PQCNC HM Well Baby Supporting Mom

8/7/2019 PQCNC HM Well Baby Supporting Mom

1/20

Improving the Quality of Maternity Care inNorth Carolina:

Supporting Mom s in B reastfeeding Achieving Br eastfeeding Frequency

www.ncbfc.orgwww.sph.unc.edu/breastfeedingwww.breastfeeding4health.com
http://www.ncbfc.org/http://www.sph.unc.edu/breastfeedinghttp://www.breastfeeding4health.com/http://www.breastfeeding4health.com/http://www.sph.unc.edu/breastfeedinghttp://www.ncbfc.org/


2/20


3/20

Our Goal in Supporting Breastfeeding:

Healthy Mom, Healthy Newborn

Evidence Base for Action

Clinical Practice and Skills

Achieving Change among All Staff


4/20

What to we wish to achieve?

Homeostasis, and

Avoidance of:

Hypothermia

Hypoglycemia

Significant weight loss

Hyperbilirubinemia

Eventually, Growth and Development


5/20

When mom and baby achieve good EBFfeeding skills during the hospital stay,

we have succeeded

From: Righard L and Alade O. (1992) Sucking technique and its effect on success of breastfeeding Birth 19(4):185-189.

0%

50%

100%

Percentage

Correct sucking technique at dischargeIncorrect sucking technique at discharge

P


6/20

How do we achieve this?

Frequent, effective breastfeeding Assessment - and support - through Observation

Skills and Outcomes1. Establishing Rapport

2. Comfort

3. Position

4. Latch

5. Effective Milk Transfer6. Cue recognition

7. Hand expression

8. Frequency


7/20


8/20

Skills 1/2/3:

Rapport, Maternal Comfort, Positions

Seek permission to observe and support

Maternal Comfort

suggest different positions

use pillows or nursing stools only if positioning looksuncomfortable or issues arise

Position

infant head, shoulders, and hips are in alignment

infant faces the mothers body. BELLY TO BELLY

Infant brought to the breast, not the breast to the infant

Avoid pushing the back of the infants head; the infant mayarch away from the breast


9/20

Cradle Hold and

Cross-Cradle Hold

Photo Joan Meek, MD, FAAP


10/20

Football Hold and Side-lying Hold

Photo Roni M. Chastain, RN

Photo Lori Feldman-Winter, MD, MPH, FAAP


11/20

Skill 4: Supporting Good Latch-on

Often helps to use C-hold/ sandwich 4 fingers underneath and away from areola:

parallel to jaw

thumb on top of the breast and away fromareola: parallel to upper lip

Rooting reflex Stimulate by touching to nipple

Infant opens his mouth wide

Mother quickly draws the infant to her breast Infant takes in an adequate amount of the

breast, notjust nipple


12/20

Proper Latch

INCORRECT

CORRECT

Nipple protected by positioning far

back in infants mouth

Breast tissue inferior to nipple

exposed to massaging action of

tongue and lower jaw.

Photos Jane Morton, MD, FAAP


13/20


14/20

Job-aid for Latch: LANCET Latch

Infant grasps the entire nipple and as much of the areola

as possible, generally more below areola The nose and chin of the infant will touch the breast;

Lips will be flanged out

Audible - swallow may not be audible first day,organizes

Nipple everted by baby

Comfort Undulating motion

act to reduce any discomfort on latch

release suction

Elimination wet diapers, meconium > seedystool

Timing as often as baby demands/cues


15/20

Skill 5 Assessing Milk Transfer

Suck and swallow: Audible swallowing

Sucking that begins with rapid bursts to stimulate

milk let-down

A rhythm of sucking, swallowing, and pauses

following establishment of milk flow Becomes slower and more rhythmic

From a few to 1 suckle/swallow per second

Undulating action no stroking, friction, or in-and-

out motion of the tongue

Debate: Milking vs Negative pressure

kill


16/20

Skill 6:

Cue Recognition

Rapid eye movements (fluttery eye movementswhile eyes are closed) Muscle tension, such as flexed arms or closed fists Wriggling or fidgety body movements

Vocalization Hand to mouth movement (even if eyes are closed,

may include sucking on own hand)

Rooting (Mouth open wide!)

You are Too Late if CryingIn newborns crying is usually a late indicator of

hunger and may lead to difficulty with latchingon to the breast or feeding well.


17/20

Skill 7: Hand expression

Follow the physiology: Relax and milk the source and the ducts

Go for empty

Disallow fullness

Watch Breastfeeding Management,Educational Tools for Physicians and Other

Professionals by Jane Morton, MD, FAAP, for

a live demonstration of how to observe andassess breastfeeding.

http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html
http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.htmlhttp://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html


18/20

Outcome/Skill 8: Frequency 10-12+ per 24 hrBreastfeeding frequency in 1st 24 hours and incidence

of hyperbilirubinemia on day 6

From: Yamauchi Y and Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth infull-term neonates. Pediatrics, 1990, 86(2):171-175.

28.1%

24.5%

15.2%

11.8%

0.0%0%

10%

20%

30%

0-2 3-4 5-6 7-8 9-11

Incidence

Frequency of breastfeeding/24 hours

N G i d S d


19/20

Next: Getting ready to See one, do

one, teach one!In your team:

Consider which staff will be with the dyad at the timewhen breastfeeding support is needed:Who is most likely to be with the mother at the time of the first

feeding?

Who is most likely to be asked for support?

List all the staff will need these skills

Discuss the current level of each of these skills amongthe staff

1) Rapport 2) Comfort 3) Position 4) Latch 5) Milk

Transfer 6) Cue recognition 7) Hand expression 8) Frequency

Consider: What additional training is needed to ensure that allstaff in contact with the mother/baby dyad at these times can

carry out this basic support? Do we have staff skilled to do this

training? How soon can this be accomplished?


20/20

Reference

AAP Breastfeeding Residency Curriculum: Preparedwith information from the AAP/ACOG Breastfeeding

Handbook for Physicians http://www.aap.org/breastfeeding/curriculum/
http://www.aap.org/breastfeeding/curriculum/http://www.aap.org/breastfeeding/curriculum/

PQCNC HM Well Baby Supporting Mom

Documents