This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
Breastfeeding Problems
Reflection
A lady I was looking after today on the postnatal ward was having problems breastfeeding. Baby had been reluctant to latch on yesterday and had been given a bottle of formula at teatime last night. During the night baby had again not latched on at all, but mum had managed to express a few millilitres of expressed breast milk on 3 occasions, which she had fed to baby successfully.
This morning after introducing myself to mum she requested a bottle of formula, which I gave her, when I went back to chat to her she had fed baby 60mls and both she and baby were asleep.
When I went to see her later she had said she had attempted to breastfeed baby again unsuccessfully and was about to express some more colostrums. She managed another few mls and fed baby straight away.
As I wasn’t 100% sure about expressing, as I hadn’t seen anybody using this method of feeding for such a sustained period I consulted the nurse in charge who advised a top up with formula at this point. Baby took another 30mls and was satisfied.
In the afternoon I asked my patient how she was managing with her feeding. She said she was still really keen to breast-feed but was very worried her baby wasn’t getting enough from the EBM alone her partner echoed this concern.
I showed the patient the breast feeding room and fridge which she was unaware of previously and asked her to call a midwife before she attempted to feed baby next so that we could help to support her and assist her with positioning and technique. I suggested that perhaps she needed to express more frequently in the meantime to build up the amount she was able express,
However as I wasn’t as familiar with expressing I would again consult with a senior colleague about the frequency and amount that this should be carried out.
This time I spoke to a different midwife she advised me that even a tiny amount of colostrum was much more beneficial than a larger amount of formula and that even 2mls would satisfy a baby for about 4 hours. I was quite surprised by this but felt it was very good to know as parents had frequently tried to equate breastfeeding with the amount of formula. The midwife also pointed out that my patient should not increase the frequency or duration of expressing and that 10 mins either side every 4 to 6 was all that was required, as excessive expressing could cause discomfort to mum.
She said that it was good idea to see mum before she attempted the next feed and that we would try to find ways of enabling her to breastfeed successfully.
At the next feed mum called us to help. She had changed baby and dad was with her and being very encouraging, but again baby was reluctant to attach. The midwife got him latched on a couple of times and baby did manage to feed for five mins before coming off and becoming distressed. Attachment was attempted for about 20 minutes but as baby was getting upset and mum was tired mum expressed a little more EBM.
After reading up a bit more on expressing, I discovered that it is actually beneficial to feed no less than 4 hourly to keep the stimulus for milk production, although this is was based on more regulated feeding with breast milk and not in the early stages with colostrums.
I also ascertained that expressing only even with the best of intentions and regularly expressing the milk supply can dry up, particularly if its being missed at night when the prolactin is produced. In addition the action of babies sucking motion is different to the action of the expressing pump, which also plays a part in diminishing supply.
I was able to share my new knowledge with mum the next day and she was keen to keep persevering with putting baby to breast, followed by trying with the nipple shields and then with expressing and feeding EBM. Before going home I gave her lots of information about support groups and about contacting her midwife for help if she required it.
last updated 05/06/07
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