Breastfeeding Skills

Question 1

What are the three things ‘nose to nipple’ helps with?

Answer 1

1. Babies head tilts back
2. Wide open mouth
3. Good deep latch

Question 2

What are the signs of ineffective attachment? (5 points for mum, 6 points for baby)

Answer 2

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

Question 3

What are the signs of effective attachment?

Answer 3

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

Question 4

Subsequent let downs = ??

Answer 4

Higher fat content in milk

Question 5

What does CHINS stand for?

Answer 5

C - Close
H - Head free
I - In line
N - Nose to nipple
S - Sustainability

Question 6

What are some possible breastfeeding positions? (four answers)

Answer 6

Cross cradle, under-arm/rugby ball hold, side-lying, laid back.

Question 7

Before providing BF support, what should we do?

Answer 7

Observe a FULL feed and talk to the mother about how she feels, and what support she would like

Question 8

How can we support effective breastfeeding? (7 points)

Answer 8

1. Get mum and baby in skin to skin contact
2. CHINS
3. Point out instinctive feeding cues (head bobbing, rooting)
4. Rub nipple on baby’s top lip to allow a wide open mouth
5. Check mother’s comfort
6. Point out signs of good attachment
7. ENCOURAGEMENT

Question 9

How can we support a woman to learn?

Answer 9

Explain reasons for what you say – the ‘why’ Keep messages simple
Check understanding
Use props to reinforce learning

Question 10

How can we assess breastfeeding? (8 points)

Answer 10

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

Question 11

What is mastitis?

Answer 11

An infection of the tissue in the breast

Question 12

What colour/consistency would we expect babies stool to be on day 1-2 and what is it called?

Answer 12

Thick tarry like substance, black, called meconium

Question 13

What colour would you expect babies stool to be on days 2-4?

Answer 13

Green (changing from meconium to normal stool)

Question 14

A suck to swallow ratio of 2:1 is linked with what?

Answer 14

Poor milk transfer

Question 15

What does painful breastfeeding indicate?

Answer 15

Ineffective attachment

Question 16

What does engorgement indicate?

Answer 16

Poor milk transfer (possibly caused by ineffective attachment/positioning?

Question 17

What can blocked ducts cause?

Answer 17

Pain/Mastitis

Question 18

What colour would you expect babies stool to be after day 4?

Answer 18

Yellowy/very light brown

Question 19

What are the signs of mastitis?

Answer 19

Pyrexia, pain from breast, sour tasting breast milk, redness, fatigue, generally ‘unwell’

Question 20

What are some benefits of expressing breastmilk?

Answer 20

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

Question 21

Why would you teach hand expression to a woman?

Answer 21

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

Question 22

What are the principles of hand expression?

Answer 22

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)

Question 23

How can let downs be promoted?

Answer 23

Gentle breast massage (no dragging of skin)
Gentle nipple rolling
Warm flannels 
Back massage
Touch / smell / photo of baby
Relaxing atmosphere – music, soft lights

Question 24

How should breast pumps be used?

Answer 24

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

Question 25

How many times should breastmilk be expressed for a sick or preterm baby?

Answer 25

8-10 times a day

Question 26

How long can breastmilk be stored?

Answer 26

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

Question 27

How can we assess expressing?

Answer 27

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?