Modern approaches to the principles of breastfeeding. Lactostasis. Postpartum mastitis.

In our institution there is order No. 486 dated 10/18/2023 “On the implementation of the principles of supporting breastfeeding babies in the UZ“ 6th City Clinical Hospital ”.

Politics (action plan) to organize breastfeeding support in the maternity hospital “6th City Clinical Hospital”:

1. The regulatory bringing the established rules of breastfeeding to pregnant women.

2. Information of pregnant women and puerpens about the advantages and technique of breastfeeding.
3. Provide medical personnel with the necessary knowledge, competence and skills for the implementation of a policy to organize breastfeeding in the hospital.
4. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their children.
5. Twice a year, training all personnel, including practical training on the benefits of breastfeeding, breastfeeding technique, advising mothers who breastfeeding.
6. On the basis of the UZ "6th GKB" to all pregnant women organize information about the advantages and technique of breastfeeding in the classroom "School of Pregnant" and in individual conversations with medical personnel.
7. Carry out the prevention of complications of breastfeeding (cracks of nipples, breast loading, mastitis) in the conditions of the AOO and AOO.
8. Inform patients about the indications for breast sediment.
9. Prohibit advertising of replacements of breast milk, nipple, dummies in the hospital.
10. Make an entry about the training of a puerpera with the principles of breastfeeding in the history of childbirth.
11. Do not give newborn and infants who are on breast feeding, no other food or drink, except for breast milk, with the exception of cases of medical indications.
12. When collecting an anamnesis, pay special attention to previously available difficulties with breastfeeding.
13. Luignes training technique for feeding: the correct arrangement of the child, effective sucking.
14. Patient training techniques of manual expressing.
15. Informing pregnant women about the dangers of using nipples and dummies among children on breastfeeding.
16. To carry out continuity in the work of a antenatal clinic, obstetric departments of a maternity hospital and a children's clinic.
17. Have visual instructive and educational information on breastfeeding (stands, posters, memos).
18. To carry out medical supervision and care of a healthy newborn child, carried out in the maternity hospital, in accordance with the recommendations of the World Health Organization and algorithms for a healthy newborn child in an obstetric institution dated 02.04.2019 No. 211.
19. Conversation of doctors of the maternity hospital of the nourishing of nursing mothers, the features of breastfeeding.
20. Control of obstetricians (midwives) of postpartum departments behind the state of the breast of the nursing mother.

The regulatory principles of activity of the maternity hospital “6th City Clinical Hospital” corresponding to the principles of breastfeeding support:

1. All medical personnel are aware of the advantages of breastfeeding and aware of the modern principles of lactation.
2. Practice the round -the -clock joint stay of the mother and the newborn - to allow them to be together in the same ward 24 hours a day.
3. Encourage breastfeeding on demand.
4. To coordinate with a woman the drugs used, to explain their effect on breastfeeding.
5. Ensure breastfeeding during illness of the newborn, if there are no medical contraindications, if it is impossible to suck the chest, feed it with breast milk using cups, spoons, pipette, syringes.
6. To inform women about the importance of breastfeeding on demand, including at night, not to limit the duration and frequency of feeding.
7. Make contact “Leather to the skin” from the first minute after the birth of a newborn.
8. Practice the obstetrician (midwife) of the maternity hospital to apply a newborn to the chest immediately after examining a neonatologist (pediatrician) in the operating room and as the child is ready, with the exception of the mother's endotracheal anesthesia with cesarean section or the need for resuscitation measures to a newborn child.
9. If the condition of the newborn child is satisfactory, he can be attached to the mother’s chest, and then transferred to the partner (father) for the contact “skin to the skin” in the maternity room under the control of the midwife (obstetrician).
10. Provide assistance and care for a healthy newborn child in the department for newborn children (joint stay).
11. To organize a regular visit to the midwife of the postpartum department of the puerpera, an explanation of errors leading to the occurrence of cracks in the nipples, stagnation of milk.
12. Apply a newborn to the mother’s chest during the first hour after childbirth in the absence of medical contraindications.
13. To lay out on the chest of the newborn during the operation a cesarean section in the operating room, with the exception of cases with medical contraindications.

Lactostasis

• The condition during lactation associated with the stagnation of milk due to a violation of its evacuation from the mammary glands.
• It is more often diagnosed in original women aged 21 to 35 years in the first weeks and months after childbirth.
• The mammary glands increase in volume, their slices become dense. These phenomena lead to swelling, loading and soreness of the glands.
• According to clinical observations of a number of researchers, skin hyperemia with lactostasis is often associated not with inflammatory phenomena, but with mechanical damage to the skin of the breast with fingers with gross accumulation.
• A consequence of lactostasis in the absence of timely treatment may be an inflammatory disease of the mammary gland - mastitis.

Varieties of lactostasis

• Lactostasis can beone -sidedAndbilateral.
• The formation of lactostasis is facilitated by an innate anomaly with the presence of narrow and winding milky ducts in a woman, as well as a history of mastopathy.

Possible causes of stagnation of milk:

• In the early postpartum period, lactostasis is associated with inconsistency between the process of milk and milk products.
• Until the 7-8th day after childbirth, the endocrine mechanism of regulation of lactation prevails, when in response to the fall of serum progesterone and estrogen, the level of prolactin and oxytocin increases after childbirth.
• Violation of the process of breeding milk and the formation of stagnation of milk, as a rule, is due to improper attachment of the baby to the chest, rare feeding, cracks and sore nipples, sluggish sucking the baby or the absence of breastfeeding due to the state of the mother or newborn.
• Under these conditions, the epithelium of the Milky ducts is damaged, and the prerequisites for the development of the infectious process are created.
• A week after childbirth, an autocrine type of lactation occurs, when milk is produced “on demand”.
• During this period, the cause of lactostasis is the technical errors of breastfeeding, leading to ineffective sucking and, accordingly, stagnation of milk or the cessation of its secretion.
• Proper combustion of breast milk is considered a key way to prevent and combat lactostasis and mastitis.

There are factors that increase the risk of developing milk stagnation:

• Flat nipple
• Slowing the chest
• narrowed milky ducts
• wearing tight underwear
• Sleep on the stomach
• Healing of the chest
• stressful situations

Diagnostics and examinations:

• Inspection
• Ultrasound of the mammary glands
• UAC
• Buck (SRB)
• If you suspect excess milk production with normal emptying of the mammary gland, it is necessary to estimate the level of prolactin.
• With an increased level of prolactin, it is recommended to conduct an MRI of the pituitary gland or MRI of the brain to exclude tumor formation in its front lobe.

Treatment of lactostasis

Milk Expression:

• To facilitate combustion of milk in the presence of cracks, it is advisable to use a dairy.
• To participate feeding or expressing breast milk (every one and a half hours).
• Claging milk with one -sided lactostasis is better to start from the sore side.
• Light breast massage is useful before sowing or feeding.
• Perform expressing until the chest becomes soft enough. No need to achieve complete emptying of the chest.
• With an increase in body temperature> 38 ° C on the 1st day from the onset of symptoms, NSAIDs can be prescribed.

N.B.! These manipulations are absolutely contraindicated in developing mastitis.

Postpartum mastitis- infectious and inflammatory damage to the mammary gland, which occurred in the postpartum period and related to the lactation process. It is manifested by pain and breast seal, hyperemia of the skin, an intoxication reaction with severe hyperthermia, chills, asthenia.

Causes of lactation mastitis:

• Lactostasis
• Nipples cracks
• The presence of a focus of infection in the body
• Reducing immunity
• Violation of the requirements of aseptics and antiseptics

Classification of lactation mastitis

Clinical and Morphological classification B. Gurtov:

• Serous
• Infiltrative
• Purulent

By localization, they distinguish:

• localized intra -percent,
• subareolar,
• Intra and retromammar
• Total chest damage.

If the mammary gland is inflamed to the discharge of the nasal from the hospital, mastitis is considered epidemic, with the development of inflammation at home at home at 3-4 weeks of the postpartum period we are talking about the endemic form of the disease.

Diagnosis of mastitis

• Ultrasound of the mammary glands
• The study of the blood formula
• tank. Sowing milk
• In difficult cases - tissue biopsy, mammography, CT, MRI

Treatment of lactation mastitis

• Patients are recommended to temporarily stop breastfeeding.
• The secretion of milk is suppressed only in a small number of patients in the presence of certain indications: rapid progression of inflammation with the transition to the infiltrative phase within 1-3 days with adequate therapy, relapse of purulent mastitis after surgery, phlegmonous and gangrenosis forms, postoperative resistance to antibiotics, decompensation by other organs and systems.

The material is prepared by the team

obstetric and physiological department.