Transcript Breastfeeding Lecture

Breastfeeding
Breastfeeding in the RCNIC
Background
• Approximately 60% of newborns admitted to the
RCNIC are receiving human milk.
• We as health care providers should educate mothers
on the benefits of breastmilk and try to increase our
breastfeeding rates.
• AWHONN* guidelines state that “nurses working with
breastfeeding women should maintain current,
evidence-based knowledge of breastfeeding
practice”.
• The American Academy of Pediatrics supports
exclusive breastfeeding for the first 6 months and
breastfeeding through the first year of life.
*AWHONN – Association of Women’s Health Obstetric and Neonatal
Nurses
Purpose Statement
• Mothers who plan to breastfeed or provide
milk for their hospitalized infant require
information and support.
• This support should be available 24/7.
• Bedside RNs in the RCNIC should be able to
perform a basic lactation assessment and
provide lactation support to RCNIC families.
Goal
• All bedside RNs in the RCNIC will be
able to perform a basic lactation
assessment and provide lactation
support to RCNIC families.
Overview
This module will present:
• Current evidence-based knowledge of
breastfeeding practice.
• Information regarding current policies
and procedures.
• Information regarding the process for
supporting breastfeeding families.
Objectives
After completion of this module, the RCNIC RN
will be able to:
1. Identify the benefits of breastfeeding for
infants
2. Identify the responsibilities of each
discipline regarding breastfeeding.
3. Assess 5 Key components of a good latch
to assist a mother who is nursing.
4. List storage times for fresh milk and frozen
milk.
Benefits of Breastmilk
Benefits of Breast Milk for a Hospitalized Infant
• Breast milk can help develop a baby's immune
system.
• Breast milk is easier to digest and will empty faster
from the stomach.
• Breast milk can lead to optimal brain development.
• Breast milk can protect the baby from respiratory
illnesses.
• Breast milk can protect the baby from intestinal
illnesses.
Breastfeeding Process - PCF
• Notified of admission
• Ask if breast or bottle feeding when
receiving report
• Notify bedside RN and PCA or Diet
Tech of feeding status
Breastfeeding Process - RN
• Notified of admission
• Determine feeding choice – breastmilk or
formula and document in ICIS.
• If breastfeeding or plans to pump – order
supplies from ESI. Collaborate with PCA or
Diet Tech to obtain labels.
• Assess Mom’s current knowledge
• Educate parents - Breastfeeding education is
included in the nutrition section of the Parent
Resource Book
• Obtain additional assistance – if needed
Breastfeeding Process – Diet Tech
• Notified of admission
• Collaborate with RN to provide written
education
• Assemble supplies at bedside as requested
– Labels
– BF cooler and kit
• Assist mom with breastpump set-up
Breastfeeding Process - PCA
• Notified of admission
• Assemble supplies at bedside as requested
– Labels
– Pump kit
– Storage containers
– Assist mom with breastpump set-up
Feeding Choice is Breastmilk but
Baby is Unable to go to Breast
• Obtain Needed Supplies
– Breast pump kit
– Storage Containers
– Labels
• Identify Breastpump locations
• Label a Breastmilk Bin and place in freezer. This
can be delegated to a PCA or Diet Tech
Pumping Information
– Initially pump every 2-3 hours around the clock
– It is best to use a hospital grade electric breast
pump like a Medela Classic, Lactina or Symphony
and a double kit.
– Wipe off the pump and counter with a fresh Saniwipe
– Pump both breasts at the same time. This helps
with let down and ensures collection of all the milk
that may leak from the breasts.
– Pump about 15 – 20 minutes each time or 2
minutes after milk stops flowing to stimulate milk
production.
Breastpumping Information
• Pump directly into a clean breast milk storage bottle or the
bottles that come with kit.
• Adjust pump to the most comfortable setting. Start on the
lowest setting and increase the suction as tolerated.
• To help with let down, try using warm compresses, breast
massage, and relaxation for a few minutes before pumping.
• Place the breast shields on the breasts and turn the pump on.
If the breast shields are too small, the service center has larger
ones to fit a larger diameter nipple. The bigger shields are
called Personal Fit Comfort or large shields.
• Do not fill the bottle completely or it may break when it is
frozen.
• Never add fresh milk to a bottle that has already been
refrigerated or frozen.
Breastpumping Information
• After pumping, use a Sani-wipe to clean pump surfaces,
counter and any spilled milk.
• Wash the parts of the kit which touch milk using dish soap
and hot water. This includes the collection bottles, shields,
yellow valve and white membrane. Then, air dry the kit on
a clean paper towel in the baby’s room or by their bedside.
• If the tubing gets milk in it, rinse and allow the tubing to dry.
If the plastic filter gets wet, allow it to dry.
• It is important to sterilize the kit every day. You can do this
by boiling it for 15 minutes or by using the dishwasher.
Breast Pump Rental
• Determine need for pump rental. Involve
social work and/or care manager in this
process
– Need to pump > 3 – 5 days?
– Plans to go home where she has no pump?
• If unable to obtain pump, the mother may use
the hand pump provided in the kit.
• There is a list of breast pump rental locations
with breastfeeding education.
Breastmilk Storage and Labels
• Provide mom with breastmilk storage containers and labels.
• The baby’s medical record number should be recorded on
each label
• Labels must have the date and time of milk collection as
well as current medications, supplements or herbal
remedies.
• Instruct mom to give labeled breastmilk to a nurse. Parents
should never place breastmilk in the refrigerator or freezer.
• Nurses will check for completeness of information prior to
putting breastmilk in the refrigerator or freezer. Breast milk
placed in the freezer should be placed in a plastic storage
bin with lid that is labeled with the baby’s name and MRN.
• Breastmilk placed in the refrigerator should be marked as
fresh and placed in a plastic ziplok bag and then placed in a
plastic bin in the refrigerator.
Breastmilk Storage and Labels
• Milk expressed at the hospital or at home should be
placed in the refrigerator immediately. Freeze the
milk if the baby is not being fed or will not use all the
milk within 48 hours.
• Mothers who express milk at home should transport
milk packed in a cooler using freezer gel packs or
just packed tightly with several bottles of frozen milk,
not ice. Milk freezes at a lower temperature than
water and may thaw if packed with ice.
• It is best to thaw milk in the refrigerator. Once
thawed; milk must be used within 24 hours for
hospitalized infants.
Storage Times
• Frozen milk thawed is good for 24 hours
• Fresh milk is good for 48 hours.
• Try to use milk in the order in which it was
pumped
• New labels have numbers to help you with
this
Nurse Responsibilities when
Feeding Breastmilk
 Breastmilk must be double-checked by two
persons by comparing the name and MRN on
the label with the information on the baby’s
ID band. This should be documented by
both persons by initialing the flow sheet.
 When taking breastmilk from the freezer,
always use the oldest date first.
 The label from the breastmilk container
should be removed and placed on a progress
notes sheet in the chart.
How to Assess Breastfeeding
Mom
– Ensure good hydration - provide mom with water and water
bottle.
– Does mother feel full before and empty after nursing?
– What is her most comfortable position?
– Would support such as a pillow or boppy be helpful?
– Does she want privacy with nursing? Would screens be
helpful?
– Document any problems
How to Assess Breastfeeding?
• Infant Signs
– Frequency of feedings/duration
– Stool Number and Appearance
• Newborns often stool every diaper change
• Meconium – Transitional-Yellow Seedy
– Wet Diapers
• Urine should be dilute
– Hunger Cues
– State
• Drowsy?
• Awake and Alert?
– Audible swallows with nursing?
– Visible Milk in mouth?
– Test Weight?
Process for Support and Education
If baby is able to go to breast the bedside nurse should
observe mom and baby during feeding and
document the latch score.
Latch score should be documented in narrative section
of flowsheet.
More information/education for documentation of latch
score coming.
Latch Scale
0
1
2
L – latch
Too sleepy or reluctant.
No latch achieved
Repeated attempts
Hold nipple in mouth
Stimulate to suck
Grasps breast
Tongue down
Lips flanged
Rhythmic sucking
A – audible swallow or
palpable swallow
None
A few with stimulation
Spontaneous and
frequent
T – type of nipple
Inverted nipple, try
nipple shield
Flat/Very short nipple
Retracts
Everted (after
stimulation)
C – Comfort
(Breast/Nipple)
Engorged, cracked,
bleeding, large blisters,
or bruises.
Severe discomfort
Filling
Reddened/small
blisters or bruises
Mild/moderate
discomfort
Soft
Non-tender or slight
discomfort
H – Hold (positioning)
Full assist
Staff hold infant to
breast
Minimal assist
Teach one side, mom
does other
Staff holds and mom
takes over
No assist from staff
Mom able to position
and hold infant.
Assessing Latch Score
• Determine a score for each of the 5 sections of the
latch scale (latch, audible swallow, type of nipple,
comfort pain scale, and hold). The sum of scores for
the 5 sections is the latch score.
• Direct observation is the best method to obtain this
information. If this is not possible, you can ask the
mom to help you assess using the LATCH scale.
• Document the latch score, actual suck time and any
issues that require follow-up or intervention in the
narrative of chart.
• If the total latch score is 7 or < or other concerns of
mother or nurse please refer to lactation resource.
Helpful Hints for Moms
Helpful Hints for Breastfeeding Moms
• To prevent nipple tenderness, start with correct positioning:
– Cradle position
– Football hold
– Lying down position
• Breastfeed frequently:
– Initially every 2 - 3 hours
– 8-12 feedings per 24 hours
• Release suction before removing the baby.
• Never use soap, alcohol or breast creams.
• If nipples become sore:
– Limit nursing time on sore nipple
– Use non-plastic lined bras or bra pads
– Apply lanolin for dry or cracked nipples
Nursing positions - Cradle
Nursing positions – Football/Clutch
Nursing positions – Cross Cradle
Nutrition
• Instruct moms to eat a well balanced diet with all
foods in moderation. If there is a history of serious
food allergies in the family, check with the doctor or
dietitian to see if mom should follow a special diet.
• It is a good routine to try to eat or drink something
when pumping.
• It is important to drink plenty of fluids to keep up the
milk supply. Water and ice are available. Moms may
have water in a covered container in the unit.
• Alcohol and caffeinated drinks are not recommended
as a regular practice.
• Try to eat foods containing calcium such as broccoli,
greens, cheese, yogurt, puddings or salmon.
Referrals and Follow-up
• This presentation provides you with the basic
information that you will need to assess and
educate breastfeeding moms.
• If you identify issues that require follow-up beyond
the scope of the information presented here, please
contact one of the RCNIC Dieticians or the PCF.
• The PCFs have a list of RCNIC staff who have
additional training and education for breastfeeding
support.
Questions
1. The benefits of breastmilk for the infant would include which of the following:
a.
Breastmilk is easier to digest
b.
Breastmilk can lead to optimal brain development
c.
Breastmilk can protect the baby from respiratory and intestinal illnesses.
d.
All of the above.
2. Who is responsible for identification of the mother’s feeding choice?

A. PCA

B. HUC

C. PCF or RN

D. Diet tech
3. Fresh breastmilk may be used for 48 hours
True or False
Questions
4. A Latch Score of _____ or less requires a lactation consult.
5. Breastmilk labels must contain the following information
a.
Name and MRN
b.
Medications the mom has taken
c.
All of the above
d.
Date and time expressed
6. When transporting breast milk, pack tightly with ice to reduce thawing.
true or false
7. All bedside RNs in the RCNIC will be able to perform a basic lactation
assessment and provide lactation support to RCNIC families.
true or false