Mother-centred teaching BF info
What does she already know? - check understanding as we go Simple language, no jargon Hands-off approach leaflets/doll/model breast ect. appropriate body language document findings/ events
Breastfeeding; physiology
Breastfeeding is regulated by hormones breastfeeding initiation + milk supply all hormonal Oxytocin - Prolactin - milk Stimulus must be upheld to stop production of FIL (BM is supply and demand)
What is FIL
feedback inhibitor of lactation
Lobules
Tiny, grape-like sacs (alveoli) grouped together that produce milk
Ducts
Tubes that drain milk from the lobules and transport it to the nipple
feedback inhibitor of lactation
protein in the milk which alerts the milk producing cells to stop producing milk if the breasts become full Stops milk production fully if not a need to continue, advise women stimulate always to inhibit FIL
Oxytocin
Works the muscle cells causing them to contract ‘let down reflex’ producing prolactin
Prolactin
Switches on the milk-producing cell through stimulation of the breast
Stimulating oxytocin
Skin to skin Gentle massage of the breast A reminder of the baby (NNU/separation))
When should you first introduce ideas of hand expression
Antenatal, community appointments
Why do we hand express?
enticing the baby, increase milk supply, slow weight gain in the baby, preterm baby/separation
How to hand express?
massage breasts
c shape by nipples
compress breast for milk flow - if not working make way up breast
rotate fingers
if supply stops/slows move to next breast
Frequency of expression
Full replacement - 10x in 24 hrs
cluster express
at least once at night, express following a feed to increase supply
Jaundiced babies?
Reassure
Top up with EMB post breastfeed cup/syringe/spoon
Storing EBM
At home
Refrigerator: 2-4 C / 8 days (hospital -24hrs-48hrs)
Ice compartment: 2 weeks
Freezer: 6 months
Thawing of EBM
Slowly in fridge for up to 12hrs or at room temperature
Do not use a microwave
Why should women breastfeed?
Baby: reduced obesity, SIDs, diabetes, dental problems and gastroenteritis and respiratory infections, higher intelligence
Mother: reduced diabetes, breast and ovarian cancer, postpartum depression
emotional attachment for mother and baby
supporting LSCS and sore nipples?
Ongoing skin to skin contact
Support with positioning and attachment/???nipple shields
Reassure mother/ IFT and community support
Hand expressing and colostrum feeds
neonatal vitals (if necessary) to ensure wellness
mother-centred approach to teaching pratical skills of BF
what the mother already knows
Explain effective positioning and attachment
no jargon, simple language
hands off approach
Make good use of leaflets/doll/model breast etc.
Check the mother’s understanding.
Use appropriate body language
Document
three key constituents of BF are NOT in IF
- Growth factors help growth and development of the baby’s gut
- Enzymes aid digestion and destroy bacteria
- ‘Lactoferrin’ aids absorption of iron and has an antibacterial effect
- The antibody IgA provides protection against the mother’s past infections and the baby’s immediate environment
- White cells destroy bacteria
What can be done to ensure breastfeeding gets off to a good start (physiology)?
‘golden hour skin to skin = early, frequent, effective feeds
feeding cues + responsive feeding
avoid supplements
link with oxytocin + FIL
Why is the UKs breastfeeding rates so low?
misconception that IF is nearly as good as BF
Lack of support - family, midwives, returning to work, lack of positive role models
Advertisement of formula - ‘hungry babies’
Why is skin-to-skin important?
thermoregulation
Good start to breastfeeding
Bonding
Calms mother and baby
Regulates heartbeat and breathing
increases positive baby biome
