newborn feeding

contractions that occur with breastfeeding

often painful during and after feeding for the first 3 to 5 days. These afterpains are more common in multiparas and tend to resolve completely within 1 week after birth.

Lactogenesis

production of milk

normal breasts during pregnancy

•Venous pattern more prominent •Nipples and areola more pigmented •Montgomery tubercles prominent •Raised pinkish red nodules on the areola •Colostrum normal after 16 weeks

how is feeding frequency determined

(Feeding frequency is determined by counting from the beginning of one feeding to the beginning of the next.) Once the infant is feeding well and gaining weight adequately, going to demand feeding is appropriate, in which case the infant determines the frequency of feedings. (With demand feeding, the infant should still receive at least eight feedings in 24 hours.)

supply-meets-demand system

(i.e., as milk is removed from the breast, more is produced). Incomplete removal of milk from the breasts can lead to decreased milk supply.

Insufficient Milk Supply

A common reason that women stop breastfeeding is perceived or actual insufficient milk supply. This often leads to formula supplementation and early weaning. Careful evaluation of the mother-infant dyad is needed, including assessment of infant weight gain or loss, feeding technique, milk transfer, and consideration of possible medical causes for low supply (e.g., medications, glandular insufficiency, previous breast surgery). Stress and fatigue can cause decreased milk production.

Hand Expression

All mothers should be instructed in hand expression. This simple technique can actually be more effective than an electric breast pump for expressing colostrum, which tends to be thicker than mature milk. Hand expression during the first 3 days after birth can have a positive effect on milk production during the early weeks. Morton and colleagues report that combining hand expression and hands-on pumping (breast massage before and during pumping) with the use of an electric breast pump can increase milk production and enhance fat content and caloric value of milk

Breast Milk Storage Guidelines for Home Use for Term Infants

Before expressing or pumping breast milk, wash your hands. • Containers for storing milk should be washed in hot, soapy water and rinsed thoroughly; they can also be washed in a dishwasher. If the water supply may not be clean, boil containers after washing. Plastic bags designed specifically for breast milk storage can be used for short-term storage (<72 hours). • Write the date of expression on the container before storing milk. A waterproof label is best. • Store milk in serving sizes of 2 to 4 ounces to prevent waste. • Storing breast milk in the refrigerator or freezer with other food items is acceptable. • 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. • When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door. • When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion. • To thaw frozen breast milk, place container in the refrigerator for gradual thawing or under warm, running water for quicker thawing. Never boil or microwave. • Milk thawed in the refrigerator can be stored for 24 hours. • Thawed breast milk should never be refrozen. • Shake milk container before feeding baby, and test the temperature of the milk on the inner aspect of your wrist. • Any unused milk left in the bottle after feeding is discarded.

Expressing and Storing Breast Milk

Breast milk expression is a common practice, typically performed to obtain breast milk for someone other than the mother to feed to the baby. It is most often associated with maternal employment. In some situations, expression of breast milk is necessary or desirable such as when engorgement occurs, when the mother's nipples are sore or damaged, when the mother and baby are separated as in the case of a preterm infant who remains in the hospital after the mother is discharged, or when the mother leaves the infant with a caregiver and will not be present for feeding. Some women express milk to have an emergency supply. Some women choose to pump exclusively, providing breast milk for their infants but never allowing the baby to suckle at the breast. Because pumping and hand expression are rarely as efficient as a baby in removing milk from the breast, the milk supply is never judged based solely on the volume expressed. Milk volume can be more accurately assessed using prefeeding and postfeeding infant weights, also known as test weights.

Frequency of Feedings

Feeding patterns vary because every mother-infant dyad is unique. Breastfeeding frequency is influenced by a variety of factors, including the infant's age, weight, maturity level, stomach capacity and gastric emptying time, and the storage capacity of the breast (i.e., the milk available when the breast is full). Newborns need to breastfeed at least 8 to 12 times in a 24-hour period Some infants breastfeed every 2 to 3 hours throughout a 24-hour period. Others cluster-feed, breastfeeding every hour or so for three to five feedings and then sleeping for 3 to 4 hours between clusters. During the first 24 to 48 hours after birth, most babies do not awaken often enough to feed. Parents need to understand that they should awaken the baby to feed at least every 3 hours during the day and at least every 4 hours at night

Mechanical Milk Expression (Pumping)

For most women, recommendations are to initiate pumping only after the milk supply is well established and the infant is latching and breastfeeding well. However, when breastfeeding is delayed after birth such as when babies are ill or preterm, mothers should begin pumping with an electric breast pump as soon as possible and continue to pump regularly until the infant is able to breastfeed effectively. Early pumping may be initiated if the baby is too sleepy to feed effectively or if there are issues with latching or milk transfer. Milk expression is essential to maintaining milk supply if breastfeeding is interrupted. Double pumping (pumping both breasts at the same time) saves time and can stimulate the milk supply more effectively than single pumping

what does human mil contain

Human milk contains immunologically active components that provide some protection against a broad spectrum of bacterial, viral, and protozoal infections. The major immunoglobulin (Ig) in human milk is secretory IgA; IgG, IgM, IgD, and IgE are also present. Human milk also contains T lymphocytes and B lymphocytes, epidermal growth factor, cytokines, interleukins, bifidus factor, complement (C3 and C4), and lactoferrin, all of which have a specific role in preventing localized and systemic bacterial and viral infections

infant stool

Infants should have at least six to eight sufficiently wet diapers (light yellow urine) every 24 hours after day 4. The first 1 to 2 days after birth, newborns pass meconium stools, which are greenish black, thick, and sticky. By day 2 or 3, the stools become greener, thinner, and less sticky. If the mother's milk has come in by day 3 or 4, the stools start to appear greenish yellow and are looser. By the end of the first week, breast milk stools are yellow, soft, and seedy (they resemble a mixture of mustard and cottage cheese). If an infant is still passing meconium stool by day 3 or 4, breastfeeding effectiveness and milk transfer should be assessed. fants should have at least three stools (quarter-size or larger) per day for the first month. Some babies stool with every feeding. The stooling pattern gradually changes; breastfed infants can continue to stool more than once per day, or they may stool only every 2 or 3 days. As long as the baby continues to gain weight and appears healthy, this decrease in the number of bowel movements is normal.

refrigerator storage

Refrigerator storage 39 ° or lower for 72 hours but 5-8 days okay

room temp storage

Room temperature storage 60-85° for 3-4 hours

Duration of Feedings

The duration of breastfeeding sessions varies greatly because the timing of milk transfer differs for each mother-baby pair. The average time for early feedings is 30 to 40 minutes or approximately 15 to 20 minutes per breast. As infants grow, they become more efficient at breastfeeding, and consequently the length of feedings decreases. The amount of time an infant spends breastfeeding is not a reliable indicator of the amount of milk the infant consumes because some of the time at the breast is spent in nonnutritive sucking. In the early days after birth, the mother may be instructed to feed on the first breast until the neonate falls asleep and try to wake the baby and offer the second breast. Some mothers prefer one-sided nursing, which means that the baby nurses only one breast at each feeding. The first breast offered should be alternated at each feeding to ensure that each breast receives equal stimulation and emptying. Instead of instructing mothers to feed for a set number of minutes, nurses should teach them to look for signs that the baby has finished feeding (e.g., the baby's sucking and swallowing pattern has slowed, the breast is softened, the baby appears content and may fall asleep or release the nipple). If a baby seems to be feeding effectively and urine output and bowel movements are adequate but the weight gain is not satisfactory, the mother may be switching to the second breast too soon. Feeding on the first breast until it softens ensures that the baby receives the higher-fat hindmilk, which usually results in increased weight gain.

getting the baby to breast feed

The mother holds the baby close to the breast with the infant's mouth directly in front of the nipple. The infant who is displaying the rooting reflex with the mouth opening widely may easily latch on. If the infant is not readily opening the mouth, the mother tickles the baby's lips with her nipple, stimulating the mouth to open. When the mouth is open wide and the tongue is down, the mother quickly "hugs" the baby to the breast, bringing him or her onto the nipple. The amount of areola in the baby's mouth with correct latch depends on the size of the baby's mouth and the size of the areola and nipple. If breastfeeding is painful, the baby likely has not taken enough of the breast into the mouth, and the tongue is pinching the nipple.

The following signs indicate that milk ejection has occurred:

The mother may feel a tingling sensation in the nipples and breasts, although many women never feel when milk ejection occurs. • The baby's suck changes from quick, shallow sucks to a slower, more drawing sucking pattern. • Audible swallowing is heard as the baby sucks. • In the early days, the mother feels uterine cramping and can have increased lochia during and after feedings. • The mother feels relaxed or drowsy during feedings. • The opposite breast may leak.

breast feeding initation

The mother needs to understand infant behaviors in relation to breastfeeding and recognize signs that the baby is ready to feed. Infants exhibit feeding-readiness cues or early signs of hunger. Instead of waiting to feed until the infant is crying in a distraught manner or withdrawing into sleep, the mother should attempt to breastfeed when the baby exhibits feeding cues

facilitating latch

To facilitate latch, the mother supports her breast in one hand with the thumb on top and four fingers underneath at the back edge of the areola. The breast is compressed slightly with the fingers parallel to the infant's lips, as one might compress a large sandwich in preparing to take a bite, so an adequate amount of breast tissue is taken into the mouth with latch. Most mothers need to support the breast during feeding for at least the first days until the infant is adept at feeding.

prolactin

levels are highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation. Prolactin is produced in response to infant suckling and emptying of the breasts

composition of human milk

changes over time as the infant grows and develops. Fat is the most variable component of human milk with changes in concentration over a feeding, over a 24-hour period, and across time. Variations in fat content exist between breasts and among individuals. During each feeding, the concentration of fat gradually increases from the lower fat foremilk to the richer hindmilk. The hindmilk contains the denser calories from fat necessary for ensuring optimal growth and contentment between feedings. Because of this changing composition of human milk during each feeding, breastfeeding the infant long enough to supply a balanced feeding is important.

latch on

defined as 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. In preparation for latch during early feedings, the mother should manually express a few drops of colostrum or milk and spread it over the nipple. This action lubricates the nipple and entices the baby to open the mouth as the milk is tasted.

Oxytocin

essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary gland is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex. has the important function of contracting the mother's uterus after birth to control postpartum bleeding and promote uterine involution. Thus mothers who breastfeed are at decreased risk for postpartum hemorrhage.

freezer storage

freezer storage 24 ° for 6 months but 12 months acceptable

The key to establishing and maintaining milk supply

frequent emptying of the breasts. Interventions for increasing milk supply are based on causative factors. In many cases, the mother is told to spend time with the baby skin-to-skin, increase feeding frequency, express milk using an electric pump, rest as much as possible, consume a healthy diet, and reduce stress.

If nonpharmacologic measures to increase milk supply are not effective

galactagogues (medications or other substances that are believed to increase milk supply) may be recommended. Mothers often use herbal galactagogues such as fenugreek, blessed thistle, goat's rue, and shatavari to increase milk production. However, there is a lack of evidence to support the use of these substance

Prolactin and oxytocin

have been called the "mothering hormones" because they affect the postpartum woman's emotions and her physical state. Many women report feeling thirsty or very relaxed during breastfeeding, probably as a result of these hormones.

Breast milk

promotes colonization and maturation of the infant's intestinal microbiome, which is essential to development of the immune system. The bacteria in human milk vary according to the stage of lactogenesis and gestational age of the infant. Maternal health status and mode of birth affect breast milk microbiota. The predominant flora of breastfed infants are L. bifidus and Bifidobacterium spp., which metabolize milk saccharides and lower the pH of infant stool; this limits the growth of pathogenic bacteria such as E. coli, Bacteroides, and Staphylococcus

Human milk

the ideal food for human infants. It is a dynamic substance with a composition that changes to meet the changing nutritional and immunologic needs of the growing infant. Breast milk is specific to the needs of each infant; for example, the milk produced by mothers of preterm infants differs in composition from that of mothers who give birth at term.

s/s the baby is hungry

• Hand-to-mouth or hand-to-hand movements • Sucking motions • Rooting reflex—infant moves toward whatever touches the area around the mouth and attempts to suck • Mouthing

Signs of Effective Breastfeeding Mother

• Onset of copious milk production (milk is "in") by day 3 or 4 • Firm tugging sensation on nipple as infant sucks but no pain • Uterine contractions and increased vaginal bleeding while feeding (first week or less) • Feels relaxed and drowsy while feeding • Increased thirst • Breasts soften or feel lighter while feeding • With milk ejection (let-down), can feel warm rush or tingling in breasts, leaking of milk from opposite breast Infant • Latches without difficulty • Has bursts of 15 to 20 sucks/swallows at a time • Audible swallowing is present • Easily releases breast at end of feeding • Infant appears content after feeding • Has at least three substantive bowel movements and six to eight wet diapers every 24 hours after day 4

Benefits to Breastfeeding for the Infant

•Decreased incidence of : •Infectious diseases •Rates of SIDS •Type I and Type II diabetes •Lymphoma, leukemia, Hodgkin disease •Decreased incidence and severity of asthma and other allergies •Otitis media •Obesity in adolescence and adulthood •Lower URI •Lower incidence of NEC in preterm infants

Benefits of Breastfeeding for the Mother

•Decreased postpartum bleeding and more rapid uterine involution •Reduced risk of ovarian cancer and breast cancer •Lower risk of HTN, hypercholesterolemia, and CV disease •Type I diabetes •Rheumatoid arthritis •Unique bonding experience •Increased maternal role attainment

Recommended Infant Nutrition

•Exclusive breastfeeding for 6 months •Breastfeeding or human milk for next 6 months

How to Know if Baby is Getting Enough Breast Milk

•First 24 hours - 1 wet, 1 dirty diaper •Second 24 hours - 2 wet, 2 dirty diapers •Third 24 hours - 3 wet, 3 dirty diapers •When milk is in - 6-8 wet, 2-10 dirty diapers

Contraindications for Breastfeeding

•In United States: HIV positive •Untreated TB •Positive human T-cell lymphotrophic virus type I or II with untreated brucellosis •Active herpes lesions around breast •Maternal illegal drug use

Benefits to Breastfeeding for the Infant(continued

•Possible enhanced cognitive development •Enhanced jaw development •Decreased problems with malocclusions and mal-alignment of teeth •Analgesic effect for infants undergoing painful procedures