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Breast Feeding
OVERVIEW: Advantages
• Babies who are breast-fed have fewer respiratory, gastrointestinal, and ear infections.
• Breast milk is an ideal food. It is easily digestible, nutrients are well-absorbed, and breast-fed babies have less constipation.
• Increased contact between mother and baby
• Economical, portable, easy to meet needs quickly
• Breast-feeding may decrease incidence of allergies in childhood.
• More rapid and complete recovery from pregnancy
• Contraindications
• Human immunodeficiency virus (HIV) infection; active tuberculosis
• Drugs of abuse will pass into human milk.
• Technique
• Mother should get in comfortable position, usually sitting or reclining with baby's head in crook of mother's arm (side-lying position is often useful following C-section delivery).
• Mother should bring baby to her, not lean toward baby, in order to avoid stress on back.
• Baby's belly and mother's belly should face each other or touch (belly-to-belly).
• Mother initiates the rooting reflex by tickling baby's lips with nipple or finger. As baby's mouth opens wide, mother guides her nipple to back of her baby's mouth while pulling the baby closer. This will ensure that the baby's gums are sucking on the areola, not the nipple.
SIGNS AND SYMPTOMS: N/A
CAUSES: N/A
SCOPE: About 56% of new mothers breast-feed in the early postpartum period and 21% were breast-feeding at 5-6 months.
MOST OFTEN AFFECTED: Females 16-45 years of age
RISK FACTORS: N/A
DIAGNOSIS PHYSICAL EXAMINATION: N/A
TESTS AND PROCEDURES: N/A
TREATMENT GENERAL MEASURES: See Patient Education
ACTIVITY: No restrictions
DIET: • Adequate calorie and protein intake while nursing
• Drink plenty of fluids.
• Continue prenatal vitamins.
• Fluoride supplement unnecessary
PATIENT EDUCATION
• Consider plans after birth, e.g., if returning to work. It is possible to nurse part-time after returning to work. Some mothers wean (stop breast-feeding) the week before returning to work.
• For some mothers, an occasional supplemental bottle can be used.
• Colostrum (a fluid that appears before milk that is rich in antibodies) is present in breast at birth but may not be seen.
• Milk will not come in before third day after birth.
• Frequent nursing (at least 9 or more times in 24 hours) will lead to milk coming in sooner and in greater quantities.
• Allow baby to determine duration of each feeding; baby will lose weight the first few days and may not get back to birth weight until day 10.
• Immediately after birth, baby should stay in mother's room, as much as possible, to encourage on-demand feeding.
• Signs of adequate nursing:
• Breasts become hard before and soft after feeding
• Six or more wet diapers in 24 hours
• Baby satisfied; appropriate weight gain (average 1 ounce per day in first few months)
• Anticipate growth spurts around 10 days, 6 weeks, 3 months, and 4-6 months. Baby will nurse more often at these times for several days. More frequent feedings will increase milk production to allow for further adequate growth.
• Supplemental baby vitamins are unnecessary unless the baby has very limited exposure to sun (If this is so, then the baby needs vitamin D).
• Weaning
• Breast milk alone is adequate food for first 6 months.
• Solids may be introduced at 4 to 6 months.
• For mothers going to work, start switching the baby to bottle-feeding during the hours mother will be gone about a week ahead of time. Do this by eliminating a breast-feed every few days and substituting pumped breast milk or formula, preferably given by another caregiver.
• To increase the likelihood that baby will take a bottle occasionally, introduce it at 3 to 4 weeks and give once or twice a week.
MEDICATIONS COMMONLY PRESCRIBED DRUGS: N/A
CONTRAINDICATIONS: N/A
PRECAUTIONS: N/A
DRUG INTERACTIONS: N/A
Other Drugs: N/A
FOLLOW UP PATIENT MONITORING: Mother and baby should be seen by the doctor within a few days of hospital discharge if she is a first-time breast-feeder.
PREVENTION/AVOIDANCE: N/A
COMPLICATIONS: N/A
WHAT TO EXPECT: A healthy baby
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: N/A
GERIATRIC: N/A
OTHERS: N/A
PREGNANCY: N/A
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