Breast Feeding
Poor latches
Can cause cracks and tears in the nipple Results in poor feeding
Symptoms of Mastitis
Fever of greater than 100.6°F (38.1°C); Red/painful/swollen breast(s) Chills "Flu-like" symptoms Baby is unable to latch on to her breast Baby is not having enough wet and dirty diapers.
Amount of Breastfeeding
8 - 12 times a day 12 times a day, and gets it right 7 - 8 times out of 12, the good skills are reinforced more often than not. 6 - 7 times, and 2 or 3 of those don't go well, the baby isn't feeling what it's like to get it right as often. Baby should gain somewhere between 4 to 7 ounces a week for the first 2 - 3 months of life, and be on track to double birth weight by 5 - 6 months of age.
Stage III
Also known as "galactopoiesis." Milk production switches from endocrine control to autocrine control. Production becomes more dependent on continual removal of milk from the breasts and less dependent on the circulating hormones. Essentially, the more a mother nurses, the more milk she will produce (Supply and Demand). Milk removal also depends on the quality of an infant's latch and quantity of suckling.
Risks of Not Breastfeeding for Infants
Among full term infants: Acute ear infection Eczema Diarrhea and vomiting Hospitalizations for lower resp tract diseases Asthma (w/ or w/o family Hx) Childhood obesity Type II diabetes mellitus Acute lymphocytic leukemia Acute myelogenous leukemia Sudden Infant Death Syndrome (SIDS) Necrotizing Enterocolitis (among preterm infants)
Signs of a successful latch
Audible swallowing noises without clicking noises from the infant's mouth (may not be audible in the very early days, but should be visible) Infant nose aligned to nipple with head tilted backwards Full rounded cheeks, no dimpling cheeks Rhythmic jaw movements
Ways to Minimize Infant Exposure to Medications in Breastfeeding Mothers
Avoid recommending sustained-release products. Suggest that a mother can alter the time she takes a medication. Once-daily dosed medications should be administered just before the infant's longest sleep interval, usually after the bedtime feeding. Mothers can also pump before taking their medications, saving the fresh milk for later feedings. Recommend older generation drugs with more established data over new products. Recommend the lowest effective dose to minimize the effects on the child. Note if a medication impacts milk production, particularly if it decreases milk supply. Consider what may be safe to take when nursing older babies compared with newborns and premature or sick infants.
Lactogenesis Stage I
Begins approximately 12 weeks before delivery with a notable increase in circulating pregnancy hormones. Breast size increases as the alveoli begin to fill with colostrum, the rich, nutrient filled, first milk to be expressed after delivery. Blood flow to the breast tissue and diameter of the areola increase. High levels of progesterone prevent full milk production until after birth.
Stage II
Begins on average 2-3 days after birth when the milk "comes in." Progesterone levels drop while prolactin levels remain high. Volume of milk produced increases each day. Milk's composition changes to mature milk, still full of nutrients for the infant's needs. The breasts produce milk whether a mother is breastfeeding or not. Frequent breastfeeding in the first week after birth increases number of prolactin receptors in the breast. Increased sensitivity to prolactin leads to more milk produced.
Tips for life with breastfeeding twins
Breastfeed them together to save time during the first weeks, but it may be best to breastfeed them individually until the babies can latch and nurse well on their own. There are several different ways that the mother can position the babies in order to nurse them at the same time. One way is to place the babies in front of her with their legs overlapping, making an X across her lap. The other position is to place both babies in the clutch hold. She will need pillows at her side (and maybe one on her lap) and she will place the babies on the pillows with their legs going toward the back of the chair. Remember that if she is placing the babies in front of her, she must try to keep their whole bodies turned toward her, their chests against her chest. Their bodies must not be facing up. This is very important to avoid soreness and also to make sure that the babies are receiving enough milk. To view pictures click here. Alternate feeding each baby from both breasts. This evens out their particular needs and also gives them extra visual exercise.
Non-steroidal Anti-inflammatory Drug (NSAIDs) Use in Breastfeeding Mothers
Compatible with breastfeeding. Ibuprofen is a better choice than naproxen due to its shorter half-life. Of the prescription agents, immediate-release diclofenac appears to have low levels in breast milk. Limited data are available for meloxicam, but drug properties of good bioavailability and long half-life make this an unfavorable choice. Celecoxib also has limited data, but it appears that milk levels would be low.
Progesterone
High levels of progesterone maintain pregnancy and suppress milk production by inhibiting prolactin. When the baby is born and the placenta is delivered, progesterone levels decrease.
Safe Skin-to-Skin
Infant's face can be seen Infant's head is in "sniffing" position Infant's nose and mouth are not covered Infant's head is turned to one side Infant's neck is straight, not bent Infant's shoulders and chest face mother Infant's legs are flexed Infant's back is covered with blankets Mother-infant dyad is monitored continuously by staff in the delivery environment and regularly on the postpartum unit When mother wants to sleep, infant is placed in bassinet or with another support person who is awake and alert
Contraindications to Breastfeeding
Infants with galactosemia, a rare condition preventing digestion of the sugar galactose Infants with phenylketonuria (PKU) Infants with certain other allergies, such as dairy or wheat, can if mothers exclude these foods from their diets Diagnosed with HIV, AIDS, or taking antiretroviral medications Diagnosed with human T-cell lymphotropic viruses Type I or II. With an active herpes simplex lesion on her nipple or areola Taking anti-metabolite medications for chemotherapy. Using or addicted to illicit drugs. Radioactive compounds require temporary cessation of breastfeeding. Women should be cautioned about infant exposure to smoke from marijuana in the environment, given emerging data on the effects of passive marijuana smoke. A history of breast surgery is not a contraindication Breast implants are rarely a problem Breast reduction may lead to decreased milk production.
Physiology of milk production
Initiation of lactation is mediated by hormone release. Progesterone, prolactin, oxytocin and cortisol each play a role in milk production and lactation.
Breast Milk
It is well suited to completely nourish infants without any need for supplements, other than previously mentioned, or formula.
Symptoms of Thrush
Itchy or burning nipples, even when not feeding baby Nipples that appear pink or red, and puffy, dry, or flaky Shooting pains in the breast during or after feedings Intense nipple or breast pain that is not improved with better latch-on and positioning Deep breast pain
Hale's Medications and Mother's Milk Lactation Risk Categories
L1 - Safest L2 - Safer L3 - Moderately Safe L4 - Possibly Hazardous L5 - Contraindicated
Aspirin Use in Breastfeeding Mothers
Lactation risk category of L3, associated with significant side effects and should be given with caution. Extremely high doses in mother can potentially produce slight bleeding in infant. Aspirin is associated with Reye Syndrome, and therefore should be avoided in lactating mothers.
Narcotic Pain Reliever Use in Breastfeeding Mothers
Limited data are available for many pain relievers. Hydrocodone-containing medications are commonly used postpartum. Infants should be monitored for sedation, apnea and constipation. Oxycodone-containing medications are used after cesarean deliveries or for mothers who have additional surgery or significant pain. Infants should also be monitored for sedation, apnea, and constipation. Fentanyl is used in epidurals and in various forms (patch, spray, lozenge). Concentrations of fentanyl in colostrum following delivery is very low. The FDA has issued a warning on the use of codeine and Tramadol for the breastfeeding mother. Risks include serious side effects in the infant such as excess sleepiness. difficulty breastfeeding, or serious breathing problems that could result in death of the infant.
Lactogenesis
Milk production Divided into 3 stages
International Code on Marketing of Breast Milk Substitutes
No advertising of breast milk substitutes to families. No free samples or supplies in the health care system. No promotion of products through health care facilities, including no free or low-cost formula. No contact between marketing personnel and mothers. No gifts or personal samples to health workers. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or the product. Information to health workers should be scientific and factual only. All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding. Unsuitable products should not be promoted for babies. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.
Pain Management for Breast Pain
Non-steroidal Anti-inflammatory Drugs (NSAIDs) Acetaminophen Aspirin Narcotic pain relievers
Cortisol
Produced in adrenal glands. Released in response to stress. High levels can delay lactogenesis while low levels and decreased stress improve breastfeeding.
Prolactin (Milk Production)
Produced in the anterior pituitary gland. Inhibited during pregnancy by progesterone. Stimulated by suckling and milk removal. Secretion results in milk production. Levels vary depending on time of day; they are highest after onset of sleep and early morning. Prolactin Inhibitory Factor (PIF) is released from the hypothalamus and it inhibits prolactin release from the pituitary gland.
Oxytocin (Let Down)
Produced in the posterior pituitary gland. Infant suckling and nipple stimulation stimulate oxytocin secretion. Serves to cause milk ejection or "let-down" (the mother may sense this as a warm sensation or tingling in the breast). Also causes uterine contractions early in the postpartum period, shrinking the uterus to its pre-pregnancy state; mothers may experience uterine cramps when let-down occurs.
Colostrum
Produced while a mother is still pregnant, approximately 12 weeks before delivery. Thick and yellow in color, considered to be "liquid gold." Though only produced in small quantities (typically 5-10 mL per feeding but can range from 2-20 mL per feeding), well suited for an infant's immature digestive system. Rich in protein and minerals and low in fat and carbohydrates, provides ideal nutrition during a newborn's first 24 to 72 hours of life. This milk has both sIGA passive antibody protection as well as anti-idiotypic active protection. Over 45 identified bioactive substances that serve to program the newborn's immune system Acts as a laxative aid for passage of meconium, an infant's first bowel movements. The first milk.
Acetaminophen Use in Breastfeeding Mothers
Safe in both pregnancy and lactation, with a lactation risk category of L1. Studies have shown a variable relative infant dose, but the concentration that appears in breast milk is well below the pediatric therapeutic dose. While pediatric concerns have not been reported, mothers should still be advised of the maximum acetaminophen dosing and warned against using multiple products containing acetaminophen concurrently.
Transition milk
Serves as a bridge between colostrum and mature milk. This milk is produced in higher volume than colostrum. Its content is lower in proteins and immunoglobulins, but higher in calories, fat, and lactose levels compared to first milk.
Mature milk
The composition changes throughout an infant's feeding; it also changes as the infant's needs change as she/he grows. Foremilk is provided when the breast is full and has a lower fat content. Hindmilk is provided when the breast is nearly empty and has a higher fat content, which increases infant satiety and contains fats needed for healthy weight gain. The baby should empty the breast before switching to the other breast to ensure that the baby is getting the hind milk with the higher fat content along with the foremilk. Mothers should be encouraged to maintain a balanced diet for their own health and well-being. The size of an infant's stomach dictates how much milk the baby can comfortably drink. Milk production closely parallels the amount of milk baby requires.
Risks of Not Breastfeeding for Mothers
Type 2 Diabetes Breast Cancer Ovarian Cancer Postpartum depression Retained gestational weight gain Metabolic syndrome Decreased risk of hypertension, high cholesterol, and diabetes
