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Breastfeeding
Anatomy
• Montgomery’s tubercules
• lactiferous sinuses
• lactiferous ducts
Anatomy
• Nipple-contains 25 nipple pores
• Areola-houses Montgomery’s glands
• Montgomery’s glands-secrete a protective lubricant
• Lobe-one of divisions of glandular tissue
• Lactiferous sinuses-milk collecting sinuses
• Alveoli-milk production glands
• Nerves-strong sucking elicits a response
Suclking Let Down Reflex
• Stimulates anterior pituitaryprolactin
• Prolactin Stimulates alveoli
• Alveoli milk
• Stimulates posterior pituitary oxytocin
• oxytocin alveoli contract
• Alveolar contraction milk ejection
Hormones of Lactation
• Estrogen-growth of ducts, inhibits milk production
• Progesterone-growth of lobules
• Prolactin-milk production,mothering behavior
• Oxytocin-milk ejection reflex
Advantages of Breastfeeding• Natural food• +bonding• no sanitation or refrig. • Fewer illnesses• less constipation• colostrumantibodies• develops dig. Enzymes• saves $
• No mixing/mistakes• stools/reg. no bad smell• no weight problems• speeds involution• less br. Cancer later• easier to travel• allergies • longer birth control• Mothers don’t make much• methane
Keys to successful breastfeeding
• Graspable Nipples
• Positions
• C hold
• Latch on
• Support
• Signs of Effective Suckling
Graspable Nipples
• Compression test
• flat inverted, and retracting nipples
• breast shells
Positions
• Cradle
• Football
• side-lying
• other
Latch on
• C-hold
• baby’s mouth open wide
• center nipple and areola in mouth
• baby’s chin and nose touch breast
• baby’s body facing mother
• baby’s lips flanged out
Support
• Use lots of pillows for baby and mom
• Mother should always bring baby to her
• sitting upright requires foot support
Signs of effective suckling
• Baby’s lips flanged out
• baby’s cheeks puffed out
• ears wiggle
• baby’s tongue down and over gumline
• no pain
• audible swallow
Signs of Letdown Reflex• Uterine cramping
• sleepiness
• thirst
• tingling, filling or tightening sensation
• leaking from opposite breast
• audible swallowing at regular intervals
• by 7 days, minimum 6 wet diapers/day
• by 7 days, minimum 4 BM’s q 24 hrs
Supply and Demand
• Do not time feedings
• nurse on one breast til baby asleep or comes off
• burp and diaper, offer second breast. Baby may or may not feed on second breast
• Sucking produces demand, body will respond with adequate supply
Baby is eating enough if:
• He nurses often
• seems relaxed after feeding
• adequate number of wet/messy diapers
• baby seems happy, alert and growing
Hunger cues
• Hands in mouth/clenched fists
• sucking motions
• rooting
• crying
Temperament
• Sleepy baby-unwrap, change diaper, situps, undress, talking
• Excited baby-swaddling, talking, rocking, bouncing, dim lighting
• sleeping patterns
• eating patterns
Days 1-7• Nurse within 1 hr birth
• nurse on demand
• room-in
• wet messy diapers will increase from one of each on day 1 to 6wet and 4bm by day 7
• Milk comes in on day 3-7
• avoid supplemental bottles
• initial nipple soreness common
• wear supportive nursing bra
after week 1, growth spurts, relief bottles
Nutrition during lactation
• 500-1000 additional calories
• 2500-3000 cc/day fluid
• protein 62-65 gms/day (4 servings)
• calcium, 1200 mg/day
• phosphorus-400mg additional/day
• niacin 20mg/day
• riboflavin 1.8mg/day
• increased vit A,C,E
Lactation diet
• 2-3 qts fluid
• 4 servings protein
• 4+ servings grains
• 5 servings dairy
• 6 servings fruits and veggies
• prenatal vitamins with iron
Common problems
FLAT AND INVERTED NIPPLES
• Compression test
• Milk cups prenatally
• Milk pump to pull out nipple
• avoid nipple shields
• football hold allows more control
Common problemsSORE NIPPLES
• occurs in almost everyone--first 3-4 minutes
• lasts 1-2 wks
• allow nipples to air dry
• aim nipple straight into mouth
• support breast with C hold
• football hold
• Always break suction before removing nipple from mouth
Common problems
ENGORGEMENT
• nurse frequently
• before feeding warm shower
• feed baby on both breasts
• gentle massage while nursing
• avoid pumping--unless baby refuses 2nd breast
Breast assessment
for lumps for cysts size and shape symmetry for engorgement for inverted, everted, or flat nipples