Breastfeeding: A MDT Approach

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Baby suckling (and or crying) sends a

Describe how the suckling of an infant
stimulates breastmilk production.
stimulus via ascending messages to hy-
pothalamus.
The hypothalamus stimulates the poste-
rior pituitary to produce oxytocin which
stimulates the myoepithelial cells of the
breast to contract and eject milk.
The hypothalamus also stimulates the
anterior pituitary via inhibition of inhibito-
ry pathway of the lactotrophs to produce
prolactin which stimulates milk secretion.
Suckling drains mammary glands via lac-
tiferous ducts.
Suckling stimulates the production of
milk for the next feed.

The WHO recommends breastmilk as

the exclusive diet of a baby up to what 6 months
age?
Breastmilk is said to have an 88% re-
duction of mortality from infection world- Breastmilk is also said to reduce inci-
wide (including chest, ear, urinary and dences of childhood eczema, diabetes,
gastrointestinal). What is it also said to obesity, SIDS and constipation.
reduce?
Breastfeeding is seen to be key in what
Bonding and temperature regulation.
two major areas of child development?
> reduced risk of breast cancer
> reduced risk of ovarian cancer
> positive impact on mental health IF
PERSONAL GOALS ARE MET (reduces
anxiety and depression)
> Helps bonding due to oxytocin release
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> theoretically 'convenient' as no need
for bottles, sterilisation or temperature
checking
What are some benefits of breastfeeding > is free (doesn't cost money)
for mothers? > nappies tend to be less 'smelly'
> reduced risk of CVD in mother due to
mobilisation of fat stores and lipids fol-
lowing pregnancy and birth
> environmentally friendly
What are some wider benefits for
> reduces mother's CVD risk which is
breast-feeding?
beneficial for global healthcare goals
•Socioeconomic status and deprivation
(need to go back to work, no where to
breastfeed, not safe to breastfeed)
•Difficulty with breastfeeding and limited
or no support
•'Breast is best' campaign (alienated
UK breastfeeding rates are some of the those finding it difficult and discouraged
lowest in the world. Why is this likely to those who partially breastfed)
be? •Industry pressure (adverts, no need for
'follow-on' milk)
•Want and or need of a career
•Barriers to breastfeeding (ie. need to go
back to work, single fathers, homosexual
relationships and those who do not iden-
tify as female)
What proportion of women stop breast
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feeding before they would like to?
81% of mother's breastfeed at birth?
What proportion will be exclusively 6 weeks = 25%
breastfeeding at 6 weeks and at 6 6 months = 1%
months?
81% of mother's breastfeed at birth?
6 weeks = 55%
What proportion will be partially breast-
6 months = 35%
feeding at 6 weeks and at 6 months?

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1) Provide information about the benefits

both to the baby and the mother.
2) Explain how babies feed and what
responsive breastfeeding is
3) Explain what good attachment and
milk transfer are and look like
4) Reassure the woman about normal
breast changes, fatigue and affects of
breastfeeding on body image and iden-
tity
5) Where needed (ie. baby in NICU or
How can we best support breastfeeding
going to work) demonstrate how and ex-
for new mother's?
plain the need for expressing milk
6) Encourage partner support
7) Explain that the right to feed in any
place is dictated by the Equality Act
2010.
8) Safety netting/times to seek help
9) Ensure specific anxieties, social and
cultural barriers are addressed where
possible (ie. substance missue, domestic
abuse, under 20 years, language barrier
etc.)
Practioners should ensure they ask
mother's if they are breastfeeding and if
so should prescribe safe medicines and
What support can be given to breast-
vitamin D supplementation.
feeding mother's with regards to moth-
er's and new medications?
GPs should use pharmacists and the
UK drug in Lactation Advisory Service to
provide safe prescriptions.

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The mother should be comfortable and

any pain during latching should last a
maximum of 10 seconds.

The mother needs to support the baby's

neck and shoulders. The back should be
in a straight line regardless of the chosen
position (of which there are many).

The baby's chin should be touching the

breast with their mouth fully around the
Describe effective latching and position- areola.
ing in breastfeeding...
A good latch will be demonstrated by the
baby suckling quickly and in short bursts
followed by suckling more deeply and
slowly.

What are the two key elements of a
breastfeeding assessment?
•History
•Breastfeeding, breast and nipple pain
history
•Brief maternal and Infant history
Observed feeding
•>1 effective feed with consent within
24hrs and again within first week
•Baby's mouth, weight gain, nappies
•Mother's nipples and breasts

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The History:
•Breastfeeding, breast and nipple pain
history
•Maternal history (previous children?
breastfed before? any issues with breast-
feeding? etc.)
•Infant history (type of birth, weight, ges-
tational age etc.)

Observed feeding:
•More than one observed effective feed
with consent within 24hrs and again with-
What are you looking for when observ- in first week (normally during post-natal
ing breastfeeding with a new mother and care)
newborn? •Check baby's mouth, weight gain and
nappies
Check for signs of a well latched baby
with a good safe position, rhythmic suck-
ling, audible swallowing and signs of con-
tentment after a feed
•Check mother's nipples and breasts

What percentage of women cannot

5%
breastfeed?

•Breast pain
•Nipple pain
•Low milk supply (true or perceived (ie.
What are some common causes for why Someone told them something, the baby
a mother may stop breastfeeding? is feeding a lot etc, the baby is not attach-
ing or positioning well.)
•Oversupply of milk leading to engorge-
ment
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What is the most common cause for
stopping breastfeeding?
Why can oversupply cause issues with of engorgement, forceful let down reflex-
breastfeeding?
What is engorgement?
What are the common causes of breast that may be able to massage out)
pain in breastfeeding individuals?
What are the common causes of breast
pain in breastfeeding individuals?
Name some causes of low milk supply in
breastfeeding mother's...
•Poor attachment leading to ineffective
milk transfer
The most common reason for stopping
breastfeeding is low milk supply (true or
perceived, which results in loss of confi-
dence), followed by nipple pain.
Oversupply is typically caused by infec-
tive attachment causing excess nipple
stimulation. Oversupply may have signs
es, leakage, infant colic. Engorgement
makes breasts and nipples painful plus
fullness of breasts means babies cannot
latch easily which worsens the problem.
Very full, painful breasts. May require
hand expressing prior to feeding or ex-
pressing if latching is very difficult.
•Engorgement
•Blocked ducts and galactoceles (lumps
•Ductal infection
•Mastitis (women can become septic)
and breast abscess
•Physiological let-down may be painful
(although this is only supposed to last a
few seconds)
•Nipple damage
•Blocked duct
•Nipple infection (thrush on the nipple,
may be present in the baby's mouth)
•Vasospasm (basically Raynaud's of the
breast)
•Insufficient access to breast (ie. mixed
feeding, bottle and breast, mother in hos-
pital/baby on ITU, use of dummies)
•Ineffective infant attachment (ie. if the
baby is premature and cannot suckle)
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What steps may be used to assist
women with low milk supply?
Not everyone wants to breastfeed nor
can they. What are some alternative
methods of feeding that may be re-
quired?
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•Maternal prolactin deficiency or sup-
pression (much rarer)
Low milk supply can be assisted with
regular and well positioned feeding.
Expressing milk can also be encouraged
to stimulate milk production. This works
because there is an inhibitory mecha-
nism that reduces production when the
breast is full, by expressing this reduces
the fullness of the breast and encour-
ages production.
Milk can be delivered via bottle or via
supplementary feeding system to help
instate/reinstate breast feeding. Supple-
mentary feeding system can also be
used for chest feeding for breastfeeding
without giving birth (see image).
If all steps have been unsuccessful, may
consider use of galactagogue that re-
duces the action of dopamine eg dom-
peridone. However, this is associated
with risk and has conditions if it is to be
used off license in this way.
Bottle, tube, cup, percutaneous endo-
scopic gastrostomy feeding, parenteral
nutrition. Either with breastmilk or formu-
la.
•Equipment and sterilisation
•Formula
•How to make up feeds
 Breastfeeding: A MDT Approach
Study online at https://quizlet.com/_czp7ty
•How to give feeds
What sort support do parents who are
•'Responsive' bottle feeding
bottle feeding need?
•Suppression of lactation
This includes feeding the baby with early
signs of hunger, watching for signs of
needing a break or fullness.

This form of bottle feeding encourages

What is Responsive Bottle feeding?
skin to skin to help bonding. The baby
should be kept close with regular skin
and eye contact. Feeds should only be
given by primary caregivers (mostly par-
ents) in the early weeks to establish
bonds.

Breastfeeding babies can lie down as

they have to work to get the milk and
therefore will not choke but in bottle feed-
ing the milk flows for them so they need
Breastfeeding babies can lie down flat to be sat up as they have less control so
when feeding but bottle fed babies need need greater help to coordinate swallow-
to be semi upright. What is the reason for ing and suckling.
this difference?

For how long should 'infant first' formula Up to 12 months (follow on milk does not
be used? need to be used)
What is the main way to suppress lacta-
Weaning from breastfeeding for the baby.
tion in mother's?
Dopamine receptor agonists which stim-
What medications may be used to sup-
ulates dopamine and inhibits Prolactin
press lactation?
such as Cabergoline or Bromocriptine.
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•following pregnancy loss

When might lactation need to be sup- •to help with gender dysphoria
pressed? •to help stop breastfeeding if weaning
was not successful
The Dopamine receptor antagonists
What is the mechanism of action of Dom-
which inhibit Dopamine and stimulate
peridone (Galactogue)?
Prolactin.

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