International Childbirth Education Association

Postpartum Doula Program

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Part 7: Breastfeeding

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� Comprehend the benefits of breastfeeding to

both mom and baby. � Identify the basic breast anatomy, and the

hormones involved in breastfeeding. � Explain what a good latch looks like. � Understand and be able to explain common

breastfeeding issues.

OObjectives:

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� Breastfeeding: A system of newborn care ◦ Food + Protection � Warmth for newborn � Emotional and physical security and safety for

both � Immunity from bacteria, viruses and fungal

infections � Protection for mom and baby � Economic food security

MMore Than Just Food

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� Less work time missed � More sleep � Decreased incidence of breast cancer,

ovarian cancer, osteoporosis and diabetes

� Increased mothering skills and confidence

� Less environmental waste

BBenefits to Mom

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� Increased IQ scores � Decreased risk of:

◦ Childhood leukemia ◦ Celiac disease ◦ Incidence and severity of allergies and asthma ◦ Ear infections ◦ Respiratory infections ◦ Meningitis ◦ Childhood obesity ◦ Diabetes

� Less SIDS in infants

BBenefits to Baby

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� Alveoli: milk making cells

� Ducts: carry milk forward through the nipple

� Mammary vessels bring blood and nutrients to alveoli to synthesize milk

BBreast Anatomy

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Q – What do I need to do to “get ready” for breastfeeding? A – Be pregnant! Your body knows to get ready to feed the baby after birth! Colostrum begins production about halfway through the pregnancy- the first meals are ready for your baby!

PPrenatal Preparation

Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management. ICEA Copyright 2015

� Prolactin stimulates the alveoli to extract nutrients from the blood vessels and make human milkpromotes calming

� Oxytocin contracts muscles surrounding the alveoli to cause “letdown”-promotes nurturing feelings and behaviors

LLactation Hormones Hormones of Lactation

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“Healthy infants should be skin to skin with their mothers immediately after birth and remain there with minimal disruptions throughout the recovery period until the first feeding is accomplished.” AAP 2005

SSkin to Skin Care

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� Mother’s temperature rises to keep baby warm! � Less newborn crying � Improved oxygen levels in the newborn � Less initial weight loss � Better weight gain in the first weeks � Enhanced early breastfeeding

SSkin to Skin With Your Baby The best start for baby and breastfeeding

Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007.

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� Infant upright, tummy to chest � Infant naked or a diaper � Mother no bra or camisole � Cover both with blanket or gown � For initial – remain together until infant self-

attaches � For encouraging breastfeeding remain skin to skin

at least 30-60 minutes and showing cues

�

““How to” Skin to Skin Holding

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� Richer in protein to maintain blood sugar levels � Higher in vitamins and minerals � Higher in immunities to prevent infections � Concentrated form designed for the first days � Laxative effect to clear meconium and excess

bilirubin

BBenefits of Colostrum

Milk does not “come in” first milk-colostrum is present at birth!

Colostrum “changes-over” to mature milk in 2-5 days after birth

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Give your baby only your milk unless medically indicated. � Keeps your baby’s intestines

healthy � Builds newborn’s immune

system � Reduces the chances of allergies � Helps assure milk supply

EExclusive Breastfeeding

Bartick M, ReinholdA. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56

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Thanks Mom for keeping me healthy by breastfeeding me for at least 6 months!

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NNewborn Stomach Capacity

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� Mouth wide open, far back on the breast.

� Nose and chin close to breast.

� Nipple stretches to back of the infant mouth- soft ”comfort zone”

�

CCorrect Latch On

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� Mouth wide open � Lips flanged back � Full, round cheeks � Nose and chin touching your breast � Sucking bursts and pauses � Listen for swallowing � Feel tugging sensation � No biting or pinching sensations � No clicking/smacking sounds

SSigns of a Good Latch

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� Start with nose to nipple

� Mother’s hand on shoulders and back - not pushing head!

� Allow head to tilt back

� Mouth opens widely � Chin and bottom lip

are first to the breast

AAsymetric Latch � Mouth comes “up and

over” to attach far back on the breast

� Nipple is in the top half of the mouth- available space tongue is the bottom half of mouth

� Attachment is “off center” further down on the areola, more areola visible above the top lip

Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management.

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Mothers and babies belong together!!!

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� Newborn’s instinctive position: head and body in alignment (straight line between ears, shoulder and hip), chin not on chest (slight backward head tilt), hips flexed

� Bring the baby to the breast- not your breast to the baby! Back and shoulders relaxed and supported.

� Cradle, cross cradle, side hold or side-lying?

BBreastfeeding Positions

No “right” or “correct” position --whichever is best for you and your baby!!!

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� 1st 24 hours: about 8 feedings, each about a teaspoon colostrum. More frequent if skin-to-skin.

� 24-48 hours: 8-10 feedings. � 3-4 days: increasing to 8-12 times/24

hours as milk volume increases � Cluster feedings!!!!!! � Length of feedings: offer the 1st

breast until finished, then offer the 2nd.

FFrequency in Feedings

No time limitations!!! ICEA Copyright 2015

Wiggling - Early Rooting – Early Fussing - Mid Body moving - Mid

Active Crying - Late

FFeeding Cues Baby Cue and Stage of Readiness

Watch the baby Not the clock!!!

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� Communication between each Mother and her baby sets the amount of milk made

� Important in the first days and weeks to establish each mother/baby unique needs

� Avoid pumping if not separated from your baby or your milk is needed for supplementation

� Avoid unnecessary supplements for best milk supply

SSupply and Demand “Request and Supply”

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� 8-12 feedings/24 hours � Can hear swallowing of colostrum

or milk � Urine is pale in color � Initial weight loss no more than

7%, stops loosing weight by 5 days and back to birth weight by 2 weeks.

� IV Therapy effect- IV fluids may increase initial weight, cause increased urine and weight loss not related to feeding

� 8-12 feedings/24 hours

AAfter the Hospital Is my baby getting enough?

DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122:s43–9.

“milk drunk”

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� Day 1-2- 1-2 wet and 1-2 stools/24 hours � Day 3 - 3 wets and stools with stools changing to

brownish green � Day 4-5 - with filling of the breasts, increases to 3-4

wets and at least 4 stools, changing to golden yellow

� Day 6 - 6-8 wets with 3-4 unformed yellow seedy stools

AAdequate Output

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NNormal Stooling Pattern

Copyright: The Birth Atlas 2002

Too little or no stools call care provider

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WWhat if…

….. and prevention ICEA Copyright 2015

� Usually defined as: <40 mg/dl

� Prevention: ◦ Skin-to-skin for warmth ◦ Early colostrum feedings ◦ No limiting of early

feedings ◦ Avoidance of “sugar

waters”

LLow Blood Sugar

USBC 2008 Achieving Exclusive Breastfeeding in the United States: Findings and Recommendations ICEA Copyright 2015

� High levels of bilirubin in infant’s blood

� Yellowing of skin and eyes � Prevention: Nurse within

60-90 minutes after birth � Frequent, unlimited

feedings of colostrum (laxative effect)

� Schedule appointment with your baby’s Dr. in 3-5 days

�

JJaundice

Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506 ICEA Copyright 2015

Causes: Improper latch and not feeding on cue

Prevention: No scheduled feeds- feed on cue with correct latch

First line of defense Correct the latch!

� Asymmetric latch � Observe for tongue tie � Review feeding cues

SSore Nipple

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What is it? Abundant milk and increasing fluid in the breasts

Causes: Inadequate emptying of the breasts or over-

stimulation with over-production or use of IV fluids Prevention:

Feed frequently with baby’s cues, avoid scheduling or skipping feedings

Filling (rounder, fuller, firmer) is normal!!! Rock-hard, hot, overly-full is not normal!!!!

EEngorgement

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� If infant unable to latch – may express a small amount, but only enough to soften the nipple/areola before feeding

� “Hang” breasts in tepid water, sink or basin, for gravity emptying. May add massage to move milk forward. Repeat as often as needed until softened and infant can latch easily

� Shower with water on back- flowing over breasts � Discontinue unnecessary pumping

EEngorgement Treatments

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� Causes: ◦ Too tight or extended wearing of bras ◦ Sleep position with pressure on the breast ◦ Inadequate emptying of the breasts: missed

feedings, scheduled or timed feedings � Symptoms: Localized redness, tenderness,

warmth and pain � Treatment:

◦ Warm compresses and massage before a feeding ◦ Usually resolves with in 24-36 hours

PPlugged Ducts

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� Symptoms: fever, flu-like symptoms, may have red streaks on the breast

� Causes: cracked nipple, plugged duct, over supply, not regularly emptying of breasts

� Call Dr. or Midwife! � Continue to breastfeed!!!

MMastitis

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� Old wives tales- no garlic, onions, chocolate, beans, citrus- not true!

� General guidelines- well balanced diet- veggies, fruit, whole grains, lean meats

� Adequate fluids and water - drink to thirst- do not force fluids

� Avoid fad or severe calorie restriction diets � Opportunity for family education on nutrition and

healthy eating habits � Minimize hormone/chemical additives

NNutrition for Breastfeeding

Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition, Maryland Heights, MO: ElsevierICEA Copyright 2015

� Hospital grade pumps- if you are separated from your newborn. Add hand expression for more milk!

� Manual pumps- economical Double pump- for return to work or school

BBreast Pumps

Remember! No need to begin pumping for 2-3 weeks, unless separated from your baby!!

Human Milk Banking Association of North America (HMBANA) (2011).Guidelines for the establishment

and operation of a donor human milk bank. Fort Worth, TX: HMBANA, accessed http://hmbana222.org

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� BOOKS ◦ Ina May’s Guide to Breastfeeding by Ina May Gaskin ◦ The Womanly Art of Breastfeeding by La Leche

League ◦ The Breastfeeding Book by Dr. William and Martha

Sears

�

IInformation on Breastfeeding

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WWebsites

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� Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management. Jones and Bartlett Learning. Burlington, MA

� Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007.

� National Alliance for Breastfeeding Academy. (2012). NABA REAL Code Monitoring. Retrieved May 28, 2012,

� Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007–2008. JAMA 2010;303:242–9.

� White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation. Washington, DC: The White House; 2010. Available at http://www.letsmove.gov/whitehouse-task-force-childhood-obesity-report-president. Accessed June 30, 2011.

� Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics, 2012

� Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition, Maryland Heights, MO: Elsevier

er-Maffei, C. 2013. Pocket Guuide For Luide For

RReferences

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� Joint Commission. Specifications manual for Joint Commission National Quality Care Measures: perinatal care.Available at http://manual.jointcommission.org/releases/TJC2011A/PerinatalCare.html. Accessed May 20, 2011.

� CDC. Breastfeeding report card—United States, 2011. Atlanta, GA: US Department of Health and Human Services,CDC; 2011. Available at http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed August 1, 2011.

� US Department of Health and Human Services. The Surgeon General’s call to action to support breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011

� CDC. Breastfeeding among U.S. children born 2000–2008, CDC National Immunization Survey. Atlanta, GA:US Department of Health and Human Services, CDC; 2010. Available at Http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed July 8, 2011

� Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56.

� US Department of Health and Human Services. Healthy People 2020: Maternal, Infant, and Child HealthObjectives.Availableathttp://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist .aspx?topicid=26. Accessed May 20, 2011

� DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122:s43–9.

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� Academy of Breastfeeding Medicine- .www.usbreastfeeding.org breastfeeding protocols � United States Breastfeeding Committee- USbreastfeeding.org – Core Measure and Basic

Competencies Tool kits � Baby Friendly USA- www.babyfriendly usa.org American Academy of Pediatrics- Policy

Statement on Breastfeeding http://pediatrics.aappublications.org/content/129/3/e827.abstract?sid=fc620c15-8dc14ae4-8e98-133e4f67f84d

� Centers for Disease Control and Prevention- http://www.cdc.gov/breastfeeding/ � Wellstart- Resources for physician education- http://wellstart.org/ � White House Task Force on Childhood Obesity - http://www.letsmove.gov/whitehouse-

task-force-childhood-obesity-report-president � American College of Obstetrics and Gynecology- Breastfeeding

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health% 20Care%20for%20Underserved%20Women/co361.pdf?dmc=1&ts=20130130T13323 59887

� Department of Health and Human Services- Healthy People Goalshealthypeople.gov/2020/topicsobjectives2020/ebr.aspx?topicId=26

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