Rooming in
Engage in a conversation with a mother regarding 2 aspects related to the importance of rooming-in 24h/day.
To learn how to recognize and respond to her baby’s feeding cues
To facilitate establishment of breastfeeding.
To facilitate mother and baby’s bonding/attachment.
To enable frequent, unrestricted responsive feeding.
To increase infant’s and mother’s well-being (less stress).
To improve infection control (lower risk of spreading infectious diseases).
Describe at least 2 early feeding cues and 1 late feeding cue.
Early cues.
Baby is waking up slowly.
Salivating or rooting.
Putting fingers or fist in or around his mouth.
Vocalizing.
Late cues.
Crying.
Going back to sleep.
Demonstrate to a mother how to safely cup-feed her infant when needed, showing at least 4 points
Hygienic measures for preparation (hands and utensils).
Ensure the baby is fully awake, alert and interested in feeding.
Hold the baby fairly upright for feeds.
Tip the cup so the milk just reaches the baby’s lips.
Let the baby lap the milk at his own pace.
When the baby ends the feed in satiation, hold the baby upright and gently rub or pat his back to bring up any wind.
Look out for and respect satiation cues.
Engage in a conversation with a mother regarding at least 4 different ways to facilitate breastfeeding in order to prevent or resolve most common conditions of the lactating breasts (sore nipples, engorgement, mother who thinks she doesn’t have enough milk, infants who have difficulty sucking).
Frequent skin-to-skin.
24h rooming-in.
Importance of skin-to-skin and rooming-in for both parents.
Infant’s cues, signs of a good latch and milk transfer, infant swallowing, and how to remove a baby from the breast if in pain.
Baby can remain at her breast for as long as he desires.
Unrestricted frequency and responsive feeding.
Avoidance of pacifiers and/or bottles during the first weeks.
Typical feeding patterns: day and night for the first weeks and at least 8 times per 24h, expecting more often during the first week.
Mother’s perception of adequate milk supply (also versus colostrum).
How the mother can confirm reliable and adequate milk production by observing specific signs in the baby.
Breastfeeding takes practice, patience, and persistence
Describe 2 aspects involved in creating a safe environment for rooming-in regardless of method birth.
Monitor mothers according to their risk assessment.
Review equipment, such as call bells, with patients and instruct patients to call for help when feeling tired or sleepy.
Conduct hourly rounding to provide assistance placing infant in bassinet when mothers or caregivers appear to be drowsy or after mother has received pain medications.
Educate families and support persons to transition newborn to the bassinet when mother is falling asleep.
Promote maternal rest by limiting staff and visitor interruptions.
Bassinette properly positioned and secured within mother’s reach.
The baby should be placed supine in the bassinet.
Describe at least 4 reasons why responsive feeding is important
Breastfeeding is facilitated following hormonal surge.
Faster development of milk supply (no delay in lactogenesis II).
Less breast engorgement.
Initial weight loss and gain are within normal limits in early postnatal period.
Mother learns to respond to her baby.
Less crying so less temptation to supplement.
Avoids triggering stress (elevated cortisol levels).
Baby learns to self-regulate intake.
Is essential to nurturing care.
Describe to a mother at least 4 steps to feed an infant a supplement in a safe manner.
Hold the baby fairly upright for feeds.
Allow the baby to drink at his/her own pace.
Baby may need short breaks during the feed and may need to burp sometimes (paced feeding).
When the baby ends the feed in satiation, hold the baby upright and gently rub or pat his back to bring up any wind.
Look out for and respect satiation cues
Describe at least 2 locally available sources for timely infant feeding information and problem management.
PP Follow up visit
Free lactation services through the hospital with IBCLC and CLS
Pediatrician or family practice office
Their local WIC office
Infant feeding phone/help lines (e.g. no phone lines from infant feeding products companies).
Explain to a mother at least 3 safety components to be sure are in place with practicing skin to skin during the postpartum hospitalization and at home, regardless of method of birth.
Infant is correctly positioned:
o STS with head facing the mother
o Mother can see baby’s face
o Baby can raise head and shoulder on its own
o Back is covered with blanket
o Baby is not swaddled
Mother-infant dyad is monitored by staff regularly on the postpartum unit
o Bedrails are raised and properly secured
o No pillows around the baby
o Spaces between the bed and rails are filled
Mother is awake, alert and well oriented
Mother guided to embrace baby in a manner that does not restrict infant from raising head and shoulder
When mother wants to sleep or feels she needs to sleep, infant is placed in bassinet or with another support person who is awake and alert.
Describe at least 2 aspects of responsive feeding (also called on-demand or baby-led feeding) independent of feeding method.
Eliminate restrictions on the frequency or length of the infant’s feeds.
Respond promptly to infants’ cues for feeding, closeness and/or comfort.
Is essential to nurturing care.
Describe at least 2 alternative feeding methods other than feeding bottles
Open cup or spoon
Dropper or syringe
Tube-feeding device with finger
Tube feeding device at the breast
Describe at least 2 ways the healthcare facility engages with community-based programs to coordinate breastfeeding messages and offer continuity of care.
Regular exchange of information with WIC
Sharing the same/similar material with parents.
Forms for automatic referral at discharge.
Explain 2 situations: 1 for the mother and 1 for the infant, when it is acceptable to separate mother and baby while in hospital.
For justifiable medical reasons affecting the mother (e.g. Mother is unconscious or unable to hold her baby).
For justifiable medical reasons affecting the baby (e.g. baby needs respiratory support or is unstable).
Engage in a conversation with a mother of a preterm, late preterm or vulnerable infant (including multiple births) regarding the importance of observing at least 2 subtle signs and behavioral state shifts to determine when it is appropriate to breastfeed.
Breastfeeding at the breast is guided by the infant’s competence and stability rather than a certain gestational/postnatal/postmenstrual age or weight.
How to recognize discrete signs of transition from deep to active sleep and waking up.
Mother is guided not to interrupt the deep sleep stage just for routine feeding.
Mother encouraged to observe her infant’s signs of interest in rooting and sucking.
Mother breastfeeds when her infant shows such signs.
Engage in a conversation with a mother who requests feeding bottles, nipples, pacifiers and soothers without medical indication, including at least 3 points.
Explore the reasons for a mother’s request for a feeding bottle, nipple or pacifier.
Address her concerns behind her request.
Educate on the risks of feeding bottles, nipples or pacifier use, especially on suckling and nutritional status.
Suggest alternatives to calm a baby.
List possible hygiene risks related to inadequate cleaning of feeding utensils.
Explain that suckling from a feeding bottle and nipple may cause breastfeeding difficulty, especially if use starts before breastfeeding is established or bottle use is prolonged.
Suggest that pacifiers may replace suckling, which can lead to a reduction of maternal milk production.
Alert the mother that a pacifier prevents the mother from observing the infant’s subtle feeding cues, which may delay feeding.
Explain that the use of feeding bottles with nipples in preterm infants interferes with learning to suckle at the breast.
Develop individualized discharge feeding plans with a mother that includes at least 6 points.
Review mother’s understanding of her baby’s unique feeding cues,
Review baby’s ability to achieve a comfortable latch,
Review signs of milk transfer with infant swallowing.
Review signs of adequate intake (stools and urine).
Review mother’s understanding of her baby’s need to feed frequently at least 8 times in 24 hours or more.
Review with mother the importance of eye-to-eye contact with baby while feeding.
Remind mother to let the baby finish nursing on the first breast, then offer the other breast until the baby seems satisfied by releasing the breast.
Review mother’s position (how she holds baby) to assure comfortable, pain-free feeds.
Review mother’s understanding of ensuring / enhancing milk production and let-down.
Review mother’s understanding of hand-expressing colostrum/breastmilk and why this is helpful.
Reinforce mother’s awareness of risks of other fluids and importance of exclusive breastfeeding for 6 months.
Reinforce mother’s awareness of risks and uses of pacifiers and teats.
Reinforce that very few medications or illnesses are contraindicated during breastfeeding.
Provide mother with accurate sources of information and how to get help if needed.
Provide the mother with information for continued breastfeeding and general health support in the community.
Remind mother that adequate food and drinks support her general health because special foods are not needed for breastfeeding.
*as applicable* Appropriate guidance specific to the mother-infant dyad.
*as applicable* Reinforce mother’s understanding of the importance of setting up a safe environment for breastfeeding.
*as applicable* Observe mother’s ability to correctly use and care for her breast pump.
*as applicable* Observe mother’s ability to correctly prepare and use infant formula.
Engage in a conversation with a mother separated from her preterm or sick infant regarding at least 2 reasons to be with her infant in the intensive care unit.
She will help her baby heal and grow better.
She will be able to breastfeed sooner and better.
She will be able to express breast milk more easily.
She can feed her baby (using tube or other means).
Her baby needs her touch, her warmth and her voice.
When the mother is not able, the presence of significant others is also important.
Describe at least 4 elements to assess when a mother says that her infant is crying frequently.
Mother’s expectations of how a baby behaves.
What strategies she has used to calm her baby.
Mother’s response to infant’s cues for feeding.
Baby’s needs for closeness and/or comfort.
Signs of good positioning and effective latching.
Suckling, swallowing, and milk transfer.
Infant’s feeding patterns.
Infant’s sleep-wake patterns.
Mother’s level of anxiety or tiredness.
Describe at least 4 elements of anticipatory guidance to give to a mother on calming or soothing techniques before or as alternatives to pacifiers.
Offer the breast again.
Skin-to-skin with mother or support person.
Hold the infant.
Walk, move around.
Rock.
Sing.
Interact with the baby.
Massage.
Describe to a mother at least 4 warning signs of infant undernourishment or dehydration for a mother to contact a health care professional after discharge.
Usually sleeping for more than 4 hours.
Baby apathetic.
Irritable or weak cry.
Always awake.
Never seeming satisfied.
Inability to suck.
More than 12 feeds per day.
Most feeds lasting more than 30 minutes.
No signs of swallowing with at least every 3–4 sucks.
Scant urine per day.
No stools per day.
Fever.
Describe an acceptable time is for introducing a pacifier to a breastfeeding infant, with regards to SUID/SIDS reduction strategies.
If an informed decision is made, pacifiers may be introduced in the breastfed infant after breastfeeding is well established, usually after approximately 4 weeks.
Describe at least 3 warning maternal signs for a mother to contact a health care professional after discharge
Persistent painful latch.
Breast lumps.
Breast pain.
Fever.
Doubts about milk production.
Aversion to the child.
Profound sadness.
Any doubt about breastfeeding self-efficacy.