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Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
Breastfeeding update
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Breastfeeding update

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This was a talk that I gave to the Maryland Chesapeake Chapter of National Association of Pediatric Nurse Practitioners to update them on breastfeeding issues.

This was a talk that I gave to the Maryland Chesapeake Chapter of National Association of Pediatric Nurse Practitioners to update them on breastfeeding issues.

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  • 45% agreed that “A mother who breastfeeds has to give up too many lifestyle habits 31% agreed that “Babies ought to be fed cereal or baby food by 3 months of age” 31% thought “one year old children should not be breastfed by their mothers” 27% thought “It is embarrassing for a mother to breastfeed in front of others”
  • Based on the change in the rate of lactose excretion
  • Transcript

    • 1. Breastfeeding Update Jane Johnston Balkam, RN,CS, CPNP, IBCLC Maryland-Chesapeake NAPNAP November 6, 2003
    • 2. Potpourri Everything you always wanted to know
    • 3. For Those Needing More Basic or Detailed Information <ul><li>Beginning Lactation Management CD-ROM from NAPNAP Annual Conference April, 2003 </li></ul><ul><li>Faculty </li></ul><ul><ul><li>Kittie Frantz, RN, CPNP </li></ul></ul><ul><ul><li>Brigitte Paine, RN, CPNP, IBCLC </li></ul></ul><ul><li>Order from: www.digitellinc.com </li></ul>
    • 4. Major Themes of Talk <ul><li>Milk Supply Issues and their Application to: </li></ul><ul><ul><li>Building a good milk supply </li></ul></ul><ul><ul><li>Milk supply issues for women who have had breast reduction surgery </li></ul></ul><ul><ul><li>Milk supply issues for women who return to work </li></ul></ul><ul><li>Other current issues </li></ul>
    • 5. American Academy of Pediatrics Recommendations <ul><li>“ Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth.” </li></ul><ul><li>“ Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet.” </li></ul><ul><li> (AAP, 1997) </li></ul>
    • 6. Healthy People 2010 Goals <ul><li>Increase the proportion of mothers who breastfeed their infants to: </li></ul><ul><ul><li>75% in the early postpartum period </li></ul></ul><ul><ul><li>50% at 6 months </li></ul></ul><ul><ul><li>25% at 1 year </li></ul></ul><ul><ul><li>(DHHS, 2000) </li></ul></ul>
    • 7. How Are We Doing? <ul><li>Current Prevalence (NIS data) </li></ul><ul><ul><li>Data from 3 rd Q National Immunization Survey Data from CDC </li></ul></ul><ul><ul><li>Subset of women asked questions about breastfeeding </li></ul></ul><ul><ul><li>Looked at exclusive breastfeeding as well as ever breastfed and duration information </li></ul></ul>
    • 8. NIS Study Results <ul><li>727 children ever breastfed, 709 for exclusive </li></ul><ul><ul><li>65.1% (95% CI: 59.5%-70.7%) of children ever breastfed </li></ul></ul><ul><ul><li>27.0% (95% CI: 21.7%-32.3%) continued to receive breast milk 6 months </li></ul></ul><ul><ul><li>12.3% (95% CI 8.9%-15.7%) continued to receive breast milk until 12 months of age </li></ul></ul><ul><li>(Li,et.al., 2003) </li></ul>
    • 9. NIS Study Results <ul><li>Exclusive Breastfeeding </li></ul><ul><ul><li>59.3% (95% CI: 53.7%-64.9%) at seven days of age </li></ul></ul><ul><ul><li>7.9% (95% CI: 5.0%-10.8%) at 6 months of age </li></ul></ul><ul><li>Study also showed that non-Hispanic blacks have the lowest rates of breastfeeding initiation and continuation </li></ul><ul><li>(Li, et.al., 2003) </li></ul>
    • 10. <ul><li>Any and exclusive breastfeeding by age, NIS, July-September 2001 (Li, et. al., 2003) </li></ul>
    • 11. <ul><li>Racial/ethnic disparities in breastfeeding (mean and 95% CI), NIS, July-Sept. 2001 (Li, et.al., 2003) </li></ul>
    • 12. NIS Study Results <ul><li>Comparison with data from 3 rd National Health and Nutrition Examination Survey (NHNES) 1988-1994 </li></ul><ul><ul><li>BF initiation  54% to 65% </li></ul></ul><ul><ul><li>Continuation of any BF  22% to 27% at 6 months and  9% to 12% at 12 months </li></ul></ul><ul><li>(Li, et.al., 2003) </li></ul>
    • 13. Public Perceptions of Breastfeeding Constraints <ul><li>Perceptions that shape women’s decisions on initiation and duration of breastfeeding </li></ul><ul><li>Healthstyles 2000 Survey, based on 3 mailed survey questionnaires </li></ul><ul><li>Survey conducted by DDB Needham worldwide (an ad agency), their follow-up survey and a Porter/Novelli survey </li></ul><ul><li>Agreement with statement suggests a potential barrier </li></ul><ul><li>Analysis done by CDC Maternal Child Nutrition Branch (Li,et.al.,2002) </li></ul>
    • 14. Public Perceptions of Breastfeeding Constraints <ul><li>Survey uses quota sampling to generate a list of 5000 adults who represent a cross-section of US adults </li></ul><ul><li>Sample is stratified on age, sex, marital status, race/ethnicity, income, region, household size, and population density </li></ul><ul><li>(Li, et.al.,2002) </li></ul>
    • 15.  
    • 16. Public Perceptions of Breastfeeding Constraints <ul><li>Other Findings </li></ul><ul><ul><li>Perceptions did not differ significantly between men and women </li></ul></ul><ul><ul><li>Blacks were more likely than whites to have negative perceptions </li></ul></ul><ul><ul><li>Negative perceptions were also more common among people with lower household incomes and those with less education </li></ul></ul><ul><ul><li>(Li, et.al, 2002) </li></ul></ul>
    • 17. National Breastfeeding Awareness Campaign <ul><li>Sponsored by DHHS with the support of the Ad Council </li></ul><ul><li>Approach based on focus group research </li></ul><ul><li>Will move away from talking just about the benefits of breastfeeding to talk about the risks of not breastfeeding </li></ul><ul><li>Panel of experts reviewed content for accuracy </li></ul><ul><li>Will launch soon and last 3 years </li></ul>
    • 18. Why Does It Matter? <ul><li>Health Care costs of Formula-Feeding in the First Year of Life </li></ul><ul><ul><li>Only 3 illnesses considered </li></ul></ul><ul><ul><li>After adjusting for confounders: </li></ul></ul><ul><ul><ul><li>2033 excess office visits </li></ul></ul></ul><ul><ul><ul><li>212 excess days of hospitalization </li></ul></ul></ul><ul><ul><ul><li>609 excess prescriptions per 1000 never-BF infants when compared with infants exclusively BF for at least 3 months </li></ul></ul></ul><ul><ul><li>Additional HC services cost $331-$475 /never BF </li></ul></ul><ul><ul><li>(Ball & Wright, 1999) </li></ul></ul>
    • 19. Physiology of Lactation <ul><li>Lactogenesis I, the initiation of lactation depends on </li></ul><ul><ul><li>Growth of glandular tissue (mammogenesis) </li></ul></ul><ul><ul><li>Differentiation of the mammary secretory epithelial cells (lactocytes) during pregnancy </li></ul></ul><ul><li>Lactogenesis II, the onset of copious milk production is closely associated with factors controlling the birth process </li></ul><ul><li>(Hartmann, et.al., 2003) </li></ul>
    • 20. Pregnancy <ul><li>Breast prepares for lactation </li></ul><ul><li>Increase in numbers of alveolar buds </li></ul><ul><li>Differentiated alveoli become more evident </li></ul><ul><li>Cellular hypertrophy occurs </li></ul><ul><li>Varies in both amount and pattern of growth in women </li></ul><ul><li>Growth stabilizes in most women by 22 weeks gestation (Hartmann, et.al.,2003) </li></ul>
    • 21. Lactogenesis I <ul><li>Development of the capability to produce milk-specific components, lactose, casein, and  -lactalbumin </li></ul><ul><li>Secretion is not discharged and components are reabsorbed </li></ul><ul><li>Since lactose is not metabolized in the blood it is cleared in the urine </li></ul><ul><li>(Hartmann, et.al.,2003) </li></ul>
    • 22. Lactogenesis I <ul><li>Since the breast is the major source of lactose in the body, the concentration of lactose in the urine can be used as an indicator of lactogenesis I </li></ul><ul><li>(Hartmann,et.al.,2003) </li></ul>
    • 23. Lactogenesis I <ul><li>Onset of lactogenesis I is highly variable </li></ul><ul><li>Occurs as early as 10 weeks and as late as 22 weeks </li></ul><ul><li>Most women have achieved lactogenesis I by 22 weeks gestation </li></ul><ul><li>(Hartmann,et.al.,2003) </li></ul>
    • 24.  
    • 25. Birth <ul><li>Little milk produced immediately after birth, regardless of length of gestation </li></ul><ul><li>37-169 g/d of colostrum produced in first 48 hours after birth regardless of length of gestation </li></ul><ul><li>(Hartmann,et.al.,2003) </li></ul>
    • 26. Lactogenesis II <ul><li>Initiation of copious milk secretion </li></ul><ul><li>Precedes the mother’s sensation of milk coming into the breast </li></ul><ul><li>Sensation of fullness occurs between 24-102 hours post birth </li></ul><ul><li>Mean 59 to 64 hours </li></ul><ul><li>Most critical stage of lactation </li></ul><ul><li>(Hartmann, et.al.,2003) </li></ul>
    • 27. Lactogenesis II <ul><li>Requires adequate levels of prolactin, insulin, and adrenocorticoid hormones </li></ul><ul><li>Triggered by withdrawal of circulating progesterone post birth following delivery of the placenta </li></ul><ul><li>Concentration of milk components changes, lactose and citrate  </li></ul><ul><li>protein and sodium  </li></ul><ul><li>(Hartmann, et.al.,2003) </li></ul>
    • 28.  
    • 29. Factors That Inhibit or Delay Lactogenesis II <ul><li>Factor </li></ul><ul><li>Inhibits </li></ul><ul><li>Retained placental fragments </li></ul><ul><li>Milk not removed </li></ul><ul><li>Delays </li></ul><ul><li>Insulin-Dependent Diabetes </li></ul><ul><li>Obese mothers </li></ul><ul><li>Prolactin Insufficiency </li></ul><ul><li>Cesarean </li></ul><ul><li>Breasts not emptied </li></ul><ul><li>Inadequate stimulation </li></ul><ul><li>(Hartmann, et.al., 2003) </li></ul><ul><li>Cause </li></ul><ul><li>Elevated progesterone </li></ul><ul><li>Autocrine inhibition </li></ul><ul><li>Unknown (  glucose uptake) </li></ul><ul><li>Unknown (  progesterone ) </li></ul><ul><li>Prolactin switches on milk specific genes </li></ul><ul><li>No labor-disturbed hormones </li></ul><ul><li>Frequency of nursing </li></ul><ul><li>Infant not sucking vigorously or frequently </li></ul>
    • 30. Establishment of Lactation <ul><li>Mothers of term infants who breastfeed on demand produce 556 to 705 g of milk a day on day 6 postpartum. </li></ul><ul><li>Mothers of preterm infants can produce 20-550 g/d by day 5 postpartum if pumping </li></ul><ul><li>Important to establish a high level of milk production (> 440 g/d) through either early,frequent breastfeeding or milk expression during lactogenesis II </li></ul><ul><li>(Hartmann,et.al.,2003) </li></ul>
    • 31. Prolactin <ul><li>Adequate levels required for Lactogenesis II </li></ul><ul><li>Normally secreted by the anterior pituitary gland at a low basal rate </li></ul><ul><li>Secretion suppressed by prolactin inhibiting factor (dopamine the main constituent) </li></ul><ul><li>Levels cycle and are highest during sleep </li></ul><ul><li>Normal range 1-20  g/L nonpregnant, up to 300  g/L during pregnancy </li></ul><ul><li>Suckling,stress,dehydration,exercise,sexual intercourse and sleep  rate </li></ul><ul><li>(Pena & Rosenfeld, 2001) </li></ul>
    • 32. The Infant’s Role <ul><li>Infant needs to be an alert, active participant </li></ul><ul><li>Must be willing to latch on to his/her mother’s breast and suck </li></ul><ul><li>Must coordinate suck-swallow-breathe </li></ul><ul><li>Must have enough energy to suck </li></ul><ul><li>Excellent discussion of assessment of mother and infant in: Cadwell, et.al.,Maternal and Infant Assessment for Breastfeeding and Human Lactation, 2002. </li></ul>
    • 33. Supplementation with Formula or Solids <ul><li>Study of change in pattern & duration of BF associated with the introduction of solids and formula </li></ul><ul><ul><li>In infants given formula, as soon as regular formula feeds started, the breastfeeding frequency and suckling duration declined swiftly </li></ul></ul><ul><ul><li>The younger an infant was at the start of regular formula feeds, the shorter the BF duration </li></ul></ul><ul><ul><li>Intro. of solids associated with no or minor changes in BF frequency and duration </li></ul></ul><ul><ul><li>(Hornell, et.al., 2001) </li></ul></ul>
    • 34.  
    • 35. Breastfeeding After Breast Reduction Surgery <ul><li>Breastfeeding is possible for many woman after breast reduction surgery and should be encouraged and supported </li></ul><ul><li>Close monitoring of the infant’s hydration status and growth are critical </li></ul>
    • 36. Defining Your Own Success: Breastfeeding After Breast Reduction Surgery Diana West La Leche League 2001
    • 37. Implications of Reduction Mammoplasty for Lactation <ul><li>Type of Surgery is a major variable </li></ul><ul><ul><li>Major nerve damage can interfere with neurohormonal reflex arc </li></ul></ul><ul><ul><li>Some milk ducts severed </li></ul></ul><ul><ul><li>More likely if nipple repositioned </li></ul></ul><ul><ul><li>Techniques to minimize scarring result in more damage to nerve and glandular tissue (West, 2001) </li></ul></ul>
    • 38.  
    • 39. Implications of Reduction Mammoplasty for Lactation <ul><li>Inferior Pedicle (McKissock) Technique </li></ul><ul><ul><li>Respects ducts and lobes necessary for milk production </li></ul></ul><ul><ul><li>Minimal compromise of the important 4 th intercostal nerve </li></ul></ul><ul><ul><li>Nipple/areolar complex remain intact </li></ul></ul><ul><ul><li>Most popular technique used in North America </li></ul></ul><ul><ul><li>(West, 2001) </li></ul></ul>
    • 40. Other Surgical Techniques Reduction Mammoplasty <ul><li>Liposuction </li></ul><ul><ul><li>Rarely used </li></ul></ul><ul><li>Periareolar (“Round Block”) </li></ul><ul><ul><li>Less visible scarring </li></ul></ul><ul><ul><li>Can also spare blood & nerve supply </li></ul></ul><ul><ul><li>(West, 2001) </li></ul></ul>
    • 41. Other Surgical Techniques in Reduction Mammoplasty <ul><li>Superior Pedicle Technique </li></ul><ul><ul><li>Involves removal of wedges of tissue from lower breast </li></ul></ul><ul><ul><li>Significant impairment of lactation likely </li></ul></ul><ul><li>Free Nipple Graft </li></ul><ul><ul><li>Most damaging </li></ul></ul><ul><ul><li>Nipple/areola complex completely removed </li></ul></ul><ul><ul><li>(West, 2001) </li></ul></ul>
    • 42. Implications of Reduction Mammoplasty for Lactation <ul><li>Unpredictable outcome </li></ul><ul><li>Never “all or nothing” </li></ul><ul><li>Results are usually better if 5 years have elapsed since surgery </li></ul><ul><li>(West, 2001) </li></ul>
    • 43. Lactation Capability <ul><li>Full Milk supply </li></ul><ul><li>Partial Milk supply </li></ul><ul><li>Absence of milk supply </li></ul><ul><li>Not possible to know ahead of time </li></ul>
    • 44. Range of Feeding Methods <ul><li>Feeding at the breast </li></ul><ul><li>Feeding at the breast with an at-the-breast supplementer </li></ul><ul><li>Feeding with artificial feeding devices </li></ul>
    • 45. Possible Breastfeeding Outcomes <ul><li>Milk supply is high and remains high </li></ul><ul><li>Milk supply is initially high and then decreases </li></ul><ul><ul><li>Initial supply endocrine driven </li></ul></ul><ul><ul><li>Supply can decrease when comes under control of autocrine system if nerve response impaired </li></ul></ul><ul><li>Low milk supply from the beginning </li></ul><ul><ul><li>Minimal functional tissue remains </li></ul></ul>
    • 46. Determining When Supplementation is Necessary <ul><li>Close monitoring of baby is essential </li></ul><ul><li>Assessment Chart </li></ul><ul><li>Record of wet and soiled diapers </li></ul><ul><li>Signs of dehydration </li></ul><ul><li>Calculate baby’s acceptable weight loss </li></ul><ul><li>Weigh baby once daily </li></ul>
    • 47. Supplementation Needed <ul><li>Loss of more than 8% of body weight </li></ul><ul><li>Gaining less than ½-1 oz.(14-28 g)/day after the 4 th day </li></ul><ul><li>Failure to regain birth weight by 2-3 weeks </li></ul><ul><li>Insufficient wet and soiled diapers </li></ul><ul><li>Signs of dehydration </li></ul><ul><li>(West, 2001) </li></ul>
    • 48. Strategies to Increase Supply <ul><li>Principle of “supply and demand” </li></ul><ul><li>May take 2-3 days possibly up to a week to increase production </li></ul><ul><li>Breastfeed more frequently (1 st choice) </li></ul><ul><li>Breast compression while feeding </li></ul><ul><li>Increase frequency or duration of pumping if at work or baby not nursing </li></ul><ul><li>Use of galactagogues or other techniques </li></ul>
    • 49. Galactagogues <ul><li>Substances taken to increase milk supply </li></ul><ul><li>Herbal remedies vs. prescription medication </li></ul><ul><li>Each culture has their own </li></ul><ul><li>Should not be your first choice when helping mothers with milk supply issues </li></ul><ul><li>Vary in safety and effectiveness </li></ul>
    • 50. Galactagogues <ul><li>Concern about side effects and interactions with other medications </li></ul><ul><li>Herbal preparations may vary in strength and purity </li></ul><ul><li>Lack of standards for dosing herbals </li></ul><ul><li>Little scientific research </li></ul>
    • 51. Types of Galactagogues <ul><li>Herbal preparations </li></ul><ul><ul><li>Potent chemicals </li></ul></ul><ul><ul><li>Not harmless because they are natural </li></ul></ul><ul><li>Nutritional </li></ul><ul><ul><li>Oatmeal </li></ul></ul><ul><ul><li>Brewer’s Yeast </li></ul></ul><ul><li>Prescription </li></ul><ul><ul><li>Felt to be most effective </li></ul></ul><ul><ul><li>(West, 2001) </li></ul></ul>
    • 52. Herbal Galactagogues <ul><li>Fenugreek (Leguminosae Trigonella foenum-graecum) </li></ul><ul><ul><li>Sold as dried, ripe seed and extracts </li></ul></ul><ul><ul><li>Used as artificial flavor for maple syrup </li></ul></ul><ul><ul><li>FDA list of Generally Regarded As Safe </li></ul></ul><ul><ul><li>Maple syrup odor in urine & sweat </li></ul></ul><ul><ul><li>High doses may produce hypoglycemia </li></ul></ul><ul><ul><li>Usual dose: 2-3 capsules (580-610 mg) 3 times/day </li></ul></ul><ul><ul><li>Reputation widespread but undocumented </li></ul></ul><ul><ul><li>(Hale, 2000) </li></ul></ul>
    • 53. Galactagogues <ul><li>Blessed Thistle (Cnicus Benedictus) </li></ul><ul><ul><li>Contains numerous chemicals </li></ul></ul><ul><ul><li>Used to treat many ailments, especially gastrointestinal since 16 th century </li></ul></ul><ul><ul><li>Reported anecdotally to be most effective when taken with fenugreek </li></ul></ul><ul><ul><li>No formal research studies exist </li></ul></ul><ul><ul><li>Usual dosage: 3-4 capsules, 3 times/day </li></ul></ul><ul><ul><li>(West, 2001;Hale, 2000) </li></ul></ul>
    • 54. Galactagogues <ul><li>Other Herbal Preparations </li></ul><ul><ul><li>Goat’s Rue (Galega Officinalis) </li></ul></ul><ul><ul><li>Alfalfa (Medicago sativa) </li></ul></ul><ul><ul><li>Nettle (Urtica urens or Urtica dioica) </li></ul></ul><ul><ul><li>European Vervain (Verbena officinalis) </li></ul></ul><ul><ul><li>Dill seed (Peucedanum graveolens) </li></ul></ul><ul><ul><li>Discussed in more detail in West, 2001 </li></ul></ul><ul><ul><li>No scientific research to support use of any of these compounds </li></ul></ul>
    • 55. Nutritional Galactagogues <ul><li>Oatmeal </li></ul><ul><ul><li>May be just a “comfort food” </li></ul></ul><ul><ul><li>No scientific evidence of an effect </li></ul></ul><ul><li>Brewer’s Yeast </li></ul><ul><ul><li>Contains protein, B vitamins, iron and minerals </li></ul></ul><ul><ul><li>May cause gassiness and can exacerbate thrush </li></ul></ul><ul><ul><li>No scientific evidence </li></ul></ul><ul><ul><li>(West, 2001) </li></ul></ul>
    • 56. Prescription Galactagogues <ul><li>Domperidone (Motilium) </li></ul><ul><ul><li>Effects milk supply by suppressing dopamine (a prolactin inhibitor) </li></ul></ul><ul><ul><li>Endorsed by Dr. Jack Newman </li></ul></ul><ul><ul><li>Can not be purchased in the U.S.and not FDA approved for use as a galactagogue </li></ul></ul><ul><ul><li>AAP has approved for use in nursing mothers </li></ul></ul><ul><ul><li>Therapeutic dose: 20-40 mg, 3-4 times/day </li></ul></ul>
    • 57. Metaclopramide (Reglan, Maxeran) <ul><li>Usually prescribed for reflux </li></ul><ul><li>Also blocks dopamine </li></ul><ul><li>Clinical studies have shown that it can  milk supply dramatically </li></ul><ul><li>Can cause significant CNS side effects, especially depression </li></ul><ul><li>Should not be taken for > 4 wk, taper after 1 week </li></ul><ul><li>AAP lists as a drug, “whose effect on nursing infants is unknown but may be of concern” </li></ul><ul><li>( West, 2001) </li></ul>
    • 58. Chinese Ear Acupressure <ul><li>Form of Traditional Chinese Medicine </li></ul><ul><li>After diagnosis, the seed of the vaccaria segetalis plant is taped tightly to a particular acu-point </li></ul><ul><li>The patient can then apply pressure 2 or 3 times daily to increase milk supply </li></ul><ul><li>Hong Yun, MD from Beijing, China conducting studies in this area </li></ul>
    • 59. Returning to Work
    • 60. Breastfeeding and Employment <ul><li>Growing numbers of U.S. women of childbearing age in the workforce </li></ul><ul><ul><li>58% of women > 20 years old in 2000 (Meeks, 2001) </li></ul></ul><ul><li>Infant Feeding Practices Study 1993 </li></ul><ul><ul><li>Expecting to work PT   or  in BF relative to those who did not expect to work (OR =.83 and .89, P > .50) </li></ul></ul><ul><ul><li>Expecting to work FT  probability of BF (OR =.47, P < .01) (Fein & Roe, 1998) </li></ul></ul>
    • 61. Breastfeeding and Employment <ul><li>Infant Feeding Practices Study 1993 </li></ul><ul><ul><li>Working full-time at 3 months postpartum  BF duration by an average of 8.6 weeks (P < .001) </li></ul></ul><ul><ul><li>Working part-time (4 hr or less) did not affect duration of BF </li></ul></ul><ul><ul><li>Part-time work of more than 4 hr/day decreased duration less than full time work </li></ul></ul><ul><ul><li>(Fein & Roe, 1998) </li></ul></ul>
    • 62. Breastfeeding and Employment <ul><li>Infant Feeding Practices Study simultaneous analysis of competition between employment and infant feeding practices </li></ul><ul><li>Finding: When considered simultaneously, the duration of work leave contributes significantly to the duration of breastfeeding. Each week of work leave  BF duration by almost ½ week (Tobit Coefficient 0.55 p  .05) (Roe, et.al., 1999) </li></ul>
    • 63. NIH Lactation Program <ul><li>Started as Pilot Program in 1998 </li></ul><ul><li>Success in helping women to breastfeed to 6 months led to permanent program </li></ul><ul><li>Served over 300 women in FY 2003 </li></ul>
    • 64. NIH Lactation Program <ul><li>Enroll during prenatal period </li></ul><ul><li>Program provides maternity leave telephone support </li></ul><ul><li>Return to work consultation </li></ul><ul><li>Ongoing support once returned to work </li></ul><ul><li>Breastfeeding Rates (past 4 years) </li></ul><ul><ul><li>60-66% BF  6 mo. of age </li></ul></ul><ul><ul><li>9-21% BF  12 mo. Of age </li></ul></ul>
    • 65. During Maternity Leave <ul><li>Establish and maintain a good milk supply </li></ul><ul><li>Introduce occasional bottles when infant is about 4 weeks old </li></ul><ul><li>Gerber NUK type nipples </li></ul><ul><li>Discuss need to pump with supervisor at work </li></ul>
    • 66. Options <ul><li>Exclusive breastfeeding </li></ul><ul><li>Partial weaning </li></ul><ul><li>Formula feeding </li></ul>
    • 67. Preparing to Return <ul><li>Establish adequate milk supply </li></ul><ul><li>Stockpiling lg. quantities not recommended-give freshest milk possible </li></ul><ul><li>Decision whether to pump at work </li></ul><ul><li>How often to pump </li></ul><ul><li>Where to pump </li></ul><ul><li>Storing the milk </li></ul>
    • 68. Pumping at Work <ul><li>Pump about every 3 to 4 hours </li></ul><ul><li>Most people need to pump 2 to 3 times daily to maintain full supply </li></ul><ul><li>Pump for 10-15 minutes at each session </li></ul><ul><li>Recent research showing best outcome with higher frequency stimulation and lower frequency expression vacuum curves (Kent, et.al., 2003) </li></ul>
    • 69. Manual Pumps <ul><li>You provide the power </li></ul><ul><li>Pump one breast at a time </li></ul><ul><li>Requires 15 to 20 minutes to empty breast </li></ul><ul><li>Recommended for occasional relief bottle, relief of engorgement, or missed feeding </li></ul><ul><li>Vary in quality and effectiveness </li></ul>
    • 70. Small Electric or Battery-Operated Pumps <ul><li>Power provided by small electric motor, look for auto-cycling </li></ul><ul><li>Requires 10 to 15 minutes to empty breast </li></ul><ul><li>Recommended for occasional relief bottle, relief of engorgement, or missed feeding </li></ul><ul><li>Not designed to handle all day every day use during fulltime employment </li></ul><ul><li>Vary greatly in quality and effectiveness </li></ul>
    • 71. Heavy-Duty Electric Pump <ul><li>Can be rented or purchased </li></ul><ul><li>Double pumping and auto-cycling </li></ul><ul><li>Require 10 to 15 minutes to empty both breasts </li></ul><ul><li>First choice for use if employed full time or collecting milk for a premature or sick infant </li></ul>
    • 72. Weaning <ul><li>Make it a slow gradual process </li></ul><ul><li>If pumping twice a day a work, cut back to pumping once a day </li></ul><ul><li>Sometimes woman will need to cut back on number of minutes she is pumping before dropping pumping sessions </li></ul><ul><li>Encourage to drop nursing sessions at home last </li></ul>
    • 73. Vitamin D Supplementation <ul><li>April 2003 AAP recommendation to add 200IU/day to every infant’s diet </li></ul><ul><li>Concern in lactation community that women will think their milk is “not good enough” </li></ul><ul><li>Important to explain that this is a precaution because of a slight  in cases of rickets and  in sunlight exposure </li></ul><ul><li>Support breast as best (Heinig, 2003) </li></ul>
    • 74. Environmental Toxins in Human Milk <ul><li>Headlines reporting toxins in breastmilk </li></ul><ul><li>Environmental Working Grp. decided use of human milk was most economic and non-invasive way to study environmental chemical levels in the general population </li></ul><ul><li>All women are at risk of exposure </li></ul><ul><li>Babies are exposed in utero </li></ul><ul><li>(Lawrence, personal communication, 2003) </li></ul>
    • 75. Environmental Toxins in Human Milk <ul><li>No data showing levels in cow’s milk, water, formula </li></ul><ul><li>No indication that breast milk contributes substantially to exposure </li></ul><ul><li>Benefits of breast milk far out way the risks of exposure </li></ul><ul><li>(Lawrence, personal communication, 2003) </li></ul>
    • 76. Questions and Concerns

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