I. Time For Change: Evidence Based Practice

A. Features of the AAP Policy

B. Table 1: Breastfeeding Definitions

II. The Role Of The Medical Professional In Breastfeeding Support

A. Table 2: Surgeon General's Workshop

B. Language, Actions And Breastfeeding

Table 3: Watch your Language

C. Creating Acceptance

D. The Baby Friendly Hospital Initiative (BFHI)

Table 4: BFHI Baby Friendly Hospital Evaluation

III. Agents For Change

Breastfeeding Issues Inspire Emotions In Medical Providers

IV. Breastfeeding: The Lost Art

A. Human Bonding

B. Inability To Breastfeed Is Critical Emotionally For The Mother

V. The History Of Infant Feeding

A. Wet Nursing

B. The Legacy Of Scientific Motherhood

C. Decline And Fall Of Breastfeeding

D. Female Breasts: A Cultural Paradox

E. The "Right" To Breastfeed Becomes A Legal Issue

VI. Commercial Production Of Artificial Baby Milk (ABM)

A. What Artificial Baby Milk (ABM) Lacks

B. Restricting Sales Of ABM

C. Artificial Baby Milks: A Great Sales Campaign

D. That "Guilt" Thing

E. The Reasons Women Bottle Feed

VII. Human Milk Is Not Interchangeable With Other Nutrient Sources

Table 5: Comparison of Human Milk to ABM

A. Hazards Associated With The Use Of Artificial Baby Milks

B. Known Risks Associated With Artificial Baby Milk

C. What Breastfeeding Provides

D. A Detailed Look At Breastfeeding's Value

1. Sociological Value Of Breastfeeding

2. Breastfeeding Can Save Millions In Health Care Dollars

Table 6: The Cost of NOT Breastfeeding

3. Breastfeeding Is Economical For Individual Families

VIII. Relative Contraindications To Breastfeeding

IX. Anatomy Of The Breast

A. Breast Size

B. External Anatomy

1. Table 7: Internal Anatomy

2. Table 8: Microscopic Anatomy

3. Table 9: External Anatomy

C. Breast Growth In Pregnancy

D. Involution Of The Lactating Breast

X. Types Of Breastmilk

A. Colostrum

B. Transitional Milk

C. Mature Milk

XI. Milk Production

A. Lactogenesis

B. Neuroendocrine Pathways - Hormonal Controls Of Lactation

1. Prolactin

2. Oxytocin   MER

C. Supportive Hormones.

D. Cellular Manufacture Of Milk

C. The Process of Engorgement

XII. Closer Look At The Components Of Human Milk

A. Protein

B. Lipids

C. Carbohydrates

D. Minerals

E. Vitamins

F. Immunological Components

XIII. Antepartum Educational Needs Of The Mother

A. Common Breastfeeding Myths

B. Breastfeeding Classes

Table 10: Breastfeeding Class Outline

XIV. Antepartum Lactation Assessment

A. Effects of Breast Surgery

1. Lumpectomy

2. Augmentation

3. Reduction

B. History Taking

C. Possible Effects Of Childhood Sexual Abuse On Breastfeeding

XV. Examination Of The Breast

Breast Lumps In Pregnant And Lactating Women

XVI. Preparation For Breastfeeding

Nursing Bras

XVII. Hospital Routines Should Support Lactation

A. Changing Hospital Routines To Support Lactation

1. Labor and Delivery Support

2. The Role Of The Doula

Table 11: Labor Outcomes Using a Doula

3. Labor Medications

a. Table 12: Perinatal Medications

b. The Concern Over Epidural Anesthesia

B. First Contact

C. Newborn Procedures

D. Nursery And Postpartum Routines

1. The Problem With Bottles

2. Routine Supplementation

3. Baby Needs Access to the Breast Around the Clock

4. Avoid Take Over Behavior

E. Assessment Of Feeding Components

F. Neonatal Weight Loss

G. Primary Failure Of Lactogenesis

XVIII. Continuity Of Information

Table 13: Keys for Nurses

A. Discharge Instructions

B. Critical Discharge Instructions

XIX. The Latch-On Process

 

A. Positioning

B. Breast Support

C. Rooting/Offering the Breast

D. Latching On

E. Is The Latch Correct?

F. Taking The Baby Off The Breast

G. Schedule Of Feedings : Newborn Feeding Patterns

H. Positions For Breastfeeding

1. Madonna or Cradle Hold

2. Side Lying

3. Football Hold

4. Positions for Twins

Table 14: Latch On

Table 15: Madonna

XX. Special Circumstances

A. Maternal Complications

1. Cesarean Section

2. Maternal Diabetes

3. Severe Illness In The Mother

B. Infant Complications

1. The Baby With Low Blood Sugar

2. Neonatal Jaundice

Table 16: Comparison of Jaundice

a. Pathological Processes

b. Neonatal Jaundice Not A Pathological Process

c. Review Of Physiologic Jaundice

d. Review Of Jaundice While Breastfeeding

e. Review Of Breastmilk Jaundice

f. Reducing The Effects Of Newborn Jaundice

g. Phototherapy

C. The Premature Infant

1. Research Proves Mother's Milk Is Best For The Preterm

2. Early Pumping Paramount When Breastfeeding Is Delayed

Table 18: Pumping Instructions for the Mother with a Hospitalized Infant

3. Enhancing Human Milk For Enteral Feedings

4. Oral Feeding Options

5. Managing The First Breastfeedings For The Preterm Infant

a. Positions for Premature Infants

XXI. Breastfeeding Devices

A. Breast Shells/Cups

B. Breast Pumps

C. Manual Pumps

D. Nipple & Breast Creams

Table 19: Breast Creams

E. Nipple Shields

Table 20: Nipple Shield Consent Form

F. Feeding Tube Devices

XXII. Medications And Breastfeeding

A. Medication Table 21

B. Herbs and Breastfeeding Table 22

XXIII. Breastfeeding: The Early Weeks

Postpartum Depression

XXIV. Weaning

XXV. Problem Solving, Lactation Clinic Advice Protocols

A. Standard Rationale In Lactation Practice

Table 23: Suggested Breastfeeding Frequency by Age

B. Latch-on Problems

Table 24: Rebirthing (hands off or laid-back breastfeding) Help for Latch-On Problems

C. Sore Nipples

D. Sore Nipples: Thrush

E. Engorgement

Table 25: Engorgement: The Cabbage Cure

F. Plugged Duct(S)

G. Mastitis

Table 26: Comparison of Plugged Duct, Mastitis, Breast Abscess

H. Breast Abscess

I. Oversupply (Overactive Let-down) Syndrome

J. Slow Weight Gain/Dehydration

K. Failure To Thrive

XXVI. Help For The Breastfeeding Couple

A. La Leche League International

B. Lactation Consultants

Table 27: IBCLE Requirements

XXVII. Case Presentations

A. Sore Nipples

B. Low Milk Supply

C. Fourteen Weeks to Latch-on

D. Breast Abscess

XXVIII. Part Two: Selections for Nurses from: Breastfeeding Basics

A. The First Four Weeks: Mother

B. The First Four Weeks: Baby

C. Questions After the First Four Weeks

D. Family Issues

E. Breastmilk Expression

1. Table 28: Manual Expression of Breastmilk

F. Storage of Breastmilk

G. Working and Nursing

H. Other Issues

XXIX. Resources

XXX. Lactation Terms: Glossary

XXXI. Works Cited

XXXII. Course Test

Copyright Marie Davis, RN, IBCLC 1999

[index]

Last reviewed: Saturday, September 25, 2010