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Title: The%20Joys%20of%20Breastfeeding

The Joys of Breastfeeding
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Nurses Role
  • Nurses responsibility to support the parents and
    promote the families sense of confidence no
    matter which type feeding the parents are
  • Recognize that cultural values influence infant
    feeding practices, be sensitive to ethnic
    background of minority populations, and
    understand that the dominant culture in any
    society defines normal maternal-infant feeding
  • Nurses responsibility to give new parents the
    knowledge, confidence, and support to do either.
  • Encourage early feedings of breast or bottle to
    stimulate peristalsis, facilitating elimination
    of the by product of bilirubin conjugation which
    decreases the risk for jaundice and enhances
    maternal infant attachment.
  • Encourage feeding within one hour after birth.

History of Breastfeeding
  • The normal used to be breastfeeding until the
    20th century when modern mothers began to want
    more freedom from their home and babies.
  • Formula became the norm by the 1950s, and
    formula companies began to cash in. Infant
    formula is the only product mass-marketed through
    hospitals to the public.
  • Today the attitude has shifted many mothers
    believe that they can be a modern mother and
    still breastfeed.
  • Today the goal for Healthy People 2020 is to
    increase the breastfeeding rate to 75 of the

Anatomy of Breast
  • The breast is composed of glandular tissue that
    has a tree like structure that is surrounded by
    supportive, nutritive, and protective tissue
    including connective tissue, fat, and lymphatic
    tissue and blood vessels.
  • The nipple has ten to twenty large branches
  • Branching from the lobes are lobules that branch
    further into ten to one hundred sac-like
    structures called alveoli.
  • The alveoli are where milk is produced.
  • The alveoli are lined with secretory cells called
    acini which produce and secrete the milk.
  • Myoepithelial cell surround the acini and
    contract to eject milk from the sac through small
    ductules into larger lactiferous ducts.
  • The ducts widen toward the nipple into milk
    collecting areas call the lactiferous sinuses.
    The infant extracts the milk through the mammary
    papilla (nipple).

Anatomy of the Breast
  • The nipple located slightly below the middle of
    the breast contains the openings of the milk
  • Surrounding the nipple is a dark pigmented area
    called the areola.
  • Behind this area lie the lactiferous sinuses.
  • The areola contains the Montgomery glands,
    sebaceous glands that secrete a substance for
    nipple lubrication and antisepsis.

Anatomy of the Breast
Physiology of Lactation
  • Preparation during pregnancy.
  • Teach mothers to wear supportive bras.
  • Encourage mothers to practice rolling the nipple
    between their fingers to promote everted nipples.
  • Encourage the use of shells for mothers with
    inverted nipples prior to delivery.
  • Promote breastfeeding classes and support groups.

Physiology of Lactation
  • Postpartum
  • Hormonal pathways
  • Birth results in a rapid drop in estrogen and
    progesterone and an increase in the secretion of
    prolactin. Prolactin promotes milk production by
    stimulating the alveolar cells of the breast.
    Prolactin levels rise in response to suckling.
  • Let-down reflex
  • Suckling also stimulates the release of oxytocin
    from the pituitary gland.
  • Oxytocin increases the contractility of the
    myoepithelial cells lining the walls of the
    mammary ducts, and a flow of milk results this is
    called the letdown reflex.
  • Often described as a tingling, prickling
    sensation as milk comes down, mothers may feel
    increased cramping, increased lochia, leaking
    from other breast, and a sense of relaxation.
    Letdown reflex is stimulated by infants cry,
    infants presence, suckling, mothers thoughts of
    infant, and sexual orgasm.

Physiology of Lactation
  • Postpartum
  • Once lactation is established
  • Prolactin decreases, and oxytocin and suckling
    facilitate milk production.
  • Production can be decreased if breast are not
    emptied regularly and completely to promote
    production of milk and to increase the quantity
    of milk. supply and demand baby sucks makes
    amount of milk needed if breasts are not emptied
    milk backs up in breasts and increases pressure
    in alveoli which causes milk secretion to

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Physiology of Lactation
  • Milk Stages
  • Colostrum yellow colored fluid present from end
    of pregnancy until 2 days after birth, colostrum
    has increase in protein and decrease in fats and
    lactose than mature milk. Rich in antibodies and
    has a laxative effect for baby.
  • Transitional milk is produced from the end of
    colostrum production until approx 2 weeks
    postpartum, this is where engorgement occurs,
    transitional milk consist of more fat, lactose,
    and water soluble vitamins
  • Mature milk has a decrease in concentration of
    immunoglobulins, decrease in total protein and
    has increase in lactose, fat, and total calories.
    10 solids, rest is water for maintaining

Initiating Breastfeeding
  • Timing
  • Before breastfeeding or bottle feeding begins
    assess bowel sounds, absence of abdominal
    distension, and rooting sucking reflex.
  • Initiate breastfeeding within the first hour
    after birth in the quiet alert stage, promotes
    bonding between mom and baby early and increases
    oxytocin levels to reduce maternal bleeding.
  • Assess effectiveness of newborns suck, swallow,
    and gag reflex, circumoral cyanosis, rapid
    respirations, diaphoresis which may indicate
    cardiovascular complications. And assess for
    tracheoesphageal fistula and esophageal atresia
    (look for increased oral mucus or hx of maternal
  • Positioning
  • use tummy to tummy is best, cradle hold, side
    lying, football hold great for c-sections,

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Initiation of Breastfeeding
  • Rooting
  • Reflex stimulated by bring the babies lips to
    mothers nipple and move the lips back and forth
    along the nipple dont touch cheek, infant will
    move toward finger.
  • Alternate breasts
  • Try to get infant to nurse on both sides of
    breast always start with the one infant nursed on
    last, unless only nurses on one breast then start
    with breast infant has not nursed on.
  • Implications for nurses.
  • Three objectives for breastfeeding
  • Provide adequate nutrition, to facilitate
    maternal-infant attachment, and to prevent trauma
    to the nipples.
  • Arrange for privacy, assist in finding a
    comfortable position, use additional pillows for
    support, evaluate babys mouth position, provide
  • Takes time to learn.
  • Pumping and Expression after 24 hours if nursing
    is not well established is recommended.

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Problems with Breastfeeding
  • Engorgement painful firmness as milk comes, hard
    to touch, skin is shiny and taut. Usually
    disappears within 24-48 h wear support bras,
    empty breasts fully, frequent feedings.
  • To treat keep nursing, use ice bags b/t
    feedings, hot shower and manual expression to
    soften nipples, pumping to soften nipples,
    increase feedings to 20 minutes. Apply warm
    compresses, cabbage leaves on inside of bra
    (reduces edema). Analgesics shortly before
  • Sore Nipples common causes are poor positioning
    and improper latch, warm compresses, air dry,
    lanonolin, breast milk on areola a natural
    emollient, frequently change positions,
  • La Leche League, lactation consultants, and
    breastfeeding support groups.

Problems with Breastfeeding
  • Breastfeeding contraindications
  • Mothers with known HIV/AIDS status, women
    diagnosed with breast cancer so they can begin
    treatment, chronic carriers of Hep B, herpes
    simplex virus only if active lesions on breast,
    TB, Cytomegalovirus Infection (CMV).
  • Galactosemia-babys intolerance of lactose,
  • Certain drugs Tegretol and Dilantin, or other
    antibiotics which may be toxic to infant
  • Mastectomy

Getting started
  • Timing
  • Positioning
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  • Assessment
  • mom-motivation and desire, knowledge, physical
    exam of nipple shape, inverted, everted, flat,
    level of anxiety, modesty
  • infant assess alignment, areolar grasp, areoloar
    compression, audible swallowing. Observation is
    imperative for support, trouble shooting and
  • The key to success is making sure a proper latch
    is established

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Nursing Diagnosis
  • Knowledge Deficit about breastfeeding, Altered
    comfort (mom), Altered nutrition less than body
    requirement (baby).
  • Interventions
  • a. positions for mom
  • b. relaxed environment
  • c. teach signs engorgement etc.
  • d. latching on c-hold, asymmetric latch
  • e. breaking suction
  • f. frequency and length of feedings
  • Evaluation successes and support.

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