Breastfeeding Basics for doctors who love children

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Breast is Best!

• Breastfeeding Basics for doctors who love
  children
• Jennifer E. Guss, MD

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Breast Feeding Benefits

• AAP recs exclusive breastfeeding for the first 6
  months of life and continuing for the second 6
  months
• breast milk is optimal nutrition ptn/fat/carb
• anti-infective properties/decr infectious dz
  diarrhea, pathogenic bacterial flora, nec, OM,
  LRTI, UTI
• prevent immune mediated dz-DM, Crohn, eczema,
  asthma, allergic gastro
• long term cognitive and psych benefits

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Breastfeeding Benefits

• mother-infant bonding enhanced-skin to skin
  contact
• improved scores on tests of cognitive devel.
• Breast fed babies have on average IQ score 7
  points higher than formula fed babies
• other factors assoc with breastfeeding enhance
  infant development/IQ socioeconomic,mat ed, mat
  IQ
• it is wonderful!

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Breastfeeding Benefits-whats in it for mom

• promotes uterine contractions to accelerate
  uterus returning to prepregnancy state
• burns 400-500 calories per day so promotes
  reversal of pregnancy weight gain
• very cheap!
• convenient! No mixing, washing, preparation
  needed!

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Statistics-USA 2003

• 70 initially breastfed some or exclusively
• at 4-5 months old only 33 are still
  breastfeeding some or exclusively
• at 12 months old only 15 are still breastfeeding
  some or exclusively
• exclusive breastfeeing rates are even lower

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Statistics-USA

• In US women most likely to breastfeed are
  married, older, higher level of education
• barriers to breastfeeding-many!

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Breast Milk Nutrition

• Protein Content 70 whey 30 casein
• Bovine milk is 18 whey 82 casein
• whey ptns digested more easily, resist acid ppt
  promotes gastric emptying
• lactoferrin, lysozyme, secetory IgA specific whey
  ptns involved in host defense

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Breast Milk Nutrition

• also passive immunity enhanced by mom excreting
  specific Abs when exposed to foreign Ag
• Lipid 50 caloric content, Arachidonic Acid and
  docosahexaenoic acid (DHA) are in human but not
  bovine milk(both VLCFA)
• deficiency of AA and DHA asoc with poorer neural,
  devel, visual function

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Breast Milk Nutrition

• CarbohydrateLactose
• minerals , vitamins, micronutrients sufficient to
  achieve optimum growth for term babies
• at 4-6mo iron must be suppl, vit D at 2 mo
• What do we give to supplement breast fed babies
  the iron and Vitamin D they need?

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• Poly-Vi-Sol with Fe 1 cc po qday
• At 4-6 months of age the infant may also begin
  with iron fortified foods( ie cereal)

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Clinical Scenario 1

• Your are visiting with a first time mother a few
  hours after the birth of her baby. She wants to
  breastfeed and asks for your guidance about how
  to proceed.

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How to breastfeed

• Mom must be relaxed, comfortable, well hydrated,
  well nourished
• begin by massaging the breast to stimulate milk
  flow
• manually express small amout of milk/colostrum to
  tempt baby to begin sucking
• get baby in position to latch on

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How to breastfeed

• cradle hold
• football hold
• proper latch
• nursing pillows Boppy/ Breast Friend

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How to feed

• breastfeed AD LIB
• offer breast whenever baby is awake
• until baby is gaining weight well at the two week
  visit, may not sleep longer than 3 hour
  intervals. May have one four hour interval per
  dayensure adequate weight gain and hydration

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How to breastfeed

• most lactation consultants and pediatricians
  recommend waiting two weeks before introducing a
  pacifier or bottle to avoid nipple confusion.
  The MD should put an order in the breastfeeding
  infants hospital chart stating no pacifiers, no
  bottles.

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Clinical Scenario 2

• On DOL 2 you visit the same mother. She is
  crying because she has blisters and cracked,
  bleeding areas on her nipples. She says she is
  in so much pain that she is dreading each feed.

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Trouble shooting

• never breastfeed for more than 45 minutes total
  each feed
• never breastfeed for more than 30 minutes on one
  breast
• for ad lib feeders dont offer breast more
  frequently than every 45 minutes

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Trouble shooting

• make sure that the baby is latched on properly
• apply lanolin cream to the nipples after each
  feed-different brands Medela Lansin-Oh, may
  be purchased at Target, Walmart, grocery stores
  in baby section with diapers and bottles

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Clinical Scenario 3

• A nursing mother calls you on postpartum day
  number 5. She thinks her milk has come in but
  isnt sure. What signs can she look for to know?

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Signs of milk ingestion

• audible swallowing/gulping
• milk drips out side of mouth
• good uo
• breasts empty/soft after feed
• baby appears milk drunk

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Clinical Scenario 4

• A new mother calls your office on post partum day
  10. She is crying because she thinks her milk
  supply is drying up and she wants desperately to
  continue breastfeeding. She is appropriately
  supplementing and the baby is well hydrated.
  What do you recommend?

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How to breastfeed

• breastfeeding burns 400-500 calories/day
• must eat and drink well to have adequate milk
  supply-make sure she is eating and drinking!
• must continue taking PNVs for mothers health
  especially her bones and teeth

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How to breastfeed

• Reglan 10mg po TID x 7 days, then stop for 7
  days. Repeat if needed.
• Reglan side effects abdominal cramping,
  diarrhea, increased infant stooling, dystonic
  reaction-treat with benadryl
• Reglan increases prolactin levels
• fenugreek

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How to breastfeed

• nurse as much as possible to increase milk
  supply.
• The body produces breastmilk based on infant
  demand

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How to Breastfeed

• set the mood! a quiet, comfortable place
• prop up on pillows
• have a large glass of water within reach
• have the phone within reach
• Dads/partners/friends can help with above

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Clinical scenario 5

• At the two month visit, the babys mother tells
  you that she will soon be returning to work but
  wants to continue to exclusively breastfeed.
  What advice can you give her?

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Breastfeeding and working

• Pumping hand held pumps, electric pumps
• Supplementing with formula
• Any amount of breast milk is good and some is
  better than none!
• Somethings better than nothing, but nothings
  better than more.

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• Somethings better than nothing, but nothings
  better than more! More by Steven Sondheim sung
  by Madonna as Breathless Mahony in the 1990s
  film Dick Tracy

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Pumping

• Milk supply is greatest at about 6AM so pump
  after first morning feed
• have baby nurse off only one breast each AM and
  pump the other. Both breasts will produce
  adequate supply.
• At work, try to pump as often as baby nurses.
  Bring photo of baby to stimulate milk supply.

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Pumping

• Expressed milk will stay fresh at room temp for
  30 minutes, in the fridge for 24 hours, in the
  freezer for at least 3 months. As with formula,
  once a bottle has been prepared and eaten from,
  it must be discarded after one hour.

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Breastfeeding Aids

• breastfeeding trainers-good after breast
  surgery(reductions, augmentations, removal of
  masses)
• Medela makes bras that hold pump horns in place
  so a woman may pump hands free
• nursing clothes

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Politics

• self conscious nurser v. La Leche Freaks
• The Right to Breastfeed Act, HR 1848- signed into
  law 9/28/99- right to bf on Federal
  property/public parks/museums
• Texas Health and Safety Code-right to bf in any
  place where the mother has a right to be, since
  1995

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