Lactation Modules.docx

Breast/Chest Feeding Benefits: Baby- 1. Digestion: breast milk is easy to digest and has the cocktail of nutrients that a baby needs; this changes as the baby's needs change too 2. Cognition: breast milk has been shown to enhance cognitive development in babies 3. Protection: brea...

Breast/Chest Feeding Benefits: Baby- 1. Digestion: breast milk is easy to digest and has the cocktail of nutrients that a baby needs; this changes as the baby's needs change too 2. Cognition: breast milk has been shown to enhance cognitive development in babies 3. Protection: breast milk may protect against gastrointestinal infections, ear infection, respiratory tract infections, and even obesity later in life 4. SIDS: breastfeeding is associated with a decrease in incidence of sudden infant death syndrome (SIDS) Parent and Family: 1. Amenorrhea: breastfeeding usually causes amenorrhea, or an absence of menstruation. This has the benefit of being a natural family planning method and allowing the birth patient to increase iron stores again after giving birth 2. Cancer: breastfeeding associated with a decrease in rates of breast and ovarian cancers for the breast-feeding person. However, regular cancer screening is still needed. 3. Cost-Effective: breast feeding means that the parents don't need to purchase formula/substitutes or bottles Community: 1. Health: breastfeeding associated with improved breast/chest feeding person and baby health outcomes; this results in less cost to the healthcare system 2. Environment: breastfeeding associated with little environmental impact (no garbage or bottles) 3. Neonatal Readmission: formula preparation mishaps are a common reason for neonatal readmission to the hospital. Usually formula mishaps are a result of the formula being too concentrate or not concentrated enough Safe Skin to skin Care: - Skin to skin immediately after birth is the best way to support breastfeeding initiation - Skin to skin after vaginal delivery: the baby is placed below the birth parent's breasts/chest, as the umbilical cord length allows - Skin to skin after c-section: the baby is placed on the birth parent's chest perpendicular to their body so baby's feet are not in the surgical area Skin to Skin and newborn transition: - The transition from the dark, warm womb to the bright, cold outside world can give the newborn quite a shock - Thermoregulation: helps the newborn regulate their own body temperature more effectively - Cardiorespiratory: helps the newborn regular their heart and breathing rate more effectively - Metabolism: helps the newborn regulate their blood sugar levels - Stress: less stress on the newborn overall - Infection: less nosocomial infections for the newborn - Crying: overall calmer baby means less crying - Skin to skin is good for everyone! It also helps the release of a surge of oxytocin, which helps deliver the placenta faster and limits postpartum bleeding. - The first house, also known as the golden hour, is important to getting off to a good start Anticipatory Guidance for feedings: - For up to 1 month old - Feeding cues display hunger and readiness to feed: smacking their lips, bringing their hands to their mouth, licking their lips, crying is a LATE hunger cue - Newborns should be fed at least 8 times every 24 hrs, most likely will feed more. Instruct parents to not watch the clock but instead watch baby for feeding cues. - On day 1 baby can have 5-7 ml/feed - On day 3 baby can have 22-27 ml/feed - In 1 week baby can have 40-60 ml/feed - In 1 month baby can have 80-150 ml/feed C-Section in Hospitals: Hand expression: - We hand express when latching is challenging, an alternative approach can provide your own milk, hand expression is an option - An effective way to supplement breastfeeding with your own milk - Hand express is good for preterm infants with difficulty latching or unable to breastfeed yet - Hand expressing increases milk supply - Hand expressing is more effective for the first 48 hours than pumping When do we hand express? - Hand expressed colostrum (first milk) can be frozen to supplement the infant if needed- this can start from 36 weeks - Anytime postpartum - Effective way to give colostrum in the first hour of life if baby is not latching - When we want to reduce the risk of hypoglycemia How do we hand express? - Prepare-wash hands, apply warm, moist towel to enhance milk flow, sit comfortably and place collection cup under the breast, massage the breast and nipples to stimulate milk ejection reflex using gentle pressure in a circular motion - Place- place thumb and forefingers approximately 1 inch behind the nipple and support the breast on the chest wall - Press-press inward toward the chest wall, squeezing gently with a slight rolling action toward the nipple - Position-change position of the fingers around the areola to express milk from as many ducts as possible. Suggesting that the breast feeder imagine the numbers on a clock as they rotate to try new positions can be a helpful visual. Cup Feeding: - We cup feed when baby is unable to latch or breastfeed for any reason - When parents and healthcare providers wish to avoid the infant developing a preference for bottle nipples - When the baby is in need of a medically indicated supplement - When? Anytime after birth and any age of baby who is in need of supplementation - How? 1. Hold the baby in a 45 degree angle 2. Secure baby's arms by wrapping them lightly to prevent them from knocking the cup 3. Lip: bring the cup to a position resting on the baby's lower lip, with the rim at the corners of the mouth 4. Tip: tip the cup slightly to allow the milk to come in complete contact with the lower lip. The infant may lick the milk like a kitten 5. Pace: let the baby pace the feeding by watching their cues. Keep the cup in position while the baby pauses. **The golden hour:** - Breast/chest feeding in the first hour after birth reduces morbidity and mortality. - Skin to skin also helps the infant regulate their blood glucose by mitigating stress responses. - Early colostrum feeds for all births reduce risk factors for hypoglycemia, jaundice and supplementation - This can be achieved with breast/chest feeding as well as hand expression and cup/spoon feeding **Effective Breastfeeding:** Health History Checklist- 1. Feeding Frequency 2. Output- 3. Hydration 4. Weight: on day 14 the baby's weight should be equal to their birth weight 5. Jaundice: hyperbilirubinemia occurs when there is excess bilirubin in the blood; the high levels of bilirubin cause jaundice, when the baby's sclera of the eyes, mucous membranes and skin appear yellow. The longer bilirubin stays in the gut, the more bilirubin is deconjugated and will re-enter the baby's circulation. Jaundice in newborns is normal and expected because we know they are turning over their red blood cells and producing bilirubin during their first several days. mild jaundice usually resolves with continued, effective breastfeeding within 2 weeks. The ingested milk helps move the bilirubin out of the baby's digestive tract, causing less bilirubin to be reabsorbed into the blood severe jaundice and hyperbilirubinemia are treated with increased milk feeds in conjunction with phototherapy (UV light) Breast Assessment: - Effective breastfeeding is not usually painful. If a breastfeeding person has nipple pain, they likely do not have a good latch when their baby is feeding - Nipple pain can turn into nipple damage if it's not addressed - If the breasts are too full for the baby to latch onto, try hand expressing some milk just before feeding to soften the breast tissue. Reverse pressure softening can help to soften the areola tissue. Cool compresses between feeds may also help reduce swelling to ensure good blood flow and drainage of milk. - If milk is not removed from the breast, it can result in milk stasis and form a blocked duct. Untreated, the blocked ducts may lead to a bacterial infection of the breast tissue called mastitis usually unilateral. - Latch set up: the baby's nose is in front of the nipple, the chin is below the nipple on the breast and when the baby opens its mouth wide, it will get a large mouthful of breast tissue, the baby's mouth is wide open and the tongue is lowered then the tip of the tongue protrudes enough to cover the lower gumline Signs of good milk transfer: - Nutritive sucking- slow, rhythmic sucks with audible suck-swallow-breathe pattern - Wide and deep jaw movements - Full cheeks - After a feed, nipples may be slightly elongated but not damaged and the breast feels softer because milk has been removed - Baby is satisfied after the feed, feeding is baby-led and they feed for as long as they want Signs of Poor Milk Transfer: - Non-nutritive sucking- rapid sucking with minimal swallowing - Any of the following sounds: clicking, smacking, gulping, slurping, our coughing - Hollow cheeks - Painful latch or damaged nipples Perceived low milk supply: supporting parents 1. Listen 2. Investigate 3. Educate 4. Follow-up Supplementation Options: Donor milk - Pasteurized human milk that is collected, treated, and stored by an official milk bank - Available with a prescription from the midwife or physician; supply sometimes limited and usually saved for high-risk, sick or premature infants - Pasteurized donor milk is the first recommended supplement when a parent's own milk is not available - This milk is safe to use! Human milk substitute - Commercial formula is a manufactured milk product that provides adequate nutrition for infants. Composition of infant formula varies from human milk in nutritional content and is usually made of processed animal milk - Powdered formula is not sterile and not recommended for infants under a certain age - Liquid ready-to-feed and liquid concentrate are both sterile forms of formula and should be used for high-risk, sick or premature infants - Commercial formula is the recommended supplement after donor milk Peer-to-peer Milk Sharing - The sharing of human milk between family members, friends or informal sharing organizations - Informal milk shared between peers is not guaranteed to be pasteurized so this method is not endorsed