PCE Breastfeeding Class Questions and Answers

PCE Breastfeeding Class Questions and Answers What can affect the healthcare professional's presentation about breastfeeding? -personal experiences -philosophy -credentials According to AWHONN, what are some of the responsibilities of staff nurses working with breastfeeding women? -implement Baby-Friendly Hospital Initiative practices -maintain current, evidence-based knowledge of BF -relay consistent, supportive messages about BF -nurses working with preterm infants should promote use of mother's own milk or donor EBM -advocate for BF as cultural norm -integrate education of breastfeeding into professional and academic programs Standards of practice for breastfeeding counselors include what four areas? -Clinical Practice -Breastfeeding education/counseling -Professional responsibilities -Legal considerations First organization in US to provide mother to mother support with Breastfeeding? La Leche League Ten 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 one hour of birth. 5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated. 7. Practice "rooming in"-- allow mothers and infants to remain together 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no pacifiers or artificial nipples to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. What are some reasons formula replaced breastfeeding? -think there is no difference between breast milk and formula -embarrassed about the idea of BF -modest, do not want to nurse publicly -do not want to be tied down -think of body secretions as "icky" -want to go back to work -want father to share more equally in baby's care -afraid of ruining figures -husbands or partners don't want their wife to BF -too nervous -think their breasts are not the right shape -too complicated -old fashioned -think they have to change their diet -sexual abuse Hormones that influence changes in the lactating breast -estrogen -progesterone -prolactin -oxytocin -TSH What triggers Lactogenesis 2? decline in progesterone due to placental separation (progesterone is a prolactin inhibitor) Lactogenesis 1 occurs when 16 weeks prenatally, complete development of mammary function during pregnancy What are some considerations when assessing the nipple for breastfeeding? unusual nipple anatomy that can cause barriers to breastfeeding (flat, inverted, large) What are some assessment considerations when a women has had a breast reduction? -full breastfeeding may not be possible after a reduction -outcomes depend on the type of procedure, amount of glandular tissue removed, and blood supply -encourage BF early and often to stimulate milk production Major components of breastmilk -water -fats -proteins -carbohydrates -vitamins -minerals milk ejection reflex release of breast milk in response to oxytocin, also called the let-down reflex Three ways to stimulate milk ejection reflex (let down) 1.) infant sucking 2.) manual expression or pumping 3.) emotional responses Three signs that let down has occurred 1.) tingling in breasts 2.) warmth/fullness 3.) dripping milk before infant nurses 4.) release of milk from nipple not being sucked 5.) uterine contractions 6.) relief from nipple or breast as baby nurses Largest component of breast milk water When should initiation of breastfeeding occur? as soon as mom and baby are emotionally and physically ready Different breastfeeding positions 1.) Football 2.) Cross cradle 3.) Saddle 4.) Sidelying 5.) Laid back 6.) Cradle What feeding cue does infant exhibit last? Crying What is cluster feeding? Baby feeds frequently in a short amount of time When does cluster feeding occur? 24-48 hours Breast milk production basic principle -milk supply works by supply and demand -frequent milk removal will increase production -use it or lose it What should a breastfeeding mother do during a "growth spurt" instruct mom to allow baby to nurse unrestricted in order to increase milk supply How long does it take for a healthy newborn to regain his birth weight? 2-3 weeks What is normal weight loss for a healthy infant during the first 3-4 days of life? 5-7% What would be expected minimal output of a 2-day old infant 2 wet diapers/day Recommended caloric intake for lactating women 2700 calories/day Three ways to make nutrition easy for lactating women 1.) drink to satisfy thirst (does NOT increase milk production) 2.) eat when hungry 3.) offer options for healthy food choices 4.) recommend mom eating her normal intake of food and drink How many calories are needed for milk production 500 calories Assessment considerations for the breastfeeding mother who is vegan? -at risk for Vitamin B12 deficiencies -decrease in vitamins A, D, and B6 Ankyloglossia Tongue tie -atypical tethered labial or lingual frenulum that restricts movement of lips/tongue Sore nipples management 1.) feed baby on less tender side first 2.) apply warm, moist compresses 3.) express breast milk and allow to air dry 4.) lanolin ointment 5.) all purpose nipple ointment 6.) gel dressings 7.) salt water soaks Breast abscess predisposing factors 1.) prior mastitis 2.) abrupt weaning Breast engorgement causes caused by vascular dilation as well as presence of early milk 1.) congestion and increased vascularity 2.) accumulation of milk 3.) edema- swelling and obstruction of lymphatic system How to use green cabbage to treat engorgement place chilled cabbage leaf in bra for 15-30 min 2-3x/day until breast softens Mastitis signs and symptoms 1.) increased fatigue 2.) flu-like symptoms such as muscle aches, nausea, and chills 3.) fever of 101.3 or greater 4.) localized breast pain that can progress to hot, reddened, and tender area Mammary candidiasis management strategies 1.) treat mom and baby simultaneously 2.) nystatin, clotrimazole, miconazole 3.) Genetian violet 4.) Dr. Jack Newan's all purpose nipple ointment 5.) oral fluconazole 6.) wash all items coming into contact with baby's mouth frequently Hyperbilirubinemia assessment considerations 1.) feeding assessments: latch on technique, quality of feeding, frequency and lengths of bursts of swallows 2.) appearance 3.) vigor 4.) evidence of dehydration 5.) % of weight loss Late preterm infant breastfeeding assessment 1.) feeding cues- sucking, swallowing, and breathing coordination 2.) sleep-wake cycles 3.) physiological stability- cold stress, hypoglycemia Management strategies to help avoid choking in the hypotonic infant 1.) use a pillow or sling to support infant 2.) "dancer hand" position 3.) nipple shield 4.) cup or spoon Behaviors exhibited by a preterm infant that indicates they are not ready for oral feeds 1.) difficulty breathing 2.) color change 3.) coughing and choking 4.) tachypnea 5.) spitting up 6.) hypertonicity 7.) flaccidity 8.) irritability 9.) gaze aversion If a newborn is not able to nurse, when should the counselor recommend that the mother begin pumping? Ideally within 1 hour, but within 6 hours after delivery Position modifications for breastfeeding a baby with a cleft palate/lip 1.) cross cradle 2.) modified football 3.) dancer hand 4.) semi upright What topics should you include when discussing lactation with a woman who is planning adoption? 1.) hormone supplementation (estrogen and progesterone) 2.) manual or electronic stim of breast and nipple 3.) newborn should suck at breast to stimulate milk production 4.) potential need for milk supplements (donor milk) 5.) supplemental feeding aids 6.) benefits and risks of pharmaceutical and herbal galactagogue supplements Management strategies for mother of multiples (twins/triplets) 1.) alternate breasts and babies with each feeding 2.) alternate breasts and babies q24hr 3.) assign each multiple a specific breast 4.) simultaneous and individual feedings 5.) partial breastfeeding Manual Pump Pros and Cons Pros: -affordable, lightweight, hand powered Cons: -tiring and time consuming Battery/Small Electronic Pumps Pros and Cons Pros: -affordable and portable Cons: -must release suction manually -batteries wear out Small Automatic Electric Pump Pros and Cons Pros: -fast/efficient -adjustable suction levels -no manual operation Cons: -can be expensive -requires outlet Hospital Grade Pump Pros and Cons Pros: -quick/efficient -double pump Cons: -bulky/heavy -requires outlet Breast Shell uses 1.) to evert flat or inverted nipples 2.) to collect leaking milk 3.) to relieve engorgement 4.) to protect painful, tender nipples What are some situations when a nipple shield would be helpful? 1.) infant unable to latch due to flat or inverted nipples 2.) infant unable to draw nipple/areola into mouth 3.) MOB nipples are sore/damaged/infected 4.) MOB has overactive let-down or oversupply 5.) infant has weak/disorganized suck 6.) nipple confusion 7.) congenital conditions Disadvantages of alternative feeding methods 1.) aspiration 2.) coughing, gagging, and pneumonia Cup feeding advantages avoid nipple from bottle preference when MOB is unable to BF Finger feeding advantages improve suck organization Spoon Feeding advantages -give colostrum -prepare baby for BF Syringe Feeding advantages -encourage latch on -initiate sucking Supplementer advantages -avoids use of artificial nipples -improves sucking patterns -increase flow rate at breast Haberman Feeder uses 1.) Cleft palate/lip 2.) Down's Syndrome 3.) Neuro dysfunction 4.) Disorganized sucking 5.) Cardiac defects 6.) Cystic fibrosis 7.) Preterm infants Considerations for discussing medication and breastfeeding 1.) determine need for meds 2.) minimize infant drug exposure 3.) confirm doctor knows MOB is BF 4.) FDA drug labeling 5.) discuss meds that are contraindicated with lactation Assessment considerations for assessing infant's response to medication in EBM? 1.) Behavioral changes: alertness, neuromuscular irritability, flaccidity, sleep 2.) GI changes: diarrhea, constipation, change in feeding behaviors 3.) Skin rashes Two categories of medications that are contraindicated with lactation 1.) antimetabolite or chemo agents 2.) active radioisotopes When should Depo-Provera for birth control be administered? After lactation is established, ~6 weeks What birth control is most compatible with breastfeeding Barrier Suggestions to minimize infant drug exposure 1.) choose drugs that don't pass readily into milk 2.) use lowest dose possible 3.) avoid BF at times of peak drug concentrations in milk How can the breastfeeding counselor empower the lactating woman? 1.) support women pre-delivery: provide education on breastfeeding, listen to mom's concerns 2.) encourage moms 3.) provide education on BF 4.) help create individualized feeding plans How can the hospital support breastfeeding women? 1.) refer to community resources 2.) provide phone number for post-discharge follow up 3.) assess MOB intent to breastfeed when returning to work or school 4.) find support before discharge Strategies for successful weaning Mother-led weaning -drop 1 breastfeed or pumping session per week and replace with formula or food -the slower the process, the more comfortable the mother is Baby-led weaning -do not offer breastfeeding, but wait until baby "asks" -offer formula or food at regular feeding times Where does breast tissue normally develop? Along the breast line -located from under the arms down to the groin What are the 3 stages of early breast development? 1.) in utero 2.) first 2 months of life 3.) puberty Breast development during menstruation -Estrogen: induces Ductal System development -Progesterone: induces Lobular-Alveolar development What is lactogenesis? The initiation of milk production How many stages of lactogenesis are there? 4 What stages of lactogenesis occur during pregnancy? 1 and 2 Lactogenesis I -breasts enlarge -high progesterone levels cause an increase in alveoli -colostrum production When does Lactogenesis I occur? 16 weeks gestation Lactogenesis II -placenta is released from the uterus and progesterone levels drop -causes alveolar cells to begin to release milk and allows them to continue to produce more milk How long does lactogenesis 2 last? 2-4 days What are the 5 main areas of the breast? -Upper Inner -Lower Inner -Upper outer -Lower Outer -Tail of Spence What are the 2 types of breast tissue and what are they composed of? -Parenchyma: ductal and lobular-alveolar structures -Strom: connective tissue (fat, vascular, nerve, lymphatic) What is an alveolus? Small cavity where milk is produced and stored -made of epithelial cells What are alveoli? multiple alveolus What is the intra-lobular duct? Connects a lobule to the lactiferous ducts What is a mammary lobule? 10-100 alveoli combined together What are lactiferous ducts? connects mammary lobules/intra-lobular ducts to the nipple Lactogenesis 3 the resupply of mature milk that occurs when milk is removed from the breast When does lactogenesis occur Day 10-14 postpartum -when mature milk is established -lasts until mom is ready to wean from breastfeeding What are the 2 main hormonal influences of breastfeeding? Prolactin and Oxytocin What is the job of Prolactin? Milk production What is the job of oxytocin? Milk release (let-down reflex) Name some of the stimuli used to release both oxytocin and prolactin? -nipple stretching -massaging the breasts -seeing, touching, smelling, hearing infant How often does the let-down reflex occur? Several times during a feeding