Promoting breastfeeding in challenging circumstances Flashcards
What is breastmilk?
the first natural food for babies providing energy and nutrients that the infant needs for the first months of life and continues to provide up to half of its energy requirements during the second half of the first year of its life (WHO 2008)
How to ensure effective attachment?
C- comfortable (encourage mum to be comfortable)
C- close to mum (skin to skin ideally)
H- head free
I- In line, body is in line with the neck and head
N- nose to nipple
mum may find it helpful to hold the breast using a c hold to direct the nipple towards to roof of the baby mouth (once attached she can let go)
wide open mouth, baby should be swiftly brought onto breast, chin leading, aim the nipple to the back of the babies mouth
babies bottom lip curled under, nose should be close but clear, more areola visible above top lip than bottom
round cheeks in baby
quiet feeding, no clicks or sucks but swallowing may be heard
uncomfortable momentarily while the nipple is being drawn out but after a few seconds should be painless
initial rapid sucks while waiting for the let down, then sucks become deeper and longer
pauses from sucking and spontaneously starting again is normal
spontaneously leaves the breast
discuss skin to skin
baby rests directly on the mothers bare chest. regulated babies temperature, heart rate, respiration rate, stimulation of gastrointestinal tract, introduction to skin bacteria and the beginning of emotional attachment.
Systematic review Moore et al (2012) - babies that received skin to skin cried less, breast fed for longer and had better cardio and respiratory stability.
what is tongue tie?
Tongue-tie (ankyloglossia,) occurs when the frenulum, or piece of tissue which bridges the gap between the underside of the tongue and the floor of the mouth is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum. (UNICEF 2017)
how does tongue tie effect breast feeding?
an inability to move the tongue in a normal way and therefore attach and suck effectively. causes sore nipples and poor weight gain in baby.
inefficient attach doesn’t rove milk from the breast (can causes other problems) and is difficult to maintain a latch, baby will slip off the breast and chop with the gums causing trauma to the nipple
how to correct tongue tie problems?
Many tongue-ties are asymptomatic and do not require treatment and some may resolve spontaneously over time. In some instances, support to improve attachment is all that is needed. However, if the condition is causing problems with feeding, surgical division of the lingual frenulum can be recommended and carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding. (UNICEF, 2017) NICE has approved the division of tongue tie.
how is tongue tie corrected?
doesn’t require GA if they’re under 8 months
takes minutes
baby is wrapped in towel
tongue is divided with sterile scissors
often not painful at all (average cry for 15 seconds)
few drops of blood, inside mouth heals quickly
what is engorgement?
an excessive build up of milk within the breast (UNICEF, 2017)
how can engorgement be prevented?
feeding frequently so milk is removed
making sure positioning and attachment are effective
avoiding infant formula which replaces breastfeeding
avoiding dummies which may reduce the frequency of breastfeeding
how can engorgement be treated?
important to manage quickly in order to prevent complications such as reduced supply, blocked cuts and mastitis
regular feeding (recognise feeding cues) - restlessness, putting fingers in mouth, rooting, rapid eye movement, smacking lips
gently hand expressing milk at the start of feeds to dotted the tissue
if breasts remain full after feeds express again until comfortable to prevent milk stasis
warm cloths / warm baths submerging breasts can help flow milk more easily.
wear a well fitting and non restricting bra
chilled cabbage leaves after feeding or expressing can reduce pain and swelling
paracetamol of ibuprofen
what is mastitis?
inflammation of the breast (unicef 2017) NHS 2017 happens when milk stasis causes a blocked duct which is not relieved, makes the breast feel painful and inflamed , flu like symptoms.
starts as non-infective, if left you’ll need to take antibiotics
what are the symptoms of mastitis?
hot and tender breasts
red patch that is painful often in triangular wedge of tissue
fever
feelings achey, tired and tearful
how to resolve mastitis?
seek assistance on positioning and attachment
carry on breastfeeding
let your baby feed on the under breast
if the effected breast is not emptied then express
warmth (flannel or bath)
rest
analgesia
if in 12-24 hours can elapse to ascertain whether the mastitis has resolved (midwife review) and referral to GP for antibiotics if no improvement (flucloxacillin, cephalexin, erythromycin)
how do you get candida (thrush) infection in the breast?
happen when nipple become cracked or damaged, candida fungus can enter the breast and cause breast and nipple pain.
can also occur after a course of antibiotics (reduces the number of helpful bacteria in the body allowing the candida fungus to flourish)
signs of thrush in breastfeeding woman:
pain in both nipples or breasts after feeds after previously having no pain after feeding
severe pain that lasts up to an hour after every feed
