Bonding & Breastfeeding

A 22 year old woman delivered her first child 24 hours ago. She had a normal vaginal delivery with a midline episiotomy and is breast feeding her baby. She complains that feels like she doesn't have enough milk for her baby. The best response is:

"This is a common feeling. Putting the baby to breast more frequently will stimulate lactation."

Promoting Bonding

- Bonding is all about contact and spending time with the baby! - Provide positive feedback, at least 10 affirmations per shift -Teach parents skills -Keep mom and baby together, continue to return baby to room -Facilitate early contact at birth -Point out the baby's responses to mother

Physiology of Milk Production and Ejection

- Sucking stimulus --> Hypothalamus --> Anterior pituitary releases prolactin --> milk production -Sucking stimulus --> Hypothalamus --> Posterior pituitary releases oxytocin --> let-down

Important Things to Teach Parents

1. Confidence and trust in the process 2. Begin breastfeeding immediately after birth and feed frequently in 1st day - 1st hr very important, baby becomes very sleep after for about 24-48 hours 3. Feed every 2-4 hours or at least 8-12X per day 4. Breastfeed on demand by looking for infant cues (rooting, mouth movements, etc.) 5. Breastfeed baby on each breast until baby pulls off, no time limit, burping between 6. Ensure proper latch 7. Listen for audible swallow 8. Check for adequate amounts of wet and dirty diapers per day 10. Stay hydrated, drink 8-10 glasses/day 11. Be aware of nipple confusion, nothing new for 2 weeks - Pacifier after 2 weeks is encouraged

Nursing Assessment of Bonding

1. Fingertip to palmar touch 2. Start by touching extremities and then move in to large body areas 3. Enfolding (holding the baby close) 4. En-face (holding the baby face-to-face) 5. Talking in high pitched tones to infant, calling the baby by name *All normal steps in bonding, these are predictable and sequential Paternal/Partner Behaviors and Adjustment - Re-living -Celebration and announcement -Aquaintance- interested in baby -Hovering or engrossment -Involvement in parenting

Reva Rubin's Phases of Bonding

1. Taking-In Phase (1st 24 hrs after birth) - Dependent and passive phase -Telling all about birth 2. Taking-On Phase or Taking Hold (2-5 days after delivery) - Dependent-independent (seeking control) - Talking all about the baby -Calling the baby by name -Interest in caring for infant, responsive to teaching -Postpartum blues also occurring -Typically takes place at home 3. Taking-Off Phase or Letting Go - Interdependent -Moving forward, taking on new roles -Letting others take care of baby, returning to work

Claiming

Recognizing the similarity and uniqueness of the new member of the family "The baby looks just like..."

Potential Problems in Breastfeeding

CONTINUE FEEDING! 1. IMS (Insufficient Milk Supply) - This is most commonly perceived and not actual, solution is to feed more often 2. Engorgement (Too Much Milk) -Usually occurs postpartum day 3-5 -Tender, swollen, hot, and hard -Frequent feeding, express some milk to soften the breast -Ice/heat, cabbage leaves, Tylenol 3. Sore Nipples -Check positioning and latch -Limiting time at breast does not prevent sore nipples, frequent feedings! 5. Mastitis (Inflammation and infection of breast) - Unilateral or localized pain, red, swollen, accompanied by fever and malaise -Continue feeding

Parent-Infant Interaction

Communication and behavior between parent and infant

Mutuality

Communication between mother and infant

Attachment

Deep and lasting emotional ties from infant to parent

Bonding

Deep and lasting emotional ties from parent to infant

Parent Acquaintance

Getting to know the infant

A new mother calls the clinic 4 days after delivery. She is breastfeeding and concerned that her baby is not getting enough milk. What is the most important question for the nurse to as this mother?

How many wet diapers has your baby had in the last 24 hours?

In assessing correct latch on, the nurse should observe that the infant's mouth is positioned:

One-half inch around the areola

A woman delivered her first baby yesterday. In response to the nurse's question about how she is feeling, the client replies that she is, "tired, sore, and hungry!" She then begins to talk about her birth experience. Based on the assessment data, the nurse determines that the client is in which phase of postpartal psychological adaptation (based on Reva Rubin's stages)?

Taking in.

The following are flow diagrams showing breast physiology. Which one of the following represents the correct sequence of events?

infant sucking - hypothalamus - -pituitary - -prolactin and oxytocin - -milk secretion and ejection

Mrs. L. had a normal spontaneous vaginal delivery of a viable male infant at 0800 and it is now 0830. She asks the nurse, "When would it be best for me to begin breastfeeding my baby?" The nurse realizes that the baby will have the greatest urge to go to breast:

within the first hour