Theresa Huseboe OB Teaching Due 11/15/10 Breast Feeding: Appearance and stages of breast milk. There are three stages to breast milk called lactogenesis. Stage 1 starts at the beginning of pregnancy as the breasts prepare for milk production. Colostrum is produced and it is a clear, yellowish fluid. Colostrum gradually changes to mature milk referred to as “the milk coming in” in stage II. By the third to fifth day after birth expect to experience a lot of milk coming in. By about the 10 th day after birth you will be in stage III of lactogenesis. (Wong, 2006) At the beginning of the feeding, the milk is bluish and contains lactose and proteins, but little fat. Such milk is called foremilk. The end of the feeding produces hindmilk or cream (about 5%). The hindmilk contains more fat, the main source of energy for your baby. If breast milk is allowed to sit for half-an-hour after being expressed, the "cream" separates and settles on top of the watery part. This is because human milk isn't homogenized, like we get in the store, the process that makes the water and fat portion in milk stay blended. (http://www.nlm.nih.gov/medlineplus), (Wong, 2006, p 773) Breast Care. Learn proper technique which is covered later. Use your finger to break suction before removing baby. Be sure to pat dry breast and allow to air dry. Use only cotton bra pad and change as soon as they get wet. Apply 100% lanolin to nipples after feeding and allowed to dry. Do not use harsh soaps or perfumed creams.( http://www.acog.org/publications/patient_education/bp029.cfm ) Nursing Procedure: 1) Hand washing. Wet hands. Apply soap. Lather and scrub for 20 seconds, be sure to clean between fingers, under nails and tops of hand. Rinse for 10 seconds. Turn off tap with paper towel and dry hands. (www.cdc.gov/clean hand s / )
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Theresa Huseboe
OB Teaching Due 11/15/10
Breast Feeding:
Appearance and stages of breast milk. There are three stages to breast milk called lactogenesis. Stage 1 starts at the beginning of pregnancy as the breasts prepare for milk production. Colostrum is produced and it is a clear, yellowish fluid. Colostrum gradually changes to mature milk referred to as “the milk coming in” in stage II. By the third to fifth day after birth expect to experience a lot of milk coming in. By about the 10th day after birth you will be in stage III of lactogenesis. (Wong, 2006)
At the beginning of the feeding, the milk is bluish and contains lactose and proteins, but little fat. Such milk is called foremilk. The end of the feeding produces hindmilk or cream (about 5%). The hindmilk contains more fat, the main source of energy for your baby. If breast milk is allowed to sit for half-an-hour after being expressed, the "cream" separates and settles on top of the watery part. This is because human milk isn't homogenized, like we get in the store, the process that makes the water and fat portion in milk stay blended. (http://www.nlm.nih.gov/medlineplus), (Wong, 2006, p 773)
Breast Care. Learn proper technique which is covered later. Use your finger to break suction before removing baby. Be sure to pat dry breast and allow to air dry. Use only cotton bra pad and change as soon as they get wet. Apply 100% lanolin to nipples after feeding and allowed to dry. Do not use harsh soaps or perfumed creams.( http://www.acog.org/publications/patient_education/bp029.cfm)
Nursing Procedure:
1) Hand washing. Wet hands. Apply soap. Lather and scrub for 20 seconds, be sure to clean between fingers, under nails and tops of hand. Rinse for 10 seconds. Turn off tap with paper towel and dry hands. (www.cdc.gov/clean hand s / )
2) Position. The football hold is comfortable if you had a cesarean. The modified cradle works well for early feedings. The side-lying will allow you to rest and if you are experiencing perineal pain and swelling. Whatever position you choose be sure have support for your arms and back. The baby is at breast level and in good body alignment. (Wong, 2006, p 775)
3) Try and have the baby nurse from both breasts at each feeding. When the baby finishes sucking the first breast, put your finger into the baby's mouth to release the sucking, and then offer the other breast. At next the feeding, start the other way round. When the baby has had enough, he or she will just fall asleep or stop sucking. (http://familydoctor.org/online/famdocen/home/women/pregnancy/birth/019.html)
4) Grasp nipple with your free hand, put your thumb on top of your breast and your other fingers below. Express a few drops of milk and spread over nipple. Using one of the positions from above bring baby to breast, not breast to baby. Lightly touch baby’s lower lip to nipple to open mouth. The mouth should cover as muck or the dark area as possible, not just the nipple. If latched on
correctly the nose, cheeks, and chin should be touching breast. If worried about breathing don’t push on breast around nose, but raise infants hip to change angle on breast.
5) Timing and frequency. Newborns need 8 to 12 feedings in a 24 hour period. Feed at least every 3 hours during the day and at least every 4 hours at night during the first few weeks. Once baby is feeding well and gaining the right amount of weight you can start demand feedings. This is when you notice feeding cues such as hand-to-mouth movements, sucking motions and tongue movements. Crying is a late sign of hunger. (Wong, 2006, P 775-776)
6)Remove infant from breast by breaking the suction, insert a clean finger between your breast and your baby's gums. When you hear a soft pop, pull your nipple out of the baby's mouth. (www.acog.org)
7) The baby is getting enough milk if content after each feeding. Your breast feels full and firm
before and less full after a feeding. Gains weight consistently after the first week. Your baby may
lose some weight in the first week. The baby should have 6 to 8 wet diapers a day. Baby has
about 2 to 5 stools a day at first then may have 2 or less a day. (www.acog.org)
8) Preventing/healing sore nipples: It is normal to feel nipples soreness the first few days of
breast feeding. The best way to prevent sore nipples is correct feeding technique. Reposition or
offer other breast. If sore nipples occur, apply ice to nipple for 2 to 3 minutes to numb before
feeding. After feeding, clean with water and express a few drops of milk and rub into sore area
and air dry. Or you can try a cooled steeped caffeinated tea bag for 1 to minutes. Or a warm
water compress may also help. They should allow to be aired dried as much as possible. If they
are too sore for breastfeeding try electric pump for 24 to 48 hours to allow for healing. Avoid using
flexible nipple shields on the market claiming to be a treatment for sore nipples. They can actually
Rooting: If you touch baby’s lip, cheek, or corner of mouth the baby should turn head and open mouth.
This will help the baby find breast or bottle for feeding.
Sucking: Rooting helps start the sucking when touched roof of mouth with nipple or a gloved finger.
Sucking is needed to draw in milk from breast or bottle.
Swallowing: When feeding the baby, swallowing follows sucking and the taking in of fluids. Check for
coordination with sucking and breathing. If the response is weak or gagging, coughing, apnea, or
vomiting occurs, this could indicate prematurity, effects of any drugs mom had on board or illness that
needs further investigation.
Grasp Palmer and Plantar: Place finger in palm of hand and again at base of toes. The infant’s fingers
curl around examiner’s finger, toes curl downward. This response lessens by 3 to 4 months and is
stronger in premature babies.
Extrusion: Touch or depress tip of tongue. Newborn should force tongue outward. This response
disappears about at fourth month as starts to develop muscles to accept solid foods.
Glabellar (Myerson): Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open.
Baby should blink for first four or five taps. If the blinking persists it is an abnormal sign and needs to be
investigated.
Tonic neck or “fencing”: With infant in a supine neutral position, turn head to one side. With head
facing left side, arm and leg on that side extend. The opposite if true if turn head to right. This response
should disappear by 3 to 4 months. Persistent response after 6 weeks is a sign of an abnormality.
Moro (or startle): Hold the infant in semi sitting position and allow head and trunk to fall
backwards with support. Place the infant on flat surface and make a loud noise. You should see a symmetric abduction and extension of arms and fingers forming a “C” with thumb and forefinger. Arms are adducted in an embracing motion and return to relaxed flexion. The baby may cry. This response is present at birth. Complete response may be seen until 8 weeks. Body jerk only in 8 to 18 weeks. Asymmetric could mean injury to brachial plexus clavicle, or humerus. Persistence response after 6 months could mean possible neurological abnormality.
Stepping or walking: Hold infant vertically under arms or trunk, allowing one foot to touch table surface.
The infant should look like they are walking by alternating flexion and extension of feet. Full term will
walk on soles and preterm walk on toes, this response in normally present for 3 to 4 weeks.
Crawling: Place the infant on stomach. The baby should make crawling movements with arms and legs.
This should disappear about 6 weeks.
Deep tendon: Use finger instead of percussion hammer. Baby should be relaxed. Tap on patellar to test
knee jerk. Should be present, if not it is abnormal and need further investigation.
Crossed extension: Lay infant on back, extend on leg, press knee down and tickle the bottom of foot.
Observe the opposite leg, it should flex, adduct and then extend. This is testing the contra lateral side of
the spinal cord.
Babinski (plantar): On the sole of foot, beginning at heel, stroke upward laterally on sole, then across
ball of foot. All the toes should hyperextend; this is normal response (negative babinski). If the big toe
should dorsiflex it is a positive babinski response. If this response is absent it requires a neurologic
exam.
Pull-to-sit: Pull infant up at wrists from supine position with head in midline. The head should come
forward with minimal lag, and then the head falls forward when placed in sitting position. The haed
should come up equally on both sides. This response disappears by forth week.
Truncal incurvation (Galant): Place baby on stomach on flat surface, run finger down back about 4 to 5
cm lateral to spine, first on one side and then the other. You should see the truck flex and pelvis is
swung towards the side you stroked. If no response this could mean general depression of nervous
system and should be investigated.
Magnet: Place baby on back, partially flex both legs and apply pressure to soles of feet. Both legs should
extend against examiner’s pressure. If no response it suggests damage to CNS. This reflex may be weak
If you are breastfeeding and drinking be sure to consume it immediately after feeding and only have one
drink to minimize the effects on baby. Alcohol may impair the milk ejection reflex. (Wong, 2006, p783)
Tobacco- use in the immediate post partum period. If you do smoke, smoke outside away from baby.
Secondhand smoke in children is responsible for increases in the severity of asthma in children, has been
linked to SIDS, respiratory tract infections, and increased risk for middle ear infections.
Secondhand Smoke isDangerousEveryone knows that smoking is bad forsmokers, but did you know:• Breathing in someone else’scigarette, pipe or cigar smoke canmake you and your children sick.• Children who live in homes wherepeople smoke may get sick moreoften with coughs, wheezing, earinfections, bronchitis or pneumonia.• Children with asthma may haveasthma attacks that are more severeor occur more often.• Opening windows or using fansor air conditioners will not stopsecondhand smoke exposure.• The U.S. Surgeon General saysthat secondhand smoke can causeSudden Infant Death Syndrome, alsoknown as SIDS.• Secondhand smoke also can causelung cancer and heart disease.(http://www.epa.gov/smokefree/)
Car seats- Recommendations:
Be sure to read manufacturer’s directions and follow exactly. Do not start car until everyone is securely
restrained. ALWAYS use restraints. The LATCH (Lower Anchors and Tethers for Children) universal child
safety seat system started in 2002. Seat belts will no longer be used to anchor child safety seats in
vehicles after 2002. (Wong, 2006, p. 1108)
Infants (less than 20 pounds and one year of age) must be in rear-facing safety seat. If car has air bag,
the infant seat should go in back seat. (Wong, 2006, p. 761)
20-40 pounds- Convertible safety seats, the seat are positioned upright and facing forward. They have
different types of harnesses, be sure to follow manufactures directions. (Wong, 2006, p 1004)
Children under age 8 and shorter than 4 feet 9 inches: Must use booster seat that meets federal safety
standards.
For Minnesota state laws visit: http://www.dps.state.mn.us/ots/Laws_Legislation/child_restraints.asp
Bonding and Stimulation:
Methods: Hold your baby close. Give your baby eye contact. Talk to your baby; say his or her name.
Smile and sing to your baby. Inspect all parts of the baby; see if you can see family resemblances. Touch
and caress your baby and learn how your baby responds. Change diapers and feed. Feel free to ask the
nurses questions.
Benefits: Holding baby close will give your baby a sense of security, trust and love. Also your baby will learn your smell and learn that it means you are there to help. The baby will learn your voice as you talk and sing. You will soon learn that your baby has different cries as you spend more time with baby. The cries can mean hunger, pain, boredom, tiredness, and time to change diaper. As you start to touch and caress your baby you will learn what your baby likes and how to soothe. Seeing family resemblances is fun and exciting and can give a sense of community within your family. (Wong, 2006, p 630-634)
Postpartum Psychological Complications:
Postpartum blues:
Onset and length: It is normal to feel joy and well being in the first two days followed by a
feeling of “blue”. You may feel emotionally unstable and cry for no reason. Don’t worry this is normal. It
usually peaks around the fifth day and goes away round the tenth day. Some things you may feel are let-
down, restless, fatigue, not able to sleep, headache, anxiety, sadness and anger.
Treatment: Although we don’t know why this happens exactly, it is thought that it is caused by
lower levels of natural chemicals circulating in your body after delivery. The best things to combat these
feeling are to try and get enough rest; nap when baby does when possible. Let your friends and family
know when it is okay to visit. Use relaxation techniques that you learned in childbirth classes. Be sure