Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
 Objective13:
Difficulties
 Objective14:
Nursing diagnoses
case studies
 Objective 15:
Finding information
on the internet
 Objective16:
Role playing
scenarios
Section 6
Section Six Contents:
 Objectives 13-16
 Topics
Recommended solutions for
breastfeeding difficulties
Nursing diagnoses
Resources and informative websites
Scenarios – Case Studies
2
Objective 13
 Recommend
solutions for
breastfeeding
difficulties
3
“My Baby is
so Sleepy”
 Sleepy Baby
Image used with permission from Justine
MacArthur on 7/24/12. Photo taken in June 2012.
4
“My Baby Can’t Latch Well”
 Difficulty with latch (assess the baby’s
frenulum. Do you see a heart-shaped
tongue?)
 Baby refuses to latch on one side vs. the
other
5
Tools to Support Breastfeeding
 The Nipple Shield
is primarily used
when the infant
will not latch to
the mother’s bare
breast.
 Fit to infant’s
mouth.
Image above is a “Nipple Shield”
6
Tools to Support Breastfeeding
 Breast Pump
 May be needed by
Mom for:
 Infant born premature or
sick
 Nipple soreness
 Being away from infant
 Returning to work
Image from Medela Pump & Style.
7
Supplemental Nursing System (SNS)
 Useful for infants
able to latch but
who need
supplementation
Images provided by Google Image, 2013.
8
“But, I’ve Got Twins!”
 Multiples:
Twins
Image provided by Google Image, 2013.
9
“I Don’t Make Enough Milk”
 Managing Low Milk Supply
 Managing Perception of Insufficient Milk
Supply
10
 In McCann et al.’s (2007) study of
breastfeeding attitudes and reported
problems in a national sample of WIC
participants, breastfeeding mothers were
asked about their own problems with
breastfeeding at the one-month interview;
70% said that they had experienced at
least one of the specific problems listed.
 Thirty-four percent of mothers said they
thought they did not have enough milk for
the infant, and 10% thought there was
something wrong with their milk.
11
Apprehension about
Breastmilk Sufficiency
 Although 71% of mothers agreed that “breast milk
alone gives a new baby all he/she needs to eat”
and 80% agreed that “any woman who wants to
can breastfeed,” fewer (55%) agreed that they had
enough breast milk.
 In this study, concern about insufficient breast milk
was the second-most frequently reported problem at
the one month interview and the most common
problem at three and five months. Apprehension
about breast milk sufficiency was strongly related to
breastfeeding cessation and formula
supplementation.
12
“I’m Too Engorged”
 Causes:
 Treatment:
13
“I Have Sore Nipples”
 Causes:
 Treatment:
14
“I Think I Have Mastitis”
 Causes:
 Treatment:
15
“I Think I’m Sick”
 KEEP NURSING! Continuing to breastfeed
while sick is providing baby with
_______________ against illness.
 Cessation should only occur if directed
by a Lactation Consultant or Provider
.
16
Avoid
Supplementation
Unless:
 Compelling
medical need
 Benefits outweigh
the risks
 Informed
decision-making
by parents
 A plan is in place
to minimize harm
and continue to
support
breastfeeding
Image taken by Jennifer DeJong, Summer
2012.
17
If Supplementation is Needed
 Use small feeds
 Protect maternal milk
supply and maternal
confidence (Pessl, 2011)
 Use smallest amount
needed for the
shortest possible time
18
Objective 14
 Write
appropriate
nursing
diagnoses for
a
Breastfeeding
-related Case
Study
19
Case Study

A 27-year-old mother presents to the clinic for her
child’s 2 month check-up, stating, “I wish I knew
more about preparing and storing milk for when I
go back to work. I just really don’t know what I’m
doing. I’m afraid I’m going to do it wrong, and
that I’m not going to find the time to do it.”

She asks you to instruct her about preparing and
storing expressed breast milk. She is planning to
return to work as a 4th-grade teacher in 3 weeks.
20
 What are
the priority
nursing
diagnoses
for the
case?
Image used with permission from Marissa Funkhouser, “Freezer Stash”, July 2012.
21
Objective 15
 Appraise
lactationrelated
information
available
on the
internet
22
Website #1

www.cdc.gov/breastfeeding/data/report
card.htm
23
Website #2

http://www.cdc.gov/vitalsigns/BreastFee
ding/?s_cid=vitalsigns_081
24
Website #3
 http://www.babyfriendlyusa.org/about-us
25
Website #4
 http://www.lalecheleague.org/
26
Website #5
 http://kellymom.com/
27
Website #6
 http://www.breastfeedinginc.ca/cont
ent.php?pagename=videos
28
Website #7

http://www.drjacknewman.com/
29
Website #8

http://www.goldenstart.info/
30
Website #9
http://www.motherlove.com/mm5/merchant.mvc?Screen=CTGY&
Store_Code=MHC&Category_Code=resources-faq-low-breast-milk
31
Website #10


http://womenshealth.gov/breastfeeding/
http://womenshealth.gov/breastfeeding/government-inaction/national-breastfeeding-campaign/index.cfm
32
Objective 16
Image used with permission from William Burleson, Office of Statewide Health
Improvement Initiatives, MN Department of Health, on 2/10/2012.
 Role-play
selected
scenarios
with one
another
33
Case Study #1
 A 25-year-old mother has just delivered her
first child. She says she is too tired to nurse
and wants you to feed the baby formula
until her milk “comes in.” States, “It’ll be
good for the baby to get used to a bottle
anyway since I have to go back to work in
2 weeks.” What is your response?
34
Case Study #2
 A 27-year-old mother presents to the clinic for her
child’s 2 month check-up, stating, “I wish I knew
more about storing milk for when I go back to work.
I’m afraid I’m going to do it wrong.”
 She asks you to instruct her about preparing and
storing expressed breast milk. She is planning to
return to work as a 4th-grade teacher in 3 weeks.
35
Storage Duration of Human Milk
for Healthy Full-Term Infants
Location
Countertop, table
Temperature
Room temperature (up to
77°F or 25°C)
Duration
Comments
6–8 hours
Containers should be
covered and kept as cool as
possible; covering the
container with a cool towel
may keep milk cooler.
Insulated cooler bag
5-39°F or -15-4°C
24 hours
Refrigerator
39°F or 4°C
5 days
Freezer
Freezer compartment of a
5°F or -15°C
refrigerator
Freezer compartment of
refrigerator with separate 0°F or -18°C
doors
Chest or upright deep
freezer
-4°F or -20°C
2 weeks
3–6 months
6–12 months
Keep ice packs in contact
with milk containers at all
times, limit opening cooler
bag.
Store milk in the back of the
main body of the
refrigerator.
Store milk toward the back
of the freezer, where
temperature is most
constant. Milk stored for
longer durations in the
ranges listed is safe, but
some of the lipids in the milk
undergo degradation
resulting in lower quality.
36
Case Study #3
 A new mom calls into the Ask-A-Nurse
stating that she is worried that she
can’t eat her usual diet because she
is nursing. What is your response?
37
End of:
 Objective13: Difficulties
 Objective14:
Nursing diagnoses case
studies
 Objective 15:
Finding information on the
internet
 Objective16: Role playing
scenarios
Next:
 Objectives 17:
Providing support in a
variety of settings
 Objectives 18:
Impact of public
health
 Objectives 19:
Evaluation of own
community – discuss
ways to support
breastfeeding where
student works and lives
38