Breastfeeding Flashcards
What providers can do for new mothers
- Support mother’s decision to breastfeed
- Avoid serving as advertiser for formula
- Provide breastfeeding support after hospital discharge
- Have breastfeeding as a standard of care
- Develop a resource team of lactation consultants
7 Laws of Breastfeeding
- Babies and mothers are hardwired to breast feed
- Mother’s body is baby’s natural habitat
- Better feel and flow happen in the comfort zone
- More breastfeeding at first means more milk later
- Every couple has its own breastfeeding rhythm
- More milk out equals more milk made
- Children wean naturally
Breastfeeding Influencing Factors
- FOB
- Attitude and knowledge of caregivers
- Commercial messages deemphasize difference between human milk and formula
- Media promotes sexual images of breasts
Breastfeeding Teaching Points for Mothers
- How to preserve the keratin layer and lubrication of the nipple on the skin
- To take in about 1” diameter of areola
- Baby needs to grasp the breast well and suckle vigorously to stimulate milk production
- Breast size corresponds to fatty and glandular tissue and NOT milk synthesis
- Breast sagging is result of pregnancy NOT lactation
- Engorgement decreases blood and lymph flow, causing edema and increasing risk for local infection
Myths about Breastfeeding
- Some women don’t make enough milk: RARE
- Is it normal for BF to hurt: NO, something wrong
- There is no milk or not enough milk the first 3-4d after birth
- BF babies need extra water in summer heat: NO enough water in milk
- Pumping tells you how much milk the mother has: Pumping produces less milk
- Not enough iron in breast milk: LACTOFERRIN
- It is easier to bottlefeed
- BF ties you down
- Modern formula is as good as breast milk
- If mom has infection, she needs to D/C BF: No, only if something like HIV
- If baby is sick he/she needs to stop BF
Potential Breast Problems
- Possible Glandular Insufficiency
- No noticeable change in breast size during pregnancy/lactation
- 1 Breast is appreciably smaller than the other
- Milk production is inadequate despite appropriate feeding practices
- Ductal atresia prevents milk from secreting
Hx of Breast Surgery and Breastfeeding
- Augmentation may damage nerves but usually does not destroy tissue
- Breast reduction is more intrusive and often affects lactation
- Resection of nipple severs all ducts and usually prevents a full milk supply
- Pedicle technique transposes the nipple, areola, and ducts
- Women previously treated for breast CA who do not have residual tumor can BF
Steps to Assess Breastfeeding: Step 1
1) B: body position
2) R: responses
3) E: emotional bonding
4) A: anatomy
5) S: suckling
6) T: time spent suckling
Steps to Assess Breastfeeding: Step 2 (latch-on)
1) Watch how the baby is latched on to the breast
- Use of the c-hold to make a sandwich for the baby to latch on: 4 fingers underneath, thumb on top; Mother’s fingers parallel to the infants jaw and behind the areola
- Acknowledgement of the rooting reflex: Middle of infant’s lip stroked with nipple; Infant opens nouth wide; Mother quickly draws the infant to her breast; Infant takes in adequate amount of the breast, not just the nipple
- Areola Grasp: Infant grasps the entire nipple and as much of the areola as possible; the nose and chin of the infant will touch the breast; lips will be flanged out
- Mother’s comfort: Gentle underlating motion, no pain with suction
- Proper release if infant does not release on its own: Mother inserts finger gently into corner of infant’s mouth to release suction
Breastfeeding Styles for Infants
- Barracuda: energetic sucker
- Excited ineffective: too eager
- Procrastinator: waits until milk appears before sucking
- Gourmet: licks and tastes milk before latch-on
- Rester: Prefers to breastfeed for a few minutes, the rest periodically
Establishment of Breastfeeding
- Discourage infant-mother separation w/in 1st hr after birth
- Help with proper positioning and attachment
- Encourage rooming in and feeding on demand
- Educate mothers about: normal vol. of colostrum; # of times the infant should stool and void, when milk “comes in”
- Discourage supplementation
- Provide f/u 48-72hrs after discharge
Establishment of breastfeeding: Colostrum
- rich in protein and antibodies
- Neutrophils promote bacterial killing, phagocytosis, and chemotaxis
- Small volume is NL:
- 7-123mL d1
- 2-10mL/feeding d1
- 5-15mL/feeding d2
- Colostrum stimulates intestinal peristalsis which decreases enterohepatic circulation, encouraging the elimination of bilirubin
- Low volume of colostrum encourages frequent feedings, which encourages milk to “come in”
Establishment of breastfeeding: When milk comes in
- Mature milk consists of foremilk (high volume, low fat) and hindmilk (low volume, high fat)
- Typically comes in at 24-102hrs postpartum
- Requires effective and frequent milk removal in the 1st week of life
How to tell if feedings are effective
- Baby is content after
- Audible swallowing during feedings
- Mother’s nipples are NOT sore
- 3+ stools/d after d1
- No weight loss after d3
- Breast feels less full after feeding
How to tell when milk has come in
- 6+ wet diapers/d
- Yellow seedy stool by d4-5
- Breasts are noticeably larger and feel firmer
- Mother may begin to feel let-down reflex
- Breasts may leak b/n feedings
