Positioning & Attachment Flashcards
(11 cards)
First time mum - SVB 6 hours ago. Needs help with positioning and attachment.
How would you introduce yourself to Robyn?
Name is Chelsea, student midwife. Was told you need some assistance with positioning and attachment, are you okay if I support you with this?
Assess based approach -
What do you already know about it? We can start with anatomy of breast, I have a model breast to use and show you.
Using the model breast identify the structures and their functions:
Nipple - central to the breast - made of erectile tissue - where milk is secreted during lactation
Areola - dark pigmented area around the nipple - small bumps & dimples around it call Montgomery’s Tubercles, these secret sebum oil to keep area moist and protected, and the scent emitted can help guide baby to the breast
Fatty tissue - makes up breast, gives it shape and size and supports the structure of the breast inside as well.
Alveoli - hollow structure that contain lactocytes - milk producing cells
Lactiferous ducts - where the milk is transported through to the nipple
Myoepithelial cells - surround the alveoli and lactiferous ducts, and help contract milk down and out of the nipple.
1) Name the hormone that stimulates milk production
2) explain the physiological process which stimulates the initiation of milk production
3) give three examples of how effective milk production can be achieved/ stimulated
1) Prolactin is the hormone that stimulates milk production. It’s produced in the anterior pituitary gland and acts on the lactocytes cells to stimulate milk production
2) Some milk may leak during pregnancy, but after the placenta has been delivered, the progesterone and oestrogen levels drop which gives rise to the prolactin hormone and levels
3) Early feeding, skin to
skin & good positioning and attachment and emptying the breast with each feed, as well as hand expressing.
1) Identify the hormone responsible for the ‘let down reflex’
2) Where is it released from?
3) Name the cells this hormone acts on?
4) Explain the factors which will help or hinder the release of this hormone?
1) Oxytocin, responsible for let down reflex.
2) Released from the posterior pituitary gland
3) When oxytocin is produced it stimulates the myoepithelial cells around the alveoli to contract and squeeze, helping to let milk travel down the lactiferous ducts and out through the nipple.
4) Help - seeing your baby, holding them close/ skin to skin, smelling your baby
Hinder - separation from your baby, stress, anxiety, pain, lack of sleep
Name the Whey Protein involved in autocrine production and maintenance of breast milk. Explain how this works?
Whey protein is called the Feedback Inhibitor of Lactation (FIL for short).
A whey protein found in breasts milk, and as your breasts fill with milk the amount of FIL rises.
Milk production works through supply and demand.
So when your breasts are full the whey protein sends signals to your brain to stop producing milk, because they’re full/ don’t need anymore.
But if your breasts are emptied well after a feed or you hand express milk, your the FIL levels decrease so your body will continue produce prolactin/ milk.
Essentially the feedback inhibitor or lactation whey protein works on a negative feedback loop. Does this make sense?
How should Robyn prepare for a feed?
Comfortable
Privacy to relax
Toilet
If you need any information leaflet with you or your phone make sure that’s to hand
Something to drink nearby
Responding to the feeding cues of baby
Try not to have hair or clothing in the way
Using the doll demonstrate the suitable positions that Robyn can adopt prior to attaching baby Zac to her breast. Give reasons for the adopted position
Find a sustainable and comfortable position for both of you for good attachment
1) cross cradle - good eye contact and control
2) rugby hold (tucked in) helpful for larger breasts or after a caesarean section
3) laid back ( biological nurturing) - deeper attachment at breast
R) Side lying (comfort ) - section or comfort at night
With the aid of the doll and using CHINS acronym - demonstrate good positioning of baby Zac at breast prior to attachment giving reasons for your actions
C - close to body - facilitate good skin to skin and baby isn’t stretching or straining to reach breast
H - head free…support neck and shoulders - allows baby to tip head back slightly to get a good latch.
I - In Line - bags head and spine should be in alignment, no twisting to feed at all - prevents straining, promotes food latch and comfort…you don’t twist your head to eat
N - Nose to Nipple - encourages baby to smell and open their mouths wide for a good latch. Prevents nipple pain
Detail the steps taken by Robyn to attach baby to the breast
Make sure you’re positioned comfortably / no obstacles in the way
Place baby to breast not breast to baby
Support neck and shoulders with one hand, and support breast with other hand in C shape
Nose to Nipple
Make sure the baby’s mouth is open wide going on to breast
They lead with their chin
Bottom lip touches breast
Nipple goes to the back of their soft palate / avoiding trauma from hard palate - can scoop breast into their mouth
Check the latch - more areola should be visible above top lip, bottom lip curled out
Explain to Robyn the signs of good attachment
Check the latch - more areola should be visible above top lip, bottom lip curled out
Baby has full mouth, cheeks out
Shouldn’t be painful
No milk down chin
Not noisy or clucking sound
Sucks will be fast as first, then longer and rhythmic, then flutter towards the end of finishing a feed
Baby Zac should come off the breast himself spontaneously
Nipple shouldn’t be mishapen after
Robyn asks you how she will know that her baby has had enough milk from her breast. What advice would you give her?
Frequency of feeds should be between 8-12 in a 24 hour period
Last from 5-40 minutes
Pattern - fast, slower, faster/ flutter is a full feed
Coming off breast themselves
Settled between feeds
And have regular wet and dirty nappies
