7. Areola Darkens in pregnancy Montgomery glands provide lubrication secrete fluid with odor of amniotic fluid
8. Fat Cells Fat determines the size of the breast All breasts have the about the same number of milk glands or lobes Size does not determine ability to make milk
19. Milk Production Lactogenesis II (2-8 days) starts after delivery of placenta drop in progesterone & estrogen prolactin level increases switch from endocrine control to autocrine
21. Composition Colostrum first food High in Protein, vitamins & minerals Antibodies Less fat & lactose than mature milk Laxative About 3 ounces in 24 hours
23. Composition Mature Milk Transitional Milk (approx. 2 weeks) Increases in fat & lactose, water soluble vitamins Decreases in protein 750 kcal/liter
24. Foremilk / Hindmilk Foremilk thinner watery milk at beginning of feeding Hind Milk higher in fat and calories Let baby finish one breast Do not limit length of time at breast
26. Milk Composition Variations to milk are normal Depend upon: time of day beginning or end of feeding maternal diet maternal hormone fluctuations
27. Immunologic and Bioactive Properties of Milk Secretory Immunoglobin A provides passive immunity Inhibited bacterial growth in gut Macrophages are abundant in human milk destroy & digest bacteria Reduction in Food Allergies
29. Benefits of Breastfeeding Benefits to Baby: Species specific Good Health Reduce risk of Disease Promotes Physical Development Provides Emotional Benefits
31. Benefits of Breastfeeding Benefits for mother reduce postpartum hemorrhage improve bone density weight loss reduce risk of cancers convenient and always available save time and money delays fertility travel easy & comfort for baby
32. Benefits to Family & Environment Family saves money Fewer healthcare costs No energy use for production No packaging materials No production animals, feed, machinery, waste disposal No transportation No contamination or disease transmission
33. Other benefits • comfort• easing of pain and discomfort• protection during illness• building of bonding and attachment with parents• social development• inducing sleep• building of trust in parents• visual development• development of communication skills• building brain organization toward positive stress handling throughout life• reduced heart disease risk factors• lowered risk of SIDS (Sudden Infant Death Syndrome)
34. Skin to Skin contact Infant naked or only in diaper Mom with breasts, chest and belly bare May have blanket over them both Mom can be sitting or reclining with infant vertical between her breasts or on one breast
35. Benefits of Skin to Skin Improves suckling Increases duration & exclusive breastfeeding Higher skin temperatures Raises blood glucose Normalizes base excess Less crying Release of oxytocin-less uterine bleeding Release of prolactin- increase in production Bonding, less anxiety for mom
37. Indications Possible dose response, separation of mom and baby for 20 minutes during 1st hour detrimental As little as 15-20 minutes beneficial Baby awake after delivery, start skin to skin as soon as possible, suckling may not occur for up to 2 hours after delivery Recommend at least 30 minutes long or longer for a more difficult birth
48. Advantages/ Disadvantages + Most frequently illustrated/ familiar + Most often used by mothers - Difficult to master- control of baby’s head - Baby may wobble on mom’s arm
50. Advantages/disadvantages + Allows mother more rest + more comfortable after a c-section with support of tummy - mother’s fear of smothering their baby
52. Advantages/disadvantages +maximize control of baby’s head +more comfortable choice of c-sections +more easily accomplished for SGA/preemie -Not often pictured in media - some mother’s not comfortable with position - more difficult to use with larger babies
55. LATCHING Nose to nipple Manual expression Tickle lip Wide open (rooting) Tongue down, nipple to roof Bring infant in toward mother Latch with entire nipple & about 1 inch of areola Lower jaw covers more than upper
56. Goal of Latching Chin touching breast Nose lightly touching breast or not at all Lips both turned outward
57. As Baby Nurses Cheeks puffed out Rocking of entire jaw Temple movement Intermittent swallows NO clicking or smacking Breast tissue
58. Mom as Baby Nurses Feels no pinching Feels strong tugs at breast Initial latch may be tender as nipple elongates Tender if nipple trauma, needs to heal Mother to detach & start over if painful Mother may feel uterine cramping
60. Nipple Assessment Nipple round and erect at detachment No creasing or blanched looking Not misshapen- like lipstick end
61. Frequency & Duration First 24 hours lots of skin to skin offer breast on cue at least every 2-3 hours encourage to ask for help May not nurse the first 24 hours but at least try Document attempts even if not successful
62. Nursing Let baby nurse as long as he wants Do not watch the clock, watch the infant Generally, 10-30 minutes, longer or shorter ok
63. Nursing Active nursing from first breast Stimulate infant if sleepy When done, burp, check diaper and offer 2 nd He may or may not take 2nd Alternate the starting breast each feeding
64. How much is enough? Breastfeeding Log 8-12 feedings in 24 hours voiding and stooling weight loss less than 10 % content after nursing swallowing breasts feel softer after nursing stools transitioning black, brown, green, yellow by one week of age
76. Treatment of Jaundice Increase frequency of feedings May need to double pump to supplement Supplement with mom’s milk or formula Phototherapy Monitor hydration Educate parents
77. Plugged ducts Inadequate emptying, pressure in breast Tender spot Warmth & message Nurse on tender breast first Proper latching & optimal positioning Rest, report fever to MD Plug may come out & look like spaghetti
78. Mastitis Bacterial infection of breast tissue Symptoms: hard, reddened tender area red streaking, fever, flu like symptoms Causes: damage to nipple open to bacteria milk stasis, inadequate emptying, plug Care Plan
80. Thrush Yeast overgrowth Predisposing factors: nipple damage, antibiotic use, yeast vaginitis Signs & Symptoms: white, pimple like dots, superficial cracking at base of nipple, constant pain, burning, itching Infant may or may not have symptoms White patches in mouth, diaper rash
82. Nutrition & Medications Well balance diet Extra 300-500 calories per day Infant may be sensitive to mom’s diet Caffeine sparingly Alcohol passes into milk Prenatal Vitamin Q day Nicotine Educate parents Dr. Hale- “Medications & Mother’s Milk”
83. Breast Pumps Manual- occasional pumping, relieve fullness, 5 minutes alternating sides for 15 mins. total Single Electric- occasional pumping, small motor, one at a time 5mins alternate to 15 mins. Double Electric-larger, stronger, more durable, regular pumping, more efficient, rent or buy, best for NICU moms, quicker
90. Case Studies Read and discuss together the following 3 cases: 1) 26 hour old male, 40 2/7 weeks gestation, 8#1 oz, nursed after delivery & 5 times since then well, he has had 1 meconium stool and 2 voids, now he hasn’t nursed for the last 5 hours and mother states he is sleepy. She is holding him skin to skin. He is asleep. What do you do?
91. Case Study 2) 22 hour old female, 36 1/7 weeks gestation, 6 # 8 oz., no latch after delivery, to the breast 5 times with only licking and nuzzling. She is sleepy with latching attempts. 1 void and 1 meconium stool is recorded. Last attempt made three hours ago. She is asleep in her crib. What would you do now?
92. Case Study 3) 24 hour old female, 37 1/7 week gestation, 6 # 2 ounces & is SGA. She nursed well after delivery and has nursed 4 times since for 15-20 minutes per feeding. She has had 3 voids and 3 meconium stools. She is putting her fingers in her mouth and her eyes are open. What do you do now?
93. Case Studies on your own 1-2 nurses per case study Studies number 4 through 8 Discuss among your group & present to others
94. Thank you! References: Lawrence, R. & Lawrence, R. (2005). Breastfeeding: a guide for the medical profession, 6th edition, Philadelphia PA, Mosby Inc. Wilson-Clay, B. & Hoover, K. (2007). The Breastfeeding Atlas, 4th edition, Manchaca, TX, LactNews Press.
