LACTATION AND BREASTFEEDING Obstetrics and Gynecology Dr Sheeba

LACTATION AND BREASTFEEDING Obstetrics and Gynecology Dr. Sheeba. S MD (Hom) Assistant Professor Dept. of OBG SKHMC

Hormones during pregnancy Estrogen stimulates the ductile systems to grow, then estrogen levels drop after birth Progesterone increases the size of alveoli and lobes Prolactin contributes to increasing the breast tissue during pregnancy LACTATION ANATOMY AND PHYSIOLOGY

Breast enlargement During pregnancy and lactation indicates the mammary glands are becoming functional Breast size before pregnancy does not determine the amount of milk a woman will produce LACTATION ANATOMY AND PHYSIOLOGY

Alveoli secrete milk and contract when stimulated Oxytocin stimulates milk secretion and is released during the ‘let down’ or milk ejection reflex After let down, milk travels into the ductules, then to the larger – lactiferous or mammary ducts LACTATION ANATOMY AND PHYSIOLOGY

Hormones during breastfeeding Prolactin levels rise with nipple stimulation Alveolar cells make milk in response to prolactin when the baby sucks Oxytocin causes the alveoli to squeeze the newly produced milk into the duct system LACTATION ANATOMY AND PHYSIOLOGY

Lactin and sucking Oxytocin Releases Milk Infant Empties Breast Production Increases LACTATION Milk Production Occurs ANATOMY AND PHYSIOLOGY Interference with this cycle decreases the milk supply.

COLOSTRUM Deep yellowish serous fluid. Alkaline in nature. Low fat for easy digestion Contains mothers antibodies which boost infants’ immune system Acts as a laxative to easy passage of meconium. Due to th antibodies and humoral factors provide immunological defence to the new born infant. BREASTFEEDING INFANT HEALTH BENEFITS

The milk comes in Transitional milk for up to 2 weeks May still have yellow appearance Amounts increase quickly as infant hungers and digestive system matures Mother's" milk making” changes from endocrine to autocrine system Mature milk Supply/demand system engorgement decreases Properties of fore milk and hind milk present BREASTFEEDING INFANT HEALTH BENEFITS

Lower risk of Diarrhea Constipation Infections Ear, respiratory, meningitis, urinary tract SIDS Allergic diseases Chronic digestive diseases Juvenile onset diabetes Acute leukemia Adult obesity BREASTFEEDING INFANT HEALTH BENEFITS

Provides immunologic protection while the infant’s immune system is maturing Antimicrobial agents Anti-inflammatory agents Immunomodulating agents BREASTFEEDING INFANT HEALTH BENEFITS

Preterm Infants Decreased necrotizing enterocolitis Decreased ROP Decreased infection rates Better able to tolerate feedings Increased IQ rates Contains long chain polyunsaturated fatty acids that help the infant’s brain develop – these are normally provided by the mother in late pregnancy, therefore preterm infants miss this BREASTFEEDING INFANT HEALTH BENEFITS

Less postpartum bleeding More rapid uterine involution Weight loss Decreased premenopausal breast cancer rates Decreased ovarian cancer rates Lactational amenorrhea Should still use progesterone only contraceptives Combined contraceptives dry up milk BREASTFEEDING MOTHER HEALTH BENEFITS

Saves money Saves time Babies love it BREASTFEEDING PARENT BENEFITS

Early breastfeeding failures deprive infants of the benefits, and leave many mothers disappointed It is a natural process, but many mothers need a lot of help BREASTFEEDING BARRIERS

Must educate mothers regarding: Positioning the baby Latching on Normal nipple soreness Cramping with breastfeeding How often to feed the baby Need to wake the baby Alerting techniques Rooting Sucking Listening for swallows Preventing engorgement Nutrition Supply and demand Infant cues BREASTFEEDING BARRIERS

Breast Pathology Flat/inverted nipples, breast reduction surgery that severed milk ducts, previous breast abscess, extremely sore nipples (cracked, bleeding, blisters, abrasions) Hormonal pathology Failure of lactogenesis, hypothyroidism Overall health Smoking, anemia, poor nutrition, depression Psychosocial Restrictive feeding schedules, mother without support system, not rooming in with baby, bottle supplementing when not medically required BREASTFEEDING Other BARRIERS Previous breastfed infant who failed to gain weight well, perinatal complication (hemorrhage, htn, infection

With infant in mother’s arms Consistent Repeat Watch Let information in a variety of ways the mother feed the baby and help the mother know she may have difficulties at first Remind mom that baby is learning with her BREASTFEEDING Praise the. METHODS mother’s progress, help build confidence TEACHING Provide discharge support

Baby gains weight No more than 7% weight loss Back to birth weight in 2 weeks 1 oz per day weight gain for the first three months Mother If is comfortable and satisfied baby is still loosing weight on the 4 th day of life: Get feeding evaluation BREASTFEEDING Remember to: 1. fed the baby THE RESULTS 2. maintain the milk supply 3. continue breastfeeding

Infants at risk for poor weight gain Premature (less than 38 weeks) Difficulty latching on Ineffective or unsustained sucking Oral anatomic abnormalities (cleft lip/palate, short frenulum, receding chin) Multiples Jaundice Cystic fibrosis Infection Cardiac disorders Neurologic problems – downs, hypo or hypertonia Poor apgars Long labor Sleepy, nondemanding, passive temperament Separation from mother early after delivery Infants less than 5 lbs BREASTFEEDING COMPLICATIONS

Mother breastfeed longer if they: Are confident at hospital discharge Have a good support system after discharge Receive follow up after discharge Upon discharge Give written information Recommend mom to keep breastfeeding record Give mom phone number for a telephone helpline Lactation consultant follow-up BREASTFEEDING HOSPITAL DISCHARGE SUPPORT

Support the mothers breastfeeding efforts Provide accurate current breastfeeding information BREASTFEEDING HOSPITAL DISCHARGE SUPPORT

Burping helps to get rid of some of the air that babies tend to swallow during feeding. Not being burped often and swallowing too much air can make a baby spit up, or seem cranky or gassy. BURPING OR THE WIND BREAKING

Weaning - Period when baby gets accustomed to food other than its mothers milk ( from 9 months to 1 year). Dangers of the weaning period : Nutritional disturbances Weaning diarrhoea Psychological trauma to the baby when weaning is abrupt. WEANING

IMMUNISATION SCHEDULE FROM BIRTH TO TWO YEARS

TIME VACCINE At birth BCG , oral polio – 1, hepatitis B – 1 st 6 to 8 weeks Triple-1 , oral polio-2 , Hib vaccine -1 and Hepatitis Bvaccine-2 10 to 12 weeks Triple-2 , oral polio 3 , Hib vaccine 2 14 to 16 weeks Triple-3, oral polio 4 , Hib vaccine 3 6 months Hepatitis B vaccine 3 9 months Measles vaccine , oral polio 5 15 to 24 months MMR(15 months). Triple and oral polio booster dose (18 months) and typhoid ( 24 months