Bailey’s Golden Start Breastfeeding
Curriculum for Nursing Students



Objective 8: Nurses’ role
Objective 9: Positions
Objective10: History and trends
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
Discuss the role of the nurse in assessing and
encouraging the breastfeeding dyad.
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When supporting normal
breastfeeding, suggest the
mother focus on getting
comfortable and give
encouragement rather than
instructions (Mohrbacher,
2010, p. 29).
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U.S. Pediatrician Christina Smillie (2008)
emphasizes to mothers that “there is no
one right way to do this” and focuses
instead on:
◦ Displaying confidence that breastfeeding
will work.
◦ Encouraging the mother to talk to her
baby.
◦ Reassuring the mother that her baby’s
actions are normal (Mohrbacher, 2010, p.
39).
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
Important to know what questions to ask.
◦
◦
◦
◦
◦
◦
◦

Breast surgery history
Past breastfeeding experience
History of sexual abuse
History of hypothyroidism?
History of Polycystic Ovarian Syndome?
Nipple concerns (inversion, flat)
Production concerns
All mothers should be assessed for potential
lactation issues prior to discharge.
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 Infant
Feeding
Cues –
Hand to
Mouth
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
May even root on
inanimate objects –
anything that
brushes against
their check or lips.
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
Would have been best to feed this baby in
the Quiet Alert State, noted in picture 2.
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 Baby
must be ready to feed
 Don’t latch baby when crying
 Tickle lips
 Undress baby (skin-to-skin)
 Proper alignment with mom (belly
to mom; chin to breast, nose to
nipple)
 Be patient
 Quickly pull baby to breast when
mouth is wide open
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

Nipple disappears
Nose and chin close to breast

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What is your
assessment
of this
baby’s
alignment?
What is your
assessment
of this
baby’s latch?
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

Ask mother how it feels: should be a deep
firm pull with out extreme pain
Many women are surprised by the strong
tugging and may not experience it as
pleasant at first
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Replace vague terms as “BF well, fair,
poor”
 IBFAT ( Infant Breastfeeding
Assessment Tool, Matthews)
 MBA (Mother Baby Assessment Score,
Mulford)
 SAIB ( Systematic Assessment of the
Infant at the Breast, Shrago & Bocar)
 LATCH tool ( Jensen, Wallace & Kelsey)

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0
1
2
L
Latch
Too sleepy or
reluctant
No latch
achieved
Repeated attempts
Hold nipple in
mouth
Stimulate to suck
Grasps breast
Tongue down
Lips flanged
Rhythmic sucking
A
Audible
swallowing
None
A few with
stimulation
T
Type of nipple
Inverted
Flat
Spontaneous and
intermittent
24 hours old
Spontaneous and
frequent
24 hours old
Everted (after
stimulation)
C
Comfort
Breast/Nipple
Engorged
Cracked,
bleeding, large
blisters, or
bruises
Severe
discomfort
Full assist (staff
holds infant at
breast)
Filling
Reddened/small
blisters or bruises
Mild/moderate
discomfort
Soft
Non-tender
Minimal assist (i.e.,
elevate head of
bed; place
pillows for
support)
Teach one side;
mother does
other
Staff holds and then
mother takes
over
No assist from staff
Mother able to
position/hold infant
H
Hold
(Positioning)
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Feeding not
observed
"How easily did your
infant grasp your
breast? Did it
take several
attempts?"
"Did you hear your
infant swallow?
How frequently
did you hear it?"
"Do your nipples
stand out or do
they flatten
easily?"
"Are your nipples
tender? Are your
breasts becoming
full and heavy?"
"Did someone help
you put the infant
to breast? Would
you like help with
the next feeding?"
15
 Which
of the following may
indicate a poor latch?
◦ A. Maternal pain
◦ B. Trauma to the breast or nipple
tissue
◦ C. Dimpling of the infant’s cheeks
◦ D. All of the above
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 Keep
the baby next to mother
 Feed
the baby breastmilk
 Keep
the baby “in love” with
the mother’s breast (Pessl,
2011).
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
Breaking the latch

Burping the baby
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 Compare
and contrast various
breastfeeding positions
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
Cradle Hold
Baby needs to be
appropriate size to fit
in the crook of Mom’s
arm without head
falling back too far.
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
Cross Cradle
◦ Provides mom more
control over latching
due to one hand free
to support breast.
◦ Useful for large
breasted or engorged
women due to
supporting breast.
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

“Tee Ball Practice for
babies – “to help hold
it!” (DeJong, 2012) or
like “Training wheels”
for a baby learning to
breastfeed
(Wiessinger)
Helpful with preterm,
late preterm infants,
Down’s syndrome,
anytime needing
more support
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
Under-arm/
Football
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
Side Lying
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
Laid Back Position
◦ Mom uses her body to
support her baby.
◦ Mother leans back in
any chair or in bed and
positions baby prone
on her abdomen.
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 Tips
for any
position
◦ Belly to belly
◦ Nose to nipple
◦ Hips aligned
◦ Use
support/Boppie
Pillow if needed
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
Tips for any position
◦ Provide support for
mom and baby so
mother does not
support the baby’s
weight the entire
feeding.
◦ Emphasize to bring
baby to mom, and do
not let mom lean over
to baby.
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http://www.youtube.com/user/Gerber?v=Q5a
W7xoOOlw&feature=pyv&ad=7361692495&kw
=breastfeeding%20more%3Alabel_breastfeedin
g%20more%3Apregnancy
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Discuss the history and current trends
of breastfeeding and lactation
education in the United States and
internationally
Stanisław Wyspiański,
"Motherhood" , pastel,
1902, National Museum,
Warsaw. Breastfeeding Is
Beautiful by Caitlin Smith
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




When mothers died in childbirth
When mothers were ill
When mothers did not produce
enough milk
When the “medicalization” of infant
feeding became normal
When formula companies wanted to
make a profit
But, survival does not equal optimal
health (Pessl, 2011).
 Remember, formula:

◦ Has no living human cells
◦ May cause GI irritation with possible bleeding
(anemia)
◦ Has excessive protein and sodium


We must re-evaluate our care and look at our
practices
We must consistently question what we are
doing
◦ Are the things we are doing in the best interest of
the mother/infant dyad?
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End of:
 Objective 8: Nurses’ role
 Objective 9: Positions
 Objective10: History and trends
Next:
 Objective 11: Best practices
 Objective 12: Breastfeeding Report Card,
Healthy People, Surgeon General’s Call to
Action
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Health/DeJong
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