Term
| Optimal length of time before first breastfeeding |
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Definition
| Within one hour after birth |
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Term
| Three procedures that may be delayed to enable skin-to-skin and first breastfeeding to be uninterrupted |
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Definition
Vitamin K injection
Bath
Eye antibiotics |
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Term
| One immunological reason to breastfeed |
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Definition
Protects against almost every infant infection
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Term
| Infants who are breastfed have a ___ lower risk of dying during their first year |
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Definition
| 21%. (increases to 38% if babies are breastfed for at least 3 months or more) |
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Term
| Chronic diseases which breastfeeding can help prevent (name 3) |
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Definition
Type 1 Diabetes mellitus
Lymphoma
All childhood cancers
Crohn's Disease
Ulcerative colitis
Cardiovascular disease
Breast cancer
Obesity |
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Term
| Two factors which are most predictive of the degree to which breastfeeding can protect against infection and disease in both mother and infant |
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Definition
Exclusivity of breastfeeding
Duration of breastfeeding |
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Term
| Women who do not breastfeed are at higher risk for:(name 2) |
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Definition
Breast and ovarian cancer
Osteoporosis
Short intervals between pregnancies
Obesity
High blood pressure
urinary tract infections |
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Term
| According to a UCLA study, 75% of women who received this intervention were likely to breastfeed, as opposed to 43% of women who did not receive this intervention. What is the intervention? |
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Definition
| Prenatal and postpartum encouragement by physician and nurses to breastfeed |
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Term
| Labor/birth factors that can negatively impact breastfeeding (name 2) |
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Definition
Systemic medications
Epidurals
Long/difficult/traumatic birth
Cesarean delivery
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Term
| Advantages to skin-to-skin immediately following birth and throughout early postpartum period (Name 2) |
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Definition
Helps infants stabilize body temperature
Helps begin the process of colonization of infant skin, gut and respiratory system to enhance immune capabilities
Helps establish breastfeeding relationship |
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Term
| Two key hormones involved in milk production |
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Definition
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Term
| Prolactin's primary role in breastfeeding is primarily to _________. |
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Definition
| Stimulate the breasts to produce milk |
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Term
| Oxytocin's primary role in breastfeeding is to _________________. |
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Definition
| Cause contractions in the alveoli of the breast to eject milk into ducts and make it available for the baby. |
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Term
| Pacifier use and formula supplementation of healthy newborns in the first 24-48 hours is associated with what two negative impacts on breastfeeding? |
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Definition
Delayed onset of lactogenesis II
Abnormal sucking patterns in infants |
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Term
Possible responses to the mother who says:
I'm too tired to keep the baby with me.
Please take the baby so I can get some sleep
Please just give the baby a bottle tonight
(name 3) |
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Definition
Provide facts about advantages of rooming-in
information about nipple confusioin/preference
Possible consequences of even one formula feed
Taking advantage of time to learn
Missing feeding cues
Missing out on special time with baby |
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Term
| Key factors in feeding position for Mother (name 4) |
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Definition
Comfort
Back and arms supported
Feet supported
Knees slightly higher than hips
Pillows as needed |
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Term
| Key factors for baby in all feeding positions (name 3) |
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Definition
Baby at level of nipple
Chest, abdomena nd knees are facing and touching mother's body, tucked in close
Head is facing forward, slightly extended, not arched or turned
Ear, shoulder and hip all in a straight line
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Term
| What are is the comon factor in a mother's hand position for all breastfeeding holds? |
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Definition
| Mother's fingers are parallel to the baby's lips. |
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Term
| The straddle position may be useful in the what situations? (name 2) |
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Definition
Small baby
Small breasts
Reflux
Some craniofacila or neurological challenges |
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Term
| The cross cradle hold is useful in what situations? (name 2) |
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Definition
Baby just learning to feed
Preterm infants
Down's syndrome infants
Anytime more feeding support is needed |
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Term
| Whare are four common breastfeeding positions for the baby? |
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Definition
Cradle hold
Cross cradle hold
Under the arm (football)
Straddle
Side-lying |
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Term
| Which breastfeeding position could be suggested when mother is tired, has had surgery or has a swollen/sore perineum? |
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Definition
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Term
| Whare are some suggestions for positioning with large breasted women? Name 3) |
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Definition
Rolled soft cloth under breast for support
Baby at level of nipple, which may mean on the lap
Support breast with hand
May work best with lying down/side-lying |
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Term
| What are some suggestions for positions with small-breasted women? (Name 2) |
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Definition
Straddle hold may work best
Use as many pillows as needed to get baby to level of breast
Reassure her that her breasts are perfectly adequate to feed her baby (explain breast anatomy if needed) |
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Term
| What are possible tools/techniques for working with a mother with flat or inverted nipples? (name 3) |
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Definition
Remember that the baby only knows the nipple that is offered
Enhance nipple protrusion using: fingers, pump, Hoffman's maneuvers, nipple everters, breast shells, nipple shields.
May take several people to get baby on
Provide reassurance to mother that most mothers and babies figure this out |
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Term
| When you are assessing Latch, what are the factors that you can SEE? (Name 3) |
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Definition
Nipple disappears
Nose and chin are close to breast
Cheeks are round and full
Angle of the lips is about 120 degrees |
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Term
| What are the factors that you can HEAR when you asses latch? (Name 3) |
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Definition
Quiet, drawing sound;
swallowing.
No clicking or "smacking."
Breaths ocur refularly, usually after every 1-3rd suck.
Use stethoscope to assess if you can't hear the swallows. |
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Term
| What are the the things that can be FELT when assessing latch? (name 2) |
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Definition
Ask the mother how she feels:
should feel a deep, firm pull but not pain.
If latch is secure, nipple will not slip out when baby's head falls back slightly. |
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Term
| What are the terms in the acronym LATCH? |
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Definition
Latch,
Audible swallowing,
Type of nipple,
Comfort of breast and nipple,
Hold (positioning) |
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Term
| What is normal milk intake for a baby aged 1-24 hours? |
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Definition
7 ml/feed or an average of 37 ml/day
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Term
| What are some key messages for parents about frequency and length of early feedings? (name 3) |
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Definition
Feed every few hours day and night.
No rules about length of feeding as long as the baby is correctly latched
No rules about one or two breasts.
Baby's don't overeat as long as they control the feeding. |
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Term
| Whare are some possible ways to wake a sleepy baby? (name 3) |
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Definition
Change environment
Undress
Skin-to-skin without trying to force a feeding
Spoon feed expressed milk
Change positions |
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Term
| What techniques can be used to elicit milk flow BEFORE trying to latch? (name 3) |
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Definition
Breast massage
Heat
Hand expression
Pump |
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Term
| What are some techniques that can be used to entice the baby to feed? Name 3 |
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Definition
Drip milk or water on to nipple
Spoon feed expressed milk
Syringe feed
Tube next to nipple |
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Term
| What are the two things that a baby must create for an effective feeding? |
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Definition
Suction for latch
Suction and compression for milk transfer |
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Term
| What are several alternative feeding techniques? (name 6) |
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Definition
Nipple shield if baby is able to latch and suck
Spoon
Syringe
Dropper
Finger feeding
SNS
Lactaid
Cup
Haberman/bottles |
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Term
| A general plan for the management of jaundice may consist of what approaches? (name 4) |
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Definition
Do not interrupt breastfeeding
Do not supplement with water
Visilize assessment to avoid further problems or improve feedings
If the baby can eat, it should be breastmilk
if the baby can feed, it should be at the breast
If there isn't enough breastmilk, supplement with formula (nutramigen may be an option) |
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Term
| What are several non-pharmacologic strategies for increasing milk supply? (name 6) |
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Definition
Feed early and often
Climb into bed to snuggle with baby
Skin-to-skin
Food and nurturing for mother
Massage, heat before and during feeds
Feed during the night
Pump after feedings
Acupuncture |
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Term
| Name two pharmacologic galactogogues to increase milk supply. |
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Definition
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Term
| List several situations that DO NOT warrant formula supplementation. |
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Definition
A sleepy baby who has had only a few feedings during the first 48 hours
Bilirubin levels between 12 and 20 mg/dl after 72 hours (NOTE: This assumes that infant is feeding well, having more than 4 yellow stools per day, and has no hemolysis or other signs of pathology.
Nighttime fussiness or constant feeding for several hours where baby is content and satisfied while on the breast and fussy if off the breast
Growth Spurts or Mother's choice |
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Term
| List four medical indications for supplementation. |
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Definition
Birthweight less than 1500 grams or gestational age below 32 weeks
SGA with potentially severa hypoglycemia
Severaly ill mother (e.g., PIH, shock, psychosis)
Inborn errors of metabolism
Acute water loss resulting in fever or other sx of dehydration
Mother taking contraindicated medication (rare) |
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Term
| List four infant indications for supplementation. |
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Definition
Hypoglycemia
Significant dehydration or fever
weight loss greater than 10% at 24 hours of age - (questionable if no other symptons exist)
Delayed bowel movements or dark stools at day 5
Insufficient intake despite an adequate milk supply
Hyperbilirubinemia related to poor intake, after adequate evaluation and management of breastfeeding
Prematurity, low birth weight if mother is unable to provide sufficient milk for baby's needs
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Term
| List three characteristics of "physiologic sore nipples". |
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Definition
Normal in first week after birth
Hurts at the start of the feeding
Skin remains intact, but is sore
Pain peaks on the third day after birth and then begins to subside |
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Term
| What are factors in nipple pain that are may require more active management? (name 3) |
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Definition
Poor position and latch
Engorement
Flat or inverted nipples
Improper tongue position in the baby's mouth |
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Term
| What are some technique to help manage nipple pain? (name 3) |
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Definition
Carefully assess early feedings for latch and position
Express some milk before latching on
Keep milk flowing and baby sucking throughout the feed.
Teach mother to watch for subtle feeding cues and remove baby carefully when non-nutritive sucking begins
Assess nipples after each feeding for signs of trauma
Avoid engorgement
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Term
| Only about ___% of women will have breasts so engorged that the baby can't latch on? |
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Definition
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Term
| List three common causes of engorgement. |
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Definition
Sleepy baby
Poor milk transfer
Poor attachement/latch
Restricted feeds or scheduled feeds
Breast reduction or augmentation
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Term
| What are the most effective strategies for avoiding or treating engorgement? (name 5) |
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Definition
Early frequent feedings or breast stimulation
Careful assessment of attachement
Breast massage during early feeds
Keep milk moving through the breast
Oxytocin nasal spray
Apply heat with warm shower, breast bath, heat packs
Ibuprofen
Ice packs after feeding |
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Term
| List 6 of the 10 steps to becoming a Baby Friendly hospital |
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Definition
Have a comprehensive breastfeeding policy
Train all health care professionals in breastfeeding
Inform all pregnant women about breastfeeding
Initiate breastfeeding within one hour of birth
Show all mothers how to breastfeed
Give infants nothing but breast milk
Practice "rooming in" 24 hours/day
Encourage breastfeeding on demand
Give no pacifiers
Establish breastfeeding support groups
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Term
| In addition to the 10 Steps, Baby Friendly hospitals must adhere to the World Health Organization code of International Marketing of Breast Milk Substitutes. In practical terms, what does this mean for a baby friendly hospital? |
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Definition
All breast milk substitutes (formulas) are purchased by the organization and the purchase price reflects fair market value.
No promotion or advertising of formulas can occur in the hospital |
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Term
| List two ways that you can locate the Fairview Breastfeeding policies and algorithms |
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Definition
Breastfeeding "Best Practice" binder
Online on Intranet under policies tab |
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Term
| How soon after a cesarean birth should a mother and baby be offered the opportunity to breastfeed? |
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Definition
| Within an hour of the time that she is able to respond to her baby, unless medically contraindicated. |
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Term
| How long after a cesarean birth should a mother be offered the chance to hold her baby? (Preferable skin-to-skin) |
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Definition
| Within a half hour of the time that she is able to respond to her baby, unless medically contraindicated. |
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Term
| How often should a baby feed within the first several days after birth? |
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Definition
| Between 8-12 times, as a minimum. |
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Term
| List three cues that baby's use to indicate readiness to feed |
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Definition
Tongue thrusting
Rooting
Restlessness or squirming
Sucking on the fist or fingers
Crying (late cue)
Lip smacking |
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Term
| List at least two FAIRVIEW resources for post-discharge breastfeeding support. |
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Definition
Mom and Baby Classes (register through OnCall, 612/672-7272)
UMMC Lactation Consultant (612/273-2220)
Fairview Baby Connection warm line (612/672-4789) |
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