Breastfeeding

Question 1

What is attachment?

Answer 1

How the baby takes the breast in his mouth to enable him to feed

Question 2

What is positioning?

Answer 2

How the mother holds her baby to help him attach effectively to the breast

Question 3

Impact of ineffective attachment for mum and baby

Answer 3

Mum: sore nipples, engorgement, mastitis, low milk production, loss of confidence

Baby: feeding frequently, frustrated, jaundice, poor weight gain, hypernatraemia

Question 4

The feed…

Answer 4

Start - short rapid sucks
Middle - active feeding - long slow rhythmic sucking and swallowing, with pauses
End - flutter sucking with occasional swallows

Question 5

Suck swallow ratio…

Answer 5

Ratio of more than 2:1 = poor milk transfer

Question 6

Subsequent let downs =

Answer 6

Increased fat content

Question 7

Recognising effective attachment

Answer 7

Feeding pain free
Chin indenting breast
Mouth wide open
Cheeks round and full
More areole visible above top lip 
Rhythmic suck/swallow
Nipple remains rounded at end

Question 8

CHIN principle

Answer 8

Close
Head free
In line 
Nose to nipple 
Sustainability

Question 9

Supporting effective breastfeeding

Answer 9

Skin to skin 
CHINS in place 
Mother calm baby, talking stroking 
Point out instinctive cues, head bobbing, rooting 
Rub nipple against top lip 
Check mothers comfort 
Point out signs of effective attachment

Question 10

Helping the mother learn

Answer 10

Explain reasons for what you say - the ‘why’ is crucial to understanding 
Keep messages simple
Emphasise principles 
Check understanding 
Build confidence and support instinct 
Use props to reinforce learning

Question 11

What mothers want

Answer 11

Practical help and tips 
Hands off 
Observe a full feed
Proactive approach 
Encouragement 
Compassion

Question 12

Assessing breastfeeding

Answer 12

Baby’s output - urine and stools
Baby’s general appearance and behaviour 
Feeding pattern (length and frequency)
Suck:swallow ratio
Gaining weigh 
Nipple shape after feeds/damage 
Engorgement/blocked ducts/mastitis

Question 13

Stools from days 1-4

Answer 13

1-2 meconium
2-4 changing breast milk coming in
4+ at least 2 soft runny yellow stools a day
Individual pattern 4-6 weeks

Question 14

Why express breast milk?

Answer 14

Tempt baby to feed if sleepy 
Provide colostrum for at risk baby 
Kick start milk production 
Relieve fullness/engorgement 
Show mother she has milk 
Obtain milk for mother who cannot feed

Prevent and manage problems eg mastitis
Social reasons

Question 15

Why teach hand expression?

Answer 15

Convenient, available anywhere, no equipment required 
Neonatal unit 
Better hormonal response
Best method for obtaining colostrum 
Target specific area of breast

Question 16

Principles of hand expression

Answer 16

Wash a hands 
Sterile container
Find right spot 
Compress and release 
Rhythmic movement 
Small drops then squirts 
Rotate as flow lessens

Question 17

Helping the let down

Answer 17

Gentle breast massage 
Gentle nipple rolling 
Warm flannels 
Back massage 
Touch smell photo of baby 
Relaxing atmosphere

Question 18

Hand expressing for sick or preterm babies

Answer 18

Skin to skin at birth if poss
Hand express within 2 hours of birt
Express at least 8 times in 24 hours, including night
Combine hand and pump as volume increases

Question 19

Using breast pump

Answer 19

Massage breast
Centre nipple - ensure good fit
Increase vacuum slowly until slightly uncomfortable and then back 10%
Pump until flow decreases
Massage and pump again
Double pumping more effective, improving volumes expressed and saving time

Question 20

Stages of lactation

Answer 20

Lactogenesis 1 - breast development and colostrum production from approx 16 weeks
Lactogenesis 2 - onset of copious milk secretion occurring 32-96 hours after birth
Lactogenesis 3 - maintenance of milk production

Question 21

Hormones after birth

Answer 21

Oestrogen and progesterone drop
Prolactin and oxytocin rise in response to touch smell sight of baby
Baby begins spontaneous breast seeking behaviour
Mothering behaviours initiated

Question 22

prolactin and oxytocin

Answer 22

Prolactin = responsible for milk production, responsive to touch and stimulation, higher at night, frequent contact/feed sets up long term production

Oxytocin = responsible for milk delivery, acts on muscle cells in pulsatile action, levels higher when baby is near, stress can temporarily delay let down

Question 23

Feedback inhibitor of lactation

Answer 23

Milk removal = milk production

Ineffective removal = reduced production

Question 24

Oxytocin: the love hormone

Answer 24

Works on feelings and emotions 
Lowers blood pressure, improves sleep 
Reduces stress levels by taking on cortisol 
Reduces pain sensitivity 
Boosts immune system 

Evidence = synthetic oxytocin can negatively impact on normal production