1. Breastfeeding and Lactation Management
Titilayo Abiona, MD, MPH
PGY 3

2. Agenda Review of Agenda 9:00-9:05 Pretest 9:05-9:10
Presentation/Demonstration
9:10-9:25
Small Group Case Studies
9:25-9:50
Post Test
9:50-9:55
Evaluation
9:55-10:00

3. Goal
To enable family medicine residents become competent in assisting mothers to breastfeed their babies successfully.

4. Objectives At the end of this workshop, residents will be able to :
Help mothers to position and attach their babies correctly for breastfeeding (small group objective)
Counsel mothers to ensure successful breastfeeding
Manage common lactation and breastfeeding difficulties

5. Introduction
Breastfeeding (BF)- numerous benefits to mothers and babies
Exclusive BF recommended in the 1st 4-6 months of life
Black, young, uneducated, WIC recipients less likely to breastfeed
Common reasons why women stop breastfeeding: sore nipples, inadequate milk supply, perception that the infant was not satiated (Ahluwalia et a. 2005)
Health workers: role to ensure successful breastfeeding

6. Our role……… To show mothers how to breastfeed
Teach correct positioning and attachment
To encourage mothers to breastfeed
Counseling
To manage common problems that prevent moms from breastfeeding/cause early cessation

7. Breastfeeding Positioning and Attachment

8. Key points of positioning
Mother:
Make the mother sit in a comfortable and convenient position (she can feed in lying down position)
Ensure that she is relaxed and comfortable
Baby:
Baby’s head and body are in a straight line
Baby’s whole body is supported
Baby’s face is opposite the nipple and the breast
Baby’s abdomen touches mother’s abdomen

9. Breastfeeding Positions

10. Key points of good attachment
Baby’s mouth is wide open
Baby’s chin touches the breast
Baby’s lower lip is curled outward
Usually the lower portion of the areola is not visible

11. Good and poor attachment

12. Positioning and Attachment Demonstration and Practice

13. Counseling

14. LISTENING AND LEARNING SKILLS
Use helpful non-verbal communication
Keep head level, pay attention, remove barriers, touch appropriately
Ask open questions
Use responses and gestures which show interest
Reflect back what the mother says
Empathize - show that you understand how she feels
Avoid words which sound judging

15. Common Breastfeeding Problems
Inverted nipples
Sore nipples
Breast engorgement
“Not enough milk”

16. “Not enough milk” Management Causes Put baby to breast frequently
Baby to be correctly attached to breast
Build mother’s confidence
Back massage and relaxation can help
Use galactogogues
Not breastfeeding often enough
Too short or hurried breastfeeding
Night feeds stopped early
Poor suckling position
Poor oxytocin reflex (anxiety, lack of confidence)
Engorgement or mastitis

17. Breast engorgement Causes Delayed and infrequent breastfeeds
Incorrect latching of the baby
Treatment
Give analgesics to relieve pain
Apply warm packs locally
Gently express milk prior to feed
Put the baby frequently to the breast

18. Inverted Nipples Treatment should begin after birth
Manually stretch and roll the nipple between the thumb and finger several times a day
Teach the mother to grasp the breast tissue so that areola forms a teat, and allows the baby to feed
Syringe suction method

19. Sore nipples Look for a cause: Check the baby’s attachment
Check the baby’s position
Examine the breasts – engorgement, fissures, candida
Wash breasts only once a day; avoid using soap
Avoid medicated lotions and ointments
Gently apply hind milk onto nipple and areola after each feed
If the problem persists, check the baby’s oral cavity for candida

20. Summary During this session we have learned:
How to help mothers to position and attach their babies correctly for breastfeeding
How to counsel mothers to ensure successful breastfeeding
How to manage common lactation and breastfeeding difficulties

21. Thank you for listening
??????