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Women's & Children's Services ST. P ETER ’S WOMEN ’S & C HILDREN ’S SERVICES EVIDENCED -B ASED BEST PRACTICE FOR BREASTFEEDING Introduction Here at St. Peter’s we encourage and support your decision to breastfeed. Breast milk is the natural and best nutrition for your baby, but the art of breastfeeding takes time and skill. Be patient with yourself and your baby. The St. Peter’s nursing staff is here to support and assist you with learning the skill of how to breastfeed. The experience of breast- Keep in mind that breast- feeding is special for so many feeding is a learned skill. rea sons, including: It requires patience and • The joyful bonding with practice. For some women, your baby the learning stages can be • The perfect nutrition only frustrating and uncomfortable. you can provide And some situations make • The cost savings breast feeding even harder, • The health benefits for such as babies born early both mother and baby or health problems in the mother. The good news is that it will get easier, and In fact, breast milk has dis - support for breastfeeding ease-fighting antibodies that mothers is growing. can help protect infants from several types of illnesses. And You are special because you moth ers who breastfeed have can make the food that is a lower risk of some health unique ly perfect for your problems, including breast baby. Invest the time in your - cancer and type 2 diabetes. self and your baby – for your health and for the bond that will last a lifetime. Colostrum – The Ideal Milk For Newborns Colostrum (First milk your breasts produce) • Will begin to form breasts as early as second trimester • Has a yellow tint (high in carotene-which is a form of Vitamin A) • Produced in small amounts-perfect for baby to learn to suck, swallow and breathe • Low in fat, high in protein, easily digested • Is high in antibodies which protect newborn from bacteria & viruses • Coats baby’s gut, eventually sealing gut to protect baby from pathogens • Acts as a laxative-helping baby expel the tarlike first stool called meconium. (Elimination of meconium helps reduce newborn’s risk of jaundice) Ì Even one bottle of artificial milk can disrupt baby’s gut flora for 2-4 weeks – so we will not offer formula to a breastfeeding baby unless medically indicated. Ì Nurse your baby early (within first 1-2 hours) and often; at least 10-12 times per 24 hours for the first 3 days. How Breastfeeding Works After birth, the delivery of the placenta causes a shift in hormones signaling the breasts to begin making milk. Baby’s sucking on nipple/areola signals brain to release PROLACTIN-a hormone that signals breasts to make milk and OXYTOCIN – a hormone that stimulates small muscles around milk glands (alveoli), to release milk into ducts which lead to nipple openings where baby can access milk. Early milk (colostrum) will change to transitional milk within several days (usually 2-3) after birth. Milk will be thinner, whiter and higher in calories and produced in larger amounts then colostrum. You can encourage this increase in milk by nursing baby early and often (10-12 times every 24 hours). 1 How to Tell Whether Your Baby Is Hungry Cues that your baby will give you which indicate he wants to nurse include: • Rooting, turning the head, especially with searching movements of the mouth • Attempting to bring a hand to the mouth • Sucking on a fist or finger • Mouthing motions of lips and tongue • Increasing alertness, especially REM under closed eyes is also a good time to offer your breast. Ì Crying is a considered a LATE feeding cue – usually after baby has offered more subtle feeding cues (as noted above). Ideally a newborn is held skin-to-skin as much as possible until breast- feeding is well established. Rooming-In – when you are medically able to respond to your infant’s needs, we will have your baby stay with you in your room and then help you to learn your baby’s feeding cues. Rooming-In helps to get breast feeding off to a good start. HUG ME – Benefits of Skin-to-Skin (Infant’s Tummy Against Mother) Positioning • Maintains baby’s body temperature better than blankets or warmer • Maintains baby’s blood glucose-even when he is not nursing • Keeps baby stress free and provides the most restful sleep • Helps orient baby to breasts and babies naturally seek breastfeeding more often • Skin-to-skin positioning with baby’s other parent also provides all these benefits except for breastfeeding benefit • Prolonged skin-to-skin positioning in NICU is called Kangaroo Care 2 How to do skin-to-skin positioning: • Ask for baby to be placed on tummy against mother, on mother’s abdomen or chest right after birth. • RN will dry baby except for forearms and hands and will wipe full term healthy baby’s mouth of mucous • Warm blankets will be placed over mother and baby • All assessments except baby’s weight can be done while skin-to-skin • After first breastfeeding (usually 1-2 hours after birth) baby can be weighed, diapered or bathed if temperature is stable and repositioned skin-to-skin between mother’s breasts on tummy, in diaper and hat, covered with blanket. Positions For Breastfeeding Self Attached – breastfeeding can begin soon after birth (usually within one hour after unmedicated birth, or may take up to two hours if mother had analgesia during labor). The healthy newborn should be dried after birth and placed on the mother’s chest for prolonged skin-to-skin holding, allowing baby to find breast and self attach. Collaborative – breastfeeding begins as the baby offers feeding cues and the mother gently assists baby to find breast. Leave baby’s hands mitten free to observe for cues of tension, relaxation, etc. Positions – include any position comfortable to the mother, which make breast accessible to baby, with baby positioned • Tummy facing mother • Nipple to nose With mother supporting baby’s shoulders (no pressure against back of baby’s head) to allow head tilt and mouth gape. Laid Back Breastfeeding (Biolog ical Nurturing) [Information Sheet Attache d] 3 Options for Positioning Football Clutch Cross Cradle Cradle – (After breastfeeding is well established and baby is latching well) Side Lying – (often preferred by mothers after cesarean birth and/or needing rest) 4 REMEMBER WITH UPRIGHT / • Transitions stools from MOTHER LED LATCH meconium to greenish stool to • Face baby with tummy yellow mustard-colored stool. towards mother • Is back to birth weight by • Baby well supported (with 10–14 days and continues to pillows/or breastfeeding steadily gain support pillow) Seems alert, active and healthy • Bring baby to breast (not breast to baby) Call your Pediatrician if baby not • Nipple to nose meeting goals and call your lacta - • Supporting baby’s upper tion consultant for follow up! back/shoulders Move baby from nipple opposite How to Wake a nose 1-3 inches away from nipple Sleepy Baby Allowing him to gape (open mouth wide) Hold baby skin-to-skin in And then bring baby into breast between feedings to improve quick and close motor & state organization (swaddled babies may not rouse How to know if Baby themselves as easily) is getting enough Offer breast when signs of light sleep are seen, i.e. REM beneath Baby is probably getting enough if: eyelids, small movements of body or other signs that baby is begin - • He is meeting goals on breast - ning to wake up. feeding log If skin-to-skin, without feeding • Breastfeeding 8-12 times a day cues noted by 5-6 hours after (24 hours) birth (or 2+ hours after feeding) • You hear swallowing with then… breastfeeding Try – • Seems satisfied after breast - • taking baby away from your feeding (relaxed hands, not skin offering feeding cues) • change diaper • Has urine and stools appropri - • wipe face or chest with wash - ate for day of life cloth • Urine is pale or light yellow • talk to baby (no brick dust urine after day three) • gently play with your baby’s arms or legs 5 • gently sit baby up supporting Engorgement his head • gently roll baby side to side Primary Engorgement may occur when your breasts have an If sleepy after he begins nursing edema caused by IV fluids admin - try breast massage or compres - istered during labor and a side sion in between sucks or stroking effect of medication. This type of arms, legs or back. engorgement usually occurs with - in the first four days after delivery Alternate Methods of while a milk supply is being estab - Feeding a Medically lished. You will find your breasts will have become taunt and have Indicated Supplement feelings of tightness or fullness. to a Breastfed Infant This usually has nothing to do with breast milk production at this Supplement Nursing time. System (SNS) Secondary Engorgement occurs • Can be used at breast to offer when your milk has come in fully supplement (formula or and you are unable to breastfeed, expressed milk), for baby who cannot pump your breasts or is able to latch and suck at must stop breastfeeding suddenly. breast. Secondary engorgement can be • Can also be used to finger relieved by pumping or breast- feed infant who is not yet feeding. latching. How to PREVENT Cup Feeding Engorgement: • Research indicates the safety • Begin breastfeeding as soon as and efficacy of cup feeding. possible after birth Spoon Feeding • Breast feed often-at least 8–12 times in 24 hours • To collect drops of hand • Let baby nurse until he finishes expressed colostrum if need - each breast-do not limit ed for baby who has not yet baby’s time at breast.
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