CERTIFIED LACTATION CONSULTANT

CERTIFIED LACTATION CONSULTANT 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 Lactogensis are there? 4 What stages of Lactogenesis occur during pregnancy? 1 and 2 Lactogenesis 1 Ductal and Lobular-Alveolar systems grow at an accelerated rate (influenced by hormones) - breasts enlarge - high progesterone levels cause an increase in alveoli - colostrum begins to produce in the alveoli When does Lactogenesis 1 occur? around 16 weeks Lactogenesis 2 The placenta is released from the uterus and progesterone levels drop - this causes the 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 Breast Anatomy What surrounds the breast tissue? Fat Nerves Lymph Tissue Vascular Network Myoepithelial Cells What is the purpose of the Myoepithelial cells? They surround the alveolus and contract (like a muscle) - pushes milk out into the ducts What is the purpose of the Vascular Network surrounding breast tissue? - supplies nutrients, materials, hormones to each alveolus for milk production - supplies hormones to the myoepithelial cells for ejection of milk What is the purpose of fat surrounding breast tissue? protection support provides space for growth What purpose do nerves serve in the breasts? Intercostal nerves 3, 4 and 5 deal with breast tissue - innervation to the nipple tells the brain to produce oxytocin when breast feeding - emptying of the alveolus tells the breast to make more milk What are Montgomery's Tubercles? Glands that secrete an antibacterial-like substance that protects the nipples and areola. - found on the nipple and areola - enlarge during pregnancy Lactogenesis 3 also known as galactopoiesis - 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 Lactogenesis 4 involution - milk production is decreased by apoptosis of the milk making epithelial cells What are the 2 main hormonal influences of breastfeeding? Prolactin and Oxytocin What is the job of Prolactin? Milk production Where is prolactin released? the anterior pituitary gland into the blood stream to the alveoli What is the main inhibitor of prolactin? progesterone When is prolactin released? When the placenta detaches, progesterone levels decrease and prolactin levels increase What are some other purposes of prolactin? - keeps alveoli glued together - inhibits ovulation Remaining fragments of placenta can cause what problem in breastfeeding? delay/decrease the release of prolactin What is the job of oxytocin? milk release (the let-down reflex) - tells the myoepithelial cells (and the uterus) to contract and move milk to the ducts and out the breast Where is oxytocin released? the posterior pituitary gland via many stimuli Name some of the stimuli used to release both Oxytocin and Prolactin - nipple stretching - massaging the breasts - Seeing/Touching/Smelling/Hearing the infant How often does the let-down reflex occur? several times during a feeding What are some signs of Prolactin/Oxytocin release? cramping thirst leaking pins and needles increased bleeding sleepy sometimes, nothing Does stress play a role in hormone release? stress can inhibit hormonal release - high levels of cortisol/catacholamines reduce oxytocin and prolactin levels List some ways to reduce stress for breastfeeding remove visitors turn lights out skin to skin sleep massage aroma therapy side lying Supportive statement example to encourage someone to breastfeed What have you heard about breast feeding? - open ended International Code of Marketing of Breast Milk Substitutes Must present detailed info on product composition to health care workers Cultural attitude that emphasizes sexual nature of breast due to harassment of breast feeding in public - cultures that sexualize breast are more often to be resistant Breast reduction try and see what happens - no assumtions, follow closely b/c ducts could be disrupted accessory nipple or breast tissue is likely to be found axilla, near umbillicus or inguinal region primary or main immunoglobulin in human milk IgA - also protects GI tract most variable component of human milk lipids - proportion of fat in milk increases as breast empties component of human milk destroyed by freezing macrophages (living cells) effective way to increase milk supply hand express after feeds - milk synthesis works by supply/demand, most important regulatory mechanism is frequent thorough removal baby is properly latched on when juncture of hard/soft palates reasons for baby prefering one side clavicle fracture, cephallhematoma on one side, subtle positioning most common cause of inadequate supply inadequate or infrequent milk removal - persistent milk stasis suppresses lactation diet of breastfeeding woman - do not need change, keep normal intake - woman living under variety of circumstances can breast feed, most components are not related to mother's intake - should eat enough calories, gain weight within same parameters as if you were not pregnant/breastfeeding lump in breast not related to lactation if changes size before/after feeds (do not change related to milk flow) prolonged elevated bilirubin - not pathological - encourage 10-12 effective feeds per day most contributing factor of breast abscess prolonged milk stasis immature sucking patterns short bursts with pauses mature sucking patterns rapid sucking followed by steady suck swallow coordinated breathing moves smoothly from rooting to latched on 34 weeker struggling to latch due to sleepiness of prematurity and delayed lactogensis from premature delivery restarting breastfeeding start with skin to skin several times a day PPD and breastfeeding most antidepressants are safe drug that rapidly decreases in breastmilk after mother stops alcohol Mag sulfate can cause maternal lethargy, drowsiness, confusion and muscle relaxation standard of practice for breastfeeding counselors clinical practice, breastfeeding and counseling, professional responsibilities, legal considerations AWHONN responsibilities of staff women working with breastfeeding mothers provide education, foster enviornment support and implement practice, current EBP preterm and vulnerable patient importance support groups first organization to provide mother to mother support la leche league 10 steps to successful breastfeeding written policy, train all staff, inform pregnant woman about benefits, initiate breastfeeding (skin to skin early), show how to breast feed, give newborns only breast milk unless otherwise indicated, practice rooming in, encourage feeding on demand, no pacifiers, support groups reasons why formula replaced breast feeding rigid beliefs (schedules, lack of confidence, anxiety), status change of women (right to vote, workforce in 20-30s), sexualization of breasts, lack of support (healthcare, media, family), workplace free samples, cultural beliefs hormones influencing changes in breast estrogen (decreases after birth), progesterone (decreases after birth, prolactin inhibitor), prolactin (increases after placenta delivery), oxytocin (helps with milk ejection), TSH (increases mammary cell response) event triggers lactogenesis II placenta expulsion - decline in progesterone, onset of copious milk secretions nipple assessments - flat/inverted: need to stimulate/sandwich - breast surgery: may have destroyed ducts, nerves - asymmetrical: decreased growth, ducts breast reduction considerations when: should be 1+ year why: asymmetrical or cosmetic how: esp if periareolar surgery major components of breastfeeding fat, protein, carbs, vitamins, minerals, water three ways to stimulate MER infant suckling, manual expression/pumping, expression of baby three signs let down has occurred tingling breasts, feeling warmth/fullness, dripping, release opposite nipple, uterine contractions, relief of discomfort largest component of breast milk water when should initiation occur as soon as mom and baby ready, give uninterrupted skin to skin last feeding cue crying cluster feeding 24-48 hrs - baby is waking up, feeding frequently for short amount of time basic principle behind breast milk production supply and demand, hand express, do not supplement growth spurt mother should not supplement, feed frequently on demand time for newborn to regain birth weight 2-3 weeks normal weight for healthy baby during 3-4 days of life 5-7 oz minimal output one diaper per day of life until milk comes in recommended caloric intake for breastfeeding woman 2700 calories, most consume 2200, min. is 1800 easy nutrition for lactation cheese, yogurt ,fresh fruit, raw veggies, nuts, hard boiled eggs, whole grains, fluids (helps w/ dehydration), 400 Vit D, no specific diet- well balanced how many calories needed for milk production 500 calories assessment considerations with vegan breastfeeding mother b12 needed, can cause muscle weakness/vomiting ankyloglossis tongue tie- labial/lingual frenulum that restricts movement of lip and tongue sore nipples feed on less tender first, warm moist compress before, cold after, hand express some and apply to nipple - lanolin and gel compress also options predisposing factors to abscess prior mastitis, delay in treatment, non compliance with abx or resistance, abrupt weaning or failure to drain/avoiding affected side breast engorgement vascular dilation, congestion, accumulate milk, edema secondary to swelling green cabbage for engorgement apply to decrease swelling, do not use if allergic to sulfa S/S of mastitis red patches on breast, low fever, hard lump (hot/red/tender), achy and run down mammary candida painful condition (both MOB and baby use treatment) nipple ointment (mupropion, nystatin, betamethasone) infant with hyperbili latch on technique, quality, frequency of feeds - assess appearance, level of vigor, dehydration, percent weight loss late preterm assess readiness, evaluate sleep/wake, stability, transfer, supplement may be indicated hypotonic infant strategies to prevent choking dancer hand, straddle, pillow, may need supplementer assess latch/suck/transfer not ready/ready for feeds ready: hands to moth, rooting, sucking not ready: stress (difficulty breathing, color changes, choking/coughing, tachypnea, spitting up)