Welcome to Midwifery & Obstetrical Nursing Blog!!

Welcome to Midwifery and Obstetrical Nursing Blog!

This blog is a platform for me to share all my lecture notes on Midwifery Nursing. Hope this will be useful to all the nursing students out there! Happy Reading!

Monday, 23 July 2012

Breastfeeding and Lactation Management


Lactation  Management

Introduction
Lactation is a complex physiologic process under neuroendocrine control,whereas breast feeding is the process by which milk is transferred from the maternal breast  to the infant. Lactation is the biologic completion of the reproductive cycle . Starting at about 16 weeks gestation the breast develops and prepares for full lactation. In the first few postpartal hours and days the breast responds to hormones and the stimulation of the infants sucking to produce and release milk

Physiology of lactation
 The physiological basis of lactation is divided into 4 phases
  • Preparation of breasts (Mammogenesis)
  • Synthesis and secretion from the breast alveoli (lactogenesis)
  • Ejection of milk (galactokinesis)
  • Maintainance of lactation (galactopoiesis)

Mammogenesis
  • It is the remarkable growth of both the ductal and lobulo-alveolar systems
Lactogenesis
  • Secretory activity begins during pregnancy but accelerated after delivery. Milk secretion actually starts from the 3rd or 4th postpartum day
Galactokinesis
  • Discharge of milk from the mammary glands depends not only on the suction exerted by the baby during suckling but also on the contractile mechanism which expresses the milk from the alveoli into the ducts.
Galactopoiesis
  • Prolactin appears to be the single most important galactopoietic hormone
  • For maintainance of effective and continuous lactation ,sucking is essential.
 Advantages of Breast feeding
  •  Ideal composition for easy digestion with  low osmotic load
  •  Protection against infection and deficiency states
    • It contains adequate protein, carbohydrate  and fat which is easily digestible. It contains Vitamin D which protects the baby against rickets
    • It contains- lactoferrin,l ysozyme, lactoperoxidase, compliments and leukocytes that hinder the growth of e-coli and thereby prevents gastroenteritis
    • It contains long chain W-3 fatty acids that is important for the neurological development of the baby
    • It contains Secretory antibody IgA, which prevents gastrointestinal infections
  •  It is readily available sterile and is given to the baby at body temperature 
  • It has laxative action and anti allergy properties

Positioning for breast feeding- cradle hold
  • Cross cradle hold
  • Football hold
  • Side lying position
  • Australian Hold
  • C hold and latch on

Correct attachment (latch-on) at the breast include:
1)      newborn's nose close to or touching the breast while it breathes through the nasolabial folds;
2)      rooting by the infant to move in and grasp the areola well behind the nipple, forming a teat;
3)      tongue moving forward beyond the lower gum, cupped and forming a trough, then removing milk from the lactiferous sinuses by peristaltic waves;
4)      the jaw moving down, creating a negative pressure gradient that facilitates transfer of the milk into the oral cavity
5)      Correct attachment of baby to the breast
6)      Burping allows the swallowed air to be realeased  from the infant's stomach.

Maternal conditions associated with breast feeding Problems

Acquired prior to pregnancy and lactation

  • Inverted or retractile nipples
  • Breast surgery
  • primary glandular insufficiency of the breasts
  • Breast trauma
 Acquired because of breast feeding Problems

  • Sore, cracked nipples
  • Engorgement
  • Blocked ducts
  • Mastittis
 Interference with lactation
  • Anxiety
  • Medical Problems
  • Nutrition and fluid intake
  • Infant's Health
Signs of Good Breastfeeding
  • Frequent feedings of 8 to 12 times every 24 hours (the baby does not have to take both breasts at each feeding)
  • The baby is allowed to feed until finished on one side (time will vary greatly with each individual mother-baby dyad)
  • Intermittent episodes of rhythmic sucking with audible swallows
  • Stools should be about 1 tablespoon or larger
  • After the third day, soft and yellow stools ranging from 4 (if large) to 10 (if small)

Breastfeeding Warning Signs (requires infant evaluation)
  •  Fewer than 6 wet diapers per 24 hours after the third day
  • Dark black, green, or brown stools after the third day
  • Fewer than 3 to 4 yellow stools (from the fourth day to the fourth week)
  • The baby seems to be nursing continuously, always hungry, and never satisfied
  • The baby is exceptionally “good” rarely crying and consistently sleeping more than 4 to 6 hours
  • Milk comes in, but swallowing or gulping is not audible
  • Milk does not seem to have come in by the fifth day
  • Sore and painful nipples throughout most feedings
  • Significant engorgement (breasts are very hard and do not soften after feeding)
  • Average daily weight gain of less than 15 to 30 g (once the milk comes in)

Baby friendly Hospital Initiative

In 1992, UNICEF and WHO launched the baby friendly initiative among all health personals ,in hospitals and maternity centres to promote ,protect and support breast feeding.

Objective: to re-establish the superiority of breast feeding in order to protect the newborn's health by becoming baby friendly.

Ten Steps
1.       There must be a written breast feeding policy
2.       All health care staff must be trained to implement this policy
3.      All pregnant women must be informed about the benefits of breast feeding
4.      Mothers should be helped to initiate breast feeding within half an hour of birth
5.      Mothers should be helped to initiate breast feeding within half an hour of birth
6.      Unless medically indicated no other food should be given
7.      To practice 'rooming in' by allowing mothers and babies to remain together
8.      To encourage demand breast feeding
9.      No artificial teats to be given to babies
10.  Breast feeding support groups are established and mothers are referred to them on discharge

Nurses Role
  • The nurse must help the mother develop skills so that she is able to feed the baby on her own
  • Emotional Support: Encouragement and reassurance
  • Practical Support: Teaching the fundamentals of good attachment so that feeding is pain free and successful
  • Informational Support: Importance of exclusive breast feeding,feeding pattern, switching breasts.

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