Successful breastfeeding begins with education! Randy Heninger LT, NC, USNR Lactation Specialist U.S. Naval Hospital Keflavik Breastfeeding Success Course

Successful breastfeeding begins with education!

Randy HeningerLT, NC, USNR

Lactation SpecialistU.S. Naval Hospital

Keflavik

Breastfeeding Success Course

A Joke to Start Us Off

4. Available in attractive containers of varying sizes.

He received an A.

A student sat in his Life-Science classroom, staring at his final exam, paper. One question stymied him: “Give four advantages of breast milk.” His first three examples:

1. No need to boil.

2. Never goes sour.

3. Available whenever necessary.

But, what fourth example to give?? Suddenly it dawned on him.

Breastfeeding through time

"Motherhood"Angelina and the child Diego

Diego Rivera

"Virgin of the Green Cushion"

Solario

Anatomy

Milk Production Cells - Mature at Birth of NewbornDuct - Carry milk to SinusesSinuses - hold milk until breast is suckled or pumpedNipple openings - 5 to 10

Anatomy (cont.)Supernumerary nipple line

LatchInitial in delivery positively impacts the long-term success of mother and infant.

ObstaclesHeavily medicated mother

NarcoticsCesarean sectionMagnesium therapy (pre-eclampsia)

Infant with a 5-minute Apgar score under 6Premature infant less than 36 weeks gestation

LatchC/Section

Timing of the milk coming in or concentration of major milk constituents does not change with type of delivery.Most nurse within one hour postoperatively some even in the recovery room.Involution of uterus

Less bleeding

VaginalWithin one hour of delivery of placenta

Oxytocin (pitocin) levels are at their highest

Involution of uterusLess bleeding

Latch

Stimulating milk-ejection reflex (let down)

Nipple stimulationRoll nipple between fingers (erect shape)Lightly stroke breast from outer to innerMessage from outer to inner

Latch

PositionCradle hold

Rest baby on a pillow, his head in the crook of your elbow. Using the C hold (four fingers under your breast, thumb on top), support your breast with your other hand.

LatchPosition (cont.)

Cross-cradle holdThis is the cradle hold with hands reversed. If you have baby in a right-handed cradle hold, for example, switch hands: Your right hand will be holding your breast, while baby's head rests in your left hand, your forearm along his back.


Football holdSit comfortably, with your back well supported, a pillow at your side and partially covering your stomach. Rest baby on the pillow, his bottom near your elbow and his back against your forearm. Use one hand to hold his head and the other to support your breast with the C hold.


Side-Lying PositionThe lying down position is basically the same as the cradle hold, but with baby and mother lying on their sides facing each other. Place two pillows under your head, a pillow behind your back, a pillow under your top leg, and a fifth pillow tucked behind your baby. Five pillows sounds like a lot, but remember a golden rule of nursing: if mother is comfortable, baby is likely to be more comfortable, too. Place your baby on her side facing you, and nestled in your arm. Slide baby up or down along the mattress to get her mouth lined up with your nipple.


Mom’s positionHow you sit, how you hold your baby, and how you offer your breast all affect how the baby latches on. These facts determine how comfortable you will be during breastfeeding.Place one or more pillows behind your lower back, and/or shoulders so that you are comfortable and relaxed.You'll need at least one pillow in your lap to bring baby up to the level of your breast, and another under the arm that will support your baby as he breastfeeds. If you are sitting in a chair, use a foot stool or something else to raise your lap so you don't have to strain or lean over to get baby closer to your breast. If you're in bed, put pillows under your knees.

LatchLatch

Opening wideUse your nipple to tickle baby's lower lip to encourage her to open her mouth wide--really wide. As the mouth opens to its widest point, direct your nipple into the center and use your arm behind to pull baby in very close to you. Don't lean forward, pushing your breast toward your baby; pull her close to your breast by moving your arm

LatchHow to Get Baby to Open Wide

Talk to your baby and say "Open." Show her what to do by opening your own mouth wide. Babies can imitate adult facial expressions. Help your baby open her mouth wider by using the index finger of the hand supporting your breast to press firmly down on your baby's chin as you pull her on. You will probably need someone else to do this for you at first.

LatchCorrect latch

Baby's top and bottom lip should be turned out (everted). When baby takes the breast with mouth open wide, he'll have a "fish mouth" look as he nurses.Baby's chin should be pressed into the breast with his nose resting on the breast, as well. You will notice that baby is able to breathe out the sides of his nose, even when pressed against your breast. Babies are designed that way. If your baby struggles, pull baby's bottom closer to you.

Latch

Wrong latch-on. Baby's lower lip should not be pursed inward, but should be turned outward.

HoweverGreat alertness and eye contact.

Latch

LatchSuckling

To take in nourishment at the breast and specifically refers to breastfeeding.Learned higher brain function vs. sucking which is a automatic reflex tested for at birth.

Coordination of suck and swallowDevelops during second trimester (swallowing of amniotic fluid).Infants swallow once every 2-3 sucks. By four days of life once with every suck.

Obstacles that influence suckingNarcotics during labor significantly lower rates and pressures compared to those whose mothers received no medication.Some studies show that Epidural anesthesia effect feeding abilities of neonates.

Latch

How do I know when my baby is done feeding?

First part of feed, tight fist gripVigorous suckle

Latch

How do I know when my baby is done feeding? (cont.)

Second part suckle is less vigorous and there are frequent pausesHand begins to open

Latch

How do I know when my baby is done feeding? (cont.)

Final stage need more be said?

LatchHow do I know if my baby is getting enough?

4-8 stools per dayMeconium birth-3 daysDark green to black thick appearance

6-8 wet diapers per day

Latch

How do I know if my baby is getting enough? (cont.)

Breastfeed stool from 2 - 4 day of life on in a term baby.Seedy mustard appearance

Latch

How do I know if my baby is getting enough? (cont.)

Swallowing during sucklingWeight gain!!!

Supply and Activities of Daily Living

CompositionColostrum, transitional and mature milk contains:

ProteinsCarbohydratesFatsWaterAntibodies


Three stages of milk development:

1 ColostrumProvides a boost of antibodiesLaxative effect that expels meconiumEstablishes lactobacillus bifidus as predominate bacteria in the sterile newborn gut.Lasts up to day four postpartum.1-123cc first 24 hours then 500cc/day by day 5.


Three stages of milk development (cont.):

2 Transitional milkUp to day 10 postpartum500cc/day


Three stages of milk development (cont.):

3 Mature milkStarts by day 10-14750cc by 3 month (singleton birth)Can vary between 200cc/day in partial breastfeeding to 3500cc/day in wet nurses.


PumpsAdded stimulation at birth

Poor latch due to meds and epidurals etc.Infant transferred to Reykjavik for treatment or monitoring.Medela Classic is used inpatient postpartum


PumpsIncrease milk supply and milk storage

WorkSittersVacationsFathers to feed in the middle of the nightMany others

Rental from hospital is the Lactina Select (30 days)

Used until personal pump arrives


PumpsRecommended personal pumps

Ameda Purely Yours160.00 to 199.00

http://www.babybungalow.com/ampuryourbre.htm



Medela Pump in Style Professional$189.00 as shown$199.00 w/car adapterProblems with milk getting into pump.

http://www.babyproductsrus.com/html/pumpinstyle2001.html



43.95 includes, Stand Travel Cover, Sealing Disc, Newborn Nipple, Spare Diaphragm, 2 Valves Good controlSold at exchange and Viking mall

http://www.babyproductsrus.com/html/avent.html


Supplemental FeedsFirst an attempt to place the infant to the breast is attempted for about 10-15 minutes before each supplemental feed!Then supplement 10-15cc of breast milk or formula to last infant about 2 hours.


Supplemental Feeds

Usually are only needed during first few days of life to one week of age.

Cup (easy inexpensive, fast, requires baby to place mouth as they would for breastfeeding.


Supplemental Feeds

Finger feedsGreat for fathers to do!Positioning is more of that an infant breastfeeding.Quick and amount is given is easily controlled.


Supplemental FeedsSupplemental NursersClosest thing to breastfeeding plus nipple stimulationReinforces bad latching.Difficult to use without help


Supplemental Feeds

Each supplemental feed is followed by 15-20 minutes of pumping.Remember to bring in mature milk at 10 days of life, the breasts must be stimulated 8-12 times per day.

Complications of Breastfeeding

Improper LatchBreak infants seal and reattempt latchCheck nipple shape and size after seal is broken.A crease through the nipple indicates an improper latch.


Improper Latch (cont.)

Continued improper latching will result in increased pain and damage to nipple. Purlentant drainage.


Improper Latch (cont.)Need more be said?


Plugged ducts and Mastitis

Plugged ducts are caused by incomplete emptying of the breastCan lead to mastitisRed, warm and tender to the touchCan reposition infant so that the chin is aligned with reddened or engorged area.


Plugged ducts and Mastitis (cont.)

A mastitis untreated can lead to abess formation.

Obstacles with Breastfeeding

Special considerationsMastectomy or breast reduction

Depending on how much functional breast tissue is remaining breastfeeding should be possible.Will take more effort and time before the fullest supply that can be will come in Pumping for additional stimulation is the key!


Special considerationsPregnancy and Breastfeeding

Milk supply will naturally decrease with pregnancy due to increased estrogen levels, supplementation may be necessary.Nipple stimulation can cause pre-term contractions that can lead to pre-term labor.Our OB says breastfeed the baby until 3 months old or complications with the above occur.Breastfeeding is not a reliable form of birth control.


Special considerationsFlat or Inverted nipples

The goal is to get the nipples to become erect so the infant can gain a proper latch. Finger rolling can relax the nipple enough to become erect.Using a pump for 2-4 minutes can produce similar results.


Special considerations

Drying up milk supply

Cold cabbage leaves work well for this purpose.Best is gradual weaning of infant as infant declares that they no longer need or want the breast.


Special considerations

Cesarean sectionAnesthesia used.Type of recovery.Reason for section.

Referenceswww.americanbaby.comwww.breastfeeding.comwww.askdrsears.comwww.about.comwww.gotmom.orgLawerance, R. M., (1999), Breastfeeding; A guide for the medical professional, (5th ed.), Boston : MA.

Documents

Successful breastfeeding begins with education! Randy Heninger LT, NC, USNR Lactation Specialist U.S. Naval Hospital Keflavik Breastfeeding Success Course