Breastfeeding Success Course
Successful breastfeeding
begins with education!
Randy Heninger
LT, NC, USNR
Lactation Specialist
U.S. Naval Hospital Keflavik
A Joke to Start Us Off
A student sat in his Life-Science
classroom, staring at his final
exam, paper. One question stymied
him: “Give four advantages of
breast milk.” His first three
examples:
1. No need to boil.
2. Never goes sour.
3. Available whenever necessary.
But, what fourth example to give??
Suddenly it dawned on him.
4. Available in attractive containers of
varying sizes.
He received an A.
Breastfeeding through time
"Virgin of the Green Cushion"
Solario
"Motherhood"
Angelina and the child Diego
Diego Rivera
Anatomy
Milk Production Cells Mature at Birth of
Newborn
Duct - Carry milk to
Sinuses
Sinuses - hold milk until
breast is suckled or
pumped
Nipple openings - 5 to
10
Anatomy (cont.)
Supernumerary nipple line
Latch
Initial in delivery positively
impacts the long-term success of
mother and infant.
Obstacles
Heavily medicated mother
Narcotics
Cesarean section
Magnesium therapy (pre-eclampsia)
Infant with a 5-minute Apgar score under 6
Premature infant less than 36 weeks gestation
Latch
C/Section
Timing of the milk coming in or concentration of
major milk constituents does not change with type
of delivery.
Most nurse within one hour postoperatively some
even in the recovery room.
Involution of uterus
Less bleeding
Vaginal
Within one hour of delivery of placenta
Oxytocin (pitocin) levels are at their highest
Involution of uterus
Less bleeding
Latch
Stimulating milkejection reflex
(let down)
Nipple stimulation
Roll nipple between
fingers (erect shape)
Lightly stroke breast
from outer to inner
Message from outer
to inner
Latch
Position
Cradle hold
Rest baby on a pillow,
his head in the crook
of your elbow. Using
the C hold (four
fingers under your
breast, thumb on
top), support your
breast with your
other hand.
Latch
Position (cont.)
Cross-cradle hold
This is the cradle hold
with hands reversed. If
you have baby in a righthanded cradle hold, for
example, switch hands:
Your right hand will be
holding your breast, while
baby's head rests in your
left hand, your forearm
along his back.
Latch
Position (cont.)
Football hold
Sit comfortably, with your
back well supported, a
pillow at your side and
partially covering your
stomach. Rest baby on
the pillow, his bottom
near your elbow and his
back against your
forearm. Use one hand to
hold his head and the
other to support your
breast with the C hold.
Latch
Position (cont.)
Side-Lying Position
The lying down position is basically the
same as the cradle hold, but with baby
and mother lying on their sides facing each
other.
Place two pillows under your head, a
pillow behind your back, a pillow under
your top leg, and a fifth pillow tucked
behind your baby. Five pillows sounds like
a lot, but remember a golden rule of
nursing: if mother is comfortable, baby is
likely to be more comfortable, too.
Place your baby on her side facing you,
and nestled in your arm. Slide baby up or
down along the mattress to get her mouth
lined up with your nipple.
Latch
Position (cont.)
Mom’s position
How you sit, how you hold your baby, and how
you offer your breast all affect how the baby
latches on. These facts determine how
comfortable you will be during breastfeeding.
Place one or more pillows behind your lower
back, and/or shoulders so that you are
comfortable and relaxed.
You'll need at least one pillow in your lap to bring
baby up to the level of your breast, and another
under the arm that will support your baby as he
breastfeeds.
If you are sitting in a chair, use a foot stool or
something else to raise your lap so you don't
have to strain or lean over to get baby closer to
your breast.
If you're in bed, put pillows under your knees.
Latch
Latch
Opening wide
Use your nipple to tickle
baby's lower lip to
encourage her to open her
mouth wide--really wide.
As the mouth opens to its
widest point, direct your
nipple into the center and
use your arm behind to pull
baby in very close to you.
Don't lean forward, pushing
your breast toward your
baby; pull her close to your
breast by moving your arm
Latch
How to Get Baby to Open
Wide
Talk to your baby and say
"Open." Show her what to do
by opening your own mouth
wide. Babies can imitate adult
facial expressions.
Help your baby open her
mouth wider by using the index
finger of the hand supporting
your breast to press firmly
down on your baby's chin as
you pull her on. You will
probably need someone else to
do this for you at first.
Latch
Correct latch
Baby's top and bottom lip
should be turned out
(everted). When baby takes the
breast with mouth open wide,
he'll have a "fish mouth" look as
he nurses.
Baby's chin should be pressed
into the breast with his nose
resting on the breast, as well. You
will notice that baby is able to
breathe out the sides of his nose,
even when pressed against your
breast. Babies are designed that
way. If your baby struggles, pull
baby's bottom closer to you.
Latch
Wrong latch-on.
Baby's lower lip should
not be pursed inward,
but should be turned
outward.
However
Great alertness and eye
contact.
Latch
Latch
Suckling
To take in nourishment at the breast and specifically refers to
breastfeeding.
Learned higher brain function vs. sucking which is a automatic
reflex tested for at birth.
Coordination of suck and swallow
Develops during second trimester (swallowing of amniotic fluid).
Infants swallow once every 2-3 sucks. By four days of life once
with every suck.
Obstacles that influence sucking
Narcotics during labor significantly lower rates and pressures
compared to those whose mothers received no medication.
Some studies show that Epidural anesthesia effect feeding
abilities of neonates.
Latch
How do I know
when my baby is
done feeding?
First part of feed,
tight fist grip
Vigorous suckle
Latch
How do I know
when my baby is
done feeding?
(cont.)
Second part suckle is
less vigorous and
there are frequent
pauses
Hand begins to open
Latch
How do I know
when my baby is
done feeding?
(cont.)
Final stage need
more be said?
Latch
How do I know if my
baby is getting
enough?
4-8 stools per day
Meconium birth-3
days
Dark green to
black thick
appearance
6-8 wet diapers per
day
Latch
How do I know if my
baby is getting
enough? (cont.)
Breastfeed stool
from 2 - 4 day of
life on in a term
baby.
Seedy mustard
appearance
Latch
How do I know if my
baby is getting
enough? (cont.)
Swallowing during
suckling
Weight gain!!!
Supply and
Activities of Daily Living
Composition
Colostrum,
transitional and
mature milk
contains:
Proteins
Carbohydrates
Fats
Water
Antibodies
Supply and
Activities of Daily Living
Three stages of milk
development:
1 Colostrum
Provides a boost of
antibodies
Laxative effect that expels
meconium
Establishes lactobacillus
bifidus as predominate
bacteria in the sterile
newborn gut.
Lasts up to day four
postpartum.
1-123cc first 24 hours then
500cc/day by day 5.
Supply and
Activities of Daily Living
Three stages of
milk development
(cont.):
2 Transitional
milk
Up to day 10
postpartum
500cc/day
Supply and
Activities of Daily Living
Three stages of milk
development
(cont.):
3 Mature milk
Starts by day 10-14
750cc by 3 month
(singleton birth)
Can vary between
200cc/day in partial
breastfeeding to
3500cc/day in wet
nurses.
Supply and
Activities of Daily Living
Pumps
Added stimulation
at birth
Poor latch due to
meds and epidurals
etc.
Infant transferred to
Reykjavik for
treatment or
monitoring.
Medela Classic is used
inpatient postpartum
Supply and
Activities of Daily Living
Pumps
Increase milk supply and
milk storage
Work
Sitters
Vacations
Fathers to feed in the middle
of the night
Many others
Rental from hospital is the
Lactina Select (30 days)
Used until personal pump
arrives
Supply and
Activities of Daily Living
Pumps
Recommended
personal pumps
Ameda Purely Yours
160.00 to 199.00
http://www.babybungalow.com/amp
uryourbre.htm
Supply and
Activities of Daily Living
Pumps
Recommended
personal pumps
Medela Pump in Style
Professional
$189.00 as shown
$199.00 w/car adapter
Problems with milk
getting into pump.
http://www.babyproductsrus.co
m/html/pumpinstyle2001.html
Supply and
Activities of Daily Living
Pumps
Recommended
personal pumps
43.95 includes, Stand
Travel Cover, Sealing
Disc, Newborn Nipple,
Spare Diaphragm, 2
Valves
Good control
Sold at exchange and
Viking mall
http://www.babyproductsrus.c
om/html/avent.html
Supply and
Activities of Daily Living
Supplemental Feeds
First an attempt to place
the infant to the breast is
attempted for about 1015 minutes before each
supplemental feed!
Then supplement 1015cc of breast milk or
formula to last infant
about 2 hours.
Supply and
Activities of Daily Living
Supplemental Feeds
Usually are only
needed during first
few days of life to
one week of age.
Cup (easy
inexpensive, fast,
requires baby to
place mouth as they
would for
breastfeeding.
Supply and
Activities of Daily Living
Supplemental Feeds
Finger feeds
Great for fathers to
do!
Positioning is more of
that an infant
breastfeeding.
Quick and amount is
given is easily
controlled.
Supply and
Activities of Daily Living
Supplemental Feeds
Supplemental Nursers
Closest thing to
breastfeeding plus nipple
stimulation
Reinforces bad latching.
Difficult to use without
help
Supply and
Activities of Daily Living
Supplemental Feeds
Each supplemental
feed is followed by
15-20 minutes of
pumping.
Remember to bring
in mature milk at 10
days of life, the
breasts must be
stimulated 8-12
times per day.
Complications of
Breastfeeding
Improper Latch
Break infants seal
and reattempt
latch
Check nipple
shape and size
after seal is
broken.
A crease through
the nipple
indicates an
improper latch.
Complications of
Breastfeeding
Improper Latch
(cont.)
Continued improper
latching will result in
increased pain and
damage to nipple.
Purlentant drainage.
Complications of
Breastfeeding
Improper Latch
(cont.)
Need more be said?
Complications of
Breastfeeding
Plugged ducts and Mastitis
Plugged ducts are caused
by incomplete emptying of
the breast
Can lead to mastitis
Red, warm and tender to
the touch
Can reposition infant so that
the chin is aligned with
reddened or engorged area.
Complications of
Breastfeeding
Plugged ducts and
Mastitis (cont.)
A mastitis untreated
can lead to abess
formation.
Obstacles with Breastfeeding
Special considerations
Mastectomy or breast
reduction
Depending on how
much functional breast
tissue is remaining
breastfeeding should be
possible.
Will take more effort
and time before the
fullest supply that can
be will come in
Pumping for additional
stimulation is the key!
Obstacles with Breastfeeding
Special considerations
Pregnancy and Breastfeeding
Milk supply will naturally decrease
with pregnancy due to increased
estrogen levels, supplementation
may be necessary.
Nipple stimulation can cause preterm contractions that can lead to
pre-term labor.
Our OB says breastfeed the baby
until 3 months old or complications
with the above occur.
Breastfeeding is not a reliable form
of birth control.
Obstacles with Breastfeeding
Special considerations
Flat or Inverted
nipples
The goal is to get the
nipples to become erect
so the infant can gain a
proper latch.
Finger rolling can relax
the nipple enough to
become erect.
Using a pump for 2-4
minutes can produce
similar results.
Obstacles with Breastfeeding
Special
considerations
Drying up milk
supply
Cold cabbage leaves
work well for this
purpose.
Best is gradual
weaning of infant as
infant declares that
they no longer need
or want the breast.
Obstacles with Breastfeeding
Special considerations
Cesarean section
Anesthesia used.
Type of recovery.
Reason for section.
References
www.americanbaby.com
www.breastfeeding.com
www.askdrsears.com
www.about.com
www.gotmom.org
Lawerance, R. M., (1999), Breastfeeding; A guide for
the medical professional, (5th ed.), Boston : MA.