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lactation management ppt
- 1. Lactation PhysiologyLactation Physiology andManagementand Management Alison Stuebe, MD, MSc astuebe@med.unc.edu
- 2. ObjectivesObjectives • Review publichealth impact of breastfeeding • Understand physiology of lactation • Identify the differential diagnosis and treatment for common breastfeeding problems » Low milk supply » Mastitis » Breast abscess
- 3. Health Impact ofHealthImpact of Not BreastfeedingNot Breastfeeding INFANTINFANT MOTHERMOTHER IllnessIllness OROR IllnessIllness OROR DiarrheaDiarrhea 2.82.8 PremenopausalPremenopausal breast cancerbreast cancer 1.41.4 Otitis mediaOtitis media 2.02.0 Ovarian cancerOvarian cancer 1.31.3 PneumoniaPneumonia 3.63.6 Type 2 DiabetesType 2 Diabetes 1.21.2 SIDSSIDS 1.61.6 AsthmaAsthma 1.41.4 LeukemiaLeukemia 1.21.2 Formula-feeding vs. breast-feeding: risk of adverse outcomes. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. AHRQ Evidence Report Number 153. April 2007.
- 4. AAP RecommendationsAAP Recommendations •Exclusive breastfeeding for the first six months of life • Continued breastfeeding for at least one year, ‘As long as is mutually desired by mother and child’ American Academy of Pediatrics (2005). "Breastfeeding and the Use of Human Milk." Pediatrics 115(2): 496-506.
- 5. ContraindicationsContraindications • HTLV-1 andHTLV-2 • HSV with lesion on the breast • Active tuberculosis • Medications that contraindicate breastfeeding • Newborn with galactosemia • Maternal HIV » US: not recommended » UNICEF: When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended; otherwise, exclusive breastfeeding is recommended during the first months of life.
- 6. Milk production Milk ejection PIF How Does LactationHappen?How Does Lactation Happen? Prolactin Oxytocin Anterior pituitary Posterior pituitary Hypothalamus Paraventricular nucleus
- 7. Where does milkcome from?Where does milk come from?
- 8. OxytocinOxytocin • Moves milkfrom lobules to sinuses, so baby can eat • Inhibited by stress, pain, anxiety • Triggered by sound, smell, sight of infant Let Down: Ejection, not suction, moves milk to the areola.
- 9. Stress and MilkVolumeStress and Milk Volume J. Pediatr 1948; 33:698-704.
- 10. Milk TransferMilk Transfer •Infant grasps most of the areola in his mouth • Tongue “milks” milk to the back of the mouth prior to swallowing. Latch: The baby’s tongue moves milk from areola to nipple.
- 11. Negative feedbackNegative feedback •Milk in lobules contains whey protein called Feedback Inhibitor of Lactation (FIL) • If milk is not removed, and lumen is full, production will decrease • Goal: 10-12 feeds in 24 hours, until baby is done. Moving Milk: Demand drives supply.
- 12. Evidence-based early careEvidence-basedearly care Latch Moving Milk Let Down Breastfeeding Success Start out right: establish normal physiology
- 13. Low Milk SupplyLowMilk Supply • Primary lactation failure » Anatomic abnormality » Sheehan’s syndrome • Disruption of normal physiology » Infrequent or inadequate milk removal » Postpartum depression • First line therapy: » Lactation consultation » Mechanical expression after breastfeeding • If needed: » Supplement after breastfeeding as indicated » Continue pumping during supplementation » Consider metoclopramide
- 14. MastitisMastitis • Definition: tender,swollen, wedge-shaped area of breast, usually unilateral, with fever, malaise, chills, and systemic symptoms • Incidence: 3 to 20% • Treatment » Rest, fluids » Antibiotics – Dicloxicllin 500mg QID x 10-14d » Empty the breast • Evaluate latch • Continue frequent breast feeding • Milk is not harmful to healthy, term infant • Abrupt weaning slows maternal recovery • Poor response requires further evaluation Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine 3(3); 2008.
- 15. Breast abscessBreast abscess •3% of women with mastitis • Diagnosis » Hard, red, tender mass after appropriate treatment » Diagnostic ultrasound • Treatment » Needle aspiration for culture / treatment » Surgical drainage for large or multiple abscesses • Follow-up care » Antibiotics » Continue breastfeeding
- 16. For more informationFormore information • American Academy of Pediatrics (2005). Breastfeeding and the Use of Human Milk. Pediatrics 115(2): 496-506. • American Academy of Family Physicians. (2001, 2/26/2007). Breastfeeding (Position Paper). • American College of Obstetrics and Gynecology (2007). Breastfeeding: Maternal and Infant Aspects. Special Report from ACOG. ACOG Clinical Review 12(1 (supplement)): 1S-16S. • Academy of Breastfeeding Medicine www.bfmed.org
Editor's Notes
- #7 Breast tissue differentiates during gestation At delivery, loss of placental hormones allows milk production to begin Infant suckling at the breast causes contraction of myoepithelial cells and release of milk
- #8 Milk produced in mammary epithelium within lobules With nursing, oxytocin triggers contraction of myoepithelial cells and transfer to sinuses
- #10 Study: 1 woman, monitored during morning feed at 7 months. 8 control days, 12 distraction days; given saline or pitocin injection prior to nursing. Pitocin returned milk supply to near-normal. Ice water - immersed feet for 10 of 30 sec; math - difficult verbal problems w/ shock if incorrect answer; toe pull - interemittent pulling of big toe, causing pain
- #11 A shallow latch, or sucking on the nipple, stimulates let down but doesn’t empty the breast. It also leads to sore, cracked nipples, engorged breasts, and hungry, frustrated babies.
- #13 Don’t distribute formula company materials in your office or hospital Ensure pediatric follow-up in the first 3-5 days Skin-to-skin at birth, nurse in the first hour Room in Feed on demand No pacifiers or formula, unless medically necessary