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Breastfeeding Best Practices
P&P
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Show me some LOVE
All About Baby Friendly
100
THIS should be initiated immediately after delivery **PRIZE ALERT: For how long?
What is Skin-to-Skin **PRIZE ALERT: Until the completion of the first feed OR At least 1 hour (if baby is exclusively formula feeding)
100
On the Labor & Delivery Unit, THIS is the name of the special time after each delivery where skin-to-skin contact and breastfeeding initiation take priority.
What is THE GOLDEN HOUR
100
All formula-feeding mothers should be taught to boil the water they use for formula because of THIS reason.
What is: The boiled water kills the Bacteria in the Formula *There is bacteria in formula which can be killed when mixed with water > 158 degrees F.
100
The letters in the term LOVE counseling mean THIS
What are: L- Listen O- Open ended Questions/ Observe V- Validate E- Educate/ Empower
100
THESE are two reasons why Brookdale Hospital is seeking Baby Friendly Designation
What are: 1) To improve the health of our patients 2) To improve the health status of this community 3) To increase/improve breastfeeding rates 4) To implement and standardize breastfeeding best practices and evidenced-based maternity care 5) To implement education and support programs for our maternity patients 6) To earn a distinguished designation and some bragging rights
200
THIS practice allows for on-demand feeding, bonding time, and increases safety and security
What is Rooming-In
200
THIS happens every day on the Mother Baby unit from 1:30pm-3:30pm. It promotes rest for mother and baby, and actually improves rooming-in and breastfeeding outcomes during the night shift.
What is QUIET TIME
200
THIS is important to reduce the likelihood of sore nipples, have a good milk transfer and ultimately, a sufficient milk supply. **PRIZE ALERT: Name 3 things that make THIS effective.
What is PROPER POSITIONING AND LATCH **PRIZE ALERT: Nose to Nipple, Belly to Belly, Skin to Skin, Early/Immediate, Alignment, Mom's comfort, Not just the nipple (must also get areola), suck/swallow, wide mouth
200
It is 2am. A 16 year old first time mom, who exclusively breastfed during the day, is now crying and requesting formula. Using the LOVE counseling method, this is the SECOND thing you should do. **PRIZE ALERT: Demonstrate how you would counsel this mother using LOVE counseling
What is: Ask open-ended questions
200
THIS organization designates hospitals as Baby-Friendly once they have completed all four phases, and had a successful in-person assessment.
What is Baby-Friendly USA
300
The American Academy of Pediatrics recommends exclusive breastfeeding for the first ____ months of an infant's life. After this time frame, ________ feeding (where solid foods are introduced in addition to breastfeeding) is recommended.
What is six months. What is complementary feeding.
300
**PRIZE ALERT** According to Brookdale's Breastfeeding policy, THESE are 3 contraindications to Breastfeeding
What are: *Galactosemia, HIV+, Breast with active herpes lesions, Illicit drug use (Marijuana, Cocaine, Heroin), Active/Untreated TB (*can pump), Fever of unknown origin >104 F, CMV, Mom receiving chemo, Mom on antiretroviral meds, radiation therapy
300
THESE are 3 benefits of breastfeeding for the mother and 3 benefits for the infant
What are: MOTHER: *Lose Weight, Uterine Involution, Decrease postpartum bleeding, lowers risk of breast and ovarian cancer, lowers risk for osteoporosis, Saves Time and Money, Bonding time with baby, Delays ovulation, Natural Birth Control (when done exclusively) BABY: *Higher IQ, More easily digested, immunities, lowers risk for asthma, allergies, obesity, diabetes, diarrhea, ear infections, Chron's disease, Celiac disease, fewer ER visits, lower risk of SIDS, Better antibody response to vaccines
300
A mother is requesting that her newborn be taken to the nursery overnight so she can sleep. THESE are 3 things you could tell the mother to educate her about the benefits of rooming-in.
What are: 1) Mothers actually sleep more soundly and have better quality sleep when babies room-in with them 2) Mothers can better learn baby's hunger cues 3) Rooming-in facilitates breastfeeding 4) Less infant crying and distress 5) Moms gain confidence in caring for baby while experienced help is present 6) Babies have more exposure to bacteria on mom's skin 7) Babies have more stable temps and blood glucose 8) Safer; less chance of misidentification
300
Brookdale Hospital is currently in THIS phase of the Baby Friendly 4-D pathway **PRIZE ALERT: Name the 4 phases of the Baby-Friendly 4D pathway
What is the Development Phase. *PRIZE ALERT: Discovery, Development, Dissemination, Designation
400
**PRIZE ALERT ** THESE are 3 differences between Colostrum and Mature Breastmilk
What are: 1) Timeframe- Colostrum = first few days of life 2) Consistency- Colostrum much thicker 3) Quantity - Colostrum comes in smaller quantity 4) Color - Colostrum more yellow; milk more white 5) Composition- Colostrum has more total protein, IgA (antibodies), lactoferrin, Sodium, Vitamin A, Vitamin C. Colustrum has less fat and sugar than mature milk 6) Benefits- Colostrum passes on immunities, has a laxative effect that helps babies pass meconium and coats the intestinal tract to protect it during future feeds
400
According to Brookdale's Breastfeeding Policy, Artificial Nipples should be avoided REGARDLESS of feeding choice (Breastmilk or Formula). THESE are 2 reasons why artificial nipples should be avoided and THESE are 2 examples of Alternate Feeding Methods that can be used when supplementing.
What are: *Because they mask feeding cues, make it difficult to achieve a good latch at the breast, make it easier to overfeed the baby, poor weight gain, interfere with the establishment of mother's milk supply, mastitis, interfere with mother's ability to understand baby's "language" and needs *What are: Syringe, Cup, Spoon, Finger Feeding, Paced Feeding Method if Nipple cannot be avoided
400
Maria had her baby 36 hours ago. She is unable to express any colostrum/milk. These are 3 things that can lead to a delay in lactation after delivery (Delayed Lactogenesis 2)
What are: **Retained Placenta, PCOS (Polycystic Ovarian Syndrome), Hypothyroidism, High Stress Levels (High Cortisol Levels), Traumatic Birth, Diabetes, Maternal Obesity, Sheehan's Syndrome, Some types of Breast Augmentation Surgery, Anatomic Breast Abnormalities, Insufficient Mammary Glandular Tissue, The use of prenatal SSRIs
400
*****DAILY DOUBLE***** Laura delivered a healthy baby girl 4 hours ago. Laura wants to exclusively breastfeed her baby but her UTOX was positive for marijuana. She is crying and states "You all are terrible! Why won't you let me breastfeed my baby? Isn't breastfeeding better for her?" Using your LOVE counseling skills, THESE are the steps you would follow when speaking with this mom. Also, demonstrate your counseling interaction.
What are: Listen - Allow Laura to speak and share her concerns. Actively LISTEN. Sit next to her, give her your attention Open ended questions- Ask open ended questions to get more information Validate- Validate her concerns and feelings. Let her know you hear her and that her concerns have merit Educate/Encourage- Now is the time to provide education and information about AAP guidelines, Brookdale's policy, drugs in breastmilk, pumping to maintain milk supply, etc. Also, encourage her!
400
THESE 2 Organizations started the Baby Friendly Hospital Initiative
What are: WHO (World Health Organization) and UNICEF (United Nations Children's Fund)
500
We no longer teach mothers to breast or formula feed on a schedule (ie: feed baby every 3 hours). Best Practice is for mother to feed _______, but with THIS time frame and frequency in mind. **PRIZE ALERT: Name 3. Name the one you would see last and state what you would do if an infant is exhibiting this.
What is: *On Demand/ According to infant's cues. While we do not teach mom to stick to any schedule, there should be a frequency of 8-12 feeds in a 24-hour period, with at least one feed occurring at night. **PRIZE ALERT: Feeding Cues- fingers/fist to mouth, turns head, licking lips, smacking sounds, sticking tongue out, rooting CRYING is a late sign. It is hard to feed at this point. We can calm the baby via skin to skin and try again once baby is calm.
500
A 19- year old first-time mother wants to exclusively breastfeed. Using Brookdale's Visitation, Rooming-in, and Breastfeeding policies, THESE are 3 things you would tell this mother that will assist her in reaching this goal.
What are: 1) She can have a support person stay with her 24 hours/day 2) Baby should room-in with her 24 hours/day 3) Observe Quiet Time during the day so she and baby can rest, and night time will be more manageable 4) Put baby to breast 8-12 times/day 5) Baby's feeding cues/ Demand Feeding 6) Breastfeeding Expectations 7) Breastfeeding Classes/ Support groups 8) Many benefits of breastfeeding (for mom and baby) 9) Continued Skin-to-Skin contact
500
***DAILY DOUBLE *** THIS is an example of the difference between equality and equity in breastfeeding practices. Equity is important because exclusive breastfeeding rates are low and vary by THESE sociodemographic factors
What is: *Equality in Breastfeeding practices is ensuring all patients have access to breastfeeding education, support, and best practices. Equity is the practice of ensuring that those patients in greatest need or at greatest risk, get the additional support/resources they need to meet those same goals. *Factors - In NYC, Mothers who are Black/African-American, with Medicaid, and who live in a high poverty neighborhood have significantly lower exclusive breastfeeding rates
500
A mother, who previously expressed a desire to exclusively breastfeed, is now requesting formula. She states, "My breasts are small and they are shaped funny. I don't think my baby is getting enough milk from me." *List the steps in the LOVE Counseling Process and List 3 important questions to ask this mother
What are: Listen, Open-Ended Questions, Validate, Educate/Empower/Encourage What are: 1) Any previous breast surgeries? 2) Baby's I&O past 24 hours? 3) How do you know when baby is hungry? 4) How often have you put baby to breast? 5) any medical hx? (hypothyroidism, PCOS, diabetes) 6) Any pain when breastfeeding? 7) How do you know baby is latched well?
500
In order for a hospital to be designated as Baby Friendly, THESE must be displayed and implemented throughout the hospital **PRIZE ALERT: Name 4
What are: THE TEN STEPS TO SUCCESSFUL BREASTFEEDING **PRIZE ALERT: 1) Have a written breastfeeding policy that is routinely communicated to all staff 2) Train all health care staff in the skills necessary to implement this policy 3) Inform all pregnant women about the benefits and management of breastfeeding 4) Help mothers initiate breastfeeding within 1 hour of birth 5) Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants 6) Give infants no food or drink other than breastmilk, unless medically indicated 7) Practice rooming-in; allow mothers and infants to remain together 24 hours/day 8) Encourage Breastfeeding on demand 9) Give no pacifiers or artificial nipples to breastfeeding infants 10) Foster the establishment of breastfeeding support groups and refer mothers to them at discharge