2Objectives List at least three signs of an effective latch BBC 6: Putting Baby to BreastObjectivesList at least three signs of an effective latchIdentify two signs of milk transfer from the breast to the infantOverviewThe responsibilities of the nurse include:Teach mothers how to position baby at breast and latch techniques- breastfeeding is a learned behavior for both mother and baby- many mothers have not had the opportunity to observe a nursing newbornAssess breastfeeding progressRefer couplets needing additional assistance and follow upTerminologyDistinguish between positioning and latch as they are often used interchangeablyPositioning – the body alignment of the mother and infant as individuals and in relation to one anotherLatch – the process of getting the baby’s mouth onto the breast for suckling2Rev. March 20092
3PositioningPositioning is how mothers hold the baby when breastfeedingMothers will be breastfeeding every 2 to 3 hours in the first weeks of lifeIt is important that mother and the baby be comfortable at ALL times
4Positioning For all breastfeeding positions: Breast must be easy to get toMother needs to be comfortableBack straight & arms supported (use pillows under your elbow and at your back)Knees level with hips when sitting (footstool or directories to elevate your feet)Remove extra clothing (for more skin-to-skin contact)Birth experience can greatly influence ability of mother and baby to fulfill their respective rolesBoth mother and baby need to be readyA mother should be encouraged to be proactive in arousing her baby for feedings- the nurse’s role includes teaching a new mother alerting and calming strategiesA mother needs time to get to know her baby- even if she has previous breastfeeding experience each baby has different behaviorsand oral motor skillsAssessing infant readiness for breastfeedingIs baby in quiet alert state and sending any feeding cues?Is baby crying and in need of calming?Was baby’s Apgar in good range?Any suctioning of airway?Any swelling or bruising of baby’s head or face?Medications given to the mother during childbirth may affect the baby’s instinctual drive to go to the breast
5PositioningRemind mothers to bring baby to breast instead of breast to babyIf you bring breast to baby, you end up being hunched over & your back will be soreBaby’s head, chest & knees face same direction
6Latch-OnWay the baby attaches to the breastCorrect latch-on is important to:Make sure baby gets enough milkAvoid sore nipplesGet the breast to make more milkNOTE: Though the steps we are about to explain seem long, it actually happens fast
7Step 1 - PositioningWatch how the mother positions the baby for feeding and look for:Maternal Comfort — suggest different positions, pillows, or nursing stools if positioning looks uncomfortableHow the infant is positioned — the head, shoulders, and hips are in alignment and the infant faces the mother’s body. The head should not be turned to the sideInfant brought to the breast, not the breast to the infantPushing on the back of the infant’s head — This should be avoided. It may cause the infant to arch away from the breast
8Step 2 – Latch-onWatch how the baby is latched to the breast and look for:Use of the C-hold to make a sandwich for the baby to latch on4 fingers underneath and thumb on top of the breastMother’s fingers should be parallel to the infant’s jaw and well behind the areolaAcknowledgement of the rooting reflexMiddle of infant’s lip stroked with nippleInfant opens his mouth wideMother quickly draws the infant to her breastInfant takes in an adequate amount of the breast, not just nipple
9Step 2 – Latch-on (cont’d) Areola graspInfant grasps the entire nipple and as much of the areola as possibleThe nose and chin of the infant will touch the breastLips will be flanged outMother’s comfortGentle undulating motionNo pain with each suckProper release if infant does not release on his ownMother inserts finger gently in corner of infant’s mouth to release suction
10Proper LatchCORRECTINCORRECTNipple protected by positioning far back in infant’s mouthBreast tissue inferior to nipple exposed to massaging action of tongue and lower jaw.
11Signs of a Good Latch Lack of constant pain Lips curled outward Mother is relaxedChin touching the breastCheeks roundedNipple may come out longer, not pinched or discoloredLips curled outwardLower lip should not be pursed inwardNostrils barely touch breast but nose rests on breastBaby’s swallows can be heard BUT sucking should not be heardBreasts are softer & feel lighter after feeding
12Signs of Incorrect Latch Immediate signsInfant’s cheeks indenting during suckling, clicking noises, lips curled inwardFrequent movement of the infant’s head and lack of swallowing soundsMaternal pain and discomfortLater signsTrauma to mother’s nipples and painPoor infant weight gainLow milk supply
13Step 3 – Milk TransferWatch the baby as she sucks and swallows and milk is transferred. Look and listen for:Audible swallowingSucking that begins with rapid bursts to stimulate milk let-downA rhythm of sucking, swallowing, and pauses following establishment of milk flowBecomes slower and more rhythmicApproximately 1 suckle/swallow per secondUndulating action — no stroking, friction, or in-and-out motion of the tongueMilk is extracted by a peristaltic action from the tip of the tongue to the base (not by negative pressure)
14Next StepsWatch Breastfeeding Management, Educational Tools for Physicians and Other Professionals by Jane Morton, MD, FAAP, for a live demonstration of how to observe and assess breastfeeding.
16BBC 6: Putting Baby to Breast AssignmentsGoal: to provide participants with an opportunity to share clinical experiences with breastfeeding positioning and latching.Please share your experiences of working with mothers, and write t how you can implement what you learned in this session to your own practice. Please post your comments under Online participation tool.-16Rev. March 200916