Download - PQCNC HM Well Baby Supporting Mom
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
1/20
Improving the Quality of Maternity Care inNorth Carolina:
Supporting Mom s in B reastfeeding Achieving Br eastfeeding Frequency
www.ncbfc.orgwww.sph.unc.edu/breastfeedingwww.breastfeeding4health.com
http://www.ncbfc.org/http://www.sph.unc.edu/breastfeedinghttp://www.breastfeeding4health.com/http://www.breastfeeding4health.com/http://www.sph.unc.edu/breastfeedinghttp://www.ncbfc.org/ -
8/7/2019 PQCNC HM Well Baby Supporting Mom
2/20
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
3/20
Our Goal in Supporting Breastfeeding:
Healthy Mom, Healthy Newborn
Evidence Base for Action
Clinical Practice and Skills
Achieving Change among All Staff
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
4/20
What to we wish to achieve?
Homeostasis, and
Avoidance of:
Hypothermia
Hypoglycemia
Significant weight loss
Hyperbilirubinemia
Eventually, Growth and Development
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
5/20
When mom and baby achieve good EBFfeeding skills during the hospital stay,
we have succeeded
From: Righard L and Alade O. (1992) Sucking technique and its effect on success of breastfeeding Birth 19(4):185-189.
0%
50%
100%
Percentage
Correct sucking technique at dischargeIncorrect sucking technique at discharge
P
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
6/20
How do we achieve this?
Frequent, effective breastfeeding Assessment - and support - through Observation
Skills and Outcomes1. Establishing Rapport
2. Comfort
3. Position
4. Latch
5. Effective Milk Transfer6. Cue recognition
7. Hand expression
8. Frequency
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
7/20
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
8/20
Skills 1/2/3:
Rapport, Maternal Comfort, Positions
Seek permission to observe and support
Maternal Comfort
suggest different positions
use pillows or nursing stools only if positioning looksuncomfortable or issues arise
Position
infant head, shoulders, and hips are in alignment
infant faces the mothers body. BELLY TO BELLY
Infant brought to the breast, not the breast to the infant
Avoid pushing the back of the infants head; the infant mayarch away from the breast
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
9/20
Cradle Hold and
Cross-Cradle Hold
Photo Joan Meek, MD, FAAP
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
10/20
Football Hold and Side-lying Hold
Photo Roni M. Chastain, RN
Photo Lori Feldman-Winter, MD, MPH, FAAP
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
11/20
Skill 4: Supporting Good Latch-on
Often helps to use C-hold/ sandwich 4 fingers underneath and away from areola:
parallel to jaw
thumb on top of the breast and away fromareola: parallel to upper lip
Rooting reflex Stimulate by touching to nipple
Infant opens his mouth wide
Mother quickly draws the infant to her breast Infant takes in an adequate amount of the
breast, notjust nipple
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
12/20
Proper Latch
INCORRECT
CORRECT
Nipple protected by positioning far
back in infants mouth
Breast tissue inferior to nipple
exposed to massaging action of
tongue and lower jaw.
Photos Jane Morton, MD, FAAP
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
13/20
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
14/20
Job-aid for Latch: LANCET Latch
Infant grasps the entire nipple and as much of the areola
as possible, generally more below areola The nose and chin of the infant will touch the breast;
Lips will be flanged out
Audible - swallow may not be audible first day,organizes
Nipple everted by baby
Comfort Undulating motion
act to reduce any discomfort on latch
release suction
Elimination wet diapers, meconium > seedystool
Timing as often as baby demands/cues
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
15/20
Skill 5 Assessing Milk Transfer
Suck and swallow: Audible swallowing
Sucking that begins with rapid bursts to stimulate
milk let-down
A rhythm of sucking, swallowing, and pauses
following establishment of milk flow Becomes slower and more rhythmic
From a few to 1 suckle/swallow per second
Undulating action no stroking, friction, or in-and-
out motion of the tongue
Debate: Milking vs Negative pressure
kill
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
16/20
Skill 6:
Cue Recognition
Rapid eye movements (fluttery eye movementswhile eyes are closed) Muscle tension, such as flexed arms or closed fists Wriggling or fidgety body movements
Vocalization Hand to mouth movement (even if eyes are closed,
may include sucking on own hand)
Rooting (Mouth open wide!)
You are Too Late if CryingIn newborns crying is usually a late indicator of
hunger and may lead to difficulty with latchingon to the breast or feeding well.
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
17/20
Skill 7: Hand expression
Follow the physiology: Relax and milk the source and the ducts
Go for empty
Disallow fullness
Watch Breastfeeding Management,Educational Tools for Physicians and Other
Professionals by Jane Morton, MD, FAAP, for
a live demonstration of how to observe andassess breastfeeding.
http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html
http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.htmlhttp://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html -
8/7/2019 PQCNC HM Well Baby Supporting Mom
18/20
Outcome/Skill 8: Frequency 10-12+ per 24 hrBreastfeeding frequency in 1st 24 hours and incidence
of hyperbilirubinemia on day 6
From: Yamauchi Y and Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth infull-term neonates. Pediatrics, 1990, 86(2):171-175.
28.1%
24.5%
15.2%
11.8%
0.0%0%
10%
20%
30%
0-2 3-4 5-6 7-8 9-11
Incidence
Frequency of breastfeeding/24 hours
N G i d S d
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
19/20
Next: Getting ready to See one, do
one, teach one!In your team:
Consider which staff will be with the dyad at the timewhen breastfeeding support is needed:Who is most likely to be with the mother at the time of the first
feeding?
Who is most likely to be asked for support?
List all the staff will need these skills
Discuss the current level of each of these skills amongthe staff
1) Rapport 2) Comfort 3) Position 4) Latch 5) Milk
Transfer 6) Cue recognition 7) Hand expression 8) Frequency
Consider: What additional training is needed to ensure that allstaff in contact with the mother/baby dyad at these times can
carry out this basic support? Do we have staff skilled to do this
training? How soon can this be accomplished?
-
8/7/2019 PQCNC HM Well Baby Supporting Mom
20/20
Reference
AAP Breastfeeding Residency Curriculum: Preparedwith information from the AAP/ACOG Breastfeeding
Handbook for Physicians http://www.aap.org/breastfeeding/curriculum/
http://www.aap.org/breastfeeding/curriculum/http://www.aap.org/breastfeeding/curriculum/