Postpartum Doula Program

International Childbirth Education Association

Comprehend the benefits of breastfeeding to both mom and baby. Identify the basic breast anatomy, and the hormones involved in breastfeeding. Explain what a good latch looks like. Understand and be able to explain common breastfeeding issues.

ICEA Copyright 2015 More Than Just Food Breastfeeding: A system of newborn care ◦ Food + Protection Warmth for newborn Emotional and physical security and safety for both Immunity from bacteria, viruses and fungal infections Protection for mom and baby Economic food security

Less work time missed More sleep Decreased incidence of breast cancer, ovarian cancer, osteoporosis and diabetes Increased mothering skills and confidence Less environmental waste

ICEA Copyright 2015 Benefits to Baby Increased IQ scores Decreased risk of: ◦ Childhood leukemia ◦ Celiac disease ◦ Incidence and severity of allergies and asthma ◦ Ear infections ◦ Respiratory infections ◦ Meningitis ◦ Childhood obesity ◦ Diabetes Less SIDS in infants

A – Be pregnant! Your body knows to get ready to feed the baby after birth! Colostrum begins production about halfway through the pregnancy- the first meals are ready for your baby!

Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation Management. ICEA Copyright 2015 Lactation Hormones Hormones of Lactation Prolactin stimulates the alveoli to extract nutrients from the blood vessels and make human milkpromotes calming Oxytocin contracts muscles surrounding the alveoli to cause “letdown”-promotes nurturing feelings and behaviors

“ skin to with their mothers immediately after birth and remain there with minimal disruptions throughout the recovery is feeding period until the first accomplished.” Skin to Skin With Your Baby The best start for baby and breastfeeding

Mother’s temperature rises to keep baby warm! Less newborn crying Improved oxygen levels in the newborn Less initial weight loss Better weight gain in the first weeks Enhanced early breastfeeding

Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007.

ICEA Copyright 2015 “How to” Skin to Skin Holding Infant upright, tummy to chest Infant naked or a diaper Mother no bra or camisole Cover both with blanket or gown For initial – remain together until infant self- attaches For encouraging breastfeeding remain skin to skin at least 30-60 minutes and showing cues

ICEA Copyright 2015 Benefits of Colostrum Richer in protein to maintain blood sugar levels Higher in vitamins and minerals Higher in immunities to prevent infections Concentrated form designed for the first days Laxative effect to clear meconium and excess bilirubin Milk does not “come in” first milk-colostrum is present at birth! Colostrum “changes-over” to mature milk in 2-5 days after birth ICEA Copyright 2015 Exclusive Breastfeeding Give your baby only your milk unless medically indicated.

Keeps your baby’s intestines healthy Builds newborn’s immune system Reduces the chances of allergies Helps assure milk supply

Bartick M, ReinholdA. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56

ICEA Copyright 2015 Signs of a Good Latch Mouth wide open Lips flanged back Full, round cheeks Nose and chin touching your breast Sucking bursts and pauses Listen for swallowing Feel tugging sensation No biting or pinching sensations No clicking/smacking sounds

ICEA Copyright 2015 Asymetric Latch Start with nose to Mouth comes “up and nipple over” to attach far back Mother’s hand on on the breast shoulders and back - Nipple is in the top half not pushing head! of the mouth- available Allow head to tilt space tongue is the back bottom half of mouth Mouth opens widely Attachment is “off Chin and bottom lip center” further down on are first to the breast the areola, more areola visible above the top lip Cadwell, K. and Turner-Maffei, C. 2013. Pocket Guide For Lactation ICEA Copyright 2015 Management. Mothers and babies belong together!!!

ICEA Copyright 2015 Breastfeeding Positions Newborn’s instinctive position: head and body in alignment (straight line between ears, shoulder and hip), chin not on chest (slight backward head tilt), hips flexed Bring the baby to the breast- not your breast to the baby! Back and shoulders relaxed and supported. Cradle, cross cradle, side hold or side-lying?

No “right” or “correct” position -- whichever is best for you and your baby!!!

ICEA Copyright 2015 ICEA Copyright 2015 Frequency in Feedings 1st 24 hours: about 8 feedings, each about a teaspoon colostrum. More frequent if skin-to-skin. 24-48 hours: 8-10 feedings. 3-4 days: increasing to 8-12 times/24 hours as milk volume increases Cluster feedings!!!!!! Length of feedings: offer the 1st breast until finished, then offer the 2nd. No time limitations!!! ICEA Copyright 2015 Feeding Cues Baby Cue and Stage of Readiness

Wiggling - Early Rooting – Early Fussing - Mid Body moving - Mid Active Crying - Late

Watch the baby Not the clock!!!

ICEA Copyright 2015 Supply and Demand “Request and Supply” Communication between each Mother and her baby sets the amount of milk made Important in the first days and weeks to establish each mother/baby unique needs Avoid pumping if not separated from your baby or your milk is needed for supplementation Avoid unnecessary supplements for best milk supply

ICEA Copyright 2015 After the Hospital Is my baby getting enough? 8-128-12 feedings/24 hours Can hear swallowing of colostrum or milk Urine is pale in color Initial weight loss no more than 7%, stops loosing weight by 5 days and back to birth weight by 2 weeks. IV Therapy effect- IV fluids may increase initial weight, cause increased urine and weight loss “milk drunk” not related to feeding

Day 1-2- 1-2 wet and 1-2 stools/24 hours Day 3 - 3 wets and stools with stools changing to brownish green Day 4-5 - with filling of the breasts, increases to 3-4 wets and at least 4 stools, changing to golden yellow Day 6 - 6-8 wets with 3-4 unformed yellow seedy stools

Too little or no stools call care provider

….. and prevention ICEA Copyright 2015 Low Blood Sugar Usually defined as: <40 mg/dl Prevention: ◦ Skin-to-skin for warmth ◦ Early colostrum feedings ◦ No limiting of early feedings ◦ Avoidance of “sugar waters”

USBC 2008 Achieving Exclusive Breastfeeding in the United States: Findings andICEA Recommendations Copyright 2015 Jaundice High levels of bilirubin in infant’s blood Yellowing of skin and eyes Prevention: Nurse within 60-90 minutes after birth Frequent, unlimited feedings of colostrum (laxative effect) Schedule appointment with your baby’s Dr. in 3-5 days

Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of humanICEA Copyright milk. Pediatrics 2015 2005;115:496–506 Sore Nipple

Causes: Improper latch and not feeding on cue Prevention: No scheduled feeds- feed on cue with correct latch First line of defense Correct the latch! Asymmetric latch Observe for tongue tie Review feeding cues

ICEA Copyright 2015 Engorgement What is it? Abundant milk and increasing fluid in the breasts Causes: Inadequate emptying of the breasts or over- stimulation with over-production or use of IV fluids Prevention: Feed frequently with baby’s cues, avoid scheduling or skipping feedings Filling (rounder, fuller, firmer) is normal!!! Rock-hard, hot, overly-full is not normal!!!!

If infant unable to latch – may express a small amount, but only enough to soften the nipple/areola before feeding “Hang” breasts in tepid water, sink or basin, for gravity emptying. May add massage to move milk forward. Repeat as often as needed until softened and infant can latch easily Shower with water on back- flowing over breasts Discontinue unnecessary pumping

Causes: ◦ Too tight or extended wearing of bras ◦ Sleep position with pressure on the breast ◦ Inadequate emptying of the breasts: missed feedings, scheduled or timed feedings Symptoms: Localized redness, tenderness, warmth and pain Treatment: ◦ Warm compresses and massage before a feeding ◦ Usually resolves with in 24-36 hours

Symptoms: fever, flu-like symptoms, may have red streaks on the breast Causes: cracked nipple, plugged duct, over supply, not regularly emptying of breasts Call Dr. or Midwife! Continue to breastfeed!!!

ICEA Copyright 2015 Nutrition for Breastfeeding Old wives tales- no garlic, onions, chocolate, beans, citrus- not true! General guidelines- well balanced diet- veggies, fruit, whole grains, lean meats Adequate fluids and water - drink to thirst- do not force fluids Avoid fad or severe calorie restriction diets Opportunity for family education on nutrition and healthy eating habits Minimize hormone/chemical additives

Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the MedicalICEA Profession, Copyright 7th 2015 Editi on, Maryland Heights, MO: Elsevier Breast Pumps Hospital grade pumps- if you are separated from your newborn. Add hand expression for more milk! Manual pumps- economical Double pump- for return to work or school

Remember! No need to begin pumping for 2-3 weeks, unless separated from your baby!!

Human Milk Banking Association of North America (HMBANA) (2011).Guidelines for the establishment and operation of a donor human milk bank. Fort Worth, TX: HMBANA, accessed http://hmbana222.org

ICEA Copyright 2015 Information on Breastfeeding BOOKS ◦ Ina May’s Guide to Breastfeeding by Ina May Gaskin ◦ The Womanly Art of Breastfeeding by La Leche League ◦ The Breastfeeding Book by Dr. William and Martha Sears

Cadwell, K. and Turner-Maffei,er-Maffei, C. 2013.2013. PocPocketket GGuideuuideide ForFor LLactation Management. Jones and Bartlett Learning. Burlington, MA Early skin-to-skin contact for mothers and their healthy newborn infants. Review article Moore ER, et al. Cochrane Database Syst Rev. 2007. National Alliance for Breastfeeding Academy. (2012). NABA REAL Code Monitoring. Retrieved May 28, 2012, Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007–2008. JAMA 2010;303:242–9. White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation. Washington, DC: The White House; 2010. Available at http://www.letsmove.gov/whitehouse-task-force-childhood- obesity-report-president. Accessed June 30, 2011. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics, 2012 Lawrence, R.A. & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession, 7th Edition, Maryland Heights, MO: Elsevier

ICEA Copyright 2015 Joint Commission. Specifications manual for Joint Commission National Quality Care Measures: perinatal care.Available at http://manual.jointcommission.org/releases/TJC2011A/PerinatalCare.html. Accessed May 20, 2011. CDC. Breastfeeding report card—United States, 2011. Atlanta, GA: US Department of Health and Human Services,CDC; 2011. Available at http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed August 1, 2011. US Department of Health and Human Services. The Surgeon General’s call to action to support breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011 CDC. Breastfeeding among U.S. children born 2000–2008, CDC National Immunization Survey. Atlanta, GA:US Department of Health and Human Services, CDC; 2010. Available at Http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed July 8, 2011 Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048–56. US Department of Health and Human Services. Healthy People 2020: Maternal, Infant, and Child HealthObjectives.Availableathttp://www.healthypeople.gov/2020/topicsobjectives2020/o bjectiveslist .aspx?topicid=26. Accessed May 20, 2011 DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122:s43–9.

ICEA Copyright 2015 Academy of Breastfeeding Medicine- .www.usbreastfeeding.org breastfeeding protocols United States Breastfeeding Committee- USbreastfeeding.org – Core Measure and Basic Competencies Tool kits Baby Friendly USA- www.babyfriendly usa.org American Academy of Pediatrics- Policy Statement on Breastfeeding http://pediatrics.aappublications.org/content/129/3/e827.abstract?sid=fc620c15-8dc14ae4- 8e98-133e4f67f84d Centers for Disease Control and Prevention- http://www.cdc.gov/breastfeeding/ Wellstart- Resources for physician education- http://wellstart.org/ White House Task Force on Childhood Obesity - http://www.letsmove.gov/whitehouse- task-force-childhood-obesity-report-president American College of Obstetrics and Gynecology- Breastfeeding http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health% 20Care%20for%20Underserved%20Women/co361.pdf?dmc=1&ts=20130130T13323 59887 Department of Health and Human Services- Healthy People Goalshealthypeople.gov/2020/topicsobjectives2020/ebr.aspx?topicId=26