Brestfeeding Presentation II

7/29/2019 Brestfeeding Presentation II

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Breastfeeding

Effective Practices, Benefits to Mothers and Infantsand The Role of the Family Physician

Folake Falaki, MD

PGY2

Emory Family Medicine.

June 25, 2009


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Outline

Introduction Anatomy and Physiology of Lactation Composition and Storage of Human Breast Milk Achieving Optimal Breastfeeding

Breastfeeding Techniques and Positions Benefits of Breastfeeding to Infants and Mothers Barriers to Effective Breastfeeding Contraindication to Breastfeeding

Reason for supplementation Role of the Family Physician Conclusion


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Breast fed infants, are Healthy Infants.


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Introduction

Breastfeeding is the optimal source of nutrition. The Human Milk isspecie specific and it provides all the essential nutrients necessary forthe growth and development of the newborn infant.

The AAP, AAFP and WHO recommend exclusive breastfeeding for

the first six months of life , and continuous breastfeeding for at least12 months of life.

The Target of USDHHS Healthy People 2010 initiative is to achievebreastfeeding at birth of 75%, 50% at 6 month and 25% at 12months of life.

2008 data published by the CDC shows that 77% of mothers in the USinitiate breastfeeding at birth. Only about 30% of women continuewith breastfeeding of the infant to 6 months of age.


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Anatomy and Physiology of Lactation

Structure of the Human Breast

Source: Lactation Education Program Nutrition Policy and Education


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Structure of the Human Breast

The Human breast are modified sweat glands responsible for lactation(milk production).

The breast contains adipose tissue and fibrous connective tissue.

Different hormones are responsible for the development of the breastand changes that occur during pregnancy.

The major hormones affecting breast development and enlargementare estrogen, progesterone and prolactin.


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Suckling Hormonal Reflex Arc

Source: Lactation Education Program Nutrition Policy and Education


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The sucking reflex arc is a hormonal positive feedback mechanism.

The sucking of the breast by the infant stimulates the nipple; this sendsmessages to the spinal cord and subsequently to the brain.

Prolactin is released from the anterior pituitary for milk production andoxytocin from the posterior pituitary for the milk let down.

Prolactin receptors are established within the first eight days of delivery.

Suckling at breast increases prolactin levels, so at each feeding, levels rise,hence more milk production.

Suckling Hormonal Reflex Arc (Contd)


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Types and Composition of Human Breast

Milk

Types of Breast Milk: Colostrum or Early Milk

Transitional Milk

Mature Milk

Colostrum or Early Milk is produced in the late stage of pregnancy till4 days after delivery; and is rich in antibodies.

Transitional Milk produced from day 410 is lower in protein incomparison to Colostrum.

Mature milk is produced from approximately ten days after delivery up

until the termination of the breastfeeding.


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Types and Composition of Human Breast

Milk (Contd)

Fat - The main lipids found in human milk are the triglyceridesphospholipids and essential fatty acids.

Protein Whey ; lactoferrin, lysozymes, immunoglobulin , A-lactalbumin, Casein; lower concentration in human milk.

Carbohydrate Include lactose and oligosaccharides.

Leukocytes - Include neutrophils, marcrophages , lymphocytes.

Non protein nitrogenurea, uric acid

Other constituents : steroid hormones, peptides, insulins, growthfactors, minerals, vitamins, lipase.


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Storage of Breast Milk

Human milk can be stored at room temperature for 6-8 hours.

Expressed milk can be stored in an insulated cooler bag with icepacksfor 24hours.

Breast milk can be stored in the refrigerator for about 5 days at about40 F.

It can also be kept in a freezer compartment of a fridge for up to twoweeks at 0 - 5F

It can be stored in a deep freezer for about 3-12 months

Breast milk should be stored in BPA (Bisphenol A) free containers.


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Achieving Optimal Breastfeeding

Activities, attitudes and procedures during the delivery and postpartum period have an impact on breastfeeding .

There is well documented evidence that skin to skin contact betweeninfant and mother helps to maintain the body temperatures, reducerisk of hypoglycemia, enhance oxytocin release and beneficialnutrition with intake of colostrum

Skin to skin contact should occur for about 1-2 hours after delivery.Procedures after delivery like weighing, administration of vitamin K,eye prophylaxis and other procedures should be delayed


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Breastfeeding should be started and fully established before dischargefrom the hospital

Physicians and health care professionals should observe at least onefeeding and ensure this is done properly and breast milk is produced

Lactation specialist should also work with parents that are havingdifficulty with breast feeding.

Early follow up after leaving the hospital is required.

Achieving Optimal Breastfeeding

(Contd)


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Signs of Effective Breastfeeding

Frequent feedings 8-12 times daily.

Intermittent episodes of rhythmic sucking with audible swallowsshould be heard while the infant is nursing.

Infant should have about 6-8 wet diapers in a 24 hour period oncebreast feeding is established.

Infant should have minimum of 3-4 bowel movements every 24 hours.

Stools should be about one tablespoon or larger and should be softand yellow after day 3.

Average daily weight gain of 15 -30g.

Infant has regained birth weight by day 10 of life.


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Good Breastfeeding Techniques

The baby should be properly positioned to achieve effective latching.

The mother should wear comfortable apparel, with the breast well exposed for theinfant to be able to latch.

The infants mouth, chin and umbilicus should be lined up with the head in a

neutral position.

The infant is brought to the breast, with the nose touching or close to the breast.

The gum line should overlap the areola, and the nipple straight back into themouth.

The tongue moves forward beyond the lower gum, cupped and forming areservoir.

Milk is removed for the lactiferous sinuses, the jaw moves down creating a

negative pressure gradient that helped transfer milk to the pharynx.


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Good Breastfeeding Techniques


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Breastfeeding Positions

Cradle Hold

This is the most common position

used by mothers.

Infants head is supported in the

elbow, the back and buttock is

supported by the arm and lifted to

the breast.

Adapted from AAFP Journal September 2001


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Football Hold Position

The infants is placed under thearm, like holding a football

Babys body is supported with theforearm and the head is supportedwith the hand.

Many mothers are not comfortablewith this position

Good position after operativeprocedures




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Side Lying Position

The mother lies on her side proppingup her head and shoulder with pillows.

The infant is also lying down facing themother.

Good position after Caesarean section.

Allows the new mother some rest.

Most mothers are scared of crushingthe baby.




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Cross Cradle Hold Position

Ideal for early breastfeeding.

Mother holds the baby crosswise inthe crook of the arm opposite thebreast the infant is to be fed.

The baby's trunk and head aresupported with the forearm and palm.

The other hand is placed beneath thebreast in a U-shaped to guide thebaby's mouth to your breast.




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Australian Hold Position

This is also called the saddlehold

Usually used for older infants

Not commonly used bymothers.

Best used in older infants withrunny nose, ear infection.




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Benefits of Breastfeeding to Infants

Helps in Gastrointestinal development and function

Helps in development of the immune system

Helps in cognitive development of the infant

Infants who are breastfed have reduced risk of infection compared to

formula fed infants.


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Breastfed infants have reduced risk of obesity later in life compared to

formula fed infants.

Reduced risk of sudden infant death syndrome, Hodgkin's lymphoma,

Leukemia and Type 1 Diabetes.

Lower risk of infections e.g. otitis media, Lower respiratory tract

infection, Diarrheal diseases, Allergies , eczema, Meningitis and

inflammatory bowel diseases.

Benefits of Breastfeeding to Infants


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Benefits of Breastfeeding to Mothers

Enhance early maternalinfant bond.

Aids involution of the uterus.

Long term breastfeeding helps in loss of the excess weight acquired

during pregnancy.

Prolonged Breastfeeding prolongs anovulation.

Documented long term effect of breastfeeding include reduced risk of

breast, ovarian and endometrial cancers.


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Supplements that increase lactation

Herbal dietary supplement

- Fennel fruit

- Aniseed fruit

- Coriander fruit

- Fenugreek seed

- Blessed thistle herb

- Not FDA approved.


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Socio-economic Benefits of Breastfeeding

Income savingsaverage of $1000 - $1200 per infant per year.

Reduced risk of infections and diseases hence reduced hospital visits

and attendant medical cost.

Mothers are more economically productive since they will spend lesstime caring for a sick child.


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Barriers To Effective Breastfeeding

Lack of confidence in mother

Belief that breast milk is not sufficient

Lack of adequate support system

History of previous breast surgery

Breast engorgement, cracked and sore nipples

Retractile nipples


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Barriers To Effective Breastfeeding

Embarrassment by mother

Jealousy by Partner and siblings

Chronic illness in mother; psychosis, Cancer.
http://www.cartoonstock.com/newscartoons/cartoonists/mpc/lowres/mpcn266l.jpg


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Contraindication to Breastfeeding

HIV , HLTV 1 & 11 infections.

Active Tuberculosis.

Herpes lesions on mothers breast.

Infant with Inborn error of metabolism; galactosemia,phenylketonuria.

Mothers on certain medications ; anticancer therapy, radioactiveisotope etc.


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Reason for Supplementation

Birth weight < 1500 g or GA < 32 weeks

Severe hypoglycemia

Acute water loss

Hyperbilirubinemia related to poor intake

Delayed bowel movement or dark stools at day 5

Delayed milk production

Weight loss >8% of birth weight.


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Role of the Family Physician

Office should be breastfeeding friendly

Staff should be well trained and willing to answer questions mothersmight have

Prenatal package should have literatures and patient hand out thatoutlines benefit of breastfeeding

Prenatal records should have a checklist that ensure all question are

addressed.


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Conclusion

Breastfeeding is the best source of nutrition for a healthy term infant.

AAP, AAFP and WHO recommends exclusive breastfeeding for thefirst six month of life and for at least twelve month of life.

Human milk is human specific and contains nutrients that are essentialfor the proper growth and development of the newborn.

Breast milk is beneficial to both infant and mother.


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References

Riordan J, Auerbach KG.Breastfeeding and Human Lactation. 2nd edition, Sudbury, Mass: Jones

and Bartlett, 1999

American Academy of Pediatrics Journals & Periodicals Pediatrics in Review

www.aappublications.org

Gartner LM, Morton J, Lawrence RA. et alBreastfeeding and the Use of Human Milk, Pediatrics

2005 Feb;115 (2): 496506

United States Department of Health and Human Services. Healthy People 2010: Volume

II. Objectives for Improving Health. Retrieved March 2009 fromhttp://www.healthypeople.gov/Document/tableofcontents.htm#volume1

McDowell MA, Wang C-Y, Kennedy-Stephenson J.Breastfeeding in the United States: Findings

from the National Health and Nutrition Examination Surveys 1999-2006. NCHS Data Briefs, No 5,

Hyattsville, MD: National Center for Health Statistics. 2008.

Wright AL.The rise of breastfeeding in the United States. Pediatric Clinics of North America 2001;

pp1-12.Gerard JT.Introduction to the Human Body: The Essentials of Anatomy and Physiology5th ed. JohnWiley & Sons, Inc.: New York, 2001

Neville MC.Anatomy and physiology of lactation. Pediatrics Clinics of North America 2001

Lawrence RA and Lawrence RM.Breastfeeding, A Guide for the Medical Profession, 6th Ed.

Elsevier Mosby, Philadelphia PA. 2005
http://www.aappublications.org/http://www.healthypeople.gov/Document/tableofcontents.htmhttp://www.healthypeople.gov/Document/tableofcontents.htmhttp://www.aappublications.org/


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References

Nancy G, Powers, Wendelin S. Breastfeeding Update 2: Clinical LactationManagement. Pediatrics In Review: May 1997; pp147-15

Ali Z, Lowry M.Early maternal-child contact: effects on later behaviour. Dev Med ChildNeurol. Vol. 23 June 1981; pp337-345Sinusas K, Gagliardi A. Initial Management of BreastfeedingAmerican Family

Physician, Journal of the AAFP; September 15, 2001Moreland J, Coombs J. Promoting and supporting Breastfeeding. American FamilyPhysician, Journal of the AAFP; April 1, 2000

Agency for Healthcare Research and QualityBreastfeeding and Maternal and InfantHealthOutcomes in Developed Countries; April 2007; #153; Retrieved March 15 2009from http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf

Protecting, promoting and supporting breastfeeding: the special role of maternity

services. A Joint WHO/UNICEF statement. Int J Gynecol Obstet 1990; 31(suppl1):171-83.

Moreland J, Coombs J Promoting and Supporting Breast FeedingAmerican Family Physician2000; 61:2093-100, 2103-4
http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdfhttp://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf

Brestfeeding Presentation II

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