RAJKUMARI AMRIT KAUR

COLLEGE OF NURSING
LESSON PLAN -TECHNIQUES
OF BREAST FEEDING
(OBSTETRICAL NURSING)
ADVISOR: MADAM MRS. SIMMI EKKA
[CLINICAL INSTRUCTOR]
SUBMITTED BY: POOJA [B.SC. HONS.
NURSING 3rd YEAR]
DATE:30-07-21
 IDENTIFICATION DATA
NAME- POOJA

CLASS- B.SC. (H) NURSING 3RD YEAR

SUBJECT- OBSTETRICAL NURSING

TOPIC- TECHNIQUES OF BREAST FEEDING

TIME- 30 MIN

METHOD OF TEACHING- LECTURE CUM DISCUSSION

LANGUAGE- ENGLISH

NAME OF ADVISOR- MADAM MRS. SIMMI EKKA

DATE- 30 JULY, 2021

AV AIDS- PPT. AND VIDEO

GENERAL OBJECTIVES
• To gain the knowledge about the topic.
• To understand the topic in general.
• To gain confidence in facing and controlling the group.
• To develop skill in sharing knowledge with the group.
• At the end of discussion student will able to answer the question related to topic.
• By this discussion student will able to apply their knowledge in clinical area in future.

TIME SPECIFIC CONTENT TEACHING & AV EVALUATION

OBJECTIVE LEARNING AIDS
ACTIVITIES
 INTRODUCTION
20sec To Breast milk is an ideal
introduce food for neonates. It is
the topic. the best gift that a
mother can give to her
baby. It contains all the
nutrients for normal
growth and
development of a baby
from the time of birth
to first 6 month of life
ensuring exclusive
breast feeding for 6
months has potential
to reduce under 5%
mortality rate by 13%
by for the most
effective intervention
that is known to
reduce newborn and
ANNOUNCEMENT child death.
So today we are going to discuss about the topic
techniques of breastfeeding.
DEFINITION Teacher, student
20sec Breast feeding is the feeding of an infant or young discuss the definition What is the
To define child with breast milk directly from female breast of breast feeding definition of
the topic rather than using infant formula from a baby bottle breast
breast or other container. feeding?
feeding ANATOMY & PHYSIOLOGY
Breast are large modified sebaceous glands, bilateral Teacher, student
1min To explain and constitute accessory reproductive organs. discuss the anatomy of What are the
anatomy Breast usually extend from the second to sixth rib in breast necessary
and physio. the mid clavicular lines. glands
Of breast It lies in the axillary fossa, sometimes deep to the present in
deep fascia. The breast weighs 200-300gm during breast?
child bearing age.
AREOLA- Areola is placed about the center of breast
and is pigmented. It is about 2.5cm in diameter.
MONTGOMERY GLANDS- These glands are accessary
glands located around the periphery of the areola.
They can secrete milk.
NIPPLES- Nipples are a muscular projection covered
by pigmented skin. Nipples accommodate about 15-
20 lactiferous ducts and their opening and these
ducts dilates and form lactiferous sinus.
MYOEPITHELIAL CELLS- Each alveolus is lined by
columnar epithelium where milk secretion occurs. A
network of branching longitudinal striated cells called
myoepithelial cells.
AMPULLA- Behind the nipple, the main duct dilates
to form ampulla where milk is stored.
 Nerve supply is from 4th ,5th and 6th intercostal nerve.
HORMONAL INFLUENCES
To explain The endocrine control of lactation can be divided into Teacher, student
about the following stage- discuss the hormonal What are the
hormonal • Mammogenesis- Preparation of breast. influences of lactation 4 stages of
1.30 influence • Lactogenesis- Synthesis and secretion of milk lactation?
min on by breast alveoli.
lactation • Galactokinesis- Ejection of milk.
• Galactopoesis- Maintenance of lactation.

ADVANTAGES OF BREAST FEEDING

To 1. BENEFITS TO BABY Teacher, student
elaborate discuss about the What are the
• Complete food
the benefits of breast benefits to
• Easily digested and well absorbed
1.30 advantages feeding the mother of
• Protection against infection
min of breast breast
• Promotes emotional bonding
feeding feeding?
• Better brain growth
2. BENEFITS TO MOTHER
• Help in involution of uterus
• Delay pregnancy
• Lowers risk of breast and ovarian cancer
• Decrease mother workload
3. BENEFITS TO FAMILY AND SOCIETY
• Save money
• Promote family planning
• Decrease needs for hospitalization
• Contributes to child survival
OTHER BENEFITS
Exclusive breast-feeding babies are at decreased risk
of: -
• Diarrhea
• Pneumonia
• Ear infection
• Death in first year of life
BREAST FEEDING POSITION Student, teacher
2 min To 1. LAID BACK BREASTFEEDING OR RECLINED discuss about position
elaborate POSITION of breast feeding
 about the Laid back breastfeeding also known as biological
position of nurturing is often the first mother try. In this baby is
breast placed on mother chest or tummy as soon as baby
feeding born, all being well baby will instinctively work this
way toward one of the mother breast and attempt to
latch on- this is known as the “breast crawl”. Skin to
skin contact help stimulates baby feeding instincts,
while gravity helps him to latch on well and keeps
him in place. This position isn’t just for new born- it
can work with babies of any age.
2. CRADLE HOLD
This is the classic position most of the mother used. It
involves mother sitting upright, with baby positioned
on his sides, his head and neck laying along mother’s
forearm and his body against mother stomach in a
tummy to tummy positioned.
3. CROSS CRADLE HOLD
Cross cradle hold looks similar to the cradle hold but
mother arms switch roles so their baby body lies
along her opposite forearm. The aim is to support
baby around his neck and shoulders to allow him to
tilt his head prior to latch. This is great newborn
breast feeding apposition and also good for small
babies and those with latching difficulty because in
this position baby is fully supported on crossed
forearm.
4. FOOT BALL POSITION
Football position also known as under arm or clutch,
in this mother sit with her baby resting along her
forearm, the baby’s body along with those who have
larger breast may also like this position.
5. SIDE LYING POSITION
Ideal for relaxed night feeds and breastfeeding in bed
or on the sofa, side lying can also be more
comfortable than sitting if mother had c section or
stitches, mother and baby need to lie on her sides
next to one another, belly to belly.
STEPS FOR SUCCESSFUL BREASTFEEDING Student, teacher
All providers of maternity services should discusses about the
To discuss 1. Have a written breastfeeding policy that is steps for successful
about steps routinely communicated to all health care breast feeding
1 min for staff.
successful 2. Train all health care staff in the skill necessary
breast to implement the breastfeeding policy.
feeding 3. Inform all pregnant women about the
benefits and no management of
breastfeeding.
4. Help mother initiate breastfeeding soon after
birth.
 5. Show mother how to breastfeed and how to
maintain lactation even if they are separated
from their babies
6. Give new born infants no food or drink other
than breast milk, unless medically indicated.
7. Practice rooming in, allowing mothers and
infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or dummies to
breastfeed infants
10. Foster the establishment of breastfeeding
support groups and refer mothers to them on
To discharge from the hospitals or clinic. Teacher, student
elaborate TECHNIQUES OF BREASTFEED discusses about What is the
3 min about POSITION OF MOTHER techniques of breast sign of good
techniques • Baby and mother should be in comfortable feed attachment?
of breast position
feeding • Mother can support her hand with pillow
• Mother should be sitting in straight position
and bring baby toward her breast
• Mother should be void before feeding so that
there is no any disturbance during feeding
• Baby’s head should be straight in line witj the
body
• Mother should have liquids half an hour
before feeding
PREPARATION OF BABY
• Vitals should be stable
• Baby should be dry, no wet clothes, nap
should be checked
• According to season baby should be covered
• Give attention to all sign of hungry delivered
by baby
LOOK FOR SIGN OF GOOD ATTACHMENT
KEY SIGN FOR GOOD ATTACHMENT INCLUDE: -
• Baby’s mouth is wide open
• Baby’s lowered lip is turned outward
• Baby’s chin is touching the breast
• More areola is visible above the baby’s
mouth than below
CAUSES OF POOR ATTACHMENT INCLUDE
• Use of feeding bottles
• Unexperienced mother
• Lack of skilled support
• Inverted nipples
Hence it is very important not to introduced bottle
feeds at any point of time. Poor attachment usually
leads to problems such as: -
• Pain or damage to nipple or sore nipples
 • Breast enlargement as milk is not removed
effectively.
• Hungry and irritable baby because of poor
milk supply
• Poor weight gain of baby
Correct positioning and attachment will ensure
effective seeking and prevent sore nipple and breast
enlargement.
THE PROPER POSITION FOR MILK TRANSFER IS: -
• Chest to chest contact of the infants and
mother
• Infant’s ear, shoulder and hip are in one line
• Baby suck the areola and the nipple holding
between the tongue and palate
FAILURE TO DEVELOP GOOD MILK TRANSFER,
MAJOR CAUSES ARE: -
• Lactation failure
• Breast pain
• Inhibition of led down reflex and failure to
empty breasts lead to ductal distortion
• Parenchymal swelling and breast
enlargement
• Nipple confusion
BREAKING THE WIND (BURPING)
• To breakup the wind the baby should be held
upright against the chest and back is gently
patted till the baby betches out the air
• It is better to breakup the wind in middle of
sucking so as to make the stomach empty,
2 min Student, teacher
enabling the baby to take more food and at
To explain discusses about What do you
the end of sucking to prevent hiccough and
the frequency of breast mean by
abdominal colic
frequency feeding duration of
of feeding FREQUENCY OF FEEDING feed?
• TIME SCHEDULE- baby should be feed in
every 2-3 hours or short interval of time.
Baby should be fed more on demand.
• DURATION OF FEED- the initial feeding
should be last at each breast get empty. This
help to condition the let down reflex.
Thereafter, baby should be fed from one
breast completely so that baby gets both the
foremilk and the hind milk. Then the baby is
put to another breast is required. Hind milk is
richer in fat and supplies more calories and
satiety to the infant. Then next feed should
start with the other breast if required.
• NIGHT FEED- baby should be feed more at
night in every 2 hourly mothers should feed
her baby. It eliminates excessive filling and
hardening of breast and also ensure sound
sleep for baby.
 • AMOUNT OF FOOD- the average
requirement of milk is about 60ml/kg/24 Student, teacher
hours on first day. 100ml/kg/24 hours on the discusses about
4 min third day and is increased to 150ml/kg/24 counselling of breast-
To discuss hour on 10th day. However, the baby can take feeding mother
about as much as he wants.
counselling COUNSELLING OF BREAST FEEDING
of breast All mother particularly the first-time mother would
feed require some help to initiate breastfeeding. Hence it
mother is important for health care provider to help them to
breast feed their babies.
1. PREPARING THE INFANTS AND THE MOTHER
• Ensure that the infant is clinically stable
• Ensure that the infant is alert
• Make sure that mother is comfortable and
relaxed
• Mother should take a fluid before half an
hour before feeding
• Make mother sit down in a comfortable and
convenient position
• Mother should be stress free, both mother
and baby should be in clean and dry clothes
2. DEMONSTRATE VARIOIS POSITION FOR
BREASTFEEDING A BABY
A mother can feed the infant in various position
whatever the position. When mother is comfortable
it is important to remember that she has to be fully
supported with her forearm and the hands.
3. DEMONSTRATE THE KEY POINT IN POSITION
• Baby head in line with the body
• Whole body is well supported
• Baby turned toward mother
• Baby’s abdomen touching mother’s abdomen
4. SHOW THE MOTHER HOW TO SUPPORT HER
BREAST
• Explain the mother that she should
• Put her finger below her breast
• Uses her first finger to support the breast
• Put her thumb above the areola helping the
shape of the breast
• Not keep the fingers near the nipple
5. SHOWING THE MOTHER HOW TO HELP THE
BABY TO ATTACH
Ask mother to
• Express a little milk on her nipple
• Touch the baby’s lips with her nipple
• Wait until the baby’s mouth is opening wide,
and the tongue is down and forward
 • Move the baby quickly onto her breast,
aiming the nipples towards the baby’s palate
and his lower lip well below the nipple
6. LOOK FOR SIGN OF GOOD ATTACHMENT
7. ASSESS IF THE INFANT IS SUCKING AND
SWALLOWING EFFECTIVELY
Effective sucking- infant take several slow deep sucks
followed by swallowing and then pauses
Ineffective sucking- infants suckle for a short time
but tries out and is unable to continue for long
enough.
If an infant is not able to attach and suck effectively
at the breast or is not able to suckle for a long
enough to complete a feed, he or she will need to fed
with a spoon or paladai until effective feeding ability
develops.
COUNSELLING REGARDING BREASTFEEDING IN
To discuss “APLAC” FORMAT
about how ASK- open ended question about breastfeeding Student, teacher
2 min can we LISTEN- clarify the doubts discusses about What do you
promote PRAISE-encourage the mother promotion of exclusive mean by
exclusive ADVISE- regarding assessment, position breast feeding exclusive
breast CHECK- check for sign of good attachment and breast
feeding correct position of baby feeding?
PROMOTE EXCLUSIVE BREASTFEEDING
Exclusive breastfeeding for 6 months means that a
baby is fed only breast milk for first 6 months of its
life, with no additional food or drinks. This is the best
nourishment for a baby and such babies are not even
given water
TO PROMOTE EXCLUSIVE BREASTFEEDING
• Promote skin to skin contact at birth and put
baby to breast as soon as possible after birth.
This is important for mother, baby and
production of milk.
• On the first day, breast milk is thick and
yellowish (colostrum). Feeding this milk
provide nutrition and prevent infection.
Some babies will not latch during first feeding
session. Give no liquid other than breast milk
(colostrum) even if the baby does not feed.
DO NOT DISCARD COLOSTRUM.
• Keep baby close to mother, it is safe for a
baby to sleep with mother.
• Mother may lie down, sit on a bed, chair or
floor to breast feed her baby.
• Breast feed during day and night for at least 8
to 10 times or whenever baby cries with
hunger.
 • The more the baby sucks at breast, more milk
the breast will produce and healthier the Teacher, student
2 min To baby becomes discusses about
introduce • Allow baby to feed at one breast until he problem in breast
the group leaves the nipple on his own. Then feed him feeding
about at the other breast if he continues to be
problem in hungry.
breast • Give baby only breast milk for 6 months. Do
feeding not give baby ghutti water, gripe water,
honey, animal or powdered milk
• Never use bottles or pacifier
PROBLEM IN BREAST FEEDING Student, teacher
1 min To explain Various problem in breastfeeding that result in discusses about
collection • ineffective breastfeeding collecting and storing
and storage • Breast engorgement of breast milk
of breast • Sore nipple
milk
• Inverted nipple
• Breast abscess
• Not enough milk
• Mastitis
COLLECTING AND STORING OF BREAST MILK
Collecting and storing breast milk is a necessity for
mother who are separated from their infants due to
To problems such as prematurity or illness. In other
summarize situations, woman may elect to return to school or
and work and wish to have breast milk available for
conclude feeding by another individual, freshly pumped breast
the topic milk can be safely stored at room temperature for 4
hours or refrigerator at 34 to 39degree F (0 degree C)
for 5 to 7 days after collection. Milk kept in a deep
freezer at 0-degree F (-19-degree Celsius) can be
stored for 6 to 12 months.
SUMMARY AND CONCLUSION
So today we have discussed about techniques of
breastfeeding different position of breastfeeding,
counselling of breastfeeding and different position of
breastfeeding and at last storage and collection of
milk. Hope you all get required knowledge from this
presentation.
BIBLIOGRAPHY
DC dutta textbook of obstetrics by dr. sayed sujon
edition 8th page no. 520-522, 523,524.
Ghai essential pediatric by vinod k paul and Arvind
bagga edition 8th page no. 150, 154, 155
Maternal-child nursing care : optimizing outcomes for
mothers, children, and families by Susan L Ward;
Shelton M Hisley
Sue Macdonald, Julia Magill-Cuerden, Mary Mayes
14th Edition