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Breastfeeding Pocket Guide for Healthcare Providers

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After Discharge From Maternity/Newborn Nursery Breastfeeding – Key Points Resources • Eight to 12 feedings at the breast should be provided Breastfeeding During Postpartum/Maternal Care Visit: • Ideally, observe breastfeeding and look for signs At Any Visit: every 24 hours, or whenever the baby shows early New York State Department of Health Continue to encourage and support. of how breastfeeding is going. Verify success, anticipate challenges and support signs of hunger such as increased alertness, physical Breastfeeding Promotion Program • Ask about breastfeeding duration and success. prolonged breastfeeding. activity, mouthing or rooting. Crying is a late sign of http://www.nyhealth.gov/community/pregnancy/breastfeeding/ Pocket Guide • Advocate exclusive breastfeeding to 6 months. Signs Breastfeeding is Going Well • Remind mother to give the baby 400 IU of oral vitamin hunger in a newborn. New York City Department of • Be prepared to refer to specific lactation specialists • Baby latches onto areola, not just nipple D drops daily until at least 1 liter or quart of formula or • In the early weeks after birth, non-demanding infants Health and Mental Hygiene and/or community resources when needed. whole milk is given daily. should be awakened to feed if four hours have elapsed • Infant suckles using jaw, not just lips In New York City, call the Women's Healthline at 3-1-1 for Health Care • Refer the mother to a lactation specialist and/or support since the beginning of the last feeding. During the 3-to 5- Day Pediatric Visit: • Infant makes swallowing sound Assess, prescribe Vitamin D, and plan ahead. group whenever needed. Keep referral information in For more information about breastfeeding, visit • Infant can latch on both breasts each exam room. Breastfeeding techniques: Centers for Disease Control and Prevention Be sure to initiate a conversation with the patient. Providers • • Discuss return-to-work plans and breast pump options. • Both breasts should be offered at each feeding for as http://www.cdc.gov/breastfeeding Suggested conversation starters include: Hospital-grade and personal electric pumps are long a period as the infant remains at the breast. The •“How is feeding going?” Signs Breastfeeding is NOT Going Well American College of Nurse-Midwives available through WIC programs and via insurance first breast offered should be alternated with each http://www.gotmom.org • “Do you have any concerns about your breasts or > • 7% infant weight loss from birth weight at 3-to 5-day pediatric visit programs, including Medicaid, in select circumstances. feeding, so that both breasts receive equal stimulation how breastfeeding is going?” Women, Infants and Children (WIC) • Infrequent wet/soiled diapers (fewer than 3-4 urine diapers/24 hrs., • Fluoride supplements are not indicated in New York City. and draining. •“How often is your baby breastfeeding?” fewer than 3-4 stools/24 hrs.) Growing Up Healthy Hotline: 1-800-522-5006 •“How is the milk flowing?” • Pacifiers and bottles should be avoided until http://www.breastfeedingpartners.org • Mother’s nipples are red, cracked (likely due to latch problem) •“Is your baby latching well?” Select Coding Options breastfeeding is well established. U.S. Department of Health and Human Services National Breastfeeding Helpline: 1-800-994-9662 Common Medications that are Compatible with Breastfeeding For Breastfeeding Encounters Nutritional guidelines: If there are signs breastfeeding is not going well, intervene www.womenshealth.gov/breastfeeding Anti- Anti- Diabetes Analgesics • Water and juice are unnecessary for breastfed as necessary, (e.g., provide telephone and in-office support, Feeding problem, newborn 779.3 La Leche League Hypertensives Infectives medications infants and may introduce contaminants or allergens. refer mother to a lactation specialist and/or support group). Feeding problem, infant >28d 783.3 1-800-Laleche (1-800-525-3243) In addition: • Supplements (water, glucose water, formula, and Methyldopa Clindamycin Insulin Morphine and Neonatal jaundice 774.6 http://www.llli.org (Aldomet) derivatives • Reinforce on-demand feeds – and no supplementation Dehydration, neonatal 775.5 other fluids) should not be given to breastfeeding Breastfeeding – Simply the Best Labetalol Ampicillin- Glyburide (infant’s Acetaminophen – will increase milk supply. Weight loss 783.21 newborns, unless medically indicated. Academy of Breastfeeding Medicine sulbactam glucose may be • Remind mothers not to take formula samples, if offered. Blocked milk duct 675.24 • All breastfed infants should receive 400 IU of oral http://www.bfmed.org/ (Unasyn) monitored, but • Remind mother to stay hydrated whenever Breast engorgement, ductal 676.24 vitamin D drops daily beginning in the first few days adverse effects breastfeeding the baby. of life and continuing until the daily consumption of are rare) Nipple infection 675.04 • Discuss benefits of exclusive breastfeeding for the Nipple, sore 676.34 vitamin D-fortified formula or milk is at least one liter Always use commercial-free Nifedipine Fluconazole Metformin Ibuprofen first 6 months of life, and the benefits of continued Supervision of lactation V24.1 or quart per day. breastfeeding materials in your office. (Procardia) Gentamicin breastfeeding through 12 months. Explore barriers, Other specified follow-up exam V67.59 if original • Complementary foods rich in iron should be introduced Consult the LactMed database about specific drugs: http://toxnet.nlm.nih.gov. work through solutions, and provide resources, support problem resolved gradually beginning around six months of age. New York State Department of Health and community referrals. Source: www.aap.org/breastfeeding/files/pdf/CODING.pdf 2963 Produced in cooperation with the NYC Department of Health Rev. 7/10 Health Mothers Can Breastfeed If They… During Prenatal Care: At the Hospital: Provide leadership in breastfeeding support from delivery through discharge. Breastfeeding confers unique • Have Cesarean Deliveries Encourage expectant mothers to Initiate breastfeeding immediately, using a semi-recumbent • Have Pierced Nipples Obstetric Providers: Pediatric Providers: health benefits to infants and breastfeed exclusively for six months. position on the side or sitting up. Remove nipple accessories before feeding to avoid the risk of • Upon arrival to labor and delivery: • Support early latch: • Take Medications infant choking. • Verify HIV status is known at labor • Place baby in immediate skin-to-skin contact to mothers. Health care providers What you say to expectant mothers and their Most medications can be taken while breastfeeding. Consult the • Have an Occasional Alcoholic Drink (mandate rapid test if not known). support early latch and breastfeeding. It is ideal to families makes a real difference. If you recommend LactMed Database about specific drugs: http://toxnet.nlm.nih.gov. Avoid breastfeeding for two hours after the drink. • Check to see that maternal medications are compatible maintain contact for at least 1-2 hours. and staff can play a critical exclusive breastfeeding, more new mothers will • Have Had Breast Surgery • Smoke with breastfeeding by consulting the LactMed Database • The opportunity to breastfeed within the first hour (including breast augmentation or reduction) Counsel mother about smoking cessation and to avoid infant about specific drugs: http://toxnet.nlm.nih.gov. after delivery should occur before the administration breastfeed for longer periods of time. of Vitamin K. • Augmentation mammoplasty: Breastfeed frequently to maintain exposure to secondhand smoke, but breastfeeding is not • Support early latch: role in promoting exclusive contraindicated. It is better to breastfeed than not. • Describe early feeding: Let them know: milk supply. • Place baby in immediate skin-to-skin contact to • Breast reduction: Monitor infant growth since milk supply could • Have Latent Tuberculosis (TB): Have a Positive PPD or support early latch and breastfeeding. It is ideal to • Reinforce that crying is a late feeding cue in a newborn. breastfeeding and increasing • “I encourage expectant mothers to breastfeed be insufficient. Gamma Interferon Blood Test maintain contact for at least 1-2 hours . • Educate mothers that they will make colostrum, a small exclusively for the first six months. I recommend they amount of thick, rich milk after the baby is born which • Breast biopsy involving an areolar incision: Women can compensate If the mother does not have clinical symptoms of activeTB, it is not • Ask pediatric team and nursing to minimize medical duration of breastfeeding. continue breastfeeding through the baby’s first year.” necessary to wait for CXR results before allowing the mother to will increase every day and is exactly what the baby by augmenting production in the unaffected breast, but monitor assessment and interventions for healthy infants until needs. Tell mothers they will feel a change in their infant growth since milk supply could be insufficient. breastfeed. first feeding is attempted. Your counseling and support • “Breast milk is the safest and best food for your baby. • Use Hormonal Contraceptives breasts after 3 or 4 days. Formula just does not give you and your baby the • Have Hepatitis B • Support continued on-demand feeds: • Reinforce to the mother that she is making the right Initiate breastfeeding after infant receives hepatitis B immune Hormones may depress milk supply, but they will not harm efforts should start while same protection against diseases.” the baby. • Encourage rooming-in
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