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About me
• RN and International Board Certified Lactation Consultant
• Owner of Arlington Lactation• Special interest in tethered oral
tissues and the breastfeeding dyads• Former L&D nurse• Clinical Research Coordinator in
pharmaceuticals• Clinical faculty at Georgetown Univ.
Take home messages
1. Breastfeeding was simple before we started making it complicated2. The ability to breastfeed is innate and dependent upon
uninterrupted mother-baby interactions3. Birth practices influence breastfeeding outcomes4. What we say and what we do MATTERS
Breastfeeding was simple before we made it complicated
Public Domain; Wikimedia Commons Raja Ravi Varma The Suckling ChildPublic Domain; Wikimedia commons
Shift from births at home to hospital birth
By McTaggart, James, Photographer (NARA record:
) i l hi
Forgot what is normal.
•Human milk is the biological norm
•Breastfeeding is normal feeding
•Normal breastfeeding begins with normal birth
Normal sequence of behaviors at birth
• Birth• Skin to skin on mother’s chest• Rest• Kick & schooch• Salivate• Mouthing movement• Seeks areola• Opens mouth wide• Latches
•Show Global Health Media video (free)•Early Initiation of Breastfeeding –Breastfeeding Series
•Begin at 4:26 •Found at https://globalhealthmedia.org/portfolio-
items/early-initiation-of-breastfeeding/?portfolioID=10861
Normal newborn behaviors (start @4:26)
http://med.stanford.edu/newborns/professional-education/breastfeeding/early-initiation-of-breastfeeding.html#t=06:24
•Show Global Health Media video (free)•Early Initiation of Breastfeeding –Breastfeeding Series
•Begin at 6:16 •Found at https://globalhealthmedia.org/portfolio-
items/early-initiation-of-breastfeeding/?portfolioID=10861
Maternal expectations
• Most mothers are not prepared to experience any difficulties or problems when breastfeeding their first baby (Colin, 2002)
• New mothers assume it will work
• Little preparation for breastfeeding.
• Expect they will learn it in the hospital
Maternal expectations
• When problems arise mothers blame themselves for lactation failure rather than the hospital system that may have contributed to it.
• Birth impacts breastfeeding
• What we say and do can change outcomes
Labor practices undermine breastfeeding
• Bedrest and continuous EFM• Supine positioning• IV fluids• Induction/augmentation• Analgesics• Instrument birth• Cesarean birth
By JennaRich (Own work) Wikimedia Commons</a>
• Lower suckling scores are linked to epidural use• Delayed first feeding at breast• Disorganized sucking coordination leads to encouragement to use
formula• Infant weight loss impacts BF Mom hears “she’s not making enough
milk” vs my baby isn't sucking well.• Formula use in the early weeks are associated with early
breastfeeding cessation
Pitocin
• Oxytocin increases parasympathetic system and serotonin
• Natural benzodiazepine• Decreases pain• Synthetic pitocin (IV or IM) interferes
with natural oxytocin• Lower circulating oxytocin levels• Higher cortisol levels = stress Highest
among group receiving pitocin and epidural
• Encourages fluid retention
IV fluids
• Postpartum edema• Delays lactogenesis• Latch on difficulties
and milk expressionby Day 2
Vacuum assisted births
• Exerts excess mechanical forces on the infant’s head
• Disrupts bony structures• Vacuum elevate the palate• Affects suck coordination
Cesarean birth and breastfeeding
• Increased risk for insufficient milk
• Delayed milk • Risk early termination (Dewey
2003).• Mother infant separation• Delayed suckling• AAP recommends initiating
preventative measures within first 3 hours to reduce risks
Steps to support breastfeeding Recognize the impact of common labor and birth practices on newborn skillsEncourage frequent feedingsHand express after each feeding to stimulate milk supply or “phone in your order for Day 3”
"Hand expression will help ensure that by the time you go home, your production will be higher.”
This will make it easier for your baby to learn just how to breastfeed and get a full feeding.
Encouragement is key. Early intervention makes a difference
A few gems to support breastfeeding
• Avoid labeling “lazy feeder”• Avoid labels “Whimpy White
Boy”• No Smush & Push• Don’t assume that flat nipples =
latching difficulties• Always ask before touching
mother’s breasts
Normal is uninterrupted skin to skin contact• Cry less (less exertion)• More stable temperature• Higher blood glucose• Feed better• When positioned prone,
stimulates feeding behaviors and opening wide
Skin to skin in the first hour
• Perform initial physical assessment and Apgar with baby skin to skin
• Weight should be done after first breastfeeding
• Eyes & Thighs performed while feeding
• Breastfeeding is natural pain reliever (oxytocin)
Hand expression at first feeding video clip
•Show Dr. Jane Morton’s video (free)•Successful Breastfeeding Begins Right at Brith•Begin at 8:50 •Found at http://med.stanford.edu/newborns/professional-education/breastfeeding/breastfeeding-in-the-first-hour.html#t=8:50
http://med.stanford.edu/newborns/professional-education/breastfeeding/breastfeeding-in-the-first-hour.html#t=8:50
Steps to ensure solid start to breastfeeding
• Encourage & compliment mother• You have exactly the right
amount of colostrum for you baby right now
• Keep your baby with you day and night
• Feed frequently skin to skin• Hand express
Spoon feeding video clip
•Show Dr. Jane Morton’s video (free)•Successful Breastfeeding Begins Right at Brith•Begin at 5:29•Found at http://med.stanford.edu/newborns/professional-education/breastfeeding/breastfeeding-in-the-first-hour.html#t=5:29
Encourage hand expression (video)spoon feed
Case study
• G3 NSVD term baby• Skin to skin; infant temperature 97.6• Blood sugar was 37; No other symptoms of hypoglycemia• Baby remained skin to skin• Nurse assisted with hand expression, collected approx. 2-3ml into a
spoon and fed baby• Re-latched baby; covered with warm bath blanket• Blood sugar was 56; temperature 98.8
Breastfeeding is a natural pain reliever
• Perform painful procedures while baby is skin to skin or latched
• Best practice is to have baby latched or feeding for at least 5 minutes
• They will not cry• Have you ever noticed that
during a perineal repair mom is less aware if breastfeeding?
Hand expression for engorgement
• Swelling and distention of the breasts in the early days caused by vascular dilation as well as the arrival of early milk
• Alveolar distension • Compression of surrounding ducts• Vascular and lymphatic compressions
• Peak 4-6 days postpartum• Second time mothers experience
engorgement sooner but resolve faster
Lymphatic system• Fluid tends to accumulate • Tight fitting bra may constrict
lymphatics and trigger fluid collection
• Maya bolman, Theory and practice of lymph drainiagetherapy: an osteopathic lymphatic technique B. Chickley 2011
Hand expression relieve breast engorgement
• Managing engorgement important for longer term breastfeeding success
• Severe engorgement associated with early weaning.
• Soften the nipple with revere pressure softening and “dancing finger”
• And breast massage AWAY from the nipple
https://goo.gl/q9LhJk
•Show Maya Bolman’s video•The Basics of Breast Massage and Hand Expression
•Begin at 2:50•Found at https://vimeo.com/user17150498
Breast massage tips and tricks
• For periareolar edema, soften the nipple/areolae with “dancing fingers”
• Start with gently fingertip massage within the areola to reduce swelling. Alternate RPS and fingertip massage
• Gentle stroking breast massage from the areola to the armpit
• Oil can reduce friction• Swelling reduced and breasts are softened
• Hand expression