Property of MN Department of Health/DeJong 1 Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students  Objective 8: Nurses’ role  Objective 9: Positions  Objective10: History and trends

 Discuss the role of the nurse in assessing and encouraging the breastfeeding dyad. Property of MN Department of Health/DeJong2

When supporting normal breastfeeding, suggest the mother focus on getting comfortable and give encouragement rather than instructions (Mohrbacher, 2010, p. 29). Property of MN Department of Health/DeJong3

U.S. Pediatrician Christina Smillie (2008) emphasizes to mothers that “there is no one right way to do this” and focuses instead on: ◦ Displaying confidence that breastfeeding will work. ◦ Encouraging the mother to talk to her baby. ◦ Reassuring the mother that her baby’s actions are normal (Mohrbacher, 2010, p. 39). Property of MN Department of Health/DeJong4

 Important to know what questions to ask. ◦ Breast surgery history ◦ Past breastfeeding experience ◦ History of sexual abuse ◦ History of hypothyroidism? ◦ History of Polycystic Ovarian Syndome? ◦ Nipple concerns (inversion, flat) ◦ Production concerns  All mothers should be assessed for potential lactation issues prior to discharge. Property of MN Department of Health/DeJong5

 Infant Feeding Cues – Hand to Mouth Property of MN Department of Health/DeJong6

 May even root on inanimate objects – anything that brushes against their check or lips. Property of MN Department of Health/DeJong7

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 Would have been best to feed this baby in the Quiet Alert State, noted in picture 2. Property of MN Department of Health/DeJong9

 Baby must be ready to feed  Don’t latch baby when crying  Tickle lips  Undress baby (skin-to-skin)  Proper alignment with mom (belly to mom; chin to breast, nose to nipple)  Be patient  Quickly pull baby to breast when mouth is wide open Property of MN Department of Health/DeJong10

 Nipple disappears  Nose and chin close to breast  Property of MN Department of Health/DeJong11

What is your assessment of this baby’s alignment? What is your assessment of this baby’s latch? Property of MN Department of Health/DeJong12

 Ask mother how it feels: should be a deep firm pull with out extreme pain  Many women are surprised by the strong tugging and may not experience it as pleasant at first Property of MN Department of Health/DeJong13

 Replace vague terms as “BF well, fair, poor”  IBFAT ( Infant Breastfeeding Assessment Tool, Matthews)  MBA (Mother Baby Assessment Score, Mulford)  SAIB ( Systematic Assessment of the Infant at the Breast, Shrago & Bocar)  LATCH tool ( Jensen, Wallace & Kelsey) Property of MN Department of Health/DeJong14

Property of MN Department of Health/DeJong15

 Which of the following may indicate a poor latch? ◦ A. Maternal pain ◦ B. Trauma to the breast or nipple tissue ◦ C. Dimpling of the infant’s cheeks ◦ D. All of the above Property of MN Department of Health/DeJong16

 Keep the baby next to mother  Feed the baby breastmilk  Keep the baby “in love” with the mother’s breast (Pessl, 2011). Property of MN Department of Health/DeJong17

 Breaking the latch  Burping the baby Property of MN Department of Health/DeJong18

 Compare and contrast various breastfeeding positions Property of MN Department of Health/DeJong19

 Cradle Hold Baby needs to be appropriate size to fit in the crook of Mom’s arm without head falling back too far. Property of MN Department of Health/DeJong20

 Cross Cradle ◦ Provides mom more control over latching due to one hand free to support breast. ◦ Useful for large breasted or engorged women due to supporting breast. Property of MN Department of Health/DeJong21

 “Tee Ball Practice for babies – “to help hold it!” (DeJong, 2012) or like “Training wheels” for a baby learning to breastfeed (Wiessinger)  Helpful with preterm, late preterm infants, Down’s syndrome, anytime needing more support Property of MN Department of Health/DeJong22

 Under-arm/ Football Property of MN Department of Health/DeJong23

 Side Lying Property of MN Department of Health/DeJong24

 Laid Back Position ◦ Mom uses her body to support her baby. ◦ Mother leans back in any chair or in bed and positions baby prone on her abdomen. Property of MN Department of Health/DeJong25

 Tips for any position ◦ Belly to belly ◦ Nose to nipple ◦ Hips aligned ◦ Use support/Boppie Pillow if needed Property of MN Department of Health/DeJong26

 Tips for any position ◦ Provide support for mom and baby so mother does not support the baby’s weight the entire feeding. ◦ Emphasize to bring baby to mom, and do not let mom lean over to baby. Property of MN Department of Health/DeJong27

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Discuss the history and current trends of breastfeeding and lactation education in the United States and internationally Stanisław Wyspiański, "Motherhood", pastel, 1902, National Museum, Warsaw. Breastfeeding Is Beautiful by Caitlin Smith Property of MN Department of Health/DeJong29

Historically, when Didn’t we Feed Babies Breastmilk?  When mothers died in childbirth  When mothers were ill  When mothers did not produce enough milk  When the “medicalization” of infant feeding became normal  When formula companies wanted to make a profit

“They Turned Out ‘Okay’…”  But, survival does not equal optimal health (Pessl, 2011).  Remember, formula: ◦ Has no living human cells ◦ May cause GI irritation with possible bleeding (anemia) ◦ Has excessive protein and sodium

 We must re-evaluate our care and look at our practices  We must consistently question what we are doing ◦ Are the things we are doing in the best interest of the mother/infant dyad? Property of MN Department of Health/DeJong32

End of:  Objective 8: Nurses’ role  Objective 9: Positions  Objective10: History and trends Next:  Objective 11: Best practices  Objective 12: Breastfeeding Report Card, Healthy People, Surgeon General’s Call to Action Property of MN Department of Health/DeJong33