00:00
APGO educational topic number 14
00:02
lactation welcome to the aapko promotion
00:05
of breastfeeding celebration hi i’m
00:07
Lecce lactation your MC for this evening
00:09
breast milk is the preferred source of
00:11
nutrition for infants and babies the
00:14
World Health Organization UNICEF the
00:16
American College of Obstetricians and
00:18
Gynaecologists and the American Academy
00:19
of Pediatrics all recommend exclusive
00:22
breastfeeding for at least six months
00:23
come join us for this exciting
00:25
celebration of breastfeeding the
00:27
objectives of this video are to list the
00:29
normal physiologic and anatomic changes
00:31
of the breast during pregnancy and
00:32
postpartum recognize and know how to
00:34
treat common postpartum abnormalities of
00:36
the breast list the benefits of
00:38
breastfeeding describe the resources and
00:41
approaches to determining medication
00:42
safety and breastfeeding and lastly
00:44
describe common challenges in the
00:46
initiation and maintenance of
00:47
breastfeeding let’s start this
00:49
discussion with some sombering
00:51
statistics according to the Centers for
00:53
Disease Control approximately 79 percent
00:56
of new moms initiate breastfeeding as
00:57
six months this number has gone down to
01:00
49 percent and at one-year only 27
01:02
percent are continuing to breastfeed for
01:04
black women at 6 months only 17 percent
01:07
are breastfeeding and at 1 year 6% are
01:09
continuing to breastfeed for Hispanic
01:12
women the rates are 35 percent
01:13
breastfeeding at 6 months and 18 percent
01:15
breastfeeding at 1 year throughout this
01:18
video it is important to consider why so
01:20
many women in the United States choose
01:21
not to breastfeed and how we can improve
01:23
these numbers let’s start with a review
01:25
of breast anatomy here is a non pregnant
01:27
breast with the areola each breast
01:32
contains 12 to 20 lobules
01:35
which are also called mammary glands
01:38
which have grape like clusters of cells
01:41
called alveoli the lobules are connected
01:44
to the areola by like 2 phorus ducts
01:49
myoepithelial cells lie in the lobules
01:53
and the alveoli these are the
01:55
myoepithelial cells during pregnancy the
01:59
areola darkens this enables the baby to
02:01
be able to see a better and breast
02:03
tissue is stimulated by estrogen and
02:05
progesterone estrogen is primarily
02:07
responsible for growth of the lobules so
02:10
they get bigger
02:12
while progesterone
02:14
stimulates alveolar hypertrophy so here
02:17
we have more alveoli breast size
02:20
increases in size by 25 to 50 percent
02:22
during pregnancy due to this growth as
02:25
well as to increase blood flow and
02:27
increased adipose tissue after delivery
02:29
estrogen and progesterone levels fall
02:31
and prolactin oxytocin levels are high
02:34
prolactin leads to milk production and
02:36
oxytocin stimulates the myoepithelial
02:38
cells to squeeze the milk out of the
02:41
ducts
02:43
breast milk is ideal nutrition for
02:45
babies it is easy to digest and is
02:47
perfectly formulated for most healthy
02:49
babies there are also important
02:51
immunological Offit’s of breast milk
02:53
babies who drink breast milk have
02:54
decreased incidence of otitis
02:56
respiratory infections diarrhea
02:58
illnesses allergic and atopic diseases
03:00
there are maternal benefits as well
03:03
breastfeeding may enhance post pregnancy
03:05
weight loss there are also long-term
03:07
decreased risks of both breast and
03:09
ovarian cancer for women who breastfeed
03:10
while breastfeeding is natural it can be
03:13
very challenging for many women reasons
03:15
for early termination within the first
03:16
months of breastfeeding include sore
03:18
nipples concerns of inadequate milk
03:20
supply and concerns that their infant
03:23
had difficulty with breastfeeding
03:24
remember that breast milk does not come
03:27
in until 48 to 72 hours after the
03:29
delivery colostrum is full of
03:31
lymphocytes and IgA IgG and IgM it is
03:35
very important that the woman have the
03:36
infant latch every two to three hours in
03:38
order to stimulate milk production milk
03:41
production runs on the supply and demand
03:43
rule the more the breasts are stimulated
03:45
the more milk will be produced many
03:47
women are often concerned that they are
03:49
not making enough colostrum or milk for
03:51
their infants a general rule is that for
03:53
the first few weeks of life a baby
03:54
should feed 8 to 12 times per day yes
03:57
that works out to every 2 to 3 hours by
03:59
day 5 of life a baby should make 6 to 8
04:02
wet diapers per day and 3 to 5 stools
04:04
per day if a baby is not reaching these
04:06
goals it could be due to inadequate milk
04:08
supply or pour milk extraction it is
04:11
important to recognize triage and treat
04:13
the common postpartum abnormalities of
04:15
breastfeeding let’s introduce our
04:17
patient testimonials this is Sally
04:19
engorgement she is a 27 year old
04:21
gravity’ one paraone who gave birth four
04:23
days ago and has been breastfeeding her
04:25
new baby every two to three hours my
04:27
breasts are swollen very soul and I have
04:30
a temp of 100.0 breast engorgement can
04:33
be very uncomfortable and Sally should
04:34
be encouraged to continue breastfeeding
04:36
and to use over-the-counter and algae
04:38
Zia for the pain our next patient is
04:40
Molly mastitis she’s a 30 year old
04:42
grabbed a tube para 2 and has developed
04:43
very high fevers up to 103 degrees
04:46
myalgias and left breast pain the baby
04:49
won’t latch well on the left nipple and
04:51
now there is a red spot and it is very
04:53
painful let’s discuss what happens when
04:56
there is mastitis when there is an
04:58
impediment to forward flow of breast
05:00
milk it backs up into the breast tissue
05:02
and this becomes an itis for infection
05:08
the impediment is often a Galactus seal
05:11
or plug duct when a patient has erythema
05:14
and fevers than she has the diagnosis of
05:16
mastitis and needs antibiotics the
05:18
first-line treatment is dicloxacillin
05:19
which will cover the most common
05:21
organism of staph aureus it is also
05:23
essential to emphasize the importance of
05:26
encouraging forward flow with aggressive
05:31
feeding and/or pumping on the affected
05:33
breast our next patient is yolanda yeast
05:37
she’s a 35 year old gravity’ 3 para 2
05:39
has been exclusively breastfeeding since
05:41
delivery and had no problems until a
05:42
couple of days ago my nipple is very
05:45
itchy and red and now my baby has white
05:48
spots in its mouth
05:49
Yolanda yeast and her baby now both have
05:51
Candida infections or thrush and should
05:53
both be treated with antifungal
05:55
medications our last patient is don’t to
05:58
give formula a gravity’ to para one at
06:00
38 weeks in clinic for a prenatal
06:02
appointment she fed her first child
06:04
formula my mother-in-law told me to use
06:06
formula until my milk came in no
06:10
mother-in-law no many women and make
06:12
this mistake of not realizing the
06:13
importance of the colostrum and the
06:15
importance of frequent feedings in order
06:17
to stimulate breast milk production note
06:19
that if a baby’s pediatrician recommends
06:21
supplementation then this recommendation
06:23
needs to be followed but there are ways
06:24
to do this that will not create nipple
06:26
confusion for the baby
06:27
are there any contraindications to
06:29
breastfeeding there are very few there
06:31
are infectious contraindications in
06:34
developed countries women with HIV or an
06:37
active hepatitis B or a TB infection
06:38
should not breastfeed in
06:40
developing countries the same
06:42
recommendation holds true if safe
06:44
alternatives to breast milk are
06:45
available it is important to note that
06:47
in developing countries breastfeeding
06:49
may be better even in the presence of
06:51
infectious diseases because it outweighs
06:53
the risks of contaminated water supply
06:55
and diseases a second infectious
06:58
breastfeeding contraindication is an
07:00
active herpetic breast lesion and lastly
07:03
galactosemia infants born with this rare
07:05
metabolic disorder should not be
07:07
breastfed screening for galactosemia is
07:09
performed at the time of the newborn
07:10
screen what about medications most
07:13
therapeutic drugs are considered safe
07:15
for breastfeeding the National
07:17
Institutes of Health has developed a
07:18
website and app called lactMed that
07:20
provides information about individual
07:22
medication safety during breastfeeding
07:24
this concludes the app co promotion of
07:26
breastfeeding celebration we have
07:28
reviewed the normal physiologic and
07:29
anatomic changes of the breast during
07:31
pregnancy and the postpartum how to
07:33
recognize and treat common postpartum
07:34
abnormalities the benefits of
07:36
breastfeeding the resources and approach
07:38
to determining medication safety and
07:40
common challenges in initiation and
07:41
maintenance of breastfeeding