This document provides information on breastfeeding basics including breast anatomy, milk production, positioning and latching, common issues, and benefits. It describes the lobes, ducts, areola, and hormones involved in lactation. Milk composition changes from colostrum to mature milk. Optimal positioning supports the baby's mouth on the breast and lower jaw. Common issues like engorgement, plugged ducts, and mastitis are explained with treatment plans. The document emphasizes the nutritional, developmental and health benefits of breastfeeding for both mother and baby.

1. Basics of BreastfeedingSt. Mary’s HospitalFamily Care SuitesOrientation

2. Anatomy

3. AnatomyGlands or lobes 15-25 lobes alveoli maternal blood supplymyoepithelial cells milk ejection reflex

4. Anatomy

5. TransportLacitferous ducts or sinuses coming from the alveoli toward nipple expand to larger ducts (like tree branches) transport milk

6. NippleMany shapes and sizes5-10 openings

7. AreolaDarkens in pregnancyMontgomery glands provide lubrication secrete fluid with odor of amniotic fluid

8. Fat CellsFat determines the size of the breastAll breasts have the about the same number of milk glands or lobesSize does not determine ability to make milk

9. Blood SupplyInternal Mammary Artery (60%)Lateral Thoracic Artery (30%)

10. Nerve Supply4th, 5th, & 6thintercostal nerves

11. Breast Assymetry

12. Areolar tissueCompressible or Fibrous

13. Size and Shape of Nipples

14. Surgical or Injury ScarsReduction or AugmentationBurns or Trauma to chest

15. Hormones for LactationProlactin : anterior pituitary hormone pregnancy effects inhibits ovulation stimulates milk synthesisOxytocin signs of “let down” uterine cramps increase bleeding thirst feeling sleepy leaking changed sucking “pins and needles” ok if nothing felt

16. Pathway & Effects of Oxytocin & Prolactin

17. Other hormonesNecessary for milk production:InsulinCortisolThyroidParathyroidHuman growth hormoneFeedback inhibitor hormone

18. Milk ProductionLactogenesis I during pregnancy progesterone and estrogen secretory cells colostrum

19. Milk ProductionLactogenesis II (2-8 days) starts after delivery of placenta drop in progesterone & estrogen prolactin level increases switch from endocrine control to autocrine

20. Milk ProductionLactogenesis III Establishment and Maintenance (8-10 days) Mature Milk

21. CompositionColostrum first food High in Protein, vitamins & minerals Antibodies Less fat & lactose than mature milk Laxative About 3 ounces in 24 hours

22. Colostrum

23. CompositionMature Milk Transitional Milk (approx. 2 weeks) Increases in fat & lactose, water soluble vitamins Decreases in protein 750 kcal/liter

24. Foremilk / HindmilkForemilk thinner watery milk at beginning of feedingHind Milk higher in fat and calories Let baby finish one breast Do not limit length of time at breast

25. Fore Milk & Hind Milk

26. Milk CompositionVariations to milk are normalDepend upon: time of day beginning or end of feeding maternal diet maternal hormone fluctuations

27. Immunologic and Bioactive Properties of MilkSecretory Immunoglobin A provides passive immunity Inhibited bacterial growth in gutMacrophages are abundant in human milk destroy & digest bacteriaReduction in Food Allergies

28. Benefits of Breastfeeding

29. Benefits of BreastfeedingBenefits to Baby:Species specificGood HealthReduce risk of DiseasePromotes Physical DevelopmentProvides Emotional Benefits

30. Benefits of Breastfeeding

31. Benefits of BreastfeedingBenefits for mother reduce postpartum hemorrhage improve bone density weight loss reduce risk of cancers convenient and always available save time and money delays fertility travel easy & comfort for baby

32. Benefits to Family & EnvironmentFamily saves moneyFewer healthcare costsNo energy use for productionNo packaging materialsNo production animals, feed, machinery, waste disposalNo transportationNo contamination or disease transmission

33. Other benefits• 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 handling throughout life• reduced heart disease risk factors• lowered risk of SIDS (Sudden Infant Death Syndrome)

34. Skin to Skin contactInfant naked or only in diaperMom with breasts, chest and belly bareMay have blanket over them bothMom can be sitting or reclining with infant vertical between her breasts or on one breast

35. Benefits of Skin to SkinImproves sucklingIncreases duration & exclusive breastfeedingHigher skin temperaturesRaises blood glucoseNormalizes base excessLess cryingRelease of oxytocin-less uterine bleedingRelease of prolactin- increase in productionBonding, less anxiety for mom

36. Benefits of Skin to Skin

37. IndicationsPossible dose response, separation of mom and baby for 20 minutes during 1st hour detrimentalAs little as 15-20 minutes beneficialBaby awake after delivery, start skin to skin as soon as possible, suckling may not occur for up to 2 hours after deliveryRecommend at least 30 minutes long or longer for a more difficult birth

38. Skin to Skin

39. Feeding cuesMouthing movementsSuckling movementsClenching of fingers or tight fist over chestHands to mouthCrying is a “Late feeding cue”

40. Feeding

41. Content Baby

42. Positioning

43. PositioningMother well supported with pillows, drink nearby, empty bladder, foot rest as needed

44. PositioningCradle HoldInfant’s body level with breastTowards mother: tummy to tummyInfant’s ear, shoulder and hip aligned

45. Breast Support“C” hold- supports breast and hands out of the way for baby to latch well

46. Breast support

47. Cradle hold

48. Advantages/ Disadvantages+ Most frequently illustrated/ familiar+ Most often used by mothers- Difficult to master- control of baby’s head- Baby may wobble on mom’s arm

49. Side lying hold

50. Advantages/disadvantages+ Allows mother more rest+ more comfortable after a c-section with support of tummy - mother’s fear of smothering their baby

51. Football or Clutch hold

52. Advantages/disadvantages+maximize control of baby’s head+more comfortable choice of c-sections+more easily accomplished for SGA/preemie-Not often pictured in media- some mother’s not comfortable with position- more difficult to use with larger babies

53. Cross Cradle

54. Cross Cradle hold

55. LATCHINGNose to nippleManual expressionTickle lipWide open (rooting)Tongue down, nipple to roofBring infant in toward motherLatch with entire nipple & about 1 inch of areolaLower jaw covers more than upper

56. Goal of LatchingChin touching breastNose lightly touching breast or not at allLips both turned outward

57. As Baby NursesCheeks puffed outRocking of entire jawTemple movementIntermittent swallowsNO clicking or smackingBreast tissue

58. Mom as Baby NursesFeels no pinchingFeels strong tugs at breastInitial latch may be tender as nipple elongatesTender if nipple trauma, needs to healMother to detach & start over if painfulMother may feel uterine cramping

59. No Biting!!

60. Nipple AssessmentNipple round and erect at detachmentNo creasing or blanched lookingNot misshapen- like lipstick end

61. Frequency & DurationFirst 24 hours lots of skin to skin offer breast on cue at least every 2-3 hours encourage to ask for help May not nurse the first 24 hours but at least try Document attempts even if not successful

62. NursingLet baby nurse as long as he wantsDo not watch the clock, watch the infantGenerally, 10-30 minutes, longer or shorter ok

63. NursingActive nursing from first breastStimulate infant if sleepyWhen done, burp, check diaper and offer 2 ndHe may or may not take 2ndAlternate the starting breast each feeding

64. How much is enough?Breastfeeding Log 8-12 feedings in 24 hours voiding and stooling weight loss less than 10 % content after nursing swallowing breasts feel softer after nursing stools transitioning black, brown, green, yellow by one week of age

65. Our Breastfeeding Log

66. Stomach capacityMarble sized at one day oldLarge marble at 2-3 days oldGolf ball at a week old

67. Feeding PlanReasons we supplementHow do we supplementWhat do we supplementPacifier use

68. Nipple Sheilds

69. Latch with shield

70. Sore NipplesCauses: Poor positioning & latch Incorrect sucking patterns Baby with tight frenulum Tight jaw, clenching Improper placement of flanges Suction of pump too high Wrong size of flanges

71. Sore cracked nipples

72. Strategies for Sore NipplesCare plan

73. EngorgementOccurs 2-5 days after deliveryLasts 24-48 hoursSwelling of the breast by increase blood & lymph fluid as milk “comes in”

74. Prevention of EngorgementNurse frequentlyCorrect latchSkin to skin contactNo supplementsPump only for comfortEngorgement care plan

75. JaundicePhysiologyBilirubin Direct & IndirectCauses Physiologic jaundice Pathological jaundice

76. Treatment of JaundiceIncrease frequency of feedingsMay need to double pump to supplementSupplement with mom’s milk or formulaPhototherapyMonitor hydrationEducate parents

77. Plugged ducts Inadequate emptying, pressure in breast Tender spot Warmth & message Nurse on tender breast first Proper latching & optimal positioning Rest, report fever to MD Plug may come out & look like spaghetti

78. MastitisBacterial infection of breast tissue Symptoms: hard, reddened tender area red streaking, fever, flu like symptoms Causes: damage to nipple open to bacteria milk stasis, inadequate emptying, plug Care Plan

79. Mastitis

80. ThrushYeast overgrowthPredisposing factors: nipple damage, antibiotic use, yeast vaginitisSigns & Symptoms: white, pimple like dots, superficial cracking at base of nipple, constant pain, burning, itchingInfant may or may not have symptoms White patches in mouth, diaper rash

81. Thrush

82. Nutrition & MedicationsWell balance dietExtra 300-500 calories per dayInfant may be sensitive to mom’s dietCaffeine sparinglyAlcohol passes into milkPrenatal Vitamin Q dayNicotineEducate parents Dr. Hale- “Medications & Mother’s Milk”

83. Breast PumpsManual- occasional pumping, relieve fullness, 5 minutes alternating sides for 15 mins. totalSingle Electric- occasional pumping, small motor, one at a time 5mins alternate to 15 mins.Double Electric-larger, stronger, more durable, regular pumping, more efficient, rent or buy, best for NICU moms, quicker

84. Breast Pumps

85. Reasons to Pump in HospitalSupplement baby- SGA, Weight lossMilk to NICU baby or separation due to illnessBaby not nursing at 24 hours of age

86. ChallengesUniversal strategiesSleepy BabyNot opening mouth wideTongue sucking/ ThrustingMucousy BabyBiting BabyFussy BabyFlat/ Inverted nipplesCreased Nipple

87. Resources“Best Baby on the Block”- Dr. Harvey KarpBreastfeeding VideosLactation Counselor CertificationCEU offeringsBreastfeeding Books & Atlases in LC officeYour friendly Lactation Consultants

88. Lactation ConsultantsLaura Rosenau, RN, IBCLCRosie Sergenian, LPN, IBCLCHolly Guenther, RN, IBCLCRuth Harding- Weaver, RN, IBCLCMelanie Betchey, RN, IBCLCJennifer Ulmer, RN, IBCLCCrystal Huene, RN, IBCLC

89. Questions Comments Concerns

90. Case StudiesRead and discuss together the following 3 cases: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?

91. Case Study2) 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?

92. Case Study3) 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?

93. Case Studies on your own1-2 nurses per case studyStudies number 4 through 8Discuss among your group & present to others

94. Thank you!References: Lawrence, R. & Lawrence, R. (2005). Breastfeeding: a guide for the medical profession, 6th edition, Philadelphia PA, Mosby Inc.Wilson-Clay, B. & Hoover, K. (2007). The Breastfeeding Atlas, 4th edition, Manchaca, TX, LactNews Press.