Breast Feeding Guidelines[1]

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    Breastfeeding Promotion

    and Support Guidelines for Healthy Full Term Infants

    Distributed by Iowa WIC Program

    Iowa Department of Public Health

    Revised August 2001

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    Page 2 Iowa Lactation Task Force

    Table of Contents

    Chapter 1 Preparing for Breastfeeding 5 The Three-Step Counseling Strategy Step 1. Ask Open-ended Questions Step 2. Affirm Feelings Step 3. Educate Benefits of Breastfeeding Barriers to Breastfeeding Contraindications to Breastfeeding Breast Changes During Pregnancy Breast and Nipple Assessment Planning for the Hospital Stay Planning a Nursing Wardrobe Chapter 1 References

    Chapter 2 Getting Started 21 How Breastfeeding Works How to Breastfeed Frequency and Duration of Feedings How To Tell If Breastfeeding Is Going Well Breastfeeding Multiples Avoiding Common Breastfeeding Problems Nursing When Ill Smoking and Breastfeeding Chapter 2 References Other Recommended References

    Chapter 3 Nutrition and Exercise During Breastfeeding 37 Food Recommendations for Breastfeeding Mothers Fluid Recommendations for Breastfeeding Mothers Food Myths Maternal Exercise and Breastfeeding Vitamin and Mineral Recommendations for Breastfed Infants Fluid Recommendations for Breastfed Infants Introducing New Foods to Baby Chapter 3 References

    Continued on next page

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    Table of Contents, Continued

    Chapter 4 Combining Breastfeeding With Employment or School 49 Feeding Options Planning Ahead During Pregnancy Teaching Hand Expression of Breastmilk Evaluating Manual Breast Pumps Evaluating Electric Breast Pumps Using Breast Pumps Keeping Expressed Breastmilk Safe Weaning Strategies Chapter 4 References

    Chapter 5 Solving Common Breastfeeding Problems 63 Basic History Taking Engorgement Plugged Ducts Sore Nipples Mastitis Thrush Feeding Refusal Biting During Feedings Sleepy Newborn Infant Fussy Infant Newborn Jaundice Ineffective or Weak Suck Chapter 5 References

    Appendices Appendix A. Where to Go For Breastfeeding Support 83 Appendix B. Client Teaching Tools 85

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    Chapter 1

    Preparing for Breastfeeding

    A pregnant woman needs to have accurate information to make an informed infant feedingdecision. Then she needs information about how to prepare for infant feeding and where to findsupport services and information. This chapter describes a proven counseling strategy, reviewsthe benefits and barriers to breastfeeding, and provides information about preparing for

    breastfeeding. The contraindications to breastfeeding are also identified.

    Contents

    The Three-Step Counseling Strategy .......................................................................................... 6

    Step 1. Ask Open-ended Questions............................................................................................. 7

    Step 2. Affirm Feelings ............................................................................................................... 8

    Step 3. Educate............................................................................................................................ 9

    Benefits of Breastfeeding .......................................................................................................... 10

    Barriers to Breastfeeding........................................................................................................... 11

    Contraindications to Breastfeeding ........................................................................................... 13

    Breast Changes During Pregnancy............................................................................................ 14

    Breast and Nipple Assessment .................................................................................................. 15

    Planning for the Hospital Stay .................................................................................................. 17

    Planning a Nursing Wardrobe ................................................................................................... 18

    Chapter 1 References ................................................................................................................ 19

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    The Three-Step Counseling Strategy

    Introduction The Three-Step Counseling Strategy developed by Best Start Social

    Marketing helps health care professionals identify and counsel women prenatally about their breastfeeding concerns. This strategy makes thefollowing three assumptions: Your time allotted for counseling is short, Clients are often reluctant to share their feelings, and You need an efficient way to identify each clients concerns so you can

    provide appropriate educational messages.

    Try thisstrategy othertimes

    This counseling strategy is also useful during follow-up encounters and it can be used successfully with other nutrition and health topics.

    The three steps The Three-Step Counseling Strategy uses the steps in the table below:

    Step Action1 Ask open-ended questions.2 Affirm feelings.3 Educate.

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    Step 2. Affirm Feelings

    Recognize her

    feelings

    The second step is to affirm a womans feelings. This acknowledges that you

    heard what she said and lets her know that her feelings are normal. This helpswomen feel more comfortable and makes them more likely to open up and bereceptive to your ideas. Affirming feelings also builds the clients self-confidence.

    Examples Sample affirmations follow: That is a common concern that I hear women express. My friend told me that, too. I remember feeling the same way myself. Many women have told me the same thing.

    Practice This step is the most difficult one to master. It is often skipped by health professionals in their rush to begin providing information. Practice this stepin role-plays with your co-workers until it feels comfortable.

    Note: The training guide provides opportunities to practice using paper and pencil, sample counseling dialogue, and role-plays.

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    Step 3. Educate

    Introduction The third step is to provide breastfeeding education targeted specifically to

    the concerns just discussed. However, many health care professionals provide more information than clients need or are ready to receive.

    Focus on theconcern heardin Step 1

    Carefully focus your education to the concern you uncovered in Step 1. Notall women have the same concerns about infant feeding. Use your limitedtime to address her specific concerns. If you talk about concerns she has notexpressed, you risk raising unnecessary doubts or concerns in her mind.

    Note: When you use this strategy postpartum, it is important to address theconcerns raised by the client before you provide anticipatory guidance on

    other topics.

    Giveinformation insmall amounts

    If you provide too much information, breastfeeding may sound complicatedand you may overwhelm your clients. It also wastes your time. Provideinformation directly related to the concerns expressed. Clients are morereceptive to information that addresses their particular needs. Focus on theneed-to-know information and save the nice-to-know information for later. This teaching strategy also promotes learning and retention.

    Talk aboutbreastfeedingoften

    Plan several short conversations about breastfeeding instead of one longsession. Research has shown that the number of times breastfeeding isdiscussed with each woman is more important than the total amount of timespent on breastfeeding education.

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    Benefits of Breastfeeding

    Introduction Breastfeeding provides numerous benefits to infants, women, and society. It

    is often appropriate to discuss these benefits during counseling. A summaryof documented benefits is provided below.

    Benefits toinfants

    Breastfeeding provides benefits to infants in the following ways: Creates a special bond between mother and infant, Decreases risk for certain types of infections and illnesses, Enhances dental development, Reduces risk for allergies, Aids in cognitive development, Reduces risk for SIDS, Decreases overfeeding, and Decreases the risk for obesity in later life.

    Benefits tomothers

    Breastfeeding provides benefits to mothers in the following ways: Helps the uterus return to pre-pregnancy size faster, Reduces risk of breast, ovarian, and uterine cancers, Decreases risk for osteoporosis, Promotes postpartum weight loss, Enhances emotional health (especially for teenaged mothers),

    Saves money otherwise spent on formula and feeding supplies, and Reduces family healthcare costs (including out-of-pocket costs and servicescovered by insurance).

    Benefits tosociety

    Breastfeeding benefits society in the following ways: Protects the environment by decreasing waste for landfills, Reduces parent days absent from work (breastfed infants are h