Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 107:
RLE MODULE 3F

BREAST CARE, BREAST FEEDING,

AND BOTTLE FEEDING

Section F - Group 6:

Ms. Wasawas, Janeryle Kerry D. - Leader

Members:

Ms. Ticong, Gwynneth

Ms. Tinosan, Mary Angeline M.

Ms. Tobias, Roxanne

Ms. Tumulak, Alyssa Claire P.

Ms. Urbiztondo, Marycon Joy A.

Ms. Ycong, Louise Marie C.

Facilitator: Ms. Josie Fe Ortega, MAN, RN

Date Submitted: September 26, 2022

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TABLE OF CONTENTS

PAGE

Learning Outcome for Breast Care, Breast Feeding, and Bottle Feeding 2

CLO#1: define the terms related to breast care. 3

CLO#2: review the anatomy and physiology of the breast. 5
CLO#3: enumerate the importance of breast care. 7
CLO#4: explain the scientific principles involved in breast care. 8
CLO#5: state the guidelines in breast care. 9
CLO#6: demonstrate beginning skills in breast care. 12
CLO#7: define the terms related to breastfeeding and bottle feeding. 14
CLO#8: explain the physiology of lactation. 17
CLO#9: enumerate the advantages of breastfeeding. 19
CLO#10: state the types of nipples. 20
CLO#11: discuss the importance of breastfeeding. 21
CLO#12: list the indications and contraindications of breastfeeding and
bottle feeding. 22
CLO#13: state guidelines in breast and bottle feeding 23
CLO#14: discuss the principle involved in breastfeeding and bottle feeding. 24
CLO#15: discuss the maternal breastfeeding reflexes. 26
CLO#16: discuss the technique used during pregnancy to prepare nipples
for nursing. 27
CLO#17: illustrate the positions in breastfeeding. 30
CLO#18: list common problems in breastfeeding. 33
CLO#19: utilize the knowledge in breastfeeding in providing care to a client
using a clinical-case scenario 34
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BREAST CARE, BREAST FEEDING, AND BOTTLE FEEDING

LEARNING OUTCOMES:

After 4.5 hours of various classroom and laboratory activities, the Level II
students will be able to:

CLO#1: define the terms related to breast care.

CLO#2: review the anatomy and physiology of the breast.
CLO#3: enumerate the importance of breast care.
CLO#4: explain the scientific principles involved in breast care.
CLO#5: state the guidelines in breast care.
CLO#6: demonstrate beginning skills in breast care.
CLO#7: define the terms related to breastfeeding and bottle feeding.
CLO#8: explain the physiology of lactation.
CLO#9: enumerate the advantages of breastfeeding.
CLO#10: state the types of nipples.
CLO#11: discuss the importance of breastfeeding.
CLO#12: list the indications and contraindications of breastfeeding and bottle feeding.
CLO#13: state guidelines in breast and bottle feeding
CLO#14: discuss the principle involved in breastfeeding and bottle feeding.
CLO#15: discuss the maternal breastfeeding reflexes.
CLO#16: discuss the technique used during pregnancy to prepare nipples for nursing.
CLO#17: illustrate the positions in breastfeeding.
CLO#18: list common problems in breastfeeding.
CLO#19 utilize the knowledge in breastfeeding in providing care to a client using a
clinical-case scenario
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CLO#1: define the terms related to breast care.

1.1 Breast Care

- Is the process of cleaning the breast of mother that helps in maintaining

hygiene and prevent from cross infection during feeding

1.2 Breast
- is a mass of glandular, fatty, and fibrous tissues positioned over the
pectoral muscles of the chest wall and attached to the chest wall by
fibrous strands called Cooper’s ligaments

1.3 Nipples
- is a raised region of tissue on the surface of the breast from which, in
females, milk leaves the breast through the lactiferous ducts to feed an
infant
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1.4 Areola
- is the pigmented area on the breast around the nipple. Areola, more
generally, is a small circular area on the body with a different histology
from the surrounding tissue, or other small circular areas such as an
inflamed region of skin.
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CLO#2: review the anatomy and physiology of the breast.

Anatomy of the Breast

(a) Lactiferous ducts divide to supply lobules, which form lobes.

(b) In the nonlactating breast, only the duct system is present.

(c) In the lactating breast, the ends of the mammary gland ducts have secretory sacs,
called alveoli, that produce milk. Surrounding the alveoli are myoepithelial cells, which
can contract, causing the milk to move out of the alveoli.

Physiology of the Breast

- fatty, connective, and glandular tissue make up the breasts. These tissues
contain cells that can produce milk. Milk leaks from tiny holes in the nipple. The
areola, a region of darker skin that surrounds the nipple, expands and darkens
during pregnancy.
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- When a newborn suckes, the nipple is stimulated, and the muscles around it
cause the nipple to stand up. The brain's pituitary gland releases the hormone
prolactin when the nipple is stimulated, which causes the breast milk gland cells
to begin producing milk. This doesn't happen until after the placenta and child
are delivered.
- The mother is then helped to relax by the hormone oxytocin, which also causes
the milk gland to contract and force milk out of the nipple. This response is
known as milk ejection or letdown.
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CLO#3: enumerate the importance of breast care.

All women should get to know how their breasts normally look and feel. During
pregnancy, breast changes also start happening such as the darkening of the areolas
and getting bigger, and pregnancy hormones will make breasts grow and prepare to
produce breast milk. Here are the importance of breast care:

1. Early Detection
Awareness surrounding breast cancer and other conditions is incredibly
important as early detection through screening. Breast screening can
catch the disease when it is most treatable.

2. Reduces Discomfort and Infection

As the breasts fill up with breast milk, the mother will experience breast
engorgement, tingling, tenderness, and the leaking of breast milk. To
minimize other types of discomfort and help prevent the growth of
infection, it is important to practice good hygiene and secure a breast
cloth for leakage.

3. For baby’s healthy consumption

When doing breast care, it does not only promote maternal health but it
promotes the health of the baby through the milk it was produced. A
healthy and clean breasts leads to a way for the baby to consume milk
healthily and safely.
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CLO#4: explain the scientific principles involved in breast care.

❖ Anatomy and Physiology
➢ In order to deal with these changes effectively, women must be aware of
and competent about the transformations in their bodies linked to breast
care throughout pregnancy.

❖ Body Mechanics
➢ Women must maintain proper body posture to prevent injuries, such as
maintaining their backs straight or not slouching when performing
breast-care tasks to prevent back pain.

❖ Microbiology
➢ In order to eliminate the colostrum and lower the risk of infection, wash
the breasts every day with clean tap water. Avoid using soap as it may
promote nipple dryness and cracking.

❖ Time and energy

➢ To save time and energy, it is necessary to prepare all the supplies needed
in advance.

❖ Physics
➢ To distribute the weight of the breasts across the shoulders, women
should wear strong, supportive bras with wide straps. Greater pressures
on the ligaments that cause breasts to expand or sagging are avoided as a
result.

❖ Chemistry
➢ Particularly when cleaning the breast with soap and other hygiene
products, the nipple's natural lubrication may be eliminated. To prevent
irritations, it is advisable to only use water when cleaning.
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CLO#5: state the guidelines in breast care.

GUIDELINES FOR THE BREASTFEEDING MOTHERS

Need of breast care for all lactating mothers is most necessary as this is directly linked
to the health of the mother and her baby. Therefore, if you are breastfeeding, it is
critical to take good care of your breasts. The health of your breasts is improved by
good breast care, which in turn makes it easier for you and your baby to breastfeed.

● Practice good hygiene

Before touching your breasts, wash your hands. Washing your breasts and
nipples in the shower or bath with warm water every day will keep them clean.
Avoid washing your breasts with soap as well. Soap can cause dry, cracked, and
irritated skin.

● Change breast pads often

If you use cotton squares or breast pads inside your bra to collect breast milk
from dripping breasts, be sure to replace them as soon as they get wet because
moisture might encourage the growth of germs. Clean, dry nursing pads can help
to prevent sore nipples, thrush, or mastitis.

● Wear a supportive bra

Select a bra that is supportive for nursing or a typical bra that is comfortable but
not too tight. Cotton is a great fabric option since it lets your skin breathe.

● Make sure your baby is latching on correctly

It is possible to stop the onset of uncomfortable breast conditions like sore
nipples, breast engorgement, plugged milk ducts, and mastitis by getting your
infant to latch on properly from the very first breastfeeding and nursing
frequently—at least every 2 to 3 hours.
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● Remove your baby from your breast correctly

When you're ready to take your baby off of the breast, do not pull them off.
Instead, gently release the suction between their lips and your breast by placing
your finger in the corner of their mouth.

● Treat sore nipples

After nursing your baby, use a gentle nipple cream or some of your breast milk
on your nipples and areola to cure (and prevent) sore nipples. Then, let them air
dry. Talk to your doctor or a lactation consultant about using hydrogel pads or
pure lanolin to help soothe your breasts if you have sore nipples.

GUIDELINES FOR THE NON BREASTFEEDING MOTHERS

Your production of breast milk will stop by itself over time. Before this happens, you
may have any of the following:

● Milk leakage may occur. Drops of milk may leak from your breasts for weeks
after delivery.

● Breast engorgement may also occur. Your breasts may feel hard to the
touch. You may see swelling and feel pressure, discomfort, or pain for up to 10
days after delivery. Breast swelling can cause you to get a fever and have muscle
aches. Engorgement can be uncomfortable, but it helps your body decrease
breast milk production.

● Wear a bra that fits correctly and provides firm support.

Breast soreness and milk leaking from your breasts may be lessened by wearing
a well-fitting bra that is not too tight. The signs of engorgement can also be
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lessened by wearing a supportive bra. Additionally, your doctor could advise

against stimulating your nipples.

● Place ice pack on your breast

This lessens the pain and swelling in the breasts. Use an ice pack, or place some
crushed ice in a bag with some toweling over it. Find out from your doctor how
often and for how long you should apply ice.

● Ask about medicine to decrease your breast pain or discomfort

Ibuprofen or acetaminophen, two over-the-counter pain relievers, may aid in
reducing discomfort and swelling. With or without a doctor's prescription, you
can purchase them. Find out how much of this medication to take and how often
to take it. Observe instructions. If ibuprofen is not taken properly, it might harm
the kidneys and cause stomach bleeding. If acetaminophen is not taken properly,
liver damage may result.
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CLO#6: demonstrate beginning skills in breast care.

When to start nursing and how to make sure you're giving your baby enough milk are
two of the most common questions new mothers have. The more information you have
beforehand, the more equipped you'll be to have a successful nursing experience during
those first few hours with your new baby.

● Start early
The first moment you are able to hold your baby is the ideal time to begin
breastfeeding. According to studies, holding newborns on your chest for at least
an hour after birth while they are still skin to skin has been demonstrated to
improve breastfeeding outcomes. When placed on your chest, a newborn will
normally instinctively find your nipple and begin sucking. However, if your baby is
having trouble latching, don't give up hope; it may only take some practice and
assistance before your little one gets it.

● Don’t stress about supply

Your body begins making colostrum, sometimes known as "first milk," even while
you are still pregnant. This unique kind of breast milk is brimming with beneficial
nutrients that support a robust immune system. The baby will have access to this
colostrum as soon as they start nursing, which is the initial step in starting a
breastfeeding relationship. It's critical to keep in mind how little newborns'
stomachs are. Don't be disheartened if you don't produce a lot of milk on your
first day; research suggests that babies only swallow about a teaspoon every
feeding in the first 24 hours after delivery. Your milk will alter and your supply
will increase as your baby grows and as you continue to nurse in order to fulfill
his or her changing nutritional needs.
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● Nurse or pump often

One of the most crucial breastfeeding newborn advice is to feed your baby
frequently in the first few days after delivery because supply and demand govern
breast milk production. This signals the brain and breasts that the baby is hungry
and that more milk should be produced. To prepare for an abundant milk
production later on, the majority of specialists advise feeding at least 8 to 10
times each day in the first week after delivery.
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CLO#7: define the terms related to breastfeeding and bottle feeding.

7.1 Breastfeeding
- the normal way of providing young infants with the nutrients they need
for healthy growth and development

7.2 Lactation
- it is described as the secretion of milk from the mammary glands and the
period of time that a mother lactates to feed her young

7.3 Colostrum
- a thin, watery, yellow fluid composed of protein, sugar, fat, water,
minerals, vitamins, and maternal antibodies, is secreted by the acinar
breast cells starting in the fourth month of pregnancy
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7.4 Burping
- The release of gas bubbles up the esophagus and out of the mouth. Some
burps, called wet burps, bring up some of the stomach contents, too,
hence the reason to always use a burp cloth when burping a baby.

7.5 Latch-on
- is how a baby attaches to his mother's breast to breastfeed. A good
breastfeeding latch is necessary to build and maintain a healthy supply of
breast milk for your baby.

Signs of a good latch are the following:

➢ The latch is comfortable and pain free.
➢ The baby's chest and stomach rest against the mother’s body, so
that the baby’s head is straight, not turned to the side.
➢ The baby's chin touches the breast.
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➢ The baby's mouth opens wide around your breast, not just the
nipple.
➢ The baby's lips turn out.
➢ The baby's tongue cups under your breast.
➢ You can hear or see the baby swallowing.
➢ The baby's ears move slightly.

7.6 Prolactin
- an anterior pituitary hormone that tells the body to make breast milk
when a person is pregnant or breastfeeding

7.7 Oxytocin
- a hormone secreted by the posterior pituitary that stimulates uterine
contractions and initiates milk let-down reflex

7.8 Breast Pump

- a mechanical device that lactating women use to extract milk from their
breasts
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CLO#8: explain the physiology of lactation.

The normal physiology of lactation is a process that starts to work long before
the newborn baby latches for the first time. Each stage of female development
necessitates a change in the substance, size, and shape of the breast. Pregnancy,
nursing, and puberty are all aspects of development. A series of physiologic changes
that are essential for effective breastfeeding affect these stages. The development of
the mammary gland (mammogenesis), the process by which the mammary gland
acquires the capacity to secrete milk (lactogenesis), and the procedure for producing
milk will all be covered in this article (lactation).

During puberty, type 1 lobules form. During each menstrual cycle, variations in
the levels of the hormones estrogen and progesterone encourage lobule 1 to develop
new alveolar buds, which eventually mature into more mature structures known as
type-2 and type-3 lobules. The female breast does not alter again after adolescence is
over until pregnancy.

In response to increasing progesterone levels, stage-II mammogenesis (alveolar

development and epithelial maturation) takes place during pregnancy. The proliferation
of secretory tissue during pregnancy is the cause of the increased amount of breast
tissue. The influence of chorionic gonadotropin contributes to the formation of lobule
type 3 in early pregnancy. These freshly generated lobules have more epithelial cells per
acinus and are greater in size. The growth of new acini slows down as the pregnancy
progresses, and colostrum or secretory material causes the lumen to swell.

The lobule continues to grow and differentiate during labor and breastfeeding,
and milk is secreted at the same time. The glandular portion of the breast has now
developed to the point where the majority of its components are epithelial, with very
little stroma. This will continue during lactation.
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Last but not least, after lactation stops, the mammary glands undergo involution,
which is triggered by a combination of local autocrine signals that indicate apoptotic cell
death and tissue remodeling as well as a lack of lactogenic hormones. Pregnancy results
in a permanent increase in lobule size and number but no complete regression. Even
after lactation, the glands could still produce milk in response to regular stimulation.
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CLO#9: enumerate the advantages of breastfeeding.

➢ Breast milk is perfectly designed for babies

➢ Breast milk protects baby from infections and diseases
➢ Breast milk is available for baby whenever the baby needs it
➢ Breastfeeding can build a strong emotional bond between mother and baby
➢ The longer you breastfeed, the longer the protection lasts and the greater the
benefits.
➢ Some studies have also found that breastfeeding for at least 6 months may
reduce your baby's chance of getting childhood leukemia.
➢ The more a mother breastfeeds, the greater the benefits. Breastfeeding lowers
risk of cancer.
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CLO#10: state the types of nipples.

❖ Everted/Protruding Nipples - Everted nipples tend to point outwards or erect

and stand up away from the areolae even when they are not being stimulated.

❖ Flat Nipples - The entire nipple is flat and blends into the areola. The nipple
can harden and become more pronounced with cold or stimulation.

❖ Inverted Nipples - The nipples retract inwards, instead of out. Sometimes, you
can use your fingers to bring it out, but sometimes, the muscles are too tight.
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CLO#11: discuss the importance of breastfeeding.

For mothers:
- Relax; when a baby feeds, the mother's body produces a surge of the bonding
hormone oxytocin, which has a soothing and relaxing effect.
- Save time and money; preparing the formula is costly and time consuming.
Breast milk, on the other hand, is constantly ready and at the perfect warmth -
great when fatigued.
- it reduces the risk of ovarian and breast cancer of the mother
- recover after the delivery of the baby and avoid severe postpartum hemorrhage
- return to pre-pregnancy weight more rapidly by burning 500 more calories every
day
- create a close emotional link with their children

For babies:
- Breastfeeding is more than food for the baby. It provides all the energy and
essential nutrients from birth up to 6 months of life.
- Breast milk is the safest and healthiest food for the baby.
- When you hold the baby close during breastfeeding, the baby can feel, smell and
see you. This helps you 11 build a close, loving bond between you and your baby
and that you can give your baby something that no one else can.
- Babies who are breastfed are also sick less often than babies who are not
breastfed.
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CLO#12: list the indications and contraindications of breastfeeding and

bottle feeding.

Indications of breastfeeding:
- Newborns
- Infants until the age of 6 months
- Mother having a sufficient supply of nutrients in breastfeeding

Contraindications of breastfeeding:
- An infant diagnosed with galactosemia
- An infant whose mother:
- has been infected with the human immunodeficiency virus (HIV)
- taking antiretroviral medications
- infected with human T-cell lymphotropic virus
- using or dependent upon an illicit drug
- receiving diagnostic or therapeutic radiation therapy

Indications of bottle feeding:

- Complete failure of breast milk production
- Death or absence of mother
- Prolonged maternal illness
- Having trouble with the infant latching in the breast

Contraindications of Bottle feeding:

- Baby has loose yellow stool
- Babies that are lactose intolerant
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CLO#13: state guidelines in breast and bottle feeding

BREAST MILK AND BREASTFEEDING
- Wash hands well with soap and water.
- Ensure that the mother is sitting comfortably. Always hold the baby close to her
and look into their eyes when feeding.
- Hold the baby fairly upright for feeding, with their head supported so that they
can breathe and swallow comfortably
- When the baby does not want any more feed, hold them upright and gently rub
or pat their back to bring up any wind.
- Look out for the baby’s cues that they have had enough milk. Don’t try and force
the baby to take more than they want.

BOTTLE FEEDING
- Sterilize the bottle by using a cold-water sterilizing solution, steam sterilizing, and
sterilization by boiling.
- Inspect the bottle and tubing to make sure it is clean. Discard and replace moldy
tubing immediately.
- If using a shared pump kit, clean pump dials, power switch, and countertop with
disinfectant wipe.
- Use breast milk storage bags or clean food-grade containers with tight fitting
lids made of glass or plastic to store expressed breast milk.
- Store freshly expressed or pumped milk at room temperature (77°F or colder) for
up to 4 hours, in the refrigerator for up to 4 days, and in the freezer for about 6
months is best.
- Clearly label the breast milk with the date it was expressed.
- Freeze breast milk in small amounts of 2 to 4 ounces to avoid wasting breast
milk that might not be finished.
- Serve the breast milk at a room temperature
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CLO#14: discuss the principle involved in breastfeeding and bottle feeding.

1. Principles involved in breastfeeding:

● Breastfeeding should start as soon as possible after birth, ideally within

the first hour, and last for at least the first six months of a baby's life. The
first milk, or colostrum, should be provided to the infant rather than
wasted.
● The infant should only be breastfed during the first six months of life.
During that period, the infant should not be given anything else to drink
or eat. If the mother has any concerns, a lactation consultant or dietitian
can evaluate her to ensure that the infant is receiving all the necessary
nutrients.
● In order to stimulate the breasts to produce an acceptable amount of
breast milk, the baby should be breastfed anytime she/he desires, day or
night (on demand).

2. Principles involved in bottle feeding:

● The purpose of feeding is to promote warm and intimate relationships.

The Parent or caregiver should give the baby his or her first bottle while
receiving help and instruction from neonatal personnel.
● Before starting bottle feedings, a baby who is at a higher risk of
swallowing issues (severe preterm, long-term respiratory reliance, known
comorbidity, such as Down syndrome) should be sent to a speech and
language therapist (SLT). Infants with Down syndrome should be
evaluated by a lactation consultant and an SLT together, with additional
input based on the baby's and the mother's needs.
● Infant readiness, as opposed to gestational age, should be taken into
account before starting bottle feedings. This includes elements like
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respiratory support, ready behaviors, pre-feeding abilities, and nasogastric

feed tolerance. Bottles should only ever be supplied when the baby is
awake and alert and according to their indications. Never offer a baby a
bottle feed if they are dozing off or too sleepy to respond to the supplied
test. Never force a child to eat.
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CLO#15: discuss the maternal breastfeeding reflexes.

❖ Milk Production
- The Anterior Pituitary Gland produces a hormone called Prolactin which is
responsible for “milk production”. Prolactin is the one that causes the
alveoli to make milk.

❖ Milk Ejection Reflex (MER)

- Oxytocin causes muscle contractions that push out of the alveoli and
through the milk ducts causing milk expulsion

❖ Let-down Reflex
- The let-down reflex is what makes breast milk flow. When your baby
sucks at the breast, tiny nerves are stimulated. This causes two hormones
– prolactin and oxytocin – to be released into your bloodstream. Prolactin
helps make the milk, while oxytocin causes the breast to push out the
milk.

❖ Nipple Erection
- During breastfeeding, mechanical stimulation of the nipple from the baby
causes the body to release oxytocin; this hormone acts on the milk glands
to contract and push milk out to the baby. It is due to the contraction of
the smooth muscle under the control of the autonomic nervous system.
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CLO#16: discuss the technique used during pregnancy to prepare nipples for
nursing.

1. Test yourself
- When stimulated, many nipples will harden and protrude. You can determine if
your nipples are actually flat or inverted by checking. It's likely that if you can
force your nipples out, your kid will be able to do the same.

Here’s how to check:

1. Place your thumb and forefinger on the edges of your areola, which is the
dark area around your nipple.

2. Squeeze gently.

3. Repeat on your other breast.

2. Hand Express
- When your breast is heavily engorged with milk, it might occasionally feel hard
and flatten. You can make your breasts softer so that your baby can latch on
more easily by hand-expressing a small amount of milk.

Here’s how to do it:

1. Cup your breast with one hand, with your other hand make a “C” shape with
your thumb and forefinger near the areola, but not on it.
2. Squeeze gently and release the pressure.
3. Repeat and try to get a rhythm going without sliding your fingers over the skin.
4. Drops of liquid should appear just before your milk begins to flow.
5. Express just enough to soften your breast.
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3. Pull back

- If you have flat or inverted nipples and are breastfeeding, pulling back on your
breast tissue could be helpful. Pulling back on the breast tissue can improve your
baby's latch, even if the nipple doesn't fully protrude. You accomplish this by
gently tugging back toward your chest while grasping the breast tissue behind
the areola.

4. Stimulate the nipple

- By gently stimulating your own nipple, you might be able to coax it out. You can
also try gently massaging your nipple with a cold, damp towel or rolling it
between your thumb and finger.

5. Hoffman technique

- Designed to aid mothers who have flat or inverted nipples in breastfeeding.

According to a 2017 study, the method significantly enhanced both the nipple
type and nursing quality.

Here’s how to perform the Hoffman technique:

1. Place your index and thumb on either side of your nipple.

2. Press your fingers firmly into the breast tissue.
3. Gently stretch the areola in each direction.
4. Repeat five times each morning if you’re able to without pain.

You can also perform the exercise with both hands, using both of your thumbs.
 29

6. Hold your breast

C-hold

- You may effortlessly direct your nipple toward your baby's mouth by using the
C-hold to regulate the movement of your breast. Additionally, it assists in
flattening your breast to improve fit in your baby's mouth.

To do it:

1. Create a “C” shape with your hand.

2. Place your hand around your breasts so that your thumb is on top of your
breast and your fingers are on the bottom.
3. Make sure your thumb and fingers are behind the areola.
4. Gently squeeze your fingers and thumb together, pressing your breast like
a sandwich.

V-hold

- Your forefinger and middle finger form a scissor-like shape around your areola
and nipple when you use the V-hold.

Here’s how you do it:

● Place your nipple between your forefinger and middle finger.

● Your thumb and forefinger should be on top of your breast and your remaining
fingers underneath the breast.
● Press down gently towards your chest to help “squeeze” out the nipple and
areola.
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CLO#17: illustrate the positions in breastfeeding.

1. The Laid-Back Nursing Position

- You can start using this natural posture as soon as you start nursing. It's a
wise decision for anyone, but breastfeeding a preterm, twins, or a baby
who struggles to latch on may be especially beneficial.

2. The Cradle Hold

- The most common nursing position. While initially it could be challenging to
breastfeed in this position, it is a frequent and comfortable manner to do so after
your baby can latch on properly.
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3. The Cross-Cradle Hold

- For breastfeeding premature babies, newborns, and infants who have problems
latching on, the cross-cradle or crossover hold is a good option. In this posture, it
is simpler to see your nipple and your child's mouth. Additionally, since you are
holding your baby's head, you have more control to direct your baby toward a
successful latch.

4. The Football Hold

- The football position, also known as the clutch hold, is ideal for
breastfeeding twins. Since the infant does not lie across your abdomen, it
is also an excellent position for breastfeeding following a cesarean section.
This technique may also be preferred by mothers with large breasts and
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those with flat or inverted nipples. It's an additional posture that provides
a clearer view of your nipples and your baby's mouth.

5. The Side-Lying Position

- When you're exhausted and want to nurse while lying down, the side-lying
posture is ideal. It is a very natural option for feedings at night, and it is
especially beneficial for mothers who have undergone a c-section.
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CLO#18: list common problems in breastfeeding.

- Sore or cracked nipples

- Too much breast milk
- Not enough breast milk
- Breast engorgement
- Breastfeeding and tongue tie
- Baby is not latching on properly
- Blocked milk duct
- Breastfeeding and thrush
- Mastitis
- Breast abscess
 34

CLO#19 utilize the knowledge in breastfeeding in providing care to a client

using a clinical-case scenario
 35

REFERENCES:

Breast Care and

Breastfeeding

1. Bottle feeding. (2022, August 3). Starship.

https://starship.org.nz/guidelines/feeding-bottle-feeding/

2. Breast Care for the Non-Breastfeeding Mother - What You Need to Know. (n.d.).

Drugs.com.

https://www.drugs.com/cg/breast-care-for-the-non-breastfeeding-mother.html

3. General principles of early and exclusive breastfeeding. (n.d.). Health Promotion

Issues During Pregnancy.

https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=45§ion=1.8

.2#:%7E:text=The%20baby%20should%20be%20breastfeed,adequate%20sup

ply%20of%20breast%20milk.

4. H
‌ ow to Care for Your Breasts When You’re Breastfeeding. (n.d.). Verywell Family.
https://www.verywellfamily.com/how-to-care-for-your-nursing-breasts-431863
5. NHS website. (2021, November 18). Benefits of breastfeeding. Nhs.Uk. Retrieved
August 20, 2022, from
https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeed
ing/benefits/#:%7E:text=breast%20milk%20protects%20your%20baby,between
%20you%20and%20your%20baby

6. Pillay, J., & Davis, T. J. (2022, July 18). Physiology, Lactation. National Library of

Medicine. https://www.ncbi.nlm.nih.gov/books/NBK499981/

7. Tips for Beginning Breastfeeding to Start Strong. (n.d.). Medela. Retrieved

August 20, 2022, from

 36

https://www.medela.us/breastfeeding/articles/tips-for-beginning-breastfeeding-to

-start-strong
 37

Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 107:
RLE MODULE 3F

BATHING NEWBORN AND CORD

DRESSING

Section F - Group 6:

Ms. Wasawas, Janeryle Kerry D. - Leader

Members:

Ms. Ticong, Gwynneth

Ms. Tinosan, Mary Angeline M.

Ms. Tobias, Roxanne

Ms. Tumulak, Alyssa Claire P.

Ms. Urbiztondo, Marycon Joy A.

Ms. Ycong, Louise Marie C.

Facilitator: Ms. Josie Fe Ortega, MAN, RN

Date Submitted: August 21, 2022

 38

TABLE OF CONTENTS

PAGE

Learning Outcome for Bathing Newborn and Cord Dressing 39

CLO#1: define the terms related to bathing a newborn. 40

CLO#2: state the importance of bathing a newborn. 43
CLO#3: identify the indications and contraindications of bathing a newborn. 44
CLO#4: discuss the different types of newborn baths. 45
CLO#5: differentiate the different ways of holding or carrying a newborn 47
CLO#6: explain theories principles and standards as applicable to bathing
newborn. 50
CLO#7: examine evidence-based nursing responsibilities and guidelines
in performing bathing newborn. 52
CLO#8: demonstrate the beginning skills in bathing a newborn. 54
CLO#9: define the terms related to cord dressing. 55
CLO#10: Give importance of cord dressing. 57
CLO#11: enumerate the indications and contraindications of cord dressing. 58
CLO#12: explain theories principles and standards as applicable to cord dressing 59
CLO#13: examine evidence-based nursing responsibilities and guidelines
in performing cord dressing. 61
CLO14: demonstrate the beginning skills in immediate cord care and
daily cord dressing. 63
CLO#15: utilize the knowledge in Bathing Newborn and Cord Dressing
in providing care to a client using a clinical-based case scenario. 64
 39

BATHING NEWBORN AND CORD DRESSING

LEARNING OUTCOMES:

After 4 hours of varied online class activities, the level II nursing students will be

able to:

CLO#1: define the terms related to bathing a newborn.

CLO#2: state the importance of bathing a newborn.
CLO#3: identify the indications and contraindications of bathing a newborn.
CLO#4: discuss the different types of newborn baths.
CLO#5: differentiate the different ways of holding or carrying a newborn
CLO#6: explain theories principles and standards as applicable to bathing newborn.
CLO#7: examine evidence-based nursing responsibilities and guidelines in performing
bathing newborn.
CLO#8: demonstrate the beginning skills in bathing a newborn.
CLO#9: define the terms related to cord dressing.
CLO#10: Give importance to cord dressing.
CLO#11: enumerate the indications and contraindications of cord dressing.
CLO#12: explain theories principles and standards as applicable to cord dressing
CLO#13: examine evidence-based nursing responsibilities and guidelines in performing
cord dressing.
CLO14: demonstrate the beginning skills in immediate cord care and daily cord
dressing.
CLO#15: utilize the knowledge in Bathing Newborn and Cord Dressing in providing care
to a client using a clinical-based case scenario.
 40

CLO #1: define the terms related to bathing a newborn.

1.1 Newborn
- refers to a baby from birth to about 2 months of age. A neonate is a child
under 28 days of age. Infants can be considered children anywhere from
birth to 1 year old.

1.2 Vernix Caseosa

- It is a white, creamy, naturally occurring biofilm covering the skin of the
fetus during the last trimester of pregnancy. Vernix coating on the
neonatal skin protects the newborn skin.

1.3 Lanugo
- a special type of body hair found on newborn babies. It is very thin, soft,
usually unpigmented, downy hair that is sometimes found on the body of
a fetus or newborn
 41

1.4 Caput Succedaneum

- refers to swelling, or edema, of an infant's scalp that appears as a lump or
bump on their head shortly after delivery.

- -

1.5 Fontanels
- In an infant, the space where 2 sutures join forms a membrane-covered
"soft spot". The fontanelles allow for growth of the brain and skull during
an infant's first year.
 42

1.6 Molding
- During a head first birth, pressure on the head caused by the tight birth
canal may 'mold' the head into an oblong rather than round shape

1.7 Meconium
- It is the first feces, or stool of the newborn. This sticky, thick, dark green
poop is made up of cells, protein, fats, and intestinal secretions, like bile.
 43

CLO#2: state the importance of bathing a newborn.

➢ Baby wipes used after meals or during diaper changes do not adequately clean
the skin and hair of a baby as frequently as regular baths.
➢ Baths reduce excessive oil production in the hair, remove excess moisture from
your baby's skin, and dry the places in between her skin folds.
➢ Proper skin care and bathing can help maintain the health and texture of the
baby's skin while providing a pleasant experience for both mother and baby.
➢ A bath is also a time to check his body for rashes or areas of dry skin
➢ While washing, massaging his arms and legs may increase blood flow in his
extremities.
➢ Taking your infant for a bath may be a calming and consoling experience for both
mother and baby.
➢ Bathing your baby exposes her to skin contact and teaches her the value of
touch.
➢ While bathing your infant, being face-to-face with her encourages eye contact
and gives you two a chance to interact positively.
 44

CLO#3: identify the indications and contraindications of bathing a newborn.

1. Indications of bathing a newborn

● Evaluate the baby's overall health and whether or not it needs to be

bathed.
● Babies only require baths once or twice a week. On other days, it's okay
to wash their bottom, hands, face, and neck only.
● Make sure everything is accessible before giving the baby a bath.
● infants should be cleaned in a warm, shallow bath. No soap is required.
● In the bathtub, never leave babies unattended. They risk quickly drowning
in extremely shallow water.

2. Contraindication of bathing a newborn

● Hypothermia
● Convulsions
● Bronchopneumonia
● Congenital Cyanotic Heart Disease
● Fresh burns
● Critical Illness
● Premature Infants
 45

CLO#4: discuss the different types of newborn baths.

Lap Bath - Maintaining a lap while bathing the infant. The mother can sponge him and
change his clothes on her lap while she is seated here on a stool. Therefore, having an
additional stool is not necessary.

Sponge Bath - Is a great option when your baby isn’t ready for a regular tub filled
with warm water and shiny bubbles.

Oil Bath - Applying oil all over the baby’s body. This is a very traditional method which
can improve skin-glow, reduce excess body heat and improve blood flow as you gently
massage the body. It's good for babies, as their skin gets moisturized and has sufficient
vitamins by this method.
 46

Tub Bath - This is the common method of giving bath to the baby. Bathing the
newborn using a bathtub or an infant bathtub. Once the baby's umbilical cord stump
has fallen off, you can carry out this procedure.
 47

CLO#5: differentiate the different ways of holding or carrying a newborn

The Cradle Hold

- Frequently shortly after their babies are born, this is the first hold that
many women will attempt. Start by placing your infant's head in the crook
of your arm and placing their noses opposite your breast. Your baby's
bottom should be supported by that hand. Turn your infant so that his or
her belly is next to your belly. Then, put your infant at your breast. Use
the other hand to support your breast.

● The Cross-Cradle or Crossover Hold

- The arms are positioned differently in this hold compared to the cradle
hold. Use the hand of that arm to support your breast instead of resting
your baby's head in the crook of your arm. The rear of your infant should
be encircled by your opposing arm. By placing your hand at the baby's
base of the head with your thumb and index finger at the baby's ear level,
you can support the baby's head, neck, and shoulder. Your infant will be
belly to belly to you, similar to the cradle hold. To lift your infant to nipple
level, you might need to place a cushion on your lap.
 48

● The Side-Lying Position

- Due to the baby's lack of pressure on the mother's belly, this posture is
comfortable for women who have undergone cesarean sections
(C-sections). Laying on your side to begin, turn your baby to face you on
the same side. Your infant should be placed such that his or her nose is
on the opposite side of your nipple. You can either cradle your baby's back
with your lower arm or tuck a rolled-up receiving blanket behind them to
keep them close to you as you use your upper arm to hold your own head
up. Use the other hand to support your breast.

● The Clutch or Football Hold

- For mothers who have had C-sections, as well as for those with large
breasts or small newborns, this posture is highly helpful. This posture is
 49

also an option for mothers of twins who want to feed both children at
once. The football grip makes it easier for babies to swallow milk, which
benefits women with strong milk ejection reflexes as well (or let down).
Set a pillow down next to you to help you get into the clutch (or football)
hold. Baby should be held in your arm while facing upward. Place your
baby's side against your side, support his or her neck with the palm of
your hand on the same arm. You should tuck your baby's legs and feet
under your arm. Then lift your baby to your breast
 50

CLO#6: explain theories, principles and standards as applicable to bathing a

newborn.

❖ Anatomy and Physiology

- A proper understanding of the anatomical features of the baby enables

correct assessment and defines which parts to clean first and how to clean

these.

❖ Physics and Chemistry

- Before giving the baby a bath, always use your hand to test the water's

temperature. Aim for bath water that is about 38 C or 100 F. Keeping the

infant's body temperature warm is encouraged by wrapping him or her in

the blanket.

- Making the solution less harsh and acceptable for the baby involves using

mild shampoo and soap that has been diluted with water.

❖ Microbiology

- The principle can be seen in the practice of medical handwashing and in

the removal of jewelry before the treatment.

- Decreased bacteria are ensured by washing the infant from front to back

and the genitalia.

❖ Psychology and Sociology

- By outlining the procedure to the mother, it might help her feel less

anxious and encourage involvement and collaboration.

 51

❖ Time and Energy

- Prepare all the materials required for a simple and efficient approach. This

not only reduces the amount of time spent on the procedure but also

ensures that you work efficiently.

❖ Safety and Security

- By taking the baby's temperature before a bath, this principle is put into

practice. Babies with low body temperatures are more susceptible to

hypothermia. It is crucial that the nurse appropriately assess it as a result.

 52

CLO#7: examine evidence-based nursing responsibilities and guidelines in

performing bathing newborn.

● Before bathing newborn

- Check the physician’s orders to see the specific precautions to be taken.
- Assess the infant’s need for bathing.
- Check the temperature, respiration and color of the skin. Turgor, Texture,
Edema, Vascularity, Moisture
- Check whether the child has taken the feed in the previous one hour.
- Check the articles available in the unit.
- Explain to mother what you are going to do
- Check the room temperature and worm it if necessary
- Close the windows and put the putt off the fan to prevent drought
- Adjust the position of the bath table to prevent the baby from falling
- Keep the table against the wall
- Place the mackintosh over the table
- Collect all articles in readiness before beginning the procedure
- Fill the basin half with warm water (37.8 or 100 f)

● During bathing newborn

- Collect articles, arrange all supplies near to bedside
- Bath table on a mattress covered with the mackintosh
- Take the baby on a bath blanket or shawl
- Check whether the baby is wet with urine or stool if wet clean the baby
with baby wipes
- Clean the baby buttocks if necessary by using a cotton swab
- Take the weight and record it
- Wash hands
- Pour water in the basin, at 100 degrees of Fahrenheit
- Wash babies face with clean water and wash with the cloth
- Wrap baby in a blanket, support the back and head held over the basin,
 53

- Wash the head and rinse well

- Place baby on the table and dry head with a towel
- Place the baby in the basin while supporting the head.
- Wash body with soap and washcloth
- Give special care to the genitalia
- Boys retract the foreskin of the penis, do not use force if it is tight.
- Wash and report to the doctor
- Place the baby back on the table
- Clean the cord and keep dry
- Dress the baby and wrap in the blanket
- Tidy up the bath table, clean the equipment, and put it in the proper
place.

● After bathing newborn

- Dress the stump, with Antiseptic Lotion and antibiotic powder
- Dress the baby, cover with a towel to prevent hyperthermia
- Give to baby Mother to give feed
- Take the articles to the utility room, disinfect them articles and clean and
dry it for next use
- Wash hands
- Record the procedure in the nurse’s record with time and date,
 54

CLO#8: demonstrate the beginning skills in bathing a newborn.

1. Prepare the materials needed

2. Remove jewelry
3. Close windows, put off electric fan, air conditioning unit
4. Perform medical handwashing
5. Check baby’s temperature
6. Remove the clothing of the baby
7. Bring baby to the tub
8. When washing the head, hold the baby in a football grip, cover both ears using
the thumb and middle finger to clip the baby’s ear lobes. Wet the scalp, and then
shampoo the baby’s head using a soft cloth/palm of the hand. Rinse thoroughly
and dry.
9. Clean each eye with a cotton ball dipped in warm water. Use more cotton to
clean around the ears. Wipe the mouth and chin with a washcloth.
10. Then, support the baby in a partially upright position using one hand and the
forearm of the dominant hand. Use the other hand to wash the body using a
mild soap. Be particular in the washing of the neck, armpit, chest, upper and
lower extremities, and genitalia. Rinse the child’s body thoroughly.
11. To clean the back, transfer the baby to the non- dominant hand then support the
chin and chest with your hand and forearm still in an upright position. Use the
other hand to wash the back in circular motion down to the buttocks. For female
babies, make sure to wash from front to back (genitalia to anus).
12. Rinse the back thoroughly.
13. After rinsing, dry the baby thoroughly with a clean bath towel.
14. Transfer the baby to the blanket. Perform cord dressing and then put on the
baby’s clothes and diaper.
15. Wrap the baby snuggly.
16. Do after care.
 55

CLO#9: define the terms related to cord dressing.

9.1. Cord Dressing

- It is a method used to wean an infant's umbilical cord after birth. It

seeks to protect against infection while also promoting complete and

appropriate umbilical cord repair.

9.2. Umbilical Cord

- The cord that, while the fetus is inside the uterus, attaches the

developing fetus to the placenta. This cord contains the umbilical arteries

and vein. At delivery, the umbilical cord is clamped and severed, and the

remaining tip becomes the belly button.

 56

9.3. Wharton’s Jelly

- an insulating and protective gelatinous substance found inside the

umbilical cord. Wharton's jelly and umbilical cord blood both contain stem

cells.

9.4. Omphalocele

- also known as exomphalos, is a birth defect of the abdominal (belly) wall.

The infant's intestines, liver, or other organs stick outside of the belly

through the belly button. The organs are covered in a thin, nearly

transparent sac that hardly ever is open or broken.

 57

9.5. Omphalitis

- an infection of the umbilicus and/or surrounding tissues, occurring

primarily in the neonatal period. It is a true medical emergency that can

rapidly progress to systemic infection and death, with an estimated

mortality rate between 7 and 15 percent.

 58

CLO#10: Give importance of cord dressing.

Maintaining your baby's cord helps avoid infection around the cord stump. Rarely,

these infections may enter your baby's body and result in a serious illness that

could be fatal. Cord dressing ensures the newborn's umbilical cord will be fully

and properly healed. Another importance is also to look for anomalies in the

veins and arteries, hernias, bleeding, infections, and other aspects of the cord

and in order to avoid infection

 59

CLO#11: enumerate the indications and contraindications of cord dressing.

1. Indications of Cord Dressing

● The skin appears red or swollen around the baby's cord stump.
● Discharge that is yellow or green that is present towards the stump's
base.
● Even after cleaning, the baby's stump still has a terrible stench.
● After 21 days, the baby's cord stump is still present.
● After the stump falls off, there may be fluid dripping from a pink or red
scar on your baby's belly button.

2. Contraindications of Cord Dressing

● Omphalitis
● Peritonitis
● Necrotizing enterocolitis
 60

CLO#12: explain theories principles and standards as applicable to cord

dressing

❖ Anatomy and Physiology

- Knowing where the cord stump is will be made easier by applying this

principle, and for this technique, it's crucial to have a thorough

understanding of the area around the stump.

❖ Microbiology

- The importance of this principle in cord care stems from its ability to

prevent pathogens from invading the area of the body that is afflicted.

❖ Physics and Chemistry

- Given that newborn skin is typically sensitive and smooth, it seems

reasonable that we should take our time when performing cord dressing

so as to avoid causing friction that could irritate the baby's skin.

- Apply chlorhexidine to the stump, cord tip, and area surrounding the

stump as soon as the cord is cut. The first 24 hours after birth are crucial

for applying chlorhexidine. One application every day for seven days can

lower the risk of local infection and possibly replace non-hygienic

conventional applications.
 61

❖ Psychology and Sociology

- The mother will comprehend the procedures more if you explain them,

especially to the first time mothers.

- To get their cooperation, parents should be taught the rules and cautions

of cord dressing. Build a good rapport with the parents.

❖ Pharmacology

- If the cord smells unpleasant or appears to be infected, inquire with your

doctor for antibiotic ointment to place on and around the cord's base. If

necessary, you can clean the cord three or four times every day.
 62

CLO#13: examine evidence-based nursing responsibilities and guidelines in

performing cord dressing.

Universal Precautions to be Maintained

● Wash your hands.

● Place cord clamp x 1 approximately 2 cm from skin.
● If LUSCS or high-risk baby, cord is clamped 4-5 cm from skin
● Cord is checked for ooze hourly for two hours after birth.
● Midwife to check cord area daily and record cord status.
● The area around the cord stump is washed carefully with water and dried when
bathing the baby. If it is moist, encourage mothers to fold nappy and plastic
under the cord area, leaving the cord exposed to air.
● Educate parents to observe and report any signs of infection (redness, stickiness
or offensive odor).
● Clamp the cord with sterile clamps and cut it with sterile scissors.
● The recommended length of the stump after cutting is 2-5 cm.
● Use rooming in where possible, with the mother as primary carer.
● Keep the cord dry and exposed to air.
● The nappy should allow for the cord to sit out of it.
● Wash hands before handling the umbilical cord and where possible avoid
touching the cord stump.
● The cord clamp will fall off between days 5-10, you do not need to remove the
clamp on discharge from hospital.
● Educate parents regarding separation of the cord.
● Explain there might be slight bleeding at the time of separation of the cord.
 63

Nursing Considerations

● The umbilical cord remnants provide an excellent medium for culture of

organisms. The cord remnant separates by a process of dry gangrene, usually
5-10 days.
● Cord remnants separate earlier and mothers have few problems when cords are
not treated, but simply washed and dried.
● Mothers need to demonstrate an adequate technique in cleaning the cord, as
many are reluctant or worried about cleaning the area.
 64

CLO #14: demonstrate the beginning skills in immediate cord care and daily
cord dressing.

Materials needed for Cord Dressing

Lined tray containing the following:

- Sterile cotton swabs/ pledgets

- Alcohol 70%
- Hydrogen peroxide
- Waste receptacle

1. Prepare the needed materials

2. Assess the cord. Note the color, odor and possible signs of bleeding, growth, and
other unusualities on the cord. A foul-smelling cord indicates infection.
3. Remove jewelry.
4. Perform medical hand washing
5. Using the first sterile cotton pledglet soaked with 70% alcohol, clean the stump
following inner to outer, circular motion, from the stump including the clamp.
Discard the first cotton pledget.
6. Use the second cotton pledglet to clean from clamp down to the base. Discard
the cotton pledget.
7. With the third cotton pledget, clean the base of the cord from inner to outer in a
circular motion. Discard the third cotton pledglet.
8. Do necessary aftercare
 65

CLO#15: utilize the knowledge in Bathing Newborn and Cord Dressing in

providing care to a client using a clinical-based case scenario.
 66

REFERENCES:

Bathing Newborn and

Cord Dressing

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kidshealth. KidsHealth. Retrieved August 20, 2022, from
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https://raisingchildren.net.au/newborns/health-daily-care/hygiene-keeping-clean/

bathing-a-newborn

3. Bonyata, K. (2018, March 17). Forceful Let-down (Milk Ejection Reflex) &
Oversupply • KellyMom.com. Retrieved Aug 20, 2022, from
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4. Breastfeeding. (n.d.). Philippine Health Advisories.

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Indications, Contraindications. Medscape.

 67

https://emedicine.medscape.com/article/80469-overview#:%7E:text=Absolute%

20contraindications%20for%20umbilical%20vein,Necrotizing%20enterocolitis

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https://www.slideshare.net/mohanasundariskrose/baby-bath-65534671

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or-neonates