Purpose: To promote the philosophy in maternal infantcare, which advocates breastfeeding and supports the normalphysiological functions, involved in the establishment of thismaternal infant process. To assist families choosing tobreastfeed with initiating and developing a successful andsatisfying experience.
Policy: •New Life Center associates will base breastfeeding instruction on the Academy of Breastfeeding Medicine Clinical Protocols, and the International Lactation Consultant Association Clinical Guidelines for the Establishment of Exclusive Breastfeeding as the primary resources in order for mothers to receive consistent information (refer to Appendices A and B). •Initiate breastfeeding orders for all breastfeeding infants.
Procedure:1. All NLC nursing associates will have knowledge in the current basic management of lactation. Written protocols are located in the Lactation Office of the NLC.2. Infants will be put to the breast as soon as possible following delivery (within 30 minutes to two hours after birth) unless contraindicated by the mother/baby condition, or patient preference.3. Breastfeeding mothers will receive a purple folder with Breastfeeding information and a Breastfeeding Log. Instructions will be given to the patient regarding usage of these.4. Infants will be fed on demand (at least 8 or more times in 24 hours). Twenty-four (24) hour rooming-in will be encouraged.5. Breastfeeding and breast care instructions will be offered to all mothers on a routine basis by NLC nursing associates. If possible, the mother and infant will be seen and assessed by the Lactation Consultant during patient’s stay.
6. No supplementary water or formula is to be given unless specifically ordered by the physician or requested by the parent. If supplements are ordered, the infant will be given the feeding method of the mother’s preference (refer to the ABM Clinical Guidelines Protocol # 3 in Appendix A). • The reason for giving a supplement will be documented in the nurse’s notes. • The importance of exclusive breastfeeding will be addressed. A mother who requests an artificial feeding will be given information regarding possible impact on successful breastfeeding.7. Mothers may breastfeed while taking prescribed customary postpartum medications unless otherwise ordered by infant’s physician. • For questions on medications and breastfeeding, refer to the reference book “Medications and Mother’s Milk” (Hale, 2008). • If the medication is categorized as a 3 or above in this book, the physician is consulted regarding the appropriateness of the medication while breastfeeding. • If the mother/baby has/have a positive toxicology screen, refer to P/P 6600.0211: Breastfeeding and Substance Abusing Mother.
8. Feedings will be assessed and evaluated by a NLC licensed nurse associate every shift for comfortable positioning and active nutritive suckling at the breast. If breastfeeding problems are assessed, the Lactation Consultant and/or NLC Nurse will work with the patient/infant to facilitate effective breastfeeding.9. If mother/infant separation occurs: • Mothers will be instructed in proper breast care and on how to initiate and/or maintain lactation. • Mother’s milk expressed during the period of separation will be collected and made available to the infant as soon after expression as is feasible. Instruction on the use of a breast pump may be performed if necessary. • If the breastmilk cannot be offered to the infant, it will be safely stored for use at a later time (refer to P/P # 6600.0604 - Breastmilk Storage). • Separated infants will receive their own mothers expressed breastmilk unless alternate feeding orders have been written by the infant’s physician.
10. Mothers are encouraged to nurse from one side well with infant self detaching and contented, burp infant, and then offer the other breast if indicated. If unable to nurse on both breasts, instruct mother to offer the next feeding using the unused breast first.11. No pacifiers are offered to breastfed infants in the NLC. Refer to Breastfeeding orders.12. Breastfeeding interactions with mother and infant are documented in the mother’s and infant’s charts under the narrative.13. The primary nurse will complete the Breastfeeding Checklist prior to discharge (see Appendix C) and place it on the chart infant’s chart under education partition.
14. A Breastfeeding Telephone Consult Sheet (Appendix E) is initiated by the primary nurse, and is placed on the patient’s chart until discharge. When the chart is broken down, this is placed on the Lactation Consultant’s Desk for follow up.15. At discharge, each Breastfeeding mother will receive the Breastfeeding Discharge Instructions Sheets (refer to Appendix D), and the Lactation Consultant’s contact card. At discharge, all mothers are encouraged to follow up if necessary regarding breastfeeding challenges by telephone or visit. A phone call (follow up) by the LC or a Nurse will be attempted within a week of the patient’s discharge.