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Here is my rough sketch of what health care providers in our clinic
could/should be addressing at each stage of pregnancy in relation to bf.
Anyone who finds it useful has my permission to adapt/use it. Anyone who
wishes to suggest changes, please do so. Arly
FIRST TRIMESTER
Bf as the preferred method of infant feeding among health professionals;
multiple health benefits for mother and baby
Breastfeeding management can improve comfort and success, avoiding problems
that may have occurred to pt or her acquaintances in the past.
Support services are available for prenatal bf education, at the hospital,
and after she returns home with baby, during the entire time of
breastfeeding.
Pumps available: manual w/electric hook-ups covered by all
insurance/Medicaid; electric pumps for rent and battery-operated pumps for
sale through LRH and Budge
Prenatal bf class offered once a month at LRH: 3rd Friday, Classroom 3,
7-9 PM, $5/couple (woman is encouraged to include partner in all prenatal
bf education, but can bring a substitute support person if desired)
Nipple assessment; intervention if needed and stability of pregnancy allows
Breastfeeding compatible with return to work
Early breast changes demonstrate body's preparation for breastfeeding.
Breast care: gentle, no "toughening," no use of harsh soaps or alcohol
Dispel bf myths
SECOND TRIMESTER
Milk composition; nutritional and immunological strengths of breastmilk;
physiology of lactation
Benefits of breastfeeding include lower illness rates for babies and less
severity of illness; ease and satisfaction for mother; and lower breast
cancer risk with long-term breastfeeding.
Some leakage possible and normal
Addressing common misconceptions related to milk insufficiency, nipple
trauma, engorgement, maternal diet, breastfeeding can be done discreetly
Father's role in caring for and bonding with baby
THIRD TRIMESTER
In the hospital: feed asap after delivery
Latch-on, positioning: goal is to avoid nipple trauma
Some initial tenderness not uncommon
Frequency and duration of feeds: goals are to bring in good milk supply
and avoid engorgement, plugged ducts
Early pp feeding patterns (sleepy first 24 hours) vs. more normal patterns
Breast care and supplies: pt should be prepared to make an initial outlay
for pump rental and consult if needed (cost will be less than formula
feeding, which is estimated to cost $1,000/year in continental U.S. in
formula and supplies alone, plus increased medical costs in form of
additional doctor visits, prescriptions, days off work, etc.)
Signs of a well-breastfed baby: urine and stool output good (6-8 wet and
3-4 poopy diapers minimum per 24 hours by time milk is fully in--no zero
output days), baby requests and takes 8-12 breastfeedings in 24 hours of at
least 15-30 minutes' duration; baby has good color and appearance, weight
gain and growth, periods of alertness and contentedness.
Exclusive breastfeeding is preferred and nutritionally adequate for babies
who meet the above criteria. Babies who fail to meet these criteria to be
assessed on an individual basis.
Breastmilk expression, storage, and transport.
Unrestricted maternal diet; caution against high use of caffeine and any
self-medication. LC's available to research drug compatibility with bf.
Learning hunger cues.
Learning infant's other needs and reasons for fussiness/crying.
Care of the mother: avoiding mastitis
Introduction of solids no earlier than 4 months, average 6 months
Effect of supplementary bottles on milk supply
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Arly Helm [log in to unmask]
MS, Nutrition & Food Science, CLE, IBCLC
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