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1.7 Conditions related to lactation outcomes

Key Points - Case Study A

Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.

Would you discuss breastfeeding at this visit?

Topic 1.1: Discussing breastfeeding
It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.

What information would you give?

Topic 1.2: What information to give
When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.

Why do breastfeeding alternatives have different effects?

Topic 1.3: Effects of Breastfeeding alternatives
These effects are due in part to the presence in breast milk of substances and systems that act against infections and inflammation.

What are mothers' common and valid concerns about breastfeeding?

Topic 1.4: Common breastfeeding concerns
Exploring her concerns and providing information and reassurance is useful in allaying anxiety and prepares the parents for their changing role.

Would you examine her breasts at this visit?

Topic 1.5: Breast examination
Examine Joanne's breasts now and again in the third trimester. Examining a mother's breasts and nipples early in pregnancy emphasises the importance of breastfeeding, provides reassurance for most women that they are 'normal', allows the identification of any variations that may cause problems.

What are the contraindications to breastfeeding?

Topic 1.6: Contraindications to breastfeeding
There are very few conditions when women should be discouraged from breastfeeding, including active tuberculosis, HIV, human T-cell leukaemia virus Type 1, brucellosis, some medications, illicit drug use and classic galactosaemia and some inborn errors of metabolism in the infant.

What conditions may be related to poorer lactation outcomes?

Topic 1.7: Conditions related to lactation outcomes
Common problems are previous lactation failure, hormonal problems and obesity.

What conditions may be related to poorer lactation outcomes?

Previous lactation failure
Only a small proportion of women are physically unable to breastfeed. However, many more initiate breastfeeding but wean before they originally intended due to unexpected and insurmountable problems. There is no reason to suspect similar difficulties occurring in a subsequent lactation unless there are fundamental anatomical or hormonal problems. Identifying the reasons for a previous early weaning enables strategies be instituted to prevent or overcome the problems.
Hormonal problems
An interplay of hormones is necessary to prepare the breasts for lactation and to initiate and maintain lactation after the infant is born. Women with hormonal conditions such as hypothyroidism, diabetes and endocrine disorders that lead to difficulty conceiving may experience difficulty initiating lactation.
Obesity
Women who are obese or overweight are less likely to be breastfeeding at any time postpartum than their normal weight counterparts1.

Case Study Activity

Think about what your response would be to the scenario presented, write it into the exercise, then submit it and read the suggestions given.

Notes

  1. # Oddy WH et al. (2006) The association of maternal overweight and obesity with breastfeeding duration