bf care

1. RUFAIDA COLLEGE OF NURSING
LESSON PLAN
ON
“BREAST CARE & TECHNIQUES OF BREASTFEEDING”
Submitted To Submitted By
Ms. Mikki Khan Ms. Deepti Kukreti
Tutor M.Sc(N) 1st
year
RCON RCON

2. GENERAL INFORMATION
Name of the student teacher :Ms. Deepti Kukreti
Topic : Care of breast and techniques of breastfeeding
Group : B.Sc 4th
year
Venue : classroom
Time duration : 2 hours
Size of group : 49
Subject :Obstetrics and Gynaecology
Method of teaching : lecture & demonstration
Av aids : ppt
Previous knowledge of the group :Group have some basic knowledge about breast care and techniques of breastfeeding.

3. GENERAL OBJECTIVES
o According To Group Point Of View:-
At the end of teaching, group will be able to understand about breast care and techniques of breast feeding and also able to re-demonstrate the procedure and
apply in clinical settings.
o According To Student Teacher Point Of View:-
At the end of the procedure, student teacher will gain more confidence and skills in demonstrating the procedure and also able to have depth knowledge about
topic.
SPECIFIC OBJECTIVES
At the end of the class students will be able to understand the topic and apply this in clinical area.

4. TIME SPECIFIC
OBJECTIVE
CONTENT LEARMING AND
TEACHING
ACTIVITY
EVALUATION

5. TIME
2min
1/2min
SPECEFIC
OBJECTIVES
To Introduce self and
topic to the group.
To define breast care
CONTENT
Definition Of breast care
Breast care means care given to the breast by the mother during her prenatal
period, intranatal period and postnatal period.
or
TEACHING AND
LEARNING
ACTIVITY
I Deepti Kukreti student
of M.sc 1st
year from
Rufaida College Of
Nursing going to present
a topic on “Breast Care
And Techniques Of
Breast Feeding”
Breasts are
very vulnerable and
fragile part of women’s
body. During pregnancy
because of various
hormonal changes in the
body, breasts too
undergo a number of
changes. Therefore, it’s
important to take special
care of them during this
period. The breasts also
show prominent signs of
pregnancy. They evolve
and prepare themselves
for the arrival of the
newcomer.
The student teacher
defines breast care.
EVALUATION
Define breast
care?

6. 1min
2min
To enlist the purposes
of breast care.
To explain the
principles involved in
breast care.
Breast care is the activity to prepare and clean the breasts during pregnancy
and lactation for breast feeding.
Purpose of doing breast care:-
 To prepare the woman for breast feeding
 To correct the minor defects of the breasts such as inverted nipples.
 To prevent sore& cracked nipples during lactation.
 To prevent engorgement of breast during puerperium.
PRINCIPLES INVOLVED IN BREAST CARE
Anatomy and Physiology- Involves the anatomy of the breast and uses parts
of the body in performing breast care.
Body Mechanics- Involves the proper position or posture in performing
breast care.
Microbiology- Cleaning the breast kills pathogenic microorganisms to
prevent infections and to promote personal hygiene.
Physics- Involves friction in cleaning the breast. Involves gravity to prevent
the breast from sagging time.
Energy- Preparation of necessary materials in performing breast care in
order to conserve time and energy.
Epidemiology- Involves in knowing the factors determining and influencing
the frequency and distribution of diseases, injury, and other health-related
events.
Chemistry- Involves in proper handling and usage of chemicals to be used
for cleansing.
Pharmacology- Involves in the medications and treatments in breast care.
Psychology-Increased awareness in breast care gives peace of mind.
The student teacher enlist
the purposes of breast
care.
The student teacher
explains the principles
involved in breast care.
What are the
purposes of
breast care?
Explain the
principles
involved in
breast care.

7. 3min To explain the care of
breast during pregnancy
period.
CARE OF THE BREAST DURING PREGNANCY PERIOD
During pregnancy due to increased blood flow, the breasts become tender
and swollen. So, special care and attention should be given to the breasts so
that after childbirth, the mother is fully prepared to breastfeed her baby
without any problem.
It is important to begin preparing the breast for breastfeeding during the
prenatal period.
(1) A well-fitting support bra should be worn at all times. This will provide
good support for the enlarging breasts. As the breasts enlarge, an increase in
bra and cup size should be worn. Avoid underwear bras, as under wires can
put pressure on milk glands and interfere with milk production.
(2) Wear a maternity sleep bra that ensures adequate breast support at night.
(3) During the last weeks of pregnancy, the breasts start preparing
themselves for lactation Pads may be worn inside the bra cups to absorb
possible colostrum leakage from the nipples. The pads should be changed if
they become wet from leakage. Prolonged moisture against the nipples may
lead to tenderness and cracking once the newborn infant begins
nursing. Select from reusable and disposable varieties available at stores.
Change them several times a day and allow the nipples to air dry each
change.
(4) The breasts should be washed daily (without soap) to remove dried
colostrum and to prevent irritation to the nipples. Lanolin may be applied to
the nipples to prevent evaporation of perspiration, thereby softening the skin.
Wet tea bags may be placed on the nipples, as the tea will release tannic acid,
which will toughen the skin. The nipples should be air dried or blow dried
after washing to help toughen them, especially if the patient plans to
breastfeed.
(5) The major change during this period is the change in the breast size due
to increase in fat and milk glands. This means, breast grows in size and
weight. Wear a comfortable and correct size of bra. They must wear a good
The student teacher
explain the care of breast
during pregnancy period.
What is the care
of breast during
pregnancy?

8. 1min To enlist the general
instructions during
breast care.
brand bra which provides support and holds the breast in place without
squeezing them.
(6) The bra size should be changed according to the change in breast size
during this phase. Choosing the right bra, prevents the breasts from
sagging.
(7) Under wire bras should be avoided as they put pressure on the milk
glands and thus interferes with lactation.
(8) As the size of the breast increases there are chances that this may lead to
stretch marks. So expecting mothers should apply and massage stretch mark
creams on their breast gently.
The nipples change in color and size as well. They sore, enlarge and stick out
more. Too much dryness, too much friction and too much wetness, makes the
nipples sore. So, in order to avoid the dryness, expecting mother should
avoid:
* Using soaps on their breasts and instead should apply good moisturising
creams on them.
* Rubbing the breast and nipples with towel
* Wearing tight and incorrect size bras
Breasts need regular and special attention during pregnancy. One should not
overlook any tumours and must visit breast physician for their advice and
treatment. Because even the smallest tumour can start growing during this
period and interfere with the ducts and prove to be a hindrance during
lactation.
GENERAL INSTRUCTIONS
 Pay special attention to the nipples
 Use circular movements while applying soap
 Never use strong soap/ antiseptic
 Never apply soap on the nipples & areole part
 Never put the baby on the breasts if the nipples are cracked
 Inspect breasts and nipples daily for engorgement, retracted/
depressed/ cracked nipples, mastitis and other complications
 Never take out nipple from baby’s mouth abruptly
 Mother should have short nails and should wash hands before feeding
The student teacher enlist
the general instructions
during breast care.
List down the
general
instructions of
breast care?

9. 10min To explain the
procedure of breast
care.
PROCEDURE
Preparatory phase:
a) Preparation of nurse:
Must understand the feeling of mother
Musk know to give advises and care related to breast
b) Preparation of articles:
 Bowl of cotton swabs
 Sponge cloth – 2
 Soap in a soap dish
 Ointment, if prescribed
 Kidney tray
 Small mackintosh and towel
 One basin
 Jug of hot water
 Screen
c) Preparation of environment:
Provide calm and safe room
Provide privacy
Provide adequate lighting
d) Preparation of mother
Provide privacy to mother
Explain procedure to the mother
Undress the upper body part
II. Implementation phase:
Wash hands
The student teacher
explain the procedure of
breast care.
Explain the
procedure of
breast care?

10. Assemble all the articles
Explain the procedure to the mother
Take the articles to the bed side
Screen the mother
Make the mother sit or lie down.
Expose one breast at a time.
Place the mackintosh and towel under breasts/ over the lap
Pour hot water in the basin
Apply soap with the hands in a circular movement start from areola ,
breast to end with applying soap on axilla.
Wash the breasts with sponge cloth like above step
Clean the nipples and remove all the crusts with cotton swab to
prevent blockage of the duct
Express little milk
Check for cracks and inversion of nipples or engorgement of the
breasts
Dry the breasts with towel
Put the baby on the breasts but before putting the baby to breast, any
discharge from baby’s eyes or nose is to be cleaned, napkin must be changed
Advise her to wear supporting bra
Make the mother and child comfortable
III. Post procedure phase
Remove all articles and screen from bed side and replace
Wash hands and do recordings.

11. 10min To explain the care of
engorged breast
After care:
Encourage mother to breast feed the child
CARE OF ENGORGED BREAST
Definition
Engorgement is a condition in which the breasts become enlarged, heavy,
hard and tender. It is often seen in varying degrees commonly between third
and fifth day of the puerperium
Purpose
To reduce discomfort of the mother by relieving pain and tenderness
To maintain lactation
To prevent further complications of the breasts
Points to Remember
Breasts must be completely empty after expression
An effort should be made to maintain lactation
Water should not be very hot
Inspect for any breast complication
Sucking by the baby and manual expression are avoided in severe
engorgement.
I. Preparatory phase:
a) Preparation of nurse:
Must understand the feeling of mother
Musk know to giv3e advises and care related to breast
The student teacher
explains the care of
engorged breast
Explain the care
of engorged
breast?

12. b) Preparation of articles:
A medium size bowl with hot water
Four sponge clothes or piece of old clean cloth
Kidney tray
Towel to spread over the mackintosh
A few pads of cotton wool in a bowl
Medicines, if prescribed
Mackintosh
A small hand towel for drying mother after the procedure
A small bowl for receiving expressed milk
c) Preparation of environment:
Provide calm and safe room
Provide privacy
Provide adequate lighting
d) Preparation of mother
Provide privacy to mother
Explain procedure to the mother
Undress the upper body part
II. Implementation phase
Bring the tray to the bed side
Explain to the mother
Screen the mother

13. 10min To explain the care of
cracked nipples.
Put the mother in a sitting or side lying position
Expose the mother’s breast
Place the mackintosh and towel under the breast
Soak two sponge clothes in hot water, wring the sponge clothes well,
test their temperature and apply on breast
Apply soap on hands & stroke the breast towards the nipple
Clean the breast again with hot water & dry with towel
Continue fomentation of the breasts for 10-15 minutes
Put baby to the breast if engorgement is reduced
Express the rest of the milk from the breast manually into clean bowl.
Clean the breast and wipe it dry and apply the medicine (if any)
Ask mother to wear well fitting bra. She can use cotton pads in the
bra for absorbing the milk secretion from breast
III. Post procedure phase:
 Wash and replace all articles
 Record condition of the breasts, nipples and if any medicine is used
After care:
 Teach patient to repeat the procedure if engorgement persist.
 Document the Condition of breasts and nipples and any
medication/ointment if used.
CARE OF CRACKED NIPPLES
Definition
Loss of surface epithelium with the formation of a raw area on the nipple or
fissure situated either at the tip or the base of the nipple is known as cracked
nipple.
.
The student teacher
explains the care of
cracked nipples.
Explain the care
of cracked
nipples?

14. Purpose
 To reduce discomfort of the mother by relieving pain
 To encourage rapid healing.
 To maintain lactation
 To prevent further complications of breast
I. Preparatory phase:
a) Preparation of nurse:
Must understand the feeling of mother
Musk know to giv3e advises and care related to breast
b) Preparation of articles:
A small covered sterile bowl with sterile swabs, soaked in saline or
boiled water.
A small covered sterile bowl with dry sterile / clean swabs and gauze
pieces.
Antiseptic ointment or cream as prescribed
Kidney tray
Screen
c) Preparation of environment:
Provide calm and safe room
Provide privacy
Provide adequate lighting
d) Preparation of mother
Provide privacy to mother
Explain procedure to the mother

15. Undress the upper body part
II. Implementation phase:
Bring articles to the bed side
Screen the patient
Explain the procedure to the patient
Expose breasts
Discard the dirty dressings in kidney tray
Wash hands
Clean the nipples and surrounding area with sterile swabs soaked in
antiseptic lotion
Dry the nipples with dry sterile gauze pieces
Apply medications as ordered
Cover the nipples with sterile gauze piece.
Support the breasts with well supporting bra
III. Post procedure phase:
Clean and replace all articles
 Record the condition of the nipples,
 Presence of any abnormality, such as bleeding, pus etc.
 Medications applied, if any
After care:
Breastfeed from the uninjured (or less injured) side first. Baby will tend to
nurse more gently on the second side offered.
The initial latch-on tends to hurt the worst – a brief application of ice
right before latching can help to numb the area.

16. 10min To discuss about the
techniques of breast
feeding.
Experiment with different breastfeeding positions to determine which is
most comfortable.
If breastfeeding is too painful, it is very important to express milk from
the injured side to reduce the risk of mastitis and to maintain supply. If
pumping is too painful, try hand expression.
TECHNIQUES OF BREAST FEEDING
Breast feeding should be started within half an hour of birth as soon as
possible after normal delivery where as in case of caesarian section delivery,
within 4 hours. Rooming in and bedding should be done with mother and
baby to prevent separation and promote breast feeding.
PREPARATION
 Wash hands
 Position comfortably and correctly use pillows or towels for support.
 Uncover the breast.
1. SIDE –LYING POSITION
 Lie on one side
 Use pillows
 Tummy to tummy
 Baby’s mouth in line with nipple.
USE:-
 Cesarean birth
 Uncomfortable sitting
 No assistance for latch on in sitting
2. FOOTBALL POSITION
To discuss about the
techniques of breast
feeding.
What are the
different
techniques of
breast feeding.

17.  Infant legs are under mother’s arm, with hand at the base of the head
and neck.
 Use pillows
 Help infant in latching on
USE:-
 Cesarean birth
 To see the latch on position
 Large breast
 Small baby
 Infant is sleepy
3. CRADLE POSITION
 Hold the infant in upright position on mother’s lap
 Infant head in crook of mother’s elbow on the same side close to the
breast, the neck is slightly extended.
 Infant ear, shoulder and hips in straight line
 Tummy to Tummy
 Chest to chest of mother and infant
4. CROSS CRADLE POSITION
Same of cradle position but just the opposite hand was used to support
the infant and the same side hand was used to hold the breast.
USE:-
 To learn Latching
 To maintain comfortness of the mother

18. LATCH ON
 Mother holds the baby in upright position on her lap.
 Mouth is wide open and the chin touches the breast.
 Mother guide the nipple and areola into the baby’s mouth for
effective milk transfer
 Peristaltic action from the tip of the tongue to the base.
DELATCHING
 Watch baby for cues that he /she is finished
 May spontaneously come off the breast
 May fall sleep
 If mother wants to stop the feeding early, break suction by inserting
finger into corner of infant’s mouth.
BURPING
 Propped up with baby’s tummy against shoulder of the mother.
 Sitting up, leaning forward on one hand of the mother with the other
hand burps at back of infant.
SUMMARY
Today we discussed
about breast care, its
purpose and principle
involved in breast care,
procedure of breast care,
care of engorged breast,
care of cracked nipples,
care of inverted nipples,
techniques and position
used in breast feeding.

19. BIBLIOGRAPHY
 Mohrbacher, Nancy, and Stock, Julie. The Breastfeeding Answer
Book, 3rd
Edition. Illinois: La Leche Leage International, 2003.
 The Breastfeeding Committee for Canada. The Baby-Friendly
Iniative in Community Health Services: a Canadian Implementation
Guide. BCC, 2002.
 World Health Organization. Evidence for the Ten Steps to Successful
Breastfeeding. Geneva: WHO, 1998.
 Google Images
CONCLUSION
There is no freedom of
choice for humans if it
has been taken away
from them at the
beginning. Breast-
feeding is not a choice,
but an obligation to the
choice.
“Give your child the
freedom of choice”.