1. Vilma Weir-Campbell Fairleigh Dickinson University

2. CONTENT OUTLINE I.Benefits of Breastfeeding. II. Preparing for Breastfeeding. III.The Lactating Breast. IV.How Milk Gets From Breast to baby. V. Getting Breastfeeding Started. VI.Positions. VII.How to Know If Your Baby is getting Enough Milk.

3. OBJECTIVES I.Understand the benefits of breastfeeding. II.Understand the physiology of breastfeeding. III.Understand the importance of breastfeeding within the 1 st hour after birth. IV. Identify the three components of effective suckling. V.Identify the advantages of various breastfeeding positions and appropriate utilization. VI. Recognize when the baby is getting enough milk. VII. Identify some common breastfeeding problems. VIII. Versatility in special situations.

4. IX. Common Problems. X. Nursing in Special Situations. XI. Summary.

5. Breastfeeding is the best form of nutrition for babies and is of vital importance to the health of both mother and baby. Despite compelling scientific evidence of the crucial importance of breastfeeding to maternal and child health, bottlefeeding is the norm in the United States. 40% of infants never taste their mother’s milk, and 80% are bottlefed by the time they reach the age of 6 months. The American Academy of Pediatrics recommends exclusive breast feeding of infants for the first 6 months after birth; it also advocates that breastfeediing be continued for at least an additional 6 months while solid foods are added. It is clear that human milk plays a vital role in the immunologic development of the infant at birth and well into the second year. Its nutritional BACKGROUND INFORMATION ON BREAST FFEDING

6. role also is clearly superior to that of other alternatives. Primary care providers can have a positive impact on the Infant feeding decision. Prenatal education has been shown to be effective at increasing the rates of breastfeeding. It is clear that human milk plays a vital role in the immunologic development of the infant at birth and well into the second year. Its nutritional role also is clearly superior to that of other alternatives. Primary care providers can have a positive impact on the

7. BENEFITS OF BREASTFEEDING Advantages for the Baby: Advantages for MOM: 1.Breast milk is the ideal first 1. Breastfeeding is more food for your baby because economical and more it is digested easily. convenient. You need Breast milk produces smaller not incur the daily curds than cow’s milk and has expence of formula or a different type of protein which go through the process allows for easier and faster of preparing, heating, digestion. Because of this, or refigerating your breast fed babies may need to milk due to its easy eat more frequently than bottle accessibility and fed babies, usually every two or perfect temperature three hours. for the baby.

8. 2.Breast milk is readily absorbed 2. Breast feeding causes and may be associated with contractions of the less stomach upsets, constipa- uterus. Breastfeeding tion or diarrhea. after delivery will assist the uterus in 3. Immunities from the mother are contracting and help passes through the milk. avoid excessive bleed Statistics show that breastfed ing. During the post- babies have a reduced incidence partum period, the of ear infections, colds, tooth uterus will continue to decay, diaper rash, and vomiting. contract in order to Breastfed babies may have a shrink back to its non- higher resistance to infections pregnant size more such as respiratory viruses and quickly. (Breastfeed- have fewer and less significant ing utilizes approxi- allergies. mately 300-500 calories/day).

9. 4.Breastfeeding provides frequent 3. Breastfeeding triggers close physical contact and helps the release of the promote feelings of security for lactating hormone both mother and baby. Prolactin, known as the “mothering 5. Suckling at the breast encourages hormone”. It may better bone, jaw, teeth and gum promote a feeling of structure. relaxation and well- being for you. 6. Breast milk is ready, warm and uncontaminated.

10. HOW MILK GETS FROM THE BREAST TO YOUR BABY. There are two elements necessary for getting milk from the breast to the baby: a breast that produces and releases milk, and a baby who is able to remove the milk from the breast by an effective suck. The manner in which the baby is attached at the breast will determine how successfully these two elements come together. The Process: 1.The nursing breast works on the principle of supply and demand. As the baby suckles at the breast, he/she stimulates the nerve endings in the nipple which sends a message to the mother’s brain. 2.The brain responds by directing the pituitary gland to release hormones, Oxytocin and Prolactin. 3.Prolactin acts on the milk glands causing them to produce milk. The more one nurses, the more milk the breasts will produce, Nursing the baby as frequently and as long as he/she demands, usually every 2-3 hours or 8-12 times in a 24 period will increase the amount of milk you produce. 4.Oxytocin release helps to keep the uterus firm and return to its prepregancy state as well as causing the cells around the milk glands to contract and move the milk down the milk ducts. This process must occur in order for the milk to be made available to the baby and is referred to as “let-down”.

11. YOUR MILK A mother’s milk is especially suited for her own baby. All breastmilk is not alike. Colostrum and breastmilk adjust with the age of the baby, and mature breast- Milk changes from feed to feed, day to day, and month to month to meet each Particular baby’s needs. Colostrum is the first milk made by the breasts, and is usually present in the breasts from the 16 th week of pregnancy. It has a clear or yellow color, a thick Consistency, and is high in protein and lower in fat and sugar. Colostrum contains Valuable enzymes and is rich in immunity factors which protects the baby against Many bacteria and viruses. It also acts as a natural laxative which helps in Eliminating the baby’s first stool, called meconium. This helps to prevent jaundice. HELPFUL HINTS 1.Begin breastfeeding soon after the baby is born in order to initiate lactation. 2.Provide uninterrupted contact between mother and baby for at least one hour after delivery. 3.During the first ½ to 2 hours after birth the suck reflex is easily stimulated; The infant is very alert and the rooting and sucking reflexes are very strong.

12. FOUR A’S Alignment:Mother in a comfortable position, with pillows Infant in flexed position and supported with pillows Infant’s head is at breast level, aligned with trunk and straight on breast (tummy to tummy). No traction exerted on breast or nipple Areolar Grasp: Mouth is opened wide, lips not pursed Lips are visible and flanged outward Tongue covers lower gums, troughed (curved) around areola At least ½ inch of areola is drawn symmetrically into mouth Complete seal and strong vacuum is formed by infant’s mouth

13. Areolar Compression: Mandible moves in a rhythmic motion (initially, approx. 2 sucks/sec., sucking slows to approx. 1 suck/sec when milk comes down No clicking or smacking sounds No drawing in or dimpling of cheeks Mother does not experience acute (sharp) nipple discomfort Audible Swallowing: Swallowing heard Number of sucks preceding a swallow decreases as milk supply increases Swallowing is evidence of milk-ejection reflex Effective Suckling: Baby’s mouth is wide open Baby’s chin is touching the breast Baby’s lower lip is curled outward

14. Baby suckles, pauses, and suckles again in slow, deep sucks Mother may hear swallowing PREMATURE INFANT Should encourage mother to breastfeed Easier to digest and better tolerated Contains Lipase (helps digest milk fat),antibodies and other factors which help protect infant from infection; contributes to better vision, and higher intelligence; hormones and enzymes may contribute to the maturation of the GI and Nervous systems Enhances bonding

15. EFFECTIVE SUCKING: Baby’s mouth is wide open. Baby’s chin is touching the breast. Baby’s lower lip is curled outward.

16. Baby suckles, pauses, and suckles again in slow, deep sucks. Mother may hear swallowing. PREMATURE INFANT Should encourage mother to breastfeed. Easier to digest and better tolerated Contains Lipase (helps digest milk fat),antibodies and other factors which help protect infant from infection; contributes to better vision, and higher intelligence; hormones and enzymes may contribute to the maturation of the GI and nervous systems enhances bonding.

17. Readiness to Breastfeed: No ideal weight or gestational age should be in stable condition. Each infant should be evaluated individually. Do not have to bottle feed first. Dancer Hand Position Support breast with C-hold and slide hand forward so that index finger and thumb are now free to grasp gently each cheek. The index finger and thumb form a “U” with the baby’s chin resting inside.

18. POSITIONING Principles: Mother needs to be comfortable and relaxed.support mother/infant with pillows ;bring infant to level of breast. Cradle hold – natural position for mother/infant. Can be difficult for mother to see infant’s face and control head position. Belly to belly position of mother/baby.

19. Football Hold – appropriate for small infant or C/S delivery. Mother can control infant’s head, allows for better visibility of infant’s mouth. Good for infants who prefer to feed in upright position.

20. Across the lap – similar to cradle except mother has better control of infant’s head. Belly to belly

21. Side lying – used mostly for early feedings, C/S deliveries, and nighttime feedings. Need pillows for support of mother’s leg and back.

22. Mother’s high risk factors: First time mother or never breastfed before, poorly educated Lack of family/friends who have breastfed ambivalence about feeding Lack of confidence no breastfeeding classes or lactation consultant visit Low rating of how well her baby breastfeeds hx of breast surgery Infant’s high risk factors: preterm birth Does not: grasp the breast with lips flanged and tongue down latch on and root easily suck vigorously suckle rhythmically swallow audible after pp day 3

23. COMMON PROBLEMS; HOW TO OVERCOME THEM Sore nipples: is the most common problem during the early days of breast feeding. This can result from: 1. Improper positioning of the infant’s mouth on the nipple. 2. Using only one position for all feedings. 3. Feedings are too far apart so that when the baby begins nursing he/she sucks very eagerly. 4. Breast care that contributes to dry, irritated nipples. 5. Trauma to the nipple because of improper removal from the breast. Engorgement: is an overfullness that is a result of incomplete or inadequate empty- ing of the breasts. All mothers are encouraged to observe the Four A’s of breastfeeding to minimize Breastfeeding problems.

24. SUMMARY When one reviews the wealth of information about the advantages of breast feeding, there can be no doubt that this practice is healthy for both mother and infant. It is past time for all health care providers to enthusiastically support, encourage and educate the women of this great nation to accept the fact that breastfeeding is normal, expected and achievable.

25. Dermer, Alicia (1998, August). Breastfeeding: What You-and Your Patients-Need to Know. Women’s Health in Primary Care, 1 (7) 599. Moreland, J. & Coombs, J. (2000, April). Promoting and Supporting Breast-feeding. American Family Physician, 61 (7) 2093. http://www.aafp.org/afp/20000401/2093.html Nichols, Francine H., & Zwelling, Elaine (1998). Maternal- Newborn Nursing, Theory and Practice. W B Saunders Co. Slusser, Wendelin & Powers, Nancy G. (1997, April). Breastfeeding Update 1: Immunology, Nutrition, and Advocacy. Pediatrics in Review Vol. 18 (4) 111. REFERENCES