BREASTFEEDING TECNIQUE

Breastfeeding The mother can rest

her arm on a pillow
in a sitting so that she need not
position, is carry the whole
probably the weight of the baby.
most widely She puts the lower
used position. arm of the baby
around her waist.

Instruct the
mother to
bring the
baby to her
breast and
not her
body to the
63
baby.
The more comfortable both
the mother and the
newborn are, the easier it
will be for the mother to
breastfeed, maintain proper
latch, and continue
breastfeeding. 2
 BREASTFEEDING TECNIQUE
• If the mother wears as
‘uncomplicated’ clothes as
possible, such as a
jumper which is simply
pulled up, or a waistcoat,

• she can easily feed her

child even in public without
being too obvious.

3
 BREASTFEEDING TECNIQUE
•Instruct the mother to cup her
breast with one hand and stroke
the baby’s lower lip with her
nipple to encourage the baby to
open wide.

4
BREASTFEEDING TECNIQUE
• The infant should never be
latched to the nipple only.

• She/He should have a good

amount of the mother’s areola
(the dark area surrounding the
nipple) in his/her mouth with
both lips turned out and
relaxed, and with the tongue
cupped under her breast.

5
 BREASTFEEDING TECNIQUE
• At the end of or even during the meal, the baby should
be given the possibility to allow any air swallowed
along with the milk to escape from the stomach.

• To do so, the baby is put over the shoulder in an

upright position for a while. This can be accompanied
by gentle taps on the baby’s back.
6
 BREASTFEEDING TECNIQUE
• If the baby stops drinking or has even fallen asleep
during the feed, its mouth should not simply be pulled
off the breast, since this could injure the nipple.
• The mother first puts her little finger into the
baby’s mouth to release the suction and then
carefully detaches the baby.

7
 BREASTFEEDING TECNIQUE
• Assessment of the Infant’s Latch
• An infant needs to properly latch on to the
mother’s breast to be able to effectively
breastfeed, get enough milk, and prevent nipple
soreness.

• The LATCH Evaluation Tool may be used

to objectively assess an infant’s latch by
assigning numeric points to key characteristics
necessary
f o r a n effective lat c h 70
1 7. 10 .20 17 M .S c.
 LATCH
L—Latch
A—Audible swallowing T
—Type of nipple C—
Comfort (breast/nipple) H
—Hold (positioning)

71
 Observations Indicating Correct Latch On
lower lip is curled outward baby’s mouth is wide open

chin lower
touches portion of
the breast the
areola is
not
visible

72
Observations Indicating Correct Latch On

73
GOOD AND POOR ATTACHMENT

74
Breastfeeding Tecnique Video

13
 Reassurance That Newborn is Getting
Adequate Amount of Breast Milk

• Audible swallowing sounds while breastfeeding

• Adequate weight gain of ≥4 to 7 oz/wk after the

fourth day of life

14
 Reassurance That Newborn is Getting
Adequate Amount of Breast Milk

• Adequate amount of wet diapers

• Stools that transition from dark, tarry (meconium) to

greenish yellow to soft, seedy, yellow-mustard
stools by the fifth day of life

• Normal skin turgor

15
 MILK EXPRESSION AND
BREAST PUMPS
• When there is a breastfeed delay (In some
situations), perinatal nurses should teach hand
expression and advise the mother to use a breast
pump

16
 MILK EXPRESSION AND BREAST
PUMPS
• Nurses should know how to correctly size the
shield/flange of the breast pump.
• Shields that are too big or too small can lead
to nipple
soreness, cracks, and excoriation.
• A shield that is too big can result in a loss of
suction

17
 MILK EXPRESSION AND
BREAST PUMPS
• Women need education on the correct use
of breast pumps and the storage of breast
milk.

• Many women begin a pumping session

by massaging the breasts and
expressing a few drops of milk. This
does a better job at stimulating letdown
than starting immediately with the pump.

80
 MILK EXPRESSION AND
BREAST PUMPS
• To stimulate lactation, women should pump at
least 8 to 12 times every 24 hours, no matter
how high the milk volume.

• Pumping at night may produce larger quantities

of milk because of the higher prolactin levels at
that time of day, and mothers should be
encouraged to pump at least once during the
night.
81
 EXPRESSING
BREAST
MILK
W as h y ou r h a n d s w ell w ith s oa p a n d
w ater

Place a clean cont ainer bel ow your breast t o

c o l l e c t m il k

Massage the breast s gently

tow ard the nipples

Place your t h u m b a nd index finger opposit e each othe r just

out side t h e d a r k circle a r o u n d t he n i p pl e

N o w press back tow ar d your chest , t hen ge ntl y s q ue e z e t o

r e l e a s e m il k

R e pe a t step 5 at di ffer ent positions a r o u n d the

M.Sc. k Sarpkay 82 a r e o la 17.10.2017
Dile a
21
22
23
24
25
26
89
 MILK EXPRESSION AND
BREAST PUMPS
• A hand pump or electic pump may also be helpful
to extract breastmilk.

• The milk can then be stored in sterile bags or

bottles. This way, the baby can be given breast-milk
even when the mother is away.

90
 Milk Storage Guidelines
LOCATION TEMPERATURE DURATION COMMENTS
Countertop Room temperature 6–8 hours Container should be covered
(up to 77°F or and kept as cool as possible
25°C)
Insulated cooler 5–39°F or −15°C 24 Keep ice packs in contact
bag hours to 4°C with milk at all times. Limit
opening the cooler bag
Refrigerator 39°F or 4°C 5 days Store milk in the back main
body of the refrigerator
and not in the shelves of
the door.
Freezer 5°F or −15°C 2 weeks Place the breast milk
compartment of container toward the back of
refrigerator 0°F or −18°C 3–6 months the freezer where the
temperature is most
consistent.
Chest or upright −4° F or −20° C 6–12 months
91
1 7 . 1 0. 2 01
Safe Preparation and Storage of
Expressed Breast Milk
• Remember to label her breast milk and to use the
oldest milk first.

• Not add fresh milk to milk that already has been

frozen.

• Not save milk from a used bottle for use at

another feeding.

30
Safely Thawing Breast Milk
• Avoid using the microwave because liquids do
not heat evenly and excess heat can destroy the
nutrient quality of the breast milk

• Place the container of frozen breast milk in a

bowl of warm (not hot) water

• Not refreeze thawed breast milk

31
Cup-feeding a baby

17.10.2017 94
Slide 4.9.3
 Impact of routine formula
supplementation
Decreased frequency or effectiveness of
suckling

Decreased amount of milk removed from breasts

Delayed milk production or reduced milk supply

Some infants have difficulty attaching to breast
if formula given by bottle
COMMON PROBLEMS
ENCOUNTERED
WITH
BREASTFEEDING
?????
COMMON PROBLEMS
ENCOUNTERED
WITH
BREASTFEEDING
• Nipple soreness
• Engorgement
• Plugged duct
• Mastitis
• Inverted Nipple
• Candida Albicans
97
SORE NIPPLE
 NIPPLE SORENESS:
• Sore nipples are a common complaint by
mothers who are initiating breastfeeding.

• Usual causes of nipple soreness are;

• incorrect latch
• improper position that results in ineffective
sucking.

M.Sc. Dilek Sarpkaya Güder 99

 NIPPLE SORENESS:
• Instruct the mother to break the suction properly,
reposition the infant, and attempt latching the baby
on again
• After breastfeeding, the mother may rub breast milk
or ultra-purified lanolin on her nipples to soothe
them.

• Encourage the mother to air-dry her nipples after

feeding, change nursing pads often, and avoid
we a r i
1
7 1
. 0
. 2 bras that are too tight 100
 BREAST ENGORGEMENT

M.Sc. Dilek 17.10.201107

Sarpkaya Güder
• ENGORGEMENT:
Engorgement occurs if
milk builds up because
of irregular and
incomplete emptying of
the breasts as
• a result of
poor latching
and
• incorrect
positioning,
infrequent feedings,
supplementation,
• nipple damage, or 102
fatigue
ENGORGEMENT:

• This fullness may turn

into engorgement when
the breasts become
hard,
• painful,
• warm,
• and throbbing with
flattening of the
nipples.
41
 ENGORGEMENT:
• To minimize engorgement, avoid supplementing
(unless prescribed by a pediatrician) and overusing
pacifiers

• Instruct the mother on how to hand express milk to

soften the breasts before feeding to allow for the
infant to have a better latch.

• Assist the mother on how to properly latch

and position infant.
42
INVERTED NIPPLE

105
Inverted Nipple:
Treatment by Syringe Method
STEP 1
Use 10 or 20cc syringe
Cut along this line with blade

STEP 2
Insert the plunger from cut
end
STEP 3 Mother gently pulls the
plunger
STEP 4 Press at the edge and allow
air to enter before removing
Before
M.Sc.feeds
Dilek
Sarpkaya
5-8 times a day 106
the syringe
17.10.2017
PLUGGED DUCT:

107
PLUGGED DUCT:
• Breast engorgement • Symptoms include
may lead to • tenderness,
plugged ducts. • heat,
• Plugged ducts are • possible redness,
small, tender
•or a palpable lump
breast lumps, the
with generalized fever.
size of a pea.

46
 PLUGGED DUCT: • The application of
hot packs and
• To relieve the plugged massaging the lump
duct, teach the while the baby is
mother to massage sucking helps move
the lump before and this blockage
during feeding.

• Breastfeed on the
unaffected side first and
ensure complete
emptying.
47
48
 PLUGGED DUCT:

• Other treatments include altering infant’s

position for feeding, and avoiding
constrictive clothing

• Continued milk stasis increases the risk for

mastitis.

49
 MASTITIS: Symptoms include;
• Mastitis is an
fever
inflammatory condition
(temperature
of the breast that may
38°C)
or may not lead to an
infection. The aching,
inflammation tends to chills,
be unilateral. swelling,
and pain at the site which
may also be red, hot,
and hard;
tenderness under the
arm; and
red streaks from lump
50
 MASTITIS:
• Treatment of mastitis • If symptoms become
includes nursing severe, most clinicians
frequently on both treat with
breasts, ensuring that antibiotics.
the affected breast is
emptied, and getting • Although antibiotics
enough rest and treat the infection,
adequate nutrition. they do not address
the underlying cause
of the mastitis.

51
 CANDIDA ALBICANS
• If the mother complains of burning pain on the
nipple or burning and shooting pains in the
breast, a fungal infection (i.e., thrush) may be
present.
• This is usually caused by Candida albicans.

52
 CANDIDA ALBICANS
• Symptoms of candida include;

• complaints of soreness,
• burning,
• pain on nipple/areola, nonstabbing pain of the
breast,
• stabbing pain in the breast,
• and/or skin changes of the nipple/areola that
looks shiny and flaky.
53
 CANDIDA ALBICANS
• Treatment can be topical or systemic.
• Every treatment plan should include both
mother and infant.

• Early diagnosis and treatment for Candida infection

of the nipple and/or breast are critical to
supporting successful long-term breastfeeding

54
 LACTATION SUPPRESSION
Some techniques that may help include:
• Wearing a well-fitting
bra or sport bra 24 hours
each day the breasts
are
soft and nontender. until
• Using mild over-
the- counter
• Applying cold packs to analgesics, taken
the breasts. These may according to
be commercial cold packs manufacturers’
or bags of frozen peas. recommendations.

55
 LACTATION SUPPRESSION
• Avoiding nipple or breast stimulation; however,

• when discomfort is severe, hand expressing or

• pumping a small amount of milk may provide
relief;

• taking a warm shower and letting the water run

over the breasts may stimulate milk leakage.

56
LACTATION SUPPRESSION

Restricting fluids is neither necessary

nor desirable.

The breasts return to normal, and tenderness

decreases within 48 to 72 hours after
engorgement occurs.

57