Transcript Document

Vilma Weir-Campbell
Fairleigh Dickinson University
CONTENT OUTLINE
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I.
II.
III.
IV.
V.
VI.
VII.
Benefits of Breastfeeding.
Preparing for Breastfeeding.
The Lactating Breast.
How Milk Gets From Breast to
baby.
Getting Breastfeeding Started.
Positions.
How to Know If Your Baby is
getting Enough Milk.
OBJECTIVES
• I. Understand the benefits of breastfeeding.
• II. Understand the physiology of breastfeeding.
• III. Understand the importance of breastfeeding
within the 1st hour after birth.
• IV. Identify the three components of effective
suckling.
• V. Identify the advantages of various
breastfeeding positions and appropriate
utilization.
• VI. Recognize when the baby is getting enough
milk.
• VII. Identify some common breastfeeding
problems.
• VIII. Versatility in special situations.
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IX.
X.
XI.
Common Problems.
Nursing in Special Situations.
Summary.
BACKGROUND INFORMATION
ON BREAST FFEDING
Breastfeeding is the best form of nutrition for babies and is of
vital importance to the health of both mother and baby.
Despite compelling scientific evidence of the crucial
importance of breastfeeding to maternal and child health,
bottlefeeding is the norm in the United States. 40% of infants
never taste their mother’s milk, and 80% are bottlefed by the
time they reach the age of 6 months. The American
Academy of Pediatrics recommends exclusive breast feeding
of infants for the first 6 months after birth; it also advocates
that breastfeediing be continued for at least an additional 6
months while solid foods are added. It is clear that human
milk plays a vital role in the immunologic development of the
infant at birth and well into the second year. Its nutritional
role also is clearly superior to that of other alternatives.
Primary care providers can have a positive impact on the
Infant feeding decision. Prenatal education has been shown
to be effective at increasing the rates of breastfeeding.
It is clear that human milk plays a vital role in the
immunologic development of the infant at birth and
well into the second year. Its nutritional role also is
clearly superior to that of other alternatives.
Primary care providers can have a positive impact on the
BENEFITS OF BREASTFEEDING
Advantages for the Baby:
Advantages for MOM:
1. Breast milk is the ideal first
1. Breastfeeding is more
food for your baby because
economical and more
it is digested easily.
convenient. You need
Breast milk produces smaller
not incur the daily
curds than cow’s milk and has
expence of formula or
a different type of protein which
go through the process
allows for easier and faster
of preparing, heating,
digestion. Because of this,
or refigerating your
breast fed babies may need to
milk due to its easy
eat more frequently than bottle
accessibility and
fed babies, usually every two or
perfect temperature
three hours.
for the baby.
2. Breast milk is readily absorbed
and may be associated with
less stomach upsets, constipation or diarrhea.
2. Breast feeding causes
contractions of the
uterus. Breastfeeding
after delivery will
assist the uterus in
3. Immunities from the mother are
contracting and help
passes through the milk.
avoid excessive bleed
Statistics show that breastfed
ing. During the postbabies have a reduced incidence
partum period, the
of ear infections, colds, tooth
uterus will continue to
decay, diaper rash, and vomiting.
contract in order to
Breastfed babies may have a
shrink back to its nonhigher resistance to infections
pregnant size more
such as respiratory viruses and
quickly. (Breastfeedhave fewer and less significant
ing utilizes approxiallergies.
mately 300-500
calories/day).
4. Breastfeeding provides frequent
close physical contact and helps
promote feelings of security for
both mother and baby.
3. Breastfeeding triggers
the release of the
lactating hormone
Prolactin, known as
the “mothering
5. Suckling at the breast encourages
hormone”. It may
better bone, jaw, teeth and gum
promote a feeling of
structure.
relaxation and wellbeing for you.
6. Breast milk is ready, warm and
uncontaminated.
HOW MILK GETS FROM THE BREAST TO YOUR BABY.
There are two elements necessary for getting milk from the breast to the baby: a breast
that produces and releases milk, and a baby who is able to remove the milk from the
breast by an effective suck. The manner in which the baby is attached at the breast
will
determine how successfully these two elements come together.
The Process:
1. The nursing breast works on the principle of supply and demand. As the baby
suckles at the breast, he/she stimulates the nerve endings in the nipple which
sends a message to the mother’s brain.
2. The brain responds by directing the pituitary gland to release hormones, Oxytocin
and Prolactin.
3. Prolactin acts on the milk glands causing them to produce milk. The more one
nurses, the more milk the breasts will produce, Nursing the baby as frequently
and
as long as he/she demands, usually every 2-3 hours or 8-12 times in a 24 period
will increase the amount of milk you produce.
4. Oxytocin release helps to keep the uterus firm and return to its prepregancy state
as well as causing the cells around the milk glands to contract and move the milk
down the milk ducts. This process must occur in order for the milk to be made
available to the baby and is referred to as “let-down”.
YOUR MILK
A mother’s milk is especially suited for her own baby. All breastmilk is not alike.
Colostrum and breastmilk adjust with the age of the baby, and mature breastMilk changes from feed to feed, day to day, and month to month to meet each
Particular baby’s needs.
Colostrum is the first milk made by the breasts, and is usually present in the
breasts from the 16th week of pregnancy. It has a clear or yellow color, a thick
Consistency, and is high in protein and lower in fat and sugar. Colostrum contains
Valuable enzymes and is rich in immunity factors which protects the baby against
Many bacteria and viruses. It also acts as a natural laxative which helps in
Eliminating the baby’s first stool, called meconium. This helps to prevent jaundice.
HELPFUL HINTS
1. Begin breastfeeding soon after the baby is born in order to initiate lactation.
2. Provide uninterrupted contact between mother and baby for at least one
hour after delivery.
3. During the first ½ to 2 hours after birth the suck reflex is easily stimulated;
The infant is very alert and the rooting and sucking reflexes are very strong.
FOUR A’S
Alignment: Mother in a comfortable position, with pillows
Infant in flexed position and supported with pillows
Infant’s head is at breast level, aligned with trunk
and straight on breast (tummy to tummy).
No traction exerted on breast or nipple
Areolar Grasp: Mouth is opened wide, lips not pursed
Lips are visible and flanged outward
Tongue covers lower gums, troughed (curved)
around areola
At least ½ inch of areola is drawn symmetrically
into mouth
Complete seal and strong vacuum is formed
by infant’s mouth
Areolar Compression: Mandible moves in a rhythmic motion
(initially, approx. 2 sucks/sec., sucking slows to
approx. 1 suck/sec when milk comes down
No clicking or smacking sounds
No drawing in or dimpling of cheeks
Mother does not experience acute (sharp) nipple
discomfort
Audible Swallowing: Swallowing heard
Number of sucks preceding a swallow decreases
as milk supply increases
Swallowing is evidence of milk-ejection reflex
Effective Suckling:
Baby’s mouth is wide open
Baby’s chin is touching the breast
Baby’s lower lip is curled outward
Baby suckles, pauses, and suckles again in
slow, deep sucks
Mother may hear swallowing
PREMATURE INFANT
Should encourage mother to breastfeed
Easier to digest and better tolerated
Contains Lipase (helps digest milk fat),antibodies and
other factors which help protect infant from infection;
contributes to better vision, and higher intelligence;
hormones and enzymes may contribute to the
maturation of the GI and Nervous systems
Enhances bonding
EFFECTIVE SUCKING:
Baby’s mouth is wide open.
Baby’s chin is touching the breast.
Baby’s lower lip is curled outward.
Baby suckles, pauses, and suckles again in
slow, deep sucks.
Mother may hear swallowing.
PREMATURE INFANT
Should encourage mother to breastfeed.
Easier to digest and better tolerated
Contains Lipase (helps digest milk fat),antibodies and
other factors which help protect infant from infection;
contributes to better vision, and higher intelligence;
hormones and enzymes may contribute to the
maturation of the GI and nervous systems
enhances bonding.
Readiness to Breastfeed:
No ideal weight or gestational age
should be in stable condition.
Each infant should be evaluated individually.
Do not have to bottle feed first.
Dancer Hand Position
Support breast with C-hold and slide hand
forward so that index finger and thumb are now
free to grasp gently each cheek. The index finger
and thumb form a “U” with the baby’s chin resting
inside.
POSITIONING
Principles:
Mother needs to be comfortable and relaxed.support
mother/infant with pillows ;bring infant to level of breast.
Cradle hold – natural
position for mother/infant.
Can be difficult for mother to
see infant’s face and control
head position. Belly to belly
position of mother/baby.
Football Hold – appropriate for small infant or
C/S delivery. Mother can control infant’s head, allows for
better visibility of infant’s mouth. Good for infants who
prefer to feed in upright position.
Across the lap – similar to
cradle except mother has
better control of infant’s head.
Belly to belly
Side lying – used mostly for early
feedings, C/S deliveries, and
nighttime feedings. Need pillows
for support of mother’s leg and
back.
Mother’s high risk factors:
First time mother or never breastfed before,
poorly educated
Lack of family/friends who have breastfed
ambivalence about feeding
Lack of confidence no breastfeeding classes
or lactation consultant visit
Low rating of how well her baby breastfeeds
hx of breast surgery
Infant’s high risk factors:
preterm birth
Does not: grasp the breast with lips flanged
and tongue down
latch on and root easily
suck vigorously
suckle rhythmically
swallow audible after pp day 3
COMMON PROBLEMS; HOW TO OVERCOME THEM
Sore nipples: is the most common problem during the early days of breast feeding.
This can result from:
1. Improper positioning of the infant’s mouth on the nipple.
2. Using only one position for all feedings.
3. Feedings are too far apart so that when the baby begins nursing he/she
sucks very eagerly.
4. Breast care that contributes to dry, irritated nipples.
5. Trauma to the nipple because of improper removal from the breast.
Engorgement: is an overfullness that is a result of incomplete or inadequate emptying of the breasts.
All mothers are encouraged to observe the Four A’s of breastfeeding to minimize
Breastfeeding problems.
SUMMARY
When one reviews the wealth of information about the advantages of
breast feeding, there can be no doubt that this practice is healthy for
both mother and infant. It is past time for all health care providers to
enthusiastically support, encourage and educate the women of this
great nation to accept the fact that breastfeeding is normal, expected
and achievable.
REFERENCES
Dermer, Alicia (1998, August) . Breastfeeding: What You-and Your
Patients-Need to Know. Women’s Health in Primary Care, 1 (7) 599.
Moreland, J. & Coombs, J. (2000, April). Promoting and Supporting
Breast-feeding. American Family Physician, 61 (7) 2093.
http://www.aafp.org/afp/20000401/2093.html
Nichols, Francine H., & Zwelling, Elaine (1998) . MaternalNewborn Nursing, Theory and Practice. W B Saunders Co.
Slusser, Wendelin & Powers, Nancy G. (1997, April). Breastfeeding
Update 1: Immunology, Nutrition, and Advocacy. Pediatrics in Review
Vol. 18 (4) 111.