HSCI 534 LACTATION FOR HCP- Final Study Guide- Merav Efrat- CSUN

What are the four developmental phases of the mammary gland?

- Mammogenesis - Lactogenesis (I & II) -Galactopoiesis -Involution

NABA (National Alliance for Breastfeeding Advocacy)

- Monitors international code of marketing of breastmilk substitutes and publishes the country report on code violations

Recall one federal breastfeeding law

- Patient Protection & Affordable Care Act (PPACA, 2010)

What is the nipple? (The Science of Lactation: The Anatomy of Breastfeeding)

- Sensory nerve endings in the nipple trigger milk release when the baby suckles - Flexible - Sensory nerve endings in the nipple trigger milk release when the baby suckles -4 to 18 milk duct openings/ nipple pores at the end of the nipple from which baby can receive the milk -Changes in nipple during pregnancy and childbirth -Types of nipples: -Everted: sticks out at rest, and more when touched -Flat: flat at rest and when touched -Pseudo-Inverted: drawn inward at rest and becomes erect -Inverted (stays drawn inward) -Retracted (rest → everted; stimulated → retracts & inverted) -Baby suckles → oxytocin (triggers milk release through sensory nerve endings)

What factors lead to the decline in breastfeeding rates in the US?

---Women became interested in having an impact outside of their home -Being separated from one's infant for a long time made BF difficult since babies need to eat between 8-12 times/day during first 3 mo. of life -They didn't have breast pump ---Scientific and technological advances resulting in safer alternatives to breast milk and made it easy to substitute wet nursing -Improved sanitary conditions of dairy barns Cleaner water -Ability to pasteurize, preserve and refrigerate foods -Creation of easier to clean feeding devices ---Chemist believed that they could create a milk that was equal or better than BM -1865 Liebig → first formula created Ingredients: cow's milk, wheat, malt, flour, and potassium bicarbonate -1867 Nestle → artificial infant food Invented for a friend whose infant could not digest cows milk -1883 there were 27 infant formulas Lacked valuable nutrients such as protein, vitamins, and minerals ---Faith in science and technology - Decrease in morbidity, mortality & improved life expectancy rates - Improved technological advances → improvements in public health (clean water, sanitation, and safe food) - "If scientist created an infant formula baby milk it must be better than mother nature's version" ---Changes in labor and delivery practices In 1900 → births moved to the hospital -Women were separated from their families and attended by hospital staff -Under anesthesia -Mother and infant were separated -Baby's were fed formula at the hospital, mothers would typically stay in the hospital for week and didn't get to BF ---Marketing of artificial infant milk -Claims that formula was a perfect sub for BM -Marketing played on parent's fears regarding their infants health and their faith in modern science -Aggressive marketing -1981- WHO → International Code of Marketing of Breast-Milk Standards for appropriate marketing and distribution of human milk substitutes.

What are the impact of the marketing of formula on infant health and breastfeeding rates? (Formula Disaster Documentary)

-Advertising was aggressive for artificial milk (formula) -Claims were made like "perfect substitute for breastmilk" -Parents feared for their infant's health, and kept faith in modern science for the sake of their baby's life -Doctors, nurses are given personal incentives and supplies by baby formula companies for clinics/hospitals to market formula over breastfeeding -Decline in breastfeeding rates around the world -Babies who were formula fed suffered Malnutrition, infections (respiratory), GI disorders (diarrhea) -Babies died more often if they were formula fed

What are the breast changes pregnant women should notice?

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

What are the key factors influencing establishment and continued production of milk?

-Breastmilk stimulation and frequent and effective milk removal -Sufficient glandular tissue -Enough intact nerve pathways and milk ducts

What is the Innocenti Declaration?

-By WHO in 1990- states the importance of breastfeeding for maternal and child health outcomes and set breastfeeding goals: -Implementation of the 10 steps to successful breastfeeding is linked to longer breastfeeding duration rates and are key to the baby friendly hospital initiative -Implementation of the code -Implementation of legal protections for employed breastfeeding women

What is the 1000 Days Challenge?

-Created by World Leaders (eg Gates Foundation) -Promotes targeted action an investment to improve nutrition during this critical period (1000 days from pregnancy till 2 yo). By exclusively BF for 6 mo and appropriate complementary foods.

What is the areola? (The Science of Lactation: The Anatomy of Breastfeeding)

-Darker Skin around the nipples -Visual target for baby -Size and color differ for every woman -Larger and darker during pregnancy

What are the common breastfeeding barriers?

-Embarrassment of public breastfeeding -Fear of pain -Time and social constraints -Lack of support -Lack of confidence regarding milk production

Ethnographic Evidence

-Ethnography- the study of other cultures -Suggest that, during ancient times, hunter-gatherers breastfed their infants -Supports that the norm was breastfeeding -They provide evidence that infants are programmed to breastfeed frequently for a short period of time and for at least 2 hrs & breastfeed anywhere between 2-6 years old

What is fatty tissue? (The Science of Lactation: The Anatomy of Breastfeeding)

-Fatty tissue is found between and around the lobes and helps cushion the breast -Fat within the breast determines breast size not milk production capabilities

What are the strategies to overcome common breastfeeding barriers?

-Fear of breastfeeding in public strategies: Mothers can join support groups Ensure the mother that others are doing it and it's perfectly normal Discuss way to do it discreetly; looking in the mirror and practicing helps prepare moms to breastfeed in public Encourage practicing breastfeeding discreetly Encourage mom to plan her outing Identify places mom can breastfeed discreetly If necessary, give baby expressed milk in public (pumped milk from brea​st) -Fear that breastfeeding will hurt strategies: Feed baby as soon as they let you know they are hungry because if they are fussy, then they might not be able to feed and it can hurt the mother. Pain= wrong position, talk about proper latch Most painful situations can be prevented by teaching proper latch and positioning skills Encourage mom to attend classes to learn about proper latch and position and about laid back breastfeeding (biological nurturing can help) Teach women warning signs that suggest a need for assistance with breastfeeding Provide women with a resource for support on breastfeeding -Fear of time constraints with breastfeeding strategies: Educate the mother about the time involved in breastfeeding vs. bottle feeding Educate mom about expressing and storing milk Reassure mom that many women have been successful at combining school/work/busy lives and can breastfeed Breastfeeding is easier as the baby grows since they will convert to eating solids with milk by 6 months Let mom know babies don't have problems taking a bottle (with expressed milk) from someone other than their mom Encourage mom to talk to supervisor at work or advisor at school to make arrangements for where she can express breastmilk -Fear of lack of breastfeeding support strategies: Provide mother with breastfeeding support (resources): Community breastfeeding support group locations Community lactation consultant contact information Breastfeeding helpline phone number Educate significant other and family member about: Benefits of breastfeeding, accurate breastfeeding procedural knowledge Strategies on how they can be involved with the baby include: Playing with baby Cuddling with holding baby close Bathing baby Dressing the baby -Fear of milk supply running out strategies: Educate mom on how to build and maintain a good milk supply Educate mom on normal breastfeeding babies behavior Dispel breastfeeding myths (ex: accurate knowledge on who can breastfeed)

What are Cooper's Ligaments? (The Science of Lactation: The Anatomy of Breastfeeding)

-Fibrous bands that provide support for the breast tissue (also called suspensory ligaments) -Breast will sag with pregnancy not if you decide to breastfeed or not

What is a mammary gland? (The Science of Lactation: The Anatomy of Breastfeeding)

-Has many different parts, each with specific functions that help the mother produce milk for her baby -Except for the uterus, no other organ changes so dramatically as the mammary glands does during pregnancy and lactation

Who are the La Leche League: Lay Breastfeeding Leaders?

-Have had experience exclusively breastfeeding; not required to do training, volunteers and not paid -Provide basic support to pregnant/ breastfeeding mothers

Who are the IBCLCs (International Board Certified Lactation Consultant)?

-Highest credential in the field of lactation -Provide clinical expertise in the management of lactation from pregnancy through weaning -Examples Failure to thrive Performing a breast or infant oral assessment Assisting a mother/ baby Have responsibility to protect, promote and support breastfeeding -Lack of minimal BF knowledge, attitudes and skills, among health care professionals, has been linked to low BF initiation and duration rates -Lack of core breastfeeding competencies and postpartum nurses -Lack of core breastfeeding competencies and pediatrician -Lack of core breastfeeding competencies and doctor Others? -Obstetricians, Pediatricians, Midwives, Nurse Practitioners, Registered Dietitian, Nurses, Pharmacists, Public Health Educators

Biological Evidence

-Humans are mammals -Unique characteristic to the female mammal is the mammary glands/breast

What is a sufficient glandular tissue?

-In order to produce adequate amounts of breastmilk, mothers need to have sufficient _______________ -In rare cases, mothers may have "hypoplasia" a condition of the breast that is characterized by insufficient ___________________________ -Some physical characteristics of this condition include: Widely spread breast Tubular, cone-shaped breast Bulbous looking areolae -Women with insufficient _________________ often report no breast changes during pregnancy = red flag that the mother may have problems with milk supply once the baby is born → refer to a lactation consultant

What happens during the breast milk stimulation and frequent and effective milk removal happens?

-Key factor influencing galactopoiesis as well as continued milk production are, breast stimulation and frequent and effective milk removal -Hormones that influence milk production: Prolactin: Tells the mother to make milk During pregnancy, prolactin stimulates alveolar growth -After birth, prolactin triggers lactogenesis 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. -Prolactin Receptor Theory Suggest 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 breast→ the more prolactin receptors in the breast the greater breastmilk production potential the woman will have. -Oxytocin: Triggers milk ejection reflex Nipple stimulation triggers the posterior pituitary gland to release oxytocin Oxytocin triggers the milk ejection reflex (let-down); as myoepithelial cells around rach milk producing cell contracts Sights, smells, and sounds of the baby and touch trigger the release of oxytocin Oxytocin also triggers contraction which help shrink the uterus back to prepregnancy size and controls postpartum bleeding. Oxytocins impact on a mother includes: Lowers blood pressure Reduces cortisol levels therefore reduces stress and anxiety Increases pain threshold Includes maternal behavior often called "mothering hormone" Oxytocin release can be inhibited by: Stress, fear, and pain -Feedback Inhibitor of lactation (FIL): FIL is a whey protein that naturally occurs in breastmilk When the breast become full, the amount of FIL increases and slows down the production of milk Frequent and effective removal of milk from the breast, prevent breast from becoming too full and producing large amounts of FIL

What are the SIGNS OF INEFFECTIVE SUCKLING AND POOR MILK TRANSFER?

-Lack of sounds of swallowing -Short, quick (flutter) sucking movements only -Mother may feel pain -Smacking & clicking sounds are heard -Dimpling or puckering of babies checks -Baby is unable to maintain latch throughout the feeding -Breast does not soften as the feeding progresses -Baby is often not content between feedings -Baby's voids and stools are not appropriate for age

What is Mammogenesis?

-Longest phase because it begins in the fetal period and goes all the way through adult life. -Begins as early as 4th to 5th week of gestation (fetal stage) -Limited development (during childhood) -Breast tissue development in females only (during puberty). Major changes in breast tissue are typically complete about 12-18 months after the onset of menses -Relatively inactive b/w event of puberty and pregnancy. First trimester of pregnancy growth occurs (eg. more ducts, enlarged, and darkened areola)

Why is "Lack of Support" a common breastfeeding barrier?

-Mother fears that she will not have support from her family members to breastfeed (her partner, her mother, her friends, etc.). Fear of support can discourage a mother from breastfeeding. -Family members might also get embarrassed around breastfeeding, or are overprotective and do not want people looking at mother while she is breastfeeding. -Lack of educating themselves about breastfeeding -Partners feel excluded from breastfeeding because they are afraid they can't bond with the baby like mom can

What are the key principles of effective positioning?

-Mother needs to find a comfortable place to breastfeed -Mother needs to select a position that works for her and her baby -Mother Needs to Find a Comfortable Place to Breastfeed Effective Positioning Ensures that: Mother is comfortable Mother's shoulders are relaxed Mother's back and arms are well supported What are some things mothers can do to increase their comfort during breastfeeding? Use one or two pillows, lay down and place baby on chest, and use different positions -Mothers Needs to Select a Position that Works for Her and Her Baby -Encourage mother to select a position that works best for her and her baby -When selecting a breastfeeding position consider: Age of baby Type of delivery (c/s vs vaginal delivery) How effectively baby is breastfeeding

Who are the Peer Counselors?

-Mothers who have had their own babies and participate in a training to provide them w/ knowledge and skills needed to educate and support mothers with normal non-clinical breastfeeding support -Similar background to mothers that are being educated -Provide basic support and education to pregnant or breastfeeding mothers -Can be paid or volunteer

Why is "Fear of Pain" a common breastfeeding barrier?

-Mothers will not want to breastfeed because it hurts, probably heard it from some women since this can happen. -Breastfeeding is not suppose to hurt, but it can be painful. If it is painful, it is because of a poor/ineffective latch

What does the milk code entail?

-No advertising of milk substitutes directly to the public -No free samples to mothers -No promotion of products in health care facilities -No gifts -No pictures/commercials that make breastfeeding look bad -All info on artificial feeding inc labels should explain the benefits BF and hazards of using the formula -All products should be of high quality

What are the SIGNS OF SUCKLING EFFECTIVENESS & MILK TRANSFER?

-Non-nutritive suckling: 2 to 3 sucks per swallow at the beginning of a feed, without significant milk transfer -This stimulates the let-down reflex -Nutritive suckling: is slower and more rhythmical, 1:1 or 2 sucks per swallow, and milk is transferred -The mother notices her milk letting down. Signs of let-down in mother include: -thirst -uterine contractions or increased lochia flow during or after feeding for first 3-5 days -Milk leaking from the opposite breast while feeding -relaxation or drowsiness

What is Healthy People 2020 (in reference to breastfeeding)?

-Objectives to increase the proportion of infants who are breastfed ever, at 6 mo, at 1 year, exclusively 3 mo, and 6 mo. -Progress towards reducing major barriers to BF success including: -Hospital policies that hinder BF: To increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies to 8.1% -Formula supplementation before mother has established her milk supply: to reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life to 14.2% -Lack of employer support for lactation: to increase the proportion of employers to have the worksite lactation support programs

What is Lactogenesis I?

-Occurs during pregnancy and is controlled by the endocrine system (hormonal driven) -Breast develops ability to secrete milk (colostrum) -This stage is often referred to as "secretory differentiation" as the alveoli in the breast change into secretory cells for milk production

What is Involution?

-Occurs on average 40 days after last breastfeeding -Once breastmilk is no longer removed from the breast, results in secretory epithelial cell apoptosis.

IBFAN (International Baby Food Action Network)

-People around the world working to reduce infant and young child morbidity and mortality -Aims to improve the health and well-being of babies, young children, their mothers and their families though the protection, promotion and support of breastfeeding -Baby Milk Action is part of IBFAN and acts to stop misleading marketing by the baby feeding industry

What are the current breastfeeding requirements?

-Professional health organizations require that mothers exclusively breastfeed their babies for the first 6 months of life, then begin to compliment the diet with other foods -How long varies by the professional organization: ---Academy of Pediatrics, Academy of Nutrition and Dietetic require at least 1 year --- WHO & American Public Health Association requires 2 years

What is the Patient Protection & Affordable Care Act (PPACA, 2010)?

-Provides for breastfeeding support and counselling services, pumps and supplies. -Provides mothers with reasonable break time during the workday to express breast milk

Historical Evidence

-Religious documents, medical literature, and statues showed that breastfeeding was a norm for infants

What is Lactogenesis II?

-Right after delivery. Occurs between postpartum day 3 to day 8. Also hormonally driven -Triggered by a rapid drop in mothers progesterone levels after baby is born and placenta is delivered -Progesterone rapidly drops -Prolactin rapidly increases -Milk volume increases -Breast begin to secrete large amounts of milk resulting in full breast -This stage is often referred to as "secretory activation" as the alveoli begin to secrete large volumes of milk -Colostral phase ends and transitional milk is produced -Factors that can delay or impair Lactogenesis 2 -Extremely long stage 2 of labor, labor analgesia, cesarean delivery, excessive blood loss after birth, retained placental fragments, hypothyroidism, obesity, DMT1, breast surgery, especially breast reduction

Who are the Lactation Educators/Counselors/Specialists?

-Similar to role of peer counselors -Do not have to have previous BF experience -Typically paid rather than volunteer** -Need to participate in some sort of training to provide them with the knowledge and skills -Provide basic support and education -Training: 20-45 hrs Certified Lactation Education (CSUN w/ UCSD extension or CAPPA → online and exam) No international or national certification exam

What are the Montgomery Glands/Tubercles? (The Science of Lactation: The Anatomy of Breastfeeding)

-Small bumps on the areola, which have a pimply appearance -Secrete an oily substance that lubricates and protects the nipple from dryness and allows the skin to breath and remain pliable -Washing nipple with anything other than unscented soap can remove this natural lubrication and cause dryness -Speculations that scent helps baby find breast

What are the advantages for the breastfed infant and the breastfeeding mother?

-Stronger immune system for baby -Weight loss for mother -Decreases chances of overweight/obesity for baby -Saves money -Bonding for mom and baby -Reduce postpartum depression -Reduces risk of ovarian cancer, breast cancer, cardiovascular disease, DMT2 -Reduces risk of: Skin allergies Ear infection GI infections Asthma Diabetes in later life of the baby Childhood leukemia SDS (Shwachman-Diamond syndrome)

How to support the breast during breastfeeding?

-The C-hold -The dancer hold ---Avoid using scissor hold

Recall at least 2 international and 2 national promoting efforts

-The International Code of Marketing of Breast Milk Substitutes -Innocenti Declaration: -The Baby Friendly Hospital Initiative -Global Strategy for Infant and Young Children Feeding -1000 Days Challenge -Healthy People 2020 -The Breastfeeding Report Card (CDC data tracker) -WIC 1972 -US Breastfeeding Committee

What is galactopoiesis?

-The establishment of lactation -Autocrine control (driven by local control hormones) -Driven by Supply & Demand- Supply is influenced by infant demand. -Effective and frequent removal of breast milk from the breast must be present for galactopoiesis to occur -Occurs approx at postpartum day 9

Why is "Time and Social Constraints" a common breastfeeding barrier?

-The mother fears that she will not be able to go out or do anything once she begins breastfeeding because of how much time it takes. Women might not want to breastfeed because they feel stuck. They are unsure how to successfully breastfeed when separated from the baby. -Women who go back to work who are not as successful, are the ones who let other women know they couldn't continue breastfeeding because there was not enough time, making it a big barrier for moms these days -There is a misperception that breastfeeding will make the baby overly dependent on them

Describe at least one factor that contributed to the rise in breastfeeding

-The natural child movement -Evolution of lactation as a specialty -The international code of marketing of breast-milk subs -Innocenti Declaration -The baby-friendly hospital Initiative -Global Strategy for Infant and Young Children Feeding -1000 Days Challenge

What is the rooting reflex and how can mothers elicit this reflex?

-The rooting reflex is the natural instinct of the newborn to turn his or her head and open his or her mouth wide -Moms can elicit this reflex by touching the baby's cheek -Once baby opens his or her mouth wide, latch baby onto the breast -Look for signs of an effective latch -Signs of an effective vs ineffective latch -If the latch is not effective, break suction and re-latch

What about enforcement code in the U.S.?

-There is none -The US was one country to vote no when it was initially adopted -Today, still no action taken

What is the Feedback Inhibitor of Lactation (FIL)?

-This is a whey protein that naturally occurs in breastmilk -When the breast become full, the amount of this increases and slows down the production of milk -Frequent and effective removal of milk from the breast, prevent breast from becoming too full and producing large amounts of this

What are the milk ducts? (The Science of Lactation: The Anatomy of Breastfeeding)

-Transports milk from the alveoli through the breast and out the nipple to the baby -No lactiferous sinuses

What is Oxytocin?

-Triggers milk ejection reflex -Nipple stimulation triggers the posterior pituitary gland to release this -Sights, smells, and sounds of the baby and touch trigger the release of this -This also triggers contraction which helps shrink the uterus back to prepregnancy size & controls postpartum bleeding -The impact this has on a mother includes: -Lowers blood pressure -Reduces cortisol levels therefore reduces stress and anxiety -Increases pain threshold -Includes maternal behavior often called "mothering hormone" -The release of this can be inhibited by: stress, fear and pain

Why is "Embarrassment of Public Breastfeeding" a common breastfeeding barrier?

-Women are afraid they will expose themselves, someone will see a breast, and then someone will say something to them -Lack of normalization regarding breastfeeding because breasts are sexualized in the media *31% americans =uncomfortable with breastfeeding in public *36% americans think breastfeeding in private places only

Describe mother-led breastfeeding?

-sit comfortably with feet supported -hold your baby close, tummy to tummy -keep hand behind areola -line the baby's nose across from your nipple -tickle his upper lip -when the baby's mouth opens wide, pull him in quickly

Recall at least three sources that provide evidence that historically breastfeeding was the norm for feeding infants:

1. Biological Evidence 2. Historical Evidence 3. Ethnographic Evidence

What are The 10 Steps of Successful Breastfeeding?

1. Have a written breastfeeding policy that is routinely communicated to all health care staff 2. Train all health care staff in skills necessary to implement this policy 3.Inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within half an hour of birth 5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants 6. Give newborn infants no food or drink other than breast milk, unless medically indicated 7. Practice rooming-in- that is, allow mothers and infants to remain together - 24 hours a day 8. Encourage breastfeeding on demand 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

List 10 steps to successful breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding . 4. Help mothers initiate breastfeeding within half an hour of birth 5. Show mothers how to breastfeeding and how to maintain lactation even if they should be separated from their infants. 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated 7. Practice rooming-in that is, allow mothers and infant to remain together 24 hrs a day. 8. Encourage BF on demand. 9. Give no artificial teats or pacifiers to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

Recall at least three California State breastfeeding laws

1. Personal Rights: Breastfeeding (1997) -Moms can BF anywhere 2. Jury Service: Breastfeeding (2000) -Exempts breastfeeding mothers from jury duty 3. Lactation Accommodation (2002) -Makes the workplace provide a reasonable amount of break time and make a reasonable effort to provide space other than the toilet stall

What are 3 step counseling strategies (similar to active listening skills and motivational interviewing)?

1. Use open ended questions and probes (tell me more) to explore concerns 2. Affirm feelings 3. Educate to target concerns (Information comes Last, use 2-3 points)

What are the 3 stem counseling strategy- similar to active listening skills and motivational interviewing?

1. Use open ended questions and probes (tell me more) to explore concerns 2. Affirm feelings 3. Educate to target concerns (Information comes Last, use 2-3 points)

What are the 8 STEPS TO LATCH & POSITIONING?

1.) Find a comfortable position 2.) Support the breast 3.) Put the baby on his side 4.) Tickle the baby's lip 5.) Pull baby onto breast 6.) Assess the latch 7.) Listen for swallowing & look for other signs of milk transfer 8.) End the feeding

What is a health behavior?

A _________ is any behavior that can impact an individual's health status

What are the Myoepithelial cells? (The Science of Lactation: The Anatomy of Breastfeeding)

A layer that surrounds the areola or milk secreting units

What are health damaging behaviors?

Actions that contribute to illness, disability injury or premature death Ex: Formula

What are health enhancing behaviors?

Actions the help prevent illness, disability, or injury (ex. breastfeeding)

What is are the lobes? (The Science of Lactation: The Anatomy of Breastfeeding)

Alveoli bunch into 7-10 grape-like clusters or called lobes

Analgesia

Analgesia is given to mothers to reduce the labor pain. The kinds of analgesia that are given to mothers include nalbuphine, alphaprodine, butorphanol, and meperidine, but has become less popular since epidural (269) b.) How the practice can influence breastfeeding i.) Analgesia reduces the opportunity of early suckling. Mothers who accept these medications throughout labor have a higher chance to leave the hospital without having the opportunity to breastfeed (269).

What can breast surgery do to nerve pathways and milk ducts?

Breast surgery or injury can severe nerves and may affect milk production

What are the epidemiological trends?

Breastfeeding rates (current breastfeeding rates are low) -81.1% initiate BF -22.3% exclusively BF -30.7% BF at one year

What can you do to build confidence in clients?

Build confidence and trust in your clients by reassuring your clients feelings

By when was artificial baby milk the norm?

By 1971 artificial baby milk was the norm with only 24% initiating breastfeeding

What is the Baby Friendly Hospital Initiative?

By WHO in 1991 to encourage and recognize hospitals birthing center who successfully implement the 10 steps to successful BF Must demonstrate that they practice the 10 steps In the US → (BFUSA) Baby Friendly USA

What is the Global Strategy for Infant and Young Children Feeding?

Created by WHO and UNICEF - focuses on -Proper marketing of human milk substitutes -Hospital policies that promote BF -Breastfeeding support for working women

Mothers with TB cannot breastfeed. Myth or truth?

DEPENDS TRUTH: It is not recommended to breastfeed if mother has not received antibiotics (active and not treated for at least 2 weeks = highly contagious)

Mothers with implants or past breast surgeries cannot breastfeed. Myth or truth?

DEPENDS TRUTH: Surgery can negatively impact milk production if milk ducts and nerves are severed. Ask mothers if they know the type and technique of surgery used for their surgery. Follow-up with a lactation consultant immediately to breastfeed successfully

Mothers who drink alcohol cannot breastfeed. Myth or truth?

DEPENDS TRUTH: alcohol does go through breast milk, but 1 drink once in a blue moon will be ok. Breastfeeding is still the best option for babies. Large quantities of alcohol can inhibit let down, but it does not inhibit milk supply. Alcohol does not help a baby sleep, it makes their sleep worse. Wait at least 2 hours until feeding infant, or mother can feed infant before drinking and pump for later on. Can get strips to dip in milk to know the amount of alcohol in your supply.

Mothers with poor eating habits cannot breastfeed. Myth or truth?

DEPENDS TRUTH: it depends on the duration of the consumption of poor diet in mother. You do not have to have the perfect diet to produce healthy breast milk. Breast milk is still better than formula if mother does not have the perfect diet. Mother should be encouraged to try and eat healthier since her body is working hard to nourish her baby. If mother is severely malnourished for a long period of time, breast milk can be compromised and lack nutrients such as vitamin A, B6, & B12. Ask moms if they are vegetarian or vegan to account for optimal B12. B12 deficiency can cause neurological problems.

How many voids and stools should a baby have during the first few weeks?

Day 2- Wet Diapers 2- Stools 2 dark loose stools Day 3- Wet Diapers 3- 2 green loose stools Day 4- Wet Diapers 4- 3 green-yellow loose stools Day 5- Wet Diapers 5- 3 yellow loose stools Day 6- Wet Diapers 6- 4 yellow loose stools Day 7 & Beyond- Wet Diapers 6- 4 yellow loose stools

What is an effective latch?

EFFECTIVE LATCH -Mouth open wide - Lips flared outward - Large amount of breast in mouth - More areola above baby's lip than below -Ear and jaw moving -Actively sucking and swallowing -Feel a strong tug that is not painful -Nose touching the breast -Mother does not feel pain -Nipple is not flattened after a feeding -No nipple abrasions and/or cracking

Why is "Lack of confidence regarding milk production" a common breastfeeding barrier?

Fear that milk production is not enough, mother lacks confidence in her body's abilities Why does this happen? Lack of education on how to establish and maintain milk supply by other mothers saying they could not produce enough milk supply so it is unlikely that she will People use formula together with breastfeeding because there must be something about breastmilk that is lacking: amount of nutrients or just doesn't fill baby up

What are the key strategies for establishing and maintaining a good milk supply?

Frequent and effective removal of breast milk from the breast Frequent feedings (8-12 every 24 hours) Avoid artificial nipples Avoid unnecessary supplements Effective removal of breast milk from the breast Effective latch, suckling, & milk transfer Effective use of breast pump Frequent kin to skin contact

What kind of information should a lactation educator focus on?

Gather information on attitudes about breastfeeding and client's current support system in relation to breastfeeding

What is the US Breastfeeding Committee?

Goal to expand awareness of value of BF and to recommend policies to government and corporate organizations that increase BF prevalence rates

What are some contraindications to breastfeeding in U.S. (Do NOT breastfeed)

HIV, has active TB, developed chicken pox 2-5 days before delivery of baby, is infected with human T-cell lymphotropic virus Type I or II, has herpes lesion on breast, receiving chemotherapy, receiving radioactive exposure/material

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

Hard to clean hand-held devices, poor sanitary conditions, lack of access to clean water, animal milk would spoil easily

Moms who are pregnant and breastfeeding another child cannot breastfeed. Myth or truth?

IN MOST CASES TRUTH: when moms are not gaining enough weight, are at risk for preterm birth (uterine bleeding or pain, or prior history) they should not breastfeed. If the mom cannot keep her weight with her baby, then the doctor will ask her to stop so she can store extra fat on her for the fetus. Child might stop breastfeeding on its own because milk turns salty when mother becomes pregnant, which causes them to wean off the breast.

What is an ineffective lunch?

INEFFECTIVE LATCH Mouth not open wide Small amount of breast in mouth Clicking sound Painful Common cause of sore and/or cracked nipples Lower lip pulled in Nipple flattened after feeding - Tight pursed lips -Space between chin & breast -Infant's lower lip pulled in -Mother may feel pain -Nipple may be flattened after a feeding -Nipple abrasions and/or cracking

When are perceived barriers addressed?

Ideally, all perceived barriers to breastfeeding are addressed during the prenatal period. The less ​barriers a pregnant woman perceives to breastfeeding, the more likely she is to initiate breastfeeding when her baby is born. As a Lactation consultant, give strategies to overcome barriers and dispel any myths the mother believes that can prevent her from breastfeeding.

Small breast cannot produce enough mil for mother's baby. Myth or truth?

MYTH TRUTH: Breast size does not determine milk production, breast size is determined by amount of fat.

Mothers who have a cold or the flu cannot breastfeed. Myth or truth?

MYTH TRUTH: When a mother feels symptoms of getting sick, her body is making antibodies, and the milk being produced has antibodies, acting as a shield to protect the baby.

Smoking will harm baby during breastfeeding so you should avoid it. Myth or truth?

MYTH TRUTH: Women who smoke are encouraged to breastfeed, it is still better than formula, but do not smoke around baby. Nicotine does enter into the breast milk so it is recommended mother breastfeed first, and then smoke so the baby does not take in a lot of nicotine. It is recommended to try and decrease smoking or quitting.

Mothers who are stressed out cannot breastfeed . Myth or truth?

MYTH TRUTH: breastfeeding releases oxytocin and prolactin hormones which will make the mother relax. Stress can affect the "let down", but as long as mother can get comfortable she would be able to pump away from her baby.

Mother of multiple babies cannot breastfeed. Myth or truth?

MYTH TRUTH: supply and demand, the more a mother feeds her babies the more milk will be produced to fit the demands of her babies. It all starts with building a good supply of milk before birth.

Were there any safe alternatives to breastmilk?

No, there were no safe alternatives to breastmilk. The safest alternative: Wet Nurse- A woman who breastfeeds a child who is not her own -Infants were also fed foods other than breastmilk given to a baby using one's hand or hand-held device such as a horn -----Other mammals milk -----Other foods using bread or cereal soaked in water or milk (pap, gruel, paneda)

Pitocin

Rationale behind implementing the practice Pitocin, another name for the hormone oxytocin that is excreted throughout labor, is used to trigger labor, which has an antidiuretic effect (268). How the practice can influence breastfeeding It has been found that prolactin levels rise faster when mothers are being given oxytocin infusion. This helps mothers lower their stress levels resulting from breastfeeding. Despite this finding, Pitocin can play a role in creating "meaty" and "flat" nipples that (268).

What are the statements by the US Health Organization?

Recommend that mothers should exclusively breastfeed their babies for the first six months of life and at least 12 months of complementary foods.

What are some conditions not contraindicated to breastfeeding (CAN breastfeed)?

Smoking, Hepatitis B & C, Cytomegalovirus (CMV) except premature or immunocompromised babies

What is the 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 breast→ the more prolactin receptors in the breast the greater breastmilk production potential the woman will have.

What is WIC 1972?

Supplemental nutrition program that provides a variety of services

Mothers with nipple rings cannot breastfeed. Myth or truth?

TRUTH Remove nipple ring during feeding because it is a choking hazard. Piercing only affects a few milk ducts so there are enough to feed baby

Mothers with HIV cannot breastfeed. Myth or truth?

TRUTH It is not recommended to breastfeed in the U.S. In 3rd world countries, breastfeeding is encouraged because the baby has a better chance of survival with its mother's milk (worst thing to do to increase risk: Mixed feedings with formula that has contaminated water with HIV virus in breast milk, makes them more susceptible to viruses since gut microbiota is down. Nipples can also be more cracked and blood will enter baby while feeding) Recommendation: Exclusively breastfeed for 3-6 months.

What is the milk code? (International and National Breastfeeding Promotion Initiatives)

The "milk code" is an executive order/law that says that healthcare systems cannot be used to promote infant formula.

What are signs of dehydration?

The baby acts lethargic and may have a weak cry The baby's skin becomes less resilient (after pinched it remains pinched) The baby looks very yellow The baby's eyes & mouth seem dry The baby's fontanel looks sunken The baby has a fever

Can hospital practices influence breastfeeding rates?

The hospital stay is a pivotal learning time for new breastfeeding mothers. Depending on the type of birth the mother has, she will spend anywhere between 24 hours to 4 days postpartum in the hospital This is the place where moms initiate breastfeeding This is the place where moms are starting to establish breastfeeding Recognizing the significant impact that hospital practices can have breastfeeding rates International, national and state policy and health promotion initiatives focused on the implementation of hospital practices that support breastfeeding The baby friendly initiative Health People 2020 breastfeeding objective "To increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies." Lactation professionals & Hospital Practices Lactation consultants' assessment typically includes questions regarding LDP experience Lactation Educators often educate pregnant women & their families on the relationship between hospital practices & breastfeeding

What is the alveoli? (The Science of Lactation: The Anatomy of Breastfeeding)

The milk making cells that develop during pregnancy

Protecting, Promoting and Supporting Breastfeeding. The Special Role of Maternity Services.

This statement describes how maternity facilities can support breastfeeding. The `Ten Steps' are a summary of the main recommendations of the Joint Statement. They are the basis of the `Baby Friendly Hospital Initiative' If a maternity facility wishes to be designated `baby friendly' it must follow all of the 'Ten Steps'.

Mothers undergoing chemotherapy cannot breastfeed. Myth or truth?

Truth It is not recommended because drug can get into milk and it is not safe for baby. Mothers will need to wean baby from breast

What is health behavior change?

Understanding why someone engages in a particular health behavior is key in motivating this We can understand why someone engages in a particular health behavior through health behavior theories, models, and constructs. They attempt to explain behavior Serve as guides or plans for designing health behavior change interventions

What tips can you give a lactation educators when giving affirmations?

Use Padding to make mothers feel safe (ex: mother's name, extra words, pausing before responding)

What are health behavior constructs?

When a concept is utilized as a part of a theory, it is called a construct Ex: Social norms, perceived behavior control, decisional balance

What's normal for a baby's weight gain?

Your baby may lose around 7% of birth weight in the first days Should return to birth weight by days 10-14 After Day 5, Baby will gain about ⅔ - 1 ounce per day for first three months

Suctioning babies noses and mouths

a.) Rationale behind implementing the practice i.) After a cesarean birth, a baby needs to have their nose and mouth suctioned because of the extra fluids that remain (271). b.) How the practice can influence breastfeeding i.) Some babies might associate a negative experience to breastfeeding since the hospital staff will most likely make the baby breastfeed after the experience (271).

Placing a baby in a warmer

a.) Rationale behind implementing the practice i.) Babies are placed in warmers because they do not have the capability of self-regulating their temperature (271). b.) How the practice can influence breastfeeding i.) Compared to skin-to-skin care, a warmer does not have the same advantage since babies placed with their mother grow attachment, stable blood glucose levels and cry for a short time (271).

Weighing, measuring and bathing a baby immediately after birth

a.) Rationale behind implementing the practice i.) By weighing, measuring and bathing a baby immediately after birth, it is beneficial to know all the information of the starting weight and measurements for future reference. By cleaning the baby, it is hygienic (271). b.) How the practice can influence breastfeeding i.) The longer that it takes for a mother to breastfeed her child, there is a higher chance that she will feed the baby formula (271).

Epidural Anesthesia

a.) Rationale behind implementing the practice i.) Epidural Anesthesia numbs the body from the uterus down. There is no sense of feeling. They are considered quick, easy, and convenient, which is the biggest reason why many women have chosen this method when giving birth (269). b.) How the practice can influence breastfeeding i.) It has been found in a cohort study that epidurals containing fentanyl and the kind of birth was connected to partial breastfeeding and breastfeeding difficulties in the first week after birth. Women that were given epidural anesthesia were probably to stop breastfeeding that those who used nonpharmacological methods of pain relief (269).

Mechanical devices used to deliver babies (forceps and vacuum)

a.) Rationale behind implementing the practice i.) Forceps and vacuum can be used to help the delivery by removing the baby from the womb (271). b.) How the practice can influence breastfeeding i.) Forceps and vacuum extraction can bruise and injure a baby. If this happens, the baby runs the risk of losing interest in feeding (271).

Spinal Anesthesia

a.) Rationale behind implementing the practice i.) Spinal Anesthesia is similar to epidural anesthesia in the sense that it dulls the pain, but is easier to administer and it does not take long to take effect. This drug also has an advantage by lowering the mother's blood pressure, which can anguish the baby. It has also resulted in a mother having nausea and vomiting and a smaller duration of anesthesia. Mothers have to be careful when taking "high spinal" since the mother's ability to breathe, cough, swallow, and a loss of arm movement affect (269). b.) How the practice can influence breastfeeding i.) Just like epidural, anesthesia affects mothers in a negative way by making them prone to having difficulties with breastfeeding and not being able to continue breastfeeding for a long time period (269).

Episiotomy

a.) Rationale behind implementing the practice i.) An episiotomy is a surgical incision through the perineum that is meant to create a larger vaginal opening during delivery (271). b.) How the practice can influence breastfeeding i.) Mothers can find it difficult to breastfeed their baby after episiotomy they can be given medications, such as ibuprofen and hydrocodone, but it, most likely, will pass through the mother's milk; there is hope since the baby will not be given large amounts of milk in the first few days of being born (271).

What is prolactin?

is a natural tranquilizer that relaxes the mother and is known to induce maternal behavior. During pregnancy, prolactin stimulates alveolar growth After birth, prolactin triggers lactogenesis II Throughout the duration of lactation, prolactin is the hormone that tells the body to produce milk