Lactation Breastfeeding, 2023 (DSG) PDF

LACTATION-BREASTFEEDING AND NURSING CARE Nursing of Obstetrics and Gynecology Assoc. Prof. Dilek Sarpkaya Güder NEU/Nursing Faculty  CONTENT OF PRESENTATION  Benefits of breastfeeding  Physiology of milk production  Biospecificity of human milk  Appearance and amount of b...

LACTATION-BREASTFEEDING AND NURSING CARE Nursing of Obstetrics and Gynecology Assoc. Prof. Dilek Sarpkaya Güder NEU/Nursing Faculty  CONTENT OF PRESENTATION  Benefits of breastfeeding  Physiology of milk production  Biospecificity of human milk  Appearance and amount of breast milk  Ten steps to successful breastfeeding  Breastfeeding management and tecnique  Milk expression and breast pumps  Common problems encountered with breastfeeding 17.11.2023 Assoc. Prof. Dilek SARPKAYA 2 GÜDER  PURPOSE OF PRESENTATION To gain knowledge and skills about lactation and breastfeeding 17.11.2023 Assoc. Prof. Dilek SARPKAYA 3 GÜDER  Breastfeeding Statistics in the World ??????? 17.11.2023 Assoc. Prof. Dilek SARPKAYA 5 GÜDER BENEFITS OF BREASTFEEDING Human milk is a dynamic food, meeting the infant’s needs to build an immune system, to grow and develop the brain, and to form attachments with other human beings. Research has produced compelling data about the short- and long-term health benefits of breastfeeding for the mother and newborn. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 6 GÜDER  NEWBORN HEALTH BENEFITS Children who were exclusively breastfed in the first half-year are significantly less prone to disase and are also better protected from allergies than children nursed with formula. It contains many antibodies aganist disease agents. It is easy to digest and its composition is always adapted to the age and needs of the child. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 7 GÜDER NEWBORN HEALTH BENEFITS Asthma, Allergies, Sudden infant death syndrome Otitis media, Cardiovascular disease Gastrointestinal (GI) infection Respiratory conditions, Childhood leukemia and lymphomas Cognitive development Obesity, Diabetes,Assoc. 17.11.2023 Necrotizing enterocolitis Prof. Dilek SARPKAYA 8 GÜDER MATERNAL HEALTH BENEFITS Stimulates uterine involution resulting in less blood loss Breastfeeding enhances mother–infant attachment. Reducation for developing breast cancer, ovarian cancer, type II diabetes. Reduced risk for developing metabolic syndrome, hypertension, hyperlipidemia, and cardiovascular disease 17.11.2023 Assoc. Prof. Dilek SARPKAYA 9 GÜDER  ECONOMIC BENEFITS It is always available, sterile and has the optimal temperature. This saves time, money and work. Exclusive use of formula and its consequent increased neonatal morbidity is responsible for substantial expenditures of healthcare dollars. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 10 GÜDER  INCIDENCE OF BREASTFEEDING HEALTHY PEOPLE GOALS The World Health Organization (WHO; 2011) extends that recommendation to 2 years or longer. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 11 GÜDER  DO YOU KNOW HOW LONG YOU HAVE BREASTFED? 17.11.2023 Assoc. Prof. Dilek SARPKAYA 12 GÜDER  PHYSIOLOGY OF MILK PRODUCTION Perinatal nurses need to understand the science of milk production. This knowledge is essential to help women breastfeed successfully. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 13 GÜDER  Myoepithelial cells Epithelial cells ducts Lactiferous sinus Nipple Areola Montgomery gland Alveoli Supporting tissue 17.11.2023 Assoc. Prof. Dilek SARPKAYA 14 and fat GÜDER  MAMMOGENESIS Mammogenesis refers to growth of the mammary glands. During pregnancy, estrogen and progesterone prepare the breasts for lactation. Numerous external changes occur. The breasts enlarge; the skin stretches and appears thinner, making veins more visible. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 15 GÜDER  MAMMOGENESIS The nipples enlarge, and the Montgomery glands become prominent and start to secrete a substance that lubricates and protects the nipples and areola. The areola grows in diameter and darkens. Internal changes in the breast also occur (developmenting mammary ducts, lobules and alveoli) 17.11.2023 Assoc. Prof. Dilek SARPKAYA 16 GÜDER  LACTOGENESIS I Lactogenesis I starts around midpregnancy and lasts until 1 to 2 days postpartum. Prolactin levels rise during pregnancy and stimulate production of colostrum, which is present from midpregnancy forward 17.11.2023 Assoc. Prof. Dilek SARPKAYA 17 GÜDER  LACTOGENESIS II Lactogenesis II is defined as the onset of copious milk production that occurs 48 to 72 hours after the birth. The higher prolactin levels, along with infant suckling, stimulate the breast to synthesize and secrete milk. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 18 GÜDER  Common Risk Factors for Delayed Onset of Lactogenesis II Primiparity Birth weight 3,600 gr Maternal age 30 years Retained placenta Cesarean birth Surgical procedures on Prolonged labor breast Obesity Insufficient mammary High levels of stress tissue during the birth Breast hypoplasia delay Premature delivery with first feeding (including late preterm) Hypothyroid Insulin dependent Hypertension diabetes mellitus 17.11.2023 Assoc. Prof. Dilek SARPKAYA 19 GÜDER  Prolactin “milk secretion” reflex Enhancing factors Hindering factors Early initiation of breastfeeds Delay in initiation Good attachment of breastfeeds, & effective suckling Pre-lacteal feeds, Bottle feeding, Frequent feeds Incorrect positioning, including night Painful breast feeds Emptying of breast Prolactin Sensory in blood impulse from Assoc. Prof. Dilek SARPKAYA GÜDER 20 nipple 17.11.2023  LACTOGENESIS III Lactogenesis III is the phase when a woman has established a mature milk supply. With autocrine control, prolactin continues to be produced in response to infant suckling and emptying of the breasts. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 21 GÜDER  LACTOGENESIS III Oxytocin is also released in response to suckling. This occurs numerous times during a feeding. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 22 GÜDER  (3) Oxytocin reflex (let down reflex or milk ejection reflex) contraction of neuroepithelial cells Surrounding alveoli ejection of milk. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 23 GÜDER  Oxytocin “milk ejection” reflex Oxytocin contracts myoepithelial cells Sensory impulse from nipple to Baby sucking brain Assoc. Prof. Dilek 24 17.11.2023 SARPKAYA GÜDER  Oxytocin reflex Stimulated by Inhibited by Thinks lovingly of baby Worry Sound of the baby Stress Sight of the baby Pain CONFIDENCE Doubt Assoc. Prof. Dilek 25 17.11.2023 SARPKAYA GÜDER  LACTOGENESIS III Some mothers feel this as a heaviness or tingling sensation in the breast. Oxytocin also stimulates uterine contractions that control postpartum bleeding and promote involution. Mothers, especially multiparous women, feel these “after-birth pains” during feedings for several days after the birth. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 26 GÜDER  LACTOGENESIS III Oxytocin is released into the newborn brain by means of milk transfer and is thought to modulate attachment behaviors between mother and newborn. Leaving milk in the breasts for long periods can contribute to slower and lower amounts of milk production. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 27 GÜDER  Summarize Lactation Anatomy and Physiology Latch On and sucking Oxytocin Release Releases Milk Infant Empties Breast Production Increases Milk Production Occurs Interference withAssoc. this cycle decreases the milk Prof. Dilek SARPKAYA 17.11.2023 supply. GÜDER 28  BIOSPECIFICITY OF HUMAN MILK Human milk is a species-specific fluid. The composition of human milk changes over time. Colostrum (1 to 5 days postpartum) evolves to transitional milk (6 to 13 days postpartum) and then into mature milk (14 days and beyond). 17.11.2023 Assoc. Prof. Dilek SARPKAYA 29 GÜDER  BIOSPECIFICITY OF HUMAN MILK Colostrum is present in the breast from about 12 to 16 weeks of pregnancy. This first milk is thick and has a yellowish color. The volume of colostrum is low (measured in teaspoons), which ensures the infant will want to nurse frequently. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 30 GÜDER  BIOSPECIFICITY OF HUMAN MILK Compared with mature milk, colostrum is higher in protein, sodium, chloride, potassium, and fat- soluble vitamins. It is rich in antioxidants, antibodies, interferon, fi bronectin, and immunoglobulins, especially secretory immunoglobulin (Ig) A. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 31 GÜDER BIOSPECIFICITY OF HUMAN MILK Colostrum begins the establishment of normal bacterial flora in the newborn’s gastrointestinal tract and exerts a laxative effect that begins elimination of meconium, decreasing the potential reabsorption of bilirubin. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 32 GÜDER  BIOSPECIFICITY OF HUMAN MILK Mature milk composition changes during the feeding. Foremilk is produced initially; it is more watery and has lower fat content. Later in the feeding on a given breast, cell membranes release fat globules and protein, which forms hindmilk 17.11.2023 Assoc. Prof. Dilek SARPKAYA 33 GÜDER BIOSPECIFICITY OF HUMAN MILK Hindmilk is high in calories and fat and is critical to growth and brain development. To make sure infants get adequate hindmilk, the baby should be allowed to completely finish on one side before offering the other breast. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 34 GÜDER  Water (%87.5) All of the vitamins and minerals Fat (lipids) (just first 6 months) NUTRITIONAL COMPONENTS Protein (the Carbohydrate whey (lactose) protein) All of the vitamins and minerals (just first 6 months) 17.11.2023 Assoc. Prof. Dilek SARPKAYA 35 GÜDER  Barriers to Breastfeeding that are Responsive to Interventions Healthcare Professionals: Apathy Misinformation Professional education that lacks information on breastfeeding Outdated clinical practices 17.11.2023 Assoc. Prof. Dilek SARPKAYA 36 GÜDER  Barriers to Breastfeeding that Are Responsive to Interventions Hospital Practices: Failing to provide skilled Lack of a breastfeeding policy support Inappropriate interventions (i.e., supplemental feeding, pacifiers, Routine separation of overuse of nipple) mother–infant dyad Disruptions of breastfeeding Delay of first feeding Discharge packs that include Routine formula or water formula samples and/or supplementation coupons for formula Use of pacifiers Lack of discharge policy Lack of staff training Lack of follow-up after discharge 17.11.2023 Assoc. Prof. Dilek SARPKAYA 37 GÜDER  Barriers to Breastfeeding that Are Responsive to Interventions Lack of Support: From partner, peers, and family From workplace From healthcare professionals 17.11.2023 Assoc. Prof. Dilek SARPKAYA 38 GÜDER  Barriers to Breastfeeding that Are Responsive to Interventions Societal Attitudes; Media portrayal of bottle-feeding as normal Commercial pressures on mothers to bottle-feed or supplement with formula Formula club sign-up sheets in obstetric offices and clinics Prenatal formula starter kits Coupons for free formula Formula ads in parent magazines Formula ads on Internet sites of interest to parents Discounted formula available through the Internet 17.11.2023 Assoc. Prof. Dilek SARPKAYA 39 GÜDER  40 Assoc. Prof. Dilek SARPKAYA GÜDER 17.11.2023  TEN STEPS TO SUCCESSFUL BREASTFEEDING (From World Health Organization/United Nations International Children’s Emergency Fund Joint Statement) 1. Have a written breastfeeding policy that is routinely communicated to all health-care staff. 2. Train all health-care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding 17.11.2023 Assoc. Prof. Dilek SARPKAYA 41 GÜDER  TEN STEPS TO SUCCESSFUL BREASTFEEDING 4. Help mothers initiate breastfeeding within 1 hour of birth. 5. Show mothers how to breastfeed and how to maintain lactation even when they are separated from their newborns. 6. Give newborns no food or 17.11.2023 drink other than breast milk, Assoc. Prof. Dilek SARPKAYA 42 unlessGÜDER medically indicated.  TEN STEPS TO SUCCESSFUL BREASTFEEDING 7. Practice “rooming-in”; allow mothers and newborns to remain together 24 hours each day. 8. Encourage unrestricted breastfeeding. 9. Give no artificial nipples or pacifiers to breastfeeding newborns. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the 17.11.2023 Assoc. Prof. Dilek SARPKAYA 43 hospital or clinic GÜDER  BREASTFEEDING MANAGEMENT AND TECNİQUE BREASTFEEDING MANAGEMENT %95 of all mothers are able to breastfeed. The size of the breast is by no means decisive for the success of breastfeeding or the amount of milk produced. Also flat or retracted nipples are no obstacle, since the baby drinks from the breast and not from the nipple. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 45 GÜDER  BREASTFEEDING MANAGEMENT Early and frequent breastfeeding along with skin-to skin contact promotes optimal breastfeeding Breastfeeding should be initiated within an hour of birth. This is an ideal time since the infant demonstrates sucking movements that peak 45 minutes 17.11.2023 after birth and decline Assoc. Prof. Dilek SARPKAYA over the next 46 2 hours. GÜDER  An important factor, especially at the beginning, is that the mother receives loving support. She needs much quiet and little stress, so that she and the baby can find their optimal feeding rhythm. If nevertheless problems occur with breastfeeding, the midwife, the infant nurse, the doctor or a breastfeeding consultant 17.11.2023 are competent advisors. Assoc. Prof. Dilek SARPKAYA 47 GÜDER  SUPPORTING THE BREAST Historically, mothers have been encouraged to support their breasts using a variety of techniques (scissor hold, C-hold, etc.). The current approach is to let the mother decide what works best for her. In some cases and in some positions, there is no need to hold the breast. In the event the breast is being held, a variety of techniques could be used as long as the mother’s fingers do not impede the infant from a correct latch or compressAssoc. 17.11.2023 ductsProf. Dilek SARPKAYA 48 GÜDER  Frequency and Duration of Breastfeeding The number of feedings depends on age, physiologic capacity of the stomach, ability of the newborn, and storage capacity of the breasts Breastfeeding patterns, however, vary widely between mother and baby pairs, over each 24-hour period, and during the course of the lactation. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 49 GÜDER  Frequency and Duration of Breastfeeding During the first weeks: 8 to 12 feedings at the breast per 24 hours Offer both breasts for at least 10 to 15 minutes each and allow for infant to stay on the breasts for as long as desired by the newborn. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 50 GÜDER  Frequency and Duration of Breastfeeding In a typical feeding, the newborn should feed on the first breast until satiated. The feeding ends when the newborn comes off the breast on its own after swallowing for most of the feeding. If the mother is uncertain whether the newborn is satisfied, she can use hand/manual expression Alternate massage is recommended when infant’s swallowing is slowing down. This technique increases the volume and fat content of the milk 17.11.2023 Assoc. Prof. Dilek SARPKAYA 51 GÜDER  FEEDING FREQUENCY AND DURATION There are no time limits on the duration of feedings. In the first days after birth, some newborns nurse from only one breast at a feeding. The other side is offered at the next feeding, usually within 1 or 2 hours. Feeding frequently encourages an abundant milk supply, minimizes engorgement and sore nipples, enhances weight gain, reduces jaundice and hypoglycemia, and increases breastfeeding duration. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 52 GÜDER  HUNGER CUES Rapid eye movements Rooting under the eyelids Mouth opening in Sucking movements response to tactile of the mouth and stimulation tongue Smacking of lips Hand-to-mouth Wide-open eyes; movements quiet, alert state Body movements Restlessness Small sounds (soft cooing or sighing sounds) 17.11.2023 Assoc. Prof. Dilek SARPKAYA 53 GÜDER Breastfeeding Tecnique Video 17.11.2023 Assoc. Prof. Dilek SARPKAYA 54 GÜDER Feeding Reflexes in the Baby Rooting reflex Sucking reflex Swallowing reflex Assoc. Prof. Dilek 55 17.11.2023 SARPKAYA GÜDER  BREASTFEEDING TECNIQUE Initiate Make sure her breastfeeding back and arms as soon as are well- possible after supported, which will allow for her the birth of the to comfortably infant. hold her baby Assist the mother in finding a comfortable position for breastfeeding. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 56 GÜDER Common Breastfeeding Positions; Cradle hold Cross-cradle or transitional hold Clutch or football hold Side-lying position 17.11.2023 Assoc. Prof. Dilek SARPKAYA 57 GÜDER  BREASTFEEDING TECNIQUE Breastfeeding The mather can rest her arm on a pillow in a sitting so that she need not position, carry the whole crading the weight of the baby. baby, is She puts the lower probably the arm of the baby around her waist. most widely used position. Instruct the mother to bring the baby to her breast and not her body to the 17.11.2023 baby.Assoc. Prof. Dilek SARPKAYA 59 GÜDER The more comfortable both the mother and the newborn are, the easier it will be for the mother to breastfeed, maintain proper latch, and continue breastfeeding. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 60 GÜDER  BREASTFEEDING TECNIQUE If the mother wears as ‘uncomplicated’ clothes as possible, such as a jumper which is simply pulled up, or a waistcoat, she can easily feed her child even in public without being too obvious. A light cloth used to cover the breast can also be helpful. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 61 GÜDER  BREASTFEEDING TECNIQUE Instruct the mother to cup her breast with one hand and stroke the baby’s lower lip with her nipple to encourage the baby to open wide. Have the mother hug the infant closer while centering her nipple into the baby’s mouth to properly latch the infant 17.11.2023 Assoc. Prof. Dilek SARPKAYA 62 GÜDER  BREASTFEEDING TECNIQUE The infant should never be latched to the nipple only. He should have a good amount of the mother’s areola (the dark area surrounding the nipple) in his mouth with both lips turned out and relaxed, and with the tongue cupped under her breast. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 63 GÜDER  BREASTFEEDING TECNIQUE At the end of or even during the meal, the baby should be given the possibility to allow any air swallowed along with the milk to escape from the stomach. To do so, the baby is put over the shoulder in an upright position for a while. This can be accompanied by gentle taps on the baby’s back. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 64 GÜDER  Slide 2g 17.11.2023 Assoc. Prof. Dilek SARPKAYA 65 GÜDER  BREASTFEEDING TECNIQUE If the baby stops drinking or has even fallen asleep during the feed, its mouth should not simply be pulled off the breast, since this could injure the nipple. The mother first puts her little finger into the baby’s mouth to release the suction and then carefully detaches the baby. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 66 GÜDER  BREASTFEEDING TECNIQUE Assessment of the Infant’s Latch An infant needs to properly latch on to the mother’s breast to be able to effectively breastfeed, get enough milk, and prevent nipple soreness. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 67 GÜDER Observations Indicating Correct Latch On Lips are rolled outward (flared). Clicking or smacking sounds are absent. Dimpled cheeks are absent. Muscles above and in front of the ear move. Both cheeks are equally close to the breast. Chin and nose are touching the breast. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 68 GÜDER Observations Indicating Correct Latch On All of the nipple and part of the areola is covered by the newborn’s mouth. More of the areola is visible above the upper lip than below it. Angle at the corner of the mouth is wide. When the lower lip is gently pulled away from the breast, the tongue is visible over the lower gum line. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 69 GÜDER  GOOD AND POOR ATTACHMENT Assoc. Prof. Dilek 70 17.11.2023 SARPKAYA GÜDER  GOOD ATTACHMENT lower lip is curled outward baby’s mouth is wide open chin lower touches portion of the breast the areola is not visible Assoc. Prof. Dilek 71 17.11.2023 SARPKAYA GÜDER  SIGNS OF ADEQUATE INTAKE Evaluating the newborn for adequate intake is based on elimination patterns, behavioral observations, moist mucous membranes, and weight gain. Wet diapers can be used to assess hydration, and the number of bowel movements provide evidence that milk transfer has occurred. Urine should be clear and pale yellow. Stools change from meconium to transitional stools to yellow, seedy liquid. Yellow stool should be present by the end of the first week. The newborn is sufficiently hydrated include moist mucous membranes and skin that does not remain tented when lightly pinched. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 72 GÜDER  The perfect match: quantity of colostrum per feed and the newborn stomach capacity 17.11.2023 Assoc. Prof. Dilek SARPKAYA 73 GÜDER  MILK EXPRESSION AND BREAST PUMPS In some situations, a woman may not be able to breastfeed early and frequently enough to stimulate and sustain lactation. When there is a delay, perinatal nurses should teach hand expression and advise the mother to use a breast pump 17.11.2023 Assoc. Prof. Dilek SARPKAYA 74 GÜDER  MILK EXPRESSION AND BREAST PUMPS Nurses should know how to correctly size the shield/flange of the breast pump. Shields that are too big or too small can lead to nipple soreness, cracks, and excoriation. A shield that is too big can result in a loss of suction, which leads to inadequate stimulation and lower milk volume 17.11.2023 Assoc. Prof. Dilek SARPKAYA 75 GÜDER  MILK EXPRESSION AND BREAST PUMPS Women need education on the correct use of breast pumps and the storage of breast milk. An aseptic technique should be used, starting with clean hands and clean equipment. Many women begin a pumping session by massaging the breasts and expressing a few drops of milk. This does a better job at stimulating letdown than starting immediately 17.11.2023 with the pump. Assoc. Prof. Dilek SARPKAYA 76 GÜDER  MILK EXPRESSION AND BREAST PUMPS To stimulate lactation, women should pump at least 8 to 12 times every 24 hours, no matter how high the milk volume. Pumping at night may produce larger quantities of milk because of the higher prolactin levels at that time of day, and mothers should be encouraged to pump at least once during the night. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 77 GÜDER  MILK EXPRESSION AND BREAST PUMPS Based on the circumstances, a mother may pump to stimulate initiation of lactation, in place of a missed feeding, between feedings, on one breast while feeding the baby on the other breast, or at the end of a feeding. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 78 GÜDER  EXPRESSING BREAST MILK W a sh y ou r h a n ds w e ll w it h soa p a n d w ater Pla ce a cle a n con t a in e r be low y ou r b r e a st t o colle ct m ilk M a ssa g e t h e br e a st s g e n t ly t ow a r d t h e n ip ple s Pla ce y ou r t h u m b a n d in de x f in g e r opposit e e a ch ot h e r j u st ou t side t h e da r k cir cle a r ou n d t h e n ipple N ow pr e ss ba ck t ow a r d y ou r ch e st , t h e n ge n t ly sq u e e z e t o r e le a se m ilk Re pe a t st e p 5 a t dif f e r e n t p osit ion s a r ou n d t h e Assoc. Prof. Dilek 79 a r e ola 17.11.2023 SARPKAYA GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 80 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 81 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 82 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 83 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 84 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 85 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 86 GÜDER  MILK EXPRESSION AND BREAST PUMPS A hand pump or electic pump may also be helpful to extract breastmilk. The milk can then be stored in sterile bags or bottles. This way, the baby can be given breast-milk even when the mother is away. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 87 GÜDER Safe Preparation and Storage of Expressed Breast Milk Wash hands before expressing and handling breast milk. Collect and store milk in clean containers that can be tightly closed. Remember to label her breast milk and to use the oldest milk first. Not add fresh milk to milk that already has been frozen. Not save milk from a used bottle for use at another feeding. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 88 GÜDER  Milk Storage Guidelines LOCATION TEMPERATURE DURATION COMMENTS Countertop Room temperature 6–8 hours Container should be covered (up to 77°F or and kept as cool as possible 25°C) Insulated cooler 5–39°F or −15°C 24 hours Keep ice packs in contact bag to 4°C with milk at all times. Limit opening the cooler bag Refrigerator 39°F or 4°C 5 days Store milk in the back main body of the refrigerator and not in the shelves of the door. Freezer 5°F or −15°C 2 weeks Place the breast milk compartment of container toward the back of refrigerator 0°F or −18°C 3–6 months the freezer where the temperature is most consistent. Chest or upright −4° F or −20° C 6–12 months deep17.11.2023 freezer Assoc. Prof. Dilek SARPKAYA GÜDER 89  Cup-feeding a baby 17.11.2023 Assoc. Prof. Dilek SARPKAYA 90 GÜDER Slide 4.9.3  Safely Thawing Breast Milk Counsel the mother to: Avoid using the microwave because liquids do not heat evenly and excess heat can destroy the nutrient quality of the breast milk Place the container of frozen breast milk in a bowl of warm (not hot) water Not refreeze thawed breast milk 17.11.2023 Assoc. Prof. Dilek SARPKAYA 91 GÜDER  COMMON PROBLEMS ENCOUNTERED WITH BREASTFEEDING Nipple soreness Engorgement Plugged duct Mastitis Inverted Nipple 17.11.2023 Candida Albicans Assoc. Prof. Dilek SARPKAYA 92 GÜDER  SORE NIPPLE Assoc. Prof. Dilek 17.11.2023 SARPKAYA GÜDER  NIPPLE SORENESS: Instruct the mother to Sore nipples are a break the suction common complaint by properly, reposition mothers who are the infant, and initiating breastfeeding. attempt latching the baby on again Usual causes of nipple soreness are incorrect After breastfeeding, latch and improper the mother may rub position that results in breast milk or ultra- ineffective sucking. purified lanolin on her nipples to soothe 17.11.2023 them. Assoc. Prof. Dilek SARPKAYA GÜDER 94  NIPPLE SORENESS: Encourage the mother to air-dry her nipples after feeding, change nursing pads often, and avoid wearing bras that are too tight 17.11.2023 Assoc. Prof. Dilek SARPKAYA 95 GÜDER BREAST ENGORGEMENT 96 17.11.2023 Assoc. Prof. Dilek SARPKAYA GÜDER  ENGORGEMENT: This fullness may turn Between the second into engorgement and sixth day after when the breasts delivery, the mother become hard, painful, will start making larger warm, and throbbing quantities of milk. with flattening of the nipples. Naturally, her breasts will feel full, larger, heavier, and maybe even slightly tender. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 97 GÜDER  ENGORGEMENT: To minimize Engorgement occurs if engorgement, avoid milk builds up because supplementing (unless of irregular and prescribed by a pediatrician) and incomplete emptying of overusing pacifiers the breasts as a result Instruct the mother on of poor latching and how to hand express incorrect positioning, milk to soften the infrequent feedings, breasts before feeding supplementation, to allow for the infant to nipple damage, or have a better latch. fatigue. Assist the mother on how to properly latch 17.11.2023 and Assoc. Prof. Dilek SARPKAYA GÜDER position infant. 98  INVERTED NIPPLE Assoc. Prof. Dilek 99 17.11.2023 SARPKAYA GÜDER Inverted Nipple: Treatment by Syringe Method STEP 1 Use 10 or 20cc syringe Cut along this line with blade STEP 2 Insert the plunger from cut end STEP 3 Mother gently pulls the plunger STEP 4 Press at the edge and allow air to enter before removing Before feeds Assoc. Prof. 5-8 Dilek times a day 100 the syringe 17.11.2023 SARPKAYA GÜDER PLUGGED DUCT: 17.11.2023 Assoc. Prof. Dilek SARPKAYA 101 GÜDER PLUGGED DUCT: Breast engorgement Symptoms include may lead to plugged tenderness, heat, ducts. possible redness, or a palpable lump with generalized fever. This Plugged ducts are is not an infectious state small, tender breast as the mother remains lumps, the size of a without a fever. pea. Sometimes the plug can be seen at the opening 17.11.2023 ofSARPKAYA Assoc. Prof. Dilek the nipple duct 102 GÜDER  PLUGGED DUCT: To relieve the plugged The application of duct, teach the mother hot packs and to massage the lump massaging the before and during lump while the baby feeding. Breastfeed on is sucking helps the unaffected side first move this blockage and ensure complete emptying. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 103 GÜDER  PLUGGED DUCT: Other treatments include Some women altering infant’s position experience repeated for feeding, and avoiding plugging of ducts and constrictive clothing. describe fatty strings being expressed from the breast. Continued milk stasis increases the risk for mastitis. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 104 GÜDER  MASTITIS: The inflammation tends Mastitis is an to be unilateral. inflammatory condition of the breast that may or may not lead to an Symptoms include infection. fever, aching, chills, swelling, and pain at the site which may also be red, hot, and hard; tenderness under the arm; and red streaks from lump toward axilla. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 105 GÜDER  MASTITIS: Treatment of mastitis If symptoms become includes nursing severe, most clinicians frequently on both treat with antibiotics. breasts (start on unaffected breast until letdown occurs and Although antibiotics then switch), ensuring that treat the infection, they the affected breast is do not address the emptied, and getting underlying cause of enough rest and the mastitis. adequate nutrition. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 106 GÜDER  CANDIDA ALBICANS Positive predictive If the mother symptoms of Candida complains of burning include complaints of pain on the nipple or soreness, burning, burning and shooting pain on pains in the breast, a nipple/areola, fungal infection (i.e., nonstabbing pain of thrush) may be present. the breast, stabbing pain in the breast, and/or skin changes of the nipple/areola that looks shiny and flaky. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 107 GÜDER  CANDIDA ALBICANS Treatment can be topical or systemic. Every treatment plan should include both mother and infant. Early diagnosis and treatment for Candida infection of the nipple and/or breast are critical to supporting successful long-term breastfeeding 17.11.2023 Assoc. Prof. Dilek SARPKAYA 108 GÜDER LACTATION SUPPRESSION In postpartum women who are not breastfeeding, milk leakage and breast pain begins 1 to 3 days after the birth, and engorgement begins between 1 and 4 days after the birth. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 109 GÜDER  LACTATION SUPPRESSION Some techniques that may help include: Wearing a well-fitting bra If the woman does not or sport bra 24 hours each want to use cold for day until the breasts are cultural reasons, soft and nontender. warmth may also provide comfort. Applying cold packs to the breasts. These may be Using mild over-the- commercial cold packs or counter analgesics, bags of frozen peas. taken according to manufacturers’ recommendations. 17.11.2023 Assoc. Prof. Dilek SARPKAYA 110 GÜDER  LACTATION SUPPRESSION This type of stimulation Avoiding nipple or breast is not enough to stimulation; however, prolong the time when discomfort is severe, needed to stop hand expressing or producing milk. pumping a small amount Restricting fluids is of milk may provide relief; neither necessary nor taking a warm shower and desirable. The breasts letting the water run over return to normal, and the breasts may stimulate tenderness decreases milk leakage. within 48 to 72 hours after engorgement 17.11.2023 occurs. Assoc. Prof. Dilek SARPKAYA GÜDER 111  REFERANCES Rice Simpson, K, Creehan P.A. Perinatal Nursing. AWHONN Promotıng the Health of Women and Newborns. Fourth Edıtıon. London: Wolters Kluwer. 2014. Taşkın, L. Doğum ve Kadın Sağlığı Hemşireliği. 13. Basım. Akademisyen Kitabevi. Ankara, 2016. ISBN: 9759466104 Nagtalon-Ramos J. Intrapartum. Maternal-Newborn Nursing Care, Best Evidence-Based Practices F.A. Davis Company. Philadelphia: 2014, 65-78. American Academy of Pediatrics: www.aap.org/breastfeeding National Women’s Health Information Center (NWHIC) Breastfeeding Helpline: 1-800-994-9662, www.womenshealth.gov World Health Organization: www.who.int/topics/breastfeeding Association of Women’s Health, Obstetric and Neonatal Nurses: www.awhonn.org 17.11.2023 Assoc. Prof. Dilek SARPKAYA 112 GÜDER 17.11.2023 Assoc. Prof. Dilek SARPKAYA 113 GÜDER  Thank you Assoc. Prof. Dilek SARPKAYA GÜDER 114 17.11.2023