See flow chart D.
Managing breastfed healthy term infants
Healthy term babies may feed enthusiastically at birth and then sleep for many hours. In order to prevent a potential negative effect on a baby’s wellbeing, establishment of feeding and the stimulation of lactation follow the flow chart overleaf from birth for all well, term babies.
Feeding Cues
Feeding cues indicate the beginning of feeding readiness when babies are more likely to latch on and suck and can occur during periods of light sleep as well as when a baby is awake. Cues include rapid eye movements under the eyelids, mouth and tongue movements, body movements and sounds, sucking on a fist. Crying can be a way of indicating that the feeding cues have been missed. Some babies will develop their readiness to feed following delivery. If this doesn’t occur, support should be provided and documented until effective feeding is established.
Syringe feeding
It is useful to give a baby small amounts of colostrum in a syringe. To give a syringe feed safely, the baby should be held in the mother’s arms slightly upright, not flat. The syringe is gently placed in between the gum and cheek and a little colostrum gently squirted in, no more than 0.2ml at a time. Allow the baby time to enjoy the milk. Move onto cup feeding once you have more than 5ml to give. If there is a clinical indication to provide formula or a mother makes an informed choice to provide formula this can also be given in a cup.
Boosting confidence
You can help and support the mother and boost her confidence by teaching her to hand express. Give her a supply of feeding syringes and feeding cups, encourage skin contact, especially in the laid-back position and help her to recognize her baby’s feeding cues. Encourage the mother to offer her breast to her baby when he/she is ready, and to feed her baby expressed breast milk until he/she is breastfeeding actively and effectively. Mother-led feeding will empower the mother as well as saving you time.
If the mother does not want to hand express
The length of labour and the type of birth may influence the mother’s feelings about hand expressing and giving colostrum intensively for the first few hours. The mother may ask to give formula instead (see below). Remember that in order to establish good milk supply, ideally the mother needs to start hand expressing within 6 hours of birth
If the mother chooses not to express colostrum
If the mother cannot, or chooses not to express her colostrum it is the responsibility of the midwife to ensure this is an informed decision based on awareness of the benefits of breastfeeding. This will be documented by the midwife in the woman’s notes. The milk should be given by cup in volumes appropriate to the baby’s age i.e. first day 5-10mls per feed, second day 10-15mls per feed, third day 20mls per feed. Formula should not exceed 20mls per feed once lactation is established.
Recognising effective feeding - ensuring mothers and staff are able to identify
Alert baby, actively sucking that is settled at the breast and ends breastfeeding spontaneously and remains settled for short periods. The feed should be pain free and the baby should demonstrate adequate wet and dirty nappies.