evaluating a breastfeed
TRANSCRIPT
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Evaluating ABreastfeed
Presented by:
Rowaida Al-Khalil
BSN-IBCLC-Senior Nursing Tutor
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Objectives
At the end of this presentation the audience willbe able to:
Observe a breastfeed
Evaluate adequate attachment for feeding .
Evaluate the babys suckling behavior at thebreast.
Assist mothers who need help withattachment.
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Somethingas naturalas
breastfeedingshouldjusthappennaturally shouldn'tit?Forhumankindtohave
survivedoverthecenturies,
babieshaveneededtobeabletoattachtotheirmothers'breastsandmusthavedoneso. Yetinour
societytoday,attachmentproblemsseemtobeverycommon.
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Could it be that we have lost theadvantages of the extended family or
village groups where young girls wouldhave observed and assisted mothers,
aunts, or sisters who were
breastfeeding. They also would havehad the assistance from them whenthey in turn had their own babies.Many new mothers today may have
never handled young babies let aloneseen one being breastfed.
The art of attaching a baby to the
breast is therefore a skill to be
learned.
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Observing a Breastfeed
While the mother isbreastfeeding her
baby quietly observewhat is happening and
record theinformation .
What to look for whenobserving a breastfeed :
Signs that the baby isattached for effectivesuckling .
Signs that the baby is
suckling and the milk isflowing .
Signs that the mothermay need help.
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Evaluating Attachment
A good attachment :
The babys mouth is openwide.
The babys chin is touchingthe breast.
The babys lower lip iscurled upward.
The babys head is tiltedslightly back.Hold is firmly againstshoulders
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Evaluating Attachment
Signs that the baby is poorly attached :
The nipple looks flattened or striped as it
leaves the babys mouth at the end of the
feed.
The mother feels pain in her nipples during
and after the feeds.
The mothers breast may be engorged due to
inefficient milk transfer.
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Evaluating infants sucklingbehavior at the breast
Listen for a suck-swallow-breathpattern
Audible swallowing is one the most importantevaluation criteria.
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If the non nutritive sucklingpattern is observed throughout
the entire feedbaby is not
attached well
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The Nurses Role in AchievingEffective Latch-on
Watch for early readiness cues
Assist with latch-on
Determine if suckling iseffective .
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Clinical Management topromote effective suckling
Basic positions for the mother
Body position of the mother
Maintain good posture
when back is straight the nipples are
in a position where the newborncan best achieve a good latch-on
Remind mother to relax hershoulders.
Bring the baby to the breast , not
the breast to the baby. Offer pillows to support the
mother's arm or the infant. Helpreposition the mother if necessary
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Clinical Management topromote effective suckling
Basic positions for the mother
Hand position for the mother
The mothers fingers should be well away from the
areola they should not occlude the lactiferous
ducts.
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Clinical Management topromote effective suckling
asic positions for the newborn
The babys whole body is facing the mother andtucked close to her (chest-to-chest and not
chest-to-ceiling )The babys head is supported ,in a straight linewith his body, and facing the breast.
Hold the infant at the level of the nipple .
The infant's lower arm, if not swaddled, should
be around the mother's thorax
The infants head should rest on the mothersforearm and NOT on the antecubital fossa.
Often, the fathercan assist the motherwith the positioning
of the infant,particularly if she is
recovering froma caesarean delivery.
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Clinical Management topromote effective suckling
Breastfeeding environment
The mother and infant should be allowed to
breastfeed in a relaxed and supportiveenvironment. Personnel should be readilyavailable to facilitate the process.Constant interruptions and a deluge of
visitors may disrupt the earlybreastfeeding experience.
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Clinical Management topromote effective suckling
asic positions for thenewborn
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Clinical Management topromote effective suckling
asic positions for the newborn
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Clinical Management topromote effective suckling
asic positions for the newborn
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Clinical Management topromote effective suckling
asic positions for the newborn
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Clinical Management topromote effective suckling
asic positions for the newborn
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Assisting the mother withattachment
Wash your hands thoroughly.
Arrange for privacy.
Help the mother to find the mostcomfortable position and ensurethere are several pillowsavailable.
Work with the mother at the eyelevel.
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Assisting the mother withattachment
Help the mother to position thebabys body:
Head and body are at the breastlevel.
Babys body aligned from the
shoulder to the iliac crest. Baby is flexed and relaxed. The babys whole body is facing
the mother and tucked close toher (chest-to-chest and notchest-to-ceiling )
Help the mother position the babyshead:
Be sure there is no pressure onthe back of the babys head
Head supported but NOTpushed in against breast.
Head tilted back slightly.
Head facing breast (NOT turnedlaterally , hyperextended ,orhyperflexed).
infants head should rest on themothers forearm and NOT onthe antecubital fossa.
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Assisting the mother withattachment
Ask the mother to support her breast inplace during the feeding with her hand (C-
hold ).After the first week , the mother should beable to get the feeding started and thenlet go ,unless her breasts are unusually
large.
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Assisting the mother withattachment
Teach baby to openwide/gape :
Move baby towardbreast, touch top lipagainst nipple
Run nipple along thebabys upper lip, fromone corner to the other,
lightly, until baby openswide. Repeat until baby opens
wide , as if yawning, andhas tongue forward
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Assisting the mother withattachment
Teach mother to establishproper areola grasp:When the baby opens hismouth wide and his tongue
comes forward over his lowergums bring him quickly to thebreast with the mothersnipple pointing to the roof ofhis mouth. His first point ofcontact will be his lower jaw
or chin well down on theareola.As his mouth closes over thebreast he should take in alarge portion of the areola.
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Assisting the mother withattachment
A proper areolar grasp Infants mouth opens widely
to cover lactiferous ducts. Lips flanged outward. Complete seal formed around
the areola :strong vacuum. Approximately 1.5 inches
( approximately 3.5 cm ) ofareolar tissue is centered in
infants mouth. Tongue is troughed and
extends over alveolar ridge.
star again.
If the baby is notattached well, or if themother feels painshe
should break the suctionby gently inserting herfinger into the corner ofthe babys mouth ,andstart again.
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Assisting the mother withattachment
Evaluate areolarcompression
Mandible moves
in a rhythmicmotion .
Tongue cuppedand troughed.
Checks full and
rounded whensucking .
Evaluate audibleswallowing
Quiet sound of
swallowing heard . Preceded by
several suckingmotions .
Increases in
frequency andconsistency aftermilk ejectionreflex.
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Assisting the mother withattachment
Ending a breastfeed Feed until the baby releases the breast
spontaneously. Offer the second breast only after the
baby has finished the first Breast;there is always milk in the breast. Do not remove the baby from the breast
if he is still suckling and swallowing. Some babies enjoy staying on the breast
long after they stop swallowing milk
(comfort sucking). If the mother wantsto end this period gently insert herfinger into the corner of the infantsmouth and remove him.
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General Reminders for the
Mother to AVOID
Pushing her breast across herbody
Chasing the baby with herbreast
Flapping the breast up and down
Holding breast with scissor grip Not supporting breast Twisting her body towards the
baby Aiming nipple to centre of
babys mouth
Holding breast away from babysnose (not necessary if the babyis well latched on, as the nosewill be away from the breastanyway)
Pulling babys chin down toopen mouth
Flexing babys head whenbringing to breast
Moving breast into babysmouth instead of bringingbaby to breast
Moving baby onto breastwithout a proper gape
Not moving baby onto breastquickly enough at height of
gape Having babys nose touch
breast first and not the chin
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Mothers should be advised to seek help if she is
experiencing the following :
PAIN except possibly brief discomfortat the beginning of a feed
BREASTS engorged
NIPPLES damaged
Compressed when the baby comesoff.
BABY
not coming off the breastspontaneously.
Restless at the breast
Not satisfied after the feed.
Taking a long time to feed (regularlymore than 30-40 min)
Feeding very frequently (more than10 feeds in 24 h)
Feeding very infrequently (fewerthan 3 feeds in the 1st 24 h or fewerthan 6 feeds in 24 h at24-48 h old )
Still passing meconium at 36-48 h.
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