1. Breastfeeding

2. Anatomy Montgomery’s tubercules lactiferous sinuses lactiferous ducts

3. Anatomy Nipple-contains  25 nipple pores Areola-houses Montgomery’s glands Montgomery’s glands-secrete a protective lubricant Lobe-one of divisions of glandular tissue Lactiferous sinuses-milk collecting sinuses Alveoli-milk production glands Nerves-strong sucking elicits a response

4. Suclking  Let Down Reflex Stimulates anterior pituitary  prolactin Prolactin  Stimulates alveoli Alveoli  milk Stimulates posterior pituitary  oxytocin oxytocin  alveoli contract Alveolar contraction  milk ejection

5. Hormones of Lactation Estrogen-growth of ducts, inhibits milk production Progesterone-growth of lobules Prolactin-milk production,mothering behavior Oxytocin-milk ejection reflex

6. Advantages of Breastfeeding Natural food +bonding no sanitation or refrig. Fewer illnesses less constipation colostrum  antibodies develops dig. Enzymes saves $ No mixing/mistakes stools/reg. no bad smell no weight problems speeds involution less br. Cancer later easier to travel allergies  longer birth control Mothers don’t make much methane

7. Keys to successful breastfeeding Graspable Nipples Positions C hold Latch on Support Signs of Effective Suckling

8. Graspable Nipples Compression test flat inverted, and retracting nipples breast shells

9. Positions Cradle Football side-lying other

10. Latch on C-hold baby’s mouth open wide center nipple and areola in mouth baby’s chin and nose touch breast baby’s body facing mother baby’s lips flanged out

11. Support Use lots of pillows for baby and mom Mother should always bring baby to her sitting upright requires foot support

12. Signs of effective suckling Baby’s lips flanged out baby’s cheeks puffed out ears wiggle baby’s tongue down and over gumline no pain audible swallow

13. Signs of Letdown Reflex Uterine cramping sleepiness thirst tingling, filling or tightening sensation leaking from opposite breast audible swallowing at regular intervals by 7 days, minimum 6 wet diapers/day by 7 days, minimum 4 BM’s q 24 hrs

14. Supply and Demand Do not time feedings nurse on one breast til baby asleep or comes off burp and diaper, offer second breast. Baby may or may not feed on second breast Sucking produces demand, body will respond with adequate supply

15. Baby is eating enough if: He nurses often seems relaxed after feeding adequate number of wet/messy diapers baby seems happy, alert and growing

16. Hunger cues Hands in mouth/clenched fists sucking motions rooting crying

17. Temperament Sleepy baby-unwrap, change diaper, situps, undress, talking Excited baby-swaddling, talking, rocking, bouncing, dim lighting sleeping patterns eating patterns

18. Days 1-7 Nurse within 1 hr birth nurse on demand room-in wet messy diapers will increase from one of each on day 1 to 6wet and 4bm by day 7 Milk comes in on day 3-7 avoid supplemental bottles initial nipple soreness common wear supportive nursing bra after week 1, growth spurts, relief bottles

19. Nutrition during lactation 500-1000 additional calories 2500-3000 cc/day fluid protein 62-65 gms/day (4 servings) calcium, 1200 mg/day phosphorus-400mg additional/day niacin 20mg/day riboflavin 1.8mg/day increased vit A,C,E

20. Lactation diet 2-3 qts fluid 4 servings protein 4+ servings grains 5 servings dairy 6 servings fruits and veggies prenatal vitamins with iron

21. Common problems FLAT AND INVERTED NIPPLES Compression test Milk cups prenatally Milk pump to pull out nipple avoid nipple shields football hold allows more control

22. Common problems SORE NIPPLES occurs in almost everyone--first 3-4 minutes lasts 1-2 wks allow nipples to air dry aim nipple straight into mouth support breast with C hold football hold Always break suction before removing nipple from mouth

23. Common problems ENGORGEMENT nurse frequently before feeding warm shower feed baby on both breasts gentle massage while nursing avoid pumping--unless baby refuses 2nd breast

24. Breast assessment  for lumps  for cysts  size and shape  symmetry  for engorgement  for inverted, everted, or flat nipples