Breastfeeding Technique Essentials

Breastfeeding Technique

• Preparation for breastfeeding should begin before or at the first contact.
• Most women choose their feeding method prior to conception.
• Psychosocial support and education can encourage breastfeeding in women who might not otherwise have considered it.
• Evidence for this strategy is anecdotal and needs further investigation.
• Nipple inversion is a common physical barrier to latch-on.
• Women with inverted nipples may need nipple shields, manual or electric pumps.
• Ideally, breastfeeding should begin immediately after delivery (within 30-40 minutes).
• For optimal positioning, mothers can use the cradle hold, football hold, or lay/side position.

Breastfeeding Technique (Clinical Situations)

• Clinical situations might prevent immediate breastfeeding (cesarean delivery, maternal perineal repair or distress).
• Breastfeeding should be initiated as soon as possible, but supplemental feeding may be necessary.
• If mothers desire to breastfeed, consider an interim feeding plan (spoon, cup or syringe feeding)

Breastfeeding Technique (Feeding Intervals)

• Breastfed infants commonly feed at least every 2-3 hours during the first several weeks postpartum.
• Nighttime feedings are necessary.
• Feeding intervals might be increased to 3-4 hours during the night, depending on necessity.

Breastfeeding Technique (Feeding Intervals/Nighttime)

• Feeding intervals can be increased at night, but the timing to stop waking infants for night feedings is a common concern.
• After the first 2 weeks postpartum, with no nutritional concerns, infants can have their own nightly feeding schedules.
• Most infants will sleep through the night by approximately 10 lbs/4.5 kg).

Breastfeeding Technique (Problems)

• Common problems with breastfeeding include sore cracked nipples and engorgement.
• Sore nipples are often caused from improper latch-on.
• Keeping nipples clean and dry between feedings can effectively prevent and treat cracking.

Problems Associated with Breastfeeding (Sore Nipples)

• Sore nipples are very common in the first few weeks.
• Constant moisture can cause soreness.
• Improper latch-on commonly causes issues with breastfeeding.
• Mild bleeding during breastfeeding is okay, but severe bleeding needs intervention.
• Mothers can use her own milk, lanolin ointment to treat cracked nipples.

Problems Associated with Breastfeeding (Engorgement)

• Engorgement is a common issue in breastfeeding, caused by inadequate or ineffective emptying of the breasts.
• Breasts become swollen and tender when milk buildup occurs.
• Mastitis (breast infection) may develop if engorgement isn't treated.
• Warm compress can help the letdown process.
• Manually expressing breast milk or using an electrical breast pump to relieve engorgement can be helpful.
• Cold packs, such as cooled cabbage leaves, can also relieve swelling.
• Antibiotics might help if mastitis occurs, but be sure to choose antibiotics safe for the infant.

Problems Associated with Breastfeeding (Lesions)

• Blebs (pimples, blisters) are another cause of sore nipples.
• Blebs appear when the milk ducts open.
• Moisturizing nipples with lanolin and gently exfoliating can treat blebs.

Problems Associated with Breastfeeding (Silicone Implants)

• Silicone implants are another contentious issue in breastfeeding.
• Research about the effect of silicone implants on lactation is limited.
• Leakage from implants, silicone in breast milk, and possible infant exposure are areas of concern.
• Silicone concentrations are typically higher in cow's milk and formula than in human milk.

Maternal Nutrition and Breastfeeding

• Certain maternal food flavors can affect the taste of breast milk (e.g., garlic, broccoli, onions).
• These types of foods may not be desirable or may cause issues for the infant; they should be avoided if the infant shows signs of issues.
• No conclusive evidence currently exists that breastfeeding mothers should avoid specific food groups to prevent allergic reactions in the infant, especially for conditions like atopic diseases.

Vegetarian Diet& Breastfeeding

• Vegetarianism has increased, so more studies have been conducted to understand breastfeeding in vegetarians.
• A vegetarian diet is one without meat ; this definition doesn't encompass the variety of vegetarianism (e.g., vegans, lacto-ovo vegetarians, lacto vegetarians)
• Pure vegetarians or vegans only consume plant-based foods; they typically avoid animal cruelty products like wool and leather.
• Lacto-ovo vegetarians consume dairy and eggs alongside plants; lacto vegetarians only include dairy

Vegetarian Diet & Breastfeeding (Nutritional Adequacy)

• Breast milk from vegetarian mothers can contain all necessary nutrients for infant development.
• A variety of foods and approaches to vegetarianism mean that there's a variety of nutrients to consider to ensure adequate intake, and supplementing vitamins might be necessary.
• If a mother doesn't wish to feed their infant lacto-ovo or pure vegetarian diets, or if those diets aren't tolerated, appropriate supplementation of B12, iron, and vitamin D may be needed.

Contraindications to Breastfeeding

• Breastfeeding may be contraindicated in mothers using certain illicit drugs (e.g., heroin, cocaine, alcohol, PCP).
• Mothers with HIV or AIDS, or those receiving medications/immunizations that can harm a child.
• Certain cancer drugs are also contraindicated.
• Infants with galactosemia should not be breastfed.

Infant Formulas

• Infant formula comes in concentrates, powders, and ready-to-feed forms.
• Concentrates and powders need dilution with water.
• Ready to feed formulas do not need added water before feeding.
• There are various formula preparations (e.g. cow's milk based, soy-based, casein-based).

Cow's Milk-Based Formula

• This type of formula is the standard for healthy term infants who aren't breastfed.
• It closely resembles human breast milk, comprising 20% whey and 80% casein.
• Contains more protein, iron, linoleic acid, carnitine, taurine, and nucleotides.

Soy-Based Formulas

• Indicated for mothers who are vegetarian or whose infants have milk allergies or intolerance.
• Contains plant-based protein, and thus has a high content of vitamins and minerals to counteract the plant-based mineral antagonists present.

Casein Hydrolysate-Based Formulas

• This formula type is recommended for infants with milk or soy protein allergies or intolerance.
• It may not be suitable for preterm infants due to potentially insufficient vitamin and mineral composition.

Premature Infant Formulas

• These formulas are recommended for infants weighing under 1800 grams (low birth weight).
• They have a higher vitamin and mineral content and sometimes higher amounts of lactose and glucose.
• Examples include Enfamil Premature, Similac Natural Care, and Similac Special Care.

Human Milk Fortifiers for Preterm Infants

• Human milk fortifiers (HMFs) are used to supplement calories, proteins, and nutrients for preterm infants.
• Enfamil-HMF, for example, is mixed to increase the osmolality of breast milk and increase caloric density (up to 24 calories/oz).
• Some brands (like Similac Natural Care) are typically mixed with breast milk on a 1:1 ratio.