ALPP CLC Exam Study Guide, Study Guides, Projects, Research of Obstetrics

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ALPP CLC Exam Study Guide
1.breast feeding: a public health priority: has been recognized as a public
health priority in tropical climates since the 1930's, but not until the
1990's in the US
2.costs to prevent needless deaths: less than $6 billion/year worldwide
3.suboptimal breastfeeding: accounts for more than 3,340 maternal
and child deaths a year, 80% are maternal
4.nursing a baby for a year or more: decreases by 10-15% the risk of
developing hypertension, diabetes, hyperlipidemia, and cardiovascular
disease
5.women who do not breastfeed: are at greater risk for myocardial
infarction and aspects of metabolic syndrome; are at a greater risk of
breast, endometrial, and ovarian cancer
6.WHO and UNICEF three strategies: for increased breastfeeding
initiation and duration in every country: promotion, protection, and
support
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ALPP CLC Exam Study Guide

  1. breast feeding: a public health priority: has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US
  2. costs to prevent needless deaths: less than $6 billion/year worldwide
  3. suboptimal breastfeeding: accounts for more than 3,340 maternal and child deaths a year, 80% are maternal
  4. nursing a baby for a year or more: decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease
  5. women who do not breastfeed: are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer
  6. WHO and UNICEF three strategies: for increased breastfeeding initiation and duration in every country: promotion, protection, and support
  1. breastfeeding promotion: focuses on advantages of breastfeeding on a person- al, community, country, or global level
  2. breastfeeding protection: focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc.
  3. breastfeeding support: focuses on the interaction of "helpers" with family as well as program development and implementation
  4. community expertise: variety of community expertise is needed to promote, protect, and support breastfeeding
  5. International models: for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols
  6. CLC: nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified
  1. nursing a baby for a year or more: decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease
  2. women who do not breastfeed: are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer
  3. WHO and UNICEF three strategies: for increased breastfeeding initiation and duration in every country: promotion, protection, and support
  4. breastfeeding promotion: focuses on advantages of breastfeeding on a person- al, community, country, or global level
  5. breastfeeding protection: focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc.
  6. breastfeeding support: focuses on the interaction of "helpers" with

family as well as program development and implementation

  1. community expertise: variety of community expertise is needed to promote, protect, and support breastfeeding
  2. International models: for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols
  3. CLC: nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competent verified
  4. CLCs and IBCLCs: health professionals who provide lactation support
  5. why is breastfeeding so difficult?: 1. unrealistic expectations
  6. lack of timely interventions
  7. unrealistic expectations: lack of preparation for what the newborn period would look like
  8. lack of timely interventions: mother's problems at 3 to 7 days posed as the greatest risk to stopping
  9. breastfeeding trends: last 150 years or some rates have declined
  10. international code of marketing of breastmilk substitutes (the code): an international health policy framework to regulate the marketing of

to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims

  1. the strategy: is intended as a guide for action
  • it identifies interventions with a proven positive impact
  • it emphasizes providing mothers and families the support they need to carry out their crucial roles
  • it explicitly defines the obligations and responsibilities in this regard of govern- ments, international organizations, and other concerned parties
  1. the world breastfeeding trends initiative: intended to track, assess, and mon- itor the implementation of the "global strategy" at the country and sub-country level
  2. what contributes to low rates of ebf globally?: - caregiver and societal beliefs favoring mixed feeding -hospital and healthcare practices and policies that are not supportive of BF
  • lack of adequate skills and support
  • aggressive promotion of infant formula and other breastmilk substitutes
  • inadequate maternity/paternity leave legislation
  • workplace policies
  • lack of knowledge about dangers of not exclusively BF and proper BF techniques
  1. how to support ebf: increase hospital and health system capacity regarding baby friendly hospital initiative -provide community based strategies including campaigns tailored to local context -strengthen monitoring and enforcement of the code -enact at least 6 months paid maternity leave -invest in training and capacity building in protection, promotion, support
  2. disparity of US breastfeeding trends: according to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents"
  3. anatomy of milk cells: myoepithelial cells, connective tissue, capillaries, ante- riole, venule, alveolar cells
  4. anatomy of human breast: glandular tissue made up of clusters of
  • conditioned over time and lasts a lifetime
  • is faster for women who already have one from previous breastfeeding
  • to condition response.. smell, touch, hear the stimulus
  1. triggering oxytocin mechanism #2: nipple stretching, happens with a proper latch
  2. triggering oxytocin mechanism #3: baby hand massage, each hand move- ment releases oxytocin
  3. hormones of lactation: have an emotional/behavioral function as well as mak- ing and moving milk; aggression, protection, bonding & trust
  4. milk composition: is complex
  • each species of mammal milk is different
  • milk is "species specific"
  1. nest or cache: mammal species with high fat/protein and low water content = infrequent feeds nest = bunnies cache = deer
  2. carry, follow, or hibernate: mammal species with hither water content milk have more frequent feeds carry = koala

follow = elephants hibernate = bears

  1. our culture: wants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers
  2. the brain: most rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth
  3. nursing pattern: should be frequent to accommodate human milk composition
  4. stages of making human milk: lactogenesis I, lactogenesis II, lactogenesis III
  5. lactogenesis I: secretory differentiation, placental hormones, colostrum
  6. lactogenesis II: secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk
  7. lactogenesis III: lactation, galactopoesis, prolactin from frequent nipple stimu- lation, frequent removal of milk, mature milk
  8. breastmilk composition: human milk changes continually, makes it impossible to obtain a single representative sample of milk

is also changes by the way it is taken

  1. babyled feeding: "the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding"
  2. maximum fat levels: obtained 30 mins post-feed
  • mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants
  1. milk composition, milk action: milk composition is complex, milk action is redundant
  • milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements
  1. less diarrhea: most readily acknowledged advantage od breastfeeding, ebf makes the biggest difference in rates and severity
  • 86% of diarrhea-associated infant deaths occurred among LBW infants
  • if breastfed baby does get diarrhea, keeping breastfeeding makes a difference in maintaining the microbiota
  1. mechanisms by which ebf protects from diarrhea: 1. ph of gut 2.low iron in gut 3.presence of bifidus factor

4.presence of hormones 5.antibodies such as SIgA 6.white blood cells 7.cell wall disrupters 8.B12 binding factor

  1. lactoferrin 10.antimicrobial activity boosters 11.mucosal wall protectors 12.microbes 13.absence of exposure to contaminants 14.antibodies 15.synergistic effect
  2. diarrhea mechanisms 1 - ph of the gut: breastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies
  3. diarrhea mechanisms 2 - low iron in the gut: relatively low iron content in human milk
  4. diarrhea mechanisms 3 - presence of bifidus factor: promotes intestinal
  1. diarrhea mechanisms 8 - B12 binding factor: reduces the amount of B12 in the intestines available to microbes
  2. diarrhea mechanisms 9 - lactoferrin: deprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms
  3. diarrhea mechanisms 10 - antimicrobial activity boosters: such as fi- bronectin and gamma interferon
  4. diarrhea mechanisms 11 - mucosal wall protectors: such as mucins and oligosaccharides, which also function as food for beneficial bacteria, adhere to microbes binding them so that they can't attach to the gut wall
  5. diarrhea mechanisms 12 - microbes: from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring
  6. diarrhea mechanisms 13 - contaminants: absence of contaminants (bottles, teats, water) and formula ingredients
  7. diarrhea mechanisms 14 - antibodies: a. when a mother is exposed to organ- isms she makes antibodies and secretes them into her milk b. another way baby is protected - cells go from the baby's mouth into

the breast and antibodies are made in the breast the process of breastfeeding has effects beyond the components of the milk. breastfeeding changes both I'mmune system

  1. gastrointestinal hormones - gastrin, chloecystokinin: promote induced in- sulin release and growth promoting effects in the gut
  2. gastrointestinal hormones - somatastin: inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut
  3. what increases gastrin and decreases somatostatin in babies?: - sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation
  • species own milk
  • decreased stress
  • touch
  • wellness
  1. adult GI hormones: also impacted by suckling when mother suckles her gastrin and cholecystokinin go up. this increases the efficacy of insulin and increases the storage of ingested

meds are used... but perhaps not at a baby-friendly hospital

  • when more intrapartum fluids have been given
  • when there was no labor prior to cesarean however, supplementation rates for weight loss decreased with routine use of 24 hr weight and did not increase untoward effects during the hospital stay
  1. what do we know about breastfed babies who become dangerously under- nourished?: report by cooper & colleagues identified a significant increase in the incidence of malnutrition and hypernatremia in breastfed infants
  • 5 sentinel cases in ohio began a chart review of the prior 4 years
  • chart review babes were 23% below birth weight on average on readmission and showed clinical signs of dehydration and hypernatremia
  • babies were: not d/c early, nursing q 3-4 or 4-6 hrs, scheduled, both breasts, 5-10. min a side, SLEEPY
  • researchers found: the class was inadequate, inadequate follow up in the commu- nity post-partum
  1. how do you know about breastfeeding adequacy?: fewer than 4 soiled dia- pers on day 4 when used in conjunction with delayed onset of lactation may indicate breastfeeding inadequacy
  • four on four... and each day after
  1. cooper findings re: weight loss findings: - babies were not identified before 10% weight loss
  • a "contented" (sleepy) baby is NOT a well-fed baby (calorically deprived babies are sleepy)
  1. breastfeeding associated hypernatremia: hypernatremia is a common com- plication of inadequate milk transfer during breastfeeding
  • completely preventable complication that seems to be relatively common
  1. hypernatremia weight loss difference: 1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants
  2. hypernatremia frequency of feeds difference: 10.2 for healthy infants vs. 7.6 in the NHD admitted infants
  3. how has the AAP responded to hypernatremia?: - ensure formal evaluation and documentation of breastfeeding by trained caregivers