Birth & Beyond California: Breastfeeding Training & QI Project

Birth & Beyond California: Breastfeeding Training & QI Project
Welcome Back! Day 2 Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant

BBC 6: Putting Baby to Breast
Assignments Observe a newborn placed skin to skin with mother for 20 minutes Observe an infant breastfeeding and listen for sucks and swallows Observe the cluster feeding pattern of the breastfeeding newborn Photograph: mother & baby skin-to-skin and offering breast/self attaching within minutes of delivery Welcome Back Activity 1: Homework Review Refer to Session Plan for Activity materials, time and instructions Background Slide lists the homework assignments given to all participants in Day 1 Goal: to provide participants with an opportunity to share clinical experiences with skin-to-skin and breastfeeding Debrief Activity Ask each participant to share their feelings about this experience - how did you feel? - what did the MOTHERS say they felt? - how do you think the BABIES felt? - what did the fathers and family members say they felt? - what would the patients report in their evaluations? Summary statements - skin-to-skin and attachment are dose related - the more time spent skin-to-skin the greater the attachment bond and improved breastfeeding outcomes - skin-to-skin improves baby’s and mother’s physical and emotional well being - babies should live on someone’s chest in the early days and weeks - African Proverb: Lucky is the child whose feet do not touch the ground until he is a year old Review administrative details Announce plan for the day (re) Introduce trainers 2 Rev. March 2009 2

Putting the Baby to Breast Positioning and Latch
BBC 6: Putting Baby to Breast Putting the Baby to Breast Positioning and Latch Refer to Session Plan for: Objectives- Also listed on slide 3 Rationale Key Messages Toolbox - AV - Materials & Handouts - Equipment Activities Birth & Beyond California: Training and QI Project 3 Rev. March 2009 3

Objectives Demonstrate three positions mothers may use to breastfeed
BBC 6: Putting Baby to Breast Objectives Demonstrate three positions mothers may use to breastfeed List at least three signs of an effective latch Identify two signs of milk transfer from the breast to the infant Identify three in-hospital strategies for early breastfeeding management 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 4 Rev. March 2009 4

Factors Influencing Positioning & Latch
BBC 6: Putting Baby to Breast Factors Influencing Positioning & Latch Infant Is baby alert and searching? Are there any underlying medical issues? Birth trauma? Birth medications? Photograph: mother and baby skin-to-skin with baby in quiet alert state 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 5 Rev. March 2009 5

Factors Influencing Positioning & Latch
BBC 6: Putting Baby to Breast Factors Influencing Positioning & Latch Maternal Is mother alert and comfortable? Level of breastfeeding education/ familiarity? Is she desirous of learning the skill? Photograph: mother holding baby Assessing maternal readiness for breastfeeding Mother should not be in pain or sedated - for a post-op Cesarean mother frequent pain assessments should be done in the recovery room and during postpartum while she and her baby are skin-to-skin and attempting breastfeeding - perineal pain : if mother is unable to sit comfortably then teach option of side-lying position Determining mothers level of knowledge: Questions to ask: - has mother breastfed before or seen a newborn breastfed? - has mother taken a breastfeeding class? - has mother seen pictures and/or observed another mother breastfeeding? Mothers need TIME to “get to know” their baby before breastfeeding Some mother’s pace is faster than others - nurses need to learn each mother’s pace and not try to rush the mother - even if she has breastfed previously, she has not breastfed THIS baby Is she willing to try putting baby to breast? - privacy is important, it may be necessary for the nurse to help mother ask visitors to leave - some visitors are helpful, but others may be a distraction or deterrent to the mother being ready to practice position and latch 6 Rev. March 2009 6

Breastfeeding in Delivery Room
BBC 6: Putting Baby to Breast Breastfeeding in Delivery Room Photograph: mother lying supine on delivery room table with infant prone on breast Helping a mother to breastfeed is part of the responsibility of a perinatal caregiver During the immediate post delivery period a mother and baby are often highly aroused and receptive to one another - this is a teachable moment for mother and baby Positioning The supine position is also known as the biologic nursing position This supine position requires an alert mother and baby - it also has advantages for the post-op cesarean mother who can not move easily Nurse support and supervision must be ongoing - a mother may need to be encouraged to feed her baby in the delivery suite - a mother may need to be shown how to help her baby self latch Both maternal and infant vital signs and assessments can be done in this position Safety considerations are of primary importance - Note to Trainer: (optional) Review safety considerations discussed in previous sessions BBC2: A&P- Slides 19 & 22 BBC4: Predictable Newborn Patterns- Slide 21 Activity 2: Delivery Room/ Biological Nurturing Refer to Session plan for Activity materials, time and instructions Background: This activity is presented In 2 parts referencing the photographs on slides 7 & 8 Note to Trainer: see next slide (8) to debrief this activity Note to Trainer: Hide this slide when printing syllabus handouts 7 Rev. March 2009 7

Recumbent Positions Side Lying
BBC 6: Putting Baby to Breast Recumbent Positions Side Lying Gives mother more rest Less discomfort on perineum Post-op C-Section Baby may be more alert Photograph 101: mother and baby in side-lying position on delivery room table Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Recumbent Positions: Side Lying Positioning option pending assessment of mother’s comfort level May be used in L& D/ Recovery and during postpartum - L&D nurses may be first to teach this position Mother and baby are in facing postures with baby at nipple height - baby is often more alert in this posture - may require additional pillows for support Safety considerations Continuous supervision in case mother is very tired and/or falls asleep Support for both mother and bay including the appropriate use of pillows - do not place anything behind baby’s head which might limit their ability to move away Activity 2 Debrief this activity in 2 phases Part 1: Mother and baby in supine/ biologic nursing position Ask L & D volunteers to guide the group through the steps needed to: help a mother and baby with positioning for baby led self latching complete assessments for both mother and baby in this position Trainers role - encourage group participation in discussion of strategies and techniques - reinforce key concepts for infant led self -latch - review safety considerations Part 2: Mother and baby in side lying position Same as part 1 (see above) Show slide 8 to conclude the debriefing and to reinforce positions options Colson, Early Human Development, 2008 8 Rev. March 2009 8

Side Lying - Variation Photograph: Postpartum mother and baby in side lying position The head of bed is elevated and the mother is supporting her baby with her hand Variation of side lying position When the mother is elevated by the head of the bed a prop behind the baby may be used to raise infant to breast level - instruct mother to use her hand to support baby’s shoulder blades and upper back Note to Trainer: Hide this slide when printing syllabus handouts 9 Rev. March 2009 9

Recumbent Positions Baby Prone on Breast
BBC 6: Putting Baby to Breast Recumbent Positions Baby Prone on Breast Instinctive position Helpful for mother with large breasts Post spinal headache where mother must lie flat Managing overactive milk release which overwhelms baby Photograph 104: 1) mother & slightly older baby prone at breast Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. 2) mother bear supine with cubs prone on her chest nursing Key points for discussion of the use of recumbent positions The recumbent position is not limited to humans - it is a position which allows all mothers the opportunity to rest Also known as the “Instinctual Position” A baby resting prone between breasts may self latch on his own - the mother can help by “wedging breast” between her fingers so baby can grasp teat A mother with large, flaccid breast may find this advantageous as breast recedes towards chest wall - before trying to “shape” the breast observe the baby as he may be able to self latch without assistance - one mothers experience: in this position her nipple was centered in a “pool” of breast and her baby was able to self latch This is a postural solution for over active let down - the baby is less likely to be overwhelmed by fast flowing milk in a prone position 10 Rev. March 2009 10

Under The Arm Position Football/ Clutch Hold
BBC 6: Putting Baby to Breast Under The Arm Position Football/ Clutch Hold Gives infant good trunk and head support Mother can support shoulders and buttocks so the baby’s lips can find the nipple more easily Baby approaches from under breast Good visibility of latch Good for preterm/ low tone baby Provides ventral flexion Photograph 95: mother seated on couch with baby in Under The Arm Hold Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Note to Trainer: Refer to this photograph when explaining the Under The Arm Position The Under The Arm Position. Also known as the Football Hold or Clutch Hold It is a position most mothers have not seen before so she may need help to be comfortable Mother needs to be sitting up straight with pillows available to support her arm and back Baby is hugged to her rib cage and moved far enough back so nose is aligned opposite the nipple - approach from underneath breast Watch for straight wrist: it is important to avoid or not aggravate carpal tunnel syndrome Flex baby at the hips and move buttocks to back of chair / bed - ventral flexion of baby helps organize baby for suckling - allowing soles of feet to touch a firm surface may cause the baby to go into reflexive extension posture and angles baby away from breast - the extension posture may be interpreted by mother as her baby not liking her Mother’s hand should be placed on baby’s shoulder blades to lift baby to her breast (also shown on slide12) - do NOT push the baby’s head on to the breast - the push will cause the baby to reflexively pull back and the baby can develop aversion to coming to breast - in this slide photo the mother could have her hand placed a little lower on the baby’s back Activity 3: Positioning Refer to Session Plan for Activity materials, time and instructions Background: This activity is to be completed in phases as a demo- return demo while showing slides 11-17 11 Rev. March 2009 11

Position Hands Over Shoulder Blades
BBC 6: Putting Baby to Breast Position Hands Over Shoulder Blades Photograph 98: Close up of hand placement on baby’s neck and shoulders Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Reinforcement slide for hand position explained on Slide 11 Mother’s hands need to stay off of the baby’s head Provide support at the base of the skull giving baby’s head some room to be tilted back for chin first approach for latch The baby’s upper back is being supported by mother’s palm and wrist The baby’s neck is resting in the web of the mother’s hand and her fingers are behind the baby’s ears Note that in this photograph the mother’s hand could even be a bit lower Activity 3: Positioning Debrief Activity following each slide demo –return demo by participants Questions to Ask: Is position comfortable? Are mother and baby in proper alignment for latch? Note to Trainer: Hide this slide when printing syllabus handouts 12 Rev. March 2009 12

Under the Arm Position Variation
BBC 6: Putting Baby to Breast Under the Arm Position Variation More comfortable for post-op or mothers with large breasts Pillow used for support of breast and baby Baby approaches from side Could be used for twins Photograph 96: mother sitting up with baby side lying on pillow at her side Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Note to Trainer: Refer to this photograph when explaining the infant side lying variation Variation: baby side lying on pillow A variation for improving maternal comfort for a mother who is: - large breasted - has a large abdomen - post –op and wants no pressure on her abdomen Mother can sit alongside bed and have baby supported on edge of mattress Baby can also be placed on pillow placed on the bed table Issues to consider when using pillows for support Generally pillows are meant to be used once breastfeeding is established Assist mother to “reconfigure” and “realign” her breast to get it to the baby’s mouth - the mother’s hands may become tired trying to hold both her breast and baby - another good technique is to use rolled towels under large breasts if the nipples are too low and just disappear under the breast Position the baby where the nipple IS (depending on size and shape of breast could even be on mom’s lap or below) then allow the breast to “drape” into the baby’s mouth - bring the baby to the breast rather than the breast to the baby - the mother can then use pillows or a rolled towel for support - towels do not lose their shape and are usually more available than pillows in the hospital 13 Rev. March 2009 13

Cross Chest Positions Cross Cradle / Transitional
BBC 6: Putting Baby to Breast Cross Chest Positions Cross Cradle / Transitional Gives baby good trunk and head support Head, neck, chest, hips in straight line Hips in flexion Mother can guide head to nipple easily Easier for women with large breasts & short upper arm Easier than football hold for many women Photograph: mother sitting up with baby in cross-cradle hold Note to Trainer: Refer to this photograph when explaining the Cross Chest Position Cross Chest Position Also known as the Cross Cradle Hold or Transitional Hold Mothers can use this position in public more easily than under the arm holds More closely approximates the cradle hold they often want to use first Cradle hold not a good first hold for most couplets - it is difficult to bring baby close and maintain good alignment and latch For those mothers that have short upper arms and a large breast this position allows for a more supportive hold of the baby Mother should be sitting up straight, flat lap, pillow support for back and lap Key Points to note on photograph Palm support of baby’s shoulder and tilted head position Baby’s chest comes to base of mother’s breast Chin touches area below areola first, followed by lower lip onto areola Asymmetrical latch Hips tucked under mothers arm to provide flexion Mother’s wrist to remain straight 14 Rev. March 2009 14

Cradle or Cuddle Hold Hold most mothers want to try – familiar
BBC 6: Putting Baby to Breast Cradle or Cuddle Hold Hold most mothers want to try – familiar Difficult to control head of newborn and guide to nipple Awkward for mothers with large breasts and short arm Eventually becomes easier Photograph 26: mother seated with baby in cradle hold Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Note to Trainer: Refer to this photograph when explaining the Cradle Hold Cradle Hold Also known as the Cuddle Hold New mothers can be encouraged to latch the baby on using a cross cradle / transitional hold and then once well latched, change arms to use the cradle hold Key Points to note on photograph The baby’s shoulder is at mom’s cleavage and the head resting on her upper arm - many text books are outdate and incorrectly instruct mother to rest baby’s head “in the crook of her elbow” The baby’s body is in good alignment, facing the breast The heel of the mother’s hand serves to support shoulder blades and can be used to guide baby to a chin first approach to the nipple 15 Rev. March 2009 15

Cradle Hold 16 BBC 6: Putting Baby to Breast
Photograph 91: Close-up of seated mother with baby held incorrectly in the in cradle hold The baby’s head is resting on the mother’s forearm Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Ask participants : What’s wrong with this photograph? It is an example of a young baby whose head is free to flop around on mother’s forearm The mother is supporting upper back with a sharp angle to her wrist The mother is probably not supporting baby’s lower torso Note to Trainer: Hide this slide when printing syllabus handouts 16 Rev. March 2009 16

Cradle Hold 17 BBC 6: Putting Baby to Breast
Photograph 92: Mother holding a slightly older baby correctly in the cradle hold Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Reinforcement Slide: correct position using cradle hold Ask Participants: What do you see? Baby’s shoulders are supported with mother’s forearm - baby fills in the space near / at the elbow Mother’s hand is support the baby’s hips The baby is well rotated into mother’s body This baby is 6 weeks old and knows how to latch Note to Trainer: Hide this slide when printing syllabus handouts 17 Rev. March 2009 17

Suck, Swallow, Breathe Activity
BBC 6: Putting Baby to Breast Suck, Swallow, Breathe Activity Activity 4: Suck, Swallow, Breathe Activity Refer to Session Plan for Activity time and instructions Activity Overview This activity should provide the participants an opportunity to stretch between didactic sessions Background information The sequencing of this activity demonstrates the importance of the midline positioning of a baby’s head and neck and the correct body alignment needed to maximize swallowing efficiency Include humor when reading script Debrief Activity The concluding statements are: A baby can suck with his head in any position but proper body alignment with head & neck in midline is necessary for a baby to swallow and breathe comfortably Proper body alignment is essential for maintaining latch and transferring milk 18 Rev. March 2009 18

Latch to the Breast Nose opposite nipple
BBC 6: Putting Baby to Breast Latch to the Breast Nose opposite nipple Support upper back and base of skull Move baby forward at shoulders; allow head to tilt back slightly Hug the baby’s buttocks in close Photograph: baby approaching breast for asymmetrical latch Introduction to Part 2: Latch In the last session we used the term attachment to mean bonding - it also can be used to discuss the attachment of the baby’s mouth to the mother’s breast - some nurses use the term latch-on In Part 2: Latch we will take a closer look at the essentials of an effective latch to the breast Note to Trainer: read bullets for each slide The steps to achieve an asymmetrical latch are explained on slides 19, 20 & 21 Anticipatory teaching: explain to mother in advance, pictures will help her visualize the process The steps for the latch are the same regardless of the posture the mother has assumed for feeding - once mother is comfortably positioned, have her bare her breast - privacy and modesty are important considerations - attach baby at level of breast - allow mother’s breast to fall to natural height - do not attempt to have mother pull breast up high Refer to photograph to explain mother’s hand position - note that the mother’s palm is over the baby’s shoulders and the head is supported at the base of the skull - the baby’s head drops back into web between thumb and index finger 19 Rev. March 2009 19

Latch to the Breast Chin touches breast first Let nipple touch lips
BBC 6: Putting Baby to Breast Latch to the Breast Chin touches breast first Let nipple touch lips WAIT for wide gape with tongue down Photograph: baby tilting head back, wide gape at the breast Steps for asymmetrical latch continued Note in photograph how baby’s chest is up against base of breast Weight of breast on chin and lower lip promotes open mouth Nipple angled towards roof of mouth Encourage mother to wait for wide gape and resist the urge to stuff the breast into the baby’s mouth or let the baby nibble his way up 20 Rev. March 2009 20

Latch to the Breast Baby takes in more of lower areola than upper
BBC 6: Putting Baby to Breast Latch to the Breast Baby takes in more of lower areola than upper Teat lays on tongue and head comes forward Asymmetrical latch If not deeply latched, remove and start again Cheeks should be rounded, no dimpling Photograph: asymmetrical latch Steps for asymmetrical latch continued Note in photograph how baby’s chest is moved into base of mother’s breast by mother’s hands over scapula Do not let baby stay latched if latch is too shallow - this results in nipple trauma and no milk transfer - teach mother to break suction and try again If needed, form the breast into a “Breast Sandwich” by using a “U hold” - keep the fingers and thumb well away from the baby’s mouth 21 Rev. March 2009 21

Latch 1,2,3 Troubleshooting Breastfeeding in the Early Weeks
BBC 6: Putting Baby to Breast Latch 1,2,3 Troubleshooting Breastfeeding in the Early Weeks The Healthy Children Project Refer to Session Plan for DVD Instructions for Use: DVD- Latch 1,2,3: Troubleshooting Breastfeeding in the Early Weeks (5:30 – 11:30) Begin at “Feeding Cues” End where screen says “Speed” Background for DVD The segment of the Latch 1,2,3 DVD that we are about to see demonstrates what you should look for step by step when assessing the latch Note to Trainer: Apologize for the overuse of the term “Ask yourself” in the film, but explain to the participants that each time they hear a question beginning with “Ask yourself…” they should realize that this is an important part of the latch assessment Debrief DVD Ask participants: What was important and interesting to you? Photographs on slide 23 and information on slides provide reinforcement teaching for information introduced in this DVD 22 Rev. March 2009 22

Breast Holds 23 BBC 6: Putting Baby to Breast
Photographs: ) “sandwiching of teat” for latch ) hand placement for football hold (C Hold) ) hand placement for cross cradle hold. (U Hold) Wilson-Clay B, Hoover K. (2005). The Breastfeeding Atlas (3rd edition). Austin, Texas: LactNews Press. Note to Trainer: Hide this slide when printing syllabus handouts 23 Rev. March 2009 23

Signs of Effective Latch
BBC 6: Putting Baby to Breast Signs of Effective Latch Wide angled mouth opening Chin deep into breast – head tilted back Much of areola taken into mouth Lips flanged back by breast Tongue visible under areola Summary slide Signs of effective latch Wait for wide gape If head is not tilted back & leading with chin then move baby forward from behind shoulders More of lower part of areola in mouth than upper areola If lower lip pushed back a little, tongue movement is visible under areola 24 Rev. March 2009 24

Signs of Effective Latch
BBC 6: Putting Baby to Breast Signs of Effective Latch Rhythmic sucking bursts with swallows Mother comfortable – baby relaxed Gliding jaw movements Summary slide Signs of an effective latch continued Audible sucking bursts - with colostral feeds, baby may suckle in bursts of 6 – 8 times before swallowing - with transitional milk feeds (day 3), baby should average 3 – 4 sucks per swallow - with mature milk, a 1:1 suck swallow ratio should be heard during a letdown Mother comfortable and baby relaxed - if mother is having pain with the feeding that persists beyond the first minute, baby should be removed - assess nipple for shape and trauma - and then re-latch baby Jaw movement should be a gliding, rotary movement - choppy, biting movements will cause nipple trauma and poor milk transfer 25 Rev. March 2009 25

Signs of Milk Transfer Swallowing by infant can be seen / heard for much of feeding Mother’s breast is firmer before feeding, softer after feeding Evidence of milk in baby’s mouth Pre and post feeding weights Being able to identify if there is any milk transfer is critical to feeding assessment In the In the immediate post partum period - the volume of transfer is very small (maybe 5 – 15 cc per feed) so audible swallows may be hard to hear - observation of jaw movements may be the only visual sign. Once milk volume increases, swallowing will be more clearly seen and heard Breast changes during feeding will only be discernable once mature milk has started to come in - typically occurs by day 3 – 5 post partum Pre and post feed weights may be a helpful tool if it is clinically necessary to determine the precise Intake and Output of the infant - a digital scale capable of accuracy to the gram would be required - this technique is most often used in the NICU 26 Rev. March 2009 26

The Nurses’ Role: Assisting with Latch-on
BBC 6: Putting Baby to Breast The Nurses’ Role: Assisting with Latch-on Position the mother Position the baby Guide the mother’s hands as needed Have her give a return demonstration Assess and document Develop a care plan This slide is a lead-in to a demonstration by the instructor and an assistant, of the nurse’s role in assisting a mother with latch Note to Trainer: refer to slide information and the DVD clip presented earlier in this session to guide your demonstration Position the mother: slides 5-10 Position the baby: slides 11-17 Latch technique: slides and DVD: Latch 1,2,3 Key Points for discussion of nurse’s role Emphasize that the nurse should not do it all for the mother Guide a mother’s movements as she learns to position and latch her baby - then ask to see an independent return demonstration - most mothers will not initially be able to consistently position and latch their baby - most mothers will need reinforcement teaching Assess and document the type and extent of help needed Develop the care plan for the couplet - one suggestion is for the mother or father to receive a handout “in their own words” - if the nurse has time available she can assist the mother to describe what she is doing - then the nurse, LC or father can write down what words the mother uses and make a “handout” for latch with HER own words 27 Rev. March 2009 27

Early Breastfeeding Management
BBC 6: Putting Baby to Breast Early Breastfeeding Management In Hospital First feeding within first hour Encourage 24 hour rooming in Teach early feeding cues; goal is at least 8 or more feeding attempts per 24 hours Avoid supplementation unless medically indicated Do not put formula bottles in crib for mother to use Discuss the slide bullets for early breastfeeding management First feeding within the first hour the baby will be most alert in the first two hours after birth Encourage 24 hour rooming-in Rooming-in provides opportunities for familiarization between baby and parents Skin-to skin contact enhances familiarization process- more is better ! Teach early feeding cues The goal is at least 8 or more feeding attempts per 24 hours Feedings may be clustered during wakeful periods Avoid supplementation unless medically indicated Use formula only if medically necessary and ordered If supplementation is required, best to first try pumping colostrum and add sterile water to increase total volume to 15 cc Do NOT put formula bottles in crib for mother to use Bottles in crib send wrong the message They are seen as encouragement to feed formula and a confirmation that mother’s milk supply is not adequate Bottles that are readily available makes it easy for parents and nurses to use formula 28 Rev. March 2009 28

BBC 6: Putting Baby to Breast Early Breastfeeding Management Early Weeks at Home Continue feeding 8–12 times per 24 hours; wake infant if necessary; lots of skin-to-skin Feeding should be at least 20–30 minutes of active suck/ swallow Watch for normal breast fullness at 48–72 hours post partum; shift from colostrum to transitional milk Watch for normal stooling and voiding patterns Review discharge instructions listed on this slide 29 Rev. March 2009 29

BBC 6: Putting Baby to Breast Early Breastfeeding Management Early weeks at home Support network for mother & breastfeeding referral for help if needed Rest and good nutrition First well baby visit at 2-3 days post discharge per AAP recommendations Second well baby visit at 2 weeks When mature milk appears (by day 5) baby should gain 1 oz./day Discharge instructions continued Note to Trainer: Advise the participants that some MD’s see the baby at 2 – 3 days then not again until 2 months Recommend that parents should be educated to GO to the MD if they are worried that their baby is not stooling, voiding or feeding appropriately - parents need encouragement to contact their primary care provider any time they have concerns 30 Rev. March 2009 30

Summary Varied nursing positions allow couplet to find the most comfortable and effective Good positioning facilitates an effective latch An asymmetrical latch promotes better milk transfer and maternal nipple comfort Observed swallowing during a feeding and adequate urine and stool output are reliable markers of intake Conclusion: summary of key concepts in this session 31 Rev. March 2009 31

Birth & Beyond California: Breastfeeding Training & QI Project

Similar presentations

Presentation on theme: "Birth & Beyond California: Breastfeeding Training & QI Project"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Birth & Beyond California: Breastfeeding Training & QI Project

Similar presentations

Presentation on theme: "Birth & Beyond California: Breastfeeding Training & QI Project"— Presentation transcript:

Similar presentations

About project

Feedback