basics of breastfeeding
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BASICS OF BREASTFEEDING
St. Mary’s HospitalFamily Care Suites
Orientation
Anatomy
Anatomy
Glands or lobes 15-25 lobes alveoli maternal blood supply myoepithelial cells milk ejection reflex
Anatomy
Transport
Lacitferous ducts or sinuses coming from the alveoli toward nipple expand to larger ducts (like tree
branches) transport milk
Nipple
Many shapes and sizes 5-10 openings
Areola
Darkens in pregnancy Montgomery glands
provide lubricationsecrete fluid with odor of amniotic
fluid
Fat Cells
Fat determines the size of the breast
All breasts have the about the same number of milk glands or lobes
Size does not determine ability to make milk
Blood Supply
Internal Mammary Artery (60%) Lateral Thoracic Artery (30%)
Nerve Supply
4th, 5th, & 6th intercostal nerves
Breast Assymetry
Areolar tissue
Compressible or Fibrous
Size and Shape of Nipples
Surgical or Injury Scars
Reduction or Augmentation
Burns or Trauma to chest
Hormones for Lactation
Prolactin : anterior pituitary hormone pregnancy effects inhibits ovulation stimulates milk synthesis Oxytocin signs of “let down” uterine cramps increase bleeding thirst feeling sleepy leaking changed sucking “pins and needles” ok if nothing felt
Pathway & Effects of Oxytocin & Prolactin
Other hormones
Necessary for milk production: Insulin Cortisol Thyroid Parathyroid Human growth hormone Feedback inhibitor hormone
Milk Production
Lactogenesis I during pregnancy progesterone and estrogen secretory cells colostrum
Milk Production
Lactogenesis II (2-8 days) starts after delivery of placenta drop in progesterone & estrogen prolactin level increases switch from endocrine control to
autocrine
Milk Production
Lactogenesis III Establishment and Maintenance (8-10
days) Mature Milk
Composition
Colostrum first food High in Protein, vitamins & minerals Antibodies Less fat & lactose than mature milk Laxative About 3 ounces in 24 hours
Colostrum
Composition
Mature Milk Transitional Milk (approx. 2 weeks) Increases in fat & lactose, water
soluble vitamins Decreases in protein 750 kcal/liter
Foremilk / Hindmilk
Foremilk thinner watery milk at beginning of
feeding
Hind Milk higher in fat and calories
Let baby finish one breastDo not limit length of time at breast
Fore Milk & Hind Milk
Milk Composition
Variations to milk are normal
Depend upon: time of day beginning or end of feeding maternal diet maternal hormone fluctuations
Immunologic and Bioactive Properties of Milk
Secretory Immunoglobin A provides passive immunity Inhibited bacterial growth in gut
Macrophages are abundant in human milk
destroy & digest bacteria
Reduction in Food Allergies
Benefits of Breastfeeding
Benefits of Breastfeeding
Benefits to Baby: Species specific Good Health Reduce risk of Disease Promotes Physical Development Provides Emotional Benefits
Benefits of Breastfeeding
Benefits of Breastfeeding
Benefits 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
Benefits to Family & Environment
Family saves money Fewer healthcare costs No energy use for production No packaging materials No production animals, feed, machinery,
waste disposal No transportation No contamination or disease transmission
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)
Skin to Skin contact
Infant naked or only in diaper Mom with breasts, chest and belly bare May have blanket over them both Mom can be sitting or reclining with
infant vertical between her breasts or on one breast
Benefits of Skin to Skin
Improves suckling Increases duration & exclusive
breastfeeding Higher skin temperatures Raises blood glucose Normalizes base excess Less crying Release of oxytocin-less uterine bleeding Release of prolactin- increase in
production Bonding, less anxiety for mom
Benefits of Skin to Skin
Indications
Possible dose response, separation of mom and baby for 20 minutes during 1st hour detrimental
As little as 15-20 minutes beneficial Baby awake after delivery, start skin to
skin as soon as possible, suckling may not occur for up to 2 hours after delivery
Recommend at least 30 minutes long or longer for a more difficult birth
Skin to Skin
Feeding cues
Mouthing movements Suckling movements Clenching of fingers or tight fist over
chest Hands to mouth Crying is a “Late feeding cue”
Feeding
Content Baby
Positioning
Positioning
Mother well supported with pillows, drink nearby, empty bladder, foot rest as needed
Positioning
Cradle Hold Infant’s body level with breast Towards mother: tummy to tummy Infant’s ear, shoulder and hip aligned
Breast Support
“C” hold- supports breast and hands out of the way for baby to latch well
Breast support
Cradle hold
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
Side lying hold
Advantages/disadvantages
+ Allows mother more rest + more comfortable after a c-section
with support of tummy
- mother’s fear of smothering their baby
Football or Clutch hold
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
Cross Cradle
Cross Cradle hold
LATCHING
Nose to nipple Manual expression Tickle lip Wide open (rooting) Tongue down, nipple to roof Bring infant in toward mother Latch with entire nipple & about 1 inch of
areola Lower jaw covers more than upper
Goal of Latching
Chin touching breast Nose lightly touching breast or not at all Lips both turned outward
As Baby Nurses
Cheeks puffed out Rocking of entire jaw Temple movement Intermittent swallows NO clicking or smacking Breast tissue
Mom as Baby Nurses
Feels no pinching Feels strong tugs at breast
Initial latch may be tender as nipple elongates
Tender if nipple trauma, needs to heal Mother to detach & start over if painful Mother may feel uterine cramping
No Biting!!
Nipple Assessment
Nipple round and erect at detachment No creasing or blanched looking Not misshapen- like lipstick end
Frequency & Duration
First 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
Nursing
Let baby nurse as long as he wants Do not watch the clock, watch the infant Generally, 10-30 minutes, longer or
shorter ok
Nursing
Active nursing from first breast Stimulate infant if sleepy When done, burp, check diaper and offer
2 nd He may or may not take 2nd
Alternate the starting breast each feeding
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
Our Breastfeeding Log
Stomach capacity
Marble sized at one day old
Large marble at 2-3 days old
Golf ball at a week old
Feeding Plan
Reasons we supplement
How do we supplement
What do we supplement
Pacifier use
Nipple Sheilds
Latch with shield
Sore Nipples
Causes: 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
Sore cracked nipples
Strategies for Sore Nipples
Care plan
Engorgement
Occurs 2-5 days after delivery Lasts 24-48 hours Swelling of the breast by increase blood
& lymph fluid as milk “comes in”
Prevention of Engorgement
Nurse frequently Correct latch Skin to skin contact No supplements Pump only for comfort Engorgement care plan
Jaundice
Physiology Bilirubin Direct & Indirect
Causes Physiologic jaundice Pathological jaundice
Treatment of Jaundice
Increase frequency of feedings May need to double pump to supplement Supplement with mom’s milk or formula Phototherapy Monitor hydration Educate parents
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
Mastitis
Bacterial infection of breast tissue Symptoms:
hard, reddened tender areared streaking, fever, flu like symptoms
Causes: damage to nipple open to bacteriamilk stasis, inadequate emptying, plug
Care Plan
Mastitis
Thrush
Yeast overgrowth
Predisposing factors: nipple damage, antibiotic use, yeast vaginitis
Signs & Symptoms: white, pimple like dots, superficial cracking at base of nipple, constant pain, burning, itching
Infant may or may not have symptoms White patches in mouth, diaper rash
Thrush
Nutrition & Medications
Well balance diet Extra 300-500 calories per day Infant may be sensitive to mom’s diet Caffeine sparingly Alcohol passes into milk Prenatal Vitamin Q day Nicotine Educate parents Dr. Hale- “Medications & Mother’s Milk”
Breast Pumps
Manual- occasional pumping, relieve fullness, 5 minutes alternating sides for 15 mins. total
Single 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
Breast Pumps
Reasons to Pump in Hospital
Supplement baby- SGA, Weight loss Milk to NICU baby or separation due to
illness Baby not nursing at 24 hours of age
Challenges
Universal strategies Sleepy Baby Not opening mouth wide Tongue sucking/ Thrusting Mucousy Baby Biting Baby Fussy Baby Flat/ Inverted nipples Creased Nipple
Resources
“Best Baby on the Block”- Dr. Harvey Karp
Breastfeeding Videos Lactation Counselor Certification CEU offerings Breastfeeding Books & Atlases in LC
office Your friendly Lactation Consultants
Lactation Consultants
Laura Rosenau, RN, IBCLC Rosie Sergenian, LPN, IBCLC Holly Guenther, RN, IBCLC Ruth Harding- Weaver, RN, IBCLC Melanie Betchey, RN, IBCLC Jennifer Ulmer, RN, IBCLC Crystal Huene, RN, IBCLC
Questions Comments Concerns
Case Studies
Read 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?
Case Study
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?
Case Study
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?
Case Studies on your own
1-2 nurses per case study Studies number 4 through 8 Discuss among your group & present to
others
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.
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