March 2016 (Adapted from UNC Nursing Policy NURS 0067)

March 2016 (adapted from UNC nursing policy NURS 0067)

UNC Newborn Nursery

Breastfeeding Information for Providers

Key Points:

·  Breastfeeding and human milk are clearly recognized by the World Health Organization and every U.S. professional organization of maternal child health care providers as optimal feeding for all infants.

·  Breastfeeding significantly decreases the incidence and severity of many common childhood illnesses, including otitis media and diarrhea, as well as childhood obesity and heart disease later in life. Women who breastfeed have a decreased incidence of osteoporosis, hip fractures later in life, and breast and ovarian cancers.

·  Contraindications to breastfeeding include infants born to mothers who are HIV positive, mothers who are Hep C positive WITH cracked or bleeding nipples, or infants with galactocemia.

Breastfeeding at UNC:

·  In an effort to protect breastfeeding, North Carolina Women’s Hospital prohibits all promotion of and group instruction for using breast milk substitutes, feeding bottles and nipples.

·  NC Women’s Hospital does not receive free infant formulas or infant feeding supplies from human milk substitute manufacturers or their representatives.

·  Pacifier use other than for medical reasons is also discouraged in North Carolina Women’s Hospital in an effort to protect breastfeeding. Because existing data do not differentiate whether pacifier use causes disruption of breastfeeding or simply is a marker of breastfeeding difficulties, it is most prudent to advise parents to use pacifiers only when necessary.

Skin to Skin:

·  Skin-to-skin contact with the mother facilitates thermoregulation of the infant and helps to facilitate breastfeeding success.

·  Skin-to-skin contact can help alleviate respiratory symptoms associated with delayed transitioning to the extra-uterine environment such as mild grunting.

·  Having the uninterrupted opportunity to breastfeed in the first hour and throughout the entire hospital stay is mutually beneficial to mothers and infants. This can help infants at risk for hypoglycemia establish euglycemia.

Early breastfeeding:

·  Colostrum is very calorie-dense and higher in protein than mature milk. It stimulates stooling, and is rich in infection-fighting properties, including immunoglobulins, which the infant is too immature to produce for several months post-birth.

·  The infant’s suckling stimulates a release of oxytocin in the mother, triggering the milk ejection reflex and a sense of calm and drowsiness, as well as uterine involution.

·  Keeping the breasts well-emptied during the first two weeks postpartum is critical to establishing an adequate long-term milk supply.

·  Feeding must be evaluated qualitatively with the mother to determine effectiveness of milk transfer. Length of time an infant feeds is neither a good indicator of infant intake nor of breast emptying. Numbers of stools and urinations are better indicators in the early postpartum period.

·  Mothers should be taught to identify their infant’s feeding cues. Early feeding cues include rooting, mouthing/sucking on hands or tongue, putting hand to mouth, searching for something to suck. Crying is a late sign of hunger.

·  Breastfed infants should be fed whenever hunger cues are noticed which is called “On Demand Feeding” or at at least 8 times in 24 hours

Donor Human Milk:

·  When mothers’ own milk is unavailable for her infant and supplementation is medically indicated, the infant is ideally supplemented with donor human milk. Donor human milk banks operate in compliance of federal regulations to ensure safe feeding of all recipients. As milk is species specific, the typical infant will react much more favorably to human milk than milk from cows or soybeans.

·  Donor milk needs to be ordered by placing a “Human milk” order in Epic

Formula:

·  Mothers choosing to formula feed need to be educated about the safe preparation of formula

·  Paced bottle feeding should be taught

·  If a mother is requesting formula supplementation, her rationale for requesting should be explored and education regarding normal lactogenesis should be provided.

·  If formula supplementation is medically necessary, an order for “infant formula” needs to be placed in Epic by the provider

Baby Friendly:

UNC is a designated “Baby Friendly” hospital meaning that we adhere to the Ten Steps to Successful Breastfeeding listed below:

1. Have a written breastfeeding policy that is routinely communicated to all health care 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 one 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 breast-milk, unless medically indicated.

7. Practice rooming in - allow mothers and infants to remain together 24 hours a 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 on discharge from the hospital or birth center.