Certified Lactation Course Exam QUESTIONS AND ANSWERS

weaning the addition of adding other foods to a diet, but not completely stopping or ceasing breastfeeding when did breastfeeding rates start to initially decline (i.e. in Britain), particularly among the wealthy population? 16th-17th century and through the 18th century which month did women historically think was the most important to breastfeed during? the summer (due to food spoilage) what three ingredients made up the first commercial formula? (early 1800's/19th century) -wheat flour -cows milk -sugar what was, and still is today, one of the biggest reasons why mothers quit breastfeeding? mothers report not producing enough milk when did bottle feeding become the "new norm", thus, causing breastfeeding rates to continue to decline? 20th century (particularly, mid 1900's) (1950's-1970's) what is the WHO code? an attempt to prevent excessive marketing of ABM (artificial baby milk) and to bring awareness of benefits of breastfeeding (although this code is not law in many countries as it interferes with marketing & freedom) breastfeeding education to pubic is critical! what are some other breastfeeding barriers mothers have? -sexual vs functional aspects of breasts -women in the workplace -"im not producing enough milk" -lack of support from medical profession where are the breasts specifically located on the body? -between 2nd & 6th rib -from sternum to mid axillary line -only gland in not fully functioning at birth *may contain hair, sweat, and oil glands hypoplastic breasts -insufficient glandular tissues -usually only extend from 3rd to 5th rib -typically have more spacing between breasts (1.5 inches or more) montgomery glands/tubercles "small bumps" located around areola that become more prominent (hypertrophy) during pregnancy & are thought to secrete substance during pregnancy/lactation & contain scent glands to help guide infant to nipple, while also helping kill pathogens that try to enter the body areola vary in shape & color; usually circular; become darker during pregnancy and do not return to pre-pregnancy color nipple contain smooth muscle fibers for erectness and graspability; normally found at 4th intercostal space that typically contain between 4-18 openings (9 on average) for milk to be expressed through during lactation nipple/areola complex thought of as one entity; both elongate up to 2-3 times resting length during breastfeeding; areola = most sensitive part of breast nipples = least sensitive everted nipples most common type of nipples; protrudes slightly at rest & everts well with stimulation flat nipples soft, but pliable & graspable pseudo-inverted nipples appear to be inverted but will evert with stimulation or compression retracted nipples type of inverted nipples that appear to be graspable but retracts, rather than everts, with compression inverted nipples/nipple inversion retracted nipples that occur with retracted both with rest and stimualtion what are some techniques for flat/inverted nipples that may help to evert nipples? -inverted syringe -supple cups -breast shells -avent nipplette -"pinch test" in last trimester of pregnancy supernumerary nipples "3rd nipple" or "accessory nipple" found along line of glandular tissue what is breast tissue composed of? 2/3 glandular tissue 1/3 adipose tissue suspensory ligaments aka cooper's ligaments; heavy fibrous bands that divide adipose and glandular tissue of breasts into segments describe breast innervation breasts and areola are high innervated by 4th-6th intercostal nerves (greatest amount of innervation from 4th intercostal nerve) to bring sensation from behind from spine along ribs to chest and breasts how to properly perform breast assessment: -examine bilaterally at same time -observe shape, size, symmetry, elasticity -look for bumps, edema, engorgement, scars, anything abnormal what are the internal features of the breasts? -4 sections called quadrants -lactocytes (cells that make milk) fill each alveoli -- alveoli fill lobes of breasts -- lobes surround areola of breasts -- breast milk secreted into lumen of alveolus -- from center of alveolus, milk moves into small channel (ductile) (many of these, delicate) -- each ductile drains into large lactiferous or mammary duct -- ducts terminate at the nipple **AKA: lactocytes -- alevoli -- small ductile -- mammary duct -- larger mammary ducts -- nipple opening what is the "foundation" of milk production? lactocytes (milk producing cells) what is witch's milk? breast buds/neonatal engorgement in full term infants that may be mistaken for baby acne; self resolve by 4 weeks pp why is it critical to ask mothers about breast changes during pregnancy when completing an assessment different hormones cause breast changes during pregnancy which are critical in assisting with breastfeeding in the pp period; examples: -estrogen: cause ductile system to proliferate -progesterone: promotes and increases the size of breast lobes and alveoli -serum prolactin: nipple growth -serum placental lactogen: areolar growth Lactogenesis I occurs between 16-20 weeks of pregnancy until milk surges, or comes in, after birth breast size increases differentiation between alveolar cells into secretory cells occur hormone prolactin stimulates mammary secretory epithelial cells to produce milk endocrine (hormonal) control Lactogenesis II occurs between PP day 3-8 where there is a rapid increase in milk volume for 2-5 days, then abruptly levels off; this is the onset of copious milk supply triggered by rapid drop in progesterone levels after placenta is delivered will feel fullness and warmth in breasts now switches from endocrine to autocrine control galactopoiesis maintenance of the established milk production under autocrine control works on a supply & demand basis breasts will decrease slightly by 6-9 months pp involution the process of weaning slowly over 3 months or longer when FIL (feedback inhibitors of lactation) in breastmilk suppress lactation if milk is not removed from the breasts describe colostrum -"first milk" -starts about 16-20 weeks gestation and mom may or may not leak this during pregnancy (which is normal, nothing to worry about); -clear to golden yellow in color, but may be greenish or brownish due to old blood -very dense and thick, gel-like; present in small aounts -acts as "gut primer" or "closure"; helps block out pathogens and clear meconium out of gut -physiologic capacity of stomach: only 20 mls at birth (note: anatomic capacity is much larger, do not go by this)