Nurse’s responsibility to support the parents and promote the families sense of confidence no matter which type feeding the parents are choosing.

Recognize that cultural values influence infant feeding practices, be sensitive to ethnic background of minority populations, and understand that the dominant culture in any society defines “normal” maternal-infant feeding interaction.

Nurse’s responsibility to give new parents the knowledge, confidence, and support to do either.

Encourage early feedings of breast or bottle to stimulate peristalsis, facilitating elimination of the by product of bilirubin conjugation which decreases the risk for jaundice and enhances maternal infant attachment.

Encourage feeding within one hour after birth.

The normal used to be breastfeeding until the 20th century when “modern mothers” began to want more freedom from their home and babies.

Formula became the norm by the 1950’s, and formula companies began to cash in. Infant formula is the only product mass-marketed through hospitals to the public.

Today the attitude has shifted many mothers believe that they can be a modern mother and still breastfeed.

Today the goal for Healthy People 2020 is to increase the breastfeeding rate to 75% of the population.

The breast is composed of glandular tissue that has a tree like structure that is surrounded by supportive, nutritive, and protective tissue including connective tissue, fat, and lymphatic tissue and blood vessels.

The nipple has ten to twenty large branches lobes. Branching from the lobes are lobules that branch further

into ten to one hundred sac-like structures called alveoli. The alveoli are where milk is produced. The alveoli are lined with secretory cells called acini which

produce and secrete the milk. Myoepithelial cell surround the acini and contract to eject

milk from the sac through small ductules into larger lactiferous ducts.

The ducts widen toward the nipple into milk collecting areas call the lactiferous sinuses. The infant extracts the milk through the mammary papilla (nipple).

The nipple located slightly below the middle of the breast contains the openings of the milk ducts.

Surrounding the nipple is a dark pigmented area called the areola.

Behind this area lie the lactiferous sinuses. The areola contains the Montgomery

glands, sebaceous glands that secrete a substance for nipple lubrication and antisepsis.

Preparation during pregnancy. Teach mothers to wear supportive bras. Encourage mothers to practice rolling the

nipple between their fingers to promote everted nipples.

Encourage the use of shells for mothers with inverted nipples prior to delivery.

Promote breastfeeding classes and support groups.

Postpartum Hormonal pathways

Birth results in a rapid drop in estrogen and progesterone and an increase in the secretion of prolactin. Prolactin promotes milk production by stimulating the alveolar cells of the breast. Prolactin levels rise in response to suckling.

Let-down reflex Suckling also stimulates the release of oxytocin from the

pituitary gland. Oxytocin increases the contractility of the myoepithelial

cells lining the walls of the mammary ducts, and a flow of milk results this is called the letdown reflex.

Often described as a tingling, prickling sensation as milk comes down, mothers may feel increased cramping, increased lochia, leaking from other breast, and a sense of relaxation. Letdown reflex is stimulated by infants cry, infants presence, suckling, mothers thoughts of infant, and sexual orgasm.

Postpartum Once lactation is established Prolactin decreases, and oxytocin and suckling

facilitate milk production. Production can be decreased if breast are not

emptied regularly and completely to promote production of milk and to increase the quantity of milk. “supply and demand” baby sucks makes amount of milk needed if breasts are not emptied milk backs up in breasts and increases pressure in alveoli which causes milk secretion to decrease.

Milk Stages Colostrum yellow colored fluid present from end

of pregnancy until 2 days after birth, colostrum has increase in protein and decrease in fats and lactose than mature milk. Rich in antibodies and has a laxative effect for baby.

Transitional milk is produced from the end of colostrum production until approx 2 weeks postpartum, this is where engorgement occurs, transitional milk consist of more fat, lactose, and water soluble vitamins

Mature milk has a decrease in concentration of immunoglobulins, decrease in total protein and has increase in lactose, fat, and total calories. 10% solids, rest is water for maintaining hydration.

Timing Before breastfeeding or bottle feeding begins assess

bowel sounds, absence of abdominal distension, and rooting sucking reflex.

Initiate breastfeeding within the first hour after birth in the quiet alert stage, promotes bonding between mom and baby early and increases oxytocin levels to reduce maternal bleeding.

Assess effectiveness of newborns suck, swallow, and gag reflex, circumoral cyanosis, rapid respirations, diaphoresis which may indicate cardiovascular complications. And assess for tracheoesphageal fistula and esophageal atresia (look for increased oral mucus or hx of maternal polyhydramnios.

Positioning use tummy to tummy is best, cradle hold, side lying,

football hold great for c-sections,

Rooting Reflex stimulated by bring the babies lips to mothers nipple

and move the lips back and forth along the nipple don’t touch cheek, infant will move toward finger.

Alternate breasts Try to get infant to nurse on both sides of breast always

start with the one infant nursed on last, unless only nurses on one breast then start with breast infant has not nursed on.

Implications for nurses. Three objectives for breastfeeding

Provide adequate nutrition, to facilitate maternal-infant attachment, and to prevent trauma to the nipples.

Arrange for privacy, assist in finding a comfortable position, use additional pillows for support, evaluate baby’s mouth position, provide reassurance.

Takes time to learn. Pumping and Expression after 24 hours if nursing is not

well established is recommended.

Engorgement painful firmness as milk comes, hard to touch, skin is shiny and taut. Usually disappears within 24-48 h wear support bras, empty breasts fully, frequent feedings.

To treat: keep nursing, use ice bags b/t feedings, hot shower and manual expression to soften nipples, pumping to soften nipples, increase feedings to 20 minutes. Apply warm compresses, cabbage leaves on inside of bra (reduces edema). Analgesics shortly before feeding.

Sore Nipples common causes are poor positioning and improper latch, warm compresses, air dry, lanonolin, breast milk on areola a natural emollient, frequently change positions,

La Leche League, lactation consultants, and breastfeeding support groups.

Breastfeeding contraindications Mothers with known HIV/AIDS status, women

diagnosed with breast cancer so they can begin treatment, chronic carriers of Hep B, herpes simplex virus only if active lesions on breast, TB, Cytomegalovirus Infection (CMV).

Galactosemia-baby’s intolerance of lactose,

Certain drugs: Tegretol and Dilantin, or other antibiotics which may be toxic to infant

Mastectomy

Timing Positioning http://newborns.stanford.edu/Breastfeeding/ABC

s.html#ABCs Assessment

mom-motivation and desire, knowledge, physical exam of nipple shape, inverted, everted, flat, level of anxiety, modesty

infant assess alignment, areolar grasp, areoloar compression, audible swallowing. Observation is imperative for support, trouble shooting and teaching.

The key to success is making sure a proper latch is established

Knowledge Deficit about breastfeeding, Altered comfort (mom), Altered nutrition less than body requirement (baby). Interventions

a. positions for mom b. relaxed environment c. teach signs engorgement etc. d. latching on –c-hold, asymmetric latch e. breaking suction f. frequency and length of feedings

Evaluation successes and support.

http://www.babycenter.com/breastfeeding

http://www.lalecheleague.org

http://www.breastfeeding.com