Hospital Based Lactation Programs and Services

Every breastfeeding mother seen by LC without referral or breastfeeding mothers seen only with referral Telephone hotline or warmline postdischarge telephone calls Prenatal classes on breastfeeding Home postpartum visits and assistance with breastfeeding Pump rental and sales Postpartum breastfeeding consults for problems by appointment or open clinic hours Continuing education for staff, area seminars, preceptorships, and breastfeeding classes Research on...

Organizations And Events That Promote Breastfeeding

1978 World Health Organization (WHO) 1979 US Department of Health and Human Services (USDHHS) 1995 World Alliance for Breastfeeding Action 1997 American Academy of Pediatrics 1998 United States Breastfeeding Committee 2000 American Academy of Nursing International Conference on Primary Care Healthy People The Surgeon General's Report on Health Promotion and Disease Prevention Promoting Health and Preventing Disease Objectives for a Nation The International Code of Marketing Breast-Milk...

Acknowledgements

I gratefully acknowledge the contributions to this book made by the following individuals Judy Angeron BA, RN, IBCLC, Coordinator, Lactation Services, Via Christi Regional Medical Center, Wichita, Kansas Kathleen G. Auerbach PhD, IBCLC, Ferndale, Washington Suzanne Bentley MSN, CNM, IBCLC, Clinical Nurse Specialist, University of Kansas, Clinical Instructor, University of Kansas, School of Nursing, Kansas City, Kansas Belinda Childs MN, ARNP, CDE, Clinic Research Coordinator, Mid-America...

Clinical Care Plan

(With permission, Parris KM., 1999). (With permission, Parris KM., 1999). assessment of the baby's mouth is a highly offensive action and would be deeply resented by the mother. One way to avoid inadvertently offending a client is to ask if the baby may be touched and to explain how the baby will be touched before doing so. Avoid causing the mother, the baby, or any other member of the client's family emotional distress as a result of words said, reports written, or other actions that reflect...

Lactation Consultants and Volunteer Counselors

The client is apt to obtain more complete services when lactation consultants maintain a congenial, reciprocal relationship with volunteer counselors as well as other health-care professionals in their community. The volunteer counselor and the lactation consultant provide similar services. They most often differ about where such service is provided, the nature of clinical assistance, and the degree of follow-up care. For example, volunteer counselors are an excellent source of preventive...

The Immune System

The body's overall immune system is known as the systemic immune system. Another immune system, the secretory immune system, invokes surfaces of the body (such as the breast) and acts locally. Lymphocytes in the secretory immune system are different from other lymphocytes. Sensitized to antigens found in the gastrointestinal or the respiratory tracts, these lymphocytes travel through mu-cosal lymphoid tissues (e.g., breasts, salivary glands, bronchi, intestines, and genitourinary tract) where...

I

10 mybp 8 6 4 2 1 .5 present day Genus Homo appears Sub-species Homo sapiens appears Ruminant milks introduced into human diet FIGURE 1-1. The antiquity of lactation.The bottom line shows the approximate times of first appearance of lactating precursors of modern humans and of regular use of nonhuman animal milk by humans. 10,000 years ago, was populated by pre-agricultural peoples who ate a wide variety of fruits, nuts, vegetables, meat (commonly small game), fish, and shellfish. This diet...

Classification of Nipple Function

Protraction Nipple moves forward considered a normal functional response. No special interventions are needed. Retraction Instead of protracting, the nipple moves inward. Minimal An infant with a strong suck exerts sufficient pressure to pull the nipple forward. A weak or premature infant may have difficulties at first. Moderate to Nipple retracts to a level even with or severe behind the surrounding areola. Inter vention is helpful to stretch the nipple outward and improve protractility....

Suckling

Suckling behavior develops early in gestation. Fetuses display a suckle reflex by 24 weeks gestation. By 28 weeks preterm babies can coordinate the suckle swallow breathe cycle at the breast and by 32 weeks can suckle in repeated bursts of more than 10 suckles and maximum suckling bursts of over 30 (Nyqvist, Sjoden, & Ewald, 1999). The precise way in which infants use their oral and facial muscles to efficiently take in nourishment from their mothers' breasts is vital information for health...

Figure

Fluctuation of human placental lactogen and prolactin serum levels in pregnancy and lactation. (From Battin DA et al. Effect of suckling on serum prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol during prolonged lactation. Obstet Gynecol 65 785-8,1985 Tyson JE et al. Am J Obstet Gynecol 113 14-20, 1972 Speroff L, Glass RH, Kase NG. Clinical gynecology, endocrinology and infertility, 4th ed. Baltimore Williams & Wilkins, 1989 283. are highest in the morning (Cregan,...

Breast Assessment

Usually little attention is given to prenatal assessment of the breast and nipples because of Western cultural inhibitions about the breast and lack of recognition of its importance. As a consequence, after giving birth, mothers may experience feeding difficulties that could have been prevented. Nurses and lactation consultants practicing as primary caregivers are the ideal people to perform a prenatal breast assessment, particularly because physicians (especially males) are often reluctant to...

Galactopoiesis

Galactopoiesis is the maintenance of the established milk production (Table 3-1). The breast is not a passive container of milk but an organ of active production that is infant- rather than hormone-driven. The removal of milk from the breasts facilitates continued milk production conversely, lack of adequate milk removal or stasis tends to limit breastmilk synthesis in the breasts. It is the quantity and quality of infant suckling or milk removal that governs breast-milk synthesis. Milk...

Pregnancy

During pregnancy, the breasts grow larger, the skin appears thinner, and the veins become more prominent. The diameter of the areola increases from about 34 mm in early pregnancy to 50 mm postpartum (Hytten, 1954), although there is a wide range of areolar width in any population. As the nipples become more erect, pigmentation of the areola increases and the glands of Montgomery enlarge. Serum hormones stimulate breast growth during pregnancy nipple growth is related to serum prolactin levels...

Workload Issues

Whatever system is used, it is wise to estimate the anticipated workload prior to the start of the lactation service. Most hospital-based programs have been in existence six or seven years and employ two to four LCs who mostly work part-time. Thus one must measure full-time equivalent hours (FTEs) in order to determine the completeness of coverage. For example, in some hospitals, three part-time LCs share seven days per week coverage. The actual number of work hours should be based upon the...

Variations

From woman to woman, breasts vary in color, size, shape, and placement on the chest wall. Lobular size varies within a single breast, from one breast to another, and from woman to woman. Moreover, breast asymmetry is common the left breast is often larger than the right. Areola and nipple color vary according to complexion pink in blonds, browner in brunettes and black in dark-skinned women. Supernumerary breasts (polymastia) and or an accessory nipple may occur at any point along the milk line...

Newborn Oral Development

Breastfeeding Breast Anatomy

Infants perform a series of complex oral movements to obtain sufficient nutriment from their mother's breast to meet daily nutritional requirements and to support rapid growth, especially during the first few months of life. Suckling is a dynamic process, as the infant is continually adjusting to a changing anatomy. The act of suckling is far more than simply obtaining food. The infant's earliest autonomous functions are focused about his mouth and pharynx area. The infant's mouth is the...

Shadowing Guidelines

Seek permission from the preceptor and the client being observed. The facility or LC may welcome you, but the mother may feel uncomfortable. Obey protocols such as wearing scrubs. As an observer, introduce yourself and speak only when appropriate. Take copious notes on what you've observed. Arrange with the preceptor to spend time after the observation period to discuss the cases and ask questions. Always thank the client being observed for her willingness to allow you into her space. Do not...

Mammogenesis

The mammary system is unlike other organ systems. From birth through puberty, pregnancy, and lactation, no other human organ displays such dramatic changes in size, shape, and function as does the breast. The Latin term for breasts, mammae, developed from the infant's cry, mamma, in seeking the breast. In some cultures, female breasts serve more than one function they attract the sexual attentions of the male adult and then give nourishment and nurturing to the suckling infant. The first part...

Hormonal Influences

Lactogenesis II is triggered following the expulsion of the placenta by a fall in progesterone levels and the continued presence of prolactin. A great deal of information about these hormonal functions during lactation is now known through radioimmunoassay FIGURE 3-7. A Gaps between alveolar cells before lactogenesis. B Intracellular gaps close tightly to one another following lactogenesis With permission, Hale T. Medications and mother's milk, 9th ed. 2000 6. FIGURE 3-7. A Gaps between...

Legal and Ethical Considerations

Whenever an LC offers advice or touches a mother or baby, she is risking a potential legal action. The action that is most likely to be brought includes battery when a client does not consent to being touched by another person , breach of warranty meaning that a service promised verbally or in writing is not provided , or the infliction of emotional distress usually through a reckless, intentional, or negligent act that harms the patient Bornmann, 1986 . People usually sue health-care workers...

World Health Organization Breastfeeding 1981

International code of marketing breast-milk substitutes. -. Protecting, promoting and supporting breastfeeding the special role of maternity services. A joint WHO UNICEF statement, Geneva WHO, 1989. -. Baby-Friendly Hospital Initiative A joint WHO UNICEF statement . Launched at the International Pae-diatric Association Meeting in Ankara, Turkey, 1991. -. WHO Global Data Bank on Breast-Feeding. Geneva Nutrition Unit of the World Health Organization, 2000. Wright A, Rice S, Wells S. Changing...

Superbill Lactation Visit Receipt

With permission, Pat Lindsey, 2003 . Medicare, Medicaid and managed care organizations MCOs . Medicare applies to individuals over age 65 and is not applicable for breastfeeding except that insurance companies usually follow Medicare rules for payment. Medicaid is a federal program administered by the states, and state regulations apply to mothers and children who qualify on the basis of poverty. The regulations in various states may differ in billing rules and regulations. About one third of...

HCPCS Codes For Breast Pumps

E0602 Breast pump, manual, any type E0603 Breast pump, electric AC and or DC any type E0604 Breast pump, heavy duty, hospital grade, piston operated, pulsatile vacuum suction release cycles, vacuum regulator, supplied, transformer, electric AC and or DC from payer to payer, and new codes may not be recognized by all payers International Lactation Consultant Association, 2002 . The Reimbursement Tool Kit available from ILCA at www.ilca.org is a valuable source of information. The Healthcare...

Tides in Breastfeeding Practice

Mary Margaret Coates and Jan Riordan Throughout the world today, an infant is apt to receive less breastmilk than at any time in the past. Until the 1940s, the prevalence of breastfeeding was high in nearly all societies. Although the feeding of manufactured milks and baby milks had begun before the turn of the century in parts of Europe and North America, the practice spread slowly during the next decades. It was still generally limited to segments of population elites, and it involved only a...

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Copyright 2005 by Jones and Bartlett Publishers, Inc. Cover image InJoy Productions, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. Library of Congress Cataloging-in-Publication Data Breastfeeding and human lactation edited by Jan Riordan.- 3rd ed. p. cm....

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Jones and Bartlett Series in Breastfeeding Human Lactation Case Studies in Breastfeeding Problem-Solving Skills and Strategies, Cadwell Turner-Maffei Clinical Lactation A Visual Guide, Auerbach Coach's Notebook Games and Strategies for Lactation Education, Smith Comprehensive Lactation Consultant Exam Review, Smith Core Curriculum for Lactation Consultant Practice, Walker, editor Counseling the Nursing Mother A Lactation Consultant's Guide, Third Edition, Lauwers Shinskie Impact of Birthing...