baby and wants to know if her diet will have any impact on her baby's health. Which of the following is the most appropriate way to respond to Julie? a) It is great that you are interested in breastfeeding. However, it is not recommended that moms who are vegetarian breastfeed. Are you open to consuming some animal products? b) It is great that you want to breastfeed! You don't have to worry about your diet because even if your diet is not perfect your breastmilk will always be perfect. c) It is great that you want to breastfeed! For the most part, regardless of what the mother eats, her breastmilk is perfect for her baby. However, if a mother's diet is lacking in some vitamins, her breastmilk will be lacking in those vitamins. This is the case with Vitamin B12, which can often be low in a vegetarian woman's diet and is particularly important for a baby's development. You may consider meeting with a registered dietitian to find out if you need to consume more foods with vitamin B12 and/or take a B12 supplement. d) None of the responses would be an appropriate way to respond

It is great that you want to breastfeed! For the most part, regardless of what the mother eats, her breastmilk is perfect for her baby. However, if a mother's diet is lacking in some vitamins, her breastmilk will be lacking in those vitamins. This is the case with Vitamin B12, which can often be low in a vegetarian woman's diet and is particularly important for a baby's development. You may consider meeting with a registered dietitian to find out if you need to consume more foods with vitamin B12 and/or take a B12 supplement.

The follow question relates to a scenario involving a pregnant mother and a lactation educator. Lactation Educator: Have you thought about how you are going to feed your baby once she is born? Pregnant Woman: Yes. I plan to formula feed. Lactation Educator: Can you tell me a little bit about why you have chosen to formula feed. Pregnant Woman: No one I know was able to breastfeed. Lactation Educator: Can you tell me a little bit about why they were not able to breastfeed? Pregnant Woman: They had trouble making milk. My mom says that women in our family don't make a lot of milk. The most likely concern this mother is expressing with regards to breastfeeding is _________________. Education you might share with this mother to help address her concerns could include _____________________.

Lack of confidence in ability to produce enough milk to nourish the baby/ the key to building milk supply is frequent and effective feedings

The Healthy People 2020 breastfeeding objectives focus attention of tracking progress towards reducing major barriers to breastfeeding. Using the key of barriers to breastfeeding listed below, Match the barrier to breastfeeding that the objective attempts to reduce. A. Formula supplementation before the mother has established her milk supply B. Hospital policies that hinder breastfeeding C. Lack of employer support for lactation To increase the proportion of employers that have worksite lactation support programs to 38%

Lack of employer support for lactation

What is this mom's concern? I want my mom/partner to help feed the baby.

Lack of support

What is this mom's concern? My mother says we can't make milk in our family.

Lack of support

Are the following tasks within the Lactation Educator's or the IBCLC's scope of practice? Educating a pregnant or breastfeeding woman about ways to maintain her milk supply while she is separated from her baby:

Lactation Educator

Are the following tasks within the Lactation Educator's or the IBCLC's scope of practice? Educating a pregnant woman on how to get breastfeeding off to a good start:

Lactation Educator

In SMART goals, the "M" stands for? a) Measurable b) Motivation c) Money d) Meaning

Measurable

A best practice to problem solving is to use which of these items to correctly identify issues for quality improvement? a) Recollection of past experiences b) Word of mouth c) Social media reports d) Metrics

Metrics

How many hospitals in the U.S. are currently are "baby-friendly designated facilities?'"

More than 600 Baby-Friendly designated facilities

The international code of marketing of breastmilk substitutes recommends all of the following EXCEPT: a) Infant formula should not be advertised publicly. b) All infant formula should be labeled with an explanation of the benefits of breastfeeding and the costs and hazards associated with artificial feeding. c) Mothers should receive free infant formula samples. d) Health care facilities should not promote infant formula

Mothers should receive free infant formula samples.

The International Code of Marketing of Breastmilk Substitutes recommends all of the following EXCEPT: A. Healthcare facilities should not promote infant formula B. Mothers should receive free infant-formula samples C. Infant formula should not be advertised publicly D. All infant formula should be labeled with an explanation of the benefits of breastfeeding and the costs and hazards associated with artificial feeding E. Formula companies should not give healthcare workers gifts

Mothers should receive free infant-formula samples

Herzberg's Two Factors theory

Motivators, hygiene factors

How much alcohol is safe to consume during pregnancy?

NONE

In the acronym TALKING, what word is associated with showing others are uniquely qualified to give you what you want? a) Need b) Integrity c) Listening d) Appreciation

Need

What is the additional caloric requirement for the first trimester?

None ‣ this is a period of development

Galactopoessis: establishment of lactation

Occurs approximately at postpartum day 9 - if the mom gets a good start to breastfeeding and the babies again effectively and frequently removing milk form the breasts this phrase occurs 9 days postpartum and last all the way through weaning

Open or Closed? How do you feel about breastfeeding?"

Open

Open or Closed? What have you heard about breastfeeding exclusively for six month?

Open

Examples of open-ended questions

Open-ended questions typically begin with the word,"what", "how", or "tell me." WHAT ‣"What has your mother told you about breastfeeding?" HOW ‣"How do you feel about breastfeeding?" TELL ME ‣Tell me why you have decided to feed your baby both breastmilk and formula?"

Which is NOT a trait of a true professional? a) Outgoing b) Has specialized knowledge c) Looks professional d) Practices self-regulation

Outgoing

Policies that promote, protect, and support breasting: The Federal Level

Patient Protection and Affordable Care Act (PPACA) (2010) - Provides for breastfeeding support and counseling services, pumps and supplies - Provides mothers with reasonable break time during the workday to express breast milk

Which form of communication solicits additional helpful information? a) Probing b) Reflecting c) Advising d) Deflecting

Probing

After the placenta is delivered which of the following changes in hormone levels occur?

Progesterone levels drop and prolactin levels rise.

What are some health-enhancing behaviors that reduce the risk of developing the following health problems? HIV/Aids

Proper use of condoms during sexual activity

All of the following are components of cultural competency EXCEPT? a) Awareness of one's own cultural world view b) A positive attitude towards cultural differences c) Providing patients with inaccurate information so their feelings are not hurt d) Developing skills to communicate and interact across cultures

Providing patients with inaccurate information so their feelings are not hurt

The IBCLC Code of Professional Conduct principles include all of the following EXCEPT? a) Preserve the confidentiality of clients b) Exercise independent judgement and avoid conflicts of interest c) Pushing the importance of breastfeeding to the client/patient even if they said no d) Report accurately and completely to other members of the healthcare team

Pushing the importance of breastfeeding to the client/patient even if they said no

Imagine that you were recently hired as a lactation educator. Your primary responsibility is to answer calls on a breastfeeding warmline. Read the scenarios below and decide whether the concern reported by the hypothetical mother calling the breastfeeding warmline is within your scope of practice. A pregnant mother calls the breastfeeding warmline. She tells you that she has a rare medical condition for which she takes a variety of medications. She asks you if it would be fine for her to breastfeed her baby. a) The concern raised in the scenario is NOT WITHIN the lactation educator's scope of practice b) The concern raised in the scenario is WITHIN the lactation educator's scope of practice

The concern raised in the scenario is NOT WITHIN the lactation educator's scope of practice

Nerves

The primary nerve that affects lactation branches from the fourth intercostal - This nerve supplies the greatest amount of sensation to areola - Trauma to this nerve might result in some loss of sensation in the breast

True or false: The consumption of folate during early pregnancy is associated with the reduction of risk of an infant developing neural tube defects.

True

True or false: The training to become an International Board Certified Lactation Consultant requires both course work and clinical hours

True

True or false: Undetected and untreated vitamin B deficiency in infants can result in severe and permanent neurological damage.

True

What happens when the breasts are stimulated?

Understanding the hormones that influence milk production

Health behavior change is complex: the only way that we can actually be effective at motivating someone to change a health behavior is if we really:

Understanding why someone engages in a particular health behavior is key to motivating health behavior change

Prior to the 1800s, the most common alternative to maternal breastfeeding (i.e., if a mother was not available to breastfeed her infant) was: a) None of the responses were the most common alternative to maternal breastfeeding b) Hand-fed foods c) Rice cereal d) Use of a wet nurse Artificial baby milk

Use of a wet nurse Artificial baby milk

The Three- Step Counseling Strategy: An Effective Tool for Communication about Breastfeeding Concerns Step 1:

Use open-ended questions and probes to explore concerns

Sheila, the healthy mother of exclusively breastfed 2-month old Taylor decides to go vegan (i.e., consume a diet that does not include animal proteins, eggs, or milk). To ensure that baby Taylor gets adequate amounts of _____ via breastmilk, Sheila will need to supplement her diet with ____. a) Calcium, Calcium b) Vitamin B12, Vitamin D c) Vitamin D, Vitamin C d) Iron, Calcium e) Vitamin B12, Vitamin B12.

Vitamin B12, Vitamin B12

THE CREATION OF THE ARTIFICIAL BABY MILK INDUSTRY · (1867) Henri Nestle, a pharmacist invented an artificial infant food.

Was invented for a friend whose infant could not digest fresh cow's milk.

What Are Some Strategies for Calming a Fussy Baby?

Ways to comfort a crying baby (i.e., calming techniques) include: ❖Holding techniques ‣ Skin-to-skin contact ‣ Wear baby (sling) ‣ Place baby on his stomach across parent's lap ❖Sounds and motion ‣ Provide a steady noise (e.g., vacuum or dryer) ‣ Take baby out for a car ride ‣ Place baby in a bouncer or swing ❖Security and warmth ‣ Put baby in a warm bath

In the 80s some experienced breastfeeding volunteer leaders began to explore the possibility of obtaining paid work assisting mothers to breastfeed * What do you think these women did?

Well basically what they did was they began work to create a certification program for a new healthcare profession with expertise in lactation

You are a lactation educator working at a hospital providing mothers with breastfeeding education prior to their discharge from the hospital. You walk into one of the postpartum rooms, where you observe Laurie, a mother of a one-day-old breastfeeding baby. She puts Alex, her son, down to sleep. Alex does not seem to be winding down to sleep, but instead you observe him rooting. Which of the following would be the most effective information to share with Laurie?

What a beautiful baby you have. What is his name? Do you know about the different cues babies give when they are hungry? Looks like Alex is hungry. I recommend you breastfeed him

Consider one open-ended questions that could help you gather information from your client relating to: Your client's current support system in relation tobreastfeeding.

What does your significant other and family think about breastfeeding?

Turn the following closed ended questions into open ended questions "Are you going to breastfeed or bottle-feed?"

What have you heard about breastfeeding vs. bottle-feed?

Consider one open-ended questions that could help you gather information from your client relating to: Your client's attitudes about breastfeeding

What have you heard about breastfeeding?

Which one of the following is considered problem solving rather than decision making? a) Deciding how many minutes should you allow the baby to sleep before removing from the breast b) Which breast pump to recommend c) Which client/patient to visit first d) What to tell the mother about her sick baby

What to tell the mother about her sick baby

What Are Health Behavior Constructs?

When a concept is utilized as a part of a theory, it is called a construct. * Examples: - Social norms - Perceived behavioral control - Decisional balance

Although other government agencies in the U.S. work to improve infant nutrition, the special supplemental Nutrition Program for _______________________________.

Women, Infants and Children (WIC) likely impacts the most infants.

The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the _______________________________________________.

World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that successfully implement the 10 steps to successful breastfeeding.

Do inverted nipples affect breastfeeding?

Yes they can - Inverted nipples may hinder the newborns ability to grasp enough nipple/areola to suckle effectively ⁃ not a deal breaker, it's just much more challenging for the mom • It is important if the mom has inverted nipple to do education. But it's important that the part of that education include the fact that you don't have to have an inverted nipple to breastfeed. Yes, it may make it challenging but it's definitely not a deal breaker

During ancient, were infants feed foods other than breastmilk?

Yes, evidence exists suggesting that during ancient times, infants were feed human milk substitutes known as hand-held foods.

The 1000 days between a woman's pregnancy and the child's 2nd birthday are _________________________________.

a unique window of opportunity to shape a healthy future for that children.

Feedback Inhibitor of Lactation (FIL) is _______________________________.

a whey protein that naturally occurs in breastmilk.

During lactation, oxytocin is responsible for a) _______________ and prolactin is responsible for b) ____________.

a) Helping milk flow through the ducts and out the nipple b) Milk production

The nipple is flexible and therefore _____________________.

able to mold and elongate to conform to the baby's mouth during feeding. - it is important that the nipple is flexible and that it stretches

Rationale for Each of the Code's KeyRecommendations NO words or pictures idealizing artificial feeding, including pictures of infants, on the products

advertising that idealizes formula and provides consumers with misleading inaccurate information can significantly affect parent's choice to breastfeed - it's really evident in the Formula Disaster documentary that misleading advertising suggesting that feeding your baby formula can make your infant a great musician had a huge impact on infant feeding decisions in the Philippines.

Rationale for Each of the Code's KeyRecommendations NO advertising of breast-milk substitutes directly to the public: ⁃ Why does the code recommend no advertising of formula directly to the public?

because advertising can influence a family's infant feeding choices, and in fact, researchers examined the impact that formula ads on breastfeeding rates had and they found there was an inverse relationship between the number of formula feeding ads and breastfeeding rates * Basically, this was some time between 1970-1999, some researchers got together and looked at ads in popular parenting magazines and found that during that time period there was a significant increase in the number of formula feeding ads and simultaneously, there was also a decrease in breastfeeding rates.

THE INTERNATIONAL BOARDCERTIFIED LACTATION CONSULTANT: QUALIFICATIONS IBCLC who is also a specialist who is focused on supporting _______________.

breastfeeding

Mammals have one characteristic that is they share and they all have _____________________.

breasts which a really made for feeding babies

The nipple has smooth muscle fiber that function as ________________________.

closure mechanism to keep milk from continuously leaking from the nipple ▸ and if you think about it there's a lot of milk being produced in the breast. If there wasn't something to close that off, mothers would just leak and leak ‣ So, it is helpful that we have that smooth muscle fiber that closes off that area so that we don't have milk constantly leaking

In breast anatomy asymmetry is ___________________.

common

Under Katz's Skill Model of Leadership which skill needs to be higher for top level leaders as opposed to supervisory personnel? a) human relations b) technical c) none of the above d) conceptual

conceptual

Direction of effort

concerned with choices people make in deciding where to put forth effort

Cultural Competence Involves

ensuring that the needs of diverse patients/clients are met by health service and public health organizations base on the acquisition of specific skills sets, valuing diversity, and taking concrete steps to ensure efficacy in serving minority populations

Code of conduct

express relevant ethical standards for professions

Content theories

focus on human needs and other unmet needs that all people have ▪︎ Maslow's Hierarchy of Needs ▪︎ Alderfer's ERG theory ▪︎ McClelland's Learned Needs Theory ▪︎ Herzberg's Two Factors theory

Process theories

focus on the context in which the task is to be completed and how people think and feel about it ▪︎ Vroom's Expectancy Theory ▪︎ Adam's Equity Theory ▪︎ Locke's Goal- ▪︎ Skinner's Reinforcement Theory

Mature milk consists of ___________________ The baby needs both for optimal growth and development.

foremilk and hindmilk.

Ethnographic evidence suggests that, during ancient times, during ancient times:

hunter gathers breastfed their infants. * We have anthropologist who does photographic studies focusing on modern-day hunter-gatherer societies like the kung in the Kalahari and what they have learned from studying the kung is that ancient day hunter-gathers all the way back that was those thousands of years ago breastfed. * Specially the kung breastfeed their infants throughout the day for short durations of time

How do you think faith in science and technology contributed to declines in breastfeeding?

if scientist create an infant baby milk it must be better than mother's nature's version.

Rationale for Each of the Code's KeyRecommendations NO promotion of products in healthcare facilities

it's inappropriate to use the healthcare system to promote formula because it sends a misleading message to families that formula is the healthiest way to feed their infant. If it wasn't the best way of feeding your baby, then why would a hospital, doctor office, or clinic have posters, name tags, or other products advertising formula?

A few examples of how lack of minimal knowledge, attitudes, and skills among health providers can influence breastfeeding rates Pediatricians

if the pediatrician doesn't have minimal breastfeeding knowledge we may have a situation where the moms having difficulty breastfeeding her baby and she goes home continues experiencing difficulties by the time she comes to her 2-week follow up appointment the baby has not regained all its weight and the pediatrician is very concerned and tells them you need to supplement with formula immediately. If the pediatrician has minimal breastfeeding knowledge and his positive attitude to prep breastfeeding he or she may consider sending that mom to work with a lactation consultant so she can help the mom maintain breastfeeding ⁃ some strategies that might be used if mother sees a lactation consultant rather than supplementing with formula the lactation consultant would likely get them on expressing breast milk and supplementing with the pump milk rather than formula ⁃ they may use something call supplemental nursing system which is essentially almost like a little necklace with a bottle and you put the breastmilk in the bottle and sew and tape a tube to the mother's breast and so with baby as they're breastfeeding they're getting milk from directly from the breast as well as a supplement

Misfeasance

improperly doing something

Due to health risks associated with using human milk substitutes/ had held foods we can assume that __________________________.

in ancient societies few babies were exclusively hand-fed

Ovo-vegetarian:

includes eggs

Fruitarian:

includes fruits, nuts, olive oil & honey

Lacto-vegetarian:

includes milk and milk products (yogurt, cheese, ice cream)

Lacto-ovo-vegetarian:

includes milk products and eggs

ETHNOGRAPHIC EVIDENCE · Inference made from modern day hunter gather societies provide good evidence that _________________.

infants are programmed to breastfed frequently, for short durations of time and for at least 2 years of life. * The kung breastfeed their infant frequently throughout the day for short durations * They also breastfeed their children anywhere between 2-6 years.

In rare cases, mothers may have, " hypoplasia" a condition of the breast that is characterized by _________________________.

insufficient glandular tissue

Critical thinking moves us towards: a) rash conclusions b) mystification c) reluctance to question received wisdom and authority d) intellectual discipline

intellectual discipline

Study designs: The strongest type of research design is the randomized control study.

is essentially when we take a group of participants that we recruit into a study, and we randomly assign them to receive the intervention, and those to receive nothing or what we call the control.

Motivation

is the set of forces that initiates, directs, and makes people persist in their efforts to accomplish a goal.

Meta-analysis

is when we have serval studies that are examining the relationship between in this context, breastfeeding and a reduction in risk in obesity, and we pull them together

‣ How long do babies feed?

it really depends. In the early days it can take a baby about 45 minutes to an hour to feed. But as they get into a rhythm it really depends on the infant.

What is the natural childbirth movement?

it was a movement that advocated that women can give birth naturally without medication with as little as intervention as possible through using variety of comfort measures including: - deep breathing

What is this mom's concern? My breasts are too small.

lack of confidence regarding milk production

Rationale for Each of the Code's KeyRecommendations NO free samples to mothers

no free samples because they can negatively impact a woman's milk supply and result in her inability to adequately nourish her baby - if a mom is struggling to breastfeed, perhaps she's experiencing a lot of pain breastfeeding or she's really concerned that she may not be producing enough milk- if she's given a free sample of formula she's much more likely to use the sample that if she has to go to the store and purchase it - the key to building a good milk supply is frequent, effective feeding, particularly in the early periods. If a mom is getting free samples in the early period and she's substituting breastfeeding sessions with the free formula sample, her body's going to start making less milk for her baby.

Prior to the 19th century there were ___________________.

no safe alternatives to breastmilk

Prior to the 19th century, breastfeeding was the ________________.

norm for feeding infants

The objective of the 1000 day challenge is a call for targeted action to improve _______________________.

nutrition, including exclusive breastfeeding rates during the critical first 1000 days of life.

Breastmilk has ________________________ that are lacking in artificial baby milk.

nutritive qualities and immunological factors

What is the correct order of Maslow's Motivational theory of needs? a) social and belonging, safety, esteem, physiological, self actualization b) safety, esteem, physiological, self actualization, social and belonging c) esteem, physiological, self actualization, social and belonging, safety d) physiological, safety, social and belonging, esteem, self actualization

physiological, safety, social and belonging, esteem, self actualization

Although WIC is the largest purchaser of formula in the U.S., in the 1980's ______________________________.

promoting breastfeeding became one of WIC's goals.

Sample size

so, if I have a very small sample size of 10 women versus a large sample size of my study of 3,000 women, or mother baby infant dyads. The study with 3,000 participants is going to be much stronger than that of 10.

Which emotional intelligence dimension is the ability to thoughtfully consider ones' feelings when acting? a) self-regulation b) self-awareness c) self-motivation d) social awareness

social awareness

The Middle Ages It was not very popular to breastfeed the reason it wasn't popular was that:

society believed that breastmilk had magical qualities and through breastmilk someone could transmit physical and psychological qualities - So there was a concern that if you hired a wet nurse was not so ethical or had physical limitations, that the wet nurse would transfer those undesirable characteristics to your infant - So at that time the preferred way/ the best wat was if the mom could be the feed the baby, feed the baby and only if there is absolutely no other choice did they use a wet nurse

In order to produce adequate amounts of breastmilk, mothers need to have _____________________________.

sufficient glandular tissue. - without sufficient glandular tissue a mom is not going to be able to make sufficient amounts and she wont be able to exclusively breastfeed her baby. In most cases if the mom is frequently feeding the baby and the baby's effectively removing milk from the breast she going to hit galactopoiesis and establish a great milk supply

Although it's common for women to have two nipples, sometimes a mom can have an extra nipple known as a ___________________________________.

supernumerary nipple- it can develop anywhere along the mammary region milk line

when a woman nurses two children of different ages it's called _______________ and producing milk for two children does require more calories and nutrients than needed to feed one

tandem nursing

For example, one benefit for the breastfeeding mother is

that she will lose her pregnancy weight much quicker

Galactopoessis: establishment of lactation Effective and frequent removal of breastmilk from ________________________________.

the breast must be present for Galactopoessis to occur

Mammogenesis Begins to develop in _________________.

the fetal Stage - Begins as early as 4th to 5th weeks of gestation males and females.

What is the Glycemic Index?

the glycemic index simply put is a measure of how quickly a food causes our blood sugar levels to rise and the measure ranks food on a scale of 0 to 100 so foods with a high glycemic index or GI are quickly digested and absorbed and it causes a rapid rise in blood sugar and the foods that rank high on the GI scale are often but not always high in processed carbs and sugars

Values

the ideas or customs of a society toward which the people of the group have an affective regard

Storage capacity does not impact milk production ability. However, it can impact ____________________________.

the infant's feeding frequency

Except for the uterus, no other organ changes so dramatically as _____________________________________.

the mammary gland during pregnancy and lactation.

How are back the participants asked to recall the breastfeeding dosage?

the most accurate way to ask women about recall, which I have seen a few studies that do this it's quite costly, but actually what they do is from the time the baby is born, they have a research assistant call and check in every few days and ask, · are you breastfeeding? Have you given anything other than breast milk? If so, how much? And they document that.

Ideally, all perceived barriers to breastfeeding are addressed during _____________________.

the prenatal period.

1989: The Child Nutrition and WIC Reauthorization Act required that a certain proportion of WIC's budget be spent on ____________________________.

the promotion and support of breastfeeding.

What changes happen to the nipple?

the shape and size during pregnancy and after childbirth

It is important to any lactation course to talk about inverted nipples because when a women has inverted _______________________________.

there's a lot of fears that she won't be able to breastfeed, which is not true

Accountability

they always take full responsibility

Looking the part

they dress appropriately for the situation

Competency

they get the job done, are reliable and find solutions

Specialized knowledge

they have a wealth of knowledge and skills that are up to date

Honesty and integrity

they keep their word, never compromise their values

Self-regulation

they stay professional under pressure, polite and have high emotional intelligence

The Promotion of Breastfeeding Intervention (PROBIT)

this is the largest randomized breastfeeding study

Where does the mammary region milk line start?

this line starts all the way in the armpit and extends all the way to the groin is called the milk line and essentially when babies are developing in the fetal period their breasts start to develop as early as five weeks. - and early on around that time, two mammary ridges that are called milk lines are formed and they extend from the armpit all the way to the inner thigh or the groin - ⁃ sometimes usually they disappear but sometimes they fail to regress and what happens is that an extra nipple is formed right on one of those lines

Nipple

tissue can stretch and heal quickly. • Why do you think that it is important? If we are talking about breastfeeding, why is it important for the nipple to health quickly? - Sometimes women can experience some cracking or bleeding on the nipple - if the baby is not latched on correctly and the mom is nursing with the baby improperly latched on, that can lead to some cracking, some bleeding, some trauma to the nipple.

Frequent and effective removal of milk from the breasts, prevent breasts from becoming _____________________________________.

too full and producing large amounts of FIL.

Negotiation- Process by which

two or more parties with different interests or perspectives attempt to reach an agreement

Cultural competency refers to the ability to _____________________.

understand, appreciate, and interact with people of different cultures

How does laid-back breastfeeding work?

we tell mom to lie back in a semi reclining position, she puts the baby on his or her tummy and again this is based on research that suggests that newborn humans like mammals are abdominal feeders and when you put them out on their tummy/ abdomen they display these anti-gravity reflexes, which prevent them from falling and assist them in latching on. So when you put them on their tummy the newborn reflexes are triggered and that helps them push up on the breast with their legs bob their head and find the nipple.

A few examples of how lack of minimal knowledge, attitudes, and skills among health providers can influence breastfeeding rates: Postpartum Nurses

who doesn't have minimal knowledge about breastfeeding and during the hospital stay the mom is having difficulty breastfeeding her baby and her nurse doesn't have much skills with latching and positioning baby onto the breast, the mom is very likely to leave the hospital using formula and not breasting effectively. In particular if that hospital doesn't have a lactation consultant to assist the mother

The American Academy of Pediatrics (2012)

· "Reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant."

BIOLOGICAL EVIDENCE

· Humans are mammals o One characteristic unique to the female mammal is the mammary glands or breasts o The breasts can secrete and release a fluid that for a time is the sole nourishment of the female's offspring. * Example: we have several mammals feeding their young. We've got a photo of gorilla feeding her young, a cow, a lamb, baby macaw and last but not least a human

The Promotion of Breastfeeding Intervention (PROBIT): Recruitment

· this study took place between June 1996-December 1997 · N- 16,500 infant pairs were recruited

Many women are faced with extra weight once the pregnancy is over. What is the recommended amount of weight loss per week?

• .5 - 2 lbs./wk

What are the recommendations for postpartum exercising?

• 150 minutes of moderate-intensity/wk • 4-6 times/week • Beginning 6-8 weeks postpartum w/ release from MD

A breastfeeding mom is worried about drinking too much coffee. What would you tell her?

• A daily cup of coffee, tea, or soda will be fine for most infants to handle. • Water is always the preferred beverage. • Watch the infant for signs of fussiness irritability and difficulty sleeping

Why might significant others/close family members not be very supportive about breastfeeding?

• A lot of it has to do with lack of knowledge about breastfeeding, lack of knowledge about the benefits of breastfeeding, lack of knowledge about how breastfeeding works, lack of knowledge about what is takes to successfully build a good milk supply to feed baby, and, also, sometimes it's actually related to fear that the mom will bond more with baby and the significant other or other family member will feel left out.

Do we need to teach mothers how to breastfeed?

• According to Susan Coulson we don't need to teach babies how to breastfeed • Babies can figure it out on their own. Susan Coulson developed a new approach to breastfeeding, which she calls a lay back breastfeeding and this is based on her research where she identified 20 different reflexes that she calls primitive neonatal reflexes, which help babies to get to the breast and transfer milk. • Based on the evidence regarding these neonatal reflexes Susan Coulson developed laid-back breastfeeding which is an approach she uses to help moms breastfeed • What she found is that we don't need to teach mothers necessarily football position or the cradle position. All we need to do is tell them lie back and let the baby figure it out on its own.

A mom is concerned about her baby reacting to her (the mom's) intake of milk. She isn't allergic to milk. What suggestions would you offer?

• All foods can be enjoyed. If the infant shows a reaction, then you may start to eliminate foods, beginning with milk, wheat, nuts, eggs etc. It may take up to 21 days for the offending food to leave the system completely. If the infant benefits from the removal of the food, great. If there is no difference, a slow re-introduction is fine.

The Tail of Spence:

• Breast tissue that extends into axillary region (armpit area). • This area can potentially get engorged and or be impacted by mastitis.

"I've heard that breastfeeding hurts." Is this belief true? Is breastfeeding painful?

• Breasting does not have to be painful- it can be. • About 75% of the time that a mom experiences pain while breastfeeding, it has to do with improper latch or positioning and it can easily be fixed with a little tweak of the latch or positioning * Sometimes, there are some other reasons why breastfeeding would be painful. • Very rare, but maybe the baby has a short frenulum - the frenulum is a little short little pieces of skin right underneath the tongues. When the frenulum is short, then the baby can't extend their tongue out when breastfeeding and what happens is that as they're breastfeeding, their tongue will flick the nipple and after a while it will cause some irritation and some cracking it can be painful. This could easily be alleviated with clipping the frenulum which doesn't hurt at all, but again, very rare.

You are a lactation educator who answers calls on a breastfeeding warmline. Julie who is in her 3rd trimester calls and reports that she has inverted nipples and heard she could fix them. How do you respond to her?

• Explain to julie how to do a pinch test to determine if her nipples are true or pseudo-inverted • if they are true inverted, let her know that her nipples may not necessarily make breastfeeding challenging. However, in some circumstances baby may have some difficulty • if she is interested in trying to evert her nipple before her baby is born, encourage her to check with her provider to determine whether is it okay for her to try to evert her nipples prenatally. • If her provider give her the green light, encourage her to work with a lactation consultant who can discuss with her commercially available products for everting her nipples • if inversion is not corrected prenatally, encourage her to ask for assistance with breastfeeding in the hospital as soon as possible after her baby is born

The International Code of Marketing of Breast-milk Substitutes What is the "Code"?

• Guidelines adopted on May 21, 1981 by the world Health Assembly of the World Health Organization (WHO), which provide standards for appropriate marketing and distribution of human milk substitutes ⁃ so, the provisions that are outlined by the code are not laws ⁃ It is up to each country to select which provisions they want to adopt, and how strictly they want to enforce them - for example: in some countries, a particular provision has become a law, and other countries, it's just a recommendation. - so again, it's up to each country to decide how much they enforce each provison

What nutrition recommendations would you give a mom who is tandem breastfeeding?

• High calorie/nutrient dense foods in snacks and meals provide good sources of additional calorie intake. ‣ Avocado ‣ Nuts & nut butter ‣ Seeds & seed butters ‣ Dried fruits ‣ Full-fat soy products ‣ Bean spreads ‣ Omega-3 (food or supplement) • Hydration

Healthy People 2020: Changes from 20210 to 2020 - In addition to tacking the proportion of infants who are breastfed, the 2020 breastfeeding objectives focus attention on tracking progress towards reducing major barriers to breastfeeding success including:

• Hospital policies that hinder breastfeeding • Formula supplementation before mother has established her milk supply • Lack of employer support for lactation

How can lack of confidence regarding milkproduction influence a woman's decision toinitiate breastfeeding?

• If I'm afraid that or I think that I'm not making enough milk for my baby, I'm concerned that I'm going to cause my baby to starve, they won't gain weight they won't grow adequately. • There's no way I'm going to initiate breastfeeding, I don't want to hurt my baby, I just want my baby to be healthy.

How can lack of support influence awoman's decision to initiatebreastfeeding?

• It can be very challenging to breastfeed if you don't have support. Breastfeeding takes a long time. • In the early period, the baby is about three to four months, moms need to feed about 8 to 12 times in 24 hours. And in the early days it can take about 45 minutes per feeding. That's a lot of time spent on the couch sitting and feeding. And if you don't have a supportive partner of family member's they may feel that you're slacking off with your responsibilities at home, sitting on the couch and breastfeeding while the dishes pile up, while laundry piles up • So, support can make a huge impact on a woman's decision to breastfeed and also to continue breastfeeding.

"I've heard that breastfeeding hurts." How can this barrier influence a mother'sdecision to initiate breastfeeding?

• Most people are not interested in adopting behaviors that will bring about pain ‣ As human, in general, we seek pleasure and we try to avoid pain. ⁃ so, if i think that breastfeeding is going to be painful, it's definitely going to impact my decision to initiate breastfeeding and I'm very likely going to choose no to

Generally, the code recommends:

• NO advertising of breastmilk substitutes directly to the public • NO free samples to mothers • NO promotion of products in healthcare facilities • NO gifts or personal samples to health workers • NO words or pictures idealizing artificial feeding, including pictures of infants, on the products • All information on artificial feeding, including the labels should explain the benefits of breastfeeding, as well as the costs and hazards associated with artificial feeding • Unsuitable products, such as condensed milk, should not be promoted for babies as an alternative to breast milk because they are not adequate for a young infant. They're not comparable to formula and they're definitely not comparable to breastmilk • All products should be of high quality and take into account the climatic and storage conditions of the country where they are used

A prenatal client tells you her doctor mentioned that her lab values indicated she has iron-deficiency anemia. What suggestions can you offer to help increase iron absorption?

• Specific example, working with her current eat patterns to increase iron from ▪︎ Animal sources (non-vegetarian) ⁃ Beef, chicken, fish, pork, turkey, eggs, ect ▪︎ Plant source (vegetarian & non-vegetarian) ⁃ Beans, legumes, spinach, nuts, peanut butter, ect. ▪︎ Combination of Vitamin C & iron-rich foods ⁃ spaghetti & meat sauce, carne asada & salsa, omelet w/ vitamin C-rich veggies, ect. ▪︎ Watch calcium intake ▪︎ Prenatal supplementation per MD

What are special considerations you would look out for when counseling a teen mom?

• Teen may still be growing • Higher risk of nutrient deficiencies ‣ Low iron ‣ Low folic acid ‣ Low calcium • High risk of ‣ Lack of nutrition knowledge ‣ Low vegetable and fruit intake

Why is it Inappropriate to Market Infant Formula in Underdeveloped Countries? It is especially inappropriate to market infant formula in underdeveloped countries because breast milk is:

• That the alternative breast milk is readily available * Free • Does not require clean water to prepare • Protects the infant from diseases prevalent in their immediate environment

How can we understand why someone engages in a particular health behavior?

• The key to understanding someone's health behavior is: Health behavior theories, models, and constructs

Endocrine control (i.e., hormonally driven)

• the endocrine system is a collection of glands that produce hormones and regulate all sorts functions including: ⁃ growth, development, reproduction • it's important to keep in mind that regardless of what the women has decided she'll do with respect to how she'll feed her infant, if she wants to formula feed her body doesn't care. The body is pregnant and it is in that 2nd trimester preparing for lactation. The hormones are preparing the body body to breatfeed. • So we'll see the body starts to actually produce closotrum

Using A Probe "I want the baby's father to help too."

• think about why a mom might say this, you know, in terms of wanting the dad to help maybe she thinks she's gonna be overwhelmed. Maybe she thinks she'll never be able to leave the baby because she doesn't know how to maintain her milk supply if she's separated from baby. She might not know how to get the dad to feel involved, she's afraid he's gonna feel left out she thinks the only way dad's can help is by feeding baby. - We really don't know but again how can you figure that out? With a question or specifically probe might you use? ▪︎ "Tell me more about what he says about breastfeeding?" ▪︎ "Are you saying you want him to feel close to the baby or do you feel you will need help with the baby? ▪︎ "What have you heard about how breastfeeding affects a father's involvement with his baby?"

What recommendations would you give if a woman did not want to use prenatal supplements?

• while eating more food to meet energy needs and the increased absorption of nutrients that occurs during pregnancy are usually enough to meet the needs for most nutrients when good food choices are • However, vitamin and mineral supplementation is routine. Supplementation helps cover "nutrition gaps." • Many women consume less than the recommended amounts of calcium, magnesium, zinc, vitamin B6, and folate • It is important to emphasize that vitamin and mineral supplements cannot replace a healthy diet

Recent research suggest that some commercially available products may help evert nipples including:

‣ Breast shells ‣ Supple cups ‣ Nipplettee

Which of the nutrients below may be lacking in the diet of a vegetarian?

‣ Protein ‣ Vitamin B12 ‣ Calcium ‣ Iron ◦ These four nutrients may be lacking in the diet of a vegetarian

1985: The International Board of Lactation Consultant Examiners (IBLCE) is established

‣ through a loan from allegedly they established the international board of lactation consultants examiners ‣ They worked to develop an exam that would enable individuals to demonstrate their clinical competencies in the field of lactation

The Exterior Breast:

⁃ Located in the superficial fascia (fibrous tissue beneath the skin) between the second rib and the sixth intercostal space.

How was breastfeeding measured?

⁃ Older studies initially would ask women, did you breastfeed, and they would say yes and then they would look at some out the health outcomes. ⁃ Were they exclusively breastfed? ⁃ If they weren't exclusively breastfed and receiving some formula, how much? Because there is a very big difference between a mom who is feeding once a day formula to their child and everything else is breast milk, versus someone who is only breastfeeding once a day.

A few examples of how lack of minimal knowledge, attitudes, and skills among health providers can influence breastfeeding rates Primary Care Doctors

⁃ let's say that the mother develops a breastfeeding infection and calls her doctor tells her primary care doctor and the doctor tells her she has to stop breastfeeding. ⁃ this actually isn't correct because if you have a breast infection the best thing to do is keep breastfeeding and if the mom listens to this inaccurate information what's going to happen if the mother stops breastfeeding she can actually get engorged and that engorgement can even turn into an abscess which requires surgical removal

During pregnancy, prolactin stimulates alveolar growth

⁃ responsible during lactation for the production and ongoing production of milk however I do want you to know that during pregnancy Prolactin does have a role it actually stimulates alveolar growth * After birth that is what triggers lactogenesis II. Remember when the baby is delivered and the placentas delivered dropped it in progesterone and whoosh surge of prolactin which triggers lactogenesis II * Throughout lactation, prolactin tells the body to produce milk * Prolactin is a natural tranquilizer that relaxes the mother and is known to induce maternal behavior

Rationale for Each of the Code's KeyRecommendations All information on artificial feeding, including the labels, should explain the benefits of breastfeeding, as well ad the costs and hazards associated with artificial feeding

⁃ this is about making sure that families make informed decisions about how to feed their infant ⁃ they're told formula is the same as breastmilk or better. That is not accurate because breastfeeding is associated with a variety of health benefits that are not associated with formula feeding and parents need to know the advantages of feeding the baby breast milk versus formula

Rationale for Each of the Code's KeyRecommendations All products should be of a high quality and take into account the climatic and storage conditions of the country where they are used

⁃ this recommendation focuses on the discussion we began earlier in this online lecture relating to how formula shouldn't be promoted in places where it cannot be safely prepared

Rationale for Each of the Code's KeyRecommendations Unsuitable products, such as condensed milk, should not be promoted for babies.

⁃ we don't want to feed a baby something that is not an alternative to breastmilk. While breast milk is better than formula, formula is a safe alternative for breastmilk. ⁃ if an infant receives formula properly and safely prepared, they're going to grow and develop adequately. If they're given foods like condensed milk or sugar water or sugar milk from a cow, that's not suitable product or alternative to breast milk. It doesn't have all the ingredients and nutrients that an infant needs to develop, and as you saw in the documentary, Formula Disaster, they actually have this store worker who was interviewed and she shared how moms who can't afford formula, purchase products like condensed milk to feed their baby, and they think it's an alternative to formula. They don't realize and they're not told that it's nothing like formula and that their readily available, free breastmilk is much superior and better for their baby

Using A Probe I know I (my wife/significant other) will need formula."

▪︎ "Tell me more about why you think you (your wife/ significant other) will need formula." ▪︎ "How do you feel about exclusive breastfeeding?" - now that's gonna tell you maybe they think that they can't exclusively breastfeed maybe they think that it's not possible for anyone or like I mentioned maybe they think formula has special vitamins ▪︎ "What have you heard about formula?"

How long should you let the mom and baby figure thingsout before intervening to protect the mom's milk supply?

▪︎ 6 hours ▪︎ If the baby is 6 hours old and still has not breastfed, it is recommended to get the mom to start to pump her breasts

Why is it normal for newborns to wake up at night?

▪︎ A baby's tummy is very small. ⁃ so they have to wake up frequently to eat. • Also what happens with the newborn is that their sleep patterns are very different than in adults - so during the first three months of life a newborn can start sleep or they do start sleep with what's referred to as light active sleep and only after about 30 minutes do they transition into deep sleep. ⁃ During that light sleep it's very very easy for them to wake up and usually we find that most infants don't sleep more than four hours even at three months and by six months most infants can sleep about six hours. So again if you've got a baby under six months it's not a realistic expectation for them to sleep a full six hours

Effective Counseling Skills:Connections Needed to Uncover Breastfeeding Concerns

▪︎ Addressing breastfeeding concerns is not a simple task. ▪︎ There is no cookie cutter script that can magically address all breastfeeding concerns. ▪︎ Developing effective counseling skills can help you uncover breastfeeding concerns and subsequently tailor support & education to meet your clients needs.

Lobes

▪︎ Alveoli bunch into grape like cluster called lobes ▪︎ Each lobe contains anywhere between 10-100 alveoli in an intricate system of ductules that branch out from the lobes and converge into lactifrtous duct behind the nipple

Padding

▪︎ Another effective counseling strategy is padding. ▪︎ Padding puts extra words or pauses into our response to make mothers feel safe and secure. ▪︎ Ways to pad responses: ‣ Use the mother's name ‣ Add extra words ‣ Pause before responding

Conflict Resolution -5 Modes Pick the best mode to begin to problem solve

▪︎ Competitive - win at all cost (not recommended unless emergent situation) ▪︎ Avoidance - never a good option since the problem will just fester ▪︎ Accommodation - giving in will just make the person resentful later on ▪︎ Compromising - good to a degree to get the problem solved but not satisfying over time ▪︎ Collaboration - the best way to come to a solution but time consuming if done properly

The 10 steps are now subdivided into two parts:

▪︎ Critical Management Procedures: ⁃ steps one and two are institutional procedures needed to ensure that care is delivered consistently and ethically. ▪︎ Key Clinical Practices: ⁃ Steps 3-10 are specific evidence-based interventions that support mothers in successfully stabling and maintaining breastfeeding.

Size of the Newborn's Stomach

▪︎ Day 1 Shooter marble 2-10 mL (1/8-5/8 tbsp.) ▪︎ Day 3 Ping-pong ball 15-30 mL (1-2 tbsp.) ▪︎ Day 10 Large egg 75-90 mL (5-6 tbsp.)

1b. Have a written infant feeding policy that is routinely communicated to staff and parents.

▪︎ Describe this Step: - Make breastfeeding care standard practice. ‣ This step involves hospitals having in place policies that support breastfeeding by creating policies at the hospitals that require staff to implement the 10 steps to successful breastfeeding. ‣ Hospitals are ensuring that staff implement practices that support breastfeeding How Does this Step Support Breastfeeding? ▪︎ Policies drives practice. So health care providers and institutions are required to follow established policies. The idea here is if clinics that are part of the 10 steps to successful breastfeeding are incorporated in the facilities policy, there is a high chance patients will receive consist care that supports breastfeeding. ‣ so if we have these policies that are visible, then we know that parents are going to see what staff are supposed to do and are more likely to request that kind of care.

1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.

▪︎ Describe this step? - Hospitals should not promote formula, bottles or teats. ▪︎ How does this step support breastfeeding? - Parents are vulnerable to marketing of artificial breast milk substitutes especially if a health-care provider is the one promoting the product. This is why the code are adopted.

Lactation Educator Application Problem solving

▪︎ Do not be too solution oriented, set goals for the Mom and check in to see re-evaluate and set new ones if necessary ‣ Risk of focusing too much on solutions at the expense of other factors in the Mom's life ▪︎ Listen carefully for feelings and concerns the Mom expresses ▪︎ Observe her body language to try to understand what she is not saying ▪︎ Allow the Mom time to define her situation and work towards solutions ▪︎ Respond to the Mom and baby's pace, not yours ▪︎ Engage in problem solving only after you have gathered sufficient information and impressions

Negotiation

▪︎ Fundamental about human interactions ▪︎ How might we engage with others in a way that yields better outcomes and understandings? ▪︎ Negotiation lens may be of value to lactation educators/consultants ‣ Focus on interests ‣ Do not think there is only one correct way of doing things ‣ Ask why she is unwilling to do something ‣ Figure out what is driving Mom's behavior ▪︎ Framing matters (not just what you say, it is also how you say it) ▪︎ Remember to take into account all relevant parties who might be influencing Mom (partner, grandmother, other family members, friends)

Case study problem solving How not to cause a delay in breastfeeding (should be within ½ hour of birth) A new Mom delivers at a very busy inner city hospital. She intends to breastfeed per the guidelines but is too tired to be assertive. Experience shows when the hospital is so busy with deliveries post partum care is affected. Question: How does the lactation consultant/educator use problem solving to make sure this situation does not repeat itself?

▪︎ Identify all the issues as they relate to the staff, the Mom, and the baby ▪︎ Make sure you understand the reasons why the staff is not complying with the recommendation and why the Mom is enabling them ▪︎ List the possible options and solutions (some examples) ‣ Collaborate with the staff about consistently meeting the current recommendation of early initiation ‣ Initiate a written policy that the nurses will follow during busy times ‣ Role play with the staff during training session what to do in these situations ‣ Educate the Mom during her prenatal time so she is aware of the recommendation ‣ Develop goals and a metric to monitor the initial breastfeeding time and share with staff ▪︎ Evaluate the options and select the one(s) that seem best ▪︎ Document what has been agreed upon ▪︎ Monitor at busy times to see if the goal is met and if not repeat cycle

Augment with Gentle Persuasion

▪︎ If Mom is not motivated, try to use methods of persuasion ▪︎ A confident attitude and communication help persuade others ▪︎ Some people could use a little push from an empathetic educator/consultant ▪︎ Breastfeeding is not easy and mothers need to be properly coached when it gets tough

Transient Nipple Soreness Is Normal

▪︎ It is normal to have some temporary, or what is referred to as "transient," nipple soreness the first few days of breastfeeding. ▪︎ The peak period of nipple tenderness occurs in the first week postpartum, particularly between days 3 and 6 postpartum ▪︎ While mild soreness or tenderness is normal, pain is not

Probes: Digging for More Information

▪︎ Most people do not give complete answers to the questions they are asked. ▪︎ Under those circumstances, you need to "dig" for more information so that you will be able to effectively choose the education that will be most helpful to the client you are working with. ▪︎ One way to get more specific information from your client is to use probes. ▪︎ Probes help you get your client to extend and clarify their response.

Oxytocin release can be Inhibited by:

▪︎ Stress ▪︎ Fear ▪︎ Pain

Lactation Educator Application Motivation

▪︎ There are many theories which try to explain why people are motivated to do things ▪︎ Mom must meet her basic needs under Maslow and ERG theories ‣ physiological and safety under Maslow ‣ existence under ERG ▪︎ Once these are met then and only then can she attend to her higher level needs ‣ esteem/self actualization under Maslow ‣ relatedness/growth under ERG ▪︎ Lactation Educator/Consultant must recognize which of Mom's needs must be met so she can be motivated to breastfeed successfully

Use TALKING acronym for persuasion from Benjamin Franklin

▪︎ Timing - chose the right moment ▪︎ Appreciation - learn to appreciate the other person's problems and concerns ▪︎ Listening - learn to listen so you can find out what you need to do to persuade ▪︎ Knowledge - Learn where the person is coming from and how to get them where you want to go ▪︎ Integrity - Never misrepresent your fundamental beliefs or motives ▪︎ Need - Show others they are uniquely qualified to give you what you want ▪︎ Giving - Learn the value of giving

What are closed-ended questions?

▪︎ Usually answered with a "yes" or "no" or a very short one or two word answer. ▪︎ Give little information with which to continue the conversation. ▪︎ Example: ‣"Are you going to breastfeed or bottle feed your baby?" ‣ "How many children do you have?"

What are the guidelines for prenatal physical activity?

▪︎ at least 150 minutes of moderate-intensity aerobic activity spread throughout the week or ▪︎ 30 minutes of moderately intense exercise on most days of the week

Vitamins and minerals:

▪︎ supplementation is recommended ▪︎ avoid over-supplementation ▪︎ RDN/DN referral ▪︎ Encourage breastfeeding ‣ aim for eating well, not perfectly

Step Two:Affirming Your Client's Feelings

▪︎Affirmations are short simple statements that let your client know their feelings are okay. ▪︎ They are the most important part of a successful communication exchange. ▪︎ Clients are typically not ready for information until they feel their opinions have been heard.

Ways To Affirm

▪︎Agree with client ‣ "I don't want my dad to see me breastfeed." ✓ Affirmation: "I worried about that too." ▪︎ Show him/her they are not alone: ‣ "I'm afraid breastfeeding will be too embarrassing ." ✓Affirmation: "I've heard other women/men say that." ▪︎ Show him/her how he/she is a good mother/father ‣ "I'd be too afraid to breastfeed since I smoke." ‣ I'd be too afraid if she breastfed since she smokes" ✓ Affirmation: "It sounds like you are already thinking about wanting to be a good mom/dad".

Name three sources of vitamin B12:

▪︎Shellfish ▪︎ Organ and game meats ▪︎ Fish ▪︎ Milk ▪︎ Ready-to-eat fortified cereals

Unpadded answers might sound like:

▪︎Why not? ▪︎How come? ▪︎What do you mean?

When discussing carbohydrates, what are three things to remember?

▸ 210 grams per day ▸ 45-65% of daily caloric intake ▸ 1/2 of grain intake should be whole ▸ Limit added sugars - all added sugars really do is contribute empty calories without any other nutrition

What are all of the possible consequences of prenatal obesity to the mother and to the baby?

▸ Gestational diabetes ▸ Hypetension ▸ C-section ▸ Birth defects ▸ Fetal death ▸ Preterm delivery ▸ Low birth weight ▸ High birth weight ▸ Delayed lactogenesis ▸ Poor long term outcomes

Strategies to Overcome Lack of Support for Breastfeeding

▸ Provide the mother with breastfeeding support resources including: ❖ Community breastfeeding support group locations - there are support groups for breastfeeding all over most cities and typically they're held once a week same location same time and it's wonderful for a mother even as early as her pregnancy to attend these groups - what she'll find is she'll see other mothers with babies who are breastfeeding and being around a lot of other women who are breastfeeding and seeing them breastfeed helps them feel more supported and encouraged them to initiate breastfeeding and continue doing so - a lot of times moms will find that throughout the breastfeeding experience they're concerned about something they share the concern and there-there's a mother with an older baby who had that concern and was able to effectively deal with it will share how she did so and that would help the mother ❖ Community lactation consultant's contact information ❖ Breastfeeding helpline phone numbers • sometimes family members aren't supportive of breastfeeding because they don't believe breast milk is better than formula ⁃ they may think that most women don't have enough milk to adequately nourish their babies one strategy to overcome this barrier is: ‣ encouraging women to bring their significant others and influential family members to prenatal breastfeeding class ▪︎ Provide the significant other and influential family members with knowledge including: ❖ Breastfeeding knowledge such as: ❖ How to successfully breastfeed

What are some Inappropriate Marketing Strategies Used by Infant-Formula Companies? Inappropriate marketing strategies include:

▸ Use of healthcare professionals (e.g., milk nurses) to promote artificial baby milk ⁃ Basically, this includes having someone who is not a nurse dress up in a white dress pretend they're a nurse and promote formula, as well as qualified nurses, physicians, midwives promoting formula ▸ Advertising of artificial baby milk in healthcare facilities ⁃ advertising can include posters of formula fed babies or infant formula brands on posters, pens, name tags. or any other promotional material in a health care facility ▸ Advertising that idealizes infant formula and makes inaccurate claims regarding its benefits ⁃ for example, in the formula disaster documentary, giving a lot of inaccurate claims about the formula saying that if you feed your baby formula, they will be child prodigy ▸ Free sample ▸ Gift to mothers and healthcare professionals

Step One: Hospital Polices

❑ One of the Critical Management Procedures ❑ The Specific Step: ❑ 1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. ❑ 1b. Have a written infant feeding policy that is routinely communicated to staff and parents. ❑ 1c. Establish ongoing monitoring and data- management systems. ❑ The Original Step ❑ Have a written breastfeeding policy that is routinely communicated to all health care staff.

What Are Some Factors That Contribute to an Infant Being a Reluctant/Sleepy Nurser?

❖ A baby whose mother had a long, medicated birth ❖ A baby born prematurely as well as late prematurely (34-36 weeks) ❖ A baby with a traumatic birth resulting from a long labor or long second-stage (when a mom pushes a baby out) ❖ A baby who has sensory overload ❖ A baby who has recently been circumcised ❖ A baby who us jaundice ❖ A baby with a neurological or congenital problem ❖ A baby who is experiencing hypothermia ❖ A baby whose first feeding was delayed

Normal Newborn Sleep Patterns

❖ All babies require a great amount of sleep, and the specific amount of sleep each baby needs varies. ❖ Sleep patterns are unique to each baby ❖ A baby's sleep can be impacted by developmental milestones and environmental stimuli, such as sound, lights, or temperature. ‣ ex) When a baby learn to sit up that is a milestone. This new achievement can cause stress in a baby and impact their sleeping patterns. Environmental stimuli such as sound, light, temperature. ❖ It is important for parents to have realistic expectations about their baby's sleep. ‣ Sleeping through the night for a baby is like 5 hours. And even five hour stretch is not realistic for a baby that's a newborn ❖ It is normal for newborns to wake up at night.

What are some consequences of mothers deciding how long the baby's feeding should last?

❖ Baby may not gain adequate amounts of weight - so if the mom takes the baby off after 5-10 minutes and the baby's not done eating only the baby knows what they need in terms of their hunger and so we may risk that that baby not gain adequate amounts of weight ❖ Baby will not get sufficient amounts of hindmilk ❖ Baby is likely to have a foremilk-hindmilk imbalance and be fussy

Strategies to Overcome Embarrassment to Breastfeed in P

❖ Clothing suggestions ⁃ there are also clothing that have been specifically developed to make Nursing easier - there's also different kinds of cover-ups that you can use once you get the baby latched on ❖ Discuss ways to breastfeed discretely ‣ Encourage practicing breastfeeding discretely ‣ practice makes better and the more the mom gets used to latching the baby on the easier it is but also if she can breastfeed at home in front of a mirror and practice see what it looks like she will see pretty quickly ways that she can breastfeed discreetly and things she can do that make it less likely that people can see any of her breasts if she's concerned about that ❖ Encourage mother to plan her outing ⁃ she could think in advance okay I'm planning on going to the mall where are there some spots that if baby gets hungry I can go and breastfeed discreetly so for example in the mall there's tons of clothing stores that have dressing rooms it's really easy to go and if the mom not comfortable she could actually pretend she's shopping grab a shirt walk into the dressing room when she notices that baby's getting hungry and feed the baby in the dressing rooms ❖ Identify places she can breastfeed discretely ❖ If necessary, plan to give baby expressed milk in public ⁃ one thing we want to make sure to let moms know is that if a mom pumps in advance let's say the baby's born about five weeks after the baby's born mom says you know what don't feel comfortable breastfeeding public I want to have a stockpile of Express breast milk so if I need to run out with the baby and the baby gets hungry I can just feed the baby breast milk I don't want to use formula

Leaking can occur:

❖ During a feeding from the opposite breast ❖ Directly before a feeding, when the breasts are full ❖ If a mom missed a feeding ❖ Due to sexual stimulation ❖ Due to hearing or seeing a baby cry

The Frequency of Normal Breastfeeding (First 3-4 months) ❖What is the norm?

❖ During the first 3-4 months, breast breastfed babies eat 8-12 times in 24 hours (about every 1 1/2-3 hours).

Strategies to Overcome Time and Social Constraints

❖ Educate mothers and their family members about the time involved in breastfeeding vs. bottle-feeding ⁃ The way that this would work is you would ask the mom okay so I want you to imagine you're gonna formula feed your baby how much time will this take walk me through all the steps from point A when you get the formula to feeding the baby: ‣ first the mom or dad or family member needs to go to the store buy the formula. Then they need to bring the formula back home they need to sterilize the water or boil the water. Next, they need to measure how much formula they need to add it in how much water and the reason for that is that we dilute the formula baby's not going to grow sufficiently and if we put too much they're going to gain too much weight so we need to measure the formula mix it up. Then we need to check to make sure that the water is not too hot because we don't want to burn the baby. Then we need to go ahead and feed the baby so we put the mix the formula we prepare put it in the bottle and start to feed the baby. ‣ Now, when you feed a baby with a bottle what happens is they swallow air and when babies swallow air and guess what they need to do yep they need to be burped so they're eating and then they get a little irritated you have to stop burp the baby, they feed. Again they might get some more air bubbles in them you gotta burp them. Once you're finished feeding the baby the formula then you need to wash the bottle wash the nipples and they need to be sterilized you can't just wash it any old way and then you're done. • Now how long does it take to breastfeed? ‣ babies hungry mom puts the baby on the breast and the baby eats ‣ with breast feeding, you don't need to go to the store you, don't need to mix it you don't need to measure it you don't need special water you don't need to check if it's too hot or too cold it's always ready to go right temperature. ❖ Educate mothers and their family members about expressing and storing breastmilk ❖ Reassure mother and their family members that many women have been successful at combining school, work, having a social life and breastfeeding ❖ Let mothers and their family know that breastfeeding becomes east as the baby grows ❖ Let mothers and their family know that babies typically don't have problems taking a bottle from someone other than their mother ❖ Encourage mothers to talk to their supervisor at work or an advisor at school to make arrangements for where she can express breastmilk when she returns to work or school after the baby is born

Strategies to Increasing a Confidence in her Mother's Milk Supply

❖ Educate the mother and her family members on how to build milk and maintain a good milk supply. • the key is the best way for a mom to build and maintain a good milk supply enough to feed her baby adequately is to frequently and effectively make sure that the baby is breastfeeding ❖ Educate the mother and her family members on normal breastfeed babies behavior ⁃ essentially is educating family members how breastfed babies behavior is very different than the formula fed baby. If the family expects the breastfed baby to act like the formula fed baby they're quickly going to believe that the moms not producing enough milk and they're gonna have concerns about her milk supply she's gonna have concerns about her milk supply and before you know it she might supplement and before you know it she's not gonna produce enough milk so that's really key ❖ Dispel breastfeeding myths (i.e., accurate knowledge on who can breastfeed)

What are the benefits of periodic waking at night?

❖ Enables the baby to signal unmet needs such as hunger, temperature control, or other discomfort. ⁃ if they were to sleep through all that they could get dehydrated underfed overheated etc ❖ Helps mother's milk supply ▪︎ The more frequently the baby eats, the more milk the mom produces. ❖ Helps decrease sudden unexpected infant deaths (SUIDs) as babies with longer periods of quiet, deep sleep are at greater risk for SUIDs ▪︎ when a baby is in a deep deep deep sleep they're at a greater risk of SUIDS and so when baby sleeps they often have sleep apnea. Sleep apnea is basically a pause in breathing and if they don't wake up the risk is that they breathing pause will last too long and then they will be a victim of SUIDs.

Strategies to Overcome Fear that Breastfeeding will be Painful

❖ Ensure mothers and their family members that breastfeeding should not hurt ❖ Most pain situations can be prevented by teach mothers and their family members proper latch and positioning skills ❖ Encourage mothers and their family members to attend a prenatal breastfeeding class to learn how to to properly latch and position baby onto the breast ❖ Teach mothers and their family members the warning signs that suggest the need for assistance with breastfeeding ❖ Provide mothers and their family members with resources for breastfeeding support ⁃ give her some resources and phone numbers so she can contact a lactation consultant or attend a local breastfeeding support group should she experience pain once baby's born and she's breastfeeding

Breastfeeding Care Plan for a Fussy Baby Under circumstances where a baby is resisting the breast, the mother can:

❖ Hold her baby calmly in skin-to-skin contact or try other calming techniques ❖ Limit latching attempts to no more than a few minutes. If latching attempts cause resistance or crying, stop and try again about 10-15 minutes later ❖ Express every 2-3 hours until regular feedings are established ❖ Provide alternative methods of feeding other than bottles: cup, spoon, syringe, or supplemental nurser

Breast Fullness Is Normal

❖ It is normal to have full breasts when milk comes in ❖ Two to three days after birth, your breasts become fuller, firmer, and heavier ❖ Your body is starting to make mature milk, which is more plentiful ❖ This should last only a few days ❖ Feed often to manage fullness and prevent engorgement

Breastfeeding Care Plan for a Sleepy Baby Under circumstances where the baby is excessively sleepy or ineffective at breastfeeding, the mother can:

❖ Keep the baby in skin-to-skin contact ⁃ when we keep babies skin-to-skin that does increase the baby's interest in nursing. They smell the breastmilk. They're close to mom, so we want to keep that baby skin-to-skin as much as possible ❖ Rouse and attempt to breastfeed the baby, about every half hour ❖ Express milk every 2-3 hours ⁃ This is for her to preserve her milk supply and also have breastmilk to supplement that baby or to feed the baby so she doesn't have to resort to formula and feed the baby and you repeat this until the baby is no longer sleepy and is waking on their own, feeding 8-12 times in 24 hours ❖ Feed the baby

Leaking Is Normal

❖ Leaking is a normal part of breastfeeding. ❖ It is normal to have leaking during the first few weeks. Typically, it is the result of breast fullness or the mother's milk letting down. ❖ The amount of leaking is variable from one mom to the next.

What is galactorrhea?

❖ Leaking that occurs after mom weans her baby ❖ Galactorrhea is a symptom, not a disease. It is caused by elevated prolactin levels, which may be caused by: ▪︎ Untreated thyroid conditions ▪︎ Psychosis and anxiety medications ▪︎ Chronic renal failure ▪︎ Pituitary, uterine, and ovarian tumors ❖Mothers who experience galactorrhea should be evaluated by their doctors.

How Do You Know It Is Time to Feed a Baby?

❖ Mothers are encouraged to follow the baby's hunger cues, not a clock ❖ Feed the baby when you notice early signs of hunger

The Baby Who Cries at the Breast What Are the Factors That Can Contribute to an Infant Being Fussy at the Breast?

❖ Oral aversion ⁃ oral aversion can development from a lot of section aggressive suctioning after the baby's born the baby is suction aggressively put right on the breast afterwards and then they associate breastfeeding with this really unpleasant feeling of something in their mouth and then every time they go and feed, they are repulsed and don't want to feed ❖ Nipple preference - is when the baby starts to prefer a bottle nipple rather than the breast because it's so much easier for them to get food out of the bottle than out of the breast ❖ Baby has discomfort from forceps or vacuum extraction ❖ Caregiver handled baby too much - overstimulated and they're really fussy every time the mom tries to feed them ❖ Baby is in pain ❖ Mom missed hunger cues and baby is very hungry ❖ Baby is withdrawing from nicotine or other drugs ❖ Baby is irritable

often is one of the reasons that influential family members particularly grandma and dad are not particularly thrilled that the mom was going to choose to breastfeed has to do with the fact that they feel that if mom breastfeeds they won't be able to bond with a baby. ❖ Strategies on how they can be involved with the baby including:

❖ Playing with baby ❖ Cuddling and holding baby closely ❖ Bathing the baby ❖ Dressing the baby

Rousing Techniques(i.e., How to Wake a Sleepy Baby)

❖ Remove blanket ❖ Undress the baby ❖ Change diaper ❖ Stimulate baby's rooting reflex ❖ Stimulate baby's sense of smell by bringing baby close to the breast so that she can detect the scent of her mother's milk ❖ Stimulate baby's sense of taste by expressing milk onto the nipple or into the baby's mouth ❖ Give baby a bath ❖ Talk to baby and try to make eye contact ❖ Put baby in skin-to-skin contact

What Strategies Can You Share With New Breastfeeding Moms to Help Them Get More Sleep?

❖ Rest when the baby sleeps - so babies sleep a lot they don't sleep in long periods of time they're not asleep 7 hours as we just discussed but they do sleep frequently and again anywhere between 8 to 20 hours so if moms rest when the baby sleeps then they're gonna definitely get more sleep. Some moms can actually nap when their baby sleeping. Other women are not Nappers they just can't nap they just only can sleep at night but if we encourage them to have these rest close their eyes take a warm bath or do something relaxing that's gonna help them get more rest ❖ Don't let baby sleep longer than 3 hours during the day. - Babies will take one long stretch typically in a 24-hour period and we want to encourage them to get that long stretch at night. If they're taking the long stretch during the day then guarantee that they're not going to be taking the long stretch at night and it is actually pretty normal for babies to sleep more during the day and be more awake at night when they're first born because what happens during pregnancy is that during the day mom is active and the active movement of the mom moving around puts the baby to sleep and as soon as that mom goes to bed at night she's not moving the baby naturally is more inclined to wake up because there's no rocking the baby with motions that she's making during the day. So they kind of have their days and nights mixed up ❖ Sleep in the same room as the baby - if the baby is sleeping very very far away from mom and dad by the time you hear the baby crying they're really hungry and it's gonna take some time before you get to the baby. So the baby's gonna be more awake alert and irritable by the time you get to the baby and also by the time you get the baby and feed the baby you're gonna be more awake and alert and it's gonna be harder for you to go back to bed. So having the baby nearby is helpful to get the baby more quickly and feed them before waking up too much ❖ When the baby wakes at night, avoid stimulation and bright lights - we don't want to turn the lights on and start playing with a baby because that's going to prevent the baby to settle down we want to kind of train them at night we sleep I'm happy to feed you but we're not gonna play right now we can play with when it's daylight ❖ Consider some sort of white noise in the room - some sort of mild white noise something that's loud enough that you don't hear every stirring the baby has or little motions but not too loud that it would prevent you from hearing the baby cry when they need something

Exceptions to Baby-Led Feedings: There are some circumstances when a mother will need to watch the clock and not rely on her baby to tell her when he or she is hungry. ❖Exceptions to baby-led feedings

❖ The reluctant / sleepy nurser ❖ The baby that is fussy at the breast

Why Do Newborns Eat So Often?

❖ Their stomachs are very small. ▪︎ A small. stomach capacity enables newborns to take in only a small amount during each feeding.

Foremilk

❖ is what your baby receives at the beginning of the feeding session. ❖ helps quench your baby's thirst and contains plenty of lactose and protein but very little fat and few calories

The Frequency of Normal Breastfeeding

❖Cluster feedings ⁃ is when babies eat in small bunches they eat frequently frequently frequently and and they may take a longer period of time where they don't eat and that's completely normal it's very common for a baby who's breastfeeding to around the afternoon at 4:00 at 4:00 4:30 5:00 5:30 and then maybe they'd go for a nice long stretch for four hours that's completely normal and expected. ⁃ And what we're looking for with normal newborn babies and their breastfeeding frequency is as long as within 24 hours they're getting that 8 to 12 feedings doesn't matter if some of those feedings are close together and some are farther apart completely normal ❖Growth spurts (Weeks 3 and 6, Months 3 and 6) ⁃ during the time that the baby has the growth spurts what's happening is that their caloric requirements have increased they need more breast milk. Now the only way for that baby to get that moms body to make more milk is supply and demand. So if the baby's caloric requirements have increased what are they gonna do? That's right they're gonna eat more frequently and if the mom feeds a baby during this growth spurt maybe 20 for 40 hours she responds every time that baby's hungry maybe they usually eat 10 times in 24 hours all of a sudden eating 16 times in that 24 hour period the mom responds she feeds a baby then subsequently her milk supply will increase. After about 24 or 48 hours that baby is going to go back to the pattern that they had before because the mom's milk supply has increased to accommodate that babies increase in caloric needs. ❖Decrease in the number of feedings around 3 months ⁃ They become more efficient at breast feeding and where they might have eaten 8 to 12 times in 24 hours now it's gonna be closer to 7 to 8 times in 24 hours we want to provide families with anticipatory guidance so that if the baby suddenly starts feeding at around 3 months a little less often parents don't freak out. The best thing to do with a mom or dad or grandma is concerned is to bring that baby in to be weighed just to make sure that they're still gaining weight adequately ❖Increase in number of feedings when achieve new milestones (e.g., learn to stand)