Question

Imagine the following scenarios:

Scenario 1: An expectant mother (Jane) comes to you because she is nervous about breastfeeding. She has heard it can be painful and is worried about how she is going to return to work while breastfeeding. She does not fully understand the benefits of breastfeeding and why it is recommend. What advice would you have for Jane? What options would be available to Janes when she returns to work?

Scenario 2:

A new mother (Susan) is experiencing a great deal of trouble breatfeeding for her new baby. The baby has latched on improperly, and susan is in a lot of pain. She is also worried that her baby is not getting enough milk, although the baby's weight is thriving and the baby is not overly fussy. What recommendations would you have for Susan?

Answer 1

1. First of all I will encourage Jane to express her concerns and feelings regarding breast feeding and other newborn care . Then after listening to her will prioritise the problems and provide solutions and help to her . Nursing interventions include :-

- Health education about breastfeeding including its benefits , techniques how to breastfeed , how to store milk for rest of the day etc

- Benefits of breastfeeding are :-

# for the baby: appropriate composition and balance of nutrients

-hormones that promote physiological dev.

-cognitive development

-protects against infections

-protects against some diseases such as type 1 diabetes

-protects against food allergies

# for mothers

-contracts the uternus

-delays the return of regular ovulation, this will lengthen birth intervals

-conserves iron stores

-may protect against breast and ovarian cancer

# OTHER

-cost savings from not needing medical treatment for childhood illnesses or time off work to care for sick children

-cost savings from not needing to purchase formula

-env. savings from not needing manufacture package or ship formula or dispose of packaging

# Other options available for Jane to work and take care of the newborn are :-

- keeping nanny or maid at home

- daycare , creches ,and babysitters

- taking relatives or neighbours help

- working from home

2. In this case Susan needs to be made aware of the proper technique of breastfeeding which will sort her all issues

Proper method of breastfeeding :

Baby-led breastfeeding attachment

The best way for you to learn about breastfeeding is to let your baby teach you!

This is called ‘baby-led attachment’, and it’s when you let baby follow his instincts to find your breast and attach. Baby-led attachment can ideally start straight after your baby is born when you have your baby skin to skin on your chest. The earlier it starts the sooner your baby will learn.

Baby-led attachment can help you avoid many common problems like sore or cracked nipples, which can be caused by poor attachment to the breast.

> Getting started with baby-led breastfeeding attachment

You can do baby-led attachment skin to skin with your baby, or with your baby lightly dressed. It’s best if you take off your bra. This means you might need a fair bit of privacy in the early days as you and your baby learn.

Here are the basic steps for this technique:

Make sure you’re comfortable and well supported with pillows. Lean back rather than sit upright.

Place your baby on your bare chest between your breasts, facing you. Gravity will help keep her in position. It’s best if your baby is awake but not crying. If she’s crying, calm her first, perhaps by letting her suck your finger.

When calm, your baby will begin to follow his instincts. He’ll start to move towards one breast. Support your baby behind his shoulders and under his bottom (hold his head only if he needs it). Let him move to where he’s trying to go – towards your nipple. Your baby knows where to go. Your job is to keep him calm. You can help him by moving his whole body a little if necessary.

Your baby will most likely position herself on an angle, with her mouth near your nipple and her feet supported by your thigh or lap.

When your baby is just below your nipple, he’ll dig his chin into your breast, reach up with an open mouth, attach to the breast and start sucking.

# Things to note

If you’ve had a caesarean section, gently encourage your baby to move her legs and body to one side of you, so she doesn’t kick or lie on your wound. Use a pillow next to you to support her legs and feet.

You can provide support behind your baby’s shoulders and bring his bottom in closer to your body if you need to.

> Mother-led breastfeeding attachment

The more traditional technique of ‘mother-led’ attachment works for many mothers and babies. You can also use this technique once you’re going well with breastfeeding.

# Here are the basic steps for this technique:

Sit upright, and support yourself well with pillows. If your breasts are small, you might need a pillow on your lap to bring your baby to the right level. But take care not to raise your baby higher than the natural fall of your breasts.

Hold your baby behind her back and shoulders (not her head), so her chest is touching your chest. Bring her nose in line with your nipple.

Gently brush your nipple from your baby’s nose to his lips – this will encourage him to open his mouth wide.

When your baby’s mouth is wide open, quickly bring your baby to your breast, directing your nipple at the roof of her mouth. Her mouth will close over your breast and she’ll start sucking.

# Checking the breastfeeding attachment

When your baby is correctly attached to your breast and feeding well, you’ll notice that:

breastfeeding feels comfortable, not painful

your baby is sucking deeply and regularly (sometimes with short pauses), and you can hear him swallowing

your baby takes the whole nipple and a large amount of the areola into his mouth, more towards his chin than his nose

your baby’s chin is pressed into your breast and his nose is clear or just touching your breast

your baby’s lips are turned out over your breast (not sucked in)

your nipples stay in good condition, and don’t show any signs of damage

your baby is draining your breast properly, so that it feels floppy after a feed.

It’s normal to feel a ‘stretching sensation’ when your baby starts sucking. But if attachment hurts, it might mean your baby isn’t correctly attached. If you want to double check whether your baby is attaching correctly contact your midwife ,child and health welfare nurse and lactation consultant .