BREASTFEEDING TEACHING TOOL

Name Joe Dian Gomez

Date: 18 JAN 2012

Reference: Olds, S and others. (2007). Maternal-Newborn Nursing and Women’s Health Care. (8th ed). New York. Pearson-Prentice Hall. Companion Website: http://www.prenhall.com/olds/

Grading Criteria

The Breastfeeding Teaching Tool should be completed prior to the first day of clinical. It will be handed in that day for review by the clinical faculty. It counts as 10 points toward your week one grade. Completion of the Breastfeeding Tool equals 10 points toward your grade for week 1. An incomplete Breastfeeding Tool or one not turned in on day 1 is a fail and 10 points will be deducted from your week one grade.

Instructions: Answer the following questions regarding breastfeeding. You may use your textbook or any breastfeeding information source to assist you.

I. Breast/Nipple Care: A. State three (3) principles of nipple care. B. State two (2) principles of breast care.

C. Explain breast massage.

D. Explain in writing: hand expression of breast milk. 1. the mother will position her thumb at the 12o’clock position on the top edge of the areola (about 1 ½ inches back from the tip of her nipple and her forefinger and middle finger pads at the 6 o’clock position on the bottom edge of the areola.2. mother will stretch her areola back toward her chest wall without lifting her fingers off her breast. 3. roll her thumb and fingers simultaneously forward compressing the ducts beneath the areola and stimulating the breast to empty the breast both manually and by triggering the let-down reflex.4. mother should repeat the sequence multiple times to completely drain her breast. Maintain a steady rhythm, cycling 45-60 times/min. also, more effective if mother repositions her fingers to other positions on the same breast.

II. Breastfeeding. A. Describe four positions for breastfeeding.

a. Modified cradle position: have mother sit upright, use pillows for support and to bring baby to nipple level so that mother does not have to lean over. Place baby on mother’s lap and turn baby as a whole towards mother so that baby’s nose lines up with mothers nipple. Maintain baby in horizontal position. Have mother support baby’s head with opposite of feeding side hand and offer breast with feeding side hand.

b. Cradle position: have mother in upright position, use pillows for support to bring infant to nipple level. Position on mother’s lap in a side lying position nose in line with nipple. If feeding from the left breast, have mother cradle baby’s head near the crook of her left arm while supporting baby’s body with left forearm. With mother’s free right hand, she can offer her left breast

c. Football hold position: have mother sit upright in comfortable position, use pillows as needed. If feeding on left side, place baby on the left side of mother’s body, heading

baby in to position feet first. Baby’s bottom should rest on pillow near mother’s left elbow. Turn baby slightly on her side so that she faces the breast. Mother’s left arm clutches baby’s body close to mother’s body. Baby’s body should feel securely tucked in under mother’s left arm. Have mother support baby’s head with left hand. With mother’s free hand, she can offer her breast. (good position for mothers with c-sections).

d. Side lying position: have mother comfortably lying on her side. Use pillows to support mother’s head and back, and provide for support for mother’s hips by placing pillows between bent knees. Place baby in side-lying position next to mother’s body. Baby’s body should face mother’s body. Baby’s nose should line up to mother’s nipple. Place a roll behind baby’s back, if desired. With mother’s free right hand, she can offer her left breast. After baby is securely attached, mom can rest her right hand anywhere that is comfortable for her.

B. Explain how to begin breastfeeding. a. Position the baby in comfortable and secure position.b. Align the baby with mother’s nipplec. Trigger the rooting reflexd. Allow baby to open wide, continue to trigger rooting reflex till baby opens mouth wide. e. Position nipple in baby’s mouth to achieve deep asymmetric latch attachment. Allow

infant to lead into breast with the chin.C. State how often and how long to feed the baby.

a. Babies should be observed for feeding cues such as waking or suckling on nearby objects including hands. Crying is a late feeding cue. Baby should be allowed to feed to satiety

D. Describe: Principle of supply and demand: a. Breastfeeding works on the principle of supply and demand.

The amount of milk you make depends on how often your baby nurses and how effectively milk is removed from your breasts. The more milk baby removes from the breast, and the more often baby nurses, the more milk you will produce. Research shows that women who nurse more frequently make more milk. It’s truly a matter of supply and demand.

E. Explain: 1. The initiation of lactation

Lactogenisis: During pregnancy, increased levels of estrogen stimulate breast duct proliferation and development, and elevated progesterone levels promote the development of lobules and alveoli in preparation for lactation. Prolactin levels rise from approximately 10ng/mL pre-pregnancy to 200ng/mL at term. Lactation is suppressed during pregnancy by elevated progesterone levels secreted by the placenta. Once the placenta is expelled at delivery, progesterone levels fall and the inhibition is removed, triggering milk production. This occurs whether the mother has breast stimulation or not. However, if by the third or fourth day breast stimulation is not occurring, prolactin levels begin to drop. By 2 weeks postpartum, prolactin levels will be back to pre-pregnancy levels and milk production will cease.

2. The “let down” reflex: Stretching of the nipple and compression of the areola signal the hypothalamus to trigger the posterior pituitary gland to release oxytocin. Oxytocin acts on myoepithelial cells surrounding the alveoli in the breast tissue to contract, ejecting milk, including the fat globules present, into the ducts. A process known as milk-ejection reflex and occurs 4-10 times during a feeding session.

F. Compare and Contrast the components of colostrum with breast milkColostrum Breast MilkLower amount of fat and lactose 13% solids (carbohydrates, proteins, and fats)Provides all nutritional requirements 87% waterContains antioxidants , high levels of Provides all necessary nutrients

lactoferrin and secretory IgALaxative effect on infant

G. Describe how to break suction at the end of a feeding. 1. Remove baby from breast by placing a finger between the baby’s gums to ensure suction is broken2. End feeding when the baby’s suckling slows, before he or she has a chance to chew on the nipple

H. Using your nursing judgment, list the four most important factors to observe when assessing the effectiveness of a feeding session.

1. Latching of the infants mouth to the nipple2. Audible swallowing of the baby3. Mother’s breasts appear to soften after breastfeeding4. Comfort of the nipple, observe for redness, cracking, pain

III. Breastfeeding Problems A. Define engorgement: Vascular congestion or distention. The swelling of breast tissue brought about by an increase in blood and lymph supply to the breast, preceding true lactation.

B. State two (2) signs of engorgement.1. Hard, warm and painful breast2. Skin of breast appears taut and shiny

C. List three (3) techniques to decrease the discomfort of engorgement 1. Warm compresses or showers just before nursing2. Cold compresses following breast feedings3. Breast massage and milk expression

D. Identify three (3) ways to ease the discomfort/healing of sore nipples. 1. Alternate breastfeeding positions throughout the day2. Ensure the nipple is way back in the baby’s mouth by getting the baby to properly onto breast3. Hold the baby closely during feeding so the nipple is not constantly being pulled

E. List three (3) interventions that are effective in: 1. Preventing mastitis

1. Avoid stress2. Avoid fatigue3. avoid/treat cracked nipples

2. Treating mastitis 1. Continued breast feeding2. Application of moist heat3. Increased fluids4. Rest5. Analgesic6. Antibiotic treatment if necessary

IV. Maternal Nutrition A. Identify the food groups and the number of servings from each group that are recommended for

breastfeeding. a. Dairy products: four (8oz) cups b. Meat and meat alternatives: two servingsc. Grain products: six to eleven servings/dayd. Fruits and fruit juices: two to four servings

e. Vegetables: three to five servingsf. Fats: as desired in moderationg. Sugar and sweets: occasionally, if desiredh. Desserts: occasionally, if desiredi. Beverages: as desired, in moderation

B. Describe the nutritional needs recommended while breastfeeding, including calories, calcium, iron, fluids.

a. Calcium: 1000mg/db. Iron: 9mg/dc. Calories: 2500-2700 caloriesd. Fluids: 8-10 (8oz) glasses of water, juices, milk and soups

V. Critical Thinking Questions A. Describe the father’s role in breastfeeding.

B. Describe three (3) ways to involve the grandparents in the breastfeeding experience.

VI. Maternal Medications A. Discuss the three “knows” about drugs and human milk.

B. Discuss the actions and effects of the following substances on the newborn when breastfeeding. 1. Caffeine: excessive consumption may cause jitteriness or wakefulness

2. Drugs (cocaine, heroin, marijuana, etc) 1. Cocaine: extreme irritability, tachycardia, vomiting, apnea2. Heroin: Tremors, restlessness, vomiting, poor feeding3. Marijuana: Drowsiness4. Amphetamines: controversial; may cause irritability, poor sleeping pattern5. Nicotine: shock, vomiting, diarrhea, decreased milk production

3. Meperidine: avoid use. May lead to neonatal depression.

4. Morphine: long-term use may cause newborn addiction

5. Antibiotics 1. aminoglycosides: may cause ototoxicity or nephrotoxicity if given for more than 2 weeks2. ampicillin: skin rash, candidiasis, diarrhea3. azithromycin: no risk to newborn4. erythromycin: accumulates in breast milk, idiopathic hypertrophic pyloric stenosis5. methacycline: possible inhibition of bone growth; may cause discoloration of the teeth; use should be avoided6. Metronidazole (flagyl): possible neurologic disorders or blood dyscrasias; delay breastfeeding for 12hours after dose7. penicillin: possible allergic response; candidiasis8. quinolones: can cause arthopathies9. sulfonamides: may cause hyperbilirubinemia; use contraindicated until infant is over 1 week old10. tetracycline: long-term use and large doses should be avoided; may cause tooth staining or inhibition of bone growth.

6. Bronchodilators: 1. aminophylline: May cause insomnia or irritability in the infant2. leukotiene inhibitors (zyflo, accolate): potential tumorigenicity

7. Antihistamines:

1. diphenhydramine (benadryl), claritin, allegra: may cause decreased milk supply; infant may become drowsy or irritable2. Clemastine (tavist): contraindicated

8. Oral Contraceptives:1. combined estrogen/progestin pills: significantly decrease milk supply; may later milk composition; may cause gynecomastia in male infants2. Progestin only (DMPA, norplant); safe if started after lactation is established

VII. Breastfeeding at home. A. Identify two (2) community resources for questions/support of breastfeeding after discharge from the hospital.

1. La Leche League International2. International Lactation Consultant Association