7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 1/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 1

9:00-10:10 Assessing the Breastfeeding Dyad

I. Goals, objectives and outlineA. Goal: Identify when babies are not sucking effectively.B. Objectives: At the end of this educational activity, the learner will be able to:

1. Describe the appearances of the baby sucking at the breast that is indicative of an

effective feeding.2. Describe visible signs of potential sucking problems.C. Outline:

1. Effective sucking2. Ineffective sucking

II. Visible signs of suckingA. Effective sucking

1. Watch for the eyes to be wide-open at the start of the feeding when the baby is a week old2. Look for a wide-open mouth, flanged lips, asymmetric latch, chin in close, the nose free

(If nose is touching, be sure baby can breathe.)

3. Count 10+ sucks in a row at the start of the feeding (Do not tell mom)4. Pauses should be shorter than 10 seconds, at the start of the feeding5. Baby should start sucking again on her own and continue this pattern for many minutes6. Cheeks should remain rounded, no dimpling7. No clicking sounds8. After the milk ejection reflex (MER) sucks should be one per second and audible swallows

should occur before discharge9. Sucking should feel like tugging or pulling, not pinching or biting (feel like a pump)10. Mother should not feel pain after the first 30 seconds11. Baby is able to drink an appropriate amount of milk (pre and post feeding weights)12. Baby is calm or asleep at the end of the feeding (not always a good indication)

B. Ineffective sucking1. Narrow angle at the corner of the baby’s mouth 2. Sucks less than 10 times in a row before pausing at the start of the feeding3. Pauses greater than 10 seconds at the start of the feeding4. Dimples the cheeks, pulling in of the cheeks Deeper latch 5. Over use of the lips to keep the seal, pulling of the breast6. Pain throughout the feeding/nipple misshapen7. Weak suck, falls off breast, no suction

Try latching on again. Check palate and tongue. Try chin support or DANCER hand position to decrease intra-oral space and support the lower jaw, named by SarahDanner, CNM and Edward Cerutti, MD. Feed with cup/spoon/syringe until baby is

stronger. At discharge switch to bottle, if the baby can suck some.8. Makes clicking sounds, breaks suction frequently. Chin support 9. Wide jaw excursions10. Milk leaks out of the corner of baby’s mouth 

11. Cannot hear swallowing12. After one week, eyes closed at the start of the feeding13. Not enough milk is transferred during the feeding (pre and post feeding weights)

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 2/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 2

14. Baby fussy and unsettled at the end of the feeding while being held (not always a goodindicator that the baby is not getting enough)

a. Some babies are fussy after a feeding because they need to burp b. Or they drank too much and may spit upc. Parents cannot distinguish satiation from exhaustion

If weight issue, might try supplementer at the breast.

15. Motion at the mouth, no movement of the ears or masseter and temporalis muscles (Allowto suck on parent’s finger with tip of finger at juncture of hard and soft palates.) 

16. Sucking tongue on roof of mouth (Suck on parent’s thumb or provide chin support.)17. Tongue not over the lower gum

a. Charm hold b. Breastfeed in a prone position for the babyc. Imitate sticking tongue out and opening mouth wided. Lip tappinge. Cup feed or place milk on baby’s chin to bring tongue forward f. Sucking on mom’s finger, so can feel when tongue comes forward 

18. Incorrect tongue motiona. Reverse suck b. In and out sawing motionc. Up-down motion with center of tongued. Rubbing along the breast with the tip of the tongue

Suck training

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 3/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 3

Bibliography

Bu’Lock F, Woolridge MW, Baum JD: Development of co-ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol 32:669-678, 1990

Chiu S-H, Anderson GC, Burkhammer MD: Skin-to-skin contact for culturally diverse women having breastfeeding difficulties during early postpartum. Breastfeeding Medicine 3(4):231-237, 2008

Colson SD, Meek JH, Hawdon JM: Optimal positions for the release of primitive neonatal reflexes

stimulating breastfeeding. Early Human Development, 84(7):441-449, 2008Donath SM, Amir LH: Effect of gestation on initiation and duration of breastfeeding. Arch Dis Child

Fetal Neonatal Ed 93(6):F448-450, 2008Genna CW: Supporting Sucking Skills in Breastfeeding Infants (2nd edition). Sudbury, MA: Jones and

Bartlett Publishers, 2013Haggstrom AN, Lammer EJ, Schneider RA, et al.: Patterns of infantile hemangiomas: new clues to

hemangioma pathogenesis and embryonic facial development. Pediatrics 117(3):698-703, 2006Jensen D, Wallace S, Kelsay P: LATCH: A breastfeeding charting system and documentation tool.

JOGNN 23, 27-32, 1994Kutner L: Breastfeeding management of the reluctant nurser. J of Human Lactation 4(1):14-15, 1988Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession (7th edition).

Philadelphia: Elsevier Mosby, 2011McMillan JA (editor). Oski’s Pediatrics: Principles and Practice 4th ed. Philadelphia: Lippincott,

Williams, & Wilkins, 2006, p 382Maher SM: An overview of solutions to breastfeeding and sucking problems. Schaumburg, IL: La

Leche League International, 1988Marmet C: Training neonates to suck correctly. MCN 9(6):401-407, 1984Miller CK, Willging JP: The implications of upper-airway obstruction on successful infant feeding.

Semin Speech Lang 28(3):190-203, 2007Milligan RA, Flenniken PM, Pugh LC: Positioning intervention to minimize fatigue in breastfeeding

women. Appl Nurs Res 9(2):67-70, 1996Mulford C: The mother-baby assessment (MBA): an “apgar score” for breastfeeding. Journal of

Human Lactation 8(2):79-82, 1992Mulford C: Subtle signs and symptoms of the let-down reflex. J of Hum Lact 6(4):177-178, 1990Pugh LC, Milligan RA: Nursing intervention to increase the duration of breastfeeding. Applied

 Nursing Research 11(4):190-194, 1998Riordan J, Wambach K: Breastfeeding and Human Lactation (4th edition). Boston, MA: Jones and

Bartlett Publishers, 2010Riordan JM, Koehn M: Reliability and validity testing of three breastfeeding assessment tools. JOGNN

26(2):181-187, 1997Riordan J, Gill-Hopple K, Angeron J: Indicators of effective breastfeeding and estimates of breast milk

intake. J Hum Lact 21(4):406-412, 2005Stables D, Hewitt G: The effect of lateral asymmetries on breastfeeding skills: can midwives’ holding

interventions overcome unilateral breastfeeding problems. Midwifery 11(1):28-36, 1995Taki M, Mizuno K, Murase M, et al. Maturational changes in the feeding behavior of infants-acomparison between breastfeeding and bottle-feeding. Acta Paediatr 99:61-67, 2010

Wilson-Clay B, Hoover K: The Breastfeeding Atlas (5th edition). Austin, TX: LactNews Press, 2013

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 4/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 4

10:30-11:40 Supplementing the Breastfeeding Infant

1.  Inborn errors of metabolism, such asa.  Maple syrup urine disease b.  Galactosemiac.  Tyrosinemia

d.  Phenylketonuria (PKU) in some cases plus breastmilk and careful monitoring

2. Infants for whom breast milk remains the best feeding option, but who may need otherfood in addition to breast milk for a limited period

a.  Very low birth weight — less than 1,500 grams b.  Very preterm — less than 32 weeks of gestational agec.  Hypoglycemia if baby does not respond to skin-to-skin, breastfeeding, and

 breast milk feedingd.   Dehydration

e.  Weight loss greater than 10% If the baby has lost 15% or more, the baby’s electrolytes need to be checked immediately. 

3.   Non-latching baby or baby who is not breastfeeding effectively (e.g. Cleft palate,

tongue-tie, maternal large, flat, or inverted nipples)

4. Maternal condition that may justify temporary avoidance of breastfeedinga.  Severe illness that prevents the mother from caring for her infant, for example,

sepsis b.  Herpes simplex virus lesions on the mother’s breast until lesions have healed.

Baby can breastfeed on the other breast, if there are no lesions.Women with herpes simplex virus type I or II may continue to breastfeed asusual, unless there are herpes lesions on the nipple or areola. Herpes isspread through contact, so the sores should be covered. If there are lesionson the nipple or areola, the mother should not breastfeed on that breast. Shecan pump or hand express milk from that breast until the sores clear.Pumping will keep up her milk supply and prevent the breasts from gettingengorged or overly full. If the parts of the breast pump that contact the milkalso touch the sores while pumping, the milk should be discarded(Lawrence, 7th ed. 2011, pp. 436, 599).

5. Maternal treatment with contraindicated medicinea.  Chemotherapy, until medication is out of her system b.  Radiation therapyc.  Sedating psychotherapeutic drugsd.   Drugs of abuse

e. 

 Alcohol abuse

5. Separation of mother and babya.  A mother with active, untreated tuberculosis (TB) should not be in the presence

of her baby. At the hospital, they will be isolated from each other. Once she has been effectively treated, which usually takes about two weeks, the two of themcan be together. During the time of isolation, the mother can express her milkand someone else can feed the infant the expressed milk. The mother can

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 5/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 5

express her milk because the tuberculosis infection is acquired throughrespiratory transmission –  not via the milk. While being treated she should washher hands well and mask for pumping and storing her milk. However, in the rarecase of a mother with TB mastitis, she should neither breastfeed nor provide breast milk until the lesion is healed, which usually takes at least two weeks(Lawrence 2011, Table 13-1, p 424). She should pump and discard her milk to

maintain her milk supply. Once she is no longer infected, she may breastfeed. b.  Active varicella virus (chicken pox) of the mother is only a contraindication “if

the maternal rash develops 5 days or less before delivery or within 2 days afterdelivery” (Lawrence, 7th ed. pp. 452-454). In that case, the mother should beisolated and the infant should be given Varicella Zoster Immune Globulin (VZIG). Expressed milk can be fed to the baby, if there are no breast lesions.The mother can resume nursing when she is no longer contagious. For shingles(zoster virus), same as for herpes simplex virus type I and II, and consider VZIGfor the baby.

c.  Women with brucellosis, an extremely rare infection, should pump and discardtheir milk from both breasts until they have been appropriately treated for 48 to96 hours (Lawrence 2011).

7. When the mother is (temporarily or permanently) not producing sufficient milk

a. Maternal anatomical abnormalities (e.g. breast surgery, hypoplasia)

b. Maternal conditions causing delayed lactogenesis II (e.g. diabetes, obesity,

hormone imbalance, thyroid conditions)

8. Intolerable maternal pain during breastfeeding

9. Permanent contraindication to breastfeeding in the USA (not in a developing nation)When the mother has HIV

Milk VolumesVolumes for supplementation recommended by the Academy of Breastfeeding Medicine

Per feeding based on 8 feedings in 24 hours TOTAL in 24 hours

Day 1 –  2 to 10 mL/feed Day 1Day 2 –  5 to 15 mL/feed Day 2Day 3 –  15 to 30 mL/feed Day 3Day 4 –  30 to 60 mL/feed Day 4

2.5 x baby’s weight in pounds = oz/24 hours oz/24 hr165 x baby’s weight in kilograms = mL/24 hours oz/24 hr

Use birth weight until back to birth weight; once beyond birth weight, use current weightIf the baby has been underfed, it might take up to 3 days to get to the total volume.

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 6/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 6

The Deem article said in 48 mothers less than 20 years of age on Day 4, infants took 7.4 oz.; Day 7,11.8 oz.; Day 10, 14.4 oz. And in 52 primiparae over 20 years Day 4, 6.4 oz.; Day 7. 12.7 oz.; Day 10,15.4 oz.

Villalpando said Day 3 milk production about 360 ml (12.8 oz.); Day 15 about 550 ml (19.6 oz.)The study was based on 30 women. By 74 hours after birth all babies had regained their birth weight.

“Measured intakes indicate that 850 ml is a reasonable average.” “Even in the second year of life, it is by no means unusual for a mother to give her baby approximately 500 ml of breast milk each day.” (Whitehead, 1995)

“725 to 850 ml/day during months 2 to 6” are average intakes for fully breastfed infants. p. 125(Neville 1987)

“...there was an average increase in breast milk intake of about 24 ml/month from months 1 to 6 with

an average intake around 760 ml/day over this period.” page 126 (Neville 1987) 

“The amount of milk consumed by the breastfed group...was significant ly lower than that consumed bythe formula-fed group.” “Length and weight gains...were similar between breast and formula-fedinfants during the f irst 24 weeks of life.” (Motil 1997)

Breastfed and artificially fed infants take in different quantities of milk and have different growth patterns. By 8 months breastfed infants have consumed 30,000 kcal less than artificially fed infants.

(Garza 1987)

Milk volume in the first 24 hours4 to 26 ml (Santoro, 2010)3 to 32 ml (Casey, 1986)

Average daily output in 98 mothers of term infants (Hill 2005)

Week 1 Day 6-7 494.6 mL 17.4 ozWeek 2 Day 14 555.9 mL 19.6 ozWeek 3 Day 21 612.4 mL 21.6 ozWeek 4 Day 28 647.7 mL 22.8 ozWeek 5 Day 35 665.9 mL 23.4 ozWeek 6 Day 42 668.2 mL 23.5 oz

Volumes of milk consumed during the first year after birth (Heinig, 1993)

Human milk Formula3 months 812 9056 months 769 9419 months 646 80612 months 448 732

average 13 mL

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 7/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 7

The goal is to feed the baby and pump in an hourOnce baby is over 24 hours old

Feed your baby at least every 3 hours. Offer your breast whenever you see feeding cues.Wake if necessary: spend 10 minutes or less trying to help baby latch-on.Use an alternate feeding method if baby has not latched-on by 10 minutes.Keep baby skin-to-skin between feedings as much as possible: sling, cuddling.

Picture the circle as one hour. 0 The goals is to feed the baby…and pump your milk  …within one hour.  TIPS TO

Then you have a break LATCH BABY ON:…for two hours, …before starting  PUMP if necessary: Drip milk…again.  If feeding with alternate method Pump 1 to 2 minutes

If used nipple shield Prefeed 5 to 15 ml 10 50 If baby had a poor feeding   Nipple shield 

Settle baby

Breastfeedor

Use alternate methodBy cup, finger-feeding,or slow flow nipple

40

Goals:At least 8 to 10 feedings in 24 hours with 20+ minutes of suckingUrine after the 3rd day: 6+ wet diapersBowel movements after the 3rd day: 3 to 4 yellow seedy stools  Barbara L. Boston 1994

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 8/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 8

Milk Volumes

ABM Clinical Protocol #3: Hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate. Breastfeeding Medicine4(3):175182, 2009

Casey CE, Neifert MR, Seacat JM, Neville MC: Nutrient intake by breastfed infants during the first five days after birth. Am J Dis Child 140(9):933-936,1986

Cregan MD, Mitoulas LR, Hartmann PE: Milk prolactin, feed volume, and duration between feeds in women breastfeeding their full-term infants over a24-hour period. Exp Physiol 87(2):207-214, 2002

de Carvalho M, Robertson S, Friedman A, Klaus M: Effect of frequent breastfeeding on early milk production and infant weight gain. Pediatrics72(3):307-311, 1983

de Carvalho M, Robertson S, Merkatz R, Klaus M: Milk intake and frequency of feeding in breastfed infants. Early Hum Dev 7(2):155-163, 1982Deem H, McGeorge M: Breastfeeding. New Zealand Medical Journal 57:539-556, 1958Doganay M, Avsar F: Effects of labor time on secretion time and quantity of breast milk. Int J Gynecol Obstet 76(2):207-211, 2002Evans KC, Evans RG, Royal R, Esterman AJ, James SL: Effect of caesarean section on breast milk transfer to the normal term newborn over the first

week of life. Arch Dis Child Fetal Neonatal Ed 88(5):F380-F382, 2003Hill PD, Aldag JC, Chatterton RT, Zinaman M: Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J

Hum Lact 21(1):22-30, 2005Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession (7th Ed). Philadelphia: Mosby, 2011

 Neville MC, Keller R, Seacat J, Lutes V, Neifert M, Casey C, Allen J, Archer P: Studies in human lactation: milk volumes in lactating women during theon set of lactation and full lactation. Am J Clin Nutr 48:1375-86, 1988

 Neville M: Physiology of lactation in Wagner CL, Purohit DM (Guest Editors): Clinics in Perinatology: Clinical Aspects of Human Milk and Lactation26(2) Philadelphia: WB Saunders Company, June 1999, pp. 251-279

Salazar G, Vio F, Garcia C, et al: Energy requirements in Chilean infants. Arch Dis Child 83(2):F120-F123, 2000Santoro W Jr, Martinez FE, Ricco RG, et al.: Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants. J Pediatr

156(1):29-32, 2010Scanlon KS, Alexander MP, Serdula MK, et al.: Assessment of infant feeding: the validity of measuring milk intake. Nutrition Reviews 60(8):235-251,

2002Scammon RE, Doyle LO: Observations on the capacity of the stomach in the first ten days of postnatal life. American Journal of Diseases of Children20:516-538, 1920

Smith L: How to supplement a supposedly breastfed baby. J Hum Lact 14(2):145-146, 1998Stellwagen LM, Hubbard E, Wolf A: The late preterm infant: a little baby with big needs. Contemporary Pediatrics Nov, 2007Stettler N, Stallings VA, Troxel AB, et al.: Weight gain in the first week of life and overweight in adulthood. Circulation 111:1897-1903, 2005UNICEF: Feeding low birth weight babies. (video) 3 UN Plaza, New York, NY 10017Villalpando S, Flores-Huerta S, López-Alarcón M, Cisneros-Silva I: Social and biological determinants of lactation. Food and Nutrition Bulletin

17(4):328-335, 1996

Supplementation Policy

Academy of Breastfeeding Medicine Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2009

Hoover K. Extreme weight loss in the breastfed newborn. J Hum Lact. 1998 Dec;14(4):288.World Health Organization. Acceptable medical reasons for use of breast-milk substitutes

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 9/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 9

1:00-2:10 Hospital Practices that Support Breastfeeding

I. Goals, objectives and outlineA. Goal: To be aware of the large body of literature supporting changes in hospital practices

to improve breastfeeding initiation, duration and exclusivityB. Objectives: At the end of this educational activity, the learner will be able to:

1. Enumerate labor and delivery practices that affect breastfeeding.2. Describe skin-to-skin care to improve breastfeeding outcomes3. List the evidence-based Ten Steps to Successful Breastfeeding4. Explain ways WIC can help hospitals to support breastfeeding

C. Outline1. Labor and delivery practices that affect breastfeeding2. Skin-to-skin care to improve breastfeeding outcomes3. Ten Steps to Successful Breastfeeding4. How WIC can help hospitals

II. Birth practices that affect breastfeeding

A.  Doula support during labor (positively affects breastfeeding)1.  Reduces the perception of pain (Kennell 1991)2.  Shortens the length of labor3.  Decreases Cesarean deliveries4.  Increases exclusive breastfeeding (Hofmeyr 1991)5.  Experience fewer breastfeeding problems6.  Socially disadvantaged mothers more likely to initiate breastfeeding (Gruber, 2013)

B.  In the past, epidural and narcotic analgesia have been implicated in (negative affect)1.  Reducing sucking ability2.  Increases the time to effective feeding3.  Can affect neurobehavioral status

C.  Routine suctioning (negative affect)Gastric suctioning is associated with delayed sucking and rooting movements(Widstrom 1987)

“When the newborn is vigorous…there is no evidence that nasopharyngeal suctioning isnecessary.” (AAP 2012) 

D.  Instrumental deliveries (vacuum or forceps) increases feeding difficulties (Demissie 2004)E.  Kind of birth

1.  Cesarean birtha.  Experience delay in milk increasing in volume b. More likely to be separated

2.  Epidural

“In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epiduralanesthesia significantly predicted breastfeeding cessation” Dozier, 2013 F.  Waiting to clamp the cord (positive affect)

1.  Would bring about these results in full-term babiesa.  Reduction in iron deficiency anemia b.  Increased duration of early breastfeedingc.  Lower blood lead concentrations at 6 months

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 10/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 10

2.  Would bring about these results in preterm babiesa.  Decreased intraventricular hemorrhage b.  Decreased need for blood transfusionc.  Higher circulating blood volumed.  Increased iron (milk deficiency may be associated with cognitive deficits)e.  Improved cerebral oxygenation (fewer days of ventilation)

f.  Reduced late-onset infectionsg.  Better cardiopulmonary adaptationh.  Higher blood pressurei.  Less likely to be discharged on oxygen j.  Higher initial glucose levels

3.  Studies vary in research protocols for defining the timing of delayed cord clampinga.  1 to 1.5 minutes b.  At least 2 minutesc.  At least 3 minutesd.  Within 30 seconds vs 3 minutese.  10 seconds vs 2 minutesf.  5-10 seconds vs 30-45 secondsg.  Before 30 seconds after 30 seconds max of 120 secondsh.  5 to 10 seconds vs 30 to 45 secondsi.  15 seconds, 1 minute, 3 minutes

4.  Temperature change causes the umbilical cord to clamp down on itself to stop the blood flow from the mother to the baby by about 5 minutes after birth

5.  ACOG December 2012 Timing of Umbilical Cord Clamping after BirthCommittee Opinion — wait at least 30 to 60 seconds

G.  Separation of newborn and mother (negative affect)1.  Interrupts the ability to self-attach and suck correctly (Righard 1990)2.  “Maternal separation may be a stressor the human neonate is not well-evolved to

cope with and may not be benign.” (Morgan BE, Horn AR, Bergman NJ. Shouldneonates sleep alone? Biol Psychiatry 70(9):817-825, 2011)

3.  Identification (e.g. bands and foot prints) can be done while baby is skin-to-skin and breastfeeding.

4.  Routine care can be done after the first breastfeeding and while baby is skin-to-skinwith mother (e.g. vitamin K, eye treatment)

H.  Delay the first bath 12+ hours increases breastfeeding exclusivity in the hospital (Preer 2013)(positive affect)

I.  Reducing infant pain (positive affect)1. Vaccination —  breastfeeding vs. topical EMLA (Gupta 2013)2. Vaccination —  breastfeeding vs. vapocoolant spray (Boroumandfar 2013)3. Heel stick (McNair 2013)4. Heel stick  — sucrose vs. SSC vs. sucrose + SSC vs breastfeeding + SSC

(Marin Gabriel 2013)5. Heel stick in preterm babies —  breast milk lowered pain scores (Ou-Yang 2013)6. Brain activity with breastfeeding not with glucose (Bembich 2013)

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 11/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 11

III. Ten Steps to Successful Breastfeeding: A global hospital initiative using evidenced-based practicesA.  What is wrong with this picture? —A mother’s request as she enters our hospital

I want to formula feed my baby — 100% get what they want.I want to combination feed my baby — 100% get what they want.I want to exclusively breastfeed my baby — less than 50% get what they want.

B.  Following the Ten Steps increases breastfeeding exclusivity

(Martis 2013, Forrester-Knauss 2013)C.  20-hours of education makes a difference in the breastfeeding supportive practices of healthcare professionals (Zakarija-Grkovic 2010)

D.  Transforming care — Exclusive breastfeeding is defined as providing nothing other thanhuman milk feedings. Exclusivity rates rose from 6% to 44% (Magri 2013)

E.  Maine hospitals, BFHI vs. not; BFHI designated hospitals were not keeping their practicesup-to-date (Hawkins 2014)

F.  Sending home formula decreases exclusivity (Feldman-Winter 2012, Sadacharan 2014)G.  None of the hospitals had a searchable system for feedings ( Labbok 2013)H.  From research to practice takes 17 years.I.  Women who experienced all 4 hospital practices had higher odds of breastfeeding at one

month and 4 months than women who experienced fewer than 4, being BFHI designateddid not make a difference. (Brodribb 2013)

J.  Breastfeeding within the 1st hour compared to more than one hour reduces risk of early-onset feeding problems in term neonates (DiFrisco 2011, Carberry 2013, Raghavan 2013)

K.  Skin-to-skin for 2+ hours after birth (Thukral 2012)L.  Still breastfeeding at 6 months higher in group who had skin-to-skin in the first hour; more

formula use when first time mother or C-birth and shorten duration (Augustin 2014)M. Visitors are a barrier to skin-to-skin care (Ferarrello 2014) N.  Cost analysis, no significant difference in the cost of following the Ten Steps

(DelliFraine 2011, Allen 2013)O.  If 90% of women breastfed exclusively for 6 months and continued with appropriate

complementary foods for over one year over 900 fewer deaths in the first year (Bartick2010) and 4,000 fewer maternal deaths (Bartick 2013)

P.   NICU at Boston Medical Center ten years after Baby-Friendly designation initiation ratesrose from 74% to 85% (1999-2009) (Parker M 2013)

Q.  More hospitals designated as BFHI in 2011 than any previous year in USA (CDC 2013)R.  October 2014 there are 199 Baby-Friendly Hospitals in the USAS.  Missouri Hannibal Regional Hospital, Hannibal, MO (07/09)

VII. What can WIC do to help hospitalsA.  Breastfeeding in-service programB.  Educational materials on state website

C.  Make bulletin boards for the hospital maternity unit, ultrasound unit, etc.D.  Peer counselors who come to the hospital to see WIC clientsE.  Give feedback from your clients about how the hospital is doingF.  Provide a list of local breastfeeding resources and up-date regularlyG.  Conduct a breastfeeding mothers’ group at the hospital H.  Send an employee to be a member of the hospital breastfeeding committee and the local

and state breastfeeding coalitionsI.  Run a breastfeeding mothers’ group at the hospital

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 12/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 12

J.  Find free patient handouts that may be copied and are translated into many languagesK.  Start a hospital collaborative — get several hospitals in an area to meet together to help

support each other in making changes.L.  Provide classes for fathers and grandmothers

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 13/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 13

Mother’s Breastfeeding Checklist  

  I know holding my baby skin to skin is a good for both of us.

  I know how the baby tells me it is time for a feeding.

  I know how to latch my baby onto both breasts.   I know I should take turns with the breast I feed from first.

  I know when my baby is finished breastfeeding that he or she will let go on his orher own and be relaxed. And I know that my baby needs to finish on the first breast before I feed the baby on the other breast.

  I can hear my baby swallowing milk during the breastfeeding sessions.

  I know breastfeeding should not hurt after 30 seconds.

  I know when and where to call if I have any breastfeeding questions.

  I know how to squeeze milk out of my breasts.

  I know my baby should eat only my milk for the first six months.

  I know how to tell that my baby is getting enough milk.

  I know how to fill out the feeding record for the first week.

  I know a wet diaper is as heavy as 3 tablespoons of water.

  I know my baby should be back to birth weight by 14 days.  I know when my baby is back to birth weight, I no longer need to

keep a feeding record

  Once my baby is back to birth weight, I know my baby should gainat least 5 to 8 ounces each week (for the first 2 months).

  I have an appointment to see the pediatrician or family doctorin 2 or 3 days after we leave the hospital.

  I know I can bring the baby’s feeding record with us to the doctor’s appointment. 

Baby’s birth weight  _________________________Baby’s discharge weight  _________________________Baby’s weight 2-3 days after discharge __________________________Baby’s weight at 10 to 14 days  __________________________

Adapted with permission from Marsha Walker

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 14/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 14

Complete this questionnaire as if you were one of the mothers whorecently delivered at your hospital or the closest hospital to you.

YES NO ?

1. Before my baby was born, I was told why and how to breastfeed.

2. The staff were knowledgeable and supportive of breastfeeding.

3. I was shown how to breastfeed my baby.

4. I was encouraged and helped to breastfeed without the use of  any other liquids for my baby.

5. My breasts were examined before and after my baby’s birth.

6. I was instructed to breastfeed whenever my baby wanted  to suck or cried.

7. At birth, my baby’s weight was recorded and given to me.

8. My baby and I had skin-to-skin contact immediately after the birth.

9. I offered my baby the breast for the first time within:  

30 minutes one hour more than one hour

10. My baby was not given anything to drink by the staff.

11. My baby and I were not separated at any time during  our hospital stay unless requested by me.

12. My baby was not given a pacifier by the staff.

13. I was not given any formula, bottles, or rubber nipples  when I left the hospital.

14. I was told when my baby would need to be examined and weighed  and how to schedule an appointment for her/him.

15. I was told how to contact a breastfeeding mother’s support group   before I left the hospital.

16. Overall, I believe my breastfeeding experience was improved  

 by this facility.

This questionnaire was taken from a WABA folder for World Breastfeeding Week.

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 15/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 15

10 Steps to Successful Breastfeeding

According to WHO/UNICEF, every facility providing maternity services andcare for newborns should:

1. Have a written breastfeeding policy that is routinely communicated

to all health care staff.

2. Train all health care staff in the skills necessary to implement this

policy.

3. Inform all pregnant women about the benefits and management of

breastfeeding.

4. Place babies immediately skin-to-skin to stabilize the newborn and

help the baby initiate breastfeeding within an hour of birth.

5. Show mothers how to breastfeed, and how to maintain lactation even

if they should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unlessmedically  indicated.

7. Practice rooming-in 

allow mothers and infants to remain

together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers to breastfeeding infants.

10. Organize and provide follow-up in the community after discharge.

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 16/25

Kay Hoover, Med, IBLCL, 613 Yale Avenue, Morton, PA 19070-1922 kay@hoover.net 16

Visually Promote Breastfeeding

On you  Button   Name tag  Bumper sticker

  Carry a breastfeeding book  Tote bag

In your space  Posters  Photos of staff with baby and positive

message  Videos playing in waiting area  Bulletin board of photos of clients who

 breastfed  Wall of clients who breastfed for one year

Items you use  Pens  Mugs  Paper  Water bottle

Mail to send out  Stickers  Envelopes

In your organization  Peer counselors  Employee pumping station

Handouts with accurate information  Culturally appropriate  Language appropriate  Colorful and attractive

Ad specialty items with positive breastfeeding

information  Bookmarkers  Magnets  Bags

Education of entire staff  In-service programs  Attend conferences  College courses

  Library of resource books  Local breastfeeding resources file

The words we use  When (not if)  Ask, “What do you know about

 breastfeeding?” (not breast or bottle, she cando both)

  Discuss advantages to the mother. (Peopleknow about the advantages to the baby.)

Incentives  Gift basket  Large gift  Monthly gift  Payment  Certificates

Encourage breastfeeding in the waiting room  Comfortable chairs  Others to set an example

Encourage staff to talk about breastfeeding withclients  Dispel myths  Take care of potential problems

Education outside of your walls  Establish lending library of books and videos

for parents  Classes on breastfeeding for mother and her

family members

  Get pregnant together with breastfeedingwomen  Telephone numbers to call if have questions

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 17/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 25

Establishing Practices that Promote, Protect, and Support Hospital Breastfeeding Policies

American Academy of Pediatrics Workgroup on Breastfeeding: Breastfeeding and the Use of Human Milk. Pediatrics 100(6):1035-1039, 1997Anand RK: Transforming health colleagues into breastfeeding advocates. WABA Activity Sheet #3, (undated) adapted from Lyra Srinivasan's stages of

change, published by SARAR International and World Neighbours in ActionAnderson G: Risk in mother-infant separation postbirth. Image: J of Nursing Scholarship 21:196-199, 1989Bono BJ: Assessment and documentation of the breastfeeding couple by health care professionals. Journal of Human Lactation 8(1):17-22, 1992Chezem J, Friesen C, Montgomery P, Fortman T, Clark H: Lactation duration: influences of human milk replacements and formula samples on women

 planning postpartum employment. JOGNN 27(6):646-651, 1998Christensson K: Temperature, metabolic adaptation and crying in healthy newborns cared for skin-to-skin or in a cot. Acta Paediatr 81:488-493, 1992Coalition for Improving Maternity Services: The mother-friendly childbirth initiative. J of Nurse-Midwifery 42(1):59-63, 1997de Carvalho M, Robertson S, Friedman A, Klaus M: Effect of frequent breastfeeding on early milk production and infant weight gain. Pediatrics 72(3):307-

311, 1983de Carvalho M, Robertson S, Klaus M: Fecal bilirubin excretion and serum bilirubin concentrations in breast -fed and bottle-fed infants. Journal of Pediatrics

107(5):786-789, 1985de Carvalho M, Robertson S, Merkatz R, Klaus M: Milk intake and frequency of feeding in breastfed infants. Early Hum Dev 7:155-163, 1982Dungy CI, et al.: Effect of discharge samples on duration of breastfeeding. Pediatrics 90(2):233-237, 1992Ellis DJ: Sup porting breastfeeding: how to implement agency change. NAACOG’s Clinical Issues 3(4):560-564, 1992Freeman C, Lowe N: Breastfeeding care in Ohio hospitals: a gap between research and practice. JOGNN 22:447-453, 1993Glover J: Supplementation of breastfeeding newborns: a flow chart for decision making. Journal of Human Lactation 11(2):127-131, 1995Hannon PR, Ehlert-Abler P, Aberman S, Williams R, Carlos M: A Multidisciplinary approach to promoting a baby friendly environment at an urban

university medical center. Journal of Human Lactation 15(4):289-296, 1999Henrikson M: A policy for supplementary/complementary feedings for breastfed newborn infants. J Human Lactation 6(1):11-14, 1990Huggins K: What every nursing mother should know at discharge: breastfeeding instructions for the first week. Mother Baby Journal 2(3):43-45, 1997International Lactation Consultant Association: Evidence-Based Guidelines for Breastfeeding Management during the First Fourteen Days. Raleigh,

 NC: ILCA, 1999Jenks M: Latch assessment documentation in the hospital nursery. J Human Lactation 7(1):19-20, 1991Jensen D, Wallace S, Kelsay P: LATCH: a breastfeeding charting system and documentation tool. JOGNN 23(1):27-32, 1994Johnson R, et al.: Effect of post-delivery care on neonatal body temperature. Act Paediatori 81:859-863, 1992Keefe M: Comparison of neonatal nighttime sleep-wake patterns in nursery rooming-in environments. Nursing Research 36:140-144, 1989Kovach AC: Hospital breastfeeding policies in the Philadelphia area: a comparison with the ten steps to successful breastfeeding. Birth 24(1):41-48, 1997Kramer MS, Chalmers B, Hodnett ED, et al.: Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA

285(4):413-420, 2001Lang S, Lawrence CJ, Orme RL: Cup feeding: an alternative method of infant feeding. Arch Dis Child 71(4):365-369, 1994Lawrence RA: Breastfeeding in Belarus. JAMA 285(4):463-464, 2001Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession (7th edition). Maryland Heights, MO: ElsevierMosby, 2012Matthews MK: The relationship between maternal labour analgesia and delay in the initiation of breastfeeding in healthy neonates in the early postpartum

 period. Midwifery 5(1):3-10, 1989Matthews MK: Assessments and suggested interventions to assist newborn breastfeeding behavior. J Human Lactation 9(4):243-248, 1993Morbacher N, Stock J: The Breastfeeding Answer Book. Schaumburg, IL: La Leche League International, 1997Mulford C: Swimming upstream: breastfeeding care in a nonbreastfeeding culture. JOGNN 24(5):464-74, 1995

 Neifert M: Early assessment of the breastfeeding infant. Contemporary Pediatrics 13(10):142-66, 1996 Neifert M, Lawrence R, Seacat J: Nipple confusion: toward a formal definition. J Pediatr 126:123-129, 1995Page-Goertz S: Discharge planning for the breastfeeding dyad. Pediatric Nursing 15(5):543-544, 1989Perez-Escamilla R, Pollitt E, Lönnerdal B, Dewey KG: Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytical

overview. American Journal of Public Health 84(1):89-97, 1994Powers NG, Naylor AJ, Wester RA: Hospital policies: crucial to breastfeeding success. Seminars in Perinatology 18(6):517-524, 1994Righard L, Alade MO: Effect of delivery room routines on success of first breast-feed. Lancet 336(8723):1105-1107, 1990Riordan J, Wambach K: Breastfeeding and Human Lactation (4th edition). Boston, MA: Jones and Bartlett Publishers, 2010Shrago L: Glucose water supplementation of the breastfed infant during the first three days of life. Journal of Human Lactation 3(3):82-86, 1987Syler GP, Sarvela P, Welshimer K, Anderson SL: A descriptive study of breastfeeding practices and policies in Missouri hospitals. J Hum Lact 13(2):103-7,

1997US Com for UNICEF: Barriers and Solutions to the Global Ten Steps to Successful Breastfeeding. 110 Maryland Ave, NE, Box 36, Washington, DC

20002, 1994UNICEF: Baby friendly ten steps to successful breastfeeding. New York: UNICEFVaughans B: Early maternal-infant contact and neonatal thermoregulation. Neonatal Network 8(5):19-21, 1990Victoria CG, et al.: Pacifier use and short breastfeeding duration: cause, consequence, or coincidence? Pediatrics 99(3):445-453, 1997Walker M: Hospital Breastfeeding Policies and Protocols: A Model for the Short Stay. Weston, MA: Lactation Associates, 1995

Wellstart International: Model Hospital Breastfeeding Policies. San Diego, CAWidstrom AM, et al.: Gastric suction in healthy newborn infants: effects on circulation and developing feeding behaviors. Acta Pædiatr Scand 76(4):566-572, 1987

Widstrom AM, Wahlberg V, et al.: Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Human Development 21(3):153-163, 1990

Winikoff B, Meyers D, Laukeran VH, Stone R: Overcoming obstacles to breastfeeding in a large municipal hospital: applications of lessons learned.Pediatrics. 80(3):423-433, 1987

World Health Organization: Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. Geneva, Switzerland: WHOPublications, 1989

Wright A, Rice S, Wells S: Changing hospital practices to increase the duration of breastfeeding. Pediatrics 97(5): 669-675, 1996

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 18/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 26

Post Birth Care to Support Early and Exclusive Breastfeeding

Aghdas K, Talat K, Sepideh B. Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women:a randomized control trial. Women Birth 27(1):37-40, 2014

Alikasifoglu M, Erginoz E, Gur ET, et al: Factors influencing the duration of exclusive breastfeeding in a group of Turkish women. J Hum Lact 17(3):220-226, 2001

AAP & ACOG: Guidelines for Perinatal Care (7th Edition). Elk Grove Village: AAP, 2012American Academy of Pediatrics Section on Breastfeeding, Eidelman AI, Schanler RJ: Breastfeeding and the Use of Human Milk. Pediatrics 129(3)e827-

e841, 2012 www.aap.org/policyACOG: Educational Bulletin Number 258, Breastfeeding: Maternal and Infant Aspects, July 2000ACOG: Breastfeeding: Maternal and Infant Aspects. ACOG Clinical Review 12(1) (Supplement)1S-16S, 2007ACOG Committee Opinion Number 543: Timing of umbilical cord clamping after birth. December 2012ACOG Committee Opinion Number 570: Breastfeeding in underserved women: increasing initiation and continuation of breastfeeding. Obstetrics

Gynecology 122(2):423-428, 2013American Academy of Pediatrics: Neonatal Resuscitation Guidelines. Pediatrics 117(5):e989-1004, 2006American Heart Association: 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular

care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics 117(5):e989-1004, 2006Anderson GC: The mother and her newborn: mutual caregivers. JOGNN 6(5):50-57, 1977Anderson GC: Risk in mother-infant separation postbirth. IMAGE: Journal of Nursing Scholarship 21(4):196-199, 1989Anderson GC: Crying, foramen ovale shunting, and cerebral volume. J Pediatr 113(2):411-412, 1988Anderson GC, McBride MR, Dahm J, et al.: Development of sucking in term infants from birth to four hours postbirth. Res Nurs Health 5(1):21-7, 1982Auerbach KG: Evidence- based care and the breastfeeding couple: key concerns. J of Midwifery & Women’s Health 45(3):205-211, 2000Aziz K, Chinnery H, Lacaze-Masmonteil T. A single-center experience of implementing delayed cord clamping in babies born at less than 33 weeks'

gestational age. Adv Neonatal Care 12(6):371-376, 2012Bergman NJ, Linley LL, Fawcus SR: Randomized controlled trail of skin-to-skin contact from birth versus conventional incubator for physiological

stabilization in 1200- to 2199-gram newborns. Acta Paediatr 93(6):779-785, 2004Britton JR: The transition to extrauterine life and disorders of transition. Clinics in Perinatology 25(2):271294, 1998Broadfoot M, Britten J, Tappin DM, MacKenzie JM: The Baby Friendly Hospital Initiative and breastfeeding rates in Scotland. Arch Dis Child Fetal

 Neonatal Ed 90(2):F114-116, 2005Brodribb W, Kruske S, Miller YD. Baby-friendly hospital accreditation, in-hospital care practices, and breastfeeding. Pediatrics 131(4):685-692, 2013Bramson L, Lee JW, Moore E, et al.: Effect of early skin-to-skin mother-infant contact during the first 3 hours following birth on exclusive breastfeeding

during the maternity hospital stay. J Hum Lact 26(2):130-137, 2010Bystrova K, Ivanova V, Edhborg M, Matthiesen AS, Ransjö-Arvidson AB, Mukhamedrakhimov R , Uvnäs-Moberg K , Widström AM. Early contact versus

separation: effects on mother-infant interaction one year later. Birth 36(2):97-109, 2009Bystrova K, Widström, A-M, Matthiesen A-S, et al.: Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on

temperature in newborn infants, subjected to different ward routines in St. Petersburg. Acta Paediatr 92:320-326, 2003Carfoot S, Williamson P, Dickson R. A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breastfeeding.

Midwifery 21(1):71-79, 2005Chapman DJ, Pérez-Escamilla R: Identification of risk factors for delayed onset of lactation. J Am Diet 99(4):450-454, 1999Chen DC, Nommsen-Rivers L, Dewey KG, Lönnerdal B: Stress during labor and delivery and early lactation performance. Am J Clin Nutr 68(2):335-344,

1998Chiu SH, Anderson GC, Burkhammer MD. Newborn temperature during skin-to-skin breastfeeding in couples having breastfeeding difficulties. Birth

32(2):115-121, 2005Christensson K: Care of the Newborn Infant: Satisfying the Need for Comfort and Energy Conservation. Dept of Woman and Child Health and International

Health and Social Medicine, Karolinska Institutet, Stockholm, Sweden, 1994Christensson K: Fathers can effectively achieve heat conservation in healthy newborn infants. Acta Paediatrica 85(11):1354-60, 1996Christensson K, Siles C, Moreno L, et al.: Temperature, metabolic adaptation and crying in healthy, full-term newborns cared for skin-to-skin or in a cot.

Acta Paediatr Scand 81(6-7):448-493, 1992Christensson K, Siles C, Cabrera T, et al.: Lower body temperatures in infants delivered by caesarean section than in vaginally delivered newborn infants.

Acta Paediatr Scand 82(2):128-131, 1993Christensson K, Ransjö-Arvidson AB, Kakoma C, et al.: Midwifery care routines and prevention of heat loss in the newborn: a study in Zambia. J Trop

Pediatr 34(5):208-12, 1988Christensson K, et al.: Randomised study of skin-to-skin versus incubator care for rewarming low-risk hypothermic neonates. Lancet 352(9134):1115, 1998Christensson K, Cabrera T, Christensson E, Uvnas-Moberg K, Winberg J: Separation distress call in the human infant in the absence of maternal body

contact. Acta Pediatrica Scand 84(5):467-473, 1995Chua S, et al.: Influence of nipple stimulation and breastfeeding on postpartum uterine activity. Br J Ob Gyn 101:804-805, 1994Chute G: NAACOG’s Clinical Issues in Perinatal and Women’s Health Nursing: Breastfeeding. 3(4) Philadelphia: J.B. Lippincott Company, 1992Clarke LL, Deutsch MJ: Becoming baby-friendly. Lifelines, December 1997

Clements MS, et al.: Influences on breastfeeding in southeast England. Acta Paediatr 86:51-56, 1997Coalition for Improving Maternity Services: The mother-friendly childbirth initiative. J of Nurse-Midwifery 42(1):59-63, 1997Colson SD, Meek JH, Hawdon JM: Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Dev 84(7):441-

449, 2008Crowell MK, Hill PD, Humenick SS: Relationship between obstetric analgesia and time of effective breastfeeding. Journal of Nurse-Midwifery 39(3):150-

156, 1994Dahlenburg GW, Burnell RH, Braybrook R: The relationship between cord serum sodium levels in newborn infants and maternal int ravenous therapy during

labour. British Journal of Obstetrics and Gynaecology 87:519-522, 1980Dalbye R, Calais E, Berg M. Mothers' experiences of skin-to-skin care of healthy full-term newborns--a phenomenology study. Sex Reprod Healthc.

2(3):107-11, 2011de Carvalho M, Robertson S, Friedman A, Klaus M: Effect of frequent breastfeeding on early milk production and infant weight gain. Pediatrics 72(3):307-

311, 1983

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 19/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 27

de Carvalho M, Robertson S, Merkatz R, Klaus M: Milk intake and frequency of feeding in breastfed infants. Early Human Development 7:155-163, 1982Demissie K Rhoads GG, Smulian JC, et al.: Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.

Brit Med J 329(7456):24-29, 2004Dewey KG. Maternal and fetal stress are associated with impaired lactogenesis in humans. J Nutr 131(11):3012S-5301S, 2001DiGirolamo AM, Grummer-Strawn LM, Fein S: Maternity care practices: implications for breastfeeding. Birth 28(2);94-100, 2001Dinwiddie R, Pitcher-Wilmott R, Schwartz JG, et al.: Cardiopulmonary changes in the crying neonate. 13:900-903, 1979Dogany M, Avsar F: Effects of labor time on secretion time and quantity of breast milk. Int J Gynecol Obstet 76(2):207-211, 2002Dombrowski MA, Anderson GC, Santori C, Burkhammer M: Kangaroo care with a postpartum woman who felt depressed. MCN 26(4):214-216, 2001

Donnelly B: Are we really doing all we can to promote breastfeeding? Contemporary Pediatrics 11:47-50, 1994Dozier AM, Howard CR, Brownell EA, Wissler RN, Glantz JC, Ternullo SR, Thevenet-Morrison KN, Childs CK, Lawrence RA. Labor epidural anesthesia,obstetric factors and breastfeeding cessation.. Matern Child Health J. 17(4):689-698, 2013Dumas L Lepage M, Bystrova K, et al.: Influence of skin-to-skin contact and rooming-in on early mother-infant interaction: a randomized controlled trial.

Clin Nurs Res 22(3):310-336, 2013Edmond KM, Zandoh C, Quigley MA, et al.: Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 117(3):e380-386, 2006Ekström A, Widström AM, Nissen E: Duration of breastfeeding in Swedish primiparous and multiparous women. J Hum Lact 19(2):172-178, 2003Ellis DJ: Supporting breastfeeding: how to implement agency change. NAACOG’s Clinical Issues 3(4):560-564, 1992Erlandsson K, Dsilna A, Fagerberg I, Christensson K: Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding

 behavior. Birth 34(2):105-114, 2007Ferber SG, Makhoul IR: The e ffect of skin-to-skin contact (Kangaroo Care) shortly after birth on the neurobehavioral responses of the term newborn: a

randomized, controlled trial. Pediatrics 113(4):858-865, 2004Fifer WP, Moon CM: The role of mother’s voice in the organization of brain function in the newborn. Acta Paedriatr Suppl 397:86-93, 1994Forster DA, McLachian HL. Breastfeeding initiation and birth setting practices: a review of the literature. J Midwifery & Women’s Health 52(3):273-280,

2007Fransson AL, Karlsson H, Nilsson K: Temperature variation in newborn babies: importance of physical contact with the mother. Arch Dis Child Fetal

 Neonatal Ed 90(6):F500-504, 2005

Freeman C, Lowe N: Breastfeeding care in Ohio hospitals: a gap between research and practice. JOGNN 22:447-453, 1993Freudigman KA, Thoman EB: Infant sleep during the first postnatal day: an opportunity for assessment of vulnerability. Pediatrics 92(3):373-379, 1993Gill NE, White MA, Anderson GC: Transitional newborn infants in a hospital nursery: time and behavior between first oral cue and first sustained cry.

 Nursing Research 33:213-217, 1984Girish M, Mujawar N, Gotmare P, et al. Impact and feasibility of breast crawl in a tertiary care hospital. J Perinatol 2012 [Epub ahead of print]Giugliani ERJ, Caiaffa WT, Vogelhut J, Witter FR, Perman JA: Effects of breastfeeding support from different sources on mothers’ decisions to breastfeed.

Journal of Human Lactation 10(3):157-161, 1994Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D'Antona D, Nardelli GB. Epidural analgesia during labor: impact on

delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med 7:262-268, 2012Gomez Papi A, et al.: Kangaroo method in delivery room for full-term babies. Anales Espanoles de Pediatria 48(6):631-633, 1998Gorrin-Peralta, JJ, Parrilla-Rodriguez AM: The management of labor and delivery and its implications for breastfeeding. PRHSJ 19(4), 2000Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 22(1):49-58, 2013Gubler T, Krähenmann F, Roos M, Zimmermann R, Ochsenbein-Kölble N. Determinants of successful breastfeeding initiation in healthy term singletons: a

Swiss university hospital observational study. J Perinat Med 41(3):331-339, 2013Hahn J: A community hospital’s experience with baby-friendly. AWHONN Lifelines 9(4):306-311, 2005Hall RT, Mercer AM, Teasley SL, et al.: A breastfeeding assessment score to evaluate the risk for cessation of breastfeeding by 7 to 10 days of age. J of

Peds 141(5):659-664, 2002Hannon PR, Ehlert-Abler P, Aberman S, Williams R, Carlos M: A Multidisciplinary approach to promoting a baby friendly environment at an urban

university medical center. Journal of Human Lactation 15(4):289-296, 1999Harlow HF, Zimmermann RR: Affectional responses in the infant monkey: orphaned baby monkeys develop a strong and persistent attachment to inanimate

surrogate mothers. Science 130(3373):421-432, 1959Hawkins JL, et al.: Obstetric anesthesia work force survey, 1981 vs 1992. Anesthesiology 87(1):135-143, 1997Hill PD, Humenick SS: The occurrence of breast engorgement. Journal of Human Lactation 10(2):79-86, 1994Hill PD, Humenick SS: Breast engorgement: patterns and selected outcomes. J Hum Lact 10(2):87-93, 1994Hill S, Shronk L: The effect of early patient-infant contact on newborn body temperature. JOGNN (8):287-290, 1979Hirose M, Hara Y, Tanaka Y: The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of

 breastfeeding and infant weight gain. Anesth Analg 82(6):1166-1169, 1996Hodnett ED, Gates S, Hofmeyr GJ, Sakala C: Continuous support for women during childbirth. Cochrane Database Syst Rev 3:CD003766, 2003Hofmeyr GJ, Nikodem VC, Wolman W, et al.: Companionship to modify the clinical birth environment: effects on progress and perceptions of labour and

 breastfeeding. Brit J Obstet Gynaecol 98:756, 1991Hoseth E, Joergensen A, Ebbesen F, Moeller M: Blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational

age. Arch Dis Child 83(2):F117-F119, 2000Huggins K: What every nursing mother should know at discharge: breastfeeding instructions for the first week. Mother Baby Journal 2(3):43-45, 1997

Hung KJ, Berg O. Early skin-to-skin after cesarean to improve breastfeeding. MCN 2011 36(5):318-324, 2011Humenick SS: The impact of epidurals on infant behavior and breastfeeding. Journal of Perinatal Edu 4(4):65-67, 1995Humenick SS: The clinical significance of breastmilk maturation rates. Birth 14(4):174-179, 1987International Lactation Consultant Association: Clinical Guidelines for the Establishment of Exclusive Breastfeeding. 2005

http://www.ilca.org/files/resources/ClinicalGuidelines2005.pdfJacobson B, Eklund G, Hamberger L, Linnarsson D, Sedvall G, Valverius M: Perinatal origin of adult self-destructive behavior. Acta Psychiatrica

Scandinavica 76(4):364-371, 1987Johnson N: Breastfeeding at one hour of age. MCN (121):12-16, 1976Johnson R, et al.: Effect of post-delivery care on neonatal body temperature. Act Paediatori 81:859-863, 1992Jonas W, Wiklund I, Nissen E, et al.: Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices. Early

Human Development 83:55-62, 2007Jordan S, Emery S, Bradshaw C, et al.: The impact of intrapartum analgesia on infant feeding. BJOG 112(7):927-934, 2005

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 20/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 28

Karlsson H: Skin to skin care: heat balance. Archives of Disease in Child Fetal & Neonatal Edition 75(2):F130-F132, 1996Kearney M, et al.: Breastfeeding problems in the first week postpartum. Nursing Research 39(2):90-95, 1990Keefe M: Comparison of neonatal nighttime sleep-wake patterns in nursery rooming-in environments. Nursing Research 36:140-144, 1989Keefe M: The impact of infant rooming-in on maternal sleep at night. JOGNN 17(2):122-126, 1988Keister D, Roberts KT, Werner SL: Strategies for breastfeeding success. American Family Physician 78(2):225-232, 2008Kennell JH, Klaus MH, McGrath S, et al.: Continuous emotional support during labor in a US hospital. JAMA 265:2197-2201, 1991Kennell JH: The time has come to reassess delivery room routines. Birth 21(1):49-51, 1994Kessler LA, Gielen AC, Diener-West M, Paige DM: The effect of a woman’s significant other on her breastfeeding decision. Journal of Human Lactation

11(2):103-109, 1995King T: Epidural anesthesia in labor. Journal of Nurse-Midwifery 42(5):377-388, 1997Kitajima H: Prevention of methicillin-resistant Staphylococcus aureus infection in neonates. Pediatr Int 45(2):238-245, 2003Kovach AC: Hospital breastfeeding policies in the Philadelphia area: a comparison with the ten steps to successful breastfeeding. Birth 24(1):41-48, 1997Kramer MS, Chalmers B, Hodnett ED, et al.: Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA

285(4):413-420, 490, 2001Kroeger M: Impact of Birthing Practices on Breastfeeding . Boston: Jones and Bartlett Publishers, 2004Kruse Lakota, Cenk CE, Feldman-Winter L, Rotondo FM: Comparing sociodemographic and hospital influences on breastfeeding initiation. Birth 32(2):81-

85, 2005Kuan LW, Britto M, Decolongon J, et al.: Health system factors contributing to breastfeeding success. Pediatrics 104(3)e28, 1999Lawrence RA: Breastfeeding in Belarus. JAMA 285(4):463-464, 2001Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession (7th edition). Maryland Heights, Missouri: Elsevier Mosby, 2011Lawrence RM, Lawrence RA: Given the benefits of breastfeeding, what contraindications exist? in Schanler RJ: The Pediatric Clinics of North America:

Breastfeeding 2001, Part I The Evidence for Breastfeeding 48(1):235-252, February 2001Lawson K, Tulloch MI: Breastfeeding duration: prenatal intentions and postnatal practices. J Adv Nurs 22(5):841-849, 1995L’Esperance C, Frantz K: Time limitation for early breastfeeding. JOGNN 114-118, March/April 1985Levine EM, Ghai V, Barton JJ, Strom CM: Mode of delivery and risk of respiratory diseases in newborns. Obstetrics & Gynecology 97(3):439-442, 2001

Lieberman E, et al.: Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 99(3):415-419, 1997Lieberman E, et al.: Intrapartum maternal fever and neonatal outcome. Pediatrics 105(1):8-13, 2000Lindenberg CS, Cabrera Artola R, Jimenez V. The effect of early post-partum mother-infant contact and breastfeeding promotion on the incidence and

continuation of breast-feeding. International Journal of Nursing Studies, 27(3), 179 – 186, 1990Loftus JR, Hill H, Cohen SE: Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor.

Anesthesiology 83(2):300-308, 1995Lothian JA: It takes two to breastfeed: the baby’s role in successful breastfeeding. J Nurse Midwifery 40(4):328-334, 1995Ludington-Hoe SM, Lewis T, Morgan K, et al.: Breast and infant temperatures with twins during shared Kangaroo Care. J Obstet Gynecol Neonatal Nurs

35(2):223-31, 2006Lvoff NM, Lvoff V, Klaus MH: Effect of the Baby-Friendly initiative on infant abandonment in a Russian hospital. Arch Pediatr Adolesc Med 154(5):474-

477, 2000McCreath WA, Wilcox S, Laing V, Crump D, Gilles J: Improving the number of mothers breastfeeding in the postpartum period. Prim Care Update

Ob/Gyns 8(1):40-43, 2001Mahmood I, Jamal M, Khan N. Effect of Mother-Infant Early Skin-to-Skin Contact on Breastfeeding Status: A Randomized Controlled Trial. J Coll

Physicians Surg Pak. 21(10):601-605, 2011Marín Gabriel MA, Llana Martín I, López Escobar A, Fernández Villalba E, Romero Blanco I, Touza Pol P. Randomized controlled trial of early skin-to-

skin contact: effects on the mother and the newborn. Acta Paediatr 99(11):1630-1634, 2010Martens PJ: Does breastfeeding education affect nursing staff beliefs, exclusive breastfeeding rates, and baby-friendly hospital initiative compliance? The

experience of a small, rural Canadian hospital. J Hum Lact 16(4):309-318, 2000Matias SL, Nommsen-Rivers LA, Creed-Kanashiro H, Dewey KG. Risk factors for early lactation problems. among Peruvian primiparous mothers. Matern

Child Nutr.6(2):120-133. 2010Matthews MK: The relationship between maternal labour analgesia and delay in the initiation of breastfeeding in healthy neonates in the early postpartum

 period. Midwifery 5(1):3-10, 1989Matthiesen A-S, Ransjö-Arvidsson A-B, Nissen E, et al.: Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking.

Birth 28(1):13-19, 2001Medves J, O’Brien B. The effect of bather and location of first bath on maintaining thermal stability in newborns. Journal of  Obstetric, Gynecologic, and

 Neonatal Nursing 33(2):175 – 182, 2004Mercer JS, McGrath MM, Hensman A, Silver H, Oh W. Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized

controlled trial. J Perinatol 23(6):466-472, 2003Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H: Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey.

Pediatrics 116(3):628-634, 2005Merewood A, Philipp BL: Implementing change: becoming baby-friendly in an inner city hospital. Birth 28(1):36-40, 2001Mikiel-Kostyra K, Mazur J, Boltruszko I: Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study. Acta

Paediatr 91:1301-1306, 2002Mikiel-Kostyra k, Mazur J, Wojdan-Godek E: Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples. SozPraventivmed 50(1):52-59, 2005

Minchin M, et al.: Expanding the WHO/UNICEF baby friendly hospital initiative (BFHI): Eleven steps to optimal infant feeding in a paediatric unit.Breastfeeding Review 4(2):87-91, 1996

Morgan BE, Horn AR, Bergman NJ. Should neonates sleep along? Biol Psychiatry 70(9):817-825, 2011Mahmood I, Jamal M, Khan N. Effect of mother-infant early skin-to-skin contact on breastfeeding status: a randomized controlled trial. J Coll Physicians

Surg Pak. 21(10):601-605, 2011Moon JL, Humenick SS: Breast engorgement: contributing variables and variables amenable to nursing intervention. J Obstet Gynecol Neonatal Nurs

18(4):309-15, 1989Morse JM, Jehle C, Gamble D: Initiating breastfeeding: a world survey of the timing of postpartum breastfeeding. Int J Nurs Stud 27(3):303-313, 1990Mulford C: Swimming upstream: breastfeeding care in a nonbreastfeeding culture. JOGNN 24(5):464-74, 1995

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 21/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 29

Murphy EK, Ricketts S, Dellaport J: Hospital practices that increase breastfeeding duration: results from a population-based study. Birth 34(3): 202-211,2007

Messmer PR, et al.: Effect of Kangaroo Care on sleep time for neonates. Pediatric Nursing 23(4):408-414, 1997Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM: Neonatal hypothermia and associated risk factors among newborns of southern

 Nepal. BMC Med. 8;8:43, 2010 Nissen E, Lilja G, Matthiesen A-S, Ransjö-Arvidsson A-B, Uvnäs-Moberg K, Widström A-M: Effects of maternal pethidine on infants’ developing

 breastfeeding behavior. Acta Pædiatr 84(2):140-145, 1995 Nissen E, Widström A-M, Lilja G, Matthiesen A-S, Uvnäs-Moberg K, Jacobsson G, Boréus LO: Effects of routinely given pethidine during labour on

infants’ developing breastfeeding behavious. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma. Acta Paediatr 86(2):201-208, 1997 Nyström, K, Axelsson K: Mothers’ experience of being separated from their newborns. JOGNN 31(3):275-282, 2002Page-Goertz S: Discharge planning for the breastfeeding dyad. Pediatric Nursing 15(5):543-544, 1989Palmer G: The Politics of Breastfeeding  (2nd Edition). London: Pandora Press, 1993Penfold S, Hill Z, Mrisho M, et al.: A large cross-sectional community-based study of newborn care practices in southern Tanzania. PLoS One.

5(12):e15593, 2010Perez-Escamilla R, Pollitt E, Lönnerdal B, Dewey KG: Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytical

overview. American Journal of Public Health 84(1):89-97, 1994Philadelphia Department of Public Health: Philadelphia Breastfeeding Resource Handbook . Philadelphia: Philadelphia Department of Public Health,

Division of Maternal, Child and Family Health, 2006Philipp BL, Merewood A, et al: Baby-Friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics 108(3):677-681,

2001Philipp BL, Malone KL, Cimo S, Merewood A: Sustained breastfeeding rates at a US Baby-Friendly Hospital. Pediatrics 112(3):666, 2003Phillips R: The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth. Newborn and Infant Nursing Reviews 13(2):67-72, 2013Powers NG, Naylor AJ, Wester RA: Hospital policies: crucial to breastfeeding success. Seminars in Perinatology 18(6):517-524, 1994Preer G, et al. Delaying the bath and in-hospital breastfeeding rates. Breastfeeding Medicine Vol 8(6):485-490, 2013

Puig G, SguasseroY: Early skin-to-skin contact for mothers and their healthy newborn infants: RHL commentary (last revised: 9 November 2007). TheWHO Reproductive Health Library; Geneva: World Health Organization

Quillin SI: Infant and mother sleep patterns during 4th postpartum week. Issues Compr Pediatr Nurs 20(2):115-123, 1997Radzyminski S: Neurobehavioral functioning and breastfeeding behavior in the newborn. J Obstet Gynecol Neonatal Nurs 34(3):335-341, 2005Rajan L: The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breastfeeding. Midwifery 10(2):87-103, 1994Raju TN. Timing of umbilical cord clamping after birth for optimizing placental transfusion. Curr Opin Pediatr. 25(2):180-187, 2013Ransjö-Arvidson AB, Matthiesen AS, Lilja G, et al.: Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and

crying. Birth 28(1):5-12, 2001Renfrew M: Positioning the baby at the breast: more than a visual skill. J of Human Lactation 5(1):13-15, 1989Righard L: Early enhancement of successful breastfeeding. World Health Forum 17:92-97, 1996Righard L, Alade MO: Effect of delivery room routines on success of first breastfeed. Lancet 336(8723):1105-1107, 1990Riordan J, Wambach K: Breastfeeding and Human Lactation (4th edition). Boston: Jones and Bartlett Publishers, 2010Riordan J, Gill-Hopple K, Angeron J: Indicators of effective breastfeeding and estimates of breast milk intake. J Hum Lact 21(4):406-412, 2005Riordan J, Gross A, Angeron J, Krumwiede B: The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. Journal of Human

Lactation 16(1):7-12, 2000Riordan J, Riordan S: The effect of labor epidurals on breastfeeding Unit 4 Lactation Consultant Series Two. Schaumburg, IL: La Leche League

International, April 2000Riordan J: Predicting breastfeeding problems. AWHONN Lifelines 2(6):31-33, 1998Rosenblatt DB, et al.: The influence of maternal analgesia on neonatal behaviour: II Epidural bupivacaine. British Journal of Obstetrics and Gynæology

88(4):407-413, 1981Rowe-Murray HJ, Fisher JRW: Baby friendly hospital practices: Cesarean section is a persistent barrier to early initiation of breastfeeding. Birth 29(2):124-

131, 2002Sallam SA, Babrs GM, Sadek RR , Mostafa AM. Knowledge, attitude, and practices regarding early start of breastfeeding among pregnant, lactating women

and healthcare workers in el-minia university hospital. Breastfeed Med 8(3):312-316, 2013Schwartz RP: Neonatal hypoglycemia: how low is too low? J of Pediatrics 131(2):171-173, 1997Scott JA, Diet GD, Landers MCG, et al.: Psychosocial factors associated with the abandonment of breastfeeding prior to hospital discharge. J Hum Lact

17(1):24-30, 2001Sepkoski CM, Lester BM, Ostheimer GW, Brazelton TB: The effects of maternal epidural anesthesia on neonatal behavior during t he first month.

Developmental Medicine and Child Neurology 34(12):1072-1080, 1992Sepkoski CM: Maternal Obstetric Medication and Newborn Behavior 131-173 in Scanlon JW: Contemporary Issues in Fetal and Neonatal Medicine:

Perinatal Anesthesia. Boston: Blackwell Scientific Publications, 1985Shrago L, Bocar D: The infant’s contribution to breastfeeding. JOGNN 19(3):209-215, 1990Shrago L: Glucose water supplementation of the breastfed infant during the first three days of life. Journal of Human Lactati on 3(3):82-86, 1987

Slaven S, Harvey D: Unlimited suckling time improves breastfeeding. Lancet February 14, 1981Smith LJ: Impact of birthing practices on the breastfeeding dyad. J Midwifery & Womens Health 52(6): 621-630, 2007Sobhy SI, Mohame NA: The effect of early initiation of breastfeeding on the amount of vaginal blood loss during the fourth stage of labor. J Egypt Public

Health Assoc 79(1-2):1-12, 2004Sobel HL, Silvestre MA, Mantaring JB 3rd: Immediate newborn care practices delay thermoregulation and breastfeeding initiation. Acta Paediatr.

100(8):1127-33, 2011Soskolne EI, et al.: The effect of early discharge and other factors on readmission rates of newborns. Arch Pediatr Adolesc Med 150(4):373-379, 1996Sullivan RM, Toubas P: Clinical usefulness of maternal odor in newborns: soothing and feeding preparatory responses. Biology of the Neonate 74:402-408,

1998Sweet DG, Hadden D, Halliday HL: The effect of early feeding on the neonatal blood glucose level at 1-hour of age. Early Human Development 55:63-66,

1999

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 22/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 30

Syler GP, Sarvela P, Welshimer K, Anderson SL: A descriptive study of breastfeeding practices and policies in Missouri hospitals. Journal of HumanLactation 13(2):103-107, 1997

Takahashi Y, Tamakoshi K , Matsushima M, et al.: Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin -to-skin contact withdifferent initiation and duration times in healthy, full-term infants. Early Hum Dev. 87(3):151-157, 2011Tarkka MT, Paunonen M, Laippala P: What contributes to breastfeeding success after childbirth in a maternity ward in Finland? Birth 25(3):175-181, 1998Taylor PM, Maloni JA, Brown DR: Early suckling and prolonged breastfeeding. AJDC 140(2):151-154, 1986Thukral A, Sankar MJ, Agarwal R, Gupta N, Deorari AK, Paul VK. Early skin-to-skin contact and breast-feeding behavior in term neonates: a randomized

controlled trial. Neonatology 102(2):114-119, 2012

US Committee for UNICEF: Barriers and Solutions to the Global Ten Steps to Successful Breastfeeding. 110 Maryland Avenue, NE, Box 36, Washington,DC 20002, 1994Vaidya K, Sharma A, Dhungel S: Effect of early mother-baby close contact over the duration of exclusive breastfeeding. Nepal Med Coll J 7(2):138-140,

2005Vaughans B: Early materanl-infant contact and neonatal thermoregulation. Neonatal Network 8(5):19-21, 1990Velandia M, Matthisen AS, Uvnäs-Moberg K, Nissen E. Onset of vocal interaction between parents and newborns in skin-to-skin contact immediately after

elective cesarean section. Birth. 37(3):192-201, 2010Victoria CG, et al.: Pacifier use and short breastfeeeding duration: cause, consequence, or coincidence? Pediatrics 99(3):445-453, 1997Vincent S. Skin-to-skin contact. Part one: just an hour of your time... Pract Midwife. 14(5):40-41, 2011Vincent S. Skin-to-skin contact. Part two: the evidence. Pract Midwife. 14(6):44-46, 2011Volmanen P, Valanne J, Alahuhta S: Breastfeeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures

and breastfeeding practices. Int J Obst Anesthesia 13:25-29, 2004Walker M: Do labor medications affect breastfeeding? Journal of Human Lactation 13(2):131-137, 1997Walters MW, Boggs KM, Ludington-Hoe S, et al: Kangaroo care at birth for full term infants. MCN 32(6):375-381, 2007Wellstart International: Model Hospital Breastfeeding Policies. San Diego, CAWidström AM, Lilja G, Aaltomaa-Michalias P, Dahllöf A, Lintula M, Nissen E. Newborn behaviour to locate the breast when skin-to-skin: a possible

method for enabling early self-regulation. Acta Paediatr. 100(1):79-85, 2011

Widstrom AM, et al.: Gastric suction in healthy newborn infants: effects on circulation and developing feeding behaviors. Acta Pædiatr Scand 76(4):566-572, 1987

Widstrom AM, Wahlberg V, et al.: Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Human Development 21(3):153-163, 1990

Wiklund I, Norman M, Uvnas-Moberg K, et al: Epidural analgesia: breastfeeding success and related factors. Midwifery 7(5):1016, 2007Wiles L: (1984) The effect of prenatal breastfeeding education on breastfeeding success and maternal perception of the infant. JOGNN 13:253-257Winberg J. Mother and newborn baby: Mutual regulation of physiology and behavior  — A selective review. Developmental Psychobiology 47(3):217 – 229,

2005Winikoff B, Meyers D, Laukeran VH, Stone R: (1987) Overcoming obstacles to breastfeeding in a large municipal hospital: applications of lessons learned.

Pediatrics. 80(3):423-433Wiswell TE, et al.: Delivery room management of the apparently vigorous meconium-stained neonate: Results of the multicenter, international collaborative

trial. Pediatrics 105(1):1-7, 2000Wittels B, Glosten B, Faure EAM, et al.: Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral

outcomes among nursing neonates. Obstetric Anesthesia 85:600-606, 1997World Health Organization: Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. Geneva, Switzerland: WHO

Publications, 1989Wright AL, BauerM, Naylor A, et al.: Increasing breastfeeding rates to reduce infant illness at the community level. Pediatrics 101(5):837-844, 1998Wright A, Rice S, Wells S: Changing hospital practices to increase the duration of breastfeeding. Pediatrics 97(5): 669-675, 1996Wyatt JS, Thoresen M: Commentaries: Hypothermia treatment and the newborn. Pediatrics 100(6):1028-1030, 1997Yamauchi Y, Yamanouchi I: Breastfeeding frequency during the first 24 hours after birth in full term neonates. Pediatrics 86(2):171-175, 1990Zanardo V, Nicolussi S, Giacomin C, et al.: Labor pain effects on colostral milk Beta-endorphin concentrations of lactating mothers. Biol Neonate 79:87-90,

2001Zanardo V, Nicolussi S, Giacomin C, et al.: Beta endorphin concentrations in human milk. J of Ped Gastroenterology and Nutrition 33:160-164, 2001Zetterström R: Breastfeeding and infant-mother interaction. Acta Paediatr Suppl 430:1-6, 1999

Pain for the newborn 

Abdulkader HM, Freer Y, Fleetwood-Walker SM, McIntosh N: Effect of suckling on the peripheral sensitivity of full-term newborninfants. Arch Dis Child Fetal Noenatal Ed 92:F130-F131, 2007

Bembich S, Davanzo R, Brovedani P, et al. Functional neuroimaging of breastfeeding analgesia by multichannel near-infraredspectroscopy. Neonatology. 104(4):255-259, 2013

Boroumandfar K, Khodaei F, Abdeyazdan Z, Maroufi M. Comparison of vaccination-related pain in infants who receive vapocoolant spray

and breastfeeding during injection. Iran J Nurs Midwifery Res. 18(1):33-37, 2013Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y: Analgesic effect of breastfeeding in term neonates: randomized controlled trial. BMJ326(7379):13-15, 2003

Castral TC, Warnock F, Leite AM, et al.: The effects of skin-to-skin contact during acute pain in preterm newborns. Eur J Pain12(4):464-471, 2008

Gray L, Watt L, Blass EM: Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 105(1):e14, 2000Gray L, Miller LW, Philipp BL, et al: Breastfeeding is analgesic in healthy newborns. Pediatrics 109(4):590-93, 2002Gray PH, Trotter JA, Langbridge P, et al.: Pain relief for neonates in Australian hospitals: a need to improve evidence-based practice.

J Paediatr Child Health 42(1-2):10-13, 2006Gupta NK, Upadhyay A, Agarwal A, et al.. Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during

wDPT vaccination. Eur J Pediatr 172(11):1527-1533, 2013

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 23/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 31

Johnston CC, Stevens B, Pinelli J, et al: Kangaroo care is effective in diminishing pain response in preterm neonates. Arch PediatrAdolesc Med 157(11):1084-1088, 2003

Leite AM, Linhares MB, Lander J, et al.: Effects of breastfeeding on pain relief in full -term newborns. Clin J Pain 25(9):827-832, 2009Ludington-Hoe SM, Hosseini R, Torrowicz DL: Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick. AACN

Clin Issues 16(3):373-387, 2005McNair C, Campbell Yeo M, Johnston C, Taddio A. Nonpharmacological management of pain during common needle puncture procedures

in infants: current research evidence and practical considerations. Clin Perinatol. 40(3):493-508, 2013

Marín Gabriel MÁ, del Rey Hurtado de Mendoza B, Jiménez Figueroa L, et al.. Analgesia with breastfeeding in addition to skin-to-skincontact during heel prick. Arch Dis Child Fetal Neonatal Ed 98(6):F499-503, 2013Okan F, Ozdil A, Bulbul A, et al.: Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates.

Ann Trop Paediatr 30(2):119-128, 2010Ou-Yang MC, Chen IL, Chen CC, et al. Expressed breast milk for procedural pain in preterm neonates: a randomized, double-blind,

 placebo-controlled trial. Acta Paediatr 102(1):15-21, 2013Pinelli J, Symington A, Ciliska D: Nonnutritive sucking in high-risk infants: benign intervention or legitimate therapy? J Obstet

Gynecol Neonatal Nurs 31(5):582-59, 2002Shah V, Taddio A, Rieder MJ: Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain

during routine childhood immunizations: systematic review and meta-analyses. Clin Ther 31 Suppl 2:S104-S151, 2009Slater R, Comelissen L, Fabrizi L, et al.: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled

trial. Lancet. 376(9748):1225-32, 2010Weissman A, Aranovitch M, Blazer S, Zimmer EZ: Heel-lancing in newborns: behavioral and spectral analysis assessment of pain control

methods. Pediatrics 124(5):e921-926, 2009

Smell

Delaunay-El Allam M, Soussignan R, Patris B, Marlier L, Schaal B: Long-lasting memory for an odor acquired at the mother's breast. Dev Sci. 13(6):849-863, 2010

Doucet S, Soussignan R, Sagot P, Schaal B: An overlooked aspect of the human breast: Areolar glands in relation with breastfeeding pattern, neonatalweight gain, and the dynamics of lactation. Early Hum Dev 88(2):119-28, 2012

Doucet S, Soussignan R, Sagot P, Schaal B: The "smellscape" of mother's breast: effects of odor masking and selective unmasking on neonatal arousal, oral,and visual responses. Dev Psychobiol 49(2):129-38, 2007

Marlier L, Schaal B: Human newborns prefer human milk: conspecific milk odor is attractive without postnatal exposure. Child Dev 76(1):155-168, 2005Mizuno K, et al: Mother-infant skin-to-skin contact after delivery results in early recognit ion of own mother’s milk odour. Act Paediatr 93(12):1640-1645,

2004Raimbault C, Saliba E, Porter RH: The effect of the odour of mother's milk on breastfeeding behaviour of premature neonates. Acta Paediatr. 2007

Mar;96(3):368-71Schaal B, Doucet S, Sagot P, et al.: Human breast areolae as scent organs: morphological data and possible involvement in maternal-neonatal coadaptation.

Dev Psyshobiol 48:100-110, 2006Schaal B, Marlier L, Soussignan R: Human foetuses learn odours from their pregnant mother's diet. Chem Senses 25(6):729-737, 2000Sullivan RM, Toubas P: Clinical usefulness of maternal odor in newborns: soothing and feeding preparatory responses. Biol Neonate 74(6):402-408, 1998

Varendi H, Porter RH, Winberg I: Attractiveness of amniotic fluid odor: Evidence of prenatal olfactory learning? Acta Paediatr 85(10):1223-1227, 1996Varendi H, Porter RH, Winberg I: Natural odour preferences of newborn infants change over time. Acta Paed iatr 86(9):985-990, 1997Varendi H, Christennsson K, Porter RH, Winberg J: Soothing effect of amniotic fluid smell in newborn infants. Early Human Development 51:47-55, 1998Varendi H, Parter RH: Breast odour as the only maternal stimulus elicits crawling towards the odour source. Acta Paediatr 90(4):372-375, 2001

Delayed Cord Clamping

ACOG — Committee opinion; Timing of umbilical cord clamping after birth. Obstet Gynecol120:1522-1526, 2012Anorlu RI, Maholwana B, Hofmeyr GJ: Methods of delivering the placenta at caesarean section. Obstet Gynecol 112(5):1173-1174, 2008Baenziger O, Stolkin E, Keel M, et al.: The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized,

controlled trial. Pediatrics 119(3):455-9, 2007Ceriani Cernadas JM, Carroli G, Pellegrini L, et al.: The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at

term: a randomized, controlled trial. Pediatrics 117(4):e779-786, 2006Chaparro CM, Neufeld LM, Tena Alaver G, et al.: Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled

trial. Lancet 367(9527):1997-2004, 2006Chaparro CM, Fornes R, Neufeld LM, et al.: Early umbilical cord clamping contributes to elevated blood lead levels among infants with higher lead

exposure. J Pediatr 151(5):506-512, 2007Gupta R, Ramji S: Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial.Indian Rediatr 39(2):130-

135, 2002Hutton EK, Hassan ED: Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA

297(11):1241-1252, 2007Kugelman A, Borenstein-Levin L, Riskin A, et al.: Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a

 prospective, randomized, controlled study. Am J Perinatol 24(5):307-315, 2007Levy T, Blickstein I: Timing of cord clamping revisited. J Perinat Med 34(4):293-297, 2006Ultee K, Swart J, van der Deure H, et al.: Delayed cord clamping in preterm infants delivered at 34 to 36 weeks gestation: A randomized controlled trial.

Arch Dis Child Fetal Neonatal Ed 93(1):F20-23, 2008Mercer JS, Vohr BR, McGrath MM, et al.: Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-

onset sepsis: a randomized, controlled trial. Pediatrics 117(4):1235-1242, 2006

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 24/25

Kay Hoover, M Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922 610-543-5995 kay@hoover.net 32

Mercer JS, McGrath MM, Hensman A, et al.: Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlledtrial. J Perinatol 23(6):466-472, 2003

Mercer JS: Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health 46(6):402-414, 2001Rabe H, Reynolds G, Diaz-Rossello J: A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants.

 Neonatology 93(2):138-144, 2008Rabe H, Reynolds G, Diaz-Rossello J: Early versus delayed umbilical cord clamping in preterm infants. Cocrane Database Syst Rev 18;(4):CD003248, 2004Rabe H, Alvarez JR, Lawn C, et al.: A management guideline to reduce the frequency of blood transfusion in very-low-birth-weight infants. Am J Perinatol

26(3):179-183, 2009

Raju TN. Timing of umbilical cord clamping after birth for optimizing placental transfusion. Curr Opin Pediatr. 25(2):180-187, 2013Stoltzfus RJ: Research needed to strengthen science and programs for the control of iron deficiency and its consequences in young children. J Nutr138(12):2542-2546, 2008

Strauss RG, Mock DM, Johnson KJ, et al.: A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterminfants: short-term clinical and laboratory endpoints. Transfusion 48(4):658-665, 2008

van Rheenen PF, Gruschke S, Brabin BJ: Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developingcountries. Ann Trop Paediatr 26(3):157-167, 2006

van Rheenen PF, Brabin BJ: Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing andindustrialised countries: a systematic review. Ann Trop Paediatr 24(1):3-16, 2004

Weckert R, Hancock H: The importance of delayed cord clamping for Aboriginal babies: a life-enhancing advantage. Women Birth 21(4):165-170, 2008Erratum in: Women Birth 22(1):41, 2009

Wiberg N, Källén K, Olofsson P: Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG115(6):697-703, 2008 Comment in: BJOG 115(9):1190-1191, 2008

Skin-to-skin to increase the blood glucose level

Christensson K: Fathers can effectively achieve heat conservation in healthy newborn infants. Acta Paediatrica 85(11):1354-60, 1996Christensson K, Siles C, Moreno L, et al.: Temperature, metabolic adaptation and crying in healthy, full-term newborns cared for skin-to-skin or in a cot.

Acta Paediatr Scand 81(6-7):448-493, 1992Mazurek T, Mikiel-Kostyra K, Mazur J, et. al.: Influence of immediate newborn care on infant adaptation to the environment. Med Wieku Rozwoj 3(2):215-

224, 1999Walters MW, Boggs KM, Ludington-Hoe S, et al: Kangaroo care at birth for full term infants. MCN 32(6):375-381, 2007Wight N, Marinelli KA: Guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates. Breastfeeding Medicine 1(3):178-184,

2006

Unexpected Collapse of Healthy Newborns

AAP: Task Force on Sudden Infant Death Syndrome: SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleepingenvironment. Pediatrics 128(5):e1-e27, 2011

Andres V, Garcia P, Rimet Y, Nicaise C, Simeoni U. Apparent life-threatening events in presumably healthy newborns during early skin-to-skin contact.Pediatrics. 2011 Apr;127(4):e1073-6

Gnigler M, Ralser E, Karall D, Reiter G, Kiechl-Kohlendorfer U. Early sudden unexpected death in infancy (ESUDI) -- three case reports and review of the

literature. Acta Paediatr. 2013 May;102(5):e235-8.Videos

Boston Medical Center, The Breastfeeding Center: From Bottles to Breast to Baby-Friendly: The Challenge to Change. DVDRighard L: Delivery Self-Attachment. Available from Health Education Associates, wwwhealthed.cc and Geddes Productions:

http://www.geddesproductioncom/breast-feeding-delivery-selfattachment.htmlUNICEF: Learning to be Baby-FriendlyWidstrom A-M: Breastfeeding is…Baby’s Choice. Stocholm, Sweden, BKG Productions. Health Education Associates, www.healthed.ccBergman N: Kangaroo Mother Care, Geddes Productions: http://www.geddesproductioncom/breast-feeding-delivery-selfattachment.htmlSpecial Delivery, Injoy Productions, Bouder, CO

U-TubeSkin-to-skin after a c-birth http://www.youtube.com/watch?v=m5RIcaK98YgBaby-Friendly Rap Music video http://www.youtube.com/watch?v=N9KptD3t110&feature=youtu.be

Association Statements

Academy of Breastfeeding Medicine: Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term. Revision,

June 2008American Academy of Pediatrics: Neonatal Resuscitation Guidelines. Pediatrics 117(5):e989-1004, 2006American Academy of Pediatrics, Committee on Fetus and Newborn: Guidelines for Perinatal Care (7th Edition) Elk Grove Village, Illinois: AAP, 2012American Academy of Pediatrics Section on Breastfeeding, Eidelman AI, Schanler RJ: Breastfeeding and the Use of Human Milk. Pediatrics 29(3):e827-

e841, 2012ACOG: Breastfeeding: Maternal and Infant Aspects. ACOG Clinical Review 12(1) (Supplement):1S-16S, 2007ACOG: Breastfeeding in underserved women: increasing initiation and continuation of breastfeeding. Obstetrics &Gynecology 122(2):423-428, 2013American Academy of Family Physicians www.aafp.org/policy/issues/i3.htmlAWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses): The role of the nurse in the promotion of breastfeeding. Clinical Position

Statement, June 1999International Lactation Consultant Association: Position Paper on Infant Feeding, 1994 www.ilca.orgKeister D Roberts KT, Werner SL: Strategies for breastfeeding success. Am Family Physician 78(2):225-232, 2008

7/24/2019 Assessing the Breastfeeding

http://slidepdf.com/reader/full/assessing-the-breastfeeding 25/25

Doulas

Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr. 1997 Oct;86(10):1034-6.Langer A, Campero L, Garcia C, Reynoso S. Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and

mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. Br J Obstet Gynaecol. 1998 Oct;105(10):1056-63. Newton KN, Chaudhuri J, Grossman X, Merewood A. Factors associated with exclusive breastfeeding among Latina women giving birth at an inner-city

 baby-friendly hospital. J Hum Lact. 2009 Feb;25(1):28-33. doi: 10.1177/0890334408329437. Nommsen-Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. Doula care, early breastfeeding outcomes, and breastfeeding status at 6

weeks postpartum among low-income primiparae. J Obstet Gynecol Neonatal Nurs. 2009 Mar-Apr;38(2):157-73. doi: 10.1111/j.1552-6909.2009.01005.x.Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med. 1999

Dec;8(10):1257-64.