Lactation and its challenges
Where is oxytocin produced?
posterior pituitary gland
ankyloglossia
tongue tie * major contributor to poor breast feeding due to tongue movement is important for BF.
S+S of nipple vasospasm
Intense burning and throbbing pain which is worse when the mother is cold. Nipple could be blanched,or turn white/blue/purple.
Breast Milk Jaundice
Due to factors within the mum's milk which prevent proteins in the baby's liver from breaking down. Last from 3-12 weeks of life Should exclude other causes of jaundice
What is the major role of prolactin
1. Responsible for growth and development of mammary tissue during pregnancy 2. Secretes milk by the epithelial cells of the alveoli
Management of breast engorgement
- Frequent expressing - Warm compress - Cabbage leafs - Pain relief
Assessing a breastfeed
- Check positioning and attachment - Can you hear swaloowing - Is there a good suck swallow - Can you see milk in the corner of the baby's mouth
How to increase low milk supply
- Educate mother/family - Encourage more frequent feeding or regular expressing - Get mother to express post feed - Use expressed milk when additional fluid required - Consider formula when breast milk is not an option - Consider galactogogues - Refer to lactation professional.
Management of tongue tie
- Education - Nipple cover - Referral to lactation consultant - Frenotomy - Improved positioning
Positioning techniques for breastfeeds
- Infant should be well supported - Face mother's body (chest to chest) - Nose in line with nipple - Avoid pressure against the back of the baby's head
Signs that tongue tie is causing feeding problems
- Nipple pain or damage - noisy feeding - baby losses suction frequently - Failure to gain weight
Signs of correct breast feeding
- Wide open mouth - Lips are flared - Chin in contact with beast - Minimal pain after few sucks
Why is correct attachment in breastfeeding important
- prevents nipple pain and damage - Assists with milk production - Essential for milk transfer
Galactogoues
Any substance that promote lactation in humans e.g. metoclopramide and domperidone (Aus favours domperiodone) Dose 10-30mg 3-4 times/day Common side effect: Dry mouth Other forms : Herbal and oats
How to assess low milk supply
Assess the child Educate parents (e.g. hydration status. wet nappies, settled b/w feeds
Mx of Nipple vasospasm
Avoid known triggers e.g. poor attachment, nipple damage, thrush,exposing nipples to cold air. Mx of episodes: - Keep nipples warm - Wear an extra layer of clothing - Apply heat packs - Avoid cold exposures - Supplements (Mg, fish oil and primrose)
Causes of mastitis
Blocked duck may lead to milk stasis and engorgement. Can present with general feeling of unwell and red breast. Antibiotics for 10-14 days.
Physiological jaundice
Caused by increased bilirubin levels caused by an inefficient liver. Commences around first week of life and resolves within 2 weeks of birth.
Causes/S+S/Treatment of nipple thrush
Causes: Recent abx use, vaginal thrush, nipple damage or unknown. Symptoms: Sore, red, itching and crusting nipples. Pain can radiate through the breast. Sign: Bright pink nipple, reddened, dry or flaky on areloa Thrush in babies mouth. Tx: Mother: Antifungal cream (minoconazole) or nystatin. Infant: Micoconazole or nilstat. Wash hands Sterilise
Define low milk supply
Considered low when a baby is not getting enough breast milk to meet their growth requirements
What can inhibit the release of oxytocin
If mother is stressed, emotionally upset or in pain
What increases maternal prolactin level
Increase suckling of infant = increase prolactin levels = increase milk production
What are the phases of lactation
Lactogenesis I - Begins week 16 of gestation continues to birth. - Primarily controlled by prolactin. Lactogenesis II - From birth to day 8-10. - Prolactin controlled. - Driven by the expulsion of placenta. Lactogenesis III - Day 8-10 post delivery. - Milk production largely controlled by milk synthesis and whey protein (Feedback Inhibitor of lactation)
Identify the main components of breast tissue
Mammary Glands - Lobules: Consist of many alevoli --> produce milk - Ducts: Carries milk to the nipples. - Nipple Connective tissue stroma - Fibrous stroma = cooper's ligament Pectorial muscle Vasculature Nerve (anterior and lateral cutaneous braches of 4th and 6th intercostal nerves) Lymph tissue Fat
On avg, how many feeds do newborns and 1-2mth infants require daily
Newborn: 8-12 times/day 1-2months: 7-9 times/day
When prolactin produced
Night
Should mothers stop breast feeding with mastitis
No - it can make the condition worse. If they can't breastfeed they should be expressing.
What is the role of oxytocin
Responsible for milk flow "Milk ejection reflex" Causes contraction of the muscles cells surrounding the alveoli forcing milk out to flow through the ducts. Linked to enhance mother infant bonding.
Hypomastia
Underdevelopment of a women's breast tissue. Commonly asymmetric.
Nipple Vasospasm
Vasospasm of the blood vessels can cause nipple pain immediately during and/or after breastfeeding.
Feedback inhibitor of lactation (FIL)
Whey protein which drives milk production in lactogenesis 3. Fuller breast = increased levels of FIL to slow down milk production. Emptier breast = decrease levels of FIL to increase milk production
Where is prolactin secreted
anterior pituitary
During pregnancy what hormones inhibit prolactin
estrogen and progesterone
Causes of nipple damage
incorrect attachment * to assess this observe the nipple after baby comes off. Should look similar to before feed.