Human Lactation Quiz

Low risk infant

infants between the age of 6-18 months who have no metabolic problems

Moderate risk infant

infants younger than 6 months of age who have metabolic problems such as complications of delivery, apnea, or GI abnormalities

What may skin thickening and dimpling be an ominous sign of?

inflammatory breast cancer

New ultrasound image shows that mammary ducts do NOT widen into behind the nipple as previously thought.

sinuses

The basic unit of the glandular structure of the breast which produces the milk are the _______, which are made up of secretory units in which the ductules terminate.

alveoli, acinar

Name ways in which an infant's mouth is different from an adult's and how that difference helps the infant breastfeed?

-An infant's hard palate is lower set than an adult's, which works with the tongue to compress the nipple. -An infant's larynx is set higher in the oral cavity, which protects the airway. -An infant's tongue fills the entire oral cavity, which supports it as it milks the breast. -An infant has fat pads in its cheeks to assist with suckling. -An infant's epiglottis lies just below the soft palate, which reduces the risk of aspirating milk.

At what period of the day (circadian rhythm) is prolactin higher?

4:00 am

What is the easiest recommendation for a medical clinician to give a breastfeeding mother when a medication is prescribed if they have reservations about it being safe for the baby?

Advice to discontinue breastfeeding

Within the areola lie ___. These tubercles which consist of mammary milk glands and sebaceous glands, together are called______

Montgomery's tubercles, areolar glands

Why is the timing of a drug dose relative to a feeding important?

Avoiding breastfeeding at times of peak concentrations of the medication in the mother's plasma will decrease the amount of the drug that is passed through the milk.

These might interfere with an effective newborn initial latch on.

Birth injuries Labor medications Absence of skin-to-skin contact

Why is it important to ask questions about any breast changes in size, swelling and tenderness during the pregnancy?

Breast changes in pregnancy signify physiologic changes consistent with glandular tissue development.

Which of the following best describes the influence of cortisol on lactation and its reliance on a healthy adrenal gland.

Cortisol acts synergistically on the mammary system in the presence of prolactin.

Following Lactogenesis II, the breasts have an amazing ability to stop the passage of unwanted substances into the breast milk. What is the gasket-like structure that accomplishes this and during what uncomfortable time in lactation does this closure happen?

Desmosome

If a breastfeeding mother comes to you and asks if it is all right for her to take a certain drug, what kind counsel CAN you give?

Discuss the lactation risk status of the medication with the mother, and explain what the categories mean. Copy the medication's entry from Medications and Mothers' Milk and provide it to the mother

L2 PROBABLY COMPATIBLE

Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L1 COMPATIBLE

Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

These activities suppress prolactin-inhibiting factor (PIF), thus increasing milk supply.

Frequent nursing Nipple stimulation Pumping milk from the breasts

Why is it important for midwives to do a breast assessment with their clients prenatally.

If you have a concern, you can discuss it with the mother ahead of time and plan accordingly.

The functional capacity of the breast to make milk is most determined by:

Infant's nursing frequency

Why is it important to keep in mind that suckling patterns change as the infant develops?

It can be reassuring to the parents to know that current problems are likely to improve and resolve over time.

Why is it important to be very gentle when putting ANYTHING, including suction bulbs or a finger, into the newborn baby's mouth?

It can lead to edema of the soft tissues and oral aversion.

What important role does expulsion of the placenta play in the onset of lactation?

It causes a sharp decline in progesterone levels, which triggers the onset of Lactogenesis II.

In addition to yielding milk and calories, what other benefits does suckling facilitate?

It enhances secretion of digestive fluids It decreases crying It increases peristalsis

How is the frequency of the suckling action on the breast different when milk flow is low (beginning of feeding) as opposed to actively flowing?

It is faster.

This best describes the influence of oxytocin on lactation.

Oxytocin causes the milk-ejection reflex.

Which of the following best describes the influence of progesterone on lactation.

Progesterone inhibits the action of prolactin. Progesterone inhibits lactation before birth.

When does the suckling ability appear to be strongest in newborns?

Soon after delivery.

Check all the factors that may delay or impair lactogenesis (check all that apply):

Stress Maternal IV fluids in labor Polycystic ovarian syndrome Cesarean birth Long second stage of labor Retained placenta Primiparity Breast surgery Pain medications in labor Maternal obesity

L5 HAZARDOUS

Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Which of the following best describes the influence of the thyroid-stimulating hormone (TSH) on lactation.

TSH levels are increased on days 3-5 postpartum.

Why is it that forcing a crying baby onto the breast is counterproductive to effective nursing?

The crying infant will will place his tongue on his palate, which inhibits sucking.

How does infant suckling affect prolactin?

The more time the baby spends suckling at the breast, the higher the prolactin levels.

Why is it so important to monitor the weight of an exclusive breastfeeding baby if the mother becomes pregnant?

The progesterone of pregnancy inhibits prolactin, which may cause a decrease in supply.

What happens if the frenulum is placed too far forward (tongue tied) to permit tongue extension upward or forward?

The tongue cannot extend and cannot grasp and hold the nipple in the mouth.

L3 PROBABLY COMPATIBLE

There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible, or controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.)

L4 POSSIBLY HAZARDOUS

There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

There is a closure of the tight junctions between the lactocytes as they swell with milk in engorgement. How does this closure affect the transfer of maternal medications?

These closed junctions prevent the passing of significant amounts of substances with a molecular weight of generally more than 500 daltons into the milk.

Why are retained placental fragments a concern to the breastfeeding mother?

They continue to produce progesterone, which inhibits lactogenesis.

How do smoking and depression affect prolactin levels?

They decrease them.

True or False: The newborn is usually a nose breather.

True

The most common medications given breastfeeding mother are analgesics and antibiotics, is it safe to continue breastfeeding while on antibiotics or analgesics?

Yes, antibiotics and analgesics are generally considered compatible with breastfeeding.

The amount of drug transported into breast milk partially depends on the drug's physicochemical characteristics. Name four such characteristics.

bioavailability pH (ion trapping) lipophilicity molecular weight

High risk infants

premature infants, neonates, unstable infants, or infants with poor renal output

Maternal factors that could affect drug passage into breast milk?

volume of milk production absorbability

These drugs or substances a woman might take while breastfeeding that can inhibit milk production?

• Bromocriptine • Cabergoline • Ergotamine • Estrogens • Progestins • Ethanol • Pseudoephedrine