TEACHING PLAN FOR BREASTFEEDING

DESCRIPTION OF THE LEARNER:

The learner is Benilda Gonzale 32 years old female born on june 2, 1979 who was admitted for Low Section Cesarean section
surgery. The learner is resideing at Bayo st. San Vicente, Baguio City, singe, Jehovas Witness as her religion. She is able to
understand and communicate in Filipino, Ilocano and English but prefers being instructed using the Filipino language .
LEARNING NEED: Additional guidelines in breastfeeding
LEARNING DIAGNOSIS: Knowledge Deficit: provision of care related to lack of knowledge regarding breastfeeding.
GOAL: After the series of nursing education, the patient would be able to demonstrate proper breastfeeding techniques.
BEHAVIORAL LEARNING
OBJECTIVES

LEARNING CONTENT

TEACHING STRATEGY,
METHODS AND
ACTIVITIES

Upon completion on the topic

regarding breastfeeding, the patient
will be able to:
1. Enumerate
4 out of 5 Advantages of Breastfeeding Lecture
advantages of breastfeeding to to the Mother
hand-outs
the mother.

2. Enumerate

4 out of 4 Advantages of Breastfeeding Lecture

hand-outs
advantages of breastfeeding to to the Baby
the newborn.

TIME ALLOTMENT
AND RESOURCES
NEEDED

discussion, 10 minutes, hand-out

discussion, 10 minutes, hand-out

METHOD OF
EVALUATION

Instant oral feedback:

The patient will be able
to share her realization,
understanding,
and
their
appreciation
regarding
the
advantages
of
breastfeeding to the
patient herself.
Instant oral feedback:
The patient will be able
to share her realization,
understanding,
and
their
appreciation
regarding
the

3. Demonstrate
the
proper Lactation
and
Proper
positioning
techniques
in Positioning Techniques in
feeding the newborn.
Breastfeeding;
Promoting
Adequate Sucking

4. Demonstrate
the
proper Techniques for Burping the
technique in burping the Breast-fed Baby
newborn after intake of milk.

5. Enumerate 3 out of 3 ways of Preventing

or
relieving
or
preventing Engorgement
engorgement of nipples.

6. Enumerate 3 out of 4 factors

that

could

worsen

sore

Relieving

Promoting Healing of Sore

or Nipples

advantages
of
breastfeeding to the
baby.
Return demonstration:
the patient would be
Demonstration,
30 minutes, visual aids able to demonstrate
the proper positioning
techniques in feeding
the newborn with a
pillow as a substitute
for a baby.
Return demonstration:
the patient would be
Demonstration,
20 minutes, visual aid able to demonstrate
regarding
proper the proper burping
burping techniques
techniques in feeding
the newborn with a
pillow as a substitute
for a baby.
Instant oral feedback:
the patient would be
Lecture
discussion, 10 minutes, hand-out
able to enumerate all
hand-outs
ways of preventing or
relieving engorgement
of
nipples
and
expresses ways on
how she can apply
these things to her
daily living.
Instant oral feedback:
the patient would be
Lecture discussion,
10 minutes, hand-out
able to verbalize 3 or
all the causes of sore

painful nipples.

or painful nipples.
Return demonstration:
the patient would be
able to show the ways
7. Demonstrate ways of promoting Promoting Healing of Sore Demonstration,
15 minutes, visual aids on promoting healing of
healing of sore nipples.
Nipples
regarding
promoting sore nipples.
healing of sore nipples Instant oral feedback:
with pictures
the patient would be
able to verbalize in her
8. Discuss the reason why Weaning the Baby
Lecture
discussion, 10 minutes, hand-out
own words the reason
mothers should wean the
handouts
behind weaning the
newborn gradually.
baby gradually.

LEARNING CONTENT
INTRODUCTION:
It is universally agreed that breast milk is the preferred method of feeding a
newborn, because it provides numerous health benefits to both the mother and
the infant; it remains the ideal nutritional source for infants through the first year
of life (Kleinmann, 2004). Nurses are prime people to teach women about the
benefits of breast-feeding and provide anticipatory guidance for problems that
may occur.
ADVANTAGES OF BREASTFEEDING TO THE MOTHER
Breastfeeding may serve a protective function in preventing breast cancer.
The release of oxytocin from the posterior pituitary gland aids in uterine
involution (the reduction in size of the uterus after childbirth). Oxytocin is
released whenever a mechanical stimulus is initiated by the sucking
mechanism of the infant.
Successful breast-feeding can have an empowering effect, because it is a
skill only a woman can master
Breast-feeding reduces the cost of feeding and preparation time.
Breast-feeding provides an excellent opportunity to enhance a true mutual
bond between mother and child.
ADVANTAGES OF BREASTFEEDING TO THE BABY
Breast milk contains secretory immunoglobulin A (IgA), which binds large
molecules of foreign proteins, including viruses and bacteria, keeping them
from being absorbed from the gastrointestinal tract (stomach) into the
infant. Lactoferrin, is an iron-binding protein in breast milk that interferes
with the growth of pathogenic bacteria. The enzyme lysozyme in breast
milk apparently actively destroys bacteria by lysing (dissolving) their cell
membranes, possibly increasing the effectiveness of antibodies.
Leukocytes in breast milk provide protection against common respiratory
infectious invaders. Macrophages, responsible for producing interferon (a
protein that protects against viruses), interfere with virus growth. The
bifidus factor is a specific growth-promoting factor for the beneficial
bacteria Lactobacillus bifidus. The presence of L. bifidus in breast milk
interferes with the colonization of pathogenic bacteria in the
gastrointestinal tract, reducing the incidence of diarrhea.
Breast milk contains the ideal electrolyte and mineral composition for
human infant growth. It is high in lactose, an easily digested sugar that
provides ready glucose for rapid brain growth. The protein in breast milk is
easily digested, and the ratio of cysteine to methionine (two amino acids)
in breast milk favors rapid brain growth in the early months. It contains
nitrogen in compounds other than protein, so that an infant can receive
cell-building materials from sources other than just protein.
Breast milk contains more linoleic acid, an essential fatty acid for skin
integrity and less sodium, potassium, calcium and phosphorus than do
many formulas. Breast milk also has a better balance of trace elements,

such as zinc. These levels of nutrients are enough to supply the infants
needs, yet they spare the infants kidneys from having to process a high
renal solute load of unused nutrients.
Breast-fed newborns appear to be able to regulate their
calcium/phosphorus levels better than infants who are bottle fed.
Decreased calcium levels in a newborn can lead to tetany (muscle
spasms).
LACTATION AND PROPER POSITIONING TECHNIQUES IN BREASTFEEDING
- Breast milk looks like nonfat milk. It is thin and almost blue-tinged in
appearance.
- Before breastfeeding, mothers must wash their hands to be sure they are
free of pathogens picked up from handling perineal pads or other sources.
Washing her breasts is not necessary unless she notices caked colostrums
(first breast fluid characterized as a thin yellowish fluid secreted by the
breasts during the second trimester onwards but most evident in the first 2
to 3 days after birth and before the onset of true lactation) on the nipples.
- Lying on her side with a pillow under her head is a good position to
assume when she is first attempting to breastfeed. This relieves fatigue
because it allows the infant to rest on the bed.
- Another position that the mother can utilize is sitting position with a pillow
under the baby. Using a football hold with the baby supported on a pillow
also may be helpful, especially if the mother had a cesarean birth.
- Brushing the infants cheek with a breast nipple stimulates a newborns
rooting reflex. The baby then turns toward the breast. Do not try to initiate a
rooting reflex by pressing a babys face against the mothers breast; this
will cause the child to turn away from the mother and toward your hand.
- If a woman has large breasts, the infant may have trouble breathing while
nursing because tissue presses against the nose. The mother can prevent
this happening by grasping the areolar margin of her breast between her
thumb and forefinger, holding the bulk of the breast supported while her
infant feeds. This also makes the nipple more protruberant.
- Frequent feeding is advantageous to sustain a milk supply, because the
more often the breasts are emptied, the more efficiently they will fill and
continue to maintain a good supply of milk.
- Help the infant break away from the breast when they are finished feeding.
Insert a finger in the corner of the infants mouth or pull down the infants
chin to release suction. Otherwise, the baby may pull too hard on the
nipple, causing crack or soreness.
PROMOTING ADEQUATE SUCKING
Often, a newborn being breast-fed drops off to sleep during the first few
feedings. To stimulate both milk production effectively and ensure
adequate fluid intake, help the mother attempt to keep the infant awake,
urging him/her to suck. To accomplish this, stroking the back of the
newborn, changing their position during feeding, rubbing their arms and
chest, changing their diaper, gently tickling the bottom of a babys feet are
ways on waking the infant effective.

 If the infant is not sucking well, the mother can use breast massage after a
feeding to empty her breasts manually. This helps ensure good milk
production for the time when the infant is ready to suck.
TECHNIQUES FOR BURPING THE BREAST-FED BABY
Some infants seem to swallow little air when they are breast-fed, whereas
others swallow a great deal. As a rule, it is helpful to bubble (burp)
newborns after they have emptied the first breast and again after the total
feeding. Placing the baby over one shoulder and gently patting or stroking
the back is an acceptable position. However, this position is not always
satisfactory for a small infant, who has poor head control.
Holding the baby in a sitting position on the lap, then leaning the child
forward against one hand, with the index finger and thumb supporting the
head, is often the best position to use. This position provides head support
but leaves the other hand free to pat the babys back. Laying the baby
prone across the lap is another alternative position.
PREVENTING OR RELIEVING ENGORGEMENT
The primary method for relieving engorgement is emptying the breasts of
milk by having the infant suck as much as before.
If an infant cannot grasp a nipple strongly because of engorgement, warm
packs applied to both breasts for a few minutes before feeding, combined
with massage to begin milk flow, often facilitates drainage and promotes
breast softness so the infant can suck.
Manual expression or the use of a breast pump to complete emptying of
the breasts after the baby has nursed can help maintain or promote a good
milk supply during the period of engorgement.
Assure the mother that symptoms of engorgement are healthy; it is an
indication that her breasts are producing milk. Engorgement is only
temporary and should begin to subside 24 hours after it first becomes
apparent.
PROMOTE HEALING OF SORE NIPPLES
Painful nipples result from the strong sucking action of a newborn.
This may be worsened by the following factors:
1. Improper positioning of an infant (failure to grasp the areola as well as the
nipple)
2. Forcefully pulling an infant from the breast
3. Allowing an infant to suck too long at a breast after the breast is emptied
4. Permitting a nipple to remain wet from leaking milk
To help prevent soreness, encourage the mother to position her baby
slightly differently for each feeding. This helps prevent the same area of
the areola from receiving the majority of pressure.
Expose nipples to air by leaving her bra unsnapped for 10 to 15 minutes
after feeding. Discourage the use of plastic liners that come with nursing
bras; it is preferable to have air always circulating around the breasts.
Applying vitamin E lotion after air exposure may toughen the nipples and
prevent further irritation.

 Advise mothers not to use a hand pump with sore nipples, because the
pressure may cause fissures to worsen. An electric or battery-operated
pump usually can be used; these devices exert less pressure on the
nipples.
WEANING
Weaning is defined as accustoming the infant to discontinue breast feeding
by substitution of other nourishment.
At any age, breast-feeding should be discontinued gradually to prevent
engorgement and pain in the mothers breast while still providing
satisfaction for the infant. To do this, the mother could first omit one breastfeeding a day, substituting a bottle-feeding or milk from a glass or cup.
Then she could omit two breast-feedings, then three, and so on, until the
child is feeding entirely from a bottle, glass, or cup.
If weaned before 12 months, infants should be weaned to formula, not
whole milk, so that they continue to receive the added vitamins and low
solute load of commercial formulas.
REFERENCES: Maternal and Child Health Nursing: Care of the Childbearing
and Childrearing Family, 5th edition, by Pillitteri, Adele, et al.
Tabers Cyclopedic Medical Dictionary, 18th edition, by Thomas, Clayton L., et al
Principles of Anatomy and Physiology, 9th edition, by Tortora, Gerard J., et al