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8) • Wide Mouth Latch… 130 ⁰ Maternal & Infant Conditions Maternal & Infant Condition Impacting •Be prepared… 70% of all breastfeeding mothers Breastfeeding in the need additional Hospital assistance with breastfeeding at some point while in the hospital Linda Kutner, RN, BSN, IBCLC, FILCA Common Conditions Seen in the Hospital Sore Nipples Maternal Conditions Infant Conditions •Frequent causes • Infant has a shallow latch • Sore nipples • Late preterm infant • Letting the infant nurse for long periods of • Fluid engorged nipples • Difficulty latching on • Flat nipples time without switching sides… hanging out • Tongue tie • Large breast and/or nipples • • Fussy infant Not holding the breast when using a gravity • Previous breast surgeries position • Problems with previous • To sleepy to nurse, falls breastfeeding experiences asleep at the breast • Using a gravity position while nursing in the • Maternal fatigue • Infant who nurses all night hospital bed • Sometimes tongue tie or bubble palate Sore Nipples Myths & Misconceptions • It’s normal to have sore nipples, everyone does • Is it initial latch-on pain? • You just have to tough it out…. • Should only last for a few seconds • It will get better in a week – or two – or three • Is it pain all the way thru the feeding? • Gradually increase the length of time the baby is at the • Does the nipple look misshapen breast to prevent nipple soreness If the baby is latched incorrectly, nipples will be sore after the infant comes off the breast? regardless of length of time • Is there trauma to the nipple? • “Let the baby nurse until she comes off spontaneously” Prolonged non-nutritive sucking can cause small blisters in first couple of days © 2015/Lactation Education Consultants Maternal & Infant Conditions Suggestions for Sore Nipples Suggestions for Sore Nipples • Massage each breast for about 60 seconds •Breast compressions during the feeding before putting the infant to the breast to will: reduce the initial latch on discomfort • Encourage the infant to nurse more vigorously • This initiates a quicker letdown and gets the • Will help drain the breast so the infant will infant swallowing sooner get more colostrum/breastmilk • Swallowing reduces the negative pressure in the infant’s mouth and helps prevent the little blisters • Help prevent engorgement when the mother from forming at the end of the mother’s nipple goes home Suggestions for Sore Nipples Rational • Watch the infant and when you see his eyes are closing and he •Discourage prolonged “hanging out” first isn’t sucking with much enthusiasm either poke him or shake the few days breast if breast compressions are not working • When you have tried to stimulate him and he still looks like he is Until there is an increase in falling asleep, take him off the breast by breaking suction colostrum/breastmilk the infant can’t stay on correctly and then moving him to the other breast one side indefinitely • Continue to watch him and move him from breast to breast till Once the milk comes in, each swallow he is satisfied releases the negative pressure in the infants • He may nurse as long as he desired, but can’t hangout on one side and give his mother blisters at the ends of her mouth and blisters are no longer a problem nipples Suggestions for Sore Nipples Suggestions for Treatment • After massaging the breasts • Lanolin start on the least sore side first • Hydrogel gel pads • Appropriate positioning • Breast shells Of mother’s body • Bactorban Get her out of bed unless using the • Olive oil laid back method • Anti-infective Of baby’s body properties Positional stability for staph aureus • Verallo-Rowell Perhaps pillows for support (2008) • Wide mouth latch… 130 ⁰ © 2015/Lactation Education Consultants Maternal & Infant Conditions • Doesn’t need to be washed off before Lanolin nursing Bactroban/Mupirocin • Mother feels someone listened to her • Antibacterial and antifungal complaint and took action • Suggest for severely traumatized • Mother is Doing Something nipples to prevent then from becoming infected with staph and possibly • Not sure it actually does a whole lot resulting in mastitis after the mother unless the mother’s nipples are really goes home dry • Use a dab on the nipple after all feedings and/or pumpings • Small study indicated a higher nipple • Rinse nipple with warm water before infection rate (bacteria or yeast) nursing or pumping to make the mother when mothers routinely used lanolin feel “safe” after every feed • Discontinue as soon as nipples heal • Sasaki et al, 2014 Hydrogel Dressings Other Causes • Good for acute nipple trauma • Invaginated nipple • Can become contaminated, especially • Pulled out by baby and with staph friable tissue removed • Good to use in the hospital by nursing • If there has been a break in the integrity of the skin for more than 4 days then staph has moved in • Don’t use on nipples that have broken skin for more than 4 days From Jan Ellen Brown • Use breast shells Other Causes of Nipple Pain Other Causes of Nipple Pain •Mom’s anatomy • Abnormalities in infant oral cavity • • Look at size of nipple in Tongue-tie (anklyoglossia) comparison to baby’s mouth •IMPERATIVE that every baby be evaluated for tongue-tie © 2015/Lactation Education Consultants Maternal & Infant Conditions Bottom Line Engorged Nipples • Result of general all-over edema of the •Sore nipples – mother’s body • • If her ankles are swollen then there will be Determine the cause additional fluid in her nipples making then bigger • Fix the problem than they normally are • THEN give mom something for her nipples • Almost always seen to have a small baby • If she needs to pump make sure she has a 27- 30 mm flange • Lying flat in bed with bra on may help “elevate” her nipples • Suggest diuresing inducing foods she can eat Flat and Inverted Nipples • Try each breast for no more than 5 minutes • Try different positions during that time • Don’t forget to try the laid back position • Cortisol levels start rising in both mother and infant when things don’t go right in a short period of time • No success in the infant latching • Tell the mother… this is the plan when these kind of things happen • Have the mother pump/hand express • Supplement the infant • Usually just a few pumpings/supplementation and infant is able to latch 22 Large Breasts Large Breasts •Women with very large breast worry most of all • Essential that you show then how to nurse safely about suffocating their infants while nursing them before they leave the hospital This is one instance where instead of saying “bring • Can place the infant on the bed and then sit beside • the bed and take the breast to the infant your baby to your breast” we say “take your • Can place the infant on the over-bed table and bring breast to your baby” it close to their body • Use the Kola hold © 2015/Lactation Education Consultants Maternal & Infant Conditions Implants Implants • If they have a periareolar incision they are 5X • Implants are the most common breast surgery you will at risk for a low milk supply see • The collection of saline in the implant can push on the • With all other incisions they are a 3X risk ducts, collapsing them so the the colostrum/breastmilk factor for low supply can’t flow • Getting pumping several times a day (4-6 times) • Ducts and nerves may have been severed during the surgery with lots of gentle massage of the breast • Surgery may have been done because in inadequate breast tissue followed by hand expressing for the first 3 days • These mothers are prone to engorgement Breast Reduction Problems with Previous Breastfeeding Experiences •Can breastfeed but rare to have a full milk supply • • (Chamblin 2006) Find out why she didn’t meet her goal(s) • Most common reason for stopping in the first week or so are: •Problems with unrelieved engorgement • Sore nipples/breasts •May need to use comfort measures • Infant fussy… seen as being unsatisfied •Decision to have a reduction done before any • I didn’t have enough milk consideration of childbearing or lactation • Did she nurse as long as she desired but didn’t enjoy it •(West, 2001; Souto, 2009) because…. • Mothers with several bouts of mastitis or sore nipples • Chronic low supply • Had to pump/supplement/take herbs or medications Suggestions for Problems with Previous In-Hospital Fatigue Breastfeeding Experiences • Mastitis • When rooming-in mothers either of vaginal • Show her how to massage her breasts to pervert milk stasis or c/section delivery tend to ensure that • Deal with nipple trauma quickly their babies have optimal care, at the • Discuss with her how she can get additional rest at home expense of their own needs and desire to • Low supply rest ( Kurth 2010, Lai 2014) • Get the mother pumping to max out laying down prolactin receptors • Using the hands on pumping will empty her breasts and prevent a decrease of • In the hospital they awake on an average of her supply 4 times during the night to feed and/care • Usually these mothers are motivated to try and for their infants (Shrago 1990) prevent recurrence of their problem © 2015/Lactation Education Consultants Maternal & Infant Conditions Late Preterm Infant In-Hospital Fatigue • Must know gestational age • • Gestational age can effect infant’s ability to breastfeed and to initiate and maintain the Prepare women ahead of time for fatigue (Childbirth Class) mother’s milk supply • Women rank fatigue as one of 5 major concerns during the postpartum • Preterm period • Any infant born before 34 weeks regardless of weight • Teach breastfeeding mothers to nurse safely
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