08.04 Breastfeeding

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Overview

  1. Breastfeeding is extremely beneficial for both mom and baby
  2. Breastfed babies have better clinical outcomes
    1. Immune protection
    2. Lower risk of asthma, allergies, respiratory issues, diarrhea, obesity, and Type 2 Diabetes Mellitus

Nursing Points

General

  1. First feeding should occur within the first hour after birth
  2. Many hospitals have lactation consultants available to reinforce and support nursing staff with breastfeeding mothers
  3. American Academy of Pediatrics (2012) recommends exclusive breastfeeding for the first 6 months of life. Then the recommendation is to introduce complementary foods, while still breastfeeding and this should continue for at least 12 months, as long as both mom & baby desire.
  4. The World Health Organization recommends breastfeeding up to 2 years of age or beyond
  5. Breastfeeding is difficult to learn
    1. Often causes mothers to give up

Assessment

  1. After meconium passes, breastfed baby’s stools transition and are seedy, yellow, watery and frequent
    1. Breastmilk acts like a laxative
  2. Assess for breast engorgement,  tenderness, redness
    1. Clogged ducts, mastitis

Therapeutic Management

  1. Promote initial feeding as soon as possible (within 1 hour of birth)
  2. When engorgement occurs, continue to feed, supportive bra
  3. Encourage appropriate latch, which prevents cracked sore nipples
  4. Increase caloric intake up to 500 additional calories daily and continue prenatal vitamin during breastfeeding
  5. Keep mom hydrated
  6. Offer encouragement
  7. Procedure
    1. Hand hygiene
    2. Position
      1. Newborn transversely and flat across chest, with mouth near nipple
      2. Biological position – baby is parallel to mom’s nipple. Straight up and down
    3. Align infant with nose to nipple
    4. Allow infant to open mouth and get as much of the breast in the mouth – all of areola
    5. Let infant dictate feeding. When sleeping baby is full and content. Awake means hungry
    6. Sucking should be silent if it is a good latch but you will see movement of infants ears/jaw and breast tissue
    7. Listen for swallowing
    8. If a bad latch occurs, detach and re-try
      1. Bad latch helps noone
    9. Release suction by inserting finger into the corner of the newborn’s mouth to unlatch
    10. Switch breasts when infant is done with feeding on one side or for the start of the next feed
  8. Encourage multiple positions if mother is comfortable
  9. LATCH – score of 0-2 for each
    1. L – Latch
    2. A – Audible swallowing
    3. T – Type of nipple
    4. C – Comfort
    5. H – Hold

Nursing Concepts

  1. Nutrition
  2. Comfort
  3. Human Development

Patient Education

  1. Demonstrate breast pump if needed (most women who are breastfeeding will utilize a breast pump at some point)
  2. Educate, reinforce, encourage
  3. Utilize lactation consultants

Reference Links

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Video Transcript

In this lesson I am going to explain breastfeeding and your role in helping parents be successful and educated.

Alright let’s start with just some basics. The first feeding should occur within the first hour after birth. So putting that baby skin to skin at delivery can help initiate this. It is your job to help this mom be successful with whatever her wishes for feeding her baby are. So what is the current recommendation? The American Academy of Pediatrics does recommend exclusive breastfeeding for the first 6 months of life. So this means only breastmilk and no supplementation. Then slowly foods are introduced and at one year weaning can start if mom and baby wish to. The World Health Organization recommends breastfeeding up to 2 years of age or beyond. So this is not easy and breastfeeding is difficult to learn. It comes with practice. Every baby has to learn it and the mom has to learn it as well. Your job is to help and assist however you can. Moms are tired and babies scream and it’s the middle of the night and they want to give up. It is not easy but your role is to be there and support them however they need.
Our assessment is going to include baby and mom. For the baby we will assess the stool. First it will be meconium which is a black tarry, sticky color. After that passes, a breastfed baby’s stool will transition and be seedy, yellow, watery and occur frequently. Breastmilk can act like a laxative. We will assess mom for breast engorgement. This will be uncomfortable and the breasts will get hard because they are full with milk. During the postpartum time frame something called mastitis might occur. This is a bacterial infection. A clogged duct causes milk to backup and bacteria grows. Assessment of this will be a high temperature, breast tenderness and redness at the infected site will occur. A clogged duct will just be a hard movable ball felt. You can see in this image the duct and this area just gets filled and clogged with milk.
Our management for this patient will be to promote the first feeding as soon as possible. This should occur within 1 hour of birth and putting the baby skin to skin will help initiate this. Breastfeeding is hard so we need to offer as much engorgement as we can. Breastfeeding moms need to increase their caloric intake. They can eat up to 500 additional calories daily. This is more of an increase than when they were pregnant! They also need to continue prenatal vitamin during breastfeeding and drink plenty of water. You need healthy nutrition and plenty of water on board for adequate milk production. Our biggest piece of management will be to assist with feedings. The best way is to always place the baby skin to skin. And in line with mom so tummy to mommy or belly to belly. The best position is the biological position where they are parallel on mom. So straight up and down. It helps keep them awake. Another common position is the cradle which is the newborn transversely and across the mom. The infant need to be aligned with nose to nipple. Then allow the infant to open mouth and get as much of the breast in the mouth all of areola. The suck reflex is in the back of the infant’s mouth so the bigger the mouthful the better the latch. You can see in the image how the areola is fulling in the mouth. The lips are flanged. This is a great latch. We need to let the infant dictate feeding. So feeding cues are rooting and sticking the tongue on. If the infant is awake he is hungry. If the baby is sleeping then the baby is full and content. When the infant is latched on we should see visual sucking occurring but never hear any sucking. This means it is not a good latch so the infant needs to be unlatched and removed. A bad latch never helps mom or baby. We need equal breast stimulation to promote adequate milk production so switching sides should occur with each feeding.
Let’s look at the LATCH score. This is used to determine how well the infant is doing and each is scored 0-2 points. L stands for the latch. Is the infant too sleepy and not latching which would be 0 points. ist here repeated attempts and we are having to do all the work and stimulate the infant, which would be a 1 or is the infant grasping the breast with a good latch and sucking properly which would be 2 points. A is for audible swallowing. None is 0, a few with stimulation is 1 and spontaneous is 2. T is type of nipple. Inverted is 0, flat is 1, and everted where it sticks out is 2. C is comfort. So for this is the mom engorged or having cracking or bleeding nipples which would be 0. If the breast is filling or has some blister or bruising this is 1 and soft nontender is a 2. H is the hold. If we have to fully assist they get a 0. If we do one side and the family does the other it is a 1 and if we do not assist at all it is a 2. This will be important to review for testing purposes.

Our education is going to be on how to use the breast pump so they are prepared when they need to use it. We are going to educate on how to latch the baby and be successful. Utilizing lactation consultants can be really helpful to reinforce this education and answer more in depth questions the mom has or for those babies that just won’t cooperate.

Our concepts are nutrition and human development because this is the food source and comfort because we have to help the mom with the comfort of the feeding.
Let’s review our key points to remember. Breastfeeding gives babies added antibody protection, reduces many health concerns for both mom and baby, and should be done exclusively for the first 6 months of life. This means only breast milk and no supplementation. Mom should increase calories by 500 a day for adequate production.

Make sure you check out the resources attached to this lesson and review the LATCH score. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 9

A nurse is talking to a new mother about nutrition while breastfeeding. Which information would the nurse most likely give to the mother about nutrition intake during this time?

  • Question 2 of 9

A nurse is educating mothers to be on the current recommendations for breastfeeding. Which of the following are true about the current recommendations?

  • Question 3 of 9

A client delivered a baby two weeks ago and is breastfeeding. The client is a vegan. Which of the following vitamins is this client at highest risk of deficiency?

  • Question 4 of 9

A nurse is educating a breastfeeding mom on nutritional needs. What should be included in the teaching? Select all that apply

  • Question 5 of 9

A nurse receives a call from a breastfeeding mom who complains of symptoms of a clogged duct. Which instructions by the nurse would be the most beneficial for the client? Select all that apply.

  • Question 6 of 9

A baby that needs no help latching on a soft nontender breast is rhythmically sucking on a blistered everted nipple and has a few stimulated swallows. What is the LATCH score?

  • Question 7 of 9

A new mother on the postpartum unit is learning how to breastfeed her baby. The mother tells the nurse that she heard that breastfeeding is best for the baby because it helps with immune function. What information would the nurse provide that explains how breastfeeding supports the infant’s immune system? Select all that apply.

  • Question 8 of 9

A nurse is caring for a postpartum patient who is breastfeeding her infant. The nurse asks the mother if she is having any pain and the patient states, “Yes, but I do not want any medication to pass through my breastmilk to the baby, so I won’t take anything.” Which response from the nurse is accurate?

  • Question 9 of 9

A nurse is caring for a 2-week old newborn that is exclusively breastfed. When assessing the characteristics of the baby’s stool, what should the nurse expect to find?

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