Basics of breastfeeding

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Basics of breastfeeding

  1. 1. Basics of Breastfeeding<br />St. Mary’s Hospital<br />Family Care Suites<br />Orientation<br />
  2. 2. Anatomy<br />
  3. 3. Anatomy<br />Glands or lobes<br /> 15-25 lobes<br /> alveoli<br /> maternal blood supply<br />myoepithelial cells<br /> milk ejection reflex<br />
  4. 4. Anatomy<br />
  5. 5. Transport<br />Lacitferous ducts or sinuses<br /> coming from the alveoli toward nipple<br /> expand to larger ducts (like tree branches)<br /> transport milk<br />
  6. 6. Nipple<br />Many shapes and sizes<br />5-10 openings<br />
  7. 7. Areola<br />Darkens in pregnancy<br />Montgomery glands<br /> provide lubrication<br /> secrete fluid with odor of amniotic fluid<br />
  8. 8. Fat Cells<br />Fat determines the size of the breast<br />All breasts have the about the same number of milk glands or lobes<br />Size does not determine ability to make milk<br />
  9. 9. Blood Supply<br />Internal Mammary Artery (60%)<br />Lateral Thoracic Artery (30%)<br />
  10. 10. Nerve Supply<br />4th, 5th, & 6thintercostal nerves<br />
  11. 11. Breast Assymetry<br />
  12. 12. Areolar tissue<br />Compressible or Fibrous<br />
  13. 13. Size and Shape of Nipples<br />
  14. 14. Surgical or Injury Scars<br />Reduction or Augmentation<br />Burns or Trauma to chest<br />
  15. 15. Hormones for Lactation<br />Prolactin : anterior pituitary hormone<br /> pregnancy effects<br /> inhibits ovulation<br /> stimulates milk synthesis<br />Oxytocin<br /> signs of “let down” <br /> uterine cramps increase bleeding<br /> thirst feeling sleepy<br /> leaking changed sucking<br /> “pins and needles” ok if nothing felt<br />
  16. 16. Pathway & Effects of Oxytocin & Prolactin<br />
  17. 17. Other hormones<br />Necessary for milk production:<br />Insulin<br />Cortisol<br />Thyroid<br />Parathyroid<br />Human growth hormone<br />Feedback inhibitor hormone<br />
  18. 18. Milk Production<br />Lactogenesis I<br /> during pregnancy<br /> progesterone and estrogen<br /> secretory cells<br /> colostrum<br />
  19. 19. Milk Production<br />Lactogenesis II (2-8 days)<br /> starts after delivery of placenta<br /> drop in progesterone & estrogen<br /> prolactin level increases<br /> switch from endocrine control to autocrine<br />
  20. 20. Milk Production<br />Lactogenesis III<br /> Establishment and Maintenance (8-10 days)<br /> Mature Milk<br />
  21. 21. Composition<br />Colostrum<br /> first food<br /> High in Protein, vitamins & minerals<br /> Antibodies<br /> Less fat & lactose than mature milk<br /> Laxative<br /> About 3 ounces in 24 hours<br />
  22. 22. Colostrum<br />
  23. 23. Composition<br />Mature Milk<br /> Transitional Milk (approx. 2 weeks)<br /> Increases in fat & lactose, water soluble <br /> vitamins <br /> Decreases in protein<br /> 750 kcal/liter<br />
  24. 24. Foremilk / Hindmilk<br />Foremilk<br /> thinner watery milk at beginning of feeding<br />Hind Milk<br /> higher in fat and calories<br /> Let baby finish one breast<br /> Do not limit length of time at breast <br />
  25. 25. Fore Milk & Hind Milk<br />
  26. 26. Milk Composition<br />Variations to milk are normal<br />Depend upon:<br /> time of day<br /> beginning or end of feeding<br /> maternal diet<br /> maternal hormone fluctuations<br />
  27. 27. Immunologic and Bioactive Properties of Milk<br />Secretory Immunoglobin A<br /> provides passive immunity<br /> Inhibited bacterial growth in gut<br />Macrophages are abundant in human milk<br /> destroy & digest bacteria<br />Reduction in Food Allergies<br />
  28. 28. Benefits of Breastfeeding<br />
  29. 29. Benefits of Breastfeeding<br />Benefits to Baby:<br />Species specific<br />Good Health<br />Reduce risk of Disease<br />Promotes Physical Development<br />Provides Emotional Benefits<br />
  30. 30. Benefits of Breastfeeding<br />
  31. 31. Benefits of Breastfeeding<br />Benefits for mother<br /> reduce postpartum hemorrhage<br /> improve bone density<br /> weight loss<br /> reduce risk of cancers<br /> convenient and always available<br /> save time and money<br /> delays fertility<br /> travel easy & comfort for baby<br />
  32. 32. Benefits to Family & Environment<br />Family saves money<br />Fewer healthcare costs<br />No energy use for production<br />No packaging materials<br />No production animals, feed, machinery, waste disposal<br />No transportation<br />No contamination <br /> or disease transmission<br />
  33. 33. Other benefits<br />• comfort• easing of pain and discomfort• protection during illness• building of bonding and attachment with parents• social development• inducing sleep• building of trust in parents• visual development• development of communication skills• building brain organization toward positive stress <br /> handling throughout life• reduced heart disease risk factors• lowered risk of SIDS (Sudden Infant Death <br /> Syndrome)<br />
  34. 34. Skin to Skin contact<br />Infant naked or only in diaper<br />Mom with breasts, chest and belly bare<br />May have blanket over them both<br />Mom can be sitting or reclining with infant vertical between her breasts or on one breast<br />
  35. 35. Benefits of Skin to Skin<br />Improves suckling<br />Increases duration & exclusive breastfeeding<br />Higher skin temperatures<br />Raises blood glucose<br />Normalizes base excess<br />Less crying<br />Release of oxytocin-less uterine bleeding<br />Release of prolactin- increase in production<br />Bonding, less anxiety for mom<br />
  36. 36. Benefits of Skin to Skin<br />
  37. 37. Indications<br />Possible dose response, separation of mom and baby for 20 minutes during 1st hour detrimental<br />As little as 15-20 minutes beneficial<br />Baby awake after delivery, start skin to skin as soon as possible, suckling may not occur for up to 2 hours after delivery<br />Recommend at least 30 minutes long or longer for a more difficult birth<br />
  38. 38. Skin to Skin<br />
  39. 39. Feeding cues<br />Mouthing movements<br />Suckling movements<br />Clenching of fingers or tight fist over chest<br />Hands to mouth<br />Crying is a “Late feeding cue”<br />
  40. 40. Feeding<br />
  41. 41. Content Baby<br />
  42. 42. Positioning<br />
  43. 43. Positioning<br />Mother well supported with pillows, drink nearby, empty bladder, foot rest as needed<br />
  44. 44. Positioning<br />Cradle Hold<br />Infant’s body level with breast<br />Towards mother: tummy to tummy<br />Infant’s ear, shoulder and hip aligned<br />
  45. 45. Breast Support<br />“C” hold- supports breast and hands out of the way for baby to latch well<br />
  46. 46. Breast support<br />
  47. 47. Cradle hold<br />
  48. 48. Advantages/ Disadvantages<br />+ Most frequently illustrated/ familiar<br />+ Most often used by mothers<br />- Difficult to master- control of baby’s head<br />- Baby may wobble on mom’s arm<br />
  49. 49. Side lying hold<br />
  50. 50. Advantages/disadvantages<br />+ Allows mother more rest<br />+ more comfortable after a c-section with <br /> support of tummy<br /> - mother’s fear of smothering their baby<br />
  51. 51. Football or Clutch hold<br />
  52. 52. Advantages/disadvantages<br />+maximize control of baby’s head<br />+more comfortable choice of c-sections<br />+more easily accomplished for SGA/preemie<br />-Not often pictured in media<br />- some mother’s not comfortable with position<br />- more difficult to use with larger babies<br />
  53. 53. Cross Cradle<br />
  54. 54. Cross Cradle hold<br />
  55. 55. LATCHING<br />Nose to nipple<br />Manual expression<br />Tickle lip<br />Wide open (rooting)<br />Tongue down, nipple to roof<br />Bring infant in toward mother<br />Latch with entire nipple & about 1 inch of areola<br />Lower jaw covers more than upper<br />
  56. 56. Goal of Latching<br />Chin touching breast<br />Nose lightly touching breast or not at all<br />Lips both turned outward<br />
  57. 57. As Baby Nurses<br />Cheeks puffed out<br />Rocking of entire jaw<br />Temple movement<br />Intermittent swallows<br />NO clicking or smacking<br />Breast tissue<br />
  58. 58. Mom as Baby Nurses<br />Feels no pinching<br />Feels strong tugs at breast<br />Initial latch may be tender as nipple elongates<br />Tender if nipple trauma, needs to heal<br />Mother to detach & start over if painful<br />Mother may feel uterine cramping<br />
  59. 59. No Biting!!<br />
  60. 60. Nipple Assessment<br />Nipple round and erect at detachment<br />No creasing or blanched looking<br />Not misshapen- like lipstick end<br />
  61. 61. Frequency & Duration<br />First 24 hours <br /> lots of skin to skin<br /> offer breast on cue<br /> at least every 2-3 hours<br /> encourage to ask for help<br /> May not nurse the first 24 hours but at least try <br /> Document attempts even if not successful<br />
  62. 62. Nursing<br />Let baby nurse as long as he wants<br />Do not watch the clock, watch the infant<br />Generally, 10-30 minutes, longer or shorter ok<br />
  63. 63. Nursing<br />Active nursing from first breast<br />Stimulate infant if sleepy<br />When done, burp, check diaper and offer 2 nd<br />He may or may not take 2nd<br />Alternate the starting breast each feeding<br />
  64. 64. How much is enough?<br />Breastfeeding Log<br /> 8-12 feedings in 24 hours<br /> voiding and stooling<br /> weight loss less than 10 %<br /> content after nursing<br /> swallowing<br /> breasts feel softer after nursing<br /> stools transitioning black, brown, green, <br /> yellow by one week of age<br />
  65. 65. Our Breastfeeding Log<br />
  66. 66. Stomach capacity<br />Marble sized at one day old<br />Large marble at 2-3 days old<br />Golf ball at a week old<br />
  67. 67. Feeding Plan<br />Reasons we supplement<br />How do we supplement<br />What do we supplement<br />Pacifier use<br />
  68. 68. Nipple Sheilds<br />
  69. 69. Latch with shield<br />
  70. 70. Sore Nipples<br />Causes:<br /> Poor positioning & latch<br /> Incorrect sucking patterns<br /> Baby with tight frenulum<br /> Tight jaw, clenching<br /> Improper placement of flanges<br /> Suction of pump too high<br /> Wrong size of flanges<br />
  71. 71. Sore cracked nipples<br />
  72. 72. Strategies for Sore Nipples<br />Care plan<br />
  73. 73. Engorgement<br />Occurs 2-5 days after delivery<br />Lasts 24-48 hours<br />Swelling of the breast by increase blood & lymph fluid as milk “comes in”<br />
  74. 74. Prevention of Engorgement<br />Nurse frequently<br />Correct latch<br />Skin to skin contact<br />No supplements<br />Pump only for comfort<br />Engorgement care plan<br />
  75. 75. Jaundice<br />Physiology<br />Bilirubin<br /> Direct & Indirect<br />Causes<br /> Physiologic jaundice<br /> Pathological jaundice<br />
  76. 76. Treatment of Jaundice<br />Increase frequency of feedings<br />May need to double pump to supplement<br />Supplement with mom’s milk or formula<br />Phototherapy<br />Monitor hydration<br />Educate parents <br />
  77. 77. Plugged ducts<br /> Inadequate emptying, pressure in breast<br /> Tender spot<br /> Warmth & message<br /> Nurse on tender breast first<br /> Proper latching & optimal positioning<br /> Rest, report fever to MD<br /> Plug may come out & look like spaghetti<br />
  78. 78. Mastitis<br />Bacterial infection of breast tissue<br /> Symptoms: <br /> hard, reddened tender area<br /> red streaking, fever, flu like symptoms <br /> Causes: <br /> damage to nipple open to bacteria<br /> milk stasis, inadequate emptying, plug<br /> Care Plan <br />
  79. 79. Mastitis<br />
  80. 80. Thrush<br />Yeast overgrowth<br />Predisposing factors: <br /> nipple damage, antibiotic use, yeast vaginitis<br />Signs & Symptoms: <br /> white, pimple like dots, superficial cracking at base of nipple, constant pain, burning, itching<br />Infant may or may not have symptoms <br /> White patches in mouth, diaper rash<br />
  81. 81. Thrush<br />
  82. 82. Nutrition & Medications<br />Well balance diet<br />Extra 300-500 calories per day<br />Infant may be sensitive to mom’s diet<br />Caffeine sparingly<br />Alcohol passes into milk<br />Prenatal Vitamin Q day<br />Nicotine<br />Educate parents <br />Dr. Hale- “Medications & Mother’s Milk”<br />
  83. 83. Breast Pumps<br />Manual- occasional pumping, relieve fullness, 5 minutes alternating sides for 15 mins. total<br />Single Electric- occasional pumping, small motor, one at a time 5mins alternate to 15 mins.<br />Double Electric-larger, stronger, more durable, regular pumping, more efficient, rent or buy, best for NICU moms, quicker<br />
  84. 84. Breast Pumps<br />
  85. 85. Reasons to Pump in Hospital<br />Supplement baby- SGA, Weight loss<br />Milk to NICU baby or separation due to illness<br />Baby not nursing at 24 hours of age<br />
  86. 86. Challenges<br />Universal strategies<br />Sleepy Baby<br />Not opening mouth wide<br />Tongue sucking/ Thrusting<br />Mucousy Baby<br />Biting Baby<br />Fussy Baby<br />Flat/ Inverted nipples<br />Creased Nipple<br />
  87. 87. Resources<br />“Best Baby on the Block”- Dr. Harvey Karp<br />Breastfeeding Videos<br />Lactation Counselor Certification<br />CEU offerings<br />Breastfeeding Books & Atlases in LC office<br />Your friendly Lactation Consultants<br />
  88. 88. Lactation Consultants<br />Laura Rosenau, RN, IBCLC<br />Rosie Sergenian, LPN, IBCLC<br />Holly Guenther, RN, IBCLC<br />Ruth Harding- Weaver, RN, IBCLC<br />Melanie Betchey, RN, IBCLC<br />Jennifer Ulmer, RN, IBCLC<br />Crystal Huene, RN, IBCLC<br />
  89. 89. Questions Comments Concerns<br />
  90. 90. Case Studies<br />Read and discuss together the following 3 cases:<br />1) 26 hour old male, 40 2/7 weeks gestation, 8#1 oz, nursed after delivery & 5 times since then well, he has had 1 meconium stool and 2 voids, now he hasn’t nursed for the last 5 hours and mother states he is sleepy. She is holding him skin to skin. He is asleep. What do you do?<br />
  91. 91. Case Study<br />2) 22 hour old female, 36 1/7 weeks gestation, 6 # 8 oz., no latch after delivery, to the breast 5 times with only licking and nuzzling. She is sleepy with latching attempts. 1 void and 1 meconium stool is recorded. Last attempt made three hours ago. She is asleep in her crib. What would you do now?<br />
  92. 92. Case Study<br />3) 24 hour old female, 37 1/7 week gestation, 6 # 2 ounces & is SGA. She nursed well after delivery and has nursed 4 times since for 15-20 minutes per feeding. She has had 3 voids and 3 meconium stools. She is putting her fingers in her mouth and her eyes are open. What do you do now?<br />
  93. 93. Case Studies on your own<br />1-2 nurses per case study<br />Studies number 4 through 8<br />Discuss among your group & present to others<br />
  94. 94. Thank you!<br />References: Lawrence, R. & Lawrence, R. (2005). Breastfeeding: a guide for the medical profession, 6th edition, Philadelphia PA, Mosby Inc.<br />Wilson-Clay, B. & Hoover, K. (2007). The Breastfeeding Atlas, 4th edition, Manchaca, TX, LactNews Press.<br />

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