BREASTFEEDING TEACHING TOOL Name Joe Dian Gomez Date: 18 JAN 2012 Reference: Olds, S and others. (2007).

Maternal-Newborn Nursing and Womens Health Care. (8th ed). New York. Pearson-Prentice Hall. Companion Website: http://www.prenhall.com/olds/ Grading Criteria The Breastfeeding Teaching Tool should be completed prior to the first day of clinical. It will be handed in that day for review by the clinical faculty. It counts as 10 points toward your week one grade. Completion of the Breastfeeding Tool equals 10 points toward your grade for week 1. An incomplete Breastfeeding Tool or one not turned in on day 1 is a fail and 10 points will be deducted from your week one grade. Instructions: Answer the following questions regarding breastfeeding. You may use your textbook or any breastfeeding information source to assist you. I. Breast/Nipple Care: A. State three (3) principles of nipple care. B. State two (2) principles of breast care. C. Explain breast massage. D. Explain in writing: hand expression of breast milk. 1. the mother will position her thumb at the 12oclock position on the top edge of the areola (about 1 inches back from the tip of her nipple and her forefinger and middle finger pads at the 6 oclock position on the bottom edge of the areola. 2. mother will stretch her areola back toward her chest wall without lifting her fingers off her breast. 3. roll her thumb and fingers simultaneously forward compressing the ducts beneath the areola and stimulating the breast to empty the breast both manually and by triggering the let-down reflex. 4. mother should repeat the sequence multiple times to completely drain her breast. Maintain a steady rhythm, cycling 45-60 times/min. also, more effective if mother repositions her fingers to other positions on the same breast. II. Breastfeeding. A. Describe four positions for breastfeeding. a. Modified cradle position: have mother sit upright, use pillows for support and to bring baby to nipple level so that mother does not have to lean over. Place baby on mothers lap and turn baby as a whole towards mother so that babys nose lines up with mothers nipple. Maintain baby in horizontal position. Have mother support babys head with opposite of feeding side hand and offer breast with feeding side hand. b. Cradle position: have mother in upright position, use pillows for support to bring infant to nipple level. Position on mothers lap in a side lying position nose in line with nipple. If feeding from the left breast, have mother cradle babys head near the crook of her left arm while supporting babys body with left forearm. With mothers free right hand, she can offer her left breast c. Football hold position: have mother sit upright in comfortable position, use pillows as needed. If feeding on left side, place baby on the left side of mothers body, heading

baby in to position feet first. Babys bottom should rest on pillow near mothers left elbow. Turn baby slightly on her side so that she faces the breast. Mothers left arm clutches babys body close to mothers body. Babys body should feel securely tucked in under mothers left arm. Have mother support babys head with left hand. With mothers free hand, she can offer her breast. (good position for mothers with c-sections). d. Side lying position: have mother comfortably lying on her side. Use pillows to support mothers head and back, and provide for support for mothers hips by placing pillows between bent knees. Place baby in side-lying position next to mothers body. Babys body should face mothers body. Babys nose should line up to mothers nipple. Place a roll behind babys back, if desired. With mothers free right hand, she can offer her left breast. After baby is securely attached, mom can rest her right hand anywhere that is comfortable for her. B. Explain how to begin breastfeeding. a. Position the baby in comfortable and secure position. b. Align the baby with mothers nipple c. Trigger the rooting reflex d. Allow baby to open wide, continue to trigger rooting reflex till baby opens mouth wide. e. Position nipple in babys mouth to achieve deep asymmetric latch attachment. Allow infant to lead into breast with the chin. C. State how often and how long to feed the baby. a. Babies should be observed for feeding cues such as waking or suckling on nearby objects including hands. Crying is a late feeding cue. Baby should be allowed to feed to satiety D. Describe: Principle of supply and demand: a. Breastfeeding works on the principle of supply and demand. The amount of milk you make depends on how often your baby nurses and how effectively milk is removed from your breasts. The more milk baby removes from the breast, and the more often baby nurses, the more milk you will produce. Research shows that women who nurse more frequently make more milk. Its truly a matter of supply and demand. E. Explain: 1. The initiation of lactation Lactogenisis: During pregnancy, increased levels of estrogen stimulate breast duct proliferation and development, and elevated progesterone levels promote the development of lobules and alveoli in preparation for lactation. Prolactin levels rise from approximately 10ng/mL prepregnancy to 200ng/mL at term. Lactation is suppressed during pregnancy by elevated progesterone levels secreted by the placenta. Once the placenta is expelled at delivery, progesterone levels fall and the inhibition is removed, triggering milk production. This occurs whether the mother has breast stimulation or not. However, if by the third or fourth day breast stimulation is not occurring, prolactin levels begin to drop. By 2 weeks postpartum, prolactin levels will be back to pre-pregnancy levels and milk production will cease. 2. The let down reflex: Stretching of the nipple and compression of the areola signal the hypothalamus to trigger the posterior pituitary gland to release oxytocin. Oxytocin acts on myoepithelial cells surrounding the alveoli in the breast tissue to contract, ejecting milk, including the fat globules present, into the ducts. A process known as milk-ejection reflex and occurs 4-10 times during a feeding session. F. Compare and Contrast the components of colostrum with breast milk

Colostrum Lower amount of fat and lactose Provides all nutritional requirements Contains antioxidants , high levels of

Breast Milk 13% solids (carbohydrates, proteins, and fats) 87% water Provides all necessary nutrients

lactoferrin and secretory IgA Laxative effect on infant

G. Describe how to break suction at the end of a feeding. 1. Remove baby from breast by placing a finger between the babys gums to ensure suction is broken 2. End feeding when the babys suckling slows, before he or she has a chance to chew on the nipple H. Using your nursing judgment, list the four most important factors to observe when assessing the effectiveness of a feeding session. 1. Latching of the infants mouth to the nipple 2. Audible swallowing of the baby 3. Mothers breasts appear to soften after breastfeeding 4. Comfort of the nipple, observe for redness, cracking, pain III. Breastfeeding Problems A. Define engorgement: Vascular congestion or distention. The swelling of breast tissue brought about by an increase in blood and lymph supply to the breast, preceding true lactation. B. State two (2) signs of engorgement. 1. Hard, warm and painful breast 2. Skin of breast appears taut and shiny C. List three (3) techniques to decrease the discomfort of engorgement 1. Warm compresses or showers just before nursing 2. Cold compresses following breast feedings 3. Breast massage and milk expression D. Identify three (3) ways to ease the discomfort/healing of sore nipples. 1. Alternate breastfeeding positions throughout the day 2. Ensure the nipple is way back in the babys mouth by getting the baby to properly onto breast 3. Hold the baby closely during feeding so the nipple is not constantly being pulled E. List three (3) interventions that are effective in: 1. Preventing mastitis 1. Avoid stress 2. Avoid fatigue 3. avoid/treat cracked nipples 2. Treating mastitis 1. Continued breast feeding 2. Application of moist heat 3. Increased fluids 4. Rest 5. Analgesic 6. Antibiotic treatment if necessary IV. Maternal Nutrition A. Identify the food groups and the number of servings from each group that are recommended for breastfeeding. a. Dairy products: four (8oz) cups b. Meat and meat alternatives: two servings c. Grain products: six to eleven servings/day d. Fruits and fruit juices: two to four servings

e. f. g. h. i.

Vegetables: three to five servings Fats: as desired in moderation Sugar and sweets: occasionally, if desired Desserts: occasionally, if desired Beverages: as desired, in moderation

B. Describe the nutritional needs recommended while breastfeeding, including calories, calcium, iron, fluids. a. Calcium: 1000mg/d b. Iron: 9mg/d c. Calories: 2500-2700 calories d. Fluids: 8-10 (8oz) glasses of water, juices, milk and soups V. Critical Thinking Questions A. Describe the fathers role in breastfeeding. B. Describe three (3) ways to involve the grandparents in the breastfeeding experience. VI. Maternal Medications A. Discuss the three knows about drugs and human milk. B. Discuss the actions and effects of the following substances on the newborn when breastfeeding. 1. Caffeine: excessive consumption may cause jitteriness or wakefulness 2. Drugs (cocaine, heroin, marijuana, etc) 1. Cocaine: extreme irritability, tachycardia, vomiting, apnea 2. Heroin: Tremors, restlessness, vomiting, poor feeding 3. Marijuana: Drowsiness 4. Amphetamines: controversial; may cause irritability, poor sleeping pattern 5. Nicotine: shock, vomiting, diarrhea, decreased milk production 3. Meperidine: avoid use. May lead to neonatal depression. 4. Morphine: long-term use may cause newborn addiction 5. Antibiotics 1. aminoglycosides: may cause ototoxicity or nephrotoxicity if given for more than 2 weeks 2. ampicillin: skin rash, candidiasis, diarrhea 3. azithromycin: no risk to newborn 4. erythromycin: accumulates in breast milk, idiopathic hypertrophic pyloric stenosis 5. methacycline: possible inhibition of bone growth; may cause discoloration of the teeth; use should be avoided 6. Metronidazole (flagyl): possible neurologic disorders or blood dyscrasias; delay breastfeeding for 12hours after dose 7. penicillin: possible allergic response; candidiasis 8. quinolones: can cause arthopathies 9. sulfonamides: may cause hyperbilirubinemia; use contraindicated until infant is over 1 week old 10. tetracycline: long-term use and large doses should be avoided; may cause tooth staining or inhibition of bone growth. 6. Bronchodilators: 1. aminophylline: May cause insomnia or irritability in the infant 2. leukotiene inhibitors (zyflo, accolate): potential tumorigenicity 7. Antihistamines:

1. diphenhydramine (benadryl), claritin, allegra: may cause decreased milk supply; infant may become drowsy or irritable 2. Clemastine (tavist): contraindicated 8. Oral Contraceptives: 1. combined estrogen/progestin pills: significantly decrease milk supply; may later milk composition; may cause gynecomastia in male infants 2. Progestin only (DMPA, norplant); safe if started after lactation is established VII. Breastfeeding at home. A. Identify two (2) community resources for questions/support of breastfeeding after discharge from the hospital. 1. La Leche League International 2. International Lactation Consultant Association