Breastfeeding and Lactation Management Titilayo Abiona, MD, MPH PGY 3

Agenda Review of Agenda 9:00-9:05 Pretest 9:05-9:10 Presentation/Demonstration 9:10-9:25 Small Group Case Studies 9:25-9:50 Post Test 9:50-9:55 Evaluation 9:55-10:00

Goal To enable family medicine residents become competent in assisting mothers to breastfeed their babies successfully.

Objectives At the end of this workshop, residents will be able to : Help mothers to position and attach their babies correctly for breastfeeding (small group objective) Counsel mothers to ensure successful breastfeeding Manage common lactation and breastfeeding difficulties

Introduction Breastfeeding (BF)- numerous benefits to mothers and babies Exclusive BF recommended in the 1st 4-6 months of life Black, young, uneducated, WIC recipients less likely to breastfeed Common reasons why women stop breastfeeding: sore nipples, inadequate milk supply, perception that the infant was not satiated (Ahluwalia et a. 2005) Health workers: role to ensure successful breastfeeding

Our role……… To show mothers how to breastfeed Teach correct positioning and attachment To encourage mothers to breastfeed Counseling To manage common problems that prevent moms from breastfeeding/cause early cessation

Breastfeeding Positioning and Attachment

Key points of positioning Mother: Make the mother sit in a comfortable and convenient position (she can feed in lying down position) Ensure that she is relaxed and comfortable Baby: Baby’s head and body are in a straight line Baby’s whole body is supported Baby’s face is opposite the nipple and the breast Baby’s abdomen touches mother’s abdomen

Breastfeeding Positions

Key points of good attachment Baby’s mouth is wide open Baby’s chin touches the breast Baby’s lower lip is curled outward Usually the lower portion of the areola is not visible

Good and poor attachment

Positioning and Attachment Demonstration and Practice

Counseling

LISTENING AND LEARNING SKILLS Use helpful non-verbal communication Keep head level, pay attention, remove barriers, touch appropriately Ask open questions Use responses and gestures which show interest Reflect back what the mother says Empathize - show that you understand how she feels Avoid words which sound judging

Common Breastfeeding Problems Inverted nipples Sore nipples Breast engorgement “Not enough milk”

“Not enough milk” Management Causes Put baby to breast frequently Baby to be correctly attached to breast Build mother’s confidence Back massage and relaxation can help Use galactogogues Not breastfeeding often enough Too short or hurried breastfeeding Night feeds stopped early Poor suckling position Poor oxytocin reflex (anxiety, lack of confidence) Engorgement or mastitis

Breast engorgement Causes Delayed and infrequent breastfeeds Incorrect latching of the baby Treatment Give analgesics to relieve pain Apply warm packs locally Gently express milk prior to feed Put the baby frequently to the breast

Inverted Nipples Treatment should begin after birth Manually stretch and roll the nipple between the thumb and finger several times a day Teach the mother to grasp the breast tissue so that areola forms a teat, and allows the baby to feed Syringe suction method

Sore nipples Look for a cause: Check the baby’s attachment Check the baby’s position Examine the breasts – engorgement, fissures, candida Wash breasts only once a day; avoid using soap Avoid medicated lotions and ointments Gently apply hind milk onto nipple and areola after each feed If the problem persists, check the baby’s oral cavity for candida

Summary During this session we have learned: How to help mothers to position and attach their babies correctly for breastfeeding How to counsel mothers to ensure successful breastfeeding How to manage common lactation and breastfeeding difficulties

Thank you for listening ??????