Breastfeeding Nutrition 526

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BreastfeedingNutrition 526

• Ginna Wall, RN, MN, IBCLC
• gwall_at_u.washington.edu
• University of Washington Medical Center
• Lactation Services

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University of Washington Medical CenterLactation
Services
Nancy Estill, Louise Peterson, Ginna Wall,
Christy Shaw, Barb Lautman
RNs, International Board Certified Lactation
Consultants
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Objectives

• Describe the function of placental hormones,
  oxytocin, and prolactin in the breastfeeding
  process
• Describe the let down reflex and list factors
  that may interfere or enhance this reflex
• Recognize major contraindications to
  breastfeeding
• Recognize factors that contribute to successful
  initiation and maintenance of breastfeeding
• Describe correct positioning and latch on for
  successful early breastfeeding

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The Most Important Factors For Good Milk Supply

1. Prepared mammary epithelium
2. Progesterone withdrawal
3. Maintained plasma prolactin
4. Removal of milk within an undefined interval
   after birth

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Prolactin
Levels rise in pregnancy
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Prolactin Hormone

• Helps women respond to stress of perinatal period
• Suckling is the most effective stimulus for
  prolactin release
• Direct stimulation of the nipple is necessary for
  prolactin release
• Prolactin levels rise as long as stimulation
  continues

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Prolactin for milk production
Prolactin
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Oxytocin
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Each alveolus opens into a ductule that leads to
one main lactiferous duct
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Let Down or Milk Ejection Reflex

• Effective milk removal depends on the ejection
  reflex
• Duct diameter increases 50

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Milk duct before letdown
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Milk duct after letdown
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Early Post-birth Events

• Baby crawls to breast
• Opens and closes hands
• Massages the breast
• Hand movements cause as high an oxytocin rise as
  sucking

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Keep baby in skin contact with mother
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Skin-to-skin contact encourages oxytocin release

• Oxytocin
• Promotes milk
• Promotes mothering behaviors
• Alleviates pain

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Oxytocin in the bloodstream

• Released with nipple stimulation
• Released in surges, lasting about 1-2 minutes
• Contracts muscle cells
• Causes uterine contractions, causing involution
• Causes contractions of the muscle cells
  surrounding alveoli and ducts in the breast,
  causing milk let down or milk ejection reflex

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Oxytocin Effects Opposite of Fight or Flight
Response

• Lowers heart rate
• Lowers blood pressure
• Lowers blood cortisol
• Stimulates endorphins
• Affects metabolic actions
• Contracts pyloric sphincter
• Releases insulin and cholecystokinin

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Oxytocin In The Brain Affects Social Behavior

• Women who have high levels of oxytocin
• Produce more milk
• Breastfeed longer
• Are more tolerant of repetitious, boring tasks
• Demonstrate more social behavior better
  listeners
• Women become more social and retain those traits
  if they continue breastfeeding

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The Let Down Reflex

• List factors that interfere with this reflex
• List factors that enhance this reflex

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Cholecystokinin stimulates oxytocin

• Food for mother

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Is it ever NOT a good idea to breastfeed?

• Contraindications to Breastfeeding
• Maternal HIV, HTLV-1, Herpes lesion on the
  nipple, Some drugs (cocaine, methamphetamine,
  radioactive drugs)
• Infant Galactosemia, PKU (partial breastfeeding
  may be possible)

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Factors that contribute to successful initiation
and maintenance of breastfeeding

• 1991 WHO/UNICEF Baby Friendly Hospital
  Initiative, Ten steps to successful
  breastfeeding
• Certified 14,500 hospitals in 125 countries
• 40 US hospitals
• In WA State
• Evergreen
• St Marys
• Okanogan
• Tacoma General
• And in 2008 UWMC!
• And Group Health!

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Baby Friendly HospitalWhat are the Ten Steps?

• Have a written breastfeeding policy that is
  routinely communicated to all health care staff.
• Train all health care staff in skills necessary
  to implement this policy.
• Inform all pregnant women about the benefits and
  management of breastfeeding.
• Help mothers initiate breastfeeding within an
  hour of birth.
• Show mothers how to breastfeed and how to
  maintain lactation, even if they should be
  separated from their infants.

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Ten Steps, continued

• Give newborn infants no food or drink other than
  breastmilk, unless medically indicated.
• Practice "rooming in" by allowing mothers and
  infants to remain together 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats, pacifiers, dummies, or
  soothers to breastfeeding infants.
• Foster the establishment of breastfeeding support
  groups and refer mothers to them on discharge
  from the hospital or birthing center.

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Does Baby FriendlyMake a Difference?

• Promotion of Breastfeeding Intervention Trial
• 30 hospitals, randomized to receive Baby-Friendly
  training, or continue routine practices
• 17,000 mother-baby pairs
• Followed for 1 year

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PROBIT ResultsKramer, JAMA, Jan 2001

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Baby-Friendly Hospital Initiative Reduction in
GI Infections and Allergies Kramer, JAMA, Jan
2001

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Maternity Care PracticesImplications for
Breastfeeding
DiGirolamo, Grummer-Strawn, and Fein, BIRTH 282,
94, June 2001

• Surveyed 1085 women who intended to breastfeed
  for more than 2 months
• Assessed 5 Baby-Friendly practices
• Breastfeeding initiation
• Supplements
• Rooming-in
• Breastfeeding on demand
• Pacifiers

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Percentage of women who stopped breastfeeding
before 6 weeks, by specific hospital practices
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Percentage of women who stopped breastfeeding
before 6 weeks, by number of Baby-Friendly
Hospital Initiative practices they experienced
DiGirolamo, BIRTH, June 2001
STOPPED BF
Number of Baby-Friendly Practices Reported
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BFHI Improves Breastfeeding Initiation Rates in
a US Hospital Setting

• Boston Medical Center
• inner-city teaching hospital
• 1800 births per year
• 15-bed Level III NICU
• primarily poor, minority, immigrant families
• Implemented Baby-Friendly policies over a 3-year
  period
• Reviewed 200 randomly selected medical records
  from each of the 3 years

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BFHI IMPLEMENTATIONEFFECTS ON BREASTFEEDING
TRENDS
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ABCs of Helping Mothers to Breastfeed

• A is for Attachment of babys mouth to mothers
  breast (latch)
• B is for Breastmilk (transfer of milk from breast
  to baby, and how to establish a good supply)
• C is for Confidence (tell her what a good mother
  she is!)

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A Good Latch

• Nipple completely disappears
• Lips are flanged out
• Angle of babys lips is about 120 degrees

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Latch Scoring Practicewith video

• Jane Morton MD 15 minutes of breastfeeding
  help

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How parents can tell that baby is getting enough

• Stooling and urination patterns
• Meconium first day (one or more)

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Stooling and urination patterns

• Transitional stool day 2-4 (usually one or more
  each day)

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Stools when milk is "in

• By day 4 4 stools each day (not just a stain in
  the diaper)
• Frequent bowel movements for the first 4-6 weeks

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Common Problems

• Sore nipples
• Engorgement
• Low milk supply
• Preterm and late preterm infants
• Questions about drugs
• Working outside the home
• Infant sleep, crying, temperament issues
• Relationships, social isolation

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Test Weighing

• Use integrating digital scale
• Reweigh promptly in exactly the same way
• 1 gram 1 ml milk

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Double-Pumping Single-Handedly
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Breastfeeding Support Services in King County
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Finding Breastfeeding Support Services in the US
breastfeeding.com ilca.org iblce.org