{"id":121,"date":"2020-08-12T20:23:22","date_gmt":"2020-08-12T20:23:22","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=121"},"modified":"2023-09-30T11:12:41","modified_gmt":"2023-09-30T11:12:41","slug":"14-lactation","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/14-lactation\/","title":{"rendered":"14. Lactation"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/H-7qG4SKQhI\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:56<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc15975bc4021648518' value='69e9dc15975bc4021648518'><input type='hidden' id='bg-show-more-text-69e9dc15975bc4021648518' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc15975bc4021648518' value='Hide Transcript'><button id='bg-showmore-action-69e9dc15975bc4021648518' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc15975bc4021648518' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 14<br \/>\n00:02<br \/>\nlactation welcome to the aapko promotion<br \/>\n00:05<br \/>\nof breastfeeding celebration hi i&#8217;m<br \/>\n00:07<br \/>\nLecce lactation your MC for this evening<br \/>\n00:09<br \/>\nbreast milk is the preferred source of<br \/>\n00:11<br \/>\nnutrition for infants and babies the<br \/>\n00:14<br \/>\nWorld Health Organization UNICEF the<br \/>\n00:16<br \/>\nAmerican College of Obstetricians and<br \/>\n00:18<br \/>\nGynaecologists and the American Academy<br \/>\n00:19<br \/>\nof Pediatrics all recommend exclusive<br \/>\n00:22<br \/>\nbreastfeeding for at least six months<br \/>\n00:23<br \/>\ncome join us for this exciting<br \/>\n00:25<br \/>\ncelebration of breastfeeding the<br \/>\n00:27<br \/>\nobjectives of this video are to list the<br \/>\n00:29<br \/>\nnormal physiologic and anatomic changes<br \/>\n00:31<br \/>\nof the breast during pregnancy and<br \/>\n00:32<br \/>\npostpartum recognize and know how to<br \/>\n00:34<br \/>\ntreat common postpartum abnormalities of<br \/>\n00:36<br \/>\nthe breast list the benefits of<br \/>\n00:38<br \/>\nbreastfeeding describe the resources and<br \/>\n00:41<br \/>\napproaches to determining medication<br \/>\n00:42<br \/>\nsafety and breastfeeding and lastly<br \/>\n00:44<br \/>\ndescribe common challenges in the<br \/>\n00:46<br \/>\ninitiation and maintenance of<br \/>\n00:47<br \/>\nbreastfeeding let&#8217;s start this<br \/>\n00:49<br \/>\ndiscussion with some sombering<br \/>\n00:51<br \/>\nstatistics according to the Centers for<br \/>\n00:53<br \/>\nDisease Control approximately 79 percent<br \/>\n00:56<br \/>\nof new moms initiate breastfeeding as<br \/>\n00:57<br \/>\nsix months this number has gone down to<br \/>\n01:00<br \/>\n49 percent and at one-year only 27<br \/>\n01:02<br \/>\npercent are continuing to breastfeed for<br \/>\n01:04<br \/>\nblack women at 6 months only 17 percent<br \/>\n01:07<br \/>\nare breastfeeding and at 1 year 6% are<br \/>\n01:09<br \/>\ncontinuing to breastfeed for Hispanic<br \/>\n01:12<br \/>\nwomen the rates are 35 percent<br \/>\n01:13<br \/>\nbreastfeeding at 6 months and 18 percent<br \/>\n01:15<br \/>\nbreastfeeding at 1 year throughout this<br \/>\n01:18<br \/>\nvideo it is important to consider why so<br \/>\n01:20<br \/>\nmany women in the United States choose<br \/>\n01:21<br \/>\nnot to breastfeed and how we can improve<br \/>\n01:23<br \/>\nthese numbers let&#8217;s start with a review<br \/>\n01:25<br \/>\nof breast anatomy here is a non pregnant<br \/>\n01:27<br \/>\nbreast with the areola each breast<br \/>\n01:32<br \/>\ncontains 12 to 20 lobules<br \/>\n01:35<br \/>\nwhich are also called mammary glands<br \/>\n01:38<br \/>\nwhich have grape like clusters of cells<br \/>\n01:41<br \/>\ncalled alveoli the lobules are connected<br \/>\n01:44<br \/>\nto the areola by like 2 phorus ducts<br \/>\n01:49<br \/>\nmyoepithelial cells lie in the lobules<br \/>\n01:53<br \/>\nand the alveoli these are the<br \/>\n01:55<br \/>\nmyoepithelial cells during pregnancy the<br \/>\n01:59<br \/>\nareola darkens this enables the baby to<br \/>\n02:01<br \/>\nbe able to see a better and breast<br \/>\n02:03<br \/>\ntissue is stimulated by estrogen and<br \/>\n02:05<br \/>\nprogesterone estrogen is primarily<br \/>\n02:07<br \/>\nresponsible for growth of the lobules so<br \/>\n02:10<br \/>\nthey get bigger<br \/>\n02:12<br \/>\nwhile progesterone<br \/>\n02:14<br \/>\nstimulates alveolar hypertrophy so here<br \/>\n02:17<br \/>\nwe have more alveoli breast size<br \/>\n02:20<br \/>\nincreases in size by 25 to 50 percent<br \/>\n02:22<br \/>\nduring pregnancy due to this growth as<br \/>\n02:25<br \/>\nwell as to increase blood flow and<br \/>\n02:27<br \/>\nincreased adipose tissue after delivery<br \/>\n02:29<br \/>\nestrogen and progesterone levels fall<br \/>\n02:31<br \/>\nand prolactin oxytocin levels are high<br \/>\n02:34<br \/>\nprolactin leads to milk production and<br \/>\n02:36<br \/>\noxytocin stimulates the myoepithelial<br \/>\n02:38<br \/>\ncells to squeeze the milk out of the<br \/>\n02:41<br \/>\nducts<br \/>\n02:43<br \/>\nbreast milk is ideal nutrition for<br \/>\n02:45<br \/>\nbabies it is easy to digest and is<br \/>\n02:47<br \/>\nperfectly formulated for most healthy<br \/>\n02:49<br \/>\nbabies there are also important<br \/>\n02:51<br \/>\nimmunological Offit&#8217;s of breast milk<br \/>\n02:53<br \/>\nbabies who drink breast milk have<br \/>\n02:54<br \/>\ndecreased incidence of otitis<br \/>\n02:56<br \/>\nrespiratory infections diarrhea<br \/>\n02:58<br \/>\nillnesses allergic and atopic diseases<br \/>\n03:00<br \/>\nthere are maternal benefits as well<br \/>\n03:03<br \/>\nbreastfeeding may enhance post pregnancy<br \/>\n03:05<br \/>\nweight loss there are also long-term<br \/>\n03:07<br \/>\ndecreased risks of both breast and<br \/>\n03:09<br \/>\novarian cancer for women who breastfeed<br \/>\n03:10<br \/>\nwhile breastfeeding is natural it can be<br \/>\n03:13<br \/>\nvery challenging for many women reasons<br \/>\n03:15<br \/>\nfor early termination within the first<br \/>\n03:16<br \/>\nmonths of breastfeeding include sore<br \/>\n03:18<br \/>\nnipples concerns of inadequate milk<br \/>\n03:20<br \/>\nsupply and concerns that their infant<br \/>\n03:23<br \/>\nhad difficulty with breastfeeding<br \/>\n03:24<br \/>\nremember that breast milk does not come<br \/>\n03:27<br \/>\nin until 48 to 72 hours after the<br \/>\n03:29<br \/>\ndelivery colostrum is full of<br \/>\n03:31<br \/>\nlymphocytes and IgA IgG and IgM it is<br \/>\n03:35<br \/>\nvery important that the woman have the<br \/>\n03:36<br \/>\ninfant latch every two to three hours in<br \/>\n03:38<br \/>\norder to stimulate milk production milk<br \/>\n03:41<br \/>\nproduction runs on the supply and demand<br \/>\n03:43<br \/>\nrule the more the breasts are stimulated<br \/>\n03:45<br \/>\nthe more milk will be produced many<br \/>\n03:47<br \/>\nwomen are often concerned that they are<br \/>\n03:49<br \/>\nnot making enough colostrum or milk for<br \/>\n03:51<br \/>\ntheir infants a general rule is that for<br \/>\n03:53<br \/>\nthe first few weeks of life a baby<br \/>\n03:54<br \/>\nshould feed 8 to 12 times per day yes<br \/>\n03:57<br \/>\nthat works out to every 2 to 3 hours by<br \/>\n03:59<br \/>\nday 5 of life a baby should make 6 to 8<br \/>\n04:02<br \/>\nwet diapers per day and 3 to 5 stools<br \/>\n04:04<br \/>\nper day if a baby is not reaching these<br \/>\n04:06<br \/>\ngoals it could be due to inadequate milk<br \/>\n04:08<br \/>\nsupply or pour milk extraction it is<br \/>\n04:11<br \/>\nimportant to recognize triage and treat<br \/>\n04:13<br \/>\nthe common postpartum abnormalities of<br \/>\n04:15<br \/>\nbreastfeeding let&#8217;s introduce our<br \/>\n04:17<br \/>\npatient testimonials this is Sally<br \/>\n04:19<br \/>\nengorgement she is a 27 year old<br \/>\n04:21<br \/>\ngravity&#8217; one paraone who gave birth four<br \/>\n04:23<br \/>\ndays ago and has been breastfeeding her<br \/>\n04:25<br \/>\nnew baby every two to three hours my<br \/>\n04:27<br \/>\nbreasts are swollen very soul and I have<br \/>\n04:30<br \/>\na temp of 100.0 breast engorgement can<br \/>\n04:33<br \/>\nbe very uncomfortable and Sally should<br \/>\n04:34<br \/>\nbe encouraged to continue breastfeeding<br \/>\n04:36<br \/>\nand to use over-the-counter and algae<br \/>\n04:38<br \/>\nZia for the pain our next patient is<br \/>\n04:40<br \/>\nMolly mastitis she&#8217;s a 30 year old<br \/>\n04:42<br \/>\ngrabbed a tube para 2 and has developed<br \/>\n04:43<br \/>\nvery high fevers up to 103 degrees<br \/>\n04:46<br \/>\nmyalgias and left breast pain the baby<br \/>\n04:49<br \/>\nwon&#8217;t latch well on the left nipple and<br \/>\n04:51<br \/>\nnow there is a red spot and it is very<br \/>\n04:53<br \/>\npainful let&#8217;s discuss what happens when<br \/>\n04:56<br \/>\nthere is mastitis when there is an<br \/>\n04:58<br \/>\nimpediment to forward flow of breast<br \/>\n05:00<br \/>\nmilk it backs up into the breast tissue<br \/>\n05:02<br \/>\nand this becomes an itis for infection<br \/>\n05:08<br \/>\nthe impediment is often a Galactus seal<br \/>\n05:11<br \/>\nor plug duct when a patient has erythema<br \/>\n05:14<br \/>\nand fevers than she has the diagnosis of<br \/>\n05:16<br \/>\nmastitis and needs antibiotics the<br \/>\n05:18<br \/>\nfirst-line treatment is dicloxacillin<br \/>\n05:19<br \/>\nwhich will cover the most common<br \/>\n05:21<br \/>\norganism of staph aureus it is also<br \/>\n05:23<br \/>\nessential to emphasize the importance of<br \/>\n05:26<br \/>\nencouraging forward flow with aggressive<br \/>\n05:31<br \/>\nfeeding and\/or pumping on the affected<br \/>\n05:33<br \/>\nbreast our next patient is yolanda yeast<br \/>\n05:37<br \/>\nshe&#8217;s a 35 year old gravity&#8217; 3 para 2<br \/>\n05:39<br \/>\nhas been exclusively breastfeeding since<br \/>\n05:41<br \/>\ndelivery and had no problems until a<br \/>\n05:42<br \/>\ncouple of days ago my nipple is very<br \/>\n05:45<br \/>\nitchy and red and now my baby has white<br \/>\n05:48<br \/>\nspots in its mouth<br \/>\n05:49<br \/>\nYolanda yeast and her baby now both have<br \/>\n05:51<br \/>\nCandida infections or thrush and should<br \/>\n05:53<br \/>\nboth be treated with antifungal<br \/>\n05:55<br \/>\nmedications our last patient is don&#8217;t to<br \/>\n05:58<br \/>\ngive formula a gravity&#8217; to para one at<br \/>\n06:00<br \/>\n38 weeks in clinic for a prenatal<br \/>\n06:02<br \/>\nappointment she fed her first child<br \/>\n06:04<br \/>\nformula my mother-in-law told me to use<br \/>\n06:06<br \/>\nformula until my milk came in no<br \/>\n06:10<br \/>\nmother-in-law no many women and make<br \/>\n06:12<br \/>\nthis mistake of not realizing the<br \/>\n06:13<br \/>\nimportance of the colostrum and the<br \/>\n06:15<br \/>\nimportance of frequent feedings in order<br \/>\n06:17<br \/>\nto stimulate breast milk production note<br \/>\n06:19<br \/>\nthat if a baby&#8217;s pediatrician recommends<br \/>\n06:21<br \/>\nsupplementation then this recommendation<br \/>\n06:23<br \/>\nneeds to be followed but there are ways<br \/>\n06:24<br \/>\nto do this that will not create nipple<br \/>\n06:26<br \/>\nconfusion for the baby<br \/>\n06:27<br \/>\nare there any contraindications to<br \/>\n06:29<br \/>\nbreastfeeding there are very few there<br \/>\n06:31<br \/>\nare infectious contraindications in<br \/>\n06:34<br \/>\ndeveloped countries women with HIV or an<br \/>\n06:37<br \/>\nactive hepatitis B or a TB infection<br \/>\n06:38<br \/>\nshould not breastfeed in<br \/>\n06:40<br \/>\ndeveloping countries the same<br \/>\n06:42<br \/>\nrecommendation holds true if safe<br \/>\n06:44<br \/>\nalternatives to breast milk are<br \/>\n06:45<br \/>\navailable it is important to note that<br \/>\n06:47<br \/>\nin developing countries breastfeeding<br \/>\n06:49<br \/>\nmay be better even in the presence of<br \/>\n06:51<br \/>\ninfectious diseases because it outweighs<br \/>\n06:53<br \/>\nthe risks of contaminated water supply<br \/>\n06:55<br \/>\nand diseases a second infectious<br \/>\n06:58<br \/>\nbreastfeeding contraindication is an<br \/>\n07:00<br \/>\nactive herpetic breast lesion and lastly<br \/>\n07:03<br \/>\ngalactosemia infants born with this rare<br \/>\n07:05<br \/>\nmetabolic disorder should not be<br \/>\n07:07<br \/>\nbreastfed screening for galactosemia is<br \/>\n07:09<br \/>\nperformed at the time of the newborn<br \/>\n07:10<br \/>\nscreen what about medications most<br \/>\n07:13<br \/>\ntherapeutic drugs are considered safe<br \/>\n07:15<br \/>\nfor breastfeeding the National<br \/>\n07:17<br \/>\nInstitutes of Health has developed a<br \/>\n07:18<br \/>\nwebsite and app called lactMed that<br \/>\n07:20<br \/>\nprovides information about individual<br \/>\n07:22<br \/>\nmedication safety during breastfeeding<br \/>\n07:24<br \/>\nthis concludes the app co promotion of<br \/>\n07:26<br \/>\nbreastfeeding celebration we have<br \/>\n07:28<br \/>\nreviewed the normal physiologic and<br \/>\n07:29<br \/>\nanatomic changes of the breast during<br \/>\n07:31<br \/>\npregnancy and the postpartum how to<br \/>\n07:33<br \/>\nrecognize and treat common postpartum<br \/>\n07:34<br \/>\nabnormalities the benefits of<br \/>\n07:36<br \/>\nbreastfeeding the resources and approach<br \/>\n07:38<br \/>\nto determining medication safety and<br \/>\n07:40<br \/>\ncommon challenges in initiation and<br \/>\n07:41<br \/>\nmaintenance of breastfeeding<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:56<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":14,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-121","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/121","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=121"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/121\/revisions"}],"predecessor-version":[{"id":1315,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/121\/revisions\/1315"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=121"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}