Key Points to Good Positioning
Engorged Breasts (Abnormal)
PROBLEM # 7: “IT’S IMPOSSIBLE TO BREASTFEED MY TWINS!”
BREASTFEEDING TWINS
1. The mother is relaxed
and comfortable.
2. Head and body are in a
straight line
3. Face is opposite the
breast
4. Upper lip or nose is
opposite the mother’s nipple.
5. Baby is supported
close to the mother’s body
6. Whole body is
supported if the mother is in a sitting position
Key Points to Good Attachment
1. The mouth is widely
open
2. The lower lip is
turned outwards
3. The chin is touching
the breast
4. More areola is visible
above the baby’s mouth than below it
5. The tongue is forward
in the mouth, and may be seen over the bottom gum
PROBLEM # 1: “MY NIPPLES ARE SORE AND CRACKED”
Management of Sore
Nipples
1. Look for a cause:
a. Check the baby’s
position at the breast
b. Check the baby’s
attachment at the breast.
c. Examine the breasts –
engorgement, fissures, candida.
d. Check the baby for
Candida.
2. Give appropriate
treatment:
a. Build the mother’s
confidence
b. Improve the baby’s
attachment and continue breastfeeding
c. Reduce engorgement,
feed frequently, express breast milk
d. Treat Candida.
3. .Advise the mother to:
a. Wash breasts only once
a day, avoid using soap
b. Avoid medicated
lotions and ointments
c. Gently smooth hindmilk
into nipple and areola after a breastfeed.
PROBLEM # 2: “MY BREASTS ARE SWOLLEN”
Clues: Both breasts are
swollen but milk is dripping.
Advice:
1. Feed whenever baby
wants (on demand)
2. Do not restrict the
length of time the baby spends on the breast
3. If she becomes
uncomfortably full, she should offer to feed her baby more often
4. Reassure her that
“condition” is NORMAL and lasts for around 36 to 72 hours
PROBLEM # 3: “MY BREASTS ARE PAINFUL, SHINY AND RED.”
Full vs. Engorged
Breasts
Full Breasts
|
Engorged Breasts
|
|
Pathology
|
Normal
36-72 hrs
after
birth
|
Abnormal
at any time
|
Character
|
Hot,
heavy, may be hard
|
Painful,
edematous , tight, shiny, may look red
|
Milk
|
Flowing
|
Not
flowing
|
Fever
|
Uncommon
|
May
occur
|
Engorged Breasts (Abnormal)
1. Look for a cause:
a. Has the mother been
going for long periods between feeds?
b. Is she restricting the
length of the feeds?
c. Is her baby well
attached?
2. .Give appropriate
ADVICE:
a. Improve the baby’s
attachment and continue breastfeeding
b. Advice her to express
a little milk to soften nipple area. This makes it easier for baby to attach.
c. Feed on demand and
more frequently.
d. Do not restrict the
time the baby breastfeeds.
PROBLEM # 4: “MY BREAST IS PATCHY RED, SWOLLEN, AND PAINFUL. I HAVE FEVER.”
Mastitis (Abnormal)
1. Look for a cause:
a. Fissured nipples
b. Not feeding often
enough
c. Tight clothes
d. Holding the breast
during a feed
e. Baby poorly attached.
2. Give appropriate
ADVICE:
a. Breastfeed more
frequently ( q3 hours and per demand)
b. A different feeding
position may help clear the blockage.
c. If mother cannot
breastfeed from affected breast, express milk every 3 hours until improved
d. If no change w/in 24
hours or if far from the health facility, she should begin antibiotics immediately:
F Give Cloxacillin 500
mg q 6 hours for 10 days.
F .If severe pain, give
paracetamol.
e. Reassess in 2 days.
f. If no improvement or
worsens, refer to a hospital.
PROBLEM # 5: “I
HAVE INVERTED NIPPLES.”
Is it True Nipple
Inversion?
PINCH TEST
Gently
compress your areola about an inch behind your nipple.
1. If nipple does not
protrude or become erect, then it is considered to be flat.
2. If nipple inverts,
retracts into the skin tissue, or becomes concave, it is considered to be
inverted.
3. True inverted or flat
nipples also will not become erect when stimulated or cold.
4. .If your nipples
protrude when stimulated as described above, they are not truly inverted and do
not need any special treatment in order to breastfeed.
Management of Flat or
Inverted Nipples
1. A mother could
breastfeed even if nipples are flat or inverted. Babies feed on areolas, not
nipples.
2. LATCHING THE NEWBORN
IMMEDIATELY ONCE WITH FEEDING CUES
F the best remedy
F easiest for baby to
learn to latch on after birth, before your milk comes in. (more difficult once breasts
are full)
3. HOFFMAN MANEUVER
F a gentle stretching
exercise whereby you pull the skin back and
away from the nipple with your fingertips
F 5 times a day, move
thumbs in a clockwise fashion around nipple
Management of
Flat/Inverted Nipples
1. ASSESS ATTACHMENT
2. MAKE A NIPPLE
F breast-sandwich”
technique
F elongates and narrows
areola
3. BREAST PUMP / SYRINGE
METHOD
F to draw out nipples
before feedings
4. BREAST SHELLS
F Between feedings or 30
mins before feedings
5. NIPPLE SHIELD
F Last resort
PROBLEM # 6: “I
AM GOING BACK TO WORK. I CANNOT BREASTFEED ANYMORE.”
Milk Expression,
Collection and Storage
1.
Milk Expression
F By hand expression
(recommended)
F By breast pump
F Express 2 weeks prior
to work
2.
Milk Collection
F Use of polypropylene
bottles
F Handwashing and
aseptic technique
F Rinse out milk
residue, wash with hot soapy water, air dry
3.
Milk Storage
F first in, first out method
THE MARMET TECHNIQUE
Gentle
Massage
Massage the milk producing cells and ducts by
pressing the breasts firmly with the flat of the fingers in to the chest wall,
beginning at the top. Move fingers in a circular motion, concentrating on one
spot at a time for a few seconds before moving on to another spot. Spiral
around the breast toward the areola as you massage. The motion is similar to
that used in a breast examination.
1. Position thumb (above
the nipple) and first two fingers (below the nipple) about 1” to 1 ½” from the
nipple. Be sure the hand forms the letter “C” and the finger pads are at 6 and
12 o’clock in line with the nipple. Note the fingers are positioned so that the
milk reservoirs lie beneath them. Avoid cupping the breast.
2. Push straight into the
chest wall. For large breasts, first lift and then push in to the chest wall.
3. Roll thumb and fingers
forward at the same time. This rolling motion compresses and empties milk
reservoirs without injuring sensitive breast tissue.
4. Repeat rhythmically to
completely drain reservoirs.
Position,
push, roll ….. Position, push, roll …..
5. Rotate the thumb and
fingers to milk other reservoirs, using both hands on each breast.
MILK COLLECTION
1.
Polypropylene Plastic
Bottles
F Hard and cloudy white
containers
F Recommended type of
plastic for long-term storage of expressed milk
2.
Bisphenol A- free
bottles
F
Recommended
bottles should be BPA-free
F
BPA:
added to plastic of feeding bottles so that they retain their shape even after
repeated sterilization
F
BPA
suspected to be toxic
Examples of Cups for
Feeding Newborn Babies
§ An ideal cup can hold 50
to 90 ml of milk.
§ It can be glass or
plastic and easily washable
§ The edge of the cup
should be rounded and smooth
§ A cup with a lid is
useful for storing expressed breast milk
MILK STORAGE
Location or Storage
|
Temp
|
Maximum recommended storage duration
|
Room Temperature
|
16-29C
|
3-4
hours optimal
6-8
hours acceptable under very clean conditions
|
Refrigerator (body)
|
4C
|
72
hours optimal
5-8
days under very clean conditions
|
Refrigerator (one door)
|
Up
to 2 weeks
|
|
Refrigerator (separate freezer)
|
2
weeks – 3 months
|
|
Deep freezer
|
-20C
|
6
months optimal
12
months acceptable
|
F Milk to be used within
48 hours need not be freezed.
F Frozen milk to be used
within 24 hours can be “thawed” down in the refrigerator
F Unused thawed milk can
be placed back in refrigerator but should be used within 24 hours or else
discard.
F No direct heating
(boiling or microwave). Just soak in lukewarm running water.
PROBLEM # 7: “IT’S IMPOSSIBLE TO BREASTFEED MY TWINS!”
BREASTFEEDING TWINS
Football hold
F Baby is held like a
clutch bag
F Nose further away from
the breast
F Baby’s trunk is secure
beside mother’s trunk
