Breastfeeding Flashcards
(24 cards)
What is attachment?
How the baby takes the breast in his mouth to enable him to feed
What is positioning?
How the mother holds her baby to help him attach effectively to the breast
Impact of ineffective attachment for mum and baby
Mum: sore nipples, engorgement, mastitis, low milk production, loss of confidence
Baby: feeding frequently, frustrated, jaundice, poor weight gain, hypernatraemia
The feed…
Start - short rapid sucks
Middle - active feeding - long slow rhythmic sucking and swallowing, with pauses
End - flutter sucking with occasional swallows
Suck swallow ratio…
Ratio of more than 2:1 = poor milk transfer
Subsequent let downs =
Increased fat content
Recognising effective attachment
Feeding pain free Chin indenting breast Mouth wide open Cheeks round and full More areole visible above top lip Rhythmic suck/swallow Nipple remains rounded at end
CHIN principle
Close Head free In line Nose to nipple Sustainability
Supporting effective breastfeeding
Skin to skin CHINS in place Mother calm baby, talking stroking Point out instinctive cues, head bobbing, rooting Rub nipple against top lip Check mothers comfort Point out signs of effective attachment
Helping the mother learn
Explain reasons for what you say - the ‘why’ is crucial to understanding Keep messages simple Emphasise principles Check understanding Build confidence and support instinct Use props to reinforce learning
What mothers want
Practical help and tips Hands off Observe a full feed Proactive approach Encouragement Compassion
Assessing breastfeeding
Baby’s output - urine and stools Baby’s general appearance and behaviour Feeding pattern (length and frequency) Suck:swallow ratio Gaining weigh Nipple shape after feeds/damage Engorgement/blocked ducts/mastitis
Stools from days 1-4
1-2 meconium
2-4 changing breast milk coming in
4+ at least 2 soft runny yellow stools a day
Individual pattern 4-6 weeks
Why express breast milk?
Tempt baby to feed if sleepy Provide colostrum for at risk baby Kick start milk production Relieve fullness/engorgement Show mother she has milk Obtain milk for mother who cannot feed
Prevent and manage problems eg mastitis
Social reasons
Why teach hand expression?
Convenient, available anywhere, no equipment required Neonatal unit Better hormonal response Best method for obtaining colostrum Target specific area of breast
Principles of hand expression
Wash a hands Sterile container Find right spot Compress and release Rhythmic movement Small drops then squirts Rotate as flow lessens
Helping the let down
Gentle breast massage Gentle nipple rolling Warm flannels Back massage Touch smell photo of baby Relaxing atmosphere
Hand expressing for sick or preterm babies
Skin to skin at birth if poss
Hand express within 2 hours of birt
Express at least 8 times in 24 hours, including night
Combine hand and pump as volume increases
Using breast pump
Massage breast
Centre nipple - ensure good fit
Increase vacuum slowly until slightly uncomfortable and then back 10%
Pump until flow decreases
Massage and pump again
Double pumping more effective, improving volumes expressed and saving time
Stages of lactation
Lactogenesis 1 - breast development and colostrum production from approx 16 weeks
Lactogenesis 2 - onset of copious milk secretion occurring 32-96 hours after birth
Lactogenesis 3 - maintenance of milk production
Hormones after birth
Oestrogen and progesterone drop
Prolactin and oxytocin rise in response to touch smell sight of baby
Baby begins spontaneous breast seeking behaviour
Mothering behaviours initiated
prolactin and oxytocin
Prolactin = responsible for milk production, responsive to touch and stimulation, higher at night, frequent contact/feed sets up long term production
Oxytocin = responsible for milk delivery, acts on muscle cells in pulsatile action, levels higher when baby is near, stress can temporarily delay let down
Feedback inhibitor of lactation
Milk removal = milk production
Ineffective removal = reduced production
Oxytocin: the love hormone
Works on feelings and emotions Lowers blood pressure, improves sleep Reduces stress levels by taking on cortisol Reduces pain sensitivity Boosts immune system
Evidence = synthetic oxytocin can negatively impact on normal production
