Breastfeeding or nursing is the practice of feeding your baby with breast milk directly from the breast. Experts recommend that new mothers exclusively breastfeed their child within the first 6 months after birth and continue through the infant’s first year of life if possible.
The frequency of breastfeeding will depend on the baby’s size and feeding preferences. Newborns typically feed every 2 to 3 hours. As the baby grows, the frequency changes.
Babies give signs that they are hungry. Initially, the baby may display the following to signal that they are ready to be fed:
- Rooting
- Sticking out their tongue
- Licking their lips
- Placing hands in their mouth
- Sucking on things
- Fussiness
- Crying (late sign)
Breastfeeding is beneficial for both the mother and the baby. Breast milk contains vitamins, fats, and proteins and offers ideal nutrition for babies. Breast milk is easy for the baby to digest and contains antibodies that help fight off infection and prevent allergies.
Breastfeeding can help mothers burn extra calories, return to pre-pregnancy weight, reduce uterine bleeding after birth, and enable the uterus to return to its pre-pregnancy state and size. Breastfeeding also offers an opportunity for mother and baby to bond.
Different breastfeeding positions can help the mother and baby feel more comfortable and relaxed while feeding. These positions include:
- Cradle position
- Football position
- Side-lying position
- Cross-cradle hold
- Laid-back position
Dry and cracked nipples, sore nipples, breast engorgement, breast infection, stress, and worries about producing, pumping, and storing breastmilk are some common breastfeeding challenges.
Nursing Process
Protection, promotion, and support of breastfeeding is a priority public health need. Nurses play an essential role in providing accurate information about breastfeeding and support to the mother and their partner.
The nurse often assists with breastfeeding initially after birth and ensures latching. The postpartum nurse helps encourage and support frequent maternal-infant contact to promote effective breastfeeding.
The nurse’s role in supporting breastfeeding varies in the time and place of care. However, the same goals are present: to help the mother initiate breastfeeding, enjoy it, and ensure the baby gets the optimum nutrition needed for growth and development.
Nursing Care Plans Related to Breastfeeding
Ineffective Breastfeeding
Breastfeeding experiences vary, and ineffective breastfeeding can occur due to many reasons.
Nursing Diagnosis: Ineffective Breastfeeding
Related to:
- Inadequate family support
- Inadequate knowledge of breastfeeding techniques
- Inadequate knowledge regarding the importance of breastfeeding
- Ineffective infant suck-swallow response
- Insufficient breast milk production
- Interrupted breastfeeding
- Maternal breast pain
- Maternal ambivalence
As evidenced by:
- Infant:
- Crying at breast
- Crying within one hour after breastfeeding
- Fussing within one hour after breastfeeding
- Inability to latch on to breast correctly
- Inadequate weight gain
- Resisting latching on to the breast
- Sustained weight loss
- Unsustained suckling at the breast
- Mother:
- Insufficient emptying of each breast during breastfeeding
- Sore nipples persisting beyond the first week
- Perceived inadequate milk supply
Expected outcomes:
- The patient will achieve effective breastfeeding with adequate breast milk intake for the infant
- The patient will efficiently demonstrate breastfeeding techniques and proper breastfeeding positioning and latching
Assessment:
1. Assess the patient’s thoughts and knowledge about breastfeeding.
Assessing the patient’s current knowledge and beliefs can help determine the appropriate breastfeeding information needed and correct any breastfeeding myths.
2. Assess risk factors that can contribute to ineffective breastfeeding.
Addressing modifiable risk factors can enable nurses to provide accurate information and support the development of breastfeeding skills.
3. Perform a breast assessment.
The nurse should assess for barriers by evaluating for sore nipples, engorgement, poor breast enlargement during pregnancy, and a history of breast surgery.
4. Assess the infant’s sucking reflex.
Early intervention of infant sucking problems can help correct the problem. Poor sucking is associated with poor feeding and can lead to complications like poor weight gain for the infant and breast engorgement for the mother.
Interventions:
1. Provide emotional support as needed and allow the patient to express her expectations.
Nurses play a vital role in the establishment and continuation of breastfeeding. Expressing support and allowing the patient to voice concerns promotes understanding and will determine the most appropriate plan of care.
2. Encourage skin-to-skin contact immediately after delivery.
Skin-to-skin holding promotes early breastfeeding initiation, improved milk supply, and breastfeeding duration.
3. Promote comfort and relaxation during breastfeeding.
Discomfort can lead to poor let-down reflexes and premature discontinuation of breastfeeding.
4. Assist in proper breastfeeding positioning.
Proper positioning can promote effective breastfeeding and reduce discomfort. Instruct the mother on multiple positions.
5. Refer the patient to lactation consultants.
Lactation consultants are available inpatient as well as in the community to address ongoing breastfeeding issues after discharge.
Insufficient Breast Milk Production
Several factors can cause low breast milk supply, including delaying the initiation of breastfeeding, and can cause poor infant feeding, low birth weight, and irritable and fussy infants even after feeding.
Nursing Diagnosis: Insufficient Breast Milk Production
Related to:
- Maternal alcohol consumption
- Maternal smoking
- Maternal malnutrition
- Ineffective latching on to the breast
- Infant’s refusal to breastfeed
- Ineffective sucking reflex
- Insufficient maternal fluid volume
- Insufficient suckling time at the breast
- Insufficient opportunity for suckling at the breast
As evidenced by:
- Breast milk expressed is less than the prescribed volume for an infant
- Absence of milk production with nipple stimulation
- Delayed milk production
- Infant frequently crying
- Infant constipation
- Infant frequently seeks to suckle at the breast
- Infant rejects breast
- Inadequate infant weight gain
- Infant voids small amounts of concentrated urine
- Unsustained suckling at the breast
- Prolonged breastfeeding time
Expected outcomes:
- The mother will increase their daily caloric and fluid intake
- The mother will increase breastfeeding frequency and duration while maintaining the correct breastfeeding position
- The infant feeds for 5-10 minutes on each breast
Assessment:
1. Assess how the patient breastfeeds.
Assessing how the patient breastfeeds can guide interventions and promote the best approaches in correcting and improving the breastfeeding experience and breast milk supply.
2. Assess causes of slow milk let-down.
Stress, caffeine or alcohol intake, pain, certain medications, smoking, and cold temperatures can all interfere with milk let-down.
Interventions:
1. Massage the breast.
Massaging the breast prior to feeding can stimulate the nerves to increase oxytocin and milk production.
2. Breastfeed when the baby is hungry.
This may be as often as 8-12 times a day in the beginning. Follow the baby’s cues and feed when they are hungry instead of trying to follow a schedule.
3. Pump in between feedings.
Pumping in between nursing sessions or when away from the baby can help build the milk supply.
4. Provide strategies on how to increase milk supply.
Offering and emptying both breasts during breastfeeding, drinking adequate fluids, and ensuring latch-on can help increase breast milk supply.
Readiness for Enhanced Breastfeeding
The patient’s motivation to learn and initiate breastfeeding can help ensure breastfeeding success. Mothers must be willing to learn and motivated to achieve effective breastfeeding.
Nursing Diagnosis: Readiness for Enhanced Breastfeeding
Related to:
- Confidence to initiate breastfeeding
- Adequate knowledge of basic breastfeeding concepts
- Normal anatomy and function of maternal breast
- Adequate family and peer support
- Interest and willingness to learn
As evidenced by:
- Infant is satiated after feeding
- Infant latches effectively
- Infant displays appropriate weight gain
- Mother expresses satisfaction with breastfeeding
- Mother responds to infant’s feeding cues
Expected outcomes:
- The patient will maintain effective breastfeeding without the need for supplemental formula
- The patient verbalizes understanding and satisfaction with the breastfeeding process
Assessment:
1. Assess for barriers.
A prior history of ineffective breastfeeding, a lack of resources or outside support, and misinformation can all be overcome to enhance breastfeeding.
2. Assess the patient’s feelings about the breastfeeding process.
This can help determine the patient’s motivation and improve the breastfeeding experience. If the mother is unwilling or uninterested in breastfeeding, attempts will be futile.
Interventions:
1. Involve the support of a partner or family.
If the mother has encouragement and help in other areas from a partner or family members, this can enhance her time and ability to breastfeed.
2. Encourage rooming in and breastfeeding on demand.
Patients who room in with the baby have greater chances of initiating exclusive breastfeeding and continuing this after discharge.
3. Ensure a balanced diet and fluid intake.
The mother requires increased caloric intake when breastfeeding and should be encouraged to drink plenty of water to support milk production.
4. Refer to WIC and community groups.
Referrals to professionals (such as Women, Infants, and Children) with special skills in breastfeeding and peer support programs help promote continued breastfeeding.
References
- Breastfeeding. Better Health. NHS. 2022. From: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/
- Breastfeeding FAQs: How Much and How Often. KidsHealth. Reviewed: November 2019. From: https://kidshealth.org/en/parents/breastfeed-often.html
- Breastfeeding. HealthyChildren.org. 2022. From: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/default.aspx
- Breastfeeding. Office on Women’s Health. Updated February 18, 2021. From: https://www.womenshealth.gov/breastfeeding
- Breastfeeding. World Health Organization. 2022. From: https://www.who.int/health-topics/breastfeeding#tab=tab_1
- The role of the nurse in support of breastfeeding. Auerbach KG. J Adv Nurs. 1979 May;4(3):263-85. DOI: 10.1111/j.1365-2648.1979.tb03008.x. PMID: 256572.
