ABM Clinical Protocol #9: Use of Galactogogues in Initiating Or Augmenting Maternal Milk Production, Second Revision 2018
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The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team
The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team By Kathryn A. Spiegel A Master’s Paper submitted to the faculty of the University of North Carolina at Chapel Hill In partial fulfillment of the requirements for the degree of Master of Public Health in the Public Health Leadership Program. Chapel Hill 2009 ___________________________ Advisor signature/printed name ________________________________ Second Reader Signature/printed name ________________________________ Date The Key to Increasing Breastfeeding Duration 2 Abstract Experts and scientists agree that human milk is the best nutrition for human babies, but are healthcare professionals (HCPs) seizing the opportunity to promote, protect, and support breastfeeding? Not only are HCPs influential to the breastfeeding dyad, they hold a responsibility to perform evidence-based interventions to lengthen the duration of breastfeeding due to the extensive health benefits for mother and baby. This paper examines current HCPs‘ education, practices, attitudes, and extraneous factors to surface any potential contributing factors that shed light on necessary actions. Recommendations to empower HCPs to provide consistent, evidence-based care for the breastfeeding dyad include: standardized curriculum in medical/nursing school, continued education for maternity and non-maternity settings, emphasis on skin-to-skin, enforcement of evidence-based policies, implementation of ‗Baby-Friendly USA‘ interventions, and development of peer support networks. Requisite resources such as lactation consultants as well as appropriate medication and breastfeeding clinical management references aid HCPs in providing best practices to increase breastfeeding duration. The Key to Increasing Breastfeeding Duration 3 The key to increasing breastfeeding duration: Empowering the healthcare team During the colonial era, mothers breastfed through their infants‘ second summer. -
Breastfeeding Management in Primary Care-FINAL-Part 2.Pptx
Breastfeeding Management in Primary Care Pt 2 Heggie, Licari, Turner May 25 '17 5/15/17 Case 3 – Sore nipples • G3P3 mom with sore nipples, baby 5 days old, full term, Breaseeding Management in yellow stools, output normal per BF log, 5 % wt loss. Primary Care - Part 2 • Mother exam: both nipples with erythema, cracked and scabbed at p, areola mildly swollen, breasts engorged and moderately tender, mild diffuse erythema, no mass. • Baby exam: strong but “chompy” suck, thick ght frenulum aached to p of tongue, with restricted tongue movement- poor lateral tracking, unable to extend tongue past gum line or lower lip, minimal tongue elevaon. May 25, 2017, Duluth, MN • Breaseeding observaon: Baby has deep latch, mom Pamela Heggie MD, IBCLC, FAAP, FABM Addie Licari, MD, FAAFP with good posioning, swallows heard and also Lorraine Turner, MD, ABIHM intermient clicking. Mom reports pain during feeding. Sore cracked nipple Type 1 - Ankyloglossia Sore Nipples § “Normal” nipple soreness is very minimal and ok only if: ü Poor latch § Nipple “tugging” brief (< 30 sec) with latch-on then resolves ü LATCH, LATCH, LATCH § No pain throughout feeding or in between feeds ü Skin breakdown/cracks-staph colonizaon § No skin damage ü Engorgement § Some women are told “the latch looks ok”… but they are in pain and curling their toes ü Trauma from pumping ü § It doesn’t maer how it “looks” … if mom is uncomfortable Nipple Shields it’s a problem and baby not geng much milk…set up for low ü Vasospasm milk supply ü Blocked nipple pore/Nipple bleb § Nipple pain is -
What Are the Acute Treatments for Migraine and How Are They Used?
2. Acute Treatment CQ II-2-1 What are the acute treatments for migraine and how are they used? Recommendation The mainstay of acute treatment for migraine is pharmacotherapy. The drugs used include (1) acetaminophen, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans and (5) antiemetics. Stratified treatment according to the severity of migraine is recommended: use NSAIDs such as aspirin and naproxen for mild to moderate headache, and use triptans for moderate to severe headache, or even mild to moderate headache when NSAIDs were ineffective in the past. It is necessary to give guidance and cautions to patients having acute attacks, and explain the methods of using medications (timing, dose, frequency of use) and medication use during pregnancy and breast-feeding. Grade A Background and Objective The objective of acute treatment is to resolve the migraine attack completely and rapidly and restore the patient’s normal functions. An ideal treatment should have the following characteristics: (1) resolves pain and associated symptoms rapidly; (2) is consistently effective; (3) no recurrence; (4) no need for additional use of medication; (5) no adverse effects; (6) can be administered by the patients themselves; and (7) low cost. Literature was searched to identify acute treatments that satisfy the above conditions. Comments and Evidence The acute treatment drugs for migraine generally include (1) acetaminophens, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans, and (5) antiemetics. For severe migraines including status migrainosus and migraine attacks refractory to treatment, (6) anesthetics, and (7) corticosteroids (dexamethasone) are used (Tables 1 and 2).1)-9) There are two approaches to the selection and sequencing of these medications: “step care” and “stratified care”. -
Use of Domperidone As a Galactagogue Drug: a Systematic
JHLXXX10.1177/0890334414561265Journal of Human LactationPaul et al 561265research-article2014 Review Journal of Human Lactation 2015, Vol. 31(1) 57 –63 Use of Domperidone as a Galactagogue © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav Drug: A Systematic Review of the DOI: 10.1177/0890334414561265 Benefit-Risk Ratio jhl.sagepub.com Catherine Paul, PharmD1, Marie Zénut, MD, PhD2,3, Agnès Dorut, CPM4, Marie-Ange Coudoré, PharmD, PhD5,6, Julie Vein, DVM, PhD7, Jean-Michel Cardot, PharmD, PhD8,9, and David Balayssac, PharmD, PhD7,10 Abstract Breastfeeding is the optimal method for feeding a newborn. However, some mothers may have difficulties lactating. Domperidone is widely used as a galactagogue but to the best of our knowledge has not been approved by any health authority. The objective of this review was to assess the benefit-risk ratio of domperidone for stimulating lactation. The benefit-risk ratio of domperidone as a galactagogue was assessed following a literature search of the PubMed database up to July 2013. Four studies were selected to assess domperidone efficacy and demonstrated an increased milk production. The limited data (60 mother-baby pairs) and the moderate methodological quality of 1 study remain insufficient to conclude on domperidone efficacy. Regarding the safety of domperidone, 7 studies were selected that exposed 113 infants to domperidone through breastfeeding. No adverse effects were observed in 85 infants, and no information was provided for the remaining 28. The limited data available remain in favor of a safe domperidone profile in infants and mothers. However, in large studies focused on gastrointestinal disorders, domperidone is responsible for drug-induced long QT syndrome and sudden cardiac death. -
Clinical Update and Treatment of Lactation Insufficiency
Review Article Maternal Health CLINICAL UPDATE AND TREATMENT OF LACTATION INSUFFICIENCY ARSHIYA SULTANA* KHALEEQ UR RAHMAN** MANJULA S MS*** SUMMARY: Lactation is beneficial to mother’s health as well as provides specific nourishments, growth, and development to the baby. Hence, it is a nature’s precious gift for the infant; however, lactation insufficiency is one of the explanations mentioned most often by women throughout the world for the early discontinuation of breast- feeding and/or for the introduction of supplementary bottles. Globally, lactation insufficiency is a public health concern, as the use of breast milk substitutes increases the risk of morbidity and mortality among infants in developing countries, and these supplements are the most common cause of malnutrition. The incidence has been estimated to range from 23% to 63% during the first 4 months after delivery. The present article provides a literary search in English language of incidence, etiopathogensis, pathophysiology, clinical features, diagnosis, and current update on treatment of lactation insufficiency from different sources such as reference books, Medline, Pubmed, other Web sites, etc. Non-breast-fed infant are 14 times more likely to die due to diarrhea, 3 times more likely to die of respiratory infection, and twice as likely to die of other infections than an exclusively breast-fed child. Therefore, lactation insufficiency should be tackled in appropriate manner. Key words : Lactation insufficiency, lactation, galactagogue, breast-feeding INTRODUCTION Breast-feeding is advised becasue human milk is The synonyms of lactation insufficiency are as follows: species-specific nourishment for the baby, produces lactational inadequacy (1), breast milk insufficiency (2), optimum growth and development, and provides substantial lactation failure (3,4), mothers milk insufficiency (MMI) (2), protection from illness. -
Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers
Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers Jean Rucks Rhodes, PhD, CNM, IBCLC High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. However, low breastfeeding rates among infants who are six and 12 months of age indicate that many mothers do not continue breastfeeding as recommended. These rates suggest that mothers, in part, may not be getting the support they need, such as from healthcare provid- ers, family members, and employers.... The early postpartum period is a critical time for establishing and supporting breastfeeding. CDC 2016 Breastfeeding Report Card 1 WHITE PAPER EXECUTIVE SUMMARY Although breastfeeding initiation is at an all-time high New evidence suggests babies’ feeding behaviors of 81%, rates of breastfeeding exclusivity and du- have an important role in determining lactation suc- ration lag behind national goals. Women who stop cess. These unique infant sucking patterns in the first breastfeeding before meeting their goals often report few days of life appear to program mothers’ breasts they did not have enough milk. for optimal milk production. New breast pump initia- tion technology that mimics early newborn sucking The ability to initiate, build and maintain breast milk is a potentially viable and safe intervention to provide volumes sufficient to meet an infant’s needs are de- at-risk mothers with additional breast stimulation for pendent on complex interwoven factors. Additionally, optimal milk production outcomes. there are multiple maternal risk factors for delayed milk production and suppressed lactation: In many lactation situations, interventions aren’t start- ed until a mother reports problems. -
Drugs That Can Cause Delirium (Anticholinergic / Toxic Metabolites)
Drugs that can Cause Delirium (anticholinergic / toxic metabolites) Deliriants (drugs causing delirium) Prescription drugs . Central acting agents – Sedative hypnotics (e.g., benzodiazepines) – Anticonvulsants (e.g., barbiturates) – Antiparkinsonian agents (e.g., benztropine, trihexyphenidyl) . Analgesics – Narcotics (NB. meperidine*) – Non-steroidal anti-inflammatory drugs* . Antihistamines (first generation, e.g., hydroxyzine) . Gastrointestinal agents – Antispasmodics – H2-blockers* . Antinauseants – Scopolamine – Dimenhydrinate . Antibiotics – Fluoroquinolones* . Psychotropic medications – Tricyclic antidepressants – Lithium* . Cardiac medications – Antiarrhythmics – Digitalis* – Antihypertensives (b-blockers, methyldopa) . Miscellaneous – Skeletal muscle relaxants – Steroids Over the counter medications and complementary/alternative medications . Antihistamines (NB. first generation) – diphenhydramine, chlorpheniramine). Antinauseants – dimenhydrinate, scopolamine . Liquid medications containing alcohol . Mandrake . Henbane . Jimson weed . Atropa belladonna extract * Requires adjustment in renal impairment. From: K Alagiakrishnan, C A Wiens. (2004). An approach to drug induced delirium in the elderly. Postgrad Med J, 80, 388–393. Delirium in the Older Person: A Medical Emergency. Island Health www.viha.ca/mhas/resources/delirium/ Drugs that can cause delirium. Reviewed: 8-2014 Some commonly used medications with moderate to high anticholinergic properties and alternative suggestions Type of medication Alternatives with less deliriogenic -
Cabergoline Patient Handout
Cabergoline For the Patient: Cabergoline Other names: DOSTINEX® • Cabergoline (ca-BERG-go-leen) is used to treat cancers that cause the body to produce too much of a hormone called prolactin. Cabergoline helps decrease the size of the cancer and the production of prolactin. It is a tablet that you take by mouth. • Tell your doctor if you have ever had an unusual or allergic reaction to bromocriptine or other ergot derivatives, such as pergoline (PERMAX®) and methysergide (SANSERT®), before taking cabergoline. • Blood tests and blood pressure measurement may be taken while you are taking cabergoline. The dose of cabergoline may be changed based on the test results and/or other side effects. • It is important to take cabergoline exactly as directed by your doctor. Make sure you understand the directions. Take cabergoline with food. • If you miss a dose of cabergoline, take it as soon as you can if it is within 2 days of the missed dose. If it is over 2 days since your missed dose, skip the missed dose and go back to your usual dosing times. • Other drugs such as azithromycin (ZITHROMAX®), clarithromycin (BIAXIN®), erythromycin, domperidone, metoclopramide, and some drugs used to treat mental or mood problems may interact with cabergoline. Tell your doctor if you are taking these or any other drugs as you may need extra blood tests or your dose may need to be changed. Check with your doctor or pharmacist before you start or stop taking any other drugs. • The drinking of alcohol (in small amounts) does not appear to affect the safety or usefulness of cabergoline. -
Drugs Affecting Milk Supply During Lactation
VOLUME 41 : NUMBER 1 : FEBRUARY 2018 ARTICLE Drugs affecting milk supply during lactation Treasure M McGuire SUMMARY Assistant director Practice and Development There are morbidity and mortality benefits for infants who are breastfed for longer periods. Mater Pharmacy Services Occasionally, drugs are used to improve the milk supply. Mater Health Services Brisbane Maternal perception of an insufficient milk supply is the commonest reason for ceasing Conjoint senior lecturer breastfeeding. Maternal stress or pain can also reduce milk supply. School of Pharmacy University of Queensland Galactagogues to improve milk supply are more likely to be effective if commenced within three weeks of delivery. The adverse effects of metoclopramide and domperidone must be Associate professor Pharmacology weighed against the benefits of breastfeeding. Faculty of Health Sciences Dopamine agonists have been used to suppress lactation. They have significant adverse effects and Medicine and bromocriptine should not be used because of an association with maternal deaths. Bond University Gold Coast nipple stimulation. Its release is inhibited by dopamine Introduction Keywords Breast milk is a complex, living nutritional fluid from the hypothalamus. Within a month of delivery, breastfeeding, that contains antibodies, enzymes, nutrients and basal prolactin returns to pre-pregnant levels in non- cabergoline, domperidone, galactagogues, lactation, hormones. Breastfeeding has many benefits for breastfeeding mothers. It remains elevated in nursing metoclopramide, prolactin babies such as fewer infections, increased intelligence, mothers, with peaks in response to infant suckling. probable protection against overweight and diabetes Drugs that act on dopamine can affect lactation. and, for mothers, cancer prevention.1 The World In response to suckling, oxytocin is released from Aust Prescr 2018;41:7-9 Health Organization recommends mothers breastfeed the posterior pituitary to enable the breast to https://doi.org/10.18773/ exclusively for six months postpartum. -
Low Milk Supply Is When Your Baby Is Not Getting Enough Milk to Gain Weight
Increasing Your Milk Supply Most women have enough milk for their babies. Low milk supply is when your baby is not getting enough milk to gain weight. You may see these signs • baby is not content after most feeding • baby does not have lots of wet and dirty diapers • baby gains weight slowly for age How to prevent • breastfeed as soon as possible after birth • hold your baby skin-to-skin • make sure your latch is comfortable. If you have questions about latch please contact a public health nurse • breastfeed often (8 or more times in 24 hours) • hand express or use a breast pump if baby is unable to latch • do not give unnecessary formula feedings What to do The most important thing is to breastfeed often – more feeding makes more milk. • offer both breasts at each feeding • switch breasts when your baby’s sucking slows down • use gentle breast massage before and during feeds Express your breastmilk • hand express or pump your milk after as many feedings as you can • if your baby is not latching, express or pump your milk at least 7 times during the day and one time during the night • feed baby extra milk (expressed breast milk or formula) if your baby is not growing well with breastfeeding Take care of yourself • rest when your baby sleeps • drink to thirst and eat well • avoid alcohol and nicotine If you do not see an increase in your milk supply, talk to your Health Care Provider about a prescription medicine called Domperidone (Motilium) • this medicine is safe for baby • the usual dose is from 1 to 3 pills, 3 or 4 times a day • milk supply should improve within 1 to 2 weeks • there may be minor side effects (i.e. -
New Abm Logo!
SUMMER 2018 BREECH! SUMMER2018 BP Portrait Winner DAME SARAH STOREY ON NATURAL TERM BREASTFEEDING THE PRIVILEGED ROLE OF OFFERING BREASTFEEDING SUPPORT NEW ABM LOGO! Meet our 2018 Pam’s Prize Winner BREASTFEEDING1 THROUGH IVF The importance of supporting women who haven’t been able to meet their breastfeeding goals Professor Amy Brown, ABM Breastfeeding Counsellor We don’t really need research to physiological protection throughout tell us that a positive breastfeeding the body. Breastfeeding helps experience can be an amazing boost maintain the hormone levels the for maternal mental health. Anyone body would expect after birth, who has met their breastfeeding keeps levels of oxytocin raised and goals knows that although it can be can help the body combat tough, the rewards are usually inflammation caused by a lack of worth it. Even when everything else sleep or pain after the birth1. All feels like its falling apart, these factors – psychological and breastfeeding can be a life raft. A physiological - help explain the common message emerging from lower levels of postnatal depression my research is often ‘Breastfeeding in women who breastfeed2. felt like the one thing I got right’. But although breastfeeding can be Likewise, from a scientific beautiful, sadly, we know that far perspective, we can see the too many women struggle to have 2 that fabulous experience. Although in the first few weeks saying they most women say that they want to weren’t ready to do so3. breastfeed, in the UK, more women have given a bottle of formula by But where does that leave women? the end of the first week than are Other than literally holding the baby exclusively breastfeeding3. -
PRESCRIBED DRUGS and NEUROLOGICAL COMPLICATIONS K a Grosset, D G Grosset Iii2
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2004.045757 on 16 August 2004. Downloaded from PRESCRIBED DRUGS AND NEUROLOGICAL COMPLICATIONS K A Grosset, D G Grosset iii2 J Neurol Neurosurg Psychiatry 2004;75(Suppl III):iii2–iii8. doi: 10.1136/jnnp.2004.045757 treatment history is a fundamental part of the healthcare consultation. Current drugs (prescribed, over the counter, herbal remedies, drugs of misuse) and how they are taken A(frequency, timing, missed and extra doses), drugs tried previously and reason for discontinuation, treatment response, adverse effects, allergies, and intolerances should be taken into account. Recent immunisations may also be of importance. This article examines the particular relevance of medication in patients presenting with neurological symptoms. Drugs and their interactions may contribute in part or fully to the neurological syndrome, and treatment response may assist diagnostically or in future management plans. Knowledge of medicine taking behaviour may clarify clinical presentations such as analgesic overuse causing chronic daily headache, or severe dyskinesia resulting from obsessive use of dopamine replacement treatment. In most cases, iatrogenic symptoms are best managed by withdrawal of the offending drug. Indirect mechanisms whereby drugs could cause neurological problems are beyond the scope of the current article—for example, drugs which raise blood pressure or which worsen glycaemic control and consequently increase the risk of cerebrovascular disease, or immunosupressants