Breastfeeding

PURPOSES

1. To ensure proper techniques of breastfeeding.

2. To give proper attachment of the newborn during feeding.
3. To promote comfort both mother and newborn during breastfeeding.

EQUIPMENT

 Pillow (as necessary)

ASSESSMENT

1. Assesses the present health condition and medications taken of the lactating mother if there are
any problem regarding health which may affect the infant.
2. Assesses mother and infant's readiness to perform the technique.
3. Assesses breast and its discharge and if nipples are inverted.
4. Assesses each family individuality to recognize cultural preferences.

PLANNING

Gathers and prepare necessary equipment.

IMPLEMENTATION

6.1 Assumes a comfortable position. A semi reclining like being in a rocking chair or side lying with a
pillow under the head is recommended.

6.2 Brushes or touch the baby's cheeks with the nipple to initiate feeding. Stimulates newborn's rooting
reflex.

6.3 Feeds the newborn on demand for only 5 minutes, increasing the time at each breast by one minute
per day until the newborn is nursing for 10 minutes at each breast making a total feeding time of 20
minutes. Feeding for too short a time prevents the newborn from receiving the richer, more satisfying
hind milk.
6.4 Places the newborn first on the breast where he was fed last. Alternating breast ensures even
stimulation emptying and increasing milk.

6.5 Newborn’s mouth should grasp not only the nipples but also the areola to compress the ducts
behind it. Look for signs of good attachment and suckling to enhance milk ejection. It gives an effective
sucking action and helps to empty the collecting sinuses completely. Making sure that infant's mouth
is wide open gives an effective sucking action.

6.6 Inserts a little clean finger release the suction from the breast then pull the chin gently downward.
This is done to break the seal. Pulling the mouth will cause sore nipples.

Documents for any pain and engorgement of the breast.

SIGN OF GOOD ATTACHMENT

1. More areola is seen on the

2. upper lip Lower lip turned outward.
3. Mouth wide open with chin touching the breast
4. Face of the baby turned towards the breast

NURSING CONSIDERATIONS:

1. A mother should teach how to properly take her newborn off the breast while he or she is
sucking.
2. Advise the mother to place the newborn skin to skin while breastfeeding this will provide the
environment to arouse the newborn to suck.
3. The nurse should guide the mother in adjusting the feeding pattern of the infant to meet its
needs.
4. Instruct mother to choose a comfortable position when breastfeeding.
5. The nurse should provide a feeding plan for the mother upon discharge.

PHYSIOLOGY OF THE MILK PRODUCTION

Colostrum, a thin, watery, yellow fluid composed of protein, sugar, fat, water, minerals,
vitamins, and maternal antibodies, is secreted by the acinar breast cells starting in the 4th
month of pregnancy. After birth, colostrum production continues until it is replaced by
transitional breast milk on the 2nd to  4th day. True or mature breast milk is produced by
the 10th day. The image below shows how the hormonal control of lactation stimulates
the process of milk let down or "let down reflex". (Seeley, 2014)
 Stimulation of the nipple by the baby’s suckling initiates action potentials in sensory neurons that connect with the
hypothalamus.

Hypothalamus stimulates the posterior pituitary to release oxytocin and the anterior pituitary to release prolactin

Oxytocin stimulates milk release from the breast. Prolactin stimulates additional milk production

Milk is secreted

BENEFITS OF BREASTFEEDING
 
B- Est for babies
R - educes incidence of allergies
E  - conomical
A - ntibodies
S  - tool-inoffensive
T - emperature always correct and constant
F - resh
E - motional bonding
E - asy once established
D- igested easily
I - mmediately available
N  - utritionally balanced
G- astroenteritis greatly reduced
 
BREASTFEEDING BARRIERS
 

 Breast Pathology
o
 Flat/ inverted nipples, breast reduction surgery that severed
milk ducts, previous breast abscess, extremely sore nipples
(cracked, bleeding, blisters, abrasions)
 Hormonal Pathology
o
 Failure of lactogenesis, hypothyroidism
 Overall health
o
 Smoking, anemia, poor nutrition, depression
 Psychosocial
o
 Restrictive feeding schedules, mother without support system,
not rooming in with baby, bottle supplementing when not
medically required.
 Other
o
 Previous breastfed infant who failed to gain weight well,
perinatal complication (hemorrhage, hypertension, infection)

BREASTFEEDING TECHNIQUES
POSITIONING AND ATTACHMENT
The positioning of the baby’s body is important for maintaining good attachment
and successful breastfeeding. Most difficulties of breastfeeding can be avoided
altogether if good attachment and positioning can be achieved at the first and early
feeds. (Degefa, 2019)
In order to achieve successful breastfeeding, there are different common positions
that the mother can try before finding the one that will work best for her and the
baby.  
1. Cradle (cross-chest):

The baby lies across mother’s lap; baby’s head lies on her forearm or in her
hand on the side from which she is feeding. His head should not be in the
crook of her arm because that takes him too far out to the side and he has to
 bend his head forward and cannot get his chin and tongue underneath the
nipple.
2. Modified cradle:

The baby lies across the mother’s lap; mother’s opposite arm and neck. This
position is very useful for newborns and very small babies, giving the
mother better control of the baby’s head and neck than the cradle hold.
3. Side-sitting (“football”):

Baby and mother sitting up; baby sits facing mother with his legs under
other’s arm; mother’s hand supports baby’s back and neck. This position is
comfortable after a cesarean delivery because the baby’s weight is away
from the incision. Sleepy babies may stay awake and feed better in this more
upright position
4. Side Lying:
The mother and baby lie side by side with mother’s lower arm extended. 

Enema
Introduction
An enema is a solution introduced into the rectum and large intestine. The action of
an enema is to distend the intestine and sometimes irritate the intestinal mucosa,
thereby increasing peristalsis and excretion of feces and flatus.
 

DEFINITION
An enema is a procedure used to stimulate bowel movement by inserting liquid or
gas through the rectum. An enema may be given to administer medication, to
stimulate bowel movements, or to treat constipation. An enema can even be given
to pregnant women to ease constipation, which is a common problem during
pregnancy.
 
PURPOSES:

 To promote defecation by stimulating peristalsis and loosening stool mass

  To cleanse the bowel prior to surgery, childbirth, or diagnostic examination
 To administer medication to exert a local effect on the rectal mucosa
 To relieve constipation, abdominal distention and fecal impaction

EQUIPMENT

● Clean gloves

● Water-soluble lubricant

● Waterproof, absorbent pads

● Bath blanket

● Toilet tissue

● Bedpan, beside commode or access to toilet

● Washbasin, washcloths, towel and soap

● IV pole

Enema kit with:

● Enema container

● Tubing and clamp

● Appropriate size rectal tube (adult: Fr 22-30)

● Correct volume of warmed solution (adult: 750 to 100ml)

● Prepackaged enema container with rectal tip

ASSESSMENT

1. Checks doctor’s order.

2. Assesses when the client had his/her last bowel movement- amount, color, and consistency of
the feces and presence of abdominal distention as well as sphincter control.

3. Assesses the client’s ability to use a toilet or commode or must remain in bed and use a bedpan.