# Presentation: 384412

## Slide 1

## Learning Objectives

- List three causes and three ways to manage each of the following breastfeeding concerns:
- Sore nipples
- Breast refusal
- Slow weight gain in infant
- Name two common consequences of unresolved breastfeeding issues
- Identify two situations when the peer counselor should refer

## Solving ProblemsWhile They are Small

- Most breastfeeding issues can be resolved
- Help mothers deal with issues early
- Listen to mothers
- Offer solutions and places to get help

## When Problems Occur: Three Rules

- Feed the baby
- Protect the mother’s milk supply
- Fix the problem

## Ouch! Sore Nipples

- Common, not normal
- Barrier to continued breastfeeding
- Can be prevented
- Causes
- Poor positioning/latch
- Baby’s mouth not open wide
- Other nipples used
- Wet nursing pads, perfumes, lotions
- Thrush in baby or mom

## Comfort Measures for Sore Nipples 

- Before feeding
- Apply ice pack or bag of frozen peas with wet washcloth
- Express a small amount of milk
- Massage breast to stimulate a MER
- Start on the side that is least sore
- Position baby correctly
- During the feeding
- Do not limit feeding
- After feeding
- Air dry and apply breast milk (and lanolin)
- Avoid creams and lotions
- Use breast shells, if necessary
- Talk to doctor about pain relief methods

## Refusing to Breastfeed

- Reasons baby might not want to breastfeed
- Mother factors
- Breasts are engorged
- Flat or inverted nipples
- Drugs during labor made baby sleepy
- Milk flows very fast
- Baby factors
- Prefers one breast over another
- Prefers other nipples
- Premature or too weak to suck
- Birth trauma

## Dealing With Refusal to Breastfeed

- Offer the breast before baby wakes fully
- Feed the baby while coaxing him to breast
- Remove milk with a breast pump
- Keep baby “skin to skin” with mother
- Simulate a “back to the womb” experience for baby such as bathing with baby, dimming lights, etc.

## Dealing With Inverted Nipples

- Inverted nipples sink in like a dimple
- Some mothers have one normal nipple and one that is flat or inverted
- Pumping can draw out inverted nipple
- Avoid artificial nipples
- YIELD

## Baby’s Weight 

- Common for babies to lose a few ounces after birth
- Babies who get off to a good start with breastfeeding rarely lose more than that
- YIELD if baby does not regain birth weight by two weeks or if mom is concerned about her baby’s weight

## Problems Have Solutions: 3-Step Practice

- Peer counselors are a tremendous source of support
- Catching small concerns early can help avoid bigger issues
- YIELD to your WIC designated breastfeeding expert

## When to Contact Mothers

- Daily calls when mothers have concerns
- Mothers rarely initiate calls
- Support from the peer counselor complements assistance from the healthcare team
- Affirm her self-confidence
- Remind mothers to keep WIC and physician appointments

## Opening the Conversation with Mothers 

- Tell me how you are feeling about breastfeeding
- Who is helping you with breastfeeding?
- What are some of the things your support people are saying about breastfeeding?
- What are some things you have tried so far?
- What are some suggestions your WIC breastfeeding expert had? Which are working for you?
- What keeps you going during this difficult time?

## “The day I had my baby, she could not latch on properly. Then, as magic in the air, I remembered the telephone number of my WIC peer counselor, who taught me how to breastfeed. In less than two hours, there she was: the Milk Fairy. That’s the nickname I’ve chosen for us, the Breastfeeding staff, since as magic, we transform really difficult situations into beautiful success stories.”
		WIC Peer Counselor

*	**	*WIC Peer Counselor