international childbirth education associationjoint commission. specifications manual for joint...
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International Childbirth Education Association
Postpartum Doula Program
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Part 7: Breastfeeding
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� Comprehend the benefits of breastfeeding to
both mom and baby. � Identify the basic breast anatomy, and the
hormones involved in breastfeeding. � Explain what a good latch looks like. � Understand and be able to explain common
breastfeeding issues.
OObjectives:
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� Breastfeeding: A system of newborn care ◦ Food + Protection � Warmth for newborn � Emotional and physical security and safety for
both � Immunity from bacteria, viruses and fungal
infections � Protection for mom and baby � Economic food security
MMore Than Just Food
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� Less work time missed � More sleep � Decreased incidence of breast cancer,
ovarian cancer, osteoporosis and diabetes
� Increased mothering skills and confidence
� Less environmental waste
BBenefits to Mom
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� Increased IQ scores � Decreased risk of:
◦ Childhood leukemia ◦ Celiac disease ◦ Incidence and severity of allergies and asthma ◦ Ear infections ◦ Respiratory infections ◦ Meningitis ◦ Childhood obesity ◦ Diabetes
� Less SIDS in infants
BBenefits to Baby
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� Alveoli: milk making cells
� Ducts: carry milk forward through the nipple
� Mammary vessels bring blood and nutrients to alveoli to synthesize milk
BBreast Anatomy
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Q – What do I need to do to “get ready” for breastfeeding? A – Be pregnant! Your body knows to get ready to feed the baby after birth! Colostrum begins production about halfway through the pregnancy- the first meals are ready for your baby!
PPrenatal Preparation
Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management. ICEA Copyright 2015
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� Prolactin stimulates the alveoli to extract nutrients from the blood vessels and make human milkpromotes calming
� Oxytocin contracts muscles surrounding the alveoli to cause “letdown”-promotes nurturing feelings and behaviors
LLactation Hormones Hormones of Lactation
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“Healthy infants should be skin to skin with their mothers immediately after birth and remain there with minimal disruptions throughout the recovery period until the first feeding is accomplished.” AAP 2005
SSkin to Skin Care
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� Mother’s temperature rises to keep baby warm! � Less newborn crying � Improved oxygen levels in the newborn � Less initial weight loss � Better weight gain in the first weeks � Enhanced early breastfeeding
SSkin to Skin With Your Baby The best start for baby and breastfeeding
Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007.
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� Infant upright, tummy to chest � Infant naked or a diaper � Mother no bra or camisole � Cover both with blanket or gown � For initial – remain together until infant self-
attaches � For encouraging breastfeeding remain skin to skin
at least 30-60 minutes and showing cues
�
““How to” Skin to Skin Holding
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� Richer in protein to maintain blood sugar levels � Higher in vitamins and minerals � Higher in immunities to prevent infections � Concentrated form designed for the first days � Laxative effect to clear meconium and excess
bilirubin
BBenefits of Colostrum
Milk does not “come in” first milk-colostrum is present at birth!
Colostrum “changes-over” to mature milk in 2-5 days after birth
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Give your baby only your milk unless medically indicated. � Keeps your baby’s intestines
healthy � Builds newborn’s immune
system � Reduces the chances of allergies � Helps assure milk supply
EExclusive Breastfeeding
Bartick M, ReinholdA. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56
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Thanks Mom for keeping me healthy by breastfeeding me for at least 6 months!
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NNewborn Stomach Capacity
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� Mouth wide open, far back on the breast.
� Nose and chin close to breast.
� Nipple stretches to back of the infant mouth- soft ”comfort zone”
�
CCorrect Latch On
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� Mouth wide open � Lips flanged back � Full, round cheeks � Nose and chin touching your breast � Sucking bursts and pauses � Listen for swallowing � Feel tugging sensation � No biting or pinching sensations � No clicking/smacking sounds
SSigns of a Good Latch
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� Start with nose to nipple
� Mother’s hand on shoulders and back - not pushing head!
� Allow head to tilt back
� Mouth opens widely � Chin and bottom lip
are first to the breast
AAsymetric Latch � Mouth comes “up and
over” to attach far back on the breast
� Nipple is in the top half of the mouth- available space tongue is the bottom half of mouth
� Attachment is “off center” further down on the areola, more areola visible above the top lip
Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management.
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Mothers and babies belong together!!!
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� Newborn’s instinctive position: head and body in alignment (straight line between ears, shoulder and hip), chin not on chest (slight backward head tilt), hips flexed
� Bring the baby to the breast- not your breast to the baby! Back and shoulders relaxed and supported.
� Cradle, cross cradle, side hold or side-lying?
BBreastfeeding Positions
No “right” or “correct” position --whichever is best for you and your baby!!!
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� 1st 24 hours: about 8 feedings, each about a teaspoon colostrum. More frequent if skin-to-skin.
� 24-48 hours: 8-10 feedings. � 3-4 days: increasing to 8-12 times/24
hours as milk volume increases � Cluster feedings!!!!!! � Length of feedings: offer the 1st
breast until finished, then offer the 2nd.
FFrequency in Feedings
No time limitations!!! ICEA Copyright 2015
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Wiggling - Early Rooting – Early Fussing - Mid Body moving - Mid
Active Crying - Late
FFeeding Cues Baby Cue and Stage of Readiness
Watch the baby Not the clock!!!
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� Communication between each Mother and her baby sets the amount of milk made
� Important in the first days and weeks to establish each mother/baby unique needs
� Avoid pumping if not separated from your baby or your milk is needed for supplementation
� Avoid unnecessary supplements for best milk supply
SSupply and Demand “Request and Supply”
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� 8-12 feedings/24 hours � Can hear swallowing of colostrum
or milk � Urine is pale in color � Initial weight loss no more than
7%, stops loosing weight by 5 days and back to birth weight by 2 weeks.
� IV Therapy effect- IV fluids may increase initial weight, cause increased urine and weight loss not related to feeding
� 8-12 feedings/24 hours
AAfter the Hospital Is my baby getting enough?
DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122:s43–9.
“milk drunk”
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� Day 1-2- 1-2 wet and 1-2 stools/24 hours � Day 3 - 3 wets and stools with stools changing to
brownish green � Day 4-5 - with filling of the breasts, increases to 3-4
wets and at least 4 stools, changing to golden yellow
� Day 6 - 6-8 wets with 3-4 unformed yellow seedy stools
AAdequate Output
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NNormal Stooling Pattern
Copyright: The Birth Atlas 2002
Too little or no stools call care provider
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WWhat if…
….. and prevention ICEA Copyright 2015
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� Usually defined as: <40 mg/dl
� Prevention: ◦ Skin-to-skin for warmth ◦ Early colostrum feedings ◦ No limiting of early
feedings ◦ Avoidance of “sugar
waters”
LLow Blood Sugar
USBC 2008 Achieving Exclusive Breastfeeding in the United States: Findings and Recommendations ICEA Copyright 2015
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� High levels of bilirubin in infant’s blood
� Yellowing of skin and eyes � Prevention: Nurse within
60-90 minutes after birth � Frequent, unlimited
feedings of colostrum (laxative effect)
� Schedule appointment with your baby’s Dr. in 3-5 days
�
JJaundice
Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506 ICEA Copyright 2015
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Causes: Improper latch and not feeding on cue
Prevention: No scheduled feeds- feed on cue with correct latch
First line of defense Correct the latch!
� Asymmetric latch � Observe for tongue tie � Review feeding cues
SSore Nipple
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What is it? Abundant milk and increasing fluid in the breasts
Causes: Inadequate emptying of the breasts or over-
stimulation with over-production or use of IV fluids Prevention:
Feed frequently with baby’s cues, avoid scheduling or skipping feedings
Filling (rounder, fuller, firmer) is normal!!! Rock-hard, hot, overly-full is not normal!!!!
EEngorgement
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� If infant unable to latch – may express a small amount, but only enough to soften the nipple/areola before feeding
� “Hang” breasts in tepid water, sink or basin, for gravity emptying. May add massage to move milk forward. Repeat as often as needed until softened and infant can latch easily
� Shower with water on back- flowing over breasts � Discontinue unnecessary pumping
EEngorgement Treatments
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� Causes: ◦ Too tight or extended wearing of bras ◦ Sleep position with pressure on the breast ◦ Inadequate emptying of the breasts: missed
feedings, scheduled or timed feedings � Symptoms: Localized redness, tenderness,
warmth and pain � Treatment:
◦ Warm compresses and massage before a feeding ◦ Usually resolves with in 24-36 hours
PPlugged Ducts
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� Symptoms: fever, flu-like symptoms, may have red streaks on the breast
� Causes: cracked nipple, plugged duct, over supply, not regularly emptying of breasts
� Call Dr. or Midwife! � Continue to breastfeed!!!
MMastitis
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� Old wives tales- no garlic, onions, chocolate, beans, citrus- not true!
� General guidelines- well balanced diet- veggies, fruit, whole grains, lean meats
� Adequate fluids and water - drink to thirst- do not force fluids
� Avoid fad or severe calorie restriction diets � Opportunity for family education on nutrition and
healthy eating habits � Minimize hormone/chemical additives
NNutrition for Breastfeeding
Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition, Maryland Heights, MO: ElsevierICEA Copyright 2015
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� Hospital grade pumps- if you are separated from your newborn. Add hand expression for more milk!
� Manual pumps- economical Double pump- for return to work or school
BBreast Pumps
Remember! No need to begin pumping for 2-3 weeks, unless separated from your baby!!
Human Milk Banking Association of North America (HMBANA) (2011).Guidelines for the establishment
and operation of a donor human milk bank. Fort Worth, TX: HMBANA, accessed http://hmbana222.org
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� BOOKS ◦ Ina May’s Guide to Breastfeeding by Ina May Gaskin ◦ The Womanly Art of Breastfeeding by La Leche
League ◦ The Breastfeeding Book by Dr. William and Martha
Sears
�
IInformation on Breastfeeding
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WWebsites
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� Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management. Jones and Bartlett Learning. Burlington, MA
� Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007.
� National Alliance for Breastfeeding Academy. (2012). NABA REAL Code Monitoring. Retrieved May 28, 2012,
� Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007–2008. JAMA 2010;303:242–9.
� White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation. Washington, DC: The White House; 2010. Available at http://www.letsmove.gov/whitehouse-task-force-childhood-obesity-report-president. Accessed June 30, 2011.
� Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics, 2012
� Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition, Maryland Heights, MO: Elsevier
er-Maffei, C. 2013. Pocket Guuide For Luide For
RReferences
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� Joint Commission. Specifications manual for Joint Commission National Quality Care Measures: perinatal care.Available at http://manual.jointcommission.org/releases/TJC2011A/PerinatalCare.html. Accessed May 20, 2011.
� CDC. Breastfeeding report card—United States, 2011. Atlanta, GA: US Department of Health and Human Services,CDC; 2011. Available at http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed August 1, 2011.
� US Department of Health and Human Services. The Surgeon General’s call to action to support breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011
� CDC. Breastfeeding among U.S. children born 2000–2008, CDC National Immunization Survey. Atlanta, GA:US Department of Health and Human Services, CDC; 2010. Available at Http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed July 8, 2011
� Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56.
� US Department of Health and Human Services. Healthy People 2020: Maternal, Infant, and Child HealthObjectives.Availableathttp://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist .aspx?topicid=26. Accessed May 20, 2011
� DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122:s43–9.
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� Academy of Breastfeeding Medicine- .www.usbreastfeeding.org breastfeeding protocols � United States Breastfeeding Committee- USbreastfeeding.org – Core Measure and Basic
Competencies Tool kits � Baby Friendly USA- www.babyfriendly usa.org American Academy of Pediatrics- Policy
Statement on Breastfeeding http://pediatrics.aappublications.org/content/129/3/e827.abstract?sid=fc620c15-8dc14ae4-8e98-133e4f67f84d
� Centers for Disease Control and Prevention- http://www.cdc.gov/breastfeeding/ � Wellstart- Resources for physician education- http://wellstart.org/ � White House Task Force on Childhood Obesity - http://www.letsmove.gov/whitehouse-
task-force-childhood-obesity-report-president � American College of Obstetrics and Gynecology- Breastfeeding
http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health% 20Care%20for%20Underserved%20Women/co361.pdf?dmc=1&ts=20130130T13323 59887
� Department of Health and Human Services- Healthy People Goalshealthypeople.gov/2020/topicsobjectives2020/ebr.aspx?topicId=26
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