Lactation management and breast VK.pptx

Management of lactation

1. Lactation management KHONJE V

2. PRESENTATION GOAL Students should understand the physiology of lactation and be able to support women during puerperium for successful breastfeeding practices

3. Learning outcomes Review the anatomy of the breast Discuss the physiology of lactation Explain the factors that affect milk production and supply Discuss the role of midwife in maintenance of lactation and breastfeeding

4. Introduction The production of milk starts within the first week of delivery Time may range from 72 hours to 1 week After 3 rd stage of labour the human placental lactogen is no longer available Progesterone and estrogen levels drop markedly Prolactin activity is no longer inhibited hence lactation established

5. Introduction Lactation is only sustained by continuous stimulation of the breast and withdraw of milk from the breast During lactation the pituitary gland increases in size by 50% due to proliferation of prolactin producing cells

6. Anatomy of the breast REVIEW

7. PHYSIOLOGY OF LACTATION Formation or production of breast milk During pregnancy the HPL and progesterone hormones stimulate the growth and differentiation of mammary glands preparing them for milk production Nerve impulses from suckling of the breast cause- The anterior pituitary gland to produce prolactin into maternal blood stream Prolactin causes the alveoli to secrete milk.

8. PHYSIOLOGY OF LACTATION Formation or production of breast milk ... Milk is formed as tinny fatty globules within the cytoplasm of the cells of the alveoli The fatty globules arise in the base of the cells and unite to form small droplets As new globules are produced, the droplets are pushed towards the surface of the cell and finally burst through the cell membrane into lactiferous tubules

9. PHYSIOLOGY OF LACTATION Formation or production of breast milk ... Droplets from other cells join together and the alveoli became filled with milk The milk is composed of proteins and glucose Glucose and amino acids are carried to the breast through blood The amino acids are converted to caseinogen while glucose into lactose

10. PHYSIOLOGY CT/D The flow of breast milk Milk is pushed along the lactiferous tubules towards the nipple by the milk which is continuously being produced behind it Some of the milk is stored in the lactiferous sinuses or ampullae beneath the areola until the next feed This is called FOREMILK.

11. PHYSIOLOGY CT/D The milk flows out when 1. It is drawn mechanically by infant suckling 2. When the myo -epithelial cells surrounding the alveoli and the ducts contract The above two events are known as The Neuro –hormonal Reflex or the The let –down reflex or Milk ejection reflex

12. PHYSIOLOGY CT/D The flow of breast milk As the baby suckles from the breast, the nipple is stimulated Impulses are transmitted to the pituitary gland 1. The anterior pituitary gland releases prolactin into the maternal blood stream for establishment of lactation. 2. The posterior pituitary gland releases oxytocin into maternal blood stream

13. PHYSIOLOGY CT/D The flow of breast milk Oxytocin stimulates the myo -epithelial cells of the breast to contract forcing milk towards the nipple or to spout The nipple becomes erect The let down reflex causes the Hind milk to be pushed toward the nipple causing milk to drip The baby’s suckling removes the foremilk which is stored in the lactiferous sinuses or the ampullae

14. PHYSIOLOGY CT/D The flow of breast milk The let down reflex is therefore important as it makes available milk stored in the ducts and tubules where it is formed If the reflex is inhibited , the baby will only access the foremilk The let down reflex may occur as a result of- Baby suckling from the breast

15. PHYSIOLOGY CT/D The flow of breast milk Hearing the baby cry Thinking of feeding the baby Feeling hot Inhibition of the letdown reflex occurs directly by sympathetic nervous system inhibition or indirectly by vasoconstriction of the mammary blood vessels

16. MILK WITHDRAW FROM THE BREAST The whole nipple and primary areola should be drawn into the baby’s mouth The baby closes the jaws onto the areola tissue situated over the lactiferous sinuses This allows milk into the baby's mouth and swallowed A vacuum is created in the baby’s mouth causing more milk to flow from lactiferous ducts to the sinuses As the breast is emptied more milk is produced and more flow towards the nipple

17. COMPOSITION OF BREASTMILK Colostrum is the a clear yellowish alkaline fluid. Available in the breasts from 16 th week of pregnancy It is high in proteins, low in carbohydrates and fat FUNCTIONS Clears the lumen of ducts by removing desquamated epithelial cells thereby preventing obstruction of ducts and infection of breasts Provides adequate kilojoules in the first few days of life The high protein content satisfies the baby’s hunger Contains high level of antibodies (IgA) , IgG , IgM which are essential for baby’s immunity Provides a laxative action facilitating passing of sticky meconeum

18. COMPOSITION OF BREASTMILK Proteins- very high in colostrum 8.5 % versus 1.5 % in actual milk Fats 2.5% in colostrum and 3.5% in the milk CHO- 3.2 % Vs 7% Water 85.6% vs 87.8% Mineral salts Leucocytes Electrolytes Fat soluble vitamins

19. Factors affecting content and supply of milk Composition of milk is dependent upon metabolism of the alveolar cells- converting amino acids and glucose into caseinogen and lactose respectively Nutrition status of the mother- malnourished mothers have a considerable reduction in milk production and reduced milk protein and kilojoule content

20. Factors affecting content and supply of milk Adequate maternal fluid intake- up to 2 litres of fluid per day is necessary for good milk production Adequate sleep and rest- prolactin build up or production is greater during sleep- lack of sleep, tiredness, and anxiety affect production of milk Regular emptying of the breast either by suckling or expression of the milk

21. Factors affecting content and supply of milk The mothers emotional state Proper positioning and attachment of the baby to the breast

22. Importance of breastfeeding/ milk Promotion of bonding Adequate supply of nutrients Source of immunity for the newborn Promotes uterine involution Contraception

23. ROLE OF MIDWIFE Education on physiology of lactation Psychological assessment and counselling Nutrition counselling Promotion of fluid intake Positioning and attachment Promotion of rest and sleep Teaching on infection prevention practices Assessing breastfeeding problems ADD MORE

24. THE END