1. Property of MN Department of Health/DeJong 1 Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students  Objective13: Difficulties  Objective14: Nursing diagnoses case studies  Objective 15:Finding information on the internet  Objective16: Role playing scenarios

2. Objective 13 Recommend solutions for breastfeeding difficulties Property of MN Department of Health/DeJong2

3. Sleepy Baby Property of MN Department of Health/DeJong3

4.  Difficulty with latch (assess the baby’s frenulum. Do you see a heart-shaped tongue?)  Baby refuses to latch on one side vs. the other Property of MN Department of Health/DeJong4

5.  The Nipple Shield is primarily used when the infant will not latch to the mother’s bare breast.  Fit to infant’s mouth. Property of MN Department of Health/DeJong5

6.  Breast Pump ◦ May be needed by Mom for:  Infant born premature or sick  Nipple soreness  Being away from infant  Returning to work Property of MN Department of Health/DeJong6

7. ◦ Useful for infants able to latch but who need supplementation Property of MN Department of Health/DeJong7  Need photo

8.  Multiples: Twins Property of MN Department of Health/DeJong8

9.  Managing Low Milk Supply  Managing Perception of Insufficient Milk Supply Property of MN Department of Health/DeJong9

10.  In McCann et al.’s (2007) study of breastfeeding attitudes and reported problems in a national sample of WIC participants, breastfeeding mothers were asked about their own problems with breastfeeding at the one-month interview; 70% said that they had experienced at least one of the specific problems listed.  Thirty-four percent of mothers said they thought they did not have enough milk for the infant, and 10% thought there was something wrong with their milk. Property of MN Department of Health/DeJong10

11.  Although 71% of mothers agreed that “breast milk alone gives a new baby all he/she needs to eat” and 80% agreed that “any woman who wants to can breastfeed,” fewer (55%) agreed that they had enough breast milk.  In this study, concern about insufficient breast milk was the second-most frequently reported problem at the one month interview and the most common problem at three and five months. Apprehension about breast milk sufficiency was strongly related to breastfeeding cessation and formula supplementation. Property of MN Department of Health/DeJong11

12.  Causes:  Treatment: Property of MN Department of Health/DeJong12

13. Causes: Treatment: Property of MN Department of Health/DeJong13

14.  Causes:  Treatment: Property of MN Department of Health/DeJong14

15. ◦ KEEP NURSING! Continuing to breastfeed while sick is providing baby with _______________ against illness. ◦ Cessation should only occur if directed by a Lactation Consultant or Provider. Property of MN Department of Health/DeJong15

16. Avoid Supplementation Unless:  Compelling medical need  Benefits outweigh the risks  Informed decision-making by parents  A plan is in place to minimize harm and continue to support breastfeeding

17. If Supplementation is Needed  Use small feeds  Protect maternal milk supply and maternal confidence (Pessl, 2011)  Use smallest amount needed for the shortest possible time

18. Objective 14 Write appropriate nursing diagnoses for a Breastfeeding- related Case Study Property of MN Department of Health/DeJong18

19.  A 27-year-old mother presents to the clinic for her child’s 2 month check-up, stating, “I wish I knew more about preparing and storing milk for when I go back to work. I just really don’t know what I’m doing. I’m afraid I’m going to do it wrong, and that I’m not going to find the time to do it.”  She asks you to instruct her about preparing and storing expressed breast milk. She is planning to return to work as a 4 th -grade teacher in 3 weeks. Property of MN Department of Health/DeJong19

20.  What are the priority nursing diagnoses for the case? Property of MN Department of Health/DeJong20

21. Appraise lactation-related information available on the internet Property of MN Department of Health/DeJong21

22.  www.cdc.gov/breastfeeding/data/reportcard. htm www.cdc.gov/breastfeeding/data/reportcard. htm Property of MN Department of Health/DeJong22

23.  http://www.cdc.gov/vitalsigns/BreastFeeding /?s_cid=vitalsigns_081 Property of MN Department of Health/DeJong23

24.  http://www.babyfriendlyusa.org/eng/index.h tml Property of MN Department of Health/DeJong24

25.  http://www.lalecheleague.org/ Property of MN Department of Health/DeJong25

26.  http://kellymom.com/ Property of MN Department of Health/DeJong26

27.  http://www.breastfeedinginc.ca/content.php? pagename=videos Property of MN Department of Health/DeJong27

28.  http://www.drjacknewman.com/ Property of MN Department of Health/DeJong28

29.  http://www.goldenstart.info/ Property of MN Department of Health/DeJong29

30.  http://www.motherlove.com/mm5/merchant. mvc?Screen=CTGY&Store_Code=MHC&Categ ory_Code=resources-faq-low-breast-milk Property of MN Department of Health/DeJong30

31.  http://womenshealth.gov/breastfeeding/ http://womenshealth.gov/breastfeeding/  http://womenshealth.gov/breastfeeding/gov ernment-in-action/national-breastfeeding- campaign/index.cfm Property of MN Department of Health/DeJong31

32. Role-play selected scenarios with one another Image used with permission from William Burleson, Office of Statewide Health Improvement Initiatives, MN Department of Health, on 2/10/2012. Property of MN Department of Health/DeJong32

33.  A 25-year-old mother has just delivered her first child. She says she is too tired to nurse and wants you to feed the baby formula until her milk “comes in.” States, “It’ll be good for the baby to get used to a bottle anyway since I have to go back to work in 2 weeks.” What is your response? Property of MN Department of Health/DeJong33

34.  A 27-year-old mother presents to the clinic for her child’s 2 month check-up, stating, “I wish I knew more about storing milk for when I go back to work. I’m afraid I’m going to do it wrong.”  She asks you to instruct her about preparing and storing expressed breast milk. She is planning to return to work as a 4 th -grade teacher in 3 weeks. Property of MN Department of Health/DeJong34

35. LocationTemperatureDurationComments Countertop, table Room temperature (up to 77°F or 25°C) 6–8 hours Containers should be covered and kept as cool as possible; covering the container with a cool towel may keep milk cooler. Insulated cooler bag5-39°F or -15-4°C24 hours Keep ice packs in contact with milk containers at all times, limit opening cooler bag. Refrigerator39°F or 4°C5 days Store milk in the back of the main body of the refrigerator. Freezer Store milk toward the back of the freezer, where temperature is most constant. Milk stored for longer durations in the ranges listed is safe, but some of the lipids in the milk undergo degradation resulting in lower quality. Freezer compartment of a refrigerator 5°F or -15°C2 weeks Freezer compartment of refrigerator with separate doors 0°F or -18°C3–6 months Chest or upright deep freezer -4°F or -20°C6–12 months Property of MN Department of Health/DeJong35

36.  A new mom calls into the Ask-A-Nurse stating that she is worried that she can’t eat her usual diet because she is nursing. What is your response? Property of MN Department of Health/DeJong36

37. End of:  Objective13: Difficulties  Objective14: Nursing diagnoses case studies  Objective 15:Finding information on the internet  Objective16: Role playing scenarios Next:  Objectives 17: Providing support in a variety of settings  Objectives 18: Impact of public health  Objectives 19: Evaluation of own community – discuss ways to support breastfeeding where student works and lives Property of MN Department of Health/DeJong37