Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
 Objective 8:
Nurses’ role
 Objective 9:
Positions
 Objective10:
History and
trends
Section 4
Section Four Contents:
 Objectives 8-10
 Topics
Nurses’ role in assessing and
encouraging breastfeeding
Breastfeeding positions
History and trends that surround
breastfeeding in the United States and
internationally
2
Objective 8
 Discuss the
role of the
nurse in
assessing and
encouraging
the
breastfeeding
dyad.
3
Breastfeeding Support
 When supporting normal
breastfeeding, suggest the
mother focus on getting
comfortable and give
encouragement rather than
instructions (Mohrbacher, 2010, p. 29).
4
U.S. Pediatrician Christina Smillie (2008)
emphasizes to mothers that “there is no
one right way to do this” and focuses
instead on:
 Displaying confidence that
breastfeeding will work.
 Encouraging the mother to talk to her
baby.
 Reassuring the mother that her baby’s
actions are normal (Mohrbacher, 2010, p. 39).
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Assessment of Mom
 Important to know what questions to ask.
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Breast surgery history
Past breastfeeding experience
History of sexual abuse
History of hypothyroidism?
History of Polycystic Ovarian Syndome?
Nipple concerns (inversion, flat)
Production concerns
 All mothers should be assessed for potential
lactation issues prior to discharge.
6
Assessment of Infant
How do you know
when an infant
wants to eat?
 Infant Feeding
Cues – Hand to
Mouth
Image taken by Jennifer DeJong, Carolyn, Spring 2008.
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Rooting
Image taken by
Jennifer DeJong,
Carolyn rooting on
blanket, Spring
2008.
May even root
on inanimate
objects –
anything that
brushes
against their
check or lips.
8
Licking Lips
Image taken by Jennifer DeJong, Carolyn, Spring 2008.
9
Crying is a LATE sign of hunger…
 Would have been best to
feed this baby in the Quiet
Alert State, noted in picture 2
Images taken by Jennifer DeJong, Carolyn, Spring
2008.
10
To latch the baby on breast
Baby must be ready to feed
Don’t latch baby when crying
Tickle lips
Undress baby (skin-to-skin)
Proper alignment with mom (belly to mom;
chin to breast, nose to nipple)
 Be patient
 Quickly pull baby to breast when mouth is
wide open





11
How to Assess Attachment: Look
 Nipple
disappears
 Nose and chin
close to breast
Image taken by Jennifer DeJong, Carolyn, Spring 2008.
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 What is your
assessment of
this baby’s
alignment?
 What is your
assessment of
this baby’s
latch?
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Assessment
of Latch:
Feel
 Ask mother how
it feels: should
be a deep firm
pull with out
extreme pain
 Many women
are surprised by
the strong
tugging and
may not
experience it as
pleasant at first
Image taken with permission by Jennifer
DeJong, Amy’s baby’s baptism, Spring 2012.
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Breastfeeding Assessment Tools
 Replace vague terms as “BF well, fair,
poor”
 IBFAT ( Infant Breastfeeding Assessment
Tool, Matthews)
 MBA (Mother Baby Assessment Score,
Mulford)
 SAIB ( Systematic Assessment of the Infant
at the Breast, Shrago & Bocar)
 LATCH tool ( Jensen, Wallace & Kelsey)
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0
1
2
Feeding not
observed
L
Too sleepy or
reluctant
No latch achieved
Repeated attempts
Hold nipple in mouth
Stimulate to suck
A
Grasps breast
Tongue down
Lips flanged
Rhythmic sucking
None
A few with stimulation
"Did you hear your
infant swallow? How
frequently did you hear
it?"
T
Inverted
Flat
Spontaneous and
intermittent
24 hours old
Spontaneous and
frequent
24 hours old
Everted (after
stimulation)
C
Engorged
Cracked, bleeding,
large blisters, or
bruises
Severe discomfort
Filling
Reddened/small blisters or
bruises
Mild/moderate discomfort
Soft
Non-tender
"Are your nipples
tender? Are your
breasts becoming full
and heavy?"
Latch
Audible
Swallowing
Type of Nipple
Comfort
Breast/Nipple
H
Hold
(Positioning)
Full assist (staff holds Minimal assist (i.e., elevate No assist from staff
infant at breast)
head of bed; place pillows Mother able to
for support)
position/hold infant
Teach one side; mother
does other
Staff holds and then mother
takes over
"How easily did your
infant grasp your
breast? Did it take
several attempts?"
"Do your nipples stand
out or do they flatten
easily?"
"Did someone help you
put the infant to
breast? Would you like
help with the next
feeding?"
Used with permission by: Sage Publications
16
NCLEX-Type Question
 Which of the following may
indicate a poor latch?
– A. Maternal pain
– B. Trauma to the breast or nipple
tissue
– C. Dimpling of the infant’s cheeks
– D. All of the above
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Even with Latch Difficulties…
 Keep the baby next to mother
 Feed the baby breastmilk
 Keep the baby “in love” with the
mother’s breast (Pessl, 2011).
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Ending the Breastfeeding Session
 Breaking the
latch
 Burping the
baby
Image taken by Christian DeJong; Mommy Burping Carolyn,
Summer 2008.
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Objective #9
 Compare and
contrast
various
breastfeeding
positions
Image taken by Jennifer DeJong; Amy and
Adeyln, Spring 2012.
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Breastfeeding Positions
Cradle Hold
 Baby needs to be appropriate size
to fit in the crook of Mom’s arm
without head falling back too far.
Image Permission: Laurel Parker,
Concordia Nursing Alum. 7/24/2012.
Image taken with permission by Jennifer DeJong;
Amy, Summer 2012.
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Breastfeeding Positions
Cross Cradle
 Provides mom more
control over latching
due to one hand free
to support breast.
 Useful for large
breasted or engorged
women due to
supporting breast.
Image used with permission; Amy Muehlenhardt with Adelyn,
Summer 2012.
22
Cross Cradle
Hold
(alternate cradle, transition)
“Tee Ball Practice for
babies – to help hold
it!” (DeJong, 2012)
“Training wheels”
for a baby learning to
breastfeed (Wiessinger)
 Helpful with preterm,
late preterm infants,
Down’s syndrome,
anytime needing
more support
Image taken by Jennifer DeJong; John
at T-ball practice, Summer 2012.
23
Breastfeeding Positions
 Under-arm/ Football
Permission from Amy Muehlenhardt; Summer
2012.
Permission from Mary Ramirez; Marissa Funkhouser’s Mom’s Group,
Summer 2012.
24
Breastfeeding
Positions
 Side Lying
Image used with permission from Kristine Sandberg; Marissa Funkhouser’s
Mom’s Group. Approval 7/25/2012. Images taken in July 2011.
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Breastfeeding Positions
Laid Back Position
 Mom uses her body
to support her baby.
 Mother leans back in
any chair or in bed
and positions baby
prone on her
abdomen.
Image used with permission by Laurel Parker, Concordia
Nursing Alum. Permission rcvd 7/24/2012.
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Breastfeeding Positions
Tips for any position




Belly to belly
Nose to nipple
Hips aligned
Use
support/Boppie
Pillow if needed
Image used with permission by Marissa, Summer 2012.
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Breastfeeding Positions
 Tips for any position
 Provide support for
mom and baby so
mother does not
support the baby’s
weight the entire
feeding.
 Emphasize to bring
baby to mom, and do
not let mom lean over
to baby.
Image used with permission from Mary Ramirez; Marissa
Funkhouser’s Mom’s Group, Summer 2012.
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A Nice Review
Click on the image
to watch:
“All About
Breastfeeding
Video” by Gerber
Click on the image to watch:
“All About Breastfeeding Video” by Gerber
2011
29
 Discuss the history
and current trends
of breastfeeding
and lactation
education in the
United States and
internationally.
Objective 10
Stanisław Wyspiański, "Motherhood“
pastel, 1902, National Museum, Warsaw.
Breastfeeding Is Beautiful by Caitlin Smith
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Historically, when Didn’t we
Feed Babies Breastmilk?
 When mothers died in childbirth
 When mothers were ill
 When mothers did not produce enough
milk
 When the “medicalization” of infant
feeding became normal
 When formula companies wanted to
make a profit
31
“They Turned Out ‘Okay’…”
 But, survival does not equal optimal
health (Pessl, 2011).
 Remember, formula:
 Has no living human cells
 May cause GI irritation with possible bleeding
(anemia)
 Has excessive protein and sodium
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Is What we are Doing Best
Practice?
 We must re-evaluate our care and look
at our practices
 We must consistently question what we
are doing
 Are the things we are doing in the best interest of
the mother/infant dyad?
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End of:
 Objective 8:
Nurses’ role
 Objective 9: Positions
 Objective10: History
and trends
Next:
 Objective 11: Best
practices
 Objective 12:
Breastfeeding
Report Card,
Healthy People,
Surgeon General’s
Call to Action
Image taken by Jennifer DeJong,
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