The World Health Organization and UNICEF have set out three strategies needed for increasing breastfeeding initiation and duration in every country. What a... [Show More] re the 3 strategies?
Breastfeeding Promotion
Breastfeeding Protection
Breastfeeding Support
Focuses on advantages of breastfeeding on a personal (personal connection), community, country (amount spent on healthcare), or global level (waste from formula & formula products)
Focuses on the good "advantages" of breastfeeding
Breastfeeding Promotion
Focuses on government, manufacturer, and social responsibility to assure breast feeding's ability to compete with commercial interests.
Includes addressing improper marketing practices
Addressing breastfeeding in public, at work, jury duty, family law, mothers in prison, etc..
Breastfeeding Protection
Focuses on the interaction of "helpers" with family as well as program development and implementation
Breastfeeding Support
Women how do not breastfeed are at a greater risk for what diseases?
Myocardial infarction
Metabolic syndrome
Coronary artery disease
Stroke
DMII
HTN
Hyperlipidemia
Cardiovascular disease
Breast, endometrial, and ovarian cancer
Reason #1 why women do not exclusively breastfeed
Unrealistic expectations from society about motherhood. Along with lack of preparation for what the newborn period would be like.
Reason #2 why women do not exclusively breastfeed
Lack of timely interventions. Mother's problems at 3-7 days posed the greatest risk for stopping which is when they are home from the hospital and alone with no support. The fastest drop-off is in the first 10 days following discharge from the hospital
The International Code of Marketing of Breast milk Substitutions
An international health policy framework to regulate the marketing of breast milk substitutes in order to protect breastfeeding. It was written in response to the marketing activities of the infant feeding industry which were promoting formula feeding over breastfeeding, which in turn was leading to a dramatic increase in maternal and infant morbidity and mortality.
What does "The Code" do?
Regulates the marketing of breast milk substitutes which includes infant formulas and any other food or drink, together with feeding bottles, and teats, intended for babies and young children. Sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries. Aims to make sure that parental choices on feeding are based on full, impartial information, rather than misleading, inaccurate or biased marketing claims.
The Global Strategy for Infant & Young Child Feeding
Is intended as a guide for action; it identifies interventions with a proven positive impact, it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties.
What contributes to low rates of exclusive breastfeeding globally?
Caregiver and societal beliefs favoring mixed feedings (believing that breast milk is not enough or that babies actions/issues are related to the breast milk/breastfeeding)
Hospital and healthcare practices and policies that are not supportive of breastfeeding
Lack of adequate skilled support
Aggressive promotion of infant formula and other breast milk substitutes rather than promoting support for breastfeeding
Inadequate maternity and paternity leave legislation and other workplace policies
Lack of knowledge about the dangers of not exclusively breastfeeding and of proper breastfeeding techniques
How to support exclusive breastfeeding
Increase hospital and health system capacity including revitalizing, expanding, and institutionalizing the baby-friendly hospital initiative in health systems
Provide community based strategies including communication campaigns tailored to the local context
Strengthen the monitoring, enforcement, and legislation related to "The Code" and subsequent resolutions.
Enact at least 6 months paid maternity leave
Invest in training and capacity building in breastfeeding protection, promotion, and support
What is the role of the pituitary glade in milk making?
Messages from certain stimulation travels through the breast to the pituitary gland which triggers it to produce prolactin and oxytocin which are two hormones needed to make milk.
How in prolactin produced?
Breast stimulation
Nipple stimulation (makes the most)
What is the first way oxytocin can be triggered?
Conditioned response/Conditioned Milk Ejection Reflex (Let down). Automatic response that comes with the association of smell, touch, sounds of baby at the breast. Also occurs on babies end with knowing what to do when placed at the breast.
What is the second way oxytocin can be triggered?
Nipple stretching that occurs with a proper latch
What is a third way oxytocin can be triggered?
Baby hand massage
What does prolactin do?
Enters receptor sites in the milk making cells and helps produce breastmilk
What does oxytocin do?
Allows for the milk to move from the milk making cells and through the nipple with "contractions" that squeeze the cells and the ducts.
Preterm milk
Appears to have different composition for the first 5-7 weeks after delivery independent of gestational age
Preterm milk appears to be higher in protein, fat, and electrolytes than mature milk
This is determined by being preterm not just having a small baby therefor it does not matter if the baby is SGA or LGA only dependent of gestational age
1+ year of lactation
After one year of lactation the milk expressed has significantly increased fat and energy contents, compared with milk expressed by women who have been lactation for a shorter time.
The volume of milk does not have to change as the baby gets older/bigger because the composition of the milk changes
Breast milk composition changes...
Over the course of lactation
Within the day there are variations on the composition of milk
Within a feeding
By the way it is taken during a feeding
and also between feedings
Fat content in breast milk
Longer times in between feedings made for a lower fat content but faster feedings made for a higher fat content where as feedings lasting longer than 30 mins made for a lower fat content
Breastfed babies can regulate fat intake quickly and thus mothers should be encouraged to practice baby led feeding
Maximum fat levels were obtained 30 mins post-feed
1 breast or 2?
There is no difference in baby's net fat intake according to the number of breasts suckled per feeding or the breastfeeding frequency
Offer the 1st breast 1st and the 2nd breast 2nd it really doesn't matter 1 breast or 2 whatever they want
Lactogenesis 1/Secretory Differentiation
Production of colostrum from the placental hormones (progesterone)
When placenta delivers the progesterone levels drop to allow for prolactin to take its place in the milk making cells
Lactogenesis 2/Secretory Activation
Begins when progesterone leaves the cells and prolactin enters the receptor sites
Milk will be a mix of colostrum and mature milk
Lactogenesis 3/Galactopoesis
Long term production of mature milk
Need frequent removal of milk and frequent nipple stimulation to continuously produce milk
How does pH of the gut effect babies
Gut pH of breastfed babies is higher than those who are formula fed or even mixed fed. Higher pH means less harmful bacteria is able to grow which helps have less issues with diarrhea
How does iron effect baby's gut
Low iron in the gut is good, breastmilk has relativly low iron content
Tons of different bacteria thrives on excess iron so having to much can cause issues
How does the presence of lactobacillus bifidus affect baby's gut
Presence of bifidus factor in breast milk promotes the growth of lactobacillus bifidus which helps maintain the low pH and crowd out the harmful bacteria
How does the presence of SIgA antibodies effect baby's gut
Antibodies such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. Mothers IgA has been found to protect against the development of necrotizing enterocolitis in preterm infants
Weight loss in breastfed infant
No more than 7% weight loss from with birth weight and no more weight loss by day 5 and should be back to birth weight by 2 weeks
Weight loss greater than 7% from birth weight indicates a possible breastfeeding problem and requires more intensive evaluation of breastfeeding and possibly intervention (not supplementation!) to correct problems and improve milk production and transfer
What causes infants to lose weight in the first postpartum days
Labor medications
More intrapartum fluids are given, they have more fluid to loss which is a normal process
No labor prior to a c-section, maybe they weren't ready to be born
How do I know my baby is getting enough milk?
One wet diaper for how old the baby is (however this can be skewed by the diuresing process and is not a good indicator of adequate hydration)
4 wets on day 4 and each day after
Multiple poops each day that change in consistency and color
How much weight should my baby be gaining
Approximently 1 ounce per day is expected in the early months by more may be needed for babies with metabolic or respiratory distress because they tend to burn more calories breathing, keeping warm, etc..
Size of the breast relates to the amount of milk produced
No!! the proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production
Need to drink a lot of fluids to produce a lot of milk
No!! There is not enough evidence to support increasing fluid intake beyond what breastfeeding mothers are likely to require to meet their needs
Maternal exercise is related to infant weight gain growth
No!!
Increased worry of stress my diminish milk supply
Not necessarily, worry/stress may alter behavior which could alter supply but not nursing enough or removing milk often enough
How do we assure an adequate milk supply?
Universal understanding of how breastfeeding works
Early initiation and adequate breastfeeding (10-12x per day)
Appropriate breastfeeding assessment
Improved and early breastfeeding support
Appropriate HCP and LCP follow-up in the postpartum period
Admitting there is no magic bullet
More nursing= more milk
Negative influences on milk production
Long spaced between feedings
Long, slow feedings-can effect prolactin production
Negative influences on milk production: Excessive pressure in the breast
Pressure on the milk making cells causes less milk to be made
Pressure can result from: vascular, lymphatic, and third spacing forces
Too much milk in the breast (engorgement)
Missed feedings
Restrictive bras and clothing
Brest implants: decrease storage and capacity and also increase the pressure on the milk cells
Engorgement
Breasts hard, hot, and shiny
Temp above normal
Feels discomfort in the breast
Nipple difficult to grasp, makes difficult for baby to latch
Occurs most commonly day 3-5
As the pressure builds up inside the breast milk production decreases, this is natures early dry up mechanism
Failure to effectively resolve prolonged symptomatic engorgement may have a negative impact on continued adequate milk supply
Placing breasts in a bowl of warm water will stimulate the milk to flow out to relieve some pressure so you can then feed
Negative influences on milk production: Breast surgery or injury
With surgery concern centers on damage to nerves which makes stimulation difficult or impossible, and damage to ducts which makes milk flowing out of breasts difficult or impossible
Counseling implication after breast surgery:
Likelyhood of full breastfeeding is unknown
The hormonal exposure of pregnancy and lactation may mitigate some effects of surgery
Assessment and close follow-up are the keys
Assure adequate nutrition for the infant
Negative influences on milk production: Sub-optimal breast anatomy
Anatomical concerns
Absence of breast changes in pregnancy or early days postpartum
No postpartum breast fullness or signs of abundant milk production
Hypoplastic breast(s) (underdeveloped, tubular, or inadequate glandular tissue)
Discrepant breast size (Unilateral underdeveloped breasts) [Show Less]
