Oxford Handbook of Midwifery (143 page)

Clinical experience suggests that judicious use of a thin silicone shield may benefit mothers with severely traumatized nipples, but they should never be used as a substitute for teaching the mother how to correct the problem of sore nipples by improving positioning and attachment. They should never be used in the early postnatal days before the milk has ‘come in’.

Supplementary feeding

Supplementary feeding is the practice of giving extra feeds of formula, glucose, or water. A recent study found that 33% of breastfed babies were given supplementary feeds while in hospital.
¹²
This study also found that breastfeeding mothers whose babies were given bottles were more likely to discontinue breastfeeding in the first 2 weeks postnatally than were other mothers.

Supplementary feeds have been associated with:
^4,12,13

Extra fluids

Giving extra fluids, either in the form of water or dextrose, to babies with jaundice has not been shown to reduce peak serum bilirubin levels, and may, in fact, cause levels to rise by reducing the milk intake and therefore delaying the evacuation of meconium.
¹⁴

In a breastfed baby, filling the stomach with water will reduce the number of feeds and interfere with the establishment of breastfeeding. Women whose babies are given extra fluids are more likely to discontinue breastfeeding.

1. Health Visitor Association and the Royal College of Midwives (1995).
   Invest in Breast Together.
   

   Milton Keynes: Health Visitor Association and the Royal College of Midwives.
   

2. Simmons V (2002). Exploring inconsistent breastfeeding advice.
   British Journal of Midwifery
   

   10
   (10), 616–19.
   

3. Victora CG, Tomasi E, Olinto MTA, Barros FC (1997). Pacifier use and short breastfeeding dura- tion: cause, consequence or coincidence?
   Pediatrics
   99
   (3), 445–53.
   
4. World Health Organization (1998).
   Evidence for the Ten Steps to Successful Breastfeeding
   . Geneva: WHO.
   

   CHAPTER 24
   Breastfeeding
   

   678
   

5. Watase S, Mourino A, Tipton G (1998). An analysis of malocclusion in children with otitis media.
   Pediatric Dentistry
   20
   (5), 327–30.
   
6. Darwazeh AM, al-Bashir A (1995). Oral candidal flora in health infants.
   Journal of Oral Pathology and Medicine
   24
   (8), 361–4.
   
7. Sakashita R. Kamegai T, Inoue N (1996). Masseter muscle activity in bottle feeding with the chewing type bottle teat: evidence from electromyographs.
   Early Human Development
   45
   , 83–92.
   
8. Gale CR, Martyn CN (1996). Breastfeeding, dummy use, and adult intelligence.
   Lancet
   

   347
   (9008), 1072–5.
   

9. Ogaard B, Larsson E, Lindsten R (1994). The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish
   

   3-year-old children.
   American Journal of Orthodontics and Dentofacial Orthopedics
   106
   (2), 161–6.
   

10. FSID (2009) Factfile 2. Research background to Reduce the risk of cot death advice by the Foundation for the Study of Infact Deaths. M
    http://fsid.org.uk/Document.Doc?id=42 (accessed 20.1.2011).
    
11. Royal College of Midwives (2002).
    Successful Breastfeeding
    . Edinburgh: Churchill Livingstone.
    
12. Bolling K, Grant C, Hamlyn B, Thornton A (2007).
    Infant Feeding Survey 2005.
    London: The Information Centre.
    
13. Henschel D, Inch S (1996).
    Breastfeeding: A guide for Midwives.
    Hale, Cheshire: Books for Midwives Press.
    
14. Nicoll A, Ginsburg R, Tripp JH (1982). Supplementary feeding and jaundice in newborns.
    Acta Paediatrica Scandinavica
    71
    , 759–761.
    

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CHAPTER 24
Breastfeeding

680‌‌

Expression of breast milk

Why express?

Expression of breast milk should be taught to all mothers as it helps them to understand how the breasts work. It can aid the mother’s under- standing of effective attachment and may help her to recognize and over- come many breastfeeding complications.
¹
Health professionals should be able to teach the skills of both hand expression and mechanical expres- sion to breastfeeding mothers.

Expression of breast milk can be helpful in a variety of situations.
¹

• General breast comfort:
  
  • To relieve discomfort from overfull breasts if a feed has been missed
    
  • To prevent leakage if mother and child are apart
    
  • To maintain healthy skin or to assist healing: if damage has occurred to the nipple, a small amount of breast milk may be applied to the nipple and areola.
    
• To assist a baby to breastfeed:
  
  • Expressing a small amount of breast milk will encourage a reluctant baby to breastfeed by enabling him to smell and taste the milk
    
  • By softening an overfull or engorged breast, enabling attachment
    
  • Milk may be expressed gently into the baby’s mouth if he or she has a weak suck.
    
• To prevent or relieve breast conditions:
  
  • Overfull breasts due to a feed being missed
    
  • Engorgement
    
  • Blocked duct
    
  • Mastitis.
    
• To stimulate milk supply:
  
  • When mother and baby are separated or baby unable to suckle
    
  • If additional stimulus is required to increase or induce lactation.
    

    •
    To maintain milk supply:
    

  • When mother and baby are separated, e.g. hospitalization, return to work
    
  • When the mother has to suspend breastfeeding temporarily, e.g. due to medication that may be harmful to the baby.
    

    Methods of expression
    

    Hand or manual expression
    

• Hand expression is usually gentler than using a pump, it can be undertaken anywhere and no/minimal equipment is needed.
  
• Hand expression requires skill, and some mothers find it difficult and prefer to use a pump.
  
• The risk of cross-infection is reduced with hand expression as less equipment is required.
  
• Hand expression is useful as a self-help method if blocked ducts, engorgement, or mastitis occurs.
  
• Inform the mother that when she first starts to express her breasts only small amounts will be expressed, but with practice it will become easier and she will be able to express more.
  

EXPRESSION OF BREAST MILK

681

How to hand express

The mother should:

• Relaxing with a warm drink, music, or TV
  
• Being near the baby or a photo of the baby
  
• Warming the breasts
  
• Gently pulling or rolling the nipples
  
• Gently massaging the breasts by stroking with the finger tips, rolling with the knuckles, or using circular movements.
  

  The mother should then: