Evaluating A Breastfeed: Presented by

Evaluating A
Breastfeed
Presented by:
Rowaida Al-Khalil
BSN-IBCLC-Senior Nursing Tutor
Rowaida Al-Khalil/IBCLC/UAE/2006
Objectives
At the end of this presentation the audience will
be able to:
Observe a breastfeed
Evaluate adequate attachment for feeding .
Evaluate the baby’s suckling behavior at the
breast.
Assist mothers who need help with
attachment.
Something as natural as
breastfeeding should just
happen naturally … shouldn't
it? For humankind to have
survived over the centuries,
babies have needed to be
able to attach to their
mothers' breasts and must
have done so. Yet in our
society today, attachment
problems seem to be very
common.

Could it be that we have lost the
advantages of the extended family or
village groups where young girls would
have observed and assisted mothers,
aunts, or sisters who were
breastfeeding. They also would have
had the assistance from them when
they in turn had their own babies.
Many new mothers today may have
never handled young babies let alone
seen one being breastfed.
The
Theart
artof
ofattaching
attachingaababy babyto tothe
the
breast
breastisistherefore
thereforeaaskill skilltotobebe
learned.
learned.
Observing a Breastfeed
What to look for when

observing a breastfeed :
While the mother is Signs that the baby is
breastfeeding her attached for effective
baby quietly observe suckling .
what is happening and Signs that the baby is
record the suckling and the milk is
information . flowing .
Signs that the mother
may need help.
Evaluating Attachment
A good attachment :
The baby’s mouth is open
wide.
The baby’s chin is touching
the breast.
The baby’s lower lip is
curled upward.
The baby’s head is tilted
slightly back.
Hold is firmly against
shoulders
Evaluating Attachment
Signs that the baby is poorly attached :
The nipple looks flattened or striped as it
leaves the baby’s mouth at the end of the
feed.
The mother feels pain in her nipples during
and after the feeds.
The mother’s breast may be engorged due to
inefficient milk transfer.
Evaluating infant’s suckling
behavior at the breast
Listen for a suck-swallow-breath pattern
Audible swallowing is one the most important
evaluation criteria.
If
Ifthe
thenon
nonnutritive
nutritivesuckling
suckling
pattern
patternisisobserved
observedthroughout
throughout
the
theentire
entirefeed
feed→→baby
babyisisnot
not
attached
attachedwell
well
The Nurse’s Role in Achieving
Effective Latch-on
 Watch for early readiness cues
 Assist with latch-on
 Determine if suckling is
effective .
Clinical Management to
promote 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 newborn
can best achieve a good latch-on
 Remind mother to relax her
shoulders.
 Bring the baby to the breast , not
the breast to the baby.
 Offer pillows to support the
mother's arm or the infant. Help
reposition the mother if necessary
Basic positions for the mother
Hand position for the mother
The mother’s fingers should be well away from the
areola→ they should not occlude the lactiferous
ducts.
Basic positions for the newborn
The baby’s whole body is facing the mother and
tucked close to her (chest-to-chest and not
chest-to-ceiling )
The baby’s head is supported ,in a straight line
with his body, and facing the breast.
Hold the infant at the level of the nipple .
The infant's lower arm, if not swaddled, should Often, the father
be around the mother's thorax can assist the mother
with the positioning
The infant’s head should rest on the mother’s of the infant,
forearm and NOT on the antecubital fossa. particularly if she is
recovering from
Rowaida Al-Khalil/IBCLC/UAE/2006 a caesarean delivery.
Breastfeeding environment
The mother and infant should be allowed to
breastfeed in a relaxed and supportive
environment. Personnel should be readily
available to facilitate the process.
Constant interruptions and a deluge of
visitors may disrupt the early
breastfeeding experience.
Basic positions for the
newborn
Assisting the mother with
attachment
Wash your hands thoroughly.

Arrange for privacy.
Help the mother to find the most
comfortable position and ensure
there are several pillows
available.
Work with the mother at the eye
level.
attachment
Help the mother to position the Help the mother position the baby’s
baby’s body: head:
 Head and body are at the breast
 Be sure there is no pressure on
level. the back of the baby’s head
 Baby’s body aligned from the
 Head supported but NOT
shoulder to the iliac crest. pushed in against breast.
 Baby is flexed and relaxed.
 Head tilted back slightly.
 The baby’s whole body is facing
the mother and tucked close to  Head facing breast (NOT turned
her (chest-to-chest and not laterally , hyperextended ,or
chest-to-ceiling ) hyperflexed).
 infant’s head should rest on the
mother’s forearm and NOT on
the antecubital fossa.
attachment
Ask the mother to support her breast in
place during the feeding with her hand (C-
hold ).
After the first week , the mother should be
able to get the feeding started and then
let go ,unless her breasts are unusually
large.
attachment
Teach baby to open

wide/gape :
 Move baby toward breast,
touch top lip against nipple
 Run nipple along the baby’s
upper lip, from one corner
to the other, lightly, until
baby opens wide.
 Repeat until baby opens
wide , as if yawning, and
has tongue forward
attachment
Teach mother to establish
proper areola grasp:
When the baby opens his
mouth wide and his tongue
comes forward over his lower
gums bring him quickly to the
breast with the mother’s
nipple pointing to the roof of
his mouth. His first point of
contact will be his lower jaw
or chin well down on the
areola.
As his mouth closes over the
breast he should take in a
large portion of the areola.
attachment
A proper areolar grasp
 Infant’s mouth opens widely If
Ifthe
thebaby
babyisisnot
not
to cover lactiferous ducts. attached
attachedwell,
well,or
orififthe
the
 Lips flanged outward. mother feels pain →
mother feels pain →she she
should
shouldbreak
breakthe
thesuction
suction
 Complete seal formed around
by
bygently
gentlyinserting
insertingherher
the areola :strong vacuum. finger
fingerinto
intothe
thecorner
cornerof of
 Approximately 1.5 inches the
thebaby’s
baby’smouth
mouth,and
,and
( approximately 3.5 cm ) of start again.
start again.
areolar tissue is centered in
infant’s mouth.
 Tongue is troughed and
extends over alveolar ridge.
attachment
Evaluate areolar Evaluate audible
compression swallowing
 Mandible moves  Quiet sound of
in a rhythmic swallowing heard .
motion .  Preceded by
 Tongue cupped several sucking
and troughed. motions .
 Checks full and  Increases in
rounded when frequency and
sucking . consistency after
milk ejection
reflex.
attachment
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 wants
to end this period →gently insert her
finger into the corner of the infant’s
mouth and remove him.
General Reminders for the
Mother to AVOID
 Pushing her breast across her  Pulling baby’s chin down to
body open mouth
 Chasing the baby with her  Flexing baby’s head when
breast bringing to breast
 Flapping the breast up and down  Moving breast into baby’s
 Holding breast with scissor grip mouth instead of bringing
 Not supporting breast baby to breast
 Twisting her body towards the  Moving baby onto breast
baby
without a proper gape
 Aiming nipple to centre of
baby’s mouth  Not moving baby onto breast
quickly enough at height of
 Holding breast away from baby’s gape
nose (not necessary if the baby  Having baby’s nose touch
is well latched on, as the nose breast first and not the chin
will be away from the breast
anyway)
Mothers should be advised to seek help if she is
experiencing the following :
Pain except possibly brief discomfort at Baby

the beginning of a feed • not coming off the breast
spontaneously.
Breasts engorged • Restless at the breast
• Not satisfied after the feed.
Nipples • Taking a long time to feed (regularly
• damaged more than 30-40 min)
• Compressed when the baby comes • Feeding very frequently (more than
off. 10 feeds in 24 h)
• Feeding very infrequently (fewer
than 3 feeds in the 1st 24 h or fewer
than 6 feeds in 24 h at24-48 h old )
• Still passing meconium at 36-48 h.

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Evaluating A

What to look for when

when back is straight the nipples

Wash your hands thoroughly.

Teach baby to open

Pain except possibly brief discomfort at Baby

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