Breastfeeding

Question 1

What are the 3 stages of lactation?

Answer 1

Lactogenesis 1
Lactogenesis 2
Lactogenesis 3

Question 2

describe lactogenesis 1

Answer 2

breast development and colostrum production from approx 16 weeks gestation

Question 3

Describe lactogenesis 2

Answer 3

Onset of copious milk secretion occurring between 32 and 96 hours after birth

Question 4

Describe lactogenesis 3

Answer 4

maintenance of milk production

Question 5

What is the areola?

Answer 5

the pigmented area at the centre of the breast. Lobules (alveoli) it is the mammary gland that produces and secrets milk

Question 6

What is the duct?

Answer 6

It carries milk secreted by the lobules through the breast tissue to open up at the nipple

Question 7

What is the Glandular tissue?

Answer 7

develops during puberty, but it is only during pregnancy that the development of the glandular tissue us complete and has the ability to produce milk.

Question 8

What happens after birth?

Answer 8

oestrogen and progesterone levels drop. Prolactin and oxytocin levels rise in response to touch, smell and sight of baby. Baby begins spontaneous breast seeking behaviour. Mothering behaviours initiated.

Question 9

What are the 2 major hormones that regulate lactation?

Answer 9

prolactin and oxytocin

Question 10

Where are the hormones produced?

Answer 10

In the pituitary gland that is located at the base of the hypothalamus

Question 11

What is the prolactin response?

Answer 11

1. baby suckles
2. sensory impulses pass from the nipple to the brain
3. Prolactin secreted by the anterior pituitary gland goes via bloodstream to the breasts
4. Acini (milk- secreting) cells produce milk

Question 12

What are the effect of the prolactin response?

Answer 12

more secreted at night
suppresses ovulation
levels peaks after the feed, to produce milk for the next feed

Question 13

What is the prolactin receptor theory?

Answer 13

Surges of prolactin prime the receptor sites

the expulsion of the placenta opens receptor sites
Unprimed receptor sites shut down, reducing potential for milk production

Frequent prolactin release maximises long term milk supply

Question 14

What does oxytocin do?

Answer 14

Works on our feelings and emotions
Lowers blood pressure and improves sleep
reduces stress levels by taking on cortisol
reduces pain sensitivity
Boosts the immune system

Question 15

What is the oxytocin reflex?

Answer 15

1. baby suckles
2. sensory impulses pass from the nipple to the brain
3. oxytocin secreted by the posterior pituitary gland goes via blood stream to the breasts
4. Myo-epithelial (muscle) cells contract and expel milk

Question 16

What are the effects of the oxytocin reflex?

Answer 16

helped by sight, sound and smell of baby
becomes conditioned over time
Hindered by anxiety, stress, pain and doubt
works before or during the feed to make the milk flow

Question 17

What makes the milk to be ejected through the lactiferous ducts?

Answer 17

the action of contraction of the myo-epithelial cells surrounding the alveoli occurs under the influence of oxytocin this contraction causes the milk to be ejected from the lactiferous duct

known as the let down reflex

Question 18

Describe the let down reflex.

Answer 18

can be felt as a tingling sensation in the breast. in the first few days after birth may feel a uterine contractions and experience increased blood loss through the vagina. the let down reflex is initially triggered by the baby suckling but also seeing , hearing touching and smelling her baby. When the child is older it may be triggered by thinking abut feeding or hearing another baby cry.

Question 19

What is Feedback Inhibitor of Lactation (FIL)?

Answer 19

FIL is a protein secreted by the lactocytes which regulate milk production at a local level. as the alveoli distend and there is a build up of FIL and milk synthesis by the lactocytes is inhibited. When the breastmilk is effectively removed, and distension removed FIL levels will fall and milk synthesis will increase

Question 20

Describe skin to skin.

Answer 20

Skin to skin contact calms the baby and helps regulate their heartbeat, temperature and breathing. It also stimulates them to seek the breast. The mother goes through physical and emotional changes at this time which prepare her for breastfeeding and mothering.

Question 21

What is the recommendation for skin to skin?

Answer 21

Undisturbed skin to skin contact between mother and bab after birth. baby gently placed on the mother for skin to skin with nappy and worm towel placed over them. Skin to skin should be the default method of care for all babies at birth.

Question 22

Why is breast milk good?

Answer 22

it is always the right temperature, requires no preparation, and it is available even in environments with poor sanitation and unsafe drinking water. Breastfeeding guarantees babies access to reliable and sufficient quantity of affordable, nutritious food

Question 23

When is optimal breastfeeding started?

Answer 23

starting within one hour of giving birth, exclusive breastfeeding for the first 6 months of life and continued breastfeeding until the age of 2

Question 24

What is colostrum?

Answer 24

This is produced by the breast from around 16 weeks of pregnancy and is the first food for a breastfed baby

Question 25

What are the special features of colostrum?

Answer 25

packed with protective factors
concentrated nutrition
strong anti- inflammatory
stimulates gut growth
small volumes- intentionally
laxative effect- to clear meconium

Question 26

What are the risks for baby by not breastfeeding?

Answer 26

Gastoenteritis
Respiratory infections
Allergies
Obesity 
Type 1 Type 2 diabetes
SIDS

Question 27

What are the risks for mum by not breastfeeding?

Answer 27

breast cancer
ovarian cancer
hip fractures
heart disease

reduces risk of post natal depression
weight comes of faster

Question 28

How do babies pick up their familial microbiome?

Answer 28

when they pass through the vagina at birth and through their mother’s milk in the postnatal period and beyond

Question 29

Why is prolonged skin to skin especially important in c section cases?

Answer 29

because the bay never passed through the vagina so didn’t pick up the microbiome from there so pro longed skin to skin and breastfeeding are extra important

Question 30

What is epigenetics?

Answer 30

changes in genes can be passed down to future generations via maternal line. Breastfeeding may result in epigenetic changes which impact on:
baby’s brain development
baby’s immune system
baby’s metabolic system

Question 31

What do parents using formula need to know?

Answer 31

No need to follow on
all brands are similar and mostly made of cows milk
information on preparing and sterilising
cows milk from 1 year
responsive bottle feeding

Question 32

What reflexes are present in a healthy baby at birth?

Answer 32

Rooting reflex
Sucking reflex
swallowing reflex

Question 33

Name 5 breast feeding positions.

Answer 33

cradle hold
cross cradle hold
Lying on your side
football hold 
laid back

Question 34

What is the suck swallow pattern of a breastfeed?

Answer 34

Beginning of feed is short rapid sucks
Active feed is long, slow, rhythmic sucking and swallowing, with pauses
End of feed- flutter sucking with occasional

Question 35

What are some responsive bottle feeding tips?

Answer 35

Feeding baby when they show signs of being hungry- feeding cues
Hold baby close in a semi upright position- looking into their eyes and talking to them whilst they feed
Gently insert teat into baby’s mouth
Follow cues for when baby needs a break or has had enough

Question 36

What are some early feeding cues?

Answer 36

stirring
mouth opening
turning head
hand in mouth 
stretching
sucking sound

Question 37

How do you know there is effective attachment?

Answer 37

Chin touching the breast
Mouth wide open
Cheeks full and rounded
More areola visible above top lip
baby rhythmically takes long sucks and swallows
Feeding is pain free although first few sucks may feel strong

Question 38

What does CHIN stand for?

Answer 38

Baby is close to mum
Head is free
baby should be inline
nose to nipple