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
When lower lip is stroked, baby’s tongue should
come forward
