Course contents

Introduction

  1. 1 Introduction

Case Study A (Joanne)

  1. 1 Case Study A (Joanne)

Discussing breastfeeding

  1. 1 Discussing breastfeeding

What information to give

  1. 1 Disadvantages of Breast Milk Substitutes

Effects of Breastfeeding alternatives

  1. 1 Effects of Breastfeeding alternatives

Common breastfeeding concerns

  1. 1
    1. 1.1
      1. 1.1.1 Encourage acquiring knowledge and support networks
        1. 1.1.1.1
      2. 1.1.2 Discuss the most appropriate outcome depending on individual circumstances
        1. 1.1.2.1
      3. 1.1.3 Encourage both parents to develop their own unique roles
        1. 1.1.3.1
      4. 1.1.4 Support breastfeeding with confidence, anywhere the mother and baby may be
        1. 1.1.4.1
      5. 1.1.5 Assist women to quit smoking and limit alcohol intake while breastfeeding, but it's better to be breastfed than formula fed even if the mother smokes.
        1. 1.1.5.1
      6. 1.1.6 Discuss healthy eating for maternal well-being
        1. 1.1.6.1

Breast examination

  1. 1
  2. 2 What anatomical variations would give rise to concerns?

Contraindications to breastfeeding

  1. 1
    1. 1.1 Active tuberculosis
      1. 1.1.1
    2. 1.2 HIV
      1. 1.2.1
    3. 1.3 Human T-cell Leukaemia Virus Type 1
      1. 1.3.1
    4. 1.4 Brucellosis
      1. 1.4.1
    5. 1.5 Medications
      1. 1.5.1
    6. 1.6 Illicit drug use
      1. 1.6.1
    7. 1.7 Classic galactosaemia and some inborn errors of metabolism in the infant
      1. 1.7.1
  2. 2 Conditions that are NOT a contraindication to breastfeeding.
    1. 2.1 Hepatitis B
      1. 2.1.1
    2. 2.2 Hepatitis C
      1. 2.2.1
    3. 2.3 Pregnancy
      1. 2.3.1

Conditions related to lactation outcomes

  1. 1 Conditions related to lactation outcomes

Medications

  1. 1 Medications

Case Study B (Joanne)

  1. 1 Case Study B (Joanne)

Preparation Before Birth

  1. 1 Preparation Before Birth

Birthing Factors that Affect Breastfeeding

  1. 1 Labour Analgesia
  2. 2 Near-term Birth

Management After Birth

  1. 1 Step 4 - Place Rosie in skin-to-skin contact
  2. 2 Step 5 - Show Joanne how to breastfeed and how to maintain lactation even if she should be separated from Rosie
  3. 3 Step 6 - Give Rosie no food or drink other than breastmilk, unless medically indicated
  4. 4 Step 7 - Practice rooming-in, allow Joanne and Rosie to remain together 24 hours a day
  5. 5 Step 8 - Encourage breastfeeding on demand
  6. 6 Step 9 - Give Rosie no artificial teats or dummies

Poor Attachment

  1. 1 Poor Attachment

Hypoglycaemia

  1. 1 Which infants are at risk and should be monitored?
  2. 2 About Hypoglycaemia
    1. 2.1 Treatment

Relationship between Jaundice and Breastfeeding

  1. 1 Would there be any concern about Rosie developing jaundice at this time?

Case Study C (Joanne)

  1. 1 Case Study C (Joanne)

Early problems

  1. 1 Early problems

Risk of SIDS

  1. 1 Risk of SIDS

Contraception

  1. 1 Contraception

Milk composition

  1. 1 Breastmilk Composition
    1. 1.1 Carbohydrates
      1. 1.1.1
    2. 1.2 Protein and non-protein nitrogen
      1. 1.2.1
    3. 1.3 Fat
      1. 1.3.1
    4. 1.4 Vitamins
      1. 1.4.1
    5. 1.5 Minerals
      1. 1.5.1
    6. 1.6 Changes in milk composition
      1. 1.6.1
    7. 1.7 Milk yield
      1. 1.7.1

Slowing of growth

  1. 1 Slowing of growth

Introducing solids

  1. 1 Introducing solids

Weaning

  1. 1 Weaning

Case Study D (Sally)

  1. 1 Case Study D (Sally)

Initial assessment

  1. 1
    1. 1.1 Questions related to adequacy of breast milk intake in the infant
      1. 1.1.1
    2. 1.2 Questions about breast or nipple problems and maternal confidence
      1. 1.2.1
    3. 1.3 Infant examination
      1. 1.3.1

Milk production

  1. 1 What initiates and controls milk production?
  2. 2 Risk factors for a delay in Lactogenesis II

Causes of inadequate infant growth

  1. 1
    1. 1.1 Reduced milk intake due to feeding patterns or routines
      1. 1.1.1
    2. 1.2 Low milk supply
      1. 1.2.1
    3. 1.3 Difficulty transferring milk
      1. 1.3.1
    4. 1.4 Increased energy expenditure
      1. 1.4.1

Increasing milk supply

  1. 1 Increase breast drainage
  2. 2 Food and rest
  3. 3 Galactagogues
  4. 4 Supplementation

Case Study E (Anna)

  1. 1 Case Study E (Anna)

Sore nipples

  1. 1 What is good attachment?
  2. 2 What to look for when assessing positioning and attachment

Factors causing nipple damage

  1. 1 Engorgement
  2. 2 Anatomical variations of mother
  3. 3 Anatomical variations of the infant
  4. 4 Neurological issues with the infant
  5. 5 Inappropriate use of lactation aids
  6. 6 High intra-oral pressure

General treatment for sore nipples

  1. 1 Assess positioning and attachment
  2. 2 Advice about breastfeeds
  3. 3 Advice about nipple treatment
  4. 4 Lactation aids
  5. 5 Rest nipples

Further causes of nipple pain

  1. 1 Infection
  2. 2 Vasospasm
  3. 3 Other dermatological conditions

Mastitis – diagnosis

  1. 1 What may predispose Anna to developing mastitis?

Mastitis – treatment and complications

  1. 1 Effective milk removal/breast drainage
    1. 1.1
      1. 1.1.1 Analgesia
        1. 1.1.1.1
      2. 1.1.2 Antibiotics
        1. 1.1.2.1
      3. 1.1.3 Supportive measures
        1. 1.1.3.1
      4. 1.1.4 The infant
        1. 1.1.4.1
  2. 2 What complications may arise from mastitis?
    1. 2.1
      1. 2.1.1 Recurrent mastitis
        1. 2.1.1.1
      2. 2.1.2 Candida infection
        1. 2.1.2.1
  3. 3 Occasionally, a woman with mastitis develops a breast abscess. What would predispose Anna to a breast abscess?
  4. 4 What symptoms or signs would make you suspect a breast abscess?
  5. 5 How would you investigate a suspected breast abscess, and what would be the most appropriate treatment?
    1. 5.1
      1. 5.1.1 Ultrasound
        1. 5.1.1.1
      2. 5.1.2 Abscess drainage
        1. 5.1.2.1
      3. 5.1.3 Antibiotics
        1. 5.1.3.1
      4. 5.1.4 Breast emptying
        1. 5.1.4.1

In conclusion

  1. 1 In conclusion