Lactation Part 2

vast majority of women do not experience

significant problems during breast feeding

most problems during breast feeding could have been prevented with

proper prenatal breastfeeding education and a positive breastfeeding initiation period

common breastfeeding conditions

pain, letdown failure, hyperactive letdown, engorgement, plugged duct, infection

pain during breast feeding

may be prevented by proper positioning of baby on breast

areola should be in

the baby’s mouth with tongue extended against lower lip

letdown failure

when milk does not eject from breast; uncommon

treatment for letdown failure

oxytocin nasal spray and relaxation techniques

hyperactive letdown

streams of milk come from breast; too active can cause infant to choke while nursing

for hyperactive letdown, mother should

express milk until flow slows down, then allow infant to nurse; don’t forget hindmilk

engorgement

breasts are overfilled with milk; when supply and demand process is not yet established and mil is abundant

prevention of engorement

nurse frequently; newborns may nurse every 1-2 hours

plugged duct

painful knot in breast caused by milk staying in the ducts

prevention of plugged duct

complete emptying of breasts and changing position of infant while feeding; breaks up fat

treatment of plugged duct

massage and warm compress

mastitis

inflammation of the breast; can be infective or noninfective

mastitis is common

2-3 weeks postpartum

mastitis can result from

sore and crackled nipples, blood borne source of bacterial infection, missing a feeding causing engorgement

most common reason to stop breastfeeding

due to low milk supply

low milk supply is caused by

not feeding regularly, diet, stress, use of estrogen

management of low milk supply

nurse of pump every 2-3 hours during day and once at night

galactogogue

drug to increase prolactin levels; helps eliminate low milk supply

most medications are excreted in breast milk but

not in meaningful levels

minimize effects of maternal medication by

timing the dose, avoiding long acting, and addressing infant signs

safety of oral contraceptive use during lactation

combined can reduce volume of breast milk

ACOG oral contraceptive use recommendation

don’t use during first 6 weeks postpartum

OC and implant that is safe and effective

progestin only

herbal remedies

sparse information; medicinal should be viewed as drugs and are contraindicated during lactation

alcohol and breast milk

consumed quickly passes to breast milk; level in breast milk is same in maternal plasma

alcohol decreases

oxytocin and let down

impact of alcohol on lactation

affects odor of milk, decreases volume consumed by infant, and interferes with REM sleep pattern of infant

alcohol wait time to breast feed

2-3 hours after 1 drink, several hours for more

nicotine levels are

1.5 to 3 times higher in breast milk than in mothers blood; must wait a few hours

marijuana and lactation

transferred and concentrated in breast milk, metabolized by infant

nursing while smoking marijuana can

change DNA RNA formation and neurotransmitter systems needed for growth

alcohol and nicotine interfere with

sleep and oxytocin

20-30 cigarettes can lower

prolactin and oxytocin levels; can also lead to nicotine addiction if continuing to breast feed

cases of babies having withdrawal symptoms at birth if

moter smoked 7 cigarettes per day

caffeine levels in breast milk

much lower

caffeine and lactation

moderate intake causes no problems; could interfere with sleep or cause hyperactivity/fussiness of infant

amphetamines, cocaine, heroin, PCP during lactation

considered drugs of abuse; should never be used when breast feeding

safest sweetener during breast feeding

aspartame and saccharin; very little is excreted into breast milk

sucralose and acesulfame

pass into breastmilk at higher levels; makes milk sweeter and can contribute to obesity

advantges of breastfeeding far outweigh

potential risks from environmental pollutants

reducing exposure of milk to environmental chemicals

avoid high fat foods, wash produce, avoid paints and nail polish, hand dry cleaning, natural cleaning products

breast feeding and HIV infection

can be transmitted to infant by breast milk; formula milk required

milk storage containers

sanitize and use BPA free plastic; no glass

store milk in refrigerator for

up to 4 days

freeze milk for up to

6 months; safe up to 2 weeks to maintain quality