Several weeks ago I posted a draft version of a handout that I develeoped
for our med/surg floor.  After many revisions using the wonderful LACTNET
wise ones suggestions, I have completed the handout.  I've been asked to
give a presentation using this at the med/surg nurse staff meetings next
month.  For those of you working in the hospital setting you know we take "
baby steps" to institute change and compliance.  I've been to the OR staff
meeting last month and hope to be invited to the Education Dept in the
coming months.  thanks again for your assist.  Feel free to copy and use
whatever parts you like.

Tip Sheet
Caring for the breastfeeding mother that is hospitalized

If a bfding mother is admitted to med/surg/ICU,  please leave a message for
Lactation @ 6-3119 or pager 6234

Ask the mother how/if she plans to maintain her milk supply while she is
separated from her nursing child.  Maintaining lactation during temporary
separations is strongly recommended.   Protecting the breastfeeding
relationship is important not only for the baby¡¦s nutrition and health, but
for the mother¡¦s well being.  Abrupt weaning leads to painful engorgement
plugged ducts and a high likelihood of mastitis. There are only 2 medical
contraindications to breastfeeding ¡V HIV ( in developed countries) and HTLV-
I (human T-cell leukemia virus type 1).  Most medications except for
antimetabolities and drugs of abuse are compatible with breastfeeding.

Does the child feed from a bottle with ¡§ formula¡¨ or human milk?  This
answer may determine her options.  If the child has never had a bottle it
may be too much to expect being separated from the mother plus learning a
new way to eat.

Options
1.    Child rooms in with mom (with a family member or friend on hand to
       help with baby care-this is not the responsibility of the nurse
       caring for the mom).  Baby continues to nurse "on demand".
2. Child be brought to mom to nurse off and on during hospital stay (may
need to pump additionally to maintain q 2-4 hrs feeding pattern depending
on age of child).
3. Mom pumps q 3hrs x 10-15 min double and milk is taken home to baby.
4. If she chooses to wean, provide her with conforming ice packs for the
breasts x 10-min q 2 hrs and ask MD for order for Motrin to reduce
inflammation and pain.  She may use a breast pump or manually express small
amts. of  milk to ¡§ take the edge¡¨ off the pain when she feels necessary.
Most insurance companies will not cover the expense of use of electric
breast pump kit for use with weaning. (Approx. $80).

The first option will optimally maintain the mother¡¦s milk supply but may
not be preferred by the mother.



Electric Breast Pump, Uses

Critical Elements
1. Mother/nurse wash hands
2. Plugs machine in
3. Opens double breast pump kit
4. Connects tubing to breast pump
5. Instructs mother to:
„Y Start on minimum suction and increase gradually
„Y Pump for 10-15 minutes each time with double pump
„Y Pump every 3 hours or follow child¡¦s feeding pattern
6. Instructs mother on milk storage (see next sheet)
7. Instructs mother to release suction by tipping breast shields off breast
before turn machine off
8. Documents on teaching sheet
„Y Time pumped
„Y Patient¡¦s response ¡V appearance of nipple tips
9. Instructs mother to clean pumping unit
„Y Remove tubing from breast shield unit
„Y Unscrews bottles from breast shield unit
„Y Store breast milk (see below for storage times)
„Y Removes valve from breast shield
„Y Washes bottles, breast shields and valves in lukewarm soapy water

„Y Rinses in clear water
„Y Places on clean towel to air dry


How to obtain an electric breast pump and kit

1 Ask MD to order an electric breast pump so insurance may cover cost.
2 Sign out the pump on the 3rd floor equipment sign out sheet.
3.   Order electric breast pump kit from distribution.
4.    Return pump to 3rd floor and sign it in on the equipment sheet after
pt is discharged.

If you ¡§ borrow¡¨ a breast pump kit from 3rd floor par cart, please bring
pt¡¦s sticker.  It needs to be placed on the taggit card so the 3rd floor
does not come up missing an item.

Storage of breastmilk

( May store labeled milk on 5th floor in pt¡¦s room in pink basin filled
with ice.  Send milk home with child¡¦s care provider everyday.)


Freshly expressed breast milk (in sealed container)
Freezer - 2 weeks in freezer compartment located in inside refrigerator
      3-4 months in separate door refrigerator/freezer
      6 months or longer in deep freezer (0 degrees F or less)
Refrigerator ¡V 8 days
Room temperature ¡V 12-24 hours (colostrum), 6-10 hours (mature milk)

Previously frozen breast milk (thawed in refrigerator or under warm running
water)
Freezer - do not re-freeze
 Refrigerator - 24 hours
 Room temperature ¡V 1 hour
Lactation Office 706-3119 pager 6234
Office hours
0800-1630 Mon - Sat
0900-1300 Sunday
Betsy Ayers RN, BSN, IBCLC
Nancy Campbell Adams RN

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