Evaluating A Breastfeed

8/7/2019 Evaluating A Breastfeed

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Rowaida Al-Khalil/IBCLC/UAE/2006

Evaluating ABreastfeed

Presented by:

Rowaida Al-Khalil

BSN-IBCLC-Senior Nursing Tutor


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Objectives

At the end of this presentation the audience willbe able to:

Observe a breastfeed

Evaluate adequate attachment for feeding .

Evaluate the babys suckling behavior at thebreast.

Assist mothers who need help withattachment.


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Somethingas naturalas

breastfeedingshouldjusthappennaturally shouldn'tit?Forhumankindtohave

survivedoverthecenturies,

babieshaveneededtobeabletoattachtotheirmothers'breastsandmusthavedoneso. Yetinour

societytoday,attachmentproblemsseemtobeverycommon.


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Could it be that we have lost theadvantages of the extended family or

village groups where young girls wouldhave observed and assisted mothers,

aunts, or sisters who were

breastfeeding. They also would havehad the assistance from them whenthey in turn had their own babies.Many new mothers today may have

never handled young babies let aloneseen one being breastfed.

The art of attaching a baby to the

breast is therefore a skill to be

learned.


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Observing a Breastfeed

While the mother isbreastfeeding her

baby quietly observewhat is happening and

record theinformation .

What to look for whenobserving a breastfeed :

Signs that the baby isattached for effectivesuckling .

Signs that the baby is

suckling and the milk isflowing .

Signs that the mothermay need help.


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Evaluating Attachment

A good attachment :

The babys mouth is openwide.

The babys chin is touchingthe breast.

The babys lower lip iscurled upward.

The babys head is tiltedslightly back.Hold is firmly againstshoulders


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Evaluating Attachment

Signs that the baby is poorly attached :

The nipple looks flattened or striped as it

leaves the babys mouth at the end of the

feed.

The mother feels pain in her nipples during

and after the feeds.

The mothers breast may be engorged due to

inefficient milk transfer.


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Evaluating infants sucklingbehavior at the breast

Listen for a suck-swallow-breathpattern

Audible swallowing is one the most importantevaluation criteria.


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If the non nutritive sucklingpattern is observed throughout

the entire feedbaby is not

attached well


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The Nurses Role in AchievingEffective Latch-on

Watch for early readiness cues

Assist with latch-on

Determine if suckling iseffective .


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Clinical Management topromote effective suckling

Basic positions for the mother

Body position of the mother

Maintain good posture

when back is straight the nipples are

in a position where the newborncan best achieve a good latch-on

Remind mother to relax hershoulders.

Bring the baby to the breast , not

the breast to the baby. Offer pillows to support the

mother's arm or the infant. Helpreposition the mother if necessary


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Basic positions for the mother

Hand position for the mother

The mothers fingers should be well away from the

areola they should not occlude the lactiferous

ducts.


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asic positions for the newborn

The babys whole body is facing the mother andtucked close to her (chest-to-chest and not

chest-to-ceiling )The babys head is supported ,in a straight linewith his body, and facing the breast.

Hold the infant at the level of the nipple .

The infant's lower arm, if not swaddled, should

be around the mother's thorax

The infants head should rest on the mothersforearm and NOT on the antecubital fossa.

Often, the fathercan assist the motherwith the positioning

of the infant,particularly if she is

recovering froma caesarean delivery.


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Breastfeeding environment

The mother and infant should be allowed to

breastfeed in a relaxed and supportiveenvironment. Personnel should be readilyavailable to facilitate the process.Constant interruptions and a deluge of

visitors may disrupt the earlybreastfeeding experience.


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asic positions for thenewborn


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Assisting the mother withattachment

Wash your hands thoroughly.

Arrange for privacy.

Help the mother to find the mostcomfortable position and ensurethere are several pillowsavailable.

Work with the mother at the eyelevel.


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Help the mother to position thebabys body:

Head and body are at the breastlevel.

Babys body aligned from the

shoulder to the iliac crest. Baby is flexed and relaxed. The babys whole body is facing

the mother and tucked close toher (chest-to-chest and notchest-to-ceiling )

Help the mother position the babyshead:

Be sure there is no pressure onthe back of the babys head

Head supported but NOTpushed in against breast.

Head tilted back slightly.

Head facing breast (NOT turnedlaterally , hyperextended ,orhyperflexed).

infants head should rest on themothers forearm and NOT onthe antecubital fossa.


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Ask the mother to support her breast inplace during the feeding with her hand (C-

hold ).After the first week , the mother should beable to get the feeding started and thenlet go ,unless her breasts are unusually

large.


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Teach baby to openwide/gape :

Move baby towardbreast, touch top lipagainst nipple

Run nipple along thebabys upper lip, fromone corner to the other,

lightly, until baby openswide. Repeat until baby opens

wide , as if yawning, andhas tongue forward


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Teach mother to establishproper areola grasp:When the baby opens hismouth wide and his tongue

comes forward over his lowergums bring him quickly to thebreast with the mothersnipple pointing to the roof ofhis mouth. His first point ofcontact will be his lower jaw

or chin well down on theareola.As his mouth closes over thebreast he should take in alarge portion of the areola.


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A proper areolar grasp Infants mouth opens widely

to cover lactiferous ducts. Lips flanged outward. Complete seal formed around

the areola :strong vacuum. Approximately 1.5 inches

( approximately 3.5 cm ) ofareolar tissue is centered in

infants mouth. Tongue is troughed and

extends over alveolar ridge.

star again.

If the baby is notattached well, or if themother feels painshe

should break the suctionby gently inserting herfinger into the corner ofthe babys mouth ,andstart again.


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Evaluate areolarcompression

Mandible moves

in a rhythmicmotion .

Tongue cuppedand troughed.

Checks full and

rounded whensucking .

Evaluate audibleswallowing

Quiet sound of

swallowing heard . Preceded by

several suckingmotions .

Increases in

frequency andconsistency aftermilk ejectionreflex.


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Ending a breastfeed Feed until the baby releases the breast

spontaneously. Offer the second breast only after the

baby has finished the first Breast;there is always milk in the breast. Do not remove the baby from the breast

if he is still suckling and swallowing. Some babies enjoy staying on the breast

long after they stop swallowing milk

(comfort sucking). If the mother wantsto end this period gently insert herfinger into the corner of the infantsmouth and remove him.


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General Reminders for the

Mother to AVOID

Pushing her breast across herbody

Chasing the baby with herbreast

Flapping the breast up and down

Holding breast with scissor grip Not supporting breast Twisting her body towards the

baby Aiming nipple to centre of

babys mouth

Holding breast away from babysnose (not necessary if the babyis well latched on, as the nosewill be away from the breastanyway)

Pulling babys chin down toopen mouth

Flexing babys head whenbringing to breast

Moving breast into babysmouth instead of bringingbaby to breast

Moving baby onto breastwithout a proper gape

Not moving baby onto breastquickly enough at height of

gape Having babys nose touch

breast first and not the chin


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Mothers should be advised to seek help if she is

experiencing the following :

PAIN except possibly brief discomfortat the beginning of a feed

BREASTS engorged

NIPPLES damaged

Compressed when the baby comesoff.

BABY

not coming off the breastspontaneously.

Restless at the breast

Not satisfied after the feed.

Taking a long time to feed (regularlymore than 30-40 min)

Feeding very frequently (more than10 feeds in 24 h)

Feeding very infrequently (fewerthan 3 feeds in the 1st 24 h or fewerthan 6 feeds in 24 h at24-48 h old )

Still passing meconium at 36-48 h.


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Documents

Evaluating A Breastfeed