Breastfeeding Skills Flashcards
What are the three things ‘nose to nipple’ helps with?
- Babies head tilts back
- Wide open mouth
- Good deep latch
What are the signs of ineffective attachment? (5 points for mum, 6 points for baby)
Mum: Sore nipples, engorgement, mastitis, low milk production, loss of confidence.
Baby: Frequent feeding, frustration, poor weight gain, jaundice, hypernatraemia (high sodium in blood), poor nappy output
What are the signs of effective attachment?
Chin indents the breast, mouth wide open, lower lip curled, more areola visible above top lip, full & rounded cheeks, good weight gain, pain-free feeding, rounded nipple at end of feed (not ‘lipstick’ shaped)
Reference: UNICEF Baby Friendly Initiative
Subsequent let downs = ??
Higher fat content in milk
What does CHINS stand for?
C - Close H - Head free I - In line N - Nose to nipple S - Sustainability
What are some possible breastfeeding positions? (four answers)
Cross cradle, under-arm/rugby ball hold, side-lying, laid back.
Before providing BF support, what should we do?
Observe a FULL feed and talk to the mother about how she feels, and what support she would like
How can we support effective breastfeeding? (7 points)
- Get mum and baby in skin to skin contact
- CHINS
- Point out instinctive feeding cues (head bobbing, rooting)
- Rub nipple on baby’s top lip to allow a wide open mouth
- Check mother’s comfort
- Point out signs of good attachment
- ENCOURAGEMENT
How can we support a woman to learn?
Explain reasons for what you say – the ‘why’ Keep messages simple
Check understanding
Use props to reinforce learning
How can we assess breastfeeding? (8 points)
Baby’s output – urine and stools Baby’s general appearance and behaviour Feeding pattern (length and frequency) Suck to swallow ratio Gaining weight? Nipple shape after feeds; nipple damage Engorgement / blocked ducts / mastitis Use of dummy / nipple shield / supplements
What is mastitis?
An infection of the tissue in the breast
What colour/consistency would we expect babies stool to be on day 1-2 and what is it called?
Thick tarry like substance, black, called meconium
What colour would you expect babies stool to be on days 2-4?
Green (changing from meconium to normal stool)
A suck to swallow ratio of 2:1 is linked with what?
Poor milk transfer
What does painful breastfeeding indicate?
Ineffective attachment
What does engorgement indicate?
Poor milk transfer (possibly caused by ineffective attachment/positioning?
What can blocked ducts cause?
Pain/Mastitis
What colour would you expect babies stool to be after day 4?
Yellowy/very light brown
What are the signs of mastitis?
Pyrexia, pain from breast, sour tasting breast milk, redness, fatigue, generally ‘unwell’
What are some benefits of expressing breastmilk?
SHORT TERM: Tempt baby to feed if sleepy Provide colostrum for at risk baby Kick-start milk production Relieve fullness or engorgement Show mother she has milk Obtain milk for a baby who cannot feed
LONG TERM:
Prevent and manage problems, e.g. mastitis, blocked ducts
Social reasons
Why would you teach hand expression to a woman?
Convenient (no equipment) Best method to obtain colostrum Better hormonal response Target specific areas of the breast Mother can express immediately if baby is admitted to neonatal unit
What are the principles of hand expression?
Wash hands and have a sterile container to collect milk Find the right spot Compress and release Rhythmic movement Small drops, then squirts Rotate as flow lessens (if required)
How can let downs be promoted?
Gentle breast massage (no dragging of skin) Gentle nipple rolling Warm flannels Back massage Touch / smell / photo of baby Relaxing atmosphere – music, soft lights
How should breast pumps be used?
Massage breast Centre nipple ensuring a good fit Increase vacuum slowly until slightly uncomfortable (not painful) then back 10% Pump until milk flow decreases Massage and pump again
How many times should breastmilk be expressed for a sick or preterm baby?
8-10 times a day
How long can breastmilk be stored?
Guidance varies between organisation: According to UNICEF BFI: Fridge - 5 days (if 4 degrees or lower) Ice compartment of fridge: 2 weeks Freezer: 6 months
According to NHS:
Fridge: 8 days (if 4 degrees or lower)
Ice compartment of fridge: 2 weeks
Freezer: 6 months
According to La Leche League: 666 rule Room Temp: 6 hours Fridge: 6-8 days Freezer: 6 months
How can we assess expressing?
8-10 times per 24 hours Good milk flow Good milk volumes Confidence in technique Breast fullness before expression, softer breasts after expression Nipple damage/trauma?
