Keys to Successful Breastfeeding

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    Keys to Successful Breastfeeding:

    Putting the 10 Steps into Practice

    Elizabeth Flight, RN, CLE, IBCLC

    Bethesda Naval Medical Center 

    Video Teletraining Program

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    How can you help a newmother breastfeed?

    • Build your knowledge base

    • Build mother’s confidence

    • Use “words that work”

    • Follow up, follow up, follow up

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    Mother’s Milk

    • Ideal for feeding and nurturing infants

    • Most complete and balanced form ofnutrition for human infants

    • Uniquely immunoprotective• Improves maternal health

    • Limited number of contraindications

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     Anatomy and Physiology

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    Nipple Structure

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    Breast Massage for

    Expression

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    Breast Compression

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    Hand Expression

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    Milk Ejection Reflex

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    Key Steps

    • Early initiation of baby to breast

    • Points for good position and latch

    • Evidence of milk transfer 

    • Assess and document a breastfeedingsession.

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    Newly-born Rooting

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    Early breastfeeding

    • Uterine involution

    • Accelerate milk production

    • Minimize engorgement

    • Enhances attachment and bonding

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    Early and Often

    • Intense suck reflex

    • Initiates gut peristalsis

    • Increased immunological properties

    (IgA)• Practice makes perfect

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    Hunger Cues

    • Rooting

    • Sucking motions

    • Motor activity/ hands to mouth

    • Tense, clenched fist• Crying-LAST SIGN of HUNGER

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    On Your Mark (Mother)

    • Comfort with pillows or towels

    • Support for heavy breasts

    • Hand position based on breast size and

    location

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    Side-lying

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    Get Set (Baby)

    • Cradle

    • Cross Cradle• Football or clutch

    • Side-lying• Australian or prone (floating prone)

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    Side-lying

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    Go!

    • Nose to nipple

    • Tickle lips

    • Be patient….

    • Wait for baby to “Open WIDE”

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    Cradle or Madonna Position

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    Reverse Clutch or Cross Cradle

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    Clutch or Football Hold

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    Football Position

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    The Gape

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    The Approach

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    Contact for Latch

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    Good Latch

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    You’re a Winner!

    • Assess for:

     – Wide open jaws, lips flanged out – Audible swallowing

     – Long sustained burst suck pattern – Comes off breast satisfied

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     Assessing over the first weeks

    • Watching for urine output

    • Watching stool patterns

    • Watch weight loss/gain

     – WHAT IS NORMAL???

    • When is it necessary to supplement?

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    Common Problems

    • Sore Nipples• Engorgement

    • Mastitis

    • Yeast infections

    • Medications

    • Baby with a problem nursing

    • Methods of supplementation

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    Tandem Nursing Preemies

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    Tandem Nursing (on the run)

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    Preemie at the Breast

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    What’s wrong with this?

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    What’s wrong with this?

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    What’s wrong with these?

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    Can we change theMilitary Medical Model?

    • SG/BUMED Instructions

    • Deckplate support for AD mothers• Training in Residency Programs

    • Staff ed & training focused on FCC• Build strong patient ed program

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    Use Evidence Based Guidelines

    • Data driven

    • UNICEF “Ten Steps”• ILCA “First 14 Days”

    • Social Marketing

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    Provide Education and Training for ALL Staff who interact with Families

    • Minimum 4-8 hours per year of

     Annual Required Training

    • Support Certification for Active Duty

     – RNC or IBCLC

    • Standardize training and “Guidelinesfor Practice” throughout the MTFs

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    Provide opportunity for training

    • Require IBCLC with EXPERIENCE

    • Internship Program• Computer Based Training/ Distributive Ed

    • Allow AD Nurses to function as LCs

    • Allow AD Nurses to teach Family- CenteredChildbirth Classes

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    Train our NMCRS Nurses

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    Build Volunteer Programs

    • Train experienced mothers in

    counseling skills for peer support• Provide annual training programs

    • Coordinate with Red Cross?• Coordinate with WIC or HMHB?

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    Update the BUMED Instructions

    • WHO Guidelines & Baby Friendly

     – No freebies• Enforce language in the Instruction for

    Formula Reps

    • Look at purchasing formula for the units

     – Dietary purchases from “general schedule”

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     Yes, we can….

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     And we have just begun…

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