Breast Feeding Technique

Aka: Breast Feeding Technique, Lactation Technique, Breast Feeding Pearls, Effective Breast Feeding Signs

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II. Technique: Breast Feeding positions

  1. Cradle hold
    1. Use arm on side of Breast Feeding
    2. Mother's antecubital space supports baby's head
    3. Mother's hand supports baby's bottom
  2. Cross-cradle hold
    1. Use arm on opposite side of Breast Feeding
    2. Mother's antecubital space supports baby's bottom
    3. Mother's hand supports baby's head
    4. Baby cradled like football inside arm
    5. Similar to football hold (except opposite Breast)
  3. Football hold (Clutch Position)
    1. Use arm on side of Breast Feeding
    2. Baby cradled like football inside arm
    3. Mother's antecubital space supports baby's bottom
    4. Mother's hand supports baby's head
  4. Side-lying position
    1. Mother lies on side Breast Feeding
    2. Baby lies facing Breast
    3. Mother's hand supports baby' head and neck
  5. Australian hold
    1. Baby sits on mothers knee on side of Breast Feeding
    2. Mother's hand supports baby's head and neck

III. Technique: General Pointers

  1. See LATCH Score for Breastfeeding Assessment
  2. Technique
    1. Avoid baby straining for nipple
    2. Baby starts with wide open mouth for latch-on
    3. Infants Tongue positioned under nipple
    4. Do not block infant's nares with Breast
    5. Infant's chin should be pressed into the mother's Breast
    6. Use finger to break infant's suction
    7. Breast Feeding should not be painful after the first 30-60 seconds of latching on
    8. Infant should have a rhythmic suck and swallow feeding pattern
  3. Ensure that infant latches on to entire areola
    1. Use C-Hold to support Breast and direct latch-on
    2. Avoid baby latching onto only nipple
      1. Results in nipple soreness and fissures
      2. Infant should latch on to as much of areola as possible
  4. Encourage infant to empty both Breasts at each feeding
    1. First 4 minutes yield 80-90% Breast Milk (foremilk)
    2. Hindmilk contains more calories and fat than foremilk
    3. Alternate the starting Breast with each feed
      1. Start left Breast with this feed (finish on right)
      2. Start right Breast with next feed (finish on left)
  5. Anxiety and Fatigue decrease milk quantity
  6. Not all crying indicates hunger
    1. Avoid using the Breast as a Pacifier

IV. Technique: Initiating Feeding

  1. Anticipate events that may negatively impact nursing
    1. Prolonged labor
    2. Cesarean Delivery
      1. No impact on nursing if started within 2 hours
      2. Cup feeding preferred if supplementation needed
        1. Howard (2003) Pediatrics 111:511-8 [PubMed]
    3. Intrapartum Narcotics
      1. Butorphanol (Stadol)
      2. Nalbuphine (Nubain)
      3. Narcotic Epidural Anesthesia (not Marcaine alone)
  2. Encourage early initiation of Breast Feeding
    1. Start Breast Feeding as soon as possible
      1. Delay nursery routine until after hour 1 of bonding
        1. Do not delay Resuscitation measures
        2. Delay weight and length measurement
        3. Delay prophylactic ocular Antibiotics
        4. Delay intramuscular Vitamin K
      2. Healthy baby on mother's Abdomen x1 hour after NSVD
      3. Attempt Breast Feeding within 2 hours of cesarean
    2. Advantages of early Breast Feeding
      1. Improves maternal-infant bonding
      2. Higher rate of continued nursing at 2-3 months
      3. Sooner feeding means sooner let-down
  3. Encourage infant rooming-in mother's hospital room
  4. Avoid supplementation unless weight loss approaches 10%
    1. Consider Breast Pump to stimulate milk production
  5. Feed on Demand (not on a strict schedule)
    1. Initially expect frequent feedings (every 1-2 hours)
    2. Expect 8-12 feedings per 24 hours in first few months
  6. Avoid Nipple confusion in first few weeks of Lactation
    1. Avoid initial Pacifier use
    2. Use alternative to bottle if supplementation needed
      1. Finger feeding
      2. Supplemental Breast kit
  7. Indications to wake baby for feeding
    1. Sleeps longer than 3-5 hours between feeds
    2. Infant falls asleep after only 5-10 minutes feeding

V. Signs: Effective Breast Feeding

  1. Baby nurses every 1.5-3 hours (8-12 times daily)
    1. Intake 2-10 ml per feed at <1 day of life
    2. Intake 5-15 ml per feed at 1-2 days of life
    3. Intake 15-30 ml (1/2 to 1 oz) per feed at 2-3 days of life
    4. Intake 30-60 ml (1 to 2 oz) per feed at 3-4 days of life
    5. Intake 60-120 ml (2-4 oz) per feed at 5 or more days of life
  2. Stools
    1. Stools per day: 1-2/day for the first 2 days, then 6-8 per day
      1. Reevaluate for adequate feeding if <3 stools/day after 4 days of life
    2. Stool color
      1. Dark Green to black for first 1-2 days
      2. Green for the next 2 days
      3. Yellow or tan, soft and seedy afterward
  3. Urine Output
    1. Very wet diapers: 6-8 per day starting by day 4-6 of life
  4. Breasts feel more full by day 2 to 5
  5. Hear and feel baby sucking and Swallowing
    1. Brief pauses in sucking to allow Swallowing
    2. Infant breathing coordinated with suck and swallow
    3. Temporomandibular Joint moves during active nursing
  6. Infant weight
    1. Expect weight loss in week 1
      1. Typically up to 7% loss of birth weight (with 10% requiring intervention)
      2. Typically weight stops falling after 3 days of life
    2. Weight begins to increase by day 4-5 of life
    3. Birth weight regained by day 10-14 of life
    4. First 3 months of weight gain is brisk
      1. Daily weight gain: 14-28 grams (1/2 to 1 ounce)
      2. Weekly weight gain: 110-220 grams (4-8 ounces)

VI. Follow-up

  1. Follow-up for clinic visit within 48 hours of discharge
  2. See Breast Feeding Resources
  3. Lactation Consultation as needed

VII. Prevention: Sanitation

  1. Wash Breast with soap and water (rinse carefully)
  2. Stored Breast Milk
    1. Do not reheat or refreeze Breast Milk after use
    2. Fill bottle with only anticipated needs

VIII. References

  1. Moreland (2000) Am Fam Physician 61:2093-100 [PubMed]
  2. Neifert (1998) Clin Perinatol 25:303-26 [PubMed]
  3. Sinusas (2001) Am Fam Physician 64:981-92 [PubMed]
  4. Westerfield (2018) Am Fam Physician 98(6): 368-73 [PubMed]
  5. Wright (1996) Pediatrics 97:669-75 [PubMed]

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