Facilitating Initiation of Lactation

Question 1

What does the WHO recommend for skin to skin after birth?

Answer 1

Uninterrupted skin-to-skin from the moment of birth until after the first feeding. Initiation of breastfeeding is often the result of direct skin to skin contact.

Question 2

How long will it take for a healthy term infant to self-latch if placed skin to skin at delivery

Answer 2

They will self latch within the first hour

Question 3

Some examples of interventions that should be delayed, minimized or eliminated in the first hour of life

Answer 3

• suctioning
• routine procedures (weight, measurements, eye prophylaxis, vitamin K
• bathing

Question 4

Nine behavioural phases an infant will progress through when allowed uninterrupted skin-to-skin in the first hour

Answer 4

Crying, relaxing, awakening, being active, crawling, resting, familiarizing, suckling, sleeping

Question 5

What is an infant safety concern to be aware of during continuous skin-to-skin?

Answer 5

Sudden Unexpected Postnatal Collapse (SUPC)

Question 6

List some elements of fostering an environment that supports the establishment of breastfeeding

Answer 6

1. The dyad should remain together as much as possible
2. routine infant assessments should take place in the infant’s room
3. healthcare providers should be aware of the impact of interrupting nursing
4. provide for the parents emotional and physical comfort
5. cluster care to minimize intrusion in the family space

Question 7

Four indicators of an effective latch

Answer 7

• Upper and lower lips are flanged outward
• tongue is cupped under the breast and is visible above the lower gum ridge
• wide gliding jaw movements
• no nipple pain or trauma

Question 8

Signs of an ineffective latch:

Answer 8

• tight, pursed lips
• lower lip pulled in
• dimpling of the cheeks
• nipple pain
• flattened or misshapen nipples

Question 9

Is clicking or smacking always a sign of a poor latch?

Answer 9

Not necessarily. A baby with a good latch can learn to release suction with an overactive let down, for example. Take whole picture into context.

Question 10

One suck per second typical of ______ sucking

Answer 10

nutritive sucking

Question 11

Rate of sucking in nonnutritive sucking

Answer 11

about 2 sucks per second with minimal or no swallowing

Question 12

Crying is a _____ indicator of hunger

Answer 12

Late

Question 13

Minimum number of feeds in 24 hours

Answer 13

8

Question 14

Elimination patterns that might indicate potential feeding problems

Answer 14

• Not passing transitional stool by day 4
• having fewer than 6 voids per day by day 4
• appearance of urate crystals after day 3
• fewer than 4 daily stools by day 4
• continuation of meconium stool by day 5

Question 15

Steps to evaluate a feeding (every 8-12 hours in the first days PP

Answer 15

• assess for effective latch and position (correct as needed)
• improve the latch if any nipple pain, even if infant appears to be swallowing and satisfied
• assess for milk transfer (sustained rhythmic suck-swallow-breathe + swallowing
• evaluate end of feeding (nipple rounded, parent relaxed, infant relaxed and satiated)

Question 16

Some reasons for failure to latch and feed

Answer 16

• drowsy as a result of labour medications
• mechanical or physical results of labour and delivery
• separation of dyad
• prematurity
• infant illness or congenital anomolies
• parental physical or psychological issues
• challenging anatomy

Question 17

If the infant is unable to feed effectively after first 24 hours, what needs to be done?

Answer 17

Protect the milk supply, feed the baby

Question 18

Teach hand expression within ______ hour(s) of birth

Answer 18

one

Question 19

Healthy infant’s average intake of colostrum

Answer 19

first 24 hours: 2-10ml
24-48 hours: 5-15 ml
48-72 hours: 15-30ml
72-96 hours: 30-60ml