Lactation counselling involves assessing and addressing any issues that may interfere with successful breastfeeding. Key aspects include observing the mother and baby's positioning and latch during feeding, assessing the mother's breasts for any issues like engorgement or soreness, and developing interventions like breastfeeding positions, pumping, or nipple shields to improve latching and milk removal. The goal is to maintain a productive breastfeeding relationship through interactive counselling and problem-solving.

1. Lactation counselling
Ms. Kaaynat Khan
Occupational Therapist

2. Definition
Importance of breastfeeding
Anatomy associated with breastfeeding
Physiology of breastfeeding
Breastfeeding

3. Breastfeeding, also known as nursing, is the feeding
of babies and young children with milk from a
woman's breast.
Health professionals recommend that breastfeeding
should begin within the first hour of a baby's life and
continue as often and as much as the baby wants.
Definition

4. Why breast feeding is important?

5.  Less blood loss following delivery
 Better uterus shrinkage
 Less postpartum depression
 Lactational amenorrhea :delays the return
of menstruation and fertility
 Decreased risk of breast cancer, cardiovascular
disease and rheumatoid arthritis
 Breastfeeding is less expensive than infant formula.
Other benefits

6. Anatomy of Breast

7. Physiology of breastfeeding

8. Definition
How to assess?
What to assess?
What to do?
Lactation counselling

9. Lactation counselling is defined as the use of an
interactive helping process to assist in maintenance
of successful BREASTFEEDING
What do you mean by lactation
counselling?

10. History: Breast feeding history form
Observation of feeding
Palpation
Examination
How to assess?

11. What do you notice about the mother? How does the
mother hold her baby?
What to assess?

12. Observe
 Size and shape of breast (may affect confidence)
 Size and shape of nipple (may affect attachment)
 Dripping milk (sign of active oxytocin reflex)
 Full, soft, engorged
 Fissures, white spots
 Redness (inflammation or infection)
 At end of feed, protracted or squashed
 Scars (breast surgery, previous abscess)
What is the condition of the mother's
breasts

13. Palpate
Both breasts :
Look for mother's face for signs of pain or tenderness
Feel for :
 Generalized fullness, hardness, engorgement
 Localized hardness, hot areas, lumps
Nipples
Ask mother to show how easily her nipples stretch out
(protract) (she places her finger and thumb on the
areola either side of her nipple, and tries to stretch the
nipple out)

14. There are several common breast conditions which
sometimes cause difficulties with breastfeeding:
Flat or inverted nipples, long or big nipples;
Engorgement;
Sore nipples and nipple fissure.

15. How does the mother hold her breast during a feed?

16. What do you notice about the baby? Does the baby look
well attached to the breast? How does the mother put
her baby onto her breast? Is the baby suckling
effectively? Does the baby seem satisfied?

17. Oral motor reflexes
Rooting reflex
Sucking reflex
Swallowing reflex
Reflexes

18. Positioning
Breast exercises for latching difficulties
Oral motor stimulation for reflex integration
OCCUPATIONAL THERAPY
INTERVENTION

19. Laid back position
Recline back about 45 degrees
Wherever you like to nurse—on
the couch, in bed, on a recline and
baby lies face down on top of
mother’s breast with his arms
hugging breast on both sides.
Good for babies with reflux, since
gravity will help with digestion.
Types of position

20. Football hold/ clutch hold
Baby tucked under arm off to
the side and held with one arm
while mother support breast
with the other arm. If you’re
holding baby on the right side,
baby will latch onto your right
breast while you support it with
your left hand.
Good for mothers having c-
section (there’s less rubbing on
the incision)
Premature child

21. Side lying position
Lie down on your side with baby
facing you. (You can put a
breastfeeding pillow or a roll-up
towel behind baby to support her
back.) Baby nurses from the
breast that’s resting on the bed.
Good for mothers having c-
section (there’s less rubbing on
the incision).

22. Cross cradle hold
Bring baby across your body,
tummy to tummy, so if baby is
nursing on your left side, you
hold baby—supporting his
neck—with your right arm
and support the breast with
your left hand.
Good for feeding premature

23. Cradle hold
Support baby with the
arm on the same side as
the breast she’s feeding
from, not the opposite
arm.

24. Upright breastfeeding
Koala or upright football hold,
have baby sit upright, facing
mother and straddling knee.
Support baby with the arm on
the same side as baby is
feeding and support breast
with the opposite hand
For babies with reflux, since
gravity will help with digestion

25. Double-cradle hold
This breastfeeding position allows
moms of multiples to nurse in
tandem, often with a
breastfeeding pillow under both
babies. Each baby lays in the crook
of each elbow, crisscrossing each
other in lap.
Double-football hold
In this hold, babies’ bodies rest on
pillows along sides and under
arms.

26. Large Nipples
Hard for a new born to latch.
Even average sized nipples can seem too big if your
baby is premature.
Solution
Suction of a breast pump to make nipples longer and
thinner before beginning to breastfeed.
Nipple shield when placed over the nipple, the shape
of the shield is smaller and easier for a baby to grasp in
his mouth.
Latching problems

28. Severe breast engorgement
Common in the first few weeks of
breastfeeding: colostrum is turning into transitional
breast milk.
Transitional breast milk stage - milk production -
swollen and hard, nipples flatten out.
Solutions
Pumping or hand expressing a little
Frequent feeding

29. Before feeding or expressing, stimulate the mother's
oxytocin reflex.
Warm compress on breasts,/ warm shower;
Massage neck and back;
Massage breast lightly;
Stimulate her breast and nipple skin;
After feeding
Cold compresses or clean cabbage leaves to reduce the
swelling.

30. Reverse pressure softening
The mother uses her fingers to press against the tissue
in a circle around the nipple. This leaves an indented
area where the baby can now latch.

31. Sore breast
Causes
Poor attachment to the breast
Tongue-tie - ineffective use of tongue
infection
Solution
Prevention-
Provide stability for the baby’s shoulders, spine and hips
with no pressure on the baby’s head, and the baby
needs to be facing the mother and not having to turn
his head to latch on.

32. Feeding the baby in response to his cues.
Pacifiers and bottles should be avoided. Babies suck on
a pacifier or bottle nipple quite differently than at the
breast and, for some, this leads to a shallow, pain-
inducing latch at the breast.
Treatment
Warm, moist compresses to nipples before and after
feeding.
Hard plastic breast shells

33. Advice
Not to wash breasts more than once a day, and not to
use soap, or rub hard with a towel.
Breasts do not need to be washed before or after feeds.
washing removes natural oils from the skin, and makes
soreness more likely.
Suggestion to rub little expressed breast milk over the
nipple and areola with her finger after breastfeeding .
this promotes healing.

34. Flat or inverted nipples
Most nipples improve around the time of delivery
without any treatment.
Solution
Nipple shield
Use a hand breast pump, or a syringe to pull her nipple
out.
Stimulating the nipple
Shaping the breast
To shape her breast, a mother supports it from
underneath with her fingers, and presses the top of the
breast gently with her thumb. She should be careful not
to hold her breast too near the nipple.

36. Premature
Small mouth- harder to get a good latch.
Less energy to suck and draw the milk out of the breast,
tire out quickly.
Solution
Nipple shield
Oral feeds should begin as soon as the baby tolerates
them.
Babies <30-32 weeks GA- let baby suck on mothers finger
while on tube feeds- stimulates digestive tract, helps
weight gain.
Frequent breaks in between

37. Perioral stimulation ranging from 5 to 15 min
Perioral stimulation followed immediately by pacifier for
NNS.
Pacifiers during gavage feeds
Sweet pacifier
Semi-demand gavage feeds & pacifier during feeds
Tactile/ kinesthetic whole body stimulation
Oral stimulation

38. Patterned
orocutaneous therapy
e ‘pulsating pacifier.

39. Nuk brush
Excellent stimulation
devices for the mouth
and tongue
Rubbing these devices
around the mouth, on
the cheeks, gums and
tongue

40. Music therapy pacifier
activated lullaby
Positive feedback in
the form of
music/mother’s voice
as an auditory input in
direct response to
efficient sucking.

41. Oral support during
feeding