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Lactation Physiology and Management






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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
Lactation Physiology and Management

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Slide 1

Lactation Physiology and Management

Alison Stuebe, MD, MSc

astuebe@med.unc.edu

Slide 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

Slide 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.

Slide 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.

Slide 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.

Slide 6

How Does Lactation Happen?

Hypothalamus

PIF

Paraventricular nucleus

Anterior pituitary

Posterior pituitary

Prolactin

Oxytocin

Milk production

Milk ejection

Slide 7

Where does milk come from?

Slide 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

Slide 9

Stress and Milk Volume

J. Pediatr 1948; 33:698-704.

Slide 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.

Slide 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.

Slide 12

Latch

Let Down

Moving Milk

Start out right: establish normal physiology

Evidence-based early care

Breastfeeding Success

Slide 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

Slide 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.

Slide 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

Slide 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


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