Positioning and Latching

Objectives List at least three signs of an effective latch BBC 6: Putting Baby to Breast Objectives List at least three signs of an effective latch Identify two signs of milk transfer from the breast to the infant Overview The responsibilities of the nurse include: Teach mothers how to position baby at breast and latch techniques - breastfeeding is a learned behavior for both mother and baby - many mothers have not had the opportunity to observe a nursing newborn Assess breastfeeding progress Refer couplets needing additional assistance and follow up Terminology Distinguish between positioning and latch as they are often used interchangeably Positioning – the body alignment of the mother and infant as individuals and in relation to one another Latch – the process of getting the baby’s mouth onto the breast for suckling 2 Rev. March 2009 2

Positioning Positioning is how mothers hold the baby when breastfeeding Mothers will be breastfeeding every 2 to 3 hours in the first weeks of life It is important that mother and the baby be comfortable at ALL times

Positioning For all breastfeeding positions: Breast must be easy to get to Mother needs to be comfortable Back straight & arms supported (use pillows under your elbow and at your back) Knees level with hips when sitting (footstool or directories to elevate your feet) Remove extra clothing (for more skin-to-skin contact) Birth experience can greatly influence ability of mother and baby to fulfill their respective roles Both mother and baby need to be ready A mother should be encouraged to be proactive in arousing her baby for feedings - the nurse’s role includes teaching a new mother alerting and calming strategies A mother needs time to get to know her baby - even if she has previous breastfeeding experience each baby has different behaviors and oral motor skills Assessing infant readiness for breastfeeding Is baby in quiet alert state and sending any feeding cues? Is baby crying and in need of calming? Was baby’s Apgar in good range? Any suctioning of airway? Any swelling or bruising of baby’s head or face? Medications given to the mother during childbirth may affect the baby’s instinctual drive to go to the breast

Positioning Remind mothers to bring baby to breast instead of breast to baby If you bring breast to baby, you end up being hunched over & your back will be sore Baby’s head, chest & knees face same direction

Latch-On Way the baby attaches to the breast Correct latch-on is important to: Make sure baby gets enough milk Avoid sore nipples Get the breast to make more milk NOTE: Though the steps we are about to explain seem long, it actually happens fast

Step 1 - Positioning Watch how the mother positions the baby for feeding and look for: Maternal Comfort — suggest different positions, pillows, or nursing stools if positioning looks uncomfortable How the infant is positioned — the head, shoulders, and hips are in alignment and the infant faces the mother’s body. The head should not be turned to the side Infant brought to the breast, not the breast to the infant Pushing on the back of the infant’s head — This should be avoided. It may cause the infant to arch away from the breast

Step 2 – Latch-on Watch how the baby is latched to the breast and look for: Use of the C-hold to make a sandwich for the baby to latch on 4 fingers underneath and thumb on top of the breast Mother’s fingers should be parallel to the infant’s jaw and well behind the areola Acknowledgement of the rooting reflex Middle of infant’s lip stroked with nipple Infant opens his mouth wide Mother quickly draws the infant to her breast Infant takes in an adequate amount of the breast, not just nipple

Step 2 – Latch-on (cont’d) Areola grasp Infant grasps the entire nipple and as much of the areola as possible The nose and chin of the infant will touch the breast Lips will be flanged out Mother’s comfort Gentle undulating motion No pain with each suck Proper release if infant does not release on his own Mother inserts finger gently in corner of infant’s mouth to release suction

Proper Latch CORRECT INCORRECT Nipple protected by positioning far back in infant’s mouth Breast tissue inferior to nipple exposed to massaging action of tongue and lower jaw.

Signs of a Good Latch Lack of constant pain Lips curled outward Mother is relaxed Chin touching the breast Cheeks rounded Nipple may come out longer, not pinched or discolored Lips curled outward Lower lip should not be pursed inward Nostrils barely touch breast but nose rests on breast Baby’s swallows can be heard BUT sucking should not be heard Breasts are softer & feel lighter after feeding

Signs of Incorrect Latch Immediate signs Infant’s cheeks indenting during suckling, clicking noises, lips curled inward Frequent movement of the infant’s head and lack of swallowing sounds Maternal pain and discomfort Later signs Trauma to mother’s nipples and pain Poor infant weight gain Low milk supply

Step 3 – Milk Transfer Watch the baby as she sucks and swallows and milk is transferred. Look and listen for: 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 Approximately 1 suckle/swallow per second Undulating action — no stroking, friction, or in-and-out motion of the tongue Milk is extracted by a peristaltic action from the tip of the tongue to the base (not by negative pressure)

Next Steps Watch Breastfeeding Management, Educational Tools for Physicians and Other Professionals by Jane Morton, MD, FAAP, for a live demonstration of how to observe and assess breastfeeding. http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html

Perfect Latch http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html

BBC 6: Putting Baby to Breast Assignments Goal: to provide participants with an opportunity to share clinical experiences with breastfeeding positioning and latching. Please share your experiences of working with mothers, and write t how you can implement what you learned in this session to your own practice. Please post your comments under Online participation tool. - 16 Rev. March 2009 16