LACTATION MANAGEMENT

SEMINAR ON LACTATION MANAGEMENT

1. SEMINAR ON LACTATION MANAGEMENT N .Suniakumari.Devi

2. MEANING OF LACTATION : Lactation is the secretion of milk by the breasts. -It is thought to be brought about by the interaction of progesterone, estrogen, prolactin and oxytocin. -Within the first month of gestation, the ducts of the mammary glands grow branches, forming more lobules and alveoli. -These structural changes make the breasts larger, more tender and heavy. -Prolactin from the anterior pituitary gland, secreted in increasing levels throughout pregnancy, triggers synthesis and secretion of milk after giving birth.

3. PURPOSES OF LACTATION : 1. To provide nutrition and immune protection to the newborn. 2 .It induces a period of infertility which serves to provide the optimal birth spacing for survival of the offspring.

4. PHYSIOLOGY OF LACTATION : The female breast is divided into 15-24 lobes. These lobes are subdivided into lobules, composed of small units called alveoli . The lobules have a system of lactiferous ductile that join larger ducts and eventually open onto the nipple surface. During pregnancy, the increased levels of estrogen, stimulate breast development in preparation of lactation. Following birth the levels of estrogen and progesterone drop rapidly and the anterior pituitary begins to secrete prolactin .

5. The hormones promotes milk production by stimulating the alveolar cells. 7. Oxytocin , secreted by the posterior pituitary when the infant sucks on the mothers nipple, triggers the letdown reflex, and a flow of milk results. 8. The letdown reflex can be stimulated by the newborns sucking presence or cry or even by maternal thoughts about her baby. 9. Milk production is decreased with repeated inhibition of the letdown reflex. 10. Failure to empty the breasts frequently and completely also decreases production. 11. As milk accumulates and is not withdrawn, the buildup of pressure in the alveoli suppresses secretion.

6. 11. Once lactation is well established, prolactin production decreases. 12. Oxytocin and sucking continue to be the facilitators of the milk production. 13. The release of oxytocin in response to the infants sucking is beneficial to the new mother. 14. Oxytocin stimulates uterine contraction and thus promotes rapid involution of the uterus.

7. INITIATION OF BREAST FEEDING : Nurse the baby more often. Resting adequately. Eating a nutritious diet. Drinking at least 8-10 glasses of water per day. 5. Choosing a night time sleeping arrangement that allows for the best sleep. HORMONES THAT INITIATES BREAST MILK : Oxytocin: Action: Triggers milk ejection reflex and uterine contraction. 2 . Prolactin : Action: Triggers milk production in emptied milk glands.

8. LACTATION SUPPRESSION: Increasing estrogen levels suppress milk formation. In case of breast engorgement, interventions carried out is applying ice packs, wearing a supportive bra and taking mild analgesics .

9. TEN STEPS OF SUCCESSFUL BREAST FEEDING: Have a written breast feeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breast feeding. Help mothers initiate breast feeding soon after birth. Show mothers how to breastfed and how to maintain lactation even if they should be separated from their infants. Give newborn infants no food or drink other than breast milk, unless medically indicated. Practice rooming-in allow mothers and infants to remain together 24hrs a day. Encourage breast feeding on demand. Give no artificial teats to breast feeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.

10. COMPOSITION OF HUMAN MILK AND COWS MILK: NUTRIENTS 1 HUMAN MILK COWS MILK 1. Energy (kcal) 2.Proteins( gms ) 3. Fats ( gms ) 4. Carbohydrates ( gms ) 5. Minerals ( gms ) 6. Calcium (mg) 7. Phosphorous (mg) 8. Iron (mg) 9. Vitamin A (mcg) 10. Thiamine (mcg) 11. Riboflavin (mcg) 65 1.1 3.4 7.4 0.1 28 11 -- 42 20 20 6.7 3.2 4.1 4.4 0.8 120 90 0.2 52 50 190

11. 12. Niacin (mcg) 13. 13. Vitamin C (mcg) -- 3 100 2

12. FEEDING BEHAVIOUR : Finishing the first breast and finishing a feed. Timing and frequency of feeds. Volume of the feed. Weight loss and weight gain.

13. EXPRESSING BREAST MILK : 1. Manual expression if milk :

14. 2 . Expressing with a breast pump: i ) Manually controlled: ii) Electrically controlled:

15. GALACTOGOGUES: Galactogogues are an agent that promotes the secretion of milk. INDIAN FOODS TO INCREASE MILK SECRETION IN NURSING MOTHERS ARE: Dried fish. Green leafy vegetables in particular spinach. Bitter gourd. Fenugreek soaked in butter milk. Garlic rasam. Jeera. Methi seeds. Plenty of fruits and vegetables. Alfalfa. Musk melon. Raw papaya. Whole potatoes. Black gram dhal.

16. 14. Peanut milk extracted by wet crushing which have been soaked in water for 24 hrs. 15. Garlic, tamarind and cotton seeds also help in increasing milk supply. 16. Soups and red gram also helps in milk production. 17. The leaves or seeds of fennel boiled in water

17. DRUGS THAT CAN INCREASE BREAST MILK : Domperidone : It increases prolactin and breast milk supply. It has fewer side effects in mother and no side effects have been reported in infants. 2. Metoclopramide: It stimulates prolactin release It is a safe and effective drug. Known by its commercial name , Reglan . Potential side effects includes fatigue, anxiety, dizziness diarrhea, and gastric cramping. 3. Chlorpromazine: Used as an alternative to or in conjunction with metoclopramide. On occasions, when unsuccessful, methyldopa may be added.

18. 4. Oxytocin: It is involved in causing milk letdown or milk ejection reflex. It can be taken orally or a nasal spray.

19. BREAST PROBLEMS : 1. Sore and damaged nipples. 2. Dermatitis.

20. 3 . Anatomical Variations: i ) Long nipple. ii) Short nipple . iii) Inverted and flat nipple.

21. PROBLEMS OF BREAST FEEDING: Engorgement: Mastitis.

22. 3. Breast abscess. 4. Blocked ducts.

23. HUMAN MILK BANKING: A human milk is a service established for collecting, screening, processing, storing and distributing donated human milk. HISTROY: -Donation of breast milk from one women to an unrelated infant has a long history. -Before this century, the infant would have been directly breastfeed by the woman who was referred to as “WET NURSE”. -In 15 th century, wet nursing became very unpopular due to spread of syphilis. -In early half of this century. The first reason for their loss of interest in human milk was the heavy promotion of infant formula, including formulas designed for preterm infants. -Later, fear of transmission of viruses, including HIV, in the body fluids led to an anxiety about donation of body fluids including breast milk.

24. INTERNATIONAL STATEMENT: WHO and UNICEF made a joint statement in 1980. Where it is not possible for the biological mother to breast feed, the first alternative, if avaiable should be the use of human milk from other sources. USES OF BANKED HUMAN MIL K: To treat many conditions, prematurity, absorption, short-gut syndrome, nephrotic syndrome, some congenital anomalies and immune deficiencies. It has a protective effect against necrotizing enterocolitis. Provided for adopted babies or older children with severe food allergies. SCREENING: Screening is extremely important. A system of triple protection is applied: i ) Review of donors health history. ii) Serum screening. iii) Heat treatment of all donor breast milk.

25. COLLECTION : -Donors are educated about hygiene and to express milk. -Hand method is the best method but some centers allow certain type of hand-pumps to be used. -Type of container used for collection also varies. -Polythene bags are associated with decrease in the IgA content of milk, while glass is linked to loss of leucocytes. -Current recommendation is glass for the collection of milk. In India, steel utensils or containers are used.

26. CONTROLS OR PASTURIZATION: Most milk banks do bacterial counts on each donor milk before pasteurization. -Banked milk is pooled, a bacterical check is done again to ensure that pooling process does not lead to contamination. -Pooling is usually from 4-6 donors. -For pasteurizing the old protocol was called “HOLDER PASTEURIZATION” -It appears that pasteurized breast milk is as good as raw breast milk at preventing NEC. The milk is again checked for bacterical counts after heat treatment but no level of growth is accepted.

27. STORAGE AND DISPATCH : -Fresh raw milk must be stored continually at 4 degree Celsius for no longer than 72 hrs. following expression, whereas fresh frozen milk can be held at 20 degree Celsius for 12 months. -Pasteurized milk may be stored in the same condition. Transportation varies from shipping milk in commercial airlines that donate their cargo space, to refrigerated vans or local volunteers driving their own vehicles.

28. WET NURSING: Wet nursing is when someone else breastfeed your baby on a permanent basis. REASONS WHY WOMAN MAY CHOOSE TO HIRE A WET NURSE: Mother is dead or extremely ill or weak and cannot breastfeed. Mother does not make any breast milk. Mother is taking certain drugs or medications. Mother wants to get pregnant again. Working mothers schedule does not allow for breastfeeding.

29. BABY FRIENDLY HOSPITAL INITIATIVE: -- Launched in 1991, by WHO and UNICEF. --To encourage hospitals to promote practices that are supportive of breastfeeding. --It was focused around to the ten steps of breast feeding. --While the woman is pregnant they expect to have a full knowledge about caring and feeding the baby. --When the baby is born they expect to give the baby to the mother and help her in breast feeding. --While breast feeding , the midwife should show them how to hold the baby and how to help him to latch on to the breast. --Midwife should offer to show them how to express milk by hand.

30. BREAST FEEDING PROMOTION NETWORK OF INDIA:[BPNI] --BPNI was founded on 3 rd December 1991 at Wardha in Maharashtra. BPNI is a registered, independent, non-profit, national organization that works towards protecting , promoting and supporting breastfeeding and appropriate complementary feeding of infants and young children. VISION: By the end of 2007, technical breast feeding support is available in at least 200 districts and BPNI is established as a leader in this movement. MISSION: -To improve all woman to exclusively breast feed their children. -Continue breast feeding for at least two years , along with adequate and appropriate complementary feeding..

31. OBJECTIVE: To enhance the nutrition, health and development of infants and young children. LEGAL STATUS: BPNI is registered as a society under the Societies Registration Act XXI of 1860. BPNI ADMINISTRATION: -BPNI headquarter is in Delhi. -It has a total of 6 full time staff and 4 part time staffs. -BPNI is linked with various professionals to produce technical material and for training.