Postpartum Nursing Care ELO B: The Term Newborn

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Questions and Answers

What is the significance of delaying the first bath for a newborn?

It allows the newborn to adjust to room temperature.

It prevents the newborn from crying during the procedure.

It ensures the newborn's temperature stabilizes between 36.5° to 37° C. (correct)

It reduces the risk of infection from environmental factors.

What immediate action should a nurse take if a newborn displays signs of persistent cyanosis?

Document the observations and wait for a doctor.

Administer oxygen immediately. (correct)

Measure the blood glucose levels.

Initiate breastfeeding without delay.

What role does the Apgar score serve in the assessment of a newborn?

It predicts the newborn's future intelligence.

It serves as a security measure against abduction.

It assesses the parental bonding capabilities.

It evaluates the overall condition and resuscitative needs. (correct)

How can heat be lost from a newborn's body post-delivery?

Through evaporation, conduction, convection, and radiation. Signup and view all the answers

Which of the following measures is crucial for ensuring the security of newborns in a healthcare facility?

Using identification bands that are matched during reunions. Signup and view all the answers

What is the normal heart rate for a newborn?

110 to 160 beats/minute Signup and view all the answers

Which of the following is NOT a sign of hypoglycemia in newborns?

Increased appetite Signup and view all the answers

What should be avoided when caring for the umbilical cord stump?

Using triple dye or alcohol Signup and view all the answers

What is the purpose of delaying cord clamping after birth for 30 to 60 seconds?

To improve newborn outcomes by increasing iron stores Signup and view all the answers

Which method is recommended for fact-checking newborn blood glucose levels?

Performing heel sticks for capillary samples Signup and view all the answers

What is one of the key indicators for the nurse to note that may require additional intervention in parent-newborn interactions?

Indifference to the newborn’s hunger signals Signup and view all the answers

What is the best way for a nurse to facilitate parent bonding with their newborn?

Providing skin-to-skin contact and talking in high-pitched tones Signup and view all the answers

Which practice is highlighted as important for first-time parents to enhance their learning about newborn care?

Receiving consistent praise while learning Signup and view all the answers

What is a sign that a newborn may be experiencing high levels of bilirubin?

Yellowing of the skin starting at the head Signup and view all the answers

Which preventive action should a nurse take during the first feeding of a newborn to guard against choking?

Carefully observe for anomalies that may cause choking Signup and view all the answers

Why is it important to administer vitamin K to newborns within the first hour of birth?

To prevent abnormal bleeding due to vitamin K deficiency. Signup and view all the answers

What is the main focus of care during Phase 1 (0 to 30 minutes) for the newborn?

Maintaining thermoregulation Signup and view all the answers

What is the primary purpose of administering prophylactic eye care to all newborns?

To prevent infections that may lead to blindness. Signup and view all the answers

Which of the following statements about administering erythromycin eye ointment is incorrect?

Eyes should be flushed after ointment application to ensure distribution. Signup and view all the answers

Which characteristic is NOT typically observed during the first phase of newborn transition (0 to 30 minutes)?

Brief changes in color Signup and view all the answers

What is the most significant risk newborns face regarding thermoregulation during the first few hours after birth?

Hypoglycemia and respiratory distress due to temperature instability. Signup and view all the answers

During which phase of the newborn's transition do rapid respirations up to 60 breaths/min occur?

Phase 2 (30 minutes to 2 hours) Signup and view all the answers

One way to prevent hypothermia in an infant is to?

Dry the infant thoroughly after birth Signup and view all the answers

Which statement regarding the initial care of a newborn is accurate concerning eye care?

Eye ointment should be administered immediately upon birth without delay. Signup and view all the answers

What occurrence can hypothermia in a newborn lead to?

Cold stress and increased metabolic rate Signup and view all the answers

What is the primary reason for keeping the umbilical cord clean and dry?

To decrease bacterial growth Signup and view all the answers

Which reflex is present at birth and typically disappears between 3 and 6 months?

Moro reflex Signup and view all the answers

What characterizes cephalohematoma in newborns?

Bleeding between the periosteum and the skull Signup and view all the answers

What is a possible indication of increased intracranial pressure in a newborn?

Bulging fontanelles at rest Signup and view all the answers

How often should the umbilical cord be cleansed to promote optimal healing?

Two to three times a day Signup and view all the answers

What is the typical position of the ears in relation to the eyes for a newborn?

The outer canthus of the eye should be even with the upper ear's joining point. Signup and view all the answers

How can a nurse assist in minimizing sensory overload for a newborn in a hospital?

By responding quietly to alarms and reducing loud discussions. Signup and view all the answers

What indicates that a newborn has developed good hearing by birth?

Startle response to sudden loud noises. Signup and view all the answers

What visual behavior is expected from a newborn during the first few months?

Visual response to objects best at 8 to 12 inches distance. Signup and view all the answers

Which behavioral pain assessment tool is commonly used to evaluate pain in nonverbal newborns?

Face, Legs, Activity, Cry, and Consolability (FLACC) Signup and view all the answers

Which method is NOT considered a noninvasive approach for pain relief in newborns?

Topical anesthetics Signup and view all the answers

What is the first sign of kidney function at birth in newborns?

First void within 12-24 hours Signup and view all the answers

What does the 'scarf sign' assess during newborn examinations?

Gestational maturity Signup and view all the answers

Which condition occurs when the testes fail to descend from the abdomen?

Cryptorchidism Signup and view all the answers

What is a major reason for recommending circumcision according to the American Academy of Pediatrics?

Prevention of penile cancer Signup and view all the answers

Study Notes

Parental Bonding and Attachment

Nurses observe parental bonding behavior, including affection, physical contact, eye contact, and interaction time
Parents should quickly recognize a newborn's communication cues like hunger and discomfort
Nurses should be aware of cultural differences and use role modeling to encourage positive parent-newborn interactions
Interventions to facilitate bonding include: calling the newborn by name, holding them en face, promoting skin-to-skin contact, and speaking gently

Providing and Teaching Routine Care

The newborn usually stays in the mother's room unless there are complications
Nurses teach parents about newborn characteristics, signs of problems, and basic care
Parents should be involved in their newborn's care to facilitate learning
Feeding and elimination patterns are assessed – the mother should describe the number of wet and soiled diapers
Meconium stools are expected at birth, but they may transition to transitional stools before discharge
If the newborn is breastfed, the nurse assesses how well the baby is nursing, the frequency and duration of nursing sessions, and any difficulties the mother is experiencing
If the newborn is formula-fed, the nurse assesses the amount of formula intake and reminds the mother to discard leftovers
The newborn's skin should be observed for jaundice, which is caused by bilirubin buildup from the breakdown of excess erythrocytes
The newborn needs a shirt, diaper, a receiving blanket for swaddling, and a cap to prevent heat loss
Parent education includes: airway maintenance, temperature regulation, expected voiding increases, stool changes, feeding, signs of illness, and follow-up appointments

Newborn Reflexes

Newborns are born with several reflexes that are normal and crucial for survival
Absence of reflexes may indicate a serious neurological problem, while asymmetric responses could signify birth trauma
Moro reflex: Startle reflex, present at birth and disappears between 3-6 months
Tonic Neck Reflex: Fencing position, present at birth and disappears between 5-7 months
Palmar grasping reflex: Fisted hand when palm is touched, present at birth and disappears by 3 months
Babinski: Toes flare outward with dorsiflexion of big toe when the lateral sole of the foot is stroked, disappears before walking
Rooting: Infant turns head and opens lips when cheek is touched near the mouth, present at birth and disappears by 3-4 months
Sucking: Suck reflex, present at birth and disappears by 7-12 months
Dance or stepping reflex: Lifting one foot then the other as if trying to walk when held upright with feet touching a surface, present at birth and disappears by 4-5 months

Newborn Head and Neck

Newborn head is larger compared to the rest of the body with a normal circumference of 32 to 36 cm (12.5 to 14.1 inches)
Molding: Changes in head shape due to pressure during birth, resolves within days to a week
Caput Succedaneum: Localized edema over the vertex of the head, crosses suture lines, and resolves without treatment within weeks
Cephalohematoma: Bleeding between the periosteum and skull, confined to one bone and doesn’t cross suture lines, reabsorbs slowly
Fontanelles: Areas where sutures between bones meet
- Anterior: Diamond-shaped, closes between 12-18 months
- Posterior: Smaller triangular, ossifies by the end of the second month

Newborn Face

Assess for symmetry, positioning of facial features, movement, and expression
Newborns are born with the sense of taste and smell

Newborn Eyes

Should be symmetric and the same size
Transient strabismus (crossed eyes) is common for the first 3-4 months
Eye color becomes fixed between 6 and 12 months
Pupils should be equal in size and react equally to light
Tears are scant or absent for the first 1 to 3 months
Mild conjunctivitis or small subconjunctival hemorrhages are considered variations of normal
Visual acuity is not well developed but newborns will fixate on points of contrast
Newborns focus best on objects 8 to 12 inches away
They respond well to human faces and geometric patterns of black and white or bright colors

Newborn Ears

Assess for placement, appearance, and maturity
Low set ears may indicate a chromosomal anomaly
Infants can hear by the last trimester and their hearing is very good after birth
Hearing is assessed by noting the infant's reaction to loud noises
Infants prefer high-pitched tones and rhythmic sounds
A hearing screening is performed before hospital discharge

Sensory Overload

Too much stimulation in the hospital environment can cause sensory overload
Nurses should respond promptly to alarms and speak quietly

Newborn Sleep

Neonates sleep approximately 15 to 20 hours a day
The sleep-wake pattern gradually stabilizes after 24 hours
The environment plays a role in sleep behavior - conversational tones can quiet a newborn, while high noise levels can cause crying
Wrapping the infant snugly and gentle rocking can promote sleep
Neonates exhibit specific reactivity patterns:
- Quiet Sleep: Infant sleeps and does not move
- REM sleep: Irregular respirations, eye movements, and limb/mouth movements
- Active alert: Diffuse motor activity
- Quiet alert: Awake, relaxed, and quiet - most responsive to testing and bonding
- Crying: Vigorous motor activity with crying
- Transitional: Moving between states - quiet but unresponsive

Pain in the Newborn

Sensory nerve fibers for pain are well developed early in fetal life
Unrelieved pain can cause physiological changes, exhaustion, irritability, and long-term developmental issues
Common pain assessment tools:
- FLACC: Behavioral assessment for nonverbal patients
- NIPS: Behavioral assessment for both full-term and preterm infants
Pain management:
- Noninvasive methods: swaddling, rocking, sucking, sucrose, quiet environment
- Medications: Opioids and topical anesthetics for severe pain
Nurses must be familiar with the medication profile before administering pain medications

Conditioned Responses

Learned responses to external stimuli
Emotions are especially subject to conditioning
Example: Hungry infant stops crying at the sound of a caregiver's footsteps

Neonatal Behavioral Assessment Scale

Developed by Brazelton, assesses neurological capacities and responses to stimuli
Areas tested: alertness, response to visual and auditory stimuli, motor coordination, excitement level, and stress response

Respiratory Status

Some fetal lung fluid can cause respiratory difficulty for several hours after birth
The infant's cry should be strong and healthy
Bulb suctioning may be required to clear mucus from the airway

Cardiovascular status

Transitional changes in respiratory and cardiovascular systems take place at birth

Newborn Assessment

After birth, the foramen ovale and ductus arteriosus close.
Newborn circulatory blood volume: Approximately 300 mL.
Auscultate for heart rate, rhythm, and any murmurs.
Murmurs can result from blood leaking through openings that haven’t closed.
Functional murmurs: Caused by blood passing through normal valves.
Organic murmurs: Caused by blood passing through abnormal openings.
Peripheral circulation may be sluggish during the first few days of life.
Acrocyanosis: Bluish discoloration of hands and feet due to reduced peripheral circulation.

Newborn Musculoskeletal System

Newborn bones are soft, flexible, and primarily composed of cartilage with minimal calcium.
Movements are initially random and uncoordinated.
Development of muscular control occurs in a predictable pattern:
- Cephalocaudal: From head to toe, head control precedes sitting.
- Proximodistal: From torso outwards, starts in the center and moves towards arms and legs.
Scarf sign: Used to assess gestational maturity by assessing resistance when one elbow is brought past midline of the chest.
Average newborn length: 46 to 56 cm (19 to 21.5 inches).
Average newborn weight: 2722 to 4082 gm (6 to 9 lbs).
Weight loss during the first 3 to 4 days: 5-10% of birth weight.
Birth weight regained by 10 days of age.

Newborn Genitourinary System

Kidney function not fully developed at birth.
Renal blood flow is about one third of an adult.
Limited capacity for reabsorption, urine concentration, and fluid balance adjustment.
First void: Expected within 12-24 hours of birth.
Wet diaper count: Expected to be around six per day.

Male Genitalia

Genitalia is developed at birth; maturation varies.
Testes descend into the scrotum before birth.
Cryptorchidism: Failure of testes to descend.
Urethral opening: Should be at the tip of the penis.
Smegma: White, cheesy substance found under the foreskin, thought to be bacteriostatic.
Routine foreskin retraction for cleaning is not recommended.

Circumcision

Most common surgical procedure performed on males.
Involves removal of the prepuce (foreskin).
American Academy of Pediatrics (AAP): States health benefits outweigh risks, but benefits are not great enough to recommend routinely for all newborns.
Benefits: Reduces penile cancer, urinary tract infections, HIV infection, and transmission of other sexually transmitted diseases.
Other reasons for circumcision: Religious, cultural, or social.
Circumcision on the 8th day after birth: Jewish tradition.
Reasons for rejecting circumcision:
- Pain and risk of surgery.
- Considered cosmetic surgery and unnecessary.
- Fear of complications, including hemorrhage, infection, stenosis, fistulas, adhesions, necrosis, and injuries to the glans penis.
Pain relief: Non-pharmacologic methods include pacifiers, oral sucrose, intrauterine sound recordings, soft talking, and dimmed lights.
Circumcision methods:
- Gomco clamp: Uses a cone-shaped device and clamp to crush blood vessels before removal.
- Plastibell clamp: Uses a plastic ring and suture to prevent bleeding during removal.

Circumcision Nursing Considerations

Before the procedure: Assist family in decision-making, ensure surgical consent is signed, keep infant NPO, have bulb syringe ready, position heat lamp or radiant warmer.
After the procedure: Hold and soothe infant, check for bleeding, notify physician if excessive bleeding occurs, monitor for urination within 6-8 hours.
Circumcision care:
- Clean with warm water.
- Do not remove yellow crust.
- Apply petroleum jelly (Gomco clamp only).
- Monitor for signs of infection.

Female Genitalia

Labia majora: Should be large and cover the clitoris and labia minora.
Labia color: May be darker than surrounding skin due to maternal hormones.
Edema and white mucous vaginal discharge: Normal findings.
Bloody mucus: Normal due to cessation of maternal sex hormones.
Pseudo menstruation: Small amount of bleeding from hormone withdrawal.
Vulva cleaning: From urethra to anus (front to back).

Newborn Integumentary System

Tissue turgor: Reflects hydration status.
Well hydrated tissue: Springs back when pinched.
Poor tissue turgor: Remains distorted, may indicate dehydration.
Lanugo: Fine hair that thins as the fetus nears term, may be present on shoulders, upper back, forehead, and face.
Vernix caseosa: Cheese-like substance that covers the newborn’s skin, protects skin in utero.
Milia: Pearly white pinpoint papules on the face, disappear without treatment.
Epstein’s pearls: Pearly white pinpoint papules in the midline of the upper palate, distinguish from thrush.
Mongolian spots: Bluish or slate grey marks resembling bruises, commonly found in the sacral area but may appear elsewhere, more frequent in newborns with dark skin, usually disappear within the first years of life.
Acrocyanosis: Bluish discoloration of hands and feet due to reduced peripheral circulation, common during the first day due to poor circulation and cold temperatures.
Physiological jaundice: Not present during the first 24 hours, appears on day 2 or 3, due to immature liver function, peaks on days 2-4, and resolves by day 5-7.

Newborn Assessment: Physiological Jaundice

Icterometer: Measures jaundice severity by comparing skin color to yellow swatches.
Transcutaneous bilirubin measurement (TcB): Non-invasive method for measuring serum bilirubin levels.

Interactive Bath

Initial bath: Removes blood, amniotic fluid, and excessive vernix.
Glove use: Required until the first bath is completed.
Assessment opportunity: Observe skin, behavior, and muscle activity.
Parental bonding: Emphasize hand hygiene, safe water temperature, and safe handling.
Daily bathing with soap and water: Not recommended.
Bath water temperature: 37.2o-38o C (99o to 100.4o F).
Bath procedure: Begin with face, proceed cephalocaudally, end with hair shampooing.

Newborn Gastrointestinal System

Abdomen: Soft, rounded, and protrudes slightly, not distended.
Auscultate bowel sounds.
Stools: Assess color, type, and consistency.
Meconium stools: Dark greenish-black, tarry, odorless, and tenacious, passed within 8-24 hours after birth.
Transitional stools: Loose, greenish-yellow with mucus, on the 2nd or 3rd day.
Breast-fed infant stools: Very soft, bright yellow.
Bottle-fed infant stools: More solid, yellow to light brown.
Iron supplements: May darken stool color.
Phototherapy: May cause greener stools.
Initial feeding: Assesses sucking, swallowing, and breathing coordination.
Stomach capacity: About 90 mL (3 oz).
Breastfeeding: Encouraged within the first hour for psychological benefits and milk production stimulation.
Bottle feeding: Started within 5 hours.
Gastric emptying: Within 2-3 hours.
Feeding: Stimulates the gastrocolic reflex, aiding stool passing.

Breastfeeding

Nutrition crucial in the first few months due to rapid brain growth and energy use.
Breast milk: Contains the full range of nutrients required by the newborn in the right proportions, easily digested, does not cause allergies, provides natural immunity, promotes meconium elimination, rarely causes constipation, promotes mouth development, convenient and economical, reduces contamination risks, facilitates maternal weight loss, enhances mother-child bonding, may reduce respiratory disorders and diabetes in the infant.
Mother's decision: Support the mother’s choice to breastfeed or bottle-feed.
Contraindications to breastfeeding:
- HIV infection
- Human T-cell lymphotrophic viruses (HTLV-1 and HTLV-2)
- Herpes simplex virus with breast lesions
- Varicella zoster virus with breast lesions

Breastfeeding Considerations

Mothers with active pulmonary tuberculosis (TB): Can pump breast milk for their infant while being isolated.
Medication timing: Administer doses immediately after nursing to minimize infant exposure.
AAP LactMed: Website for reviewing drug effects during lactation.
Drugs to avoid while breastfeeding: Cytotoxic drugs, drugs of abuse, radioactive compounds, some psychotropic drugs, antianxiety drugs, bromocriptine, ergotamine, fish with high mercury levels.
Generally safe drugs during lactation: Narcotics, sedatives, anticonvulsants, antihistamines, decongestants, antihypertensives, antimicrobials, coffee.
Nursing care: Help mother position the newborn correctly, facilitate proper latch-on, provide reassurance and praise.

Communication

Cross-cultural communication: Verify understanding by having the woman repeat teaching in her own words.
Cultural considerations:
- Galactogogues (breast milk stimulators): Commonly used across cultures.
- Garlic: Flavors breast milk but does not harm the newborn.
- Respect cultural practices.

Breastfeeding Positions

Cradle hold: Mother holds infant with head in her antecubital area, provide support with pillows or blankets.
Football hold: Good for mothers with cesarean incisions, support infant’s head with one hand and body alongside the hip.
Side-lying position: Good for night feedings and mothers with cesarean birth, lie with infant’s body parallel, use pillows or blankets for support.
Proper newborn positioning: Chest-to-chest with mother, head and neck in alignment, facing the mother, at the level of the breast nipple, nipple centered to nose and aimed towards the roof of the mouth.

Essential Breastfeeding Techniques

Proper body alignment of newborn.
Newborn’s mouth wide open for areola grasp.
Proper hand position of mother on breast.
Newborn’s mouth moves rhythmically to compress areola.
Audible swallow.
Mother is relaxed and supported.
Room is warm and private.
Newborn ends feeding relaxed and satiated.
Mother has soft, non-engorged breasts at the end of feeding.

Breastfeeding Techniques for Mothers

Handwashing before breastfeeding.
Gentle breast washing with plain water.
Manually expressing colostrum to erect the nipple.
Starting with the opposite breast from the previous feed.
Proper hand position on the breast: C position or scissors hold, do not tip nipple upward.
Latch-on: Let the newborn become alert and hungry, brush nipple against lower lip, bring infant close when mouth opens wide to ensure areola is in the mouth, check tongue position, and achieve effective latch-on.

Breastfeeding Suckling Patterns

Suckling is the term for breastfeeding.
Newborns exhibit varying suckling patterns during breastfeeding.

Newborn Breastfeeding & Sucking

Newborns may suck several times before swallowing, but generally swallow with each suck after 4 days.
A soft "ka" or "ah" sound indicates successful feeding.
Noisy sucking or smacking sounds, or dimpling of the cheeks, indicate improper mouth position.
"Fluttering" sucking motions indicate non-nutritive suckling.
Mothers should break suction by inserting a finger in the corner of the newborn's mouth or indenting their breast. Pulling the newborn away can cause sore nipples.

Assessing Successful Breastfeeding

Breasts should feel firm before feeding and softer after.
Let-down reflex (tingling sensation with milk dripping) should occur when feeding is due.
Newborns nurse for 10-15 minutes per breast, 8-10 times daily.
An audible swallow should be heard.
Newborns should demand feeding and appear relaxed after feeding.
Newborns should have 6-8 wet diapers and multiple stools daily.
By 14 days, newborns should have regained their birth weight.

Preventing Breastfeeding Problems

Pain, anxiety, and insecurity can inhibit the let-down reflex and lead to breastfeeding problems.
Lactation consultants and La Leche League can help with support and advice.
Most birth centers have "warm lines" for breastfeeding and newborn support.

Frequency & Duration of Feedings

Breastfed newborns usually nurse every 2-3 hours due to small stomach capacity and easy digestion.
Newborns may cluster feedings at frequent intervals followed by longer periods without feeding.
If a newborn hasn't nursed in 3 hours, gently awaken and attempt breastfeeding.
Short feedings may not satisfy the newborn's hunger due to lower calorie density in foremilk.
Let-down reflex can take up to 5 minutes, and a lack of hindmilk (richer milk) can lead to frequent hunger, frustrating the mother.
Engorgement will occur if milk isn't removed, and milk production can decrease.

Recognizing Hunger in Newborns

Hand-to-mouth movements
Mouth and tongue movements
Sucking motions
Rooting movements
Clenched fists
Kicking of legs
Crying (late sign of hunger)

Baby-Friendly Hospital Initiative

Launched by UNICEF and WHO in 1991 to support and promote breastfeeding.
Hospitals must meet specific criteria to be certified:
- Written breastfeeding policy and staff education.
- Parent education on breastfeeding techniques.
- Breastfeeding initiated in the delivery room or maintained if separation occurs.
- Only breast milk is fed, and feeding on demand is encouraged.
- Mother and newborn room-in 24 hours a day.
- No pacifiers or artificial nipples are used.
- Formula samples aren't distributed at discharge, and support group referrals are offered.

Advantages of Breastfeeding

Lower rates of otitis media, respiratory infections, gastroenteritis, UTIs, thrush.
Reduced risk of diabetes, childhood leukemia, obesity, and necrotizing enterocolitis.
Positive influence on intelligence.
Only 22.3% of mothers in the US exclusively breastfed for 6 months or more in 2016.

The Sleepy Newborn

Some newborns are sleepy and need to be awakened for feedings until a routine is established.
Try unwrapping, diaper change, holding upright, talking softly, or gentle massage to awaken.

The Fussy Newborn

Some newborns awaken crying, making it difficult to observe hunger cues.
Calm the newborn by swaddling, holding close, and talking calmly before feeding.
Stiffening and crying after feeding can indicate thrush, gas, cramps, or illness, requiring healthcare intervention.

Flat or Inverted Nipples

Gently roll nipples between thumb and forefinger to help them become erect.

Supplemental Feedings and Nipple Confusion

Supplemental feedings of formula or water should not be offered to healthy breastfeeding newborns.
Bottle feeding can lead to nipple confusion due to easier fluid access and different tongue movements, potentially causing breastfeeding difficulties.
Pacifiers are not recommended until 3-4 weeks of age, when breastfeeding is established.

Breast Engorgement

Early, regular, and frequent nursing helps prevent engorgement.
If engorgement occurs, pump breasts to soften the areola and initiate milk flow.
Cold applications between feedings and heat before feeding can reduce discomfort.
Manual massage can help soften breasts and express milk.

Nipple Trauma

Correct newborn positioning is the best preventive measure.
Formula feeding can worsen trauma and pain, causing engorgement.
Warm water compresses offer relief.
Applying breast milk to nipples can aid healing.
Ointments are not effective and should be removed before breastfeeding.

Hygiene

Do not use soap on breasts.
Wear a supportive, not overly tight bra 24/7.

Special Breastfeeding Situations

Multiple Births

Mother's body adjusts milk supply to meet the demands of multiple newborns.
Twins can be fed one at a time or simultaneously using the crisscross hold.

Premature Birth

Breastfeeding is particularly beneficial for preterm newborns due to its immunological advantages.
Mothers can pump and freeze milk for tube feedings if necessary.
Mothers may prefer the cross-cradle hold when nursing preterm infants.

Breast Surgery

Previous breast surgery can affect breastfeeding if incisions were near the areola.
Silicone breast implants don't negatively influence breastfeeding.
Consult a lactation specialist.

Delayed Feedings/Using a Breast Pump

Teach mothers how to pump milk if breastfeeding is delayed.
Portable pumps allow mothers to continue pumping while at work.
Double pumping systems increase milk production.
Pumping should last 10 minutes on each breast every 3 hours.
Proper flange positioning is essential to prevent nipple trauma.
Start the pump on high speed, low suction, adjusting to medium speed and comfort once milk flow begins.
Daily milk production after breastfeeding is established should be approximately 750-1050 mL (25-35 oz).
Weaning from the pump should be gradual; sudden cessation can lead to discomfort and engorgement.

Storing and Freezing Breast Milk

Use or store breast milk within 1 hour of pumping.
Glass or hard plastic containers are safe for storage.
Clear, hard plastic bottles made of polycarbonate are safe for freezing.
Polystyrene bottles are not designed for frozen storage.
Polyethylene containers (plastic bags) can puncture and may not preserve all nutrients.
Use BPA-free plastic containers.
Thaw in the refrigerator for 24 hours or under lukewarm running water.
Microwaving is not recommended.
Store at room temperature for 4-6 hours, in the refrigerator for 4 days, or in the freezer for 2 weeks (refrigerator) or 6 months (deep freezer).
Thawed milk should not be stored longer than 24 hours.

Maternal Nutrition

Mothers need approximately 500 additional calories daily beyond their non-pregnant diet.
Choose foods from all food groups:
- Meat, fish, poultry, eggs, beans, nuts
- Milk and dairy products
- Vegetables
- Fruits
- Breads, cereals, and grains
Lactating women need a 20%-30% increase in vitamins and minerals, double the pre-pregnancy folic acid intake, and a 40%-50% increase in calcium and phosphorus.
- Include 2 cups of milk, 2 ounces of meat or peanut butter, a slice of whole wheat bread, a citrus fruit, and a salad with half a cup of dark green or yellow vegetables daily.
Increased vitamin D and sun exposure are also vital.
About 1 liter of uncaffeinated fluids is needed daily.
Lactose intolerant women can substitute milk products with tofu, soy milk, or canned salmon with bones.
Continue taking prenatal vitamins during lactation unless well-nourished.
Certain foods can affect the taste of breast milk or cause gas in infants, such as chocolate, cabbage, beans, and broccoli.

Weaning

Gradual weaning is preferable to abrupt weaning, which can cause engorgement, mastitis, and distress for the newborn.
Eliminate one feeding at a time, waiting several days before eliminating another.
Begin with the least favorite feeding and eliminate the favorite feeding last.
Expect comfort nursing if the newborn is tired, ill, or uncomfortable.
If abrupt weaning is necessary, expect breast engorgement and use supportive bras, ice packs, analgesics, or cabbage leaves for relief.
Breast pumping is not recommended during abrupt weaning.

Formula Feeding

Reasons for formula feeding: embarrassment, lack of support, discomfort at not knowing milk intake, lack of flexibility.