7. Relactation.pptx redae maldey hayelom

Presentations

1. I F C c ic Sand ra Lan g 1 Relactation and wet nursing

2. https:// www.laleche.org.uk/relactation- induced-lactation/ 26/08/20181IFC cic Sandra Lang 2

3. Relactation The ability of a woman who has stopped breastfeeding no matter how long ago, to start again. 1IFC cic Sandra Lang 3

4. Induced lactation The ability of a woman who has never been pregnant to produce breastmilk… 1IFC cic Sandra Lang 4

5. 1 I F I F C C c i c ic Sandra Lang 5 Indications for relactation The baby and mother have been separated Poor breastfeeding technique or mismanagement The baby has been sick A relative or friend will feed the baby because the mother is sick, HIV+ve, has died Emergency situations *Adoption or surrogacy (+ induced lactation)

6. What is needed for Relacation The most important elements to successful relactation are: a mother who is highly motivated Has time has a good support system, has realistic expectations, Breast stimulation and a baby with a good sucking reflex 26/08/20181IFC cic Sandra Lang 6

7. Will the mother produce enough milk? It depends upon individual circumstances… Any amount is beneficial… For many women who relactate or induce lactation Breastfeeding is more than simply the production of milk... it is also about closeness and nurturing…… 26/08/20181IFC cic Sandra Lang 7

8. Relaction: the mother Mother’s motivation Frequency of breastfeeding /expression Lactation gap/ experience Interaction with baby/ willing to sleep with baby Close contact and carrying Has she been pregnant before /for how long BREAST STIMULATION VITAL.. General health and nutrition Effective treatment of thyroid problems/ diabetes Previous damage to breasts/ nipples surgery, burns Previous damage to Pituitary gland Reason of any infertility Support system 1IFC cic Sandra Lang 8

9. Relactation: Factors related to the baby Age < > 6 months Willingness to suckle Breastfeeding gap Feeding experience Intake of complementary food 1IFC cic Sandra Lang 9

10. The physiology of relactation Little research into physiology of relactation and induced lactation… what do w e kn o w is … . ? Milk production depends upon : Growth of secretory alveoli in the breast Secretion of milk by cells of the secretory alveoli Removal of milk by the baby or by expression Hormones play a major role in all these processes…… 1IFC cic Sandra Lang 10

11. Prolactin Produced by anterior pituitary gland Important for development of secretory alveoli and secretion of milk by alveolar cells Nipple stimulation important In NON-LACTATING breast, prolactin stimulates growth of secretory alveoli As alveoli develop prolactin stimulates cells to produce milk proteins and lactose and to secrete milk Different kinds of nipple stimulation: Suckling, manual and mechanical expression 1IFC cic Sandra Lang 11

12. 1 I F I F C C c i c ic Sandra Lang 1 2 Oxytocin Removal of milk requires oxytocin Oxytocin causes small muscle cells around secretory alveoli to contract and press out milk Oxytocin DOES NOT HELP if there is no milk in the breast The mother’s psychological state affects oxytocin

13. Inducing lactation.. Stimulate breast growth with oral contraceptives ..oral or injected Used to INDUCE lactation in adoptive mothers to mimic hormones of pregnancy.. and stimulate development and growth of secretory alveoli Breastmilk usually begins a few days after hormones stop… NO CONTROLLED STUDIES 1IFC cic Sandra Lang 13

14. Composition of milk in relactation and induced lactation NO SIGNIFICANT differences noted compared with milk produced in early postnatal period Kleinmann et al (1980) observed mothers who had NEVER been pregnant produced no colostrum BUT their milk at 5 days had similar amounts of total protein, alpha-lactalbumin, IgA 1IFC cic Sandra Lang 14

15. How to begin? If the baby is willing to suckle.. EVERY DAY: Feed baby directly at the breast or use a breastfeeding supplementer as often as possible.. every 1-2 hours.. at least 8-12 times in 24 hours Use both breasts for as long as possible, at least 10-15 minutes each time Ensure good attachment and positioning Until there is sufficient milk use a cup or breastfeeding supplementer to give supplements of formula or donor milk – use a cup AFTER using the breast Try to avoid bottles or pacifiers 1IFC cic Sandra Lang 15

16. If the baby is unwilling to suckle Ensure the baby is not ill, has NO oral problem Have lots of skin to skin contact.. Offer the breast regularly Use a breastfeeding supplementer with donor milk or formula milk Stimulate the breast and nipple – manually or mechanically Give formula or donor milk or the mother’s EBM by CUP after offering the breast first Reduce the number of cup feeds as the mother’s milk supply increases 1IFC cic Sandra Lang 16

17. Persuading Grandmother and sisters 1IFC cic Sandra Lang 17

18. How long till breastmilk flows? Dependent upon when breastfeeding stopped Approximately 42 days for ‘involution‘ of the breast to occur after breastfeeding stops A few days to a few weeks… Earlier when lactation recently stopped 4-6 weeks to produce significant amounts Amounts vary Weight gain Weigh once a week 6 or more wet nappies a day ..PATIENCE 1IFC cic Sandra Lang 18

19. Galactologues (to stimulate milk flow) HORMONAL P HAR M ACO L O G I C A L HERBAL DIETARY TREATMENTS 1 I F I F C C c i c ic Sandra Lang 19

20. Rules for Galactagogues Generally ONLY work when prolactin levels are low and combined with frequent breastfeeding and expressing . Advisable to measure prolactin levels beforehand Usually work quickly 24- 48 hours Metoclopramide If it doesn’t work in a few days, discontinue. Long-term, discontinue gently, with slow tapering of dose. Domperidone is probably safer and is the preferred option. 1 I F I F C C c i c ic Sandra Lang 20

21. 1IFC cic Sandra Lang 2 1 According to TOM HALE galactogogues : Stimulate milk production by increasing levels of PROLACTIN . Drugs Include: Domperidone (Motilum) Ideal - no CNS problems, only headache. Metoclopramide Problems include depression, GI symptoms They ONLY work if Prolactin level is low FENUGREEK probably works, but studies are limited. 1 study in 2000 – 10 women, 3 capsules 500 mgs 3x day 24-72 hours to see increase in milk. But in studies increased milk from a mean of 207- 464ml a day over a week Any local remedies?

22. Be aware of side effects Domperidone Do NOT use if: On ketaconazole or erythromycin ( use Metoclopramide ) Impaired cardiac conduction Cardiac disease eg. congestive cardiac failure Severe hepatic impairment Fenugreek Possible profuse sweating and urine has maple syrup smell Some diarrhoea Some increased aggravation of asthma symptoms 2 cases of fenugreek allergy Caution if diabetic, Fg lowers blood sugar 26/08/20181IFC cic Sandra Lang 22

23. Increasing milk supply by breastfeeding Feed often Start and finish at the breast, use breast compression Keep baby close at all times Make sure attachment and positioning is good Keep calm Hand express to start milk flow then use a mechanical pump if available 1IFC cic Sandra Lang 2 3

24. How to tell that milk is increasing Hormonal changes may affect mood Breasts feel hotter, tingling, fuller, heavier Feeling thirsty Leaking breasts or expressing more Baby gains weight, more wet, dirty nappies Baby starts to refuse supplements 26/08/20181IFC cic Sandra Lang 2 4

25. 1IFC cic Sandra Lang 2 5 What milk to give until sufficient breast milk is produced? Your own EBM/Donor breastmilk Give before using any formula needed Wet nurse Ready made Infant Formula more convenient in nursing supplementer, or use Infant Formula made according to Codex Alimentaris standards and guidelines

26. Care for the mother and baby Food Fluids Rest Time off work Monitor breast changes Monitoring the babies weight Urine and stools SUPPORT, SUPPORT,SUPPORT 1 I F I F C C c i c ic Sandra Lang 26

27. Studies of relactation S l ome ( 1956 ) – 1 gr a ndmo t h e rs in Na t a l r e l ac t a t e d f or for their grandchildren Newton (1967), Cohen (1971, Marieskind (1973) individual experiences Jellife (1970s) – regimes for re-establishment of lactation among mothers in UGANDA Brown (1977, 1978) – Review of experiences in India and Vietnam Bose (1981) – reports of successful lactation in mothers of sick and preterm babies in USA Marquis (1998) – common occurrence in Peru community 1 I F I F C C c i c ic Sandra Lang 27

28. Studies of induced lactation Auerbach and Avery (1981) …3 studies 240 women who breastfed an adopted baby 83 had NEVER been pregnant; 55 had been pregnant but never breastfed; 102 had breastfed before 1 I F I F C C c i c ic Sandra Lang 28

29. Wet nursing Wet-nursing is when a breastfeeding woman feeds another woman’s baby In an emergency it can be life-saving Is wet-nursing ever used in your countries? 26/08/20181IFC cic Sandra Lang 29

30. Criteria for wet nursing The woman must: be in good health - not taking any medicines which are contraindicated for breastfeeding be HIV negative - tested at least three months after the last time she had unprotected sex, or after any other possible exposure to HIV protect herself from HIV while breastfeeding – not having sex or using a condom each time she has sex or having sex with the same partner and is HIV -ve Not share needles or piercing objects Feed the baby on demand night and day Be aware of how to prevent breast problems Be aware that if the baby is HIV +ve she may be at risk of HIV – she must not breastfeed if she has cracked nipples or the baby has thrush or sore patched in his mouth I F C c ic Sand ra Lan g 3

31. 1 I F I F C C c i c ic Sandra Lang 3 1 T o prevent the need for relactation in the mother Give good breastfeeding support from birth Support the BFHI & ‘Ten Steps’ Include a basic breastfeeding assessment at each clinical meeting Give positive encouragement