Vilma Weir-Campbell

Fairleigh Dickinson University

CONTENT OUTLINE

• I. Benefits of Breastfeeding.• II. Preparing for Breastfeeding.• III. The Lactating Breast.• IV. How Milk Gets From Breast to • baby.• V. Getting Breastfeeding Started.• VI. Positions.• VII. How to Know If Your Baby is • getting Enough Milk.

OBJECTIVES

• I. Understand the benefits of breastfeeding.• II. Understand the physiology of breastfeeding.• III. Understand the importance of breastfeeding within the 1st hour after birth.• IV. Identify the three components of effective suckling. • V. Identify the advantages of various breastfeeding

positions and appropriate utilization.• VI. Recognize when the baby is getting enough milk.• VII. Identify some common breastfeeding problems.• VIII. Versatility in special situations.

• IX. Common Problems.• X. Nursing in Special Situations.• XI. Summary.

Breastfeeding is the best form of nutrition for babies and is ofvital importance to the health of both mother and baby. Despite compelling scientific evidence of the crucial importance of breastfeeding to maternal and child health,bottlefeeding is the norm in the United States. 40% of infants never taste their mother’s milk, and 80% are bottlefed by thetime they reach the age of 6 months. The American Academy of Pediatrics recommends exclusive breast feeding of infants for the first 6 months after birth; it also advocates that breastfeediing be continued for at least an additional 6months while solid foods are added. It is clear that humanmilk plays a vital role in the immunologic development of the infant at birth and well into the second year. Its nutritional

BACKGROUND INFORMATION ON BREAST FFEDING

role also is clearly superior to that of other alternatives.Primary care providers can have a positive impact on theInfant feeding decision. Prenatal education has been shownto be effective at increasing the rates of breastfeeding. It is clear that human milk plays a vital role in the immunologic development of the infant at birth and well into the second year. Its nutritional role also is clearly superior to that of other alternatives.Primary care providers can have a positive impact on the

BENEFITS OF BREASTFEEDINGAdvantages for the Baby: Advantages for MOM:1. Breast milk is the ideal first 1. Breastfeeding is more food for your baby because economical and more it is digested easily. convenient. You need Breast milk produces smaller not incur the daily curds than cow’s milk and has expence of formula or a different type of protein which go through the process allows for easier and faster of preparing, heating, digestion. Because of this, or refigerating your breast fed babies may need to milk due to its easy eat more frequently than bottle accessibility and fed babies, usually every two or perfect temperature three hours. for the baby.

2. Breast milk is readily absorbed 2. Breast feeding causes and may be associated with contractions of the less stomach upsets, constipa- uterus. Breastfeeding tion or diarrhea. after delivery will assist the uterus in 3. Immunities from the mother are contracting and help passes through the milk. avoid excessive bleed Statistics show that breastfed ing. During the post- babies have a reduced incidence partum period, the of ear infections, colds, tooth uterus will continue to decay, diaper rash, and vomiting. contract in order to Breastfed babies may have a shrink back to its non- higher resistance to infections pregnant size more such as respiratory viruses and quickly. (Breastfeed- have fewer and less significant ing utilizes approxi- allergies. mately 300-500 calories/day).

4. Breastfeeding provides frequent 3. Breastfeeding triggers close physical contact and helps the release of the promote feelings of security for lactating hormone both mother and baby. Prolactin, known as the “mothering 5. Suckling at the breast encourages hormone”. It may better bone, jaw, teeth and gum promote a feeling of structure. relaxation and well- being for you. 6. Breast milk is ready, warm and uncontaminated.

HOW MILK GETS FROM THE BREAST TO YOUR BABY.

There are two elements necessary for getting milk from the breast to the baby: a breastthat produces and releases milk, and a baby who is able to remove the milk from thebreast by an effective suck. The manner in which the baby is attached at the breast

will determine how successfully these two elements come together.The Process:1. The nursing breast works on the principle of supply and demand. As the baby suckles at the breast, he/she stimulates the nerve endings in the nipple which sends a message to the mother’s brain.2. The brain responds by directing the pituitary gland to release hormones, Oxytocin and Prolactin.3. Prolactin acts on the milk glands causing them to produce milk. The more one nurses, the more milk the breasts will produce, Nursing the baby as frequently

and as long as he/she demands, usually every 2-3 hours or 8-12 times in a 24 period will increase the amount of milk you produce.4. Oxytocin release helps to keep the uterus firm and return to its prepregancy state as well as causing the cells around the milk glands to contract and move the milk down the milk ducts. This process must occur in order for the milk to be made available to the baby and is referred to as “let-down”.

YOUR MILK

A mother’s milk is especially suited for her own baby. All breastmilk is not alike.Colostrum and breastmilk adjust with the age of the baby, and mature breast-Milk changes from feed to feed, day to day, and month to month to meet eachParticular baby’s needs.

Colostrum is the first milk made by the breasts, and is usually present in the breasts from the 16th week of pregnancy. It has a clear or yellow color, a thickConsistency, and is high in protein and lower in fat and sugar. Colostrum contains Valuable enzymes and is rich in immunity factors which protects the baby againstMany bacteria and viruses. It also acts as a natural laxative which helps inEliminating the baby’s first stool, called meconium. This helps to prevent jaundice.

HELPFUL HINTS1. Begin breastfeeding soon after the baby is born in order to initiate lactation.2. Provide uninterrupted contact between mother and baby for at least one hour after delivery.3. During the first ½ to 2 hours after birth the suck reflex is easily stimulated; The infant is very alert and the rooting and sucking reflexes are very strong.

FOUR A’S

Alignment: Mother in a comfortable position, with pillowsInfant in flexed position and supported with pillowsInfant’s head is at breast level, aligned with trunk and straight on breast (tummy to tummy).No traction exerted on breast or nipple

Areolar Grasp: Mouth is opened wide, lips not pursedLips are visible and flanged outwardTongue covers lower gums, troughed (curved)around areolaAt least ½ inch of areola is drawn symmetricallyinto mouthComplete seal and strong vacuum is formedby infant’s mouth

Areolar Compression: Mandible moves in a rhythmic motion(initially, approx. 2 sucks/sec., sucking slows toapprox. 1 suck/sec when milk comes downNo clicking or smacking soundsNo drawing in or dimpling of cheeksMother does not experience acute (sharp) nipple discomfort

Audible Swallowing: Swallowing heardNumber of sucks preceding a swallow decreasesas milk supply increasesSwallowing is evidence of milk-ejection reflex

Effective Suckling:Baby’s mouth is wide openBaby’s chin is touching the breastBaby’s lower lip is curled outward

Baby suckles, pauses, and suckles again inslow, deep sucksMother may hear swallowing

PREMATURE INFANT

Should encourage mother to breastfeedEasier to digest and better toleratedContains Lipase (helps digest milk fat),antibodies and other factors which help protect infant from infection;contributes to better vision, and higher intelligence;hormones and enzymes may contribute to the maturation of the GI and Nervous systemsEnhances bonding

EFFECTIVE SUCKING:

Baby’s mouth is wide open.Baby’s chin is touching the

breast.Baby’s lower lip is curled

outward.

Baby suckles, pauses, and suckles again inslow, deep sucks.Mother may hear swallowing.

PREMATURE INFANT

Should encourage mother to breastfeed.Easier to digest and better toleratedContains Lipase (helps digest milk fat),antibodies and other factors which help protect infant from infection;contributes to better vision, and higher intelligence;hormones and enzymes may contribute to the maturation of the GI and nervous systemsenhances bonding.

Readiness to Breastfeed:

No ideal weight or gestational ageshould be in stable condition.Each infant should be evaluated individually.Do not have to bottle feed first.

Dancer Hand Position

Support breast with C-hold and slide hand forward so that index finger and thumb are now free to grasp gently each cheek. The index finger and thumb form a “U” with the baby’s chin restinginside.

POSITIONING

Principles:Mother needs to be comfortable and relaxed.support

mother/infant with pillows ;bring infant to level of breast.

Cradle hold – natural position for mother/infant. Can be difficult for mother tosee infant’s face and control head position. Belly to belly position of mother/baby.

Football Hold – appropriate for small infant or C/S delivery. Mother can control infant’s head, allows for better visibility of infant’s mouth. Good for infants who prefer to feed in upright position.

Across the lap – similar to cradle except mother has better control of infant’s head. Belly to belly

Side lying – used mostly for early feedings, C/S deliveries, and nighttime feedings. Need pillows for support of mother’s leg and back.

Mother’s high risk factors:First time mother or never breastfed before,poorly educatedLack of family/friends who have breastfedambivalence about feedingLack of confidence no breastfeeding classes or lactation consultant visitLow rating of how well her baby breastfeedshx of breast surgery

Infant’s high risk factors:preterm birthDoes not: grasp the breast with lips flanged

and tongue down latch on and root easily suck vigorously suckle rhythmically swallow audible after pp day 3

COMMON PROBLEMS; HOW TO OVERCOME THEM Sore nipples: is the most common problem during the early days of breast feeding.This can result from: 1. Improper positioning of the infant’s mouth on the nipple. 2. Using only one position for all feedings. 3. Feedings are too far apart so that when the baby begins nursing he/she sucks very eagerly. 4. Breast care that contributes to dry, irritated nipples. 5. Trauma to the nipple because of improper removal from the breast.

Engorgement: is an overfullness that is a result of incomplete or inadequate empty- ing of the breasts.All mothers are encouraged to observe the Four A’s of breastfeeding to minimize Breastfeeding problems.

SUMMARY

When one reviews the wealth of information about the advantages of

breast feeding, there can be no doubt that this practice is healthy for

both mother and infant. It is past time for all health care providers to

enthusiastically support, encourage and educate the women of this

great nation to accept the fact that breastfeeding is normal, expected

and achievable.

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