1 / 16

Lactation Physiology and Management

Lactation Physiology and Management. Alison Stuebe, MD, MSc astuebe@med.unc.edu. Objectives. Review public health impact of breastfeeding Understand physiology of lactation Identify the differential diagnosis and treatment for common breastfeeding problems Low milk supply Mastitis

sanne
Download Presentation

Lactation Physiology and Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Lactation Physiology and Management Alison Stuebe, MD, MSc astuebe@med.unc.edu

  2. Objectives • Review public health impact of breastfeeding • Understand physiology of lactation • Identify the differential diagnosis and treatment for common breastfeeding problems • Low milk supply • Mastitis • Breast abscess

  3. Health Impact of Not Breastfeeding Formula-feeding vs. breast-feeding: risk of adverse outcomes. Breastfeeding and Maternal and Infant Health Outcomes inDeveloped Countries. AHRQ Evidence Report Number 153. April 2007.

  4. AAP Recommendations • Exclusive breastfeeding for the first six months of life • Continued breastfeeding for at least one year, ‘As long as is mutually desired by mother and child’ American Academy of Pediatrics (2005). "Breastfeeding and the Use of Human Milk." Pediatrics 115(2): 496-506.

  5. Contraindications • HTLV-1 and HTLV-2 • HSV with lesion on the breast • Active tuberculosis • Medications that contraindicate breastfeeding • Newborn with galactosemia • Maternal HIV • US: not recommended • UNICEF: When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended; otherwise, exclusive breastfeeding is recommended during the first months of life.

  6. How Does Lactation Happen? Hypothalamus PIF Paraventricular nucleus Anterior pituitary Posterior pituitary Prolactin Oxytocin Milk production Milk ejection

  7. Where does milk come from?

  8. Let Down: Ejection, not suction, moves milk to the areola. Oxytocin • Moves milk from lobules to sinuses, so baby can eat • Inhibited by stress, pain, anxiety • Triggered by sound, smell, sight of infant

  9. Stress and Milk Volume J. Pediatr 1948; 33:698-704.

  10. Latch: The baby’s tongue moves milk from areola to nipple. Milk Transfer • Infant grasps most of the areola in his mouth • Tongue “milks” milk to the back of the mouth prior to swallowing.

  11. Moving Milk:Demand drives supply. Negative feedback • Milk in lobules contains whey protein called Feedback Inhibitor of Lactation (FIL) • If milk is not removed, and lumen is full, production will decrease • Goal: 10-12 feeds in 24 hours, until baby is done.

  12. Latch Let Down Moving Milk Start out right: establish normal physiology Evidence-based early care Breastfeeding Success

  13. Low Milk Supply • Primary lactation failure • Anatomic abnormality • Sheehan’s syndrome • Disruption of normal physiology • Infrequent or inadequate milk removal • Postpartum depression • First line therapy: • Lactation consultation • Mechanical expression after breastfeeding • If needed: • Supplement after breastfeeding as indicated • Continue pumping during supplementation • Consider metoclopramide

  14. Mastitis • Definition: tender, swollen, wedge-shaped area of breast, usually unilateral, with fever, malaise, chills, and systemic symptoms • Incidence: 3 to 20% • Treatment • Rest, fluids • Antibiotics – Dicloxicllin 500mg QID x 10-14d • Empty the breast • Evaluate latch • Continue frequent breast feeding • Milk is not harmful to healthy, term infant • Abrupt weaning slows maternal recovery • Poor response requires further evaluation Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine 3(3); 2008.

  15. Breast abscess • 3% of women with mastitis • Diagnosis • Hard, red, tender mass after appropriate treatment • Diagnostic ultrasound • Treatment • Needle aspiration for culture / treatment • Surgical drainage for large or multiple abscesses • Follow-up care • Antibiotics • Continue breastfeeding

  16. For more information • American Academy of Pediatrics (2005). Breastfeeding and the Use of Human Milk. Pediatrics 115(2): 496-506. • American Academy of Family Physicians. (2001, 2/26/2007). Breastfeeding (Position Paper). • American College of Obstetrics and Gynecology (2007). Breastfeeding: Maternal and Infant Aspects. Special Report from ACOG. ACOG Clinical Review 12(1 (supplement)): 1S-16S. • Academy of Breastfeeding Medicinewww.bfmed.org

More Related