Breastfeeding

The major determinants of successful Breastfeeding can be determined by the SAIB scale,(Systematic Assessment of the Infant at breast), which is a four point system in which four areas are assessed and if each goal is reached the mother will get 4 points, if not then she may need more education or assistance in breastfeeding. The SAIB scale is broken down into: Alignment/Positioning, Areola Latch-On, Areola Compression/Sucking, Audible Swallowing. There are certain criteria for each of these categories as shown on the SAIB sheet that was received first day of class.

The other determinant is the LATCH system that looks for, Latch, Audible Swallowing, Type of Nipple, Comfort, HoldÐ'... these are scored from 0-2 for how well each of these are achieved. A quick checklist that the mother can followto tell if she is successfully feeding would be: 1. your baby's mouth is wide with lips curled out.

2. his chin and nose are resting against the breast 3. he has taken as much of the areola as possible into his mouth 4. he is suckling rhythmically and deeply in short bursts separated by pauses 5. you can hear him swallowing regularly 6. your nipple is comfortable after the first few suckles. Some signs that you might be doing it wrong, 1. your baby's head is not in line with his body. 2. he is sucking on the nipple only, instead of suckling on the areola with the nipple far back in his mouth 3. he is sucking in a ligh, quick, fluttery manner rather than taking deep, regular suckles. 4. his cheeks are puckered inward or you hear clicking noises. 5. you don't hear him swallow regularly after your milk production has increases. Both of these check lists take into consideration aspects from both the SAIB and LATCH scales.

The let down reflex is the physiologic process of the movement of milk through and out of the breast. The milk is produced in the alveoli, which are located distally to the nipples. The Lactiferous duct system connects the alveoli to the nipple openings and is lined with myoepithelial cells that contract under the influence of the hormone oxytocin. Contraction of the myoepitehlial cells causes milk to eject through the ductal transport system. Oxytocin activates the milk ejection reflex, this is a hormone that is released by the posterior pituitary which receives messages from afferent neurons located in the mothers nipples and areola in response to sucking. A psychogenic stimulus, such as hearing the baby cry, can also stimulate the reflex. Oxytocin may need 2+ minutes of sucking for a full response peaking at 6-10. Setting limitations for the first few feedings, to ensure let down is essential for success. Stimulation may be caused by tactile stimulation by the infants mouth during feeding. This initiates the neurohormonal process of milk efection, regulated by oxytocin. When the mother delivers and receives Pitocin this is also a catalyst for milk production as it is synthetic oxytocin. Size may affect the volume of milk more nursing may be necessary, but is it does not affect the production. As long as your baby is feeding sufficiently your body will produce milk, if the baby does not feed enough or often the less milk produced.

I already went over the two scales used to determine proper feeding, they need to be assessed within the first 12 hours after birth. The first feed within 2 hours is an introduction of mom to baby and should be unobtrusive but assistance should be given to make the experience less frustrating. Charting by the nurse should be done with detail rather than just stating that the baby breastfed. Ie: infant held in cradle position, unable to arouse sleepy infant, latch-on not accomplished. The full systematic assessment of breastfeeding should be done for mother and baby before discharge.

Correct positioning: the cradle hold, support the head on the arm that is on the same side as the breast to use. Head in crook of elbow, support back with your forearm and cup the bottom or upper thigh with hand. Arm tucked or behind you, roll his body toward you, pelvis against abdomen, chest on chest, mouth with nipple, align head with rest of body.l

The crossover hold, or cross cradle is the same except you support baby on opposite arm than breast feeding, support back and upper back rather than bottom, this position is good for a baby who is having difficulty latching on, since you have a better ability to turn and position the head.

The clutch or football hold, this is good for sections, twins, large breasts. Hold your baby the same way you would clutch a pocketbook underarm or a football. Place him beside you, head near breast, tuck body near your side, forearm supports upperback, hand and fingers support shoulders, neck and head.

Reclining or lying down, for sections. Pillows behind back and between knees, keep back and hips in straight line. Hold baby as close as possible, on his side, mouth even with nipples, and your lower arm around him. Support your breast with other hand while gently guiding baby to breast. No need to change position for other breast just put a pillow under baby to bring level with other breast.

Inverted or flat nipples. Inverted nipples retract inward toward the breast instead of protruding. Flat nipples neither retract nor protrude but remain more or less flat. These conditions can cause latch issues when breastfeeding. Inverted nipples may even cause and impediment in milk flow. They are also more prone to injury, but fortunately inverted or flat nipples become sufficiently everted or normally protruding during pregnancy, so by the time the baby is born breastfeeding can happen without much difficulty. To correct inverted nipples routinely recommended is breast shells, plastic cups with a hole in the center that are pressed against the breasts, nipple rolling has no effect. No need to address this issue until after the baby is born, but make the doctor aware of the situation.

A teaching plan for a breast feeding mother would include the SAIB scale or the LATCH scale in order for them to know whether or not the baby is latching correctly, the check list I went over would be good for the mother to post as a quick indicator of problems. They should be taught to chart breast feeding sessions so they can monitor times, which breast is first, and how many diapers are being soiled in order to monitor proper nutrition levels being reached. They should be taught what to do if they are to return to work, how to pump, when to pump, how to store and use stored milk. What to do for sore nipples, good hygiene used when breastfeeding, positions to use. I think the most important thing they should go home knowing is that there are people they can call once at home that will help them, like; La Leche league, the nurses at the hospital,

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