Lactation

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APGO educational topic number 14
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lactation welcome to the aapko promotion
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of breastfeeding celebration hi i’m
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Lecce lactation your MC for this evening
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breast milk is the preferred source of
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nutrition for infants and babies the
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World Health Organization UNICEF the
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American College of Obstetricians and
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Gynaecologists and the American Academy
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of Pediatrics all recommend exclusive
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breastfeeding for at least six months
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come join us for this exciting
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celebration of breastfeeding the
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objectives of this video are to list the
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normal physiologic and anatomic changes
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of the breast during pregnancy and
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postpartum recognize and know how to
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treat common postpartum abnormalities of
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the breast list the benefits of
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breastfeeding describe the resources and
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approaches to determining medication
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safety and breastfeeding and lastly
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describe common challenges in the
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initiation and maintenance of
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breastfeeding let’s start this
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discussion with some sombering
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statistics according to the Centers for
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Disease Control approximately 79 percent
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of new moms initiate breastfeeding as
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six months this number has gone down to
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49 percent and at one-year only 27
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percent are continuing to breastfeed for
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black women at 6 months only 17 percent
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are breastfeeding and at 1 year 6% are
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continuing to breastfeed for Hispanic
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women the rates are 35 percent
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breastfeeding at 6 months and 18 percent
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breastfeeding at 1 year throughout this
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video it is important to consider why so
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many women in the United States choose
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not to breastfeed and how we can improve
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these numbers let’s start with a review
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of breast anatomy here is a non pregnant
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breast with the areola each breast
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contains 12 to 20 lobules
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which are also called mammary glands
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which have grape like clusters of cells
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called alveoli the lobules are connected
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to the areola by like 2 phorus ducts
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myoepithelial cells lie in the lobules
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and the alveoli these are the
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myoepithelial cells during pregnancy the
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areola darkens this enables the baby to
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be able to see a better and breast
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tissue is stimulated by estrogen and
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progesterone estrogen is primarily
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responsible for growth of the lobules so
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they get bigger
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while progesterone
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stimulates alveolar hypertrophy so here
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we have more alveoli breast size
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increases in size by 25 to 50 percent
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during pregnancy due to this growth as
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well as to increase blood flow and
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increased adipose tissue after delivery
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estrogen and progesterone levels fall
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and prolactin oxytocin levels are high
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prolactin leads to milk production and
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oxytocin stimulates the myoepithelial
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cells to squeeze the milk out of the
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ducts
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breast milk is ideal nutrition for
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babies it is easy to digest and is
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perfectly formulated for most healthy
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babies there are also important
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immunological Offit’s of breast milk
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babies who drink breast milk have
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decreased incidence of otitis
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respiratory infections diarrhea
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illnesses allergic and atopic diseases
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there are maternal benefits as well
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breastfeeding may enhance post pregnancy
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weight loss there are also long-term
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decreased risks of both breast and
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ovarian cancer for women who breastfeed
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while breastfeeding is natural it can be
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very challenging for many women reasons
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for early termination within the first
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months of breastfeeding include sore
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nipples concerns of inadequate milk
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supply and concerns that their infant
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had difficulty with breastfeeding
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remember that breast milk does not come
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in until 48 to 72 hours after the
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delivery colostrum is full of
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lymphocytes and IgA IgG and IgM it is
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very important that the woman have the
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infant latch every two to three hours in
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order to stimulate milk production milk
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production runs on the supply and demand
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rule the more the breasts are stimulated
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the more milk will be produced many
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women are often concerned that they are
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not making enough colostrum or milk for
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their infants a general rule is that for
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the first few weeks of life a baby
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should feed 8 to 12 times per day yes
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that works out to every 2 to 3 hours by
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day 5 of life a baby should make 6 to 8
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wet diapers per day and 3 to 5 stools
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per day if a baby is not reaching these
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goals it could be due to inadequate milk
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supply or pour milk extraction it is
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important to recognize triage and treat
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the common postpartum abnormalities of
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breastfeeding let’s introduce our
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patient testimonials this is Sally
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engorgement she is a 27 year old
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gravity’ one paraone who gave birth four
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days ago and has been breastfeeding her
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new baby every two to three hours my
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breasts are swollen very soul and I have
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a temp of 100.0 breast engorgement can
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be very uncomfortable and Sally should
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be encouraged to continue breastfeeding
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and to use over-the-counter and algae
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Zia for the pain our next patient is
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Molly mastitis she’s a 30 year old
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grabbed a tube para 2 and has developed
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very high fevers up to 103 degrees
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myalgias and left breast pain the baby
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won’t latch well on the left nipple and
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now there is a red spot and it is very
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painful let’s discuss what happens when
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there is mastitis when there is an
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impediment to forward flow of breast
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milk it backs up into the breast tissue
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and this becomes an itis for infection
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the impediment is often a Galactus seal
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or plug duct when a patient has erythema
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and fevers than she has the diagnosis of
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mastitis and needs antibiotics the
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first-line treatment is dicloxacillin
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which will cover the most common
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organism of staph aureus it is also
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essential to emphasize the importance of
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encouraging forward flow with aggressive
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feeding and/or pumping on the affected
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breast our next patient is yolanda yeast
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she’s a 35 year old gravity’ 3 para 2
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has been exclusively breastfeeding since
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delivery and had no problems until a
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couple of days ago my nipple is very
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itchy and red and now my baby has white
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spots in its mouth
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Yolanda yeast and her baby now both have
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Candida infections or thrush and should
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both be treated with antifungal
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medications our last patient is don’t to
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give formula a gravity’ to para one at
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38 weeks in clinic for a prenatal
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appointment she fed her first child
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formula my mother-in-law told me to use
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formula until my milk came in no
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mother-in-law no many women and make
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this mistake of not realizing the
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importance of the colostrum and the
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importance of frequent feedings in order
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to stimulate breast milk production note
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that if a baby’s pediatrician recommends
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supplementation then this recommendation
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needs to be followed but there are ways
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to do this that will not create nipple
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confusion for the baby
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are there any contraindications to
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breastfeeding there are very few there
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are infectious contraindications in
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developed countries women with HIV or an
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active hepatitis B or a TB infection
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should not breastfeed in
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developing countries the same
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recommendation holds true if safe
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alternatives to breast milk are
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available it is important to note that
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in developing countries breastfeeding
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may be better even in the presence of
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infectious diseases because it outweighs
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the risks of contaminated water supply
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and diseases a second infectious
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breastfeeding contraindication is an
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active herpetic breast lesion and lastly
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galactosemia infants born with this rare
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metabolic disorder should not be
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breastfed screening for galactosemia is
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performed at the time of the newborn
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screen what about medications most
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therapeutic drugs are considered safe
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for breastfeeding the National
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Institutes of Health has developed a
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website and app called lactMed that
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provides information about individual
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medication safety during breastfeeding
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this concludes the app co promotion of
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breastfeeding celebration we have
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reviewed the normal physiologic and
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anatomic changes of the breast during
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pregnancy and the postpartum how to
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recognize and treat common postpartum
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abnormalities the benefits of
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breastfeeding the resources and approach
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to determining medication safety and
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common challenges in initiation and
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maintenance of breastfeeding