Assisting breastfeeding in Neonates

Breastfeeding comprises more than lactation. It adds to the interaction between the mother and baby, her response to his signals and his response to hers, the tactile contact between the nursing couple and the ingestion of milk by the baby.

Lactation is the physiological process that leads to the secretion of milk in alveoli of the female breast, its passage along the ducts due to the “let down” reflex, and its ejection into the mouth of the baby by suckling.

Nurse’s Responsibility in Breastfeeding

Antenatal Preparation

• During antenatal checkup, the nurse needs to help the mother if she has any specific problems relating to breastfeeding, such as the size of the breasts, nipples, etc. Provide strong emotional support after delivery when they are going through a lot of mood swings due to hormonal changes.
• Examine the nipples to see whether they are normal and protractile.
• The care of nipples is necessary to prevent mechanical problems of feeding. If nipples are retracted, they should be pulled out at least once a day.
• Advice the mother to wear appropriate-size brassiere during pregnancy.
• Calculating brassiere size during pregnancy

Measure the rib cage of expectant mother under the breast in inches and add 4-5 inches for an even number. This is the brassiere size (S1) – 32,34 etc. Measure the top of the mother’s breast without a bra on (S2). S2 – S1 = cup size (AA, A, B, C, D, DO, etc.). For example, <1 inch means A.

• Advice the mother to eat a well-balanced diet with extra proteins, calcium, and iron.
• Mother should be informed during pregnancy of the following:
• The advantages of breastfeeding
• The importance of rooming in policy
• The importance of unrestricted feeding
• Correct technique of breastfeeding
• Importance of colostrum
• The mother should be told that the adequate milk is secreted from the third day of the postpartum.

Positioning

Any position that is comfortable to the mother is acceptable because she has to feed frequently and for longer durations. There are many ways a mother can hold the baby to breastfeed.

The most common methods are:

• Indian method: Sitting on the floor cross-legged with one thigh drawn up on which the baby’s back is resting; the mother has her baby close to her.
• Cradle position: Sitting, the mother cradles the baby in her arm.
• Modified cradle position: Sitting, the mother cradles the baby in her arm. Her hand supports the baby’s head and neck.
• Football hold: Sitting or leaning back, the baby is under the mother’s arm with his feet pointing back. His abdomen touches the side of the mother’s chest. The baby’s body is supported by the mother’s arm.
  This position is good for feeding twins simultaneously.
• Side lying position: Lying on her side, with baby facing the mother supports the baby’s head and neck with her arm. This position is comfortable for night feeds and when the mother has a cesarean operation.
• Supine position: Lying on her back with baby’s face down on her chest, the mother’s hand supports the baby’s head on her breast. She uses the other hand to hold the breast and helps the baby attach (latch on) well to the nipple and areola. The supine position helps to avoid pain immediately after cesarean section and makes it possible for a drowsy mother to breastfeed.

In all these positions:

• The baby’s head and body should be in straight line.
• Baby’s face should face the breast, with nose opposite the nipple.
• Mother should hold the baby’s body close to hers.
• Mother should support the newborn’s bottom also, and not just the head and shoulders.

Burping technique

To remove the excess air that entered along with the feed, we can use the following techniques.

• Baby’s chin rests on the shoulder of the caregiver with head and neck supported.
  Hold the baby with one hand and pat the back with another hand (commonly used technique).
• Keep the baby in sitting position on the caregiver’s lap, supporting the chest with base of hand and cupping the chin with thumb and index fingers. Pat the back of the baby with another hand.
• Lay the baby across the lap in prone position with abdomen rest on the thigh of caregiver.

Hold the head higher than the chest and pat the back of the baby.

Care of Breast

• Advice the mother to clean the breast with clean wet cloth from nipple to areola in circular motion before feeding.
• Daily washing is necessary for breast hygiene.
• Brassieres may be worn in order to provide comfortable support and are useful if the breasts leak and breast pads are used.

Signs of Adequate Feeding

• Adequate urine output: An exclusively breastfed baby usually passes dilute urine at least six to eight times in 24 hours except the first 3 days of birth, when the baby is on colostrum.
• Weight gain: For the first 6 months of life, a baby should gain at least 500 g of weight each month or 125 g each week.
• Abundant milk flow in 2-4 days of delivery.
• Correct latch on and rhythmical sucking.
• At least 8-12 feeds/day.
• Baby should appear satisfied after nursing and probably will fall asleep at the second breast.

Expressing Breast Milk

Indications

• Where there is concern about the interval between feeds in the early newborn period.
• Where there are problems in attaching the baby to the breast.
• Where the baby is separated from the mother, owing to prematurity or illness.
• Where there is concern about the baby’s rate of growth, or the mother’s milk supply (expressing to top up with the mother’s own milk may be necessary in the short-term while the cause of the problem is resolved).
• Later in lactation, when the mother may need to be separated from her baby for periods (occasionally or regularly).

Methods of Expressing Breast Milk

• Manual expression of milk
• Expressing with a breast pump
• Hand pumps
• Manually controlled
• Electrically controlled

General Guidelines for Storage of Breast Milk

• The lactating mothers and the family members can be educated about storage of breast milk in home setting.
• Various factors, such as amount of milk, temperature of the atmosphere during milk expression, temperature fluctuations if any in refrigerator and freezer, and hygiene have influence on duration of breast milk storage

Cleaning and sterilization of feeding articles

Procedure

• Rinse the feeding bottle with running water, then using soap solution clean the bottle with bottle brush.
• Mouth of the bottle should be washed first using rotatory movement, then wash the inside and outside of the bottle using the same motion.
• Clean the teat by inverting it.
• Wash all other equipment using the scrubber
• Put all the articles, including feeding bottle, in sterilizer or big vessel containing water.
• Boil for 7-10 minutes after it reaches boiling point.
• Then put all the plastic articles and boil for 3-5 minutes.
• Remove all the sterile equipment from the vessel or sterilizer and place it in sterile container.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
5. Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294.
6. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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