Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Four: Objectives 8-10
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Four: Objectives 8-10
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Four: Objectives 8-10
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
8/5/2013
Try to make this simple.
When supporting normal breastfeeding, suggest the mother focus on getting comfortable and give
encouragement rather than INSTRUCTIONS. (Mohrbacher, p. 29)
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Put value on the mother’s intuition and do not be so prescriptive of how she shall “do” breastfeeding.
(Mohrbacher, 2010, p. 39)
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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When is your baby’s follow-up appointment?
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong, Carolyn, Spring 2008.
◦Rooting
◦Hand to mouth movements
◦Squirming
◦Sucking on hands
◦Smacking lips
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◦Yawning
Encourage breastfeeding on demand.
Early signs of hunger—rooting, hands-to-mouth, mouth activity—need to be pointed out to parents,
especially since newborns often do these with their eyes closed, and parents may miss or misinterpret the
cues. Crying is a late sign of hunger.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong, Carolyn rooting on blanket, Spring 2008.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong, Carolyn, Spring 2008.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Images taken by Jennifer DeJong, Carolyn, Spring 2008.
Would have been best to begin feeding this baby in the Quiet Alert Phase, in picture 1,
than to have waited --- after the crying started. Crying is a late sign of hunger, picture 1.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong, Carolyn, Spring 2008.
Cheeks round and full, no dimpling
Wide angle
Lips are flanged
Suck becomes rhythmic and is sustained
Quiet drawing sound, swallowing, no “clicking” or “smacking”.
Don’t obsess with hearing swallows
Signs of Poor Latch
Maternal pain
Trauma to the breast or nipple tissue
Infant’s nose touching the breast
Frequent moving of the infant’s head
Indentation of the infant’s cheeks
Infant’s lips are not flanged
Section Four: Objectives 8-10
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Could consider taking baby’s hat off.
Remove blanket.
If won’t wake up, take clothes off; change diaper.
Pull baby so her belly is on mom’s belly. (R shoulder more towards mom)
Latch appears okay, but ask mom about pain. Assess nipple.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken with permission by Jennifer DeJong, Amy’s baby’s baptism, Spring 2012.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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This scoring system, developed in 1994, was designed to assist healthcare providers in evaluating the
mother/infant dyad. Each letter of the acronym represents a section of breastfeeding assessment.
Used with permission by: Sage Publications
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Answer: D
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Christian DeJong; Mommy Burping Carolyn, Summer 2008.
• Done at the end of the feeding or if infant latched improperly at start of feeding.
• Improperly breaking an infant’s latch can cause nipple trauma.
• Need to teach parents how to break latch to prevent unnecessary trauma.
• Insert pinky finger into side of infant’s mouth to break suction, slide infant off of breast.
• Burp baby by holding them up under the jaw line and patting (somewhat firmly) on the midback. May also massage baby’s back.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; Amy and Adeyln, Spring 2012.
What do you think?
Is there a “right” way to hold the baby?
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Large image taken with permission by Jennifer DeJong; Amy, Summer 2012.
Small image - Image used with permission by Laurel Parker, Concordia Nursing Alum. Permission
granted on 7/24/2012 to DeJong via email.
• Harder for Mom to assist with latching in this position, but common after breastfeeding is more
established.
• Better position to use once baby and mom have latching figured out.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image used with permission; Amy Muehlenhardt with Adelyn, Summer 2012.
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Section Four: Objectives 8-10
Opposite-side arm from breast encircles the baby, forearm going up the baby’s spine
Baby’s head supported by mother’s hand at the nape of the neck
Mother’s thumb and forefinger encircle nape of baby’s neck
Mother’s palm between the baby’s shoulder blades
Pillows can support the baby at breast level
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; John at T-ball practice, Summer 2012.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image 1 used with permission from Amy Muehlenhardt; Summer 2012.
Image 2 used with permission from Mary Ramirez; Marissa Funkhouser’s Mom’s Group, Summer 2012.
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Section Four: Objectives 8-10
Baby is in side lying position at mother’s side.
Do not let feet sit at back of chair or it will initiate stand reflex and baby will push away from breast.
Useful in mother’s with c-section due to incision across abdomen.
Useful in babies with reflux due to placing infant on incline while breastfeeding.
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image used with permission from Kristine Sandberg; Marissa Funkhouser’s Mom’s Group. Approval
received on 7/25/2012. Images taken in July 2011.
• Need to discuss safety with mom r/t not falling asleep while feeding.
• Useful for mom’s with sore bottoms.
• Useful for large breasted moms due to using the bed to support the breast.
• Useful for sleepy baby due to not cuddled as close to Mom.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image used with permission by Laurel Parker, Concordia Nursing Alum. Permission granted on 7/24/2012 to DeJong via email.
Advantages of mother reclining:
• Baby is using basic reflexes to help him find breasts, gravity helps him and he doesn’t expend energy trying to stabilize himself
• Mother doesn’t need to do so much, isn’t required to “latch” baby
• Most early difficulties with latch can be traced to interference with hospital routines and separation of babies from their
mothers, as well as casual and unnecessary supplementation with bottles and formula
Question:
Placing a baby in skin-to-skin contact with the mother following birthing has all of the following effects, EXCEPT:
Stabilizes the baby’s temperature
Increases mothers release of oxytocin
NO: Decreases the baby’s heart rate
Stabilizes the baby’s respirations
Assists the mother to bond closely with her baby
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image used with permission by Marissa, Summer 2012.
Position baby belly to belly, nose to nipple, and hips aligned.
Baby locates breast by nipple color and scent, allow them to see and smell breast prior to latching.
Baby will latch easier to an erect nipple. Mom may need to roll nipple between her fingers.
Make sure baby has a nice wide open mouth when attempting latch.
Baby should look like it is taking a big bite of a sandwich. Off centered with lower jaw in contact with
tissue first. (CLC training book, 2005)
• Once the breast is drawn into the mouth the infants sucking elongates the nipple to allow the correct
compression to be placed on the milk ducts. (Wilson-Clay & Hoover, 2005)
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Comfortable Latch and Positioning
Infant and mother are comfortably together chest-to-chest, avoiding any gaps.
Align nose to nipple.
Infant’s head tilted slightly back.
Assess that infant’s mouth is wide open.
Help infant onto the breast. Avoid pushing on infant’s head. Support infant firmly behind shoulders and back.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image used with permission from Mary Ramirez; Marissa Funkhouser’s Mom’s Group, Summer 2012.
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Students may want to watch this on their own time.
http://www.youtube.com/user/Gerber?v=Q5aW7xoOOlw&feature=pyv&ad=7361692
495&kw=breastfeeding%20more%3Alabel_breastfeeding%20more%3Apregnancy
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According to Phillipp et al. (2001), the history of monitoring lactation
initiation and duration rates in the U.S. along with implementing the BFHI
includes controversy. Obtaining accurate and unbiased national
breastfeeding prevalence rates has been reported as flawed by
lactation experts because breastfeeding-related data are collected and
analyzed by Ross Products Division, Abbott Laboratories, a U.S.-based
formula company (Cadwell, 1999). Researchers suspect these data may
represent exaggerated conclusions about national breastfeeding
initiation frequencies, especially when any newborn who has received
even a “sip” or more of human milk before hospital discharge is classified
as a “breastfed newborn” according to current definitions. It is alleged
that national initiation rates may be far less than currently reported
(Phillipp, Merewood & O’Brien, 2001).
Culture and Social Norms: United States Perspectives
(Macrosystem)
In the early 1900s, more than two-thirds of mothers in the U.S.
breastfed their infants (Hirschman & Butler, 1981).
Decreasing rates of breastfeeding began to occur following
World War II when more women of child-bearing age
remained in the workforce (Wright & Schanler, 2001), and in
1972, breastfeeding initiation rates reached an all-time low
when only 22% of women breastfed. Rates began to
increase again, from 33.4% in 1975, to 54% in 1980, and
59.7% in 1984 (Martinez & Krieger, 1985) with increased
education and support for breastfeeding.
Although a rise in national breastfeeding rates has occurred
since the mid 1970s, rates remain low when compared to
other developed countries like Sweden where there is a
>98% initiation rate and a 6-month breastfeeding duration
rate of 80%. In contrast, approximately 60% of women in the
U.S. breastfeed either exclusively or in combination with
formula feeding at the time of hospital discharge; only 25%
of mothers breastfeed their babies at 6 months (often
supplementing with formula); and, only 12% of mothers
breastfeed to one year (USDHHS, 2000).
Section Four: Objectives 8-10
According to BFUSA (2009), by December 1998, more than 13,000
hospitals worldwide were designated as BF Hospitals by UNICEF, most of
which were in developing countries. Although 70 or more hospitals in the
U.S., including one hospital in Minnesota (Dodgson, 1999), had filed letters
of intent to become BF-designated institutions, only 20 had completed
this process by August 1999. As of 2001, greater than 16,000 sites
worldwide had received BF designation, but as of June 2000, only 25 of
these sites were located in the U.S. (Phillip et al., 2001). Yet progress is
being made. Since October 2010, there were 84 documented BF
Hospitals in the U.S. and since December 3, 2010, there were 102.
According to the Shealy et al. (2005), there are many different types of
facilities that have achieved BFHI status in the U.S., including very small
facilities serving low-risk, high-income, privately insured clients as well as
very large facilities serving mostly high-risk, low-income, publicly insured,
or uninsured clients. Even military facilities and freestanding birth centers
have achieved BFHI status. Regardless of facility type, however, one
finding is consistent: those facilities that have achieved BFHI designation
have seen improved outcomes for their newborns and mothers as well as
greater patient and staff satisfaction (Kramer et al, 2001).
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Formula still causes the gut irritation (less than before), which is why there is so much iron placed in formula (to
prevent the anemia).
Section Four: Objectives 8-10
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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