est for baby. educes the incidence of allergies such as asthma and eczema. conomical; no waste.

ntibodies; greater immunity to infections and diseases. tool inoffensive; hardly ever constipated. emperature always ideal.

resh milk.
motionally bonding. easy once established.

igested easily within 2-3hrs.

mmediately available. utritionally optimal.

astroenteritis greatly reduced.

 An infant with galactosemia. Herpes lesions on the mother's nipples. Mother is on a restricted-nutrient diet that prevents

quality milk production. Mother is receiving medications that are inappropriate for breastfeeding, such as lithium or methotrexate. Maternal exposure to radioactive compounds, as could happen during thyroid testing. Breast cancer, HIV (human immunodeficiency virus), and active tuberculosis.

 Ask all women during pregnancy whether they plan

to breast-feed or formula-feed their newborn. Nipple rolling is no longer advised because it could lead to preterm labor. Practicing manual expression of milk may be helpful. Do not use soap on their breasts during pregnancy because soap tends to dry and crack nipples. Women who has inverted nipples may need to wear a nipple cup (a plastic shell) to help the nipples become more protuberant.

 Grasp the dark circle (areola) with your

thumb above and two fingers below. Push in toward your chest wall, then squeeze gently, slowly rolling your fingers toward your nipple but not onto your nipple.

Rotate your fingers around the breast and

repeat the process to drain the entire breast. Collect your breast milk in a clean container. Refrigerate or freeze the milk if you are not going to use it immediately.

1. Assess client's knowledge about breastfeeding and listen to her concerns. Allow time for questions.
Assessment provides a baseline for identifying teaching needs and building on knowledge base.

2. Explore previous exposure to breastfeeding, including any misinformation, misconceptions, or myths. Use visual aids as appropriate.
Exploration provides opportunities for teaching, clarifying, and correcting information. Audio-visual material enhances learning.

3. Initiate a referral to a lactation consultant.

Lactation consultant provides an additional source of support, encouragement, and information.

4. Assist client with attaining a comfortable position, using pillows as necessary for support.
Proper positioning with support aids in client relaxation prior to feeding.

5. Demonstrate various positions to hold newborn, and assist with positioning.

Proper positioning enhances the letdown reflex and promotes latching on. Knowledge of other positions helps to increase client self-confidence.

Cross Cradle Position

Hold your baby across your body as you breastfeed.

This position works well: if you are learning to breastfeed if you have a small baby.

Football Position
This position works well: if you are learning to breastfeed if you have a small baby if you have large breasts if you have flat or sore nipples if you had a caesarean birth if your baby has trouble latching on to your breast.

Cradle Position
Nestle your baby in your arm in a cradle hold. This involves cradling the baby with your arm on the same side as the breast being presented.

This position works well: after you are comfortable with breastfeeding

Side-Lying Position
Lie on your side in bed facing your baby. Use pillows as needed to support your head, back, and upper leg.

This position works well: if you find it too painful to sit if you want to rest when you breastfeed if you have large breasts if you had a caesarean birth

Try different positions. For all positions, check that: Your back and arms are well supported. A pillow behind your back and under your arms will help. Your baby's head and body are raised up to your breast. A pillow under your baby will help. Your baby's chest is facing and touching your chest. Place your baby on his/her side except in the football position. For the football position, place your baby on his/her back or slightly turned to the breast. Your baby's mouth is facing your nipple. Bring baby to you instead of leaning over or pushing your nipple into your baby's mouth.

6. Instruct client in how to elicit rooting reflex and help newborn grasp nipple.

Rooting reflex assists in latching on. Nipple trauma or inadequate milk flow may occur if the newborn latches on improperly

Brushing the infant's cheek with a nipple stimulates the newborn's rooting reflex. The baby will then turn toward the breast. Do not try to initiate a rooting reflex by pressing the baby's face against the mother's breast: this will cause the child to turn away from the mother and toward you. It is important that infants open their mouths wide enough so they can grasp the nipple and areola when sucking. This gives them an effective sucking action and helps to empty the collecting sinuses completely.

7. Advice client to feed newborn on one breast, starting for approximately 10 minutes, and then switch to the other side, gradually increasing the time on each breast with subsequent feedings.

Feeding for too short a time prevents the newborn from receiving the richer, more satisfying hindmilk.

8. Instruct client how to break suction to remove newborn from breast.

Proper removal prevents nipple trauma. As important as making certain that infants grasp the areola is helping them to break away from the breast when they are through feeding. Have the mother insert a finger in the corner of the infant's mouth or pull down the infant's chin. Otherwise, the baby may pull too hard on the nipple and cause cracking or soreness.

9. Instruct client to begin next feeding on breast newborn finished on at last feedings. Suggest client attach a safety pin to her bra on the side to begin the next feeding.

Alternating breasts ensures even stimulation and emptying, increasing milk supply. Safety pin acts as a reminder for the client about where to begin.

For additional feedings, an infant should be placed first at the breast at which he or she fed last in the previous feeding. This ensures that each breast is completely emptied at every other feeding. Milk forms in response to being used. If the breasts are completely emptied, they completely fill again. If half emptied, they only half fill, and, after a time, milk production will be insufficient for proper nourishment.

10. Continue to observe client and newborn interaction with subsequent feedings. Provide feedback and suggestions, reinforcing accomplishments and assisting with any difficulties.
Continued observation provides opportunities for additional teaching and feedback. Feedback and positive reinforcement promote selfconfidence and learning, enhancing the success of teaching and effectiveness of breastfeeding.

11. Instruct client in care of nipples and measures to prevent problems.

Proper nipple care reduces the risk of problems that might interfere with breastfeeding and thus diminish client satisfaction and confidence.

12. Encourage client to wear a comfortable suppoting bra at all times.

Well-fitting bra provides support to full breasts.
13. Advise client to drink at least 4 to 6 8-oz glasses of fluid per day. Adequate fluid intake is essential to maintain an adequate milk supply.