Section 5: Teaching the Skills of Breastfeeding Flashcards
Cross cradle nursing position
- Align baby’s so that it doesn’t go past the nipple
- Right hand under baby’s face - pillow for cheek, support weight of head with hand
- sit baby’s bottom on arm (as if it were a shelf)
- or let baby’s bottom fall diagonally a bit and squeeze against rib cage
- Wrap body and legs around mother
- Pull baby’s bottom into body with inside/underside of forearm
- this brings baby to breast with nipple pointing to roof of moutn
- Head supported but NOT pushed against breast
- Head tilted back slightly, nose up and chin coming into breast (nose never touches breast)
- Use whole arm to bring baby onto breast when mouth is wide
- Baby’s chin should be far away from chest
Proper latching
- WATCH LOWER LIP, aim it as far from base of nipple as possible, so tongue draws lots of breast into mouth
- Move baby’s body and head together – keep baby uncurled
- If you keep your wrist straight, with baby’s cheek resting on your fingers, then baby’s chin will not bend down toward his chest
- Once latched, baby’s top lip will be close to nipple, areola shows above lip
- Keep baby’s chin close against your breast
- move baby toward breast, touch top lip against nipple
- move mouth away SLIGHTLY
- touch top lip against nipple again, move away again
- repeat until baby opens wide and has tongue forward
- Or, better yet, run nipple along the baby’s upper lip, from one corner to the other, lightly, until baby opens wide
Avoid placing baby down in a feeding position until
- you are completely ready to latch baby
- The longer baby waits while you get ready (undoing your breast, etc) the more frustrated baby gets and the less open baby’s mouth will go.
Mother’s view while latching baby
Mother’s view of nursing baby
Mother’s posture when nursing
- Sit with straight, well-supported back
- Trunk facing forwards, lap flat
Baby’s Position Before Feed Begins
Nipple points to the baby’s upper lip or nostril
Baby’s Body when nursing
- Placed not quite tummy to tummy, but so that baby comes up to breast from below and baby’s eyes make contact with mother’s Support Breast
- Firm inner breast tissue by raising breast slightly with fingers placed flat on chest wall and thumb pointing up (if helpful, also use sling or tensor bandage around breast)
Move baby quickly onto breast
- Head tilted back slightly
- pushing in across shoulders so chin and lower jaw make contact (not nose) while mouth still wide open
- keep baby uncurled (means tongue nearer breast)
- lower lip is aimed as far from nipple as possible so baby’s tongue draws in maximum amount of breast tissue
Mother needs to AVOID
- pushing her breast across her body
- chasing the baby with her breast
- flapping the breast up and down
- holding breast with scissor grip
- not supporting breast
- twisting her body towards the baby instead of slightly away
- aiming nipple to centre of baby’s mouth
- pulling baby’s chin down to open mouth
- flexing baby’s head when bringing to breast
- moving breast into baby’s mouth instead of bringing baby to breast
- moving baby onto breast without a proper gape
- not moving baby onto breast quickly enough at height of gape
- having baby’s nose touch breast and not the chin
- holding breast away from baby’s nose (not necessary if the baby is well latched on, as the nose will be away from the breast anyway)
Strategies that promote breastfeeding success include
- initiating early breastfeeding,
- encouraging frequent breastfeeding,
- encouraging rooming-in,
- providing skilful assistance,
- discouraging routine formula supplementation,
- teaching mothers to recognize the signs of adequate milk intake in their infant
- most important of all, educating mothers about the association between sustained milk supply and efficient removal of milk from the breast.
What is the most important strategy for breastfeeding success?
educating mothers about the association between sustained milk supply and efficient removal of milk from the breast.
The optimal time to initiate breastfeeding is
- as soon as the situation allows
- If the birth has been uncomplicated, the mother should be encouraged to breastfeed immediately.
The benefits of early initiation of breastfeeding for both mother and baby include the following
- Reducing postpartum blood loss because infant suckling stimulates the uterus to contract.
- Taking advantage of the newborn’s alertness immediately following birth to establish latching-on and suckling.
- Ensuring the baby will receive the immunologic and laxative benefits of colostrum. The laxative effects stimulate the elimination of meconium.
- Ensuring the stimulation of milk production and reducing the risk of engorgement.
- Increasing infant/mother bonding.
- Enhancing breastfeeding success and contributing to the continuation of breastfeeding.
In order to support a new mother and her infant as they initiate breastfeeding, it is important to
- Provide an environment that is private, quiet, and conducive for teaching and learning.
- Find the most comfortable position for the mother
BF positioning for cesarean delivery
- Women who have had a Caesarean delivery may find sitting in bed withthe support of several pillows comfortable
- ask her what will help to achieve the most comfortable position for her.
Chair sitting positioning for breastfeeding
- choose one with low arms that can accommodate pillows
- have the mother sitting as close as possible to a 90° angle
- This will allow her breasts to be at an angle that will accommodate latch-on
- use a footstool to raise the mother’s kneesslightly above her lap.
Lying down position breastfeeding
- mother well supported by pillows under head, at her back, between her knees, and at the foot of the bed to raise her knees slightly
- baby should be at breast level.
The following principles apply to all breastfeeding positions:
- Supporting the breast because - firmer for easier latch-on, keeps the weight of the breast off the baby’s chin.
- Bringing the baby to the breast, not the breast to the baby.
- Having the baby directly face the breast.
- Making sure the baby’s body is well aligned.
- Stimulating the rooting reflex by tickling the baby’s lips with the mother’s nipple.
- Bringing the baby quickly to the breast when his or her mouth opens wide.
- Ensuring the baby’s nose and chin are touching the breast.
One of the most important factors in breastfeeding is always
maintaining correct positioning of the baby while suckling at the breast
Cradle Hold Position
- mother sits with back supported,
- baby at breast level,
- baby’s body directly faces breast
- baby’s head on mother’s forearm, not in the crook of the elbow,
- mother supports her breast with her opposite hand,
- mother’s other hand is on baby’s bottom to help pull the baby in close to her body, “tummy to tummy”
- pillow for arm rest or foot stool optional
Lying Down Position
- baby’s body well aligned at breast level,
- baby facing mother’s body and breast
- slight elevation of mother’s head
- pillows to support mother’s back and between her knees,
- the hand on the mother’s top side supports the lower breast and guides it into the infant’s mouth,
- the mother supports her breast with one hand and holds the baby close with the other
- the baby’s position can be maintained by supporting the back with a rolled towel
- it is sometimes helpful for the mother to roll slightly toward the baby to geta deeper latch.
Lying down position is beneficial for mothers who
have had Caesarean births, or are unable to sit comfortably.
Foodball hold position
- baby is tucked like a football under the mother’s arm on the same side she is nursing from,
- baby should be facing the mother’s breast with feet pointing toward the mother’s back,
- baby is raised to breast level and lined up “nose to nipple,”
- baby’s head is held behind the ears,
- baby’s body directly faces the mother’s breast,
- baby’s body is well aligned,
- mother’s hand supports her breast position,
- mother’s back is supported in a comfortable straight-backed chair tomaintain a 90° angle
- mother has both feet on a footstool.
football position allows the mother to
have more control when her baby needs extra head support
Premature infants are often held in what position.
football hold
Modified cradle hold position
- baby’s head is raised to breast level,
- baby directly faces the mother’s breast, tummy to tummy,
- mother supports her breast position with her one hand,
- mother supports baby’s head at the base of his or her head
- use of a footstool is advised to help maintain position.
Modified cradle hold is especially helpful for
a mother who has a premature or sleepy baby.
Correct latch-on requires
- baby correctly positioned at the breast
- displays a willingness to breastfeed.
Teaching correct latch on - offering breast to baby
- Instruct the mother to hold her breast with four fingers underneath, well behind the areola, to support the weight of her breast.
Teaching correct latch - encouraging baby to open mouth wide
- There are various approaches to encourage the baby to open its mouth wide one of which is to tickle the baby’s top lip.
- When the baby opens its mouth wide, have the mother pull the baby onto the breast quickly, so that it can take as much of the nipple and areola into its mouth as possible.
Teaching correct latch - how to tell if baby is latched properly
The baby’s lower lip should be curled out with its chin, and its nose should touch the breast
If the baby does not latch on correctly the first few times,
have the mother try again until correct latch-on is accomplished.
How to detach baby from the breast
- place a finger into the side of the baby’s mouth between the gums, break the suction, then take the baby away from the breast.
- Breaking the suction prior to removing the baby from the breast will reduce nipple trauma.
Reassuring signs of adequate milk intake/normal postpartum progress
- Baby skin to skin several times a day for 60-90 min
- Bbay in mother’s arms most of the time, sleeps within reach
- Baby alert around 10 hrs/day, cues for feeds 8+ times/day, obviously satiated after feeds
- Baby rarely cries, mom responds quickly to early feding cues
- Baby actively suckles at least 140 min/day, 5-1 times with audible swallowing, realeases breast spontaneously
- after feeds, nipples are comfortable, wet, intact
- breasts softer after feeds
- both mom and baby comfortable/drowsy
- Baby’s mucous membranes wet/responsive skin turgor
- Baby passes 5+ loose/yellow stools per day after first week
- Baby soaks 6+ diapers per day by end of first week, urine is clear
- Mother reports milk came in
- mom is confident with ability to calm/feed baby
What is the first and often only fix needed for breastfeeding problems?
Fix latch and positioning
What should you do if the baby falls asleep after latching?
- Keep baby skin to skin
- watch for cues that baby has cycled through deep sleep and is beginning to awaken
- arm/leg movement
- mouthing
- grimacing
How to assess baby’s moutn
- Mouth should be wide and gently domed
- tongue should be long enough to extend over lower gum
- note baby’s response to light stroking of lower lip - tongue will come forward
- frenulum should be far enough away from tip of tonuge to prevent stricture during suckling
Tongue Tie
Lip tie
Digital examination for breastfeeding problems
- Use clean, gloved finger with short nail
- slide into baby’s moutn pad side up, nail side down
- tongue should groove around finger
- when pad of finger touches the palate, baby usually initiates a suck response
- includes massaging by tongue on underside of finger from knuckle to tip
- nail bed should feel as if it is being pulled deeper into baby’s mouth
- suction should be rhythmic
- may stop when they realize it is not a breast
Urine output usually exceeds fluid intake for the first
3-4 days after birth
When is the neonate at risk for dehydration?
after 24 hours without receiving fluid nutrient
Guidelines for the infant who does not latch
0-24 hours
- no supplement necessary as long as baby has periods of awake/quiet, normal vitals and blood sugar
- Attempt to breastfeed during quiet, alert times at least every 3hr
- Encourage quiet environment
- If not latched by 18-24 h, provide pump
- pump at least 9 times in 24 hr
- Alternative: Teach mother hand expression
Guidelines for the infant who does not latch
24-48 hrs
- Attempt to breastfeed every 3 hr
- If unsuccessful after 10 hrs, feed expressed = 10=15 ml
- Apply nipple shield if baby too weak to latch or mother has flat/inverted nipples
- continue to pump
- use alternative feeding methods as appropriate (finger feed, sppon, cup, slow flow nipple)
- continue skin-to-skin, quiet environment
- Continue pumping at least 8 times in 24 hr
Guidelines for the infant who does not latch
>48 hrs
- Attempt breastfeeding every 2-3 hrs
- If unsuccessful, give expressed breastmilk = 30-60 ml or breastmilk + formula to equal same
- Consider nipple shield if neeed
- Use alternative methods (cups, spoons, etc)
- Continue skin to skin/quiet environment
- Continue to pump at least 8 times/24 hr
Neonatal feeding amounts for day 1
- Few drops to 5 ml per feed
- few drops to 2 tbsp in 24 hr
Nonatal feeding amounts day 2
- 5-15 ml
- 1/4 to 1/2 cup in 24 hr
Nonatal feeding amounts day 3
- 15-30 ml
- 1/2 to 1 cup in 24 hr
Nonatal feeding amounts day 4
- 30-45 ml
- 1.5 cups in 24 hrs
Nonatal feeding amounts day 5
- 45-60 ml
- 1.5-2 cups in 24 hr
Helping baby latch if mother has inverted/flat nipples
- teach mother to compress breast tissue into proper shape
- push down on breast gently as baby latches
- Pull back on breast tissue so nipples protrude
- pump to pull out nipples
- Use nipple shield twice weekly
- use nipple expandingdevice
- wear shells between dfeedings
First feedings
- initiate breastfeeding ASAP following birth.
- should be unrestricted and frequent
- feed on the first breast and then offer second breast
- If the baby does not take the second breast, it should be offered first at the next feeding.
Breastfed infants should brestfeed how much?
8-12 times in 24 hrs
How many wet diapers should a baby have by end of the first week?
6-8 heavy, wet diapers per day
How many bowel movements should the breastfed baby have for the first 4 weeks?
pass a bowel movement with each feeding or second feeding
What is a normal suckling pattern?
Suck-pause-suck
what provides the greatest volume in a feeding
foremilk
The hindmilk is
high in fat content and is available in less volume
. Making sure the baby receives the hindmilk is important because
it contains the fat necessary for growth.
There is a relationship between the milk flow and
suckling rate.
Is all suckling associated with a swallow?
- NO
- as evidenced by the less frequent swallowing near the end of the feed.
The change in the suck–swallow ratio results from
the availability of milk.
Normal, healthy newborns that are breastfed do not require
complementary or supplementary feedings.
How to teach the mom who asks“How do I know my baby is getting enough milk?”
breastmilk is quickly digested and babies will want to feed frequently
Reassuring signs of adequate milk intake and normal postpartum progress toward the end of the first week include:
- six or more wet diapers per day
- five or more loose, yellow stools per day
- weight gain
- contentedness between feedings
A baby will indicate hunger eight or more times a day, and obvious satiety after feeds.
What is the baby friendly initiative?
- international program to increase breastfeeding worldwide.
- Global decline in BF rates in the last century
- In 1991, in response to these concerns, the World Health Organization and United Nations International Children’s Emergency Fund (WHO/UNICEF) launched the Baby-Friendly Initiative (BFI)
What are the Ten Steps to Successful Breastfeeding
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding soon after birth.
- Show mothers how to breastfeed and how to maintain lactation if they are separated from their infants.
- Give newborn infants no food or drink other than breastmilk unless medicallyindicated. (Included in this step is the requirement that a “baby friendly” healthfacility must pay the fair market price for all formula and infant feeding supplies that [are] used and cannot accept free or heavily discounted formula and supplies.)
- Practice rooming-in and allow mothers and infants to stay together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer others to them on discharge from the health facility.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Have a written breastfeeding policy that is
routinely communicated to all health care staff.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Train all health care staff in
the skills necessary to implement this policy.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Inform all pregnant women about
the benefits and management of breastfeeding.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Help mothers initiate breastfeeding
soon after birth.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Show mothers how to
breastfeed and how to maintain lactation if they are separated from their infants.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Give newborn infants no food or drink other than breastmilk unless
medically indicated
Included in this step is the requirement that a “baby friendly” health facility must pay the fair market price for all formula and infant feeding supplies that [are] used and cannot accept free or heavily discounted formula and supplies.)
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Practice
rooming-in and allow mothers and infants to stay together 24 hours a day.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Encourage
breastfeeding on demand.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- Give no
artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
- foster the establishment of
breastfeeding support groups and refer others to them on discharge from the health facility.
The Baby-Friendly Initiative has been proven to
- increase breastfeeding rates
- reduce complications
- mprove mothers’ health care experiences
- it represents a standard of care that all health facilities in all countries should strive to attain.
Signs of adequate milk supply/ normal postpartum progress
Baby skin-to-skin several times a day for how long?
60-90 min
Signs of adequate milk supply/ normal postpartum progress
Post feeding
after feeds, nipples are comfortable, wet, intact
Signs of adequate milk supply/ normal postpartum progress
Monitoring for dehydration
Baby’s mucous membranes wet/responsive skin turgor
Signs of adequate milk supply/ normal postpartum progress
After feeds, mom and baby should be
comfortable/drowsy
Signs of adequate milk supply/ normal postpartum progress
After feeds, breasts should be
softer
Signs of adequate milk supply/ normal postpartum progress
Suckling and feeding
- Baby actively suckles at least 140 min/day, 5-1 times with audible swallowing
- realeases breast spontaneously
Signs of adequate milk supply/ normal postpartum progress
Crying
- Baby rarely cries, mom responds quickly to early feding cues
Signs of adequate milk supply/ normal postpartum progress
urine
- Baby soaks 6+ diapers per day by end of first week
- urine is clear
Signs of adequate milk supply/ normal postpartum progress
Stools
Baby passes 5+ loose/yellow stools per day after first week
Signs of adequate milk supply/ normal postpartum progress
Alertness and feeding
- Baby alert around 10 hrs/day
- cues for feeds 8+ times/day
- obviously satiated after feeds
Signs of adequate milk supply/ normal postpartum progress
Mother’s feelings
mom is confident with ability to calm/feed baby
Signs of adequate milk supply/ normal postpartum progress
Milk status
Mother reports milk came in
Signs of adequate milk supply/ normal postpartum progress
Sleeping
Baby in mother’s arms most of the time, sleeps within reach
Benefits of early breastfeeding
Ensuring baby receives
- immunologic and laxative benefits of colostrum
- The laxative effects stimulate the elimination of meconium.
Benefits of early breastfeeding
Reducing postpartum blood loss
because infant suckling stimulates the uterus to contract.
Breastfeeding positioning
Ensure baby’s mouth and chin are
touching the breast.
Breastfeeding positioning
When the baby’s mouth opens wide
Bring the baby quickly to the breast
Breastfeeding positioning
Stimulate the rooting reflex by
tickling the baby’s lips with the mother’s nipple.
Breastfeeding positioning
Make sure baby’s body is
well aligned.
Breastfeeding positioning
Have baby directly face
the breast.
Breastfeeding positioning
Bring baby
- the breast
- not the breast to the baby.
Breastfeeding positioning
Support the breast because
- firmer for easier latch-on
- keeps the weight of the breast off the baby’s chin.
Baby’s mouth should be
wide and gently domed
Baby’s tongue should be
long enough to extend over lower gum
When lower lip is stroked, baby’s tongue should
come forward
Frenulum should be
far enough away from tip of tonuge to prevent stricture during suckling
Why should the breast be supported during breastfeeding?
- firmer for easier latch-on
- keeps the weight of the breast off the baby’s chin.
Baby should direclty face
the breast
When latching, stimulate the rooting reflex by
tickling the baby’s lips with the mother’s nipple.
When latching, bring the baby quickly to the breast when
his or her mouth opens wide.
ensure baby’s nose and chin are
touching the breast.
In cradle hold, where should the baby’s head rest?
mother’s forearm, not in the crook of the elbow,
In modified cradle hold, where does mother support baby’s head?
- At the BASE of the head
When bringing baby in for latch, push across
- shoulders
- so chin and lower jaw make contact (not nose) while mouth still wide open
When bringing baby in for latch, keep baby
uncurled (means tongue nearer breast)
When bringing baby in for latch, how do you aim the lower lip?
- as far from nipple as possible
- so baby’s tongue draws in maximum amount of breast tissue
why do breastfed babies want to feed frequently?
breastmilk is quickly digested
What are reassurng signs of adequate milk intake?
- six or more wet diapers per day
- five or more loose, yellow stools per day
- weight gain
- contentedness between feedings
- obvious satiety after feeds
.
how many times a day will a baby indicate hunger?
- eight or more times a day
Lower lip when latching
aim it as far from base of nipple as possible, so tongue draws lots of breast into mouth
When latching, how to keep baby’s chin from bending toward chest
keep wrist straight with baby’s cheek resting on fingers
Once latched, baby’s top lip will be
- close to nipple
- areola shows above lip
When latching, keep baby’s chiin
close against your breast
When latching, how to encourage baby open mouth wide
- move baby toward breast, touch top lip against nipple
- move mouth away SLIGHTLY
- touch top lip against nipple again, move away agai
- repeat until baby opens wide and has tongue forward
OR:
- run nipple along the baby’s upper lip, from one corner to the other, lightly, until baby opens wide
