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NURS 330: Obstetrics > LEC 6: Breastfeeding > Flashcards

LEC 6: Breastfeeding Flashcards

1
Q

What are the 10 steps to successful breastfeeding?

A
  1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff
  2. Train all health care staff in skills necessary to implement this policy
  3. Inform all pregnant women about the benefits and management of breastfeeding
  4. Help mothers initiate breastfeeding within a half-hour of birth
  5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants
  6. Give newborn infants no food or drink other than breast milk unless medically indicated
  7. Practice rooming-in – allow mothers and infants to remain together 24 hours a day
  8. Encourage breastfeeding on demand
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
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2
Q

Health Impact of Breastfeeding on Infants

A
  • During infancy breastfeeding reduces the risk of:
    • Acute otitis media
    • Atopic dermatitis
      • Eczema
    • GI infections
      • Diarrhea, gastro0enteritis, and tummy upset
    • Lower respiratory tract disease
    • Asthma
    • SIDS
  • Beyong infancy breastfeeding protects against
    • Obesity
    • Risk of CV disease
    • Auto-immune disease
    • Type 1 and 2 diabetes
    • Childhood leukemia
  • Breastmilk is recommended for all babies, especially for preterm infants
    • Preterm breastmilk has more protein, fat, antibodies, and lactoferrine than mature milk, making it more sutied for the needs ot preterm babies than any artificial formula
    • Human milk offers protection against Necrotizing Enterocolitis (NEC) and bacteria
    • Breastmilk may be expressed and used before the baby is able to breastfeed
    • Fresh breastmilk when available maintanins better protective quality than frozen (destroyes leykocytes)
    • There are also anti-allergic benefirst of breastmilk. Healthcare professional should assess for family history of eczema, asthma, food allergies
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3
Q

Health Impact of Breastfeeding on Mothers

A
  • Some known benefits of breastfeeding for mothers include
    • Foster healthy attachment between mother and chold
    • Foster recovery from birth
    • Convenient and less costly
    • Environmentally friendly
  • Woman who do not breastfeed are at a higher risl of
    • Developin anemia
    • Retaining fat deposited during pregnancy, which may later result in obesity
    • Become pregnant soon after the baby’s birth
    • Breast cancer
    • Hip fracturs in older age
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4
Q

What dose breastmilk contain?

A
  • Antobodies
  • Living cells
  • Enzymes
  • Hormones
    • Artifical milk does not contian these things
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5
Q

Risk with Formula for In fants and Children

A
  • Asthma
  • Allergy
  • Reduced cognitive
  • Respiratory infection
  • Ear infections
  • Dental malformations
  • Gastroenteritis/ diarrhea
  • Nutrient deficiency
  • Childhood cancers
  • Chronic diseases
  • Diabetes
  • Obesity
  • SIDS
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6
Q

Formula Increases Mother’s Risks for:

A
  • Breast cancer
  • Ovarina cancer
  • Osteoporosis
  • Rheumatoid arthritis
  • Diabetes
  • Overweight
  • Reduced natural child spacing
  • Increased stress and anxiety
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7
Q

Nutritional Needs of Breastfeedig Mothers

A
  • It is recommeneded that mothers eat a balanced diets based on a variety of healthy foods, and eat as theor appetitie dictates
  • Mothers should drink to satisy their thirs- a mother does not have to drink milk to make milk
  • It is best for mothers to limit thire caffine intake (including coffee, tea, cola, and chocolate)
  • Limit alcohol intka. Although the is no known “safe” amount of alcohol in breastmilk, occasional moderate alcohol intake is compatible with breastfeeding
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8
Q

Medications and Breastfeeding Mother

A
  • There is ever changing information related to breastfeeding and medications, however very few drugs are contraindicated
  • It is rarely necessary to interrupt breastfeeding due to maternal medication
  • The benefits of breastfeeding for mothers and babies usually outweigh the risk of the infant exposure to the drug.
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9
Q

Roles of Partners in Breastfeeding

A
  • Setting the family tone
    • Partners can create a positive family atmosphere toward breastfeeding.
    • If breastfeeding is viewed as making a positive difference in the health and well-being of the baby and as a high priority for his partner and child, this attitude wills et the desired tone for achieving success.
  • Giving support and encouragement
  • Providing practical help
    • Small efforts can make a big difference.
    • Can bring a hungry infant to the breastfeeding mother when the baby wakrs up and help with burping and diaper changes
    • Help with chores such as cleaning, meal preparation, and laundry
  • Bulding a relationship with the baby
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10
Q

Breast Anatomy

A
  • Ducts branch close to the nipple
  • Lectiferous sinuses do not exists
    • The ducts just come stright to the nipple
  • Glandular tissue is found close to the nipple
  • Subcutaneous fat is minimal at the base of the nipple
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11
Q

Sore Nipples

A
  • One of the most common complaints, usually caused by:
    • Incorrect positioning of the baby
    • The mother’s hands or fingers may be over the areola, resulting in the baby being unable to latch successfully beyong the nipple with the gums over the areola
    • If the baby’s frenulum is so short that the tongue cannot extend over the lower gum, and the mother’s nipples have been sore for two to three weeks, consider if the baby should be referred and the frenulum clipped
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12
Q

Interventions to Help with Sore Nipples

A
  • Helping the mother improve latch and positoning
    • If necessary, show the motehr how to feed the baby in different feeding positions
  • Treat skin conditions or remove the source of irritation
  • Explain to mother the importance of a calm and unhurried environment
    • It is helpfulf or the let down reflex to happen
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13
Q

Prolactin

A
  • Milk prduction
  • Produced in anterior pituritary gland
  • Initiates milk production
  • Released in waves in response to stimulation
  • Levels peak middle of the night
  • Prolactin hormone is what makes mom sleepu; sedtes mom to relax and feed baby
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14
Q

Oxytocin

A
  • Milk let down
  • Prodiced in posterior pituitary gland
  • Responsible for milk let down
  • Released in waves in response to suckling
  • Uterine contractions
  • Increased thrist, a warm or flushed feeling
  • Turns the tap on
  • Homones that helps to get the tummy back in shape
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15
Q

Stimulate Let Down

A
  • The baby’s rooting and suchling are the natural stimuli for letdown when breastfeeding is initiated early and the baby is calm. before the bay is overly hungry and begins to cry
  • Breastfeed in a quite and relaxed place
  • Breastfeed before the baby becomes overly hungry and begins crying
  • Clothe the baby only in a diper to promote skin-to-skin contact
  • Support the baby in vertical, skin-to-skin position, with nose at the level of the mother’s nipple, to facilitate the normal refelxes and self-latch behaviours
  • If necressary, gently message until letdown occurs
    • Warmth may be applied with a warm wet towel, a warm bath or shower, a heating pad on low, or a water bottler wrapped in a cloth
    • Gently express mse breastmilk out
  • Leave breastmilk in the nippler after feeding, allowing the nipplers to air dry
  • Avoid using bras with plastic liners or wet breast pads resulting in the nippler being kept less moist
  • Assess for possible trush infection in the baby and/or the mother
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16
Q

Outline for Breastfeeding Baby in the Hospital

A
  • The first thre days
  • Baby’s readiness to eat
  • Techniques of good latch
  • Preventing soreness
  • Message and expression
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17
Q

ABC Model

A
  • Access
    • Is the baby in the restaurant?
  • Building supply
    • Is mom comfortable
    • Breastfeeding should not hurt- if there is soreness then something is wrong
  • Calories
    • Is baby swallowing?
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18
Q

How can you help mothers initiate breastfeeding within a half hour of birth?

A
  • Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage motehrs to recognize when babies are ready to breastfeed, offering help if needed.
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19
Q

Skin-to-Skin

A
  • Stabilize temperature, heart rate, and respirations
  • Increases blood sugar
  • Normal flora (colonize)
  • Skin to skin can help solve breasfeeding problems, prevent hypoglycemia and other newborn difficulties, reduce pain, and set the stage for optimal brain developmemnt.
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20
Q

The Magic of Skin-to-Skin

A
  • Temperature and blood sugars stabilzie
  • Blood pressure and stress hormones decrease
  • Feel good hormone oxytocin released
  • Growth hormones stimulated
  • Appetite and digestive efficiency increase
  • Builds baby’s immune system (colonize)
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21
Q

The Value of Skin-to-Skin COntact

A
  • Maintains body warmth
  • Serves as a pain analgesic
  • Reduces infanct crying
  • Improves maternal attachment
  • Improves breastfeeding
  • Lowers stress levels in mothers
22
Q

Encourgment

A
  • When the mammary glands cause breast expansion and pressure
  • Occurs when milk is not removed, the blood and lymph can become congested and stop flowing, resulting in swelling
    • The breast will become hot, hard and painful, and look tight and shiny
    • The nipple may be stretched tight and flat, which makes it difficult for the baby to latch and which can result in sore nipples
23
Q

Causes of Engorgement

A
  • Delay in starting to breastfeed soon after baby’s birth
  • Poor latch, so that milk is not removed effectively
  • Infrequent feednig, not feeding at night or short duration of feeds
  • Introduction of supplementary feeding is a very common cause:leads to unfrquent or less frequent breastfeeding
  • Temporarily stopping breastfeeding without expressing for the miseed breastfeeds
  • Stress, fatigue
  • Prevention: advice the mother to breastfeed exculsively (no supplements) and frequently through the night
24
Q

Interventions for Engorgment

A
  • Advise the mother to do the following before feeding:
    • Apply heat, massage the breast
    • Areolar expression- by hand: to soften the areolar area to facilitate latching and effective breastfeeding
    • Apply cold cabbahe leaves to the breast leaving the areola free
    • Reverse pressure softening (RPS)
  • In between feeding:
    • Use cold to relieve edema
    • Use analgesics for comfort
    • Use supports for the breast even overnoght
25
Q
A
26
Q

Blocked Ducts

A
  • When stasis and external pressure can cause a bloacked duct
  • Occurs when one or more of the collecting ducts in the breast become plugged with cells, other breast milk compnents
27
Q

Causes of Blocked Ducts

A
  • Infrequent breastfeeding
  • Inadequate removal of milk
  • Local pressure on one area of the breast, from tight clothing, lying on the breast, prssure of themother’s fingers on the breast, or trauma to the breast
28
Q

Assessments of Blocked Ducts

A
  • Unilateral symtpms
    • Mild tenderness
    • Heat
    • Possible redness
    • Palpable lump if the blocked duct is more superficial
    • Potential white dot or bleb at the end of the nipple,
    • Body temperatur of <38.4C
  • Gradual onset of symptoms, otherwise feeling well
29
Q

Interventions for Blocked Ducts

A
  • Remove milk frequently, ensure the baby is fed often
  • Ensure proper latching
  • Offer the baby to the affected breast first- if it’s not too painful
  • Gently message the blocked duct area towards the nipple before and during the feed
  • Ensure properly fitted clothin
  • If the mother has a fever, for longer than 24 hours, symptoms do not subside after 24 hours of frequent and effective feeding or milk ezpression, or the mother’s condition worsens- seek medical assessment
30
Q

Mastitis

A
  • An inflammatory condition of the breast, whoch may or may not be accompanied by infection
  • Mothers can still breastfeed
31
Q

What are contributing factors for mastitis?

A

Inadequate drainage of the breast, stress and fatigue, blocked ducts, sore, cracked nipplers, overabundant breastmilk supplu, engorgement and milk stasis, external pressure on the rbeast, previous history of mastitis in multiparas

32
Q

Interventions for Mastitis

A
  • During breastfeeding encourage mothers to:
    • Offer the affected side first, but can use the unaffected side first if it is too painful
    • Use a variety of positions- use positionts that have the baby’s chin or nose pointing towards the affected area
    • Gently message the affected area during the breastfeeding to promote breastmilk from the area
    • Assess the baby is correctley latched and positoned
    • Assess the baby is effectively sucking and swallowing long enough to effectively remove from the breast
33
Q

Early Brestfeeding

A
  • Quite and alert state
    • Memory imprint
    • Orientate
    • Sucking reflex
  • Colostrum
    • 67 cal/ 100 mL
    • Antibodies- IGA
      • Cannot duplicate IGA
    • Vitamin K
    • High protein
34
Q

How to initiatie early breasfeeding for the normal newborn?

A
  • Keep mother and baby together
  • Place baby on mother’s chest in dipper only (skin to skin)
  • Let baby start suckling when ready
  • Do not hurry or interrupt the process
35
Q

Hunger Cues

A
  • Rapid eye movment
  • Waking, eyes open
  • Squirming, stretching, searching
  • Squeaking, smacking, sucking
  • Rooting
  • Hands to mouth
  • Crying is a late hunger cue
36
Q

How often should a baby be fed?

A
  • Baby’s small stomach capacity
  • Day 1 to 10
    • At least 8 time sin 24 hours in the early days
    • Need small amoutns often
    • Breastmilk is digested in 90 minutes
37
Q

Waking Techniques to Cue Baby to Eat

A
  • Unrawp or unbundle baby
  • Undress baby
  • Burp baby on knee or lap
  • Stimualte rooting reflex
  • Doll’s eye technique
38
Q

What is the key to successful breastfeeding?

A

That the baby gets a good latch to the breast.

39
Q

Positioning

A
  • Want a good drink line
    • Ear, shoulder, and hip stright
    • Tipping back; need to give baby extension so they can breath and eat better
  • Baby up to the level of the breast, facing mom
  • Safe zone is nippler touching the palate
    • Tip baby;s head back, touch nipple to baby’s upper lip.
    • Baby will open wide if mother waits - wait for baby to reach
  • Thumb of hand is at 10 or 2 on the breast
    • Neaver leave at 12 ocklock
    • Mother’s hand does not support the breast well and keeps the baby from latching deep
    • When baby is latching- moms fingers need to come off the areola
40
Q

Mother’s View when Baby is Latching

A
  • Bbay’s head titled slightly back
  • LEAD baby in quickly with base of hand on shoulders
  • Chin touches first
  • Baby’s body close against mother
41
Q

Mother’s View of Nursing Baby

A
  • Head tilted slightly back
  • Chin wll in against breast
  • 5 to 10 sucks- take a breath- 5 to 10 sucks- breath
42
Q

What are we looking for when assessing a feeding?

A
  • Postion of mother
  • Positon of baby
    • Baby’s nose should not be in; want tip back
    • Baby should not be around the nipple
  • Presentation of breast
  • Latch on
  • Nursing patterns
    • Drink and rest
    • Affectively drinking up to the temple
    • Should not be making a “tuk” sound when feeding
  • Removal from breast
43
Q

More Feeds 1st 24 Hours Correlates Strongly with:

A
  • More stools
  • Less weight loss
  • Less jaundice
  • Greater milk intak in days 2, 3, and 5
  • More stimulation now mean more milk later
44
Q

Length of Brestfeeding

A
  • No specific length og time to eat, depends on the baby
    • Baby will let us know when they are done
  • Moms make milk as they feed
  • Feed as often as inffant shows interest
    • If mom says “im feeding every hour and deeds are lasting an hour” red flag
    • Want to know what baby is doing, is baby making “munching” soudns? Can you hear baby swallowing?
  • Feed as long as infant shows interest
45
Q

What is milk transfer dependent on?

A
  • Alignment
  • Areolar grasp
  • Areolar compression
  • Audible swallowing
  • Mom should always offer both sides
  • Good positioning
  • Big open mouth and deep latch
  • Deep effective sustained draws (drinking)
  • Audible swallowing (whispered aaa)
46
Q

For Breastfeeding to Succeed

A
  • The baby able and willing to feed
  • The motehr able and willing to let her baby nurse
  • Breastfeeding should be comfortable and pleasant for both
  • Circumstances and surrounding support the dad and mother feels free to continue
47
Q

What the Infant Food Companies Foget to Tell You

A
  • Its expensive
  • It requires costlier and tiresome sterilization of bottles
  • Damages her immune system
  • It under nourishes the chold if over-diluted
  • Maker baby more prone to infections, especiallu diarrhea
48
Q

Concerns about Not Enough Milk: Signs and Symptoms in the Baby

A
  • Suckling and swallowing
  • Urine and stool output related to age of the baby, after baby has passed meconium
  • Brith weight in first few days
    • Expected weight loss is <10% in first 3 to 4 days; being regains by 2 weeks of age
  • Birth weight in few weeks, baby should regain birth weight by:
    • >112g/ week in first 3 to 4 months
    • 5g/ week in months 4 to 6
    • >42g/week in months 6 to 12
    • Baby usually doubles weight at 5 months and triples it by 12 months
  • General behaviour: no lethargy or irritability; doesn’t refuse breast; watch for content, calm babies that don’t fee adequately
  • Dehydration = late signs
49
Q

Concerns about Not Enough Milk: Signs and Symptoms in the Mothers

A
  • No signs of a let-down or milk ejection reflex (MER)
    • Mothers may not recognize milk let-down unless they feel it but may recognize when the baby’s sucks change from shallow and quick to deep and slow
  • No breast changes after birth, E.g. no breast engorgement or breast milk coming in
  • No breast changes during pregnancy
    • E.g., no tenderness, darkening of the areola, enlargement or leaking
  • One breast that is markedly different in size and/or shape from the other
  • Unusual shaped breasts, E.g. cone shaped
  • Breast injury, surgery, or biopsy in which nerves and ducts in the breasts are damaged
    • E.g. burns to the breast, breast reduction surgery with incisions to the areola and/or nipple
    • Breast implants usually do not affect milk supply
  • Loss of sensation in the breast.
50
Q

Low Milk Production Causes

A
  • Infrequent, scheduled, or short feeds
  • Poor suckling or latch
  • Supplementary feeding (that is, not exclusive breastfeeding).
  • Psychological
51
Q

Low Milk Transfer Causes

A
  • The baby is poorly latched to the breast and not suckling effectively. The baby may seem restless during a breastfeed and may pull away or tug at the breast
  • Breastfeeds are short and hurried or infrequent
  • The baby is removed from one breast too soon
  • The baby is ill or premature and not able to suck strongly and for long enough to obtain the milk the baby needs
52
Q

Improving Milk Intake and Milk Prduction

A
  • Listen to the mother and ask relevant questions
  • Look at the baby: Alertness, appearance, behaviour, and weight chart
  • Offer suggestions
  • Build the mother’s confidence
  • Help the baby to latch well to the breast (more effective positioning)
  • Encourage more frequent feeding
  • Teach the mother feeding cues
  • Encourage skin-to-skin
  • Suggest avoiding pacifiers and artificial nipples
  • Suggest offering the breast to the baby if unsettled
  • Avoiding or reducing supplement use
  • Feed frequently on both breasts
  • Ensure the letdown reflex is initiated

NURS 330: Obstetrics (19 decks)

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