Breastfeeding

galactosemia

Contraindications to Breastfeeding · Newborns with ______________ should not receive human milk · Breastfeeding is contraindicated in mothers who are positive for human T-cell lymphomatic virus types I or II or with untreated brucellosis · Don't breastfeed if you have tuberculosis or active herpes simplex lesions on breasts · HIV is often considered a contraindication in the US

1 Sepsis 2 Necrotizing enterocolitis 3 Retinopathy of prematurity 4 Metabolic syndrome

Benefits of Breastfeeding for Preterm Infants · Lower rates of 1 2 3 4 · Improved § Insulin metabolism § Neurodevelopmental outcomes

at first breast until baby stops, then burp, go to other breast. No time limits for how long the baby can stay on a breast.

Best Practices for Breastfeeding · Avoid any supplemental feedings unless medically indicated. (Healthy People 2020 goal). § If supplementation is deemed necessary, expressed milk is best § Indications for supplementary feeding: hypoglycemia, dehydration, weight loss more than 7%, delayed passage of bowel movement, meconium stool past day 5, poor milk transfer, or hyperbilirubinemia § Maternal indications for supplement: intolerable pain during feeding or delayed lactogenesis. Possible breast augmentation/reduction · Avoid artificial nipples (pacifiers, bottles) for 3-4 weeks(not forever). Avoid pacifiers at first to let the mom and baby get used to breastfeeding · Pay attention to latch at each feeding. · Allow feeding __________________________

Initiate skin-skin contact and feedings within an hour of birth, if possible. This begins to establish the mother's milk supply (she will only make milk if the milk that is in her breasts is removed)

Best Practices for Breastfeeding · Ideal time to start breastfeeding: _____________________________________________________ § The colostrum (first milk) has the best immunoglobulins § Helps the uterus to contract to prevent bleeding § When baby has no complications, skin-skin contact can be initiated and baby can stay there until they are able to breastfeed for the first time (both vaginal and c-section birth) § Routine procedures (vitamin K, erythromycin, bathing, weighing) can be delayed until baby has completed first breastfeeding

1 Type 2 diabetes 2 Cancer: Breast, Ovarian, & Endometrial 3 Postpartum depression 4 Hypertension, hypercholesterolemia, cardiovascular disease 5 Rheumatoid arthritis

Maternal Benefits of Breastfeeding · Special bond with babies and increased maternal role attainment · Assists in involution: Controls postpartum bleeding & aids in shrinking uterus · Lower Risk of : 1 2 3 4 5 · Protection against osteoporosis and hip fracture later in life · More rapid postpartum weight loss · Delayed return of menses · Endorphins: Nursing releases endorphins which results in relaxation · Sleep: Nursing moms get more rest than formula feeding moms because they don't have to get up in the middle of the night and warm a bottle before feeding. They have warm milk already ready. · Convenience: Less work for mom during times of travel or disaster · Confidence: Knowing her body can sustain her baby

Hindmilk

Milk Production · Colostrum, Foremilk, Hindmilk: § Colostrum: yellow, first 2-3 days after birth § Foremilk: blueish, diluted milk; comes out at first of the feeding § __________________: yellower-white milk; comes out at end of feeding. It contains more fat and helps the baby sleep · Size and volume of a newborn's stomach

· Wear a supportive bra · Empty the breasts: feed the baby (best option), or use the breast pump · Warm soaks before feeding (helps milk come out) · Ice packs after feeding (helps with discomfort) · This should only last 24-48 hours

What do you tell a breastfeeding client having breast engorgement? Give 4 suggestions.

· Wear a supportive bra for 72 hours · Ice packs · Cold cabbage leaves · This should only last 24-48 hours

What do you tell a formula feeding client to do about engorgement? Name 3 suggestions.

A. Check the latch.

When a client has sore nipples, what should the nurse do first? A. Check the latch. B. Offer nipple cream C. Have the client use a breast pump instead of feeding. D. Stop breastfeeding for a few feedings E. Use a nipple shield

Sucking Reflex!

Which newborn reflex assists in latching properly? · 1. _________________________________ · Rooting reflex helps them turn toward anything that strokes their cheek Breastfeeding Tools · Breast pumps · Breast Pads: tuck inside bra to help absorb milk that leaks out · Have a good, comfortable chair or place to breastfeed · Bopee U-shaped pillow: fits around mom's belly and the baby rests in it while breastfeeding. They can also prop the baby up in the pillow after feeding to help them stay upright · Breastfeeding shawls to let them breastfeed in public

BEFORE birth

Try to talk to moms about breastfeeding _________________! It will be harder to discuss and decide on formula vs. breastmilk after the baby is out! Support them no matter what, but always explain risks and benefits of each (them let them decide!).

D. When latched on, the infant's nose, cheek, and chin are touching the breast.

A nurse is giving instructions to a parent about how to breastfeed their newborn. Which of the following actions by the parent indicates understanding of the teaching? A. The mother places a few drops of water on her nipple before feeding. B. The mother gently removes her nipple from the infant's mouth to break the suction. C. When she is ready to breastfeed, the mother gently strokes the newborn's cheek with her finger. D. When latched on, the infant's nose, cheek, and chin are touching the breast.

D. Cradle position

A nurse is reviewing breastfeeding positions with the mother of a newborn. Which of the following is an appropriate position for the nurse to discuss? A. Over-the-shoulder position B. Supine position C. Chin-supported position D. Cradle position

10 - 12 times per day (every 2 to 3 hours).

Best Practices for Breastfeeding · Allow feeding at first breast until baby stops, then burp, go to other breast. No time limits for how long the baby can stay on a breast. · Offer breast as soon as feeding cues occur - don't wait for crying. § Feeding cues: putting hand up to mouth, sucking on hand, making mouth movements, sticking tongue out, making movements · Feed the baby _____________________________________ (per powerpoint) · Breastfeeding is recommended for the first 6 months of life and continued as complementary foods are introduced. Breastfeeding should continue for 1 year and thereafter as desired by the mother

placement of the infant's mouth over the nipple, areola, and breast making a seal between the mouth and breast to create adequate suction for milk removal.

Proper Latch is the Key: · Latch: _______________________________________________________________________ § In preparation for latch, mother should manually express a few drops of colostrum/milk and spread it over the nipple to lubricate it and entice the baby to open their mouth § Promote rooming-in! Referral to breastfeeding support groups if needed

B. Attempts to place his hand in his mouth

A nurse is caring for a newborn. Which of the following actions by the newborn indicates readiness to feed? A. Spits up clear mucus B. Attempts to place his hand in his mouth C. Turns his head toward sounds D. Lies quietly with his eyes open

C. Place used bottles in the dishwasher. D. Check the nipple for appropriate flow of formula. E. Use tap water to dilute concentrated formula.

A nurse is reviewing formula preparation with parents who plan to bottle feed their newborn. Which of the following should be included in the teaching? (Select all that apply.) A. Use a disinfectant wipe to clean the lid of the formula can. B. Store prepared formula in the refrigerator for up to 72 hr. C. Place used bottles in the dishwasher. D. Check the nipple for appropriate flow of formula. E. Use tap water to dilute concentrated formula.

C. Keep the nipple full of formula throughout the feeding.

A nurse is teaching a group of new parents about proper techniques for bottle feeding. Which of the following instructions should the nurse provide? A. Burp the newborn at the end of the feeding. B. Hold the newborn close in a supine position. C. Keep the nipple full of formula throughout the feeding. D. Refrigerate any unused formula.

· 1. L = latch - lips flanged, areola in mouth (milk is stored behind areola, so they can't just have the nipple in the mouth) · 2. A = audible swallowing? · 3. T = type of nipple (everted, flat, inverted?) · 4. C = comfort during feeding - breastfeeding should NOT hurt. Pain will prevent breastfeeding · 5. H = help - how much help does mom need with latching the baby?

Assessing Correct Latch - LATCH: 1 2 3 4 5

infant semi-reclining (not supine) and hold the bottle close at 45 degrees so that fluid fills the nipple and none of the air is allowed to enter it. Place the bottle on top of baby's tongue to start feeding

Bottle Feeding Babies · For bottle feedings: feed every 3-4 hours. Wake baby every 3hr during day and every 4hr at night until feeding well and gaining weight · Hold baby for all feedings. Infant should be semi-upright with good head support · A bottle should never be propped with a pillow and left with the infant. It can cause choking and deprives baby of interactions of feedings. It can also cause dental decay and nursing caries · A slow-flow nipple is often used for the first few weeks until baby gets used to using bottle · Position: _____________________________________________________________________________________ · Paced-bottle feeding: bottle is held kind of horizontally (45 degrees). When baby pauses between bursts of sucking, the parent withdrawals nipple and allows it to rest on baby's lips until they are ready to resume sucking. This slows flow of milk from bottle so baby is in more control § Works well for babies who are mainly fed via breastfeeding but occasionally need bottle · If baby falls asleep, spits out nipple, seals the lips, turns head away, or ceases to suck, it usually means they are full! § Signs of stress that indicate need to stop feeding: turning head, arching back, choking, sputtering, changing color, moving arms, tensing fists · Place baby on back after feedings · Wash bottles in dishwasher, boiled, or wash by hand in hot/soapy water · Prepared formula can be refrigerated for up to 48hr. Don't use expired formula

1 Hand-to-mouth or hand-to-hand movements 2 Sucking motions 3 Rooting reflex: infant moves toward whatever touches the area around the mouth and attempts to suck 4 Mouthing or sticking tongue out

Breastfeeding Initiation · Infant Feeding-readiness cues (aka early signs of hunger): 1 2 3 4 · Babies usually consume mall mounts of milk in first 3 days of life. As they adjust to extrauterine life and digestive track is cleared of meconium, the milk intake increases up to 60-90mL by the end of the first week. · Help mom and baby initiate successful breastfeeding. Build maternal confidence, such as educating her and assisting her with latching, positioning, signs of good feeding, and self-care measures (preventing engorgement)

allows women to breastfeed while laying down, which is helpful at night so mom can rest while breastfeeding. Mother's with perineal pain often use this position

Breastfeeding Positions · For initial feeding, it can be beneficial to help mom breastfeed in a semi-reclining position with baby lying prone, skin-to-skin on mother's chest. Mom is more relaxed, nipple pain is reduced, and she has more feedrom to use her hands. · Football/Crutch-Hold: under the arm; often recommended for early feedings because mom can see baby's mouth easily · Chest Position: best after birth · Cradle Position: not really good for newborns, it doesn't help with head control for the newborn (they can't hold onto the breast very well yet) · Cross Cradle: the baby should not need to turn their head. You want baby and mom to be belly to belly · Hand expression: put hands on areola, press hands back toward chest, and milk should drip into container · Laying Down: _____________________________________________________________________________________ · Underarm position: baby is rested on a pillow, like a football, with belly to belly position · Underarm position for twins · Cross position for twins

1. Acute otitis media 2. Non-specific gastroenteritis and childhood inflammatory bowel disease 3. Severe lower respiratory tract infections 4. Atopic dermatitis 5. Asthma in young children 6. Obesity 7. Type 1 and type 2 diabetes 8. Childhood leukemia 9. Sudden infant death syndrome (SIDS) 10.Necrotizing enterocolitis 11.Celiac disease 12.Dental malocclusion

Breastfeeding and Risk Reduction · Current evidence demonstrates breastfeeding associated with reduction in risk of: 1 2 3 4 5 6 7 8 9 10 11 12

satiety control § Normal weight and growth

Childhood Growth Benefits of Breastfeeding · Breastfed babies exhibit better ________________________- - · Formula fed babies are also 32% more likely to develop childhood obesity · Obesity is one of the most significant childhood health problems in the U.S. § Affects 20% of children in the U.S., with up to 30% classified as overweight for age § Incidence decreased in the breastfed population § Greatest protection with breastfeeding for > 12 months

unwrap baby, change diaper, cool cloth on face, stimulate - rub back, feet, sit up and down, talk to baby, turn them side-side - STIMULATE! ("annoy the baby")

Feeding problems - what to do... · Assess first: § Breastfeeding: CHECK LATCH!, observe feeding § Formula feeding: check amounts, any vomiting? § Sleepy baby: ______________________________________________ § Crying/Fussy baby: calm them down, skin to skin contact, swaddle, reduce stimuli, talk to baby, and rock the baby § No weight gain: check breastfeeding method, massage breast during feeding, pump for breastmilk, feed by cup, system, or syringe · If baby is spitting up, they might have dairy allergy · AVOID PROBLEMS by AVOIDING SUPPLEMENTS OR WATER,& ARTIFICIAL NIPPLES - remember Healthy 2020 goals, · only nurses can make it work! Give them the support they need

calm them down, skin to skin contact, swaddle, reduce stimuli, talk to baby, and rock the baby

Feeding problems - what to do... · Assess first: § Breastfeeding: CHECK LATCH!, observe feeding § Formula feeding: check amounts, any vomiting? § Sleepy baby: unwrap baby, change diaper, cool cloth on face, stimulate - rub back, feet, sit up and down, talk to baby, turn them side-side - STIMULATE! ("annoy the baby") § Crying/Fussy baby: __________________________________________________ § No weight gain: check breastfeeding method, massage breast during feeding, pump for breastmilk, feed by cup, system, or syringe · If baby is spitting up, they might have dairy allergy · AVOID PROBLEMS by AVOIDING SUPPLEMENTS OR WATER,& ARTIFICIAL NIPPLES - remember Healthy 2020 goals, · only nurses can make it work! Give them the support they need

convenient, saves money, and is "green"

Financial Benefits of Breastfeeding · Breastfeeding is _______________, _______________, and _____ · Reduced annual health care costs · Lower employee absenteeism because of ill infant · Convenient and cost effective · Environmentally friendly · Decreased energy demands for production and transport of infant formula · Less expensive that infant formula

every 3 hr during the day and at least every 4hr at night

Frequency of Breastfeeding (PER TEXTBOOK) · Newborns need to breastfeed at least 8-12 times in a 24hr period. Some infants breastfeed every 2-3hr in a day. Others cluster-feed, and breastfeed every hour or so for 3-5 feedings and then sleep for 3-4hrs between clusters. (PER TEXTBOOK) · In first 24-48hr, most babies don't awaken often enough to feed, so parents should wake baby every ________________________________________________________________________ · Once baby is feeding well and gaining adequate weight, demand feeding is appropriate (the baby determines frequency of feedings). With demand feeding, baby should still get at least 8 feedings in 24 hours § Caution parents against attempting to place newborn infants on strict feeding schedules. Strict feeding schedules (forcing baby to wait so long before feeding) can result in failure to meet nutritional needs · Keeping newborn close is the best way to respond to feeding cues

B. Output

How do you know the baby is getting enough milk? A. Weight gain B. Output C. Type of stool D. Add formula (you don't add formula because it reduces the amount of milk mom makes)

7-10% of birthweight after birth before beginning to gain weight. § Loss of more than 7% in breastfeeding infant during first 3 days of life needs to be investigated

How much should the birthweight change with good feeding? · Since newborns are born with extra fluid in their system so they can transition to feeding, it is normal for them to lose up to ______________________________________ - · After early milk has transitioned to mature milk, infants should gain about 110-200g (3.9-7oz) per week for the first 3 months. § or 20-28g (0.7-1oz) per day for the first 3 months. · During the first 2 days of life, babies need an intake of 60-80mL/kg/24hr § From 3-7 days of life, fluid need is 100-150mL/kg/24hr · Warning signs of ineffective breastfeeding: inadequate weight gain, minimal output, feeding constantly

This takes about 2-3 days, but does depend on how much the baby feeds

How soon after birth does the colostrum change to milk? · _____________________________________

C. 3300 gm You expect it to go down before it goes up.

If a baby's birthweight is 3500 gm, how much should the baby weight at discharge? A. 3600 gm B. 4000 gm C. 3300 gm D. 3500 gm

Dark, concentrated

Indicators of Effective Breastfeeding · Keep a feeding diary in early days of breastfeeding. Take this to follow-ups · Baby's output is indicative of feeding adequacy. · As the volume of breast milk increases, urine becomes more dilute and should be light yellow. _______________________________ urine can be associated with inadequate intake ad possible dehydration. · Infants should have at least 6-8 wet diapers every 24hr after day 4. · Infant should have at least 3 stools per day for the first month. Some babies stool with each feeding. Stooling gradually changes § The first 1-2 days after birth, meconium is passed (green, black, thick, sticky) § By day 2-3, stools get greener, thinner, less sticky § If mom's milk has come in by day 3-4, stools become green-yellow and looser § By the end of the first week, breast milk stools are yellow, soft, seedy (mixture of mustard and cottage cheese)

1 American stigma: breasts are associated highly with sexual activity 2 Many moms breastfeed in hiding

Infant Feeding Decision-Making · For most women, there is a clear choice to either breastfeed or formula-feed. Some women choose both · Some women want their baby to get breast milk but prefer not to feed directly from breasts, so they express milk and bottle-feed it to their baby · Most women choose to breastfeed because of benefits for the baby · Women who perceive support from partner/family are more likely to breastfeed · Social Stigma 1 2 · Some women fear it will be painful or worry that they won't make enough milk · A major obstacle to breastfeeding is employment and need to return to work after birth. Access to breast pumps, pumping facilities, and time for pumping impact the ability to continue breastfeeding when mom returns to work or school. · Healthcare personal have influence by teaching benefits of breastfeeding

§ 1. Mother reports firm tugging sensation but no pinching/pain § 2. Baby sucks with cheeks rounded, NOT dimpled § 3. Baby's jaw glides smoothly with sucking § 4. Swallowing is audible

Proper Latch is the Key: · Latch: placement of the infant's mouth over the nipple, areola, and breast making a seal between the mouth and breast to create adequate suction for milk removal. · 4 big Signs of effective breastfeeding: 1 2 3 4 · IT SHOULD NOT BE PAINFUL. Anytime latch is not correct or sucking is not present, the baby should be removed and latch should be attempted again.

3 substantive bowel movements and 6-8 wet diapers every 24hr after day 4

Proper Latch is the Key: · Latch: placement of the infant's mouth over the nipple, areola, and breast making a seal between the mouth and breast to create adequate suction for milk removal. · Maternal signs of effective breastfeeding: 1. Onset of copious milk production in day 3-4 2. Firm tugging on nipple. No pain 3. Uterine contractions and increased lochia (oxytocin stimulation) 4. Relaxed/drowsy 5. Increased thirst 6. Breasts soften or feel lighter 7. With ejection, can feel warm or tingling, or leaking from opposite breast · Infant signs of effective breastfeeding 1. Latches without difficulty 2. Has bursts of 15-20 sucks/swallows at a time 3. Audible swallowing 4. Easily releases breast at end of feeding 5. Infant appears content after feeding 6. Has ___________________________

§ Mother supports her breast in one hand with thumb on top and four fingers underneath, then she compresses the breast slightly with fingers parallel to the infant's lips (provides adequate breast tissue for baby's mouth) § Nose on target with nipple, so it touches the roof of the mouth (stimulates suck reflex) § Tickle lower lip with nipple (stimulates opening of mouth) § Wait for wide mouth to latch § Baby's lips should be flanged with chin tucked § The baby stimulates milk release using the tongue

Proper Latch is the Key: · Latch: placement of the infant's mouth over the nipple, areola, and breast making a seal between the mouth and breast to create adequate suction for milk removal. · To facilitate latch: - - - -

put it in warm water or under a running sink (don't shake) or put in the refrigerator (best) § Milk that is thawed in the refrigerator can be stored for 24hr

Storing Breastmilk · expression of breastmilk can be helpful with engorgement, when nipples are sore or damaged, when mom and baby are separated, or when mother temporarily leaves infant with a caregiver. · Before expression of milk, wash hands. · Milk storage containers should be washed in hot soapy water and rinse thoroughly (or dishwasher). · Plastic storage bags for breast milk can be used for less than 72 hours · Write date of expression on storage containers before storing milk. · Store milk in serving sizes of 2-4oz to prevent waste · You can combine milk from pumping sessions in the same day; cool freshly expressed milk before adding it to the refrigerated container. Do not add warm milk to a container of refrigerated milk · Breastmilk can be stored under very clean conditions at room temp for 8hr · Keeps in refrigerator for up to 8 days · Keeps in average freezer up to 6 months. In freezer, put bottles in back/side of freezer (not the door) · Keeps in deep freeze up to 12 months · Never re-freeze thawed milk · NEVER THAW FROZEN MILK IN MICROWAVE!!! This can cause heat to distribute unevenly and can cause boiling bubbles to form in the center of liquid, which may not be detected when drops of milk are checked for temperature. Microwaving also decreases nutrients/lysozymes in milk. § NEVER boil milk to thaw it § To thaw frozen milk, _________________________________________________________ · Shake the container before feeding, and test temperature of milk on inner wrist · Unused portions of breast milk must be discarded after thawing or warming

· Keeps in refrigerator for up to 8 days · Keeps in average freezer up to 6 months. In freezer, put bottles in back/side of freezer (not the door) · Keeps in deep freeze up to 12 months

Storing Breastmilk · expression of breastmilk can be helpful with engorgement, when nipples are sore or damaged, when mom and baby are separated, or when mother temporarily leaves infant with a caregiver. · Before expression of milk, wash hands. · Milk storage containers should be washed in hot soapy water and rinse thoroughly (or dishwasher). · Plastic storage bags for breast milk can be used for less than 72 hours · Write date of expression on storage containers before storing milk. · Store milk in serving sizes of 2-4oz to prevent waste · You can combine milk from pumping sessions in the same day; cool freshly expressed milk before adding it to the refrigerated container. Do not add warm milk to a container of refrigerated milk · Breastmilk can be stored under very clean conditions at room temp for 8hr · Keeps in refrigerator for up to ____________ · Keeps in average freezer up to ____________. In freezer, put bottles in back/side of freezer (not the door) · Keeps in deep freeze up to____________ · Never re-freeze thawed milk · NEVER THAW FROZEN MILK IN MICROWAVE!!! This can cause heat to distribute unevenly and can cause boiling bubbles to form in the center of liquid, which may not be detected when drops of milk are checked for temperature. Microwaving also decreases nutrients/lysozymes in milk. § NEVER boil milk to thaw it § To thaw frozen milk, put it in warm water or under a running sink (don't shake) or put in the refrigerator (best) § Milk that is thawed in the refrigerator can be stored for 24hr · Shake the container before feeding, and test temperature of milk on inner wrist · Unused portions of breast milk must be discarded after thawing or warming

brain development. It promotes brain growth due to large amounts of lactulose § Higher IQ's & improved brain and nervous system development § IQ advantage of 10-12 points studied at ages 8, 12, and 18.

Who Benefits From Breastfeeding? · Children · Mothers · Society Benefits of Breastfeeding · Breast milk is species specific to human beings, so it contains nutrients for humans and is optimal for babies · Minimizes exposure to foreign protein · Optimal developmental outcomes · Customized food; it is specific to each infant (milk made by preterm mothers is different from full-term) · Breast milk is the perfect food for newborns. It is easy for them to digest § Complete mix of nutrients & antibodies (and vitamins and minerals) § Composition varies with growth and nutritional needs · Milk varies in taste depending on what mom eats · Promotes appropriate growth pattern. It provides protein and nitrogen for neurologic cell building and improve baby's ability to regular calcium/phosphorus levels · Breast milk is crucial for _______________________ - - · The colostrum (first milk) coats the GI tract. Breast milk promotes colonization and maturation of baby's intestinal microbiome. Colostrum also promotes passage of meconium by acting as a laxative · Nursing promotes facial structure development and enhanced speech · Promotes mother-infant attachment § Oxytocin release · Immune Benefits of Breastfeeding § Antiviral and antibacterial factors: IgA, IgG, IgM, IgD, and IgE; T lymphocytes and B lymphocytes, leukocytes, macrophages, and lactoferrin § When a breastfeeding mother is exposed to a pathogen she produces immunoglobulins that are passed through the milk to protect the newborn

gaining weight, voiding 6-8x/day, and are content between feedings

· Duration of Breast Feedings § Average time for early breastfeeding's is 30-40 minutes or 15-20min per breast. As infants grow, they get better at breastfeeding, and the length of feedings decrease § Early after birth, mother may be taught to feed on the first breast until the neonate falls asleep, then wake the baby and offer the other breast. Some mothers prefer one-sided nursing (baby nurses one breast at each feeding) § Alternate first breast offered with each feeding to make sure both empty § Look for signs that baby is finished feeding (sucking/swallowing pattern has slowed, and the breast is softened, the baby appears content and may fall asleep or release the nipple) § Burp baby after feeding upright/over shoulder by gently patting on the back § Infants are feeding adequately if they are _________________________________________________________________ § If baby seems to be feeding effectively and urine output/bowel movements are good but they're not gaining weight, the mother may be switching to the next breast too soon. Feed on the breast until it softens (ensure baby gets hindmilk) to encourage weight gain

1. Mother can feel tingling in breasts/nipples 2. Baby's suck changes from quick, shallow sucks to slower, drawing suck pattern 3. Audible swallowing 4. Early postpartum: mother may feel contractions/cramping or have increased lochia during/after feedings 5. Mother may feel relaxed/drowsy during feedings 6. Opposite breast may leak

· To prevent nipple trauma when baby is taken off breast, the mother is taught to break suction by inserting a finger into the side of the baby's mouth between gums and leave it there until the nipple is completely out of the mouth · Nurses should observe at least one feeding every 8-12 hours · Maternal Signs of Milk Let Down or Milk Ejection: 1 2 3 4 5 6