Oxford Handbook of Midwifery (148 page)

Cup feeding

learn suck/swallow/breathing coordination.

Technique for cup feeding

CHAPTER 24
Breastfeeding

702

• In effect, the baby laps from the cup, rather than milk being poured into the baby’s mouth.
  
• It is important that the milk is offered but never poured.
  

  The Lact-Aid
  ^®
  

• This is a feeding tube device that allows the infant to be supplemented at the breast with either EBM or formula.
  ⁹
  
• The aim of these devices is to deliver a faster flow of milk to the baby while he or she is still suckling at the breast.
  
• Feeding tube devices are helpful for mothers who have a very poor milk supply, are trying to re-establish lactation, or if attempting to induce lactation for an adopted baby.
  
• Mothers need supervision when first using these devices.
  
• They are more effective if the baby is able to latch onto the breast, although an augmented flow may assist a baby to suck better because he or she is being rewarded for their efforts.
  

  Technique
  

• The tube is usually positioned on the nipple so that it enters the baby’s mouth centred along the palate. However, the positioning of the tube may need to be adapted to enable the baby to obtain the flow of milk more effectively.
  
• The flow of milk from the receptacle is determined by a combination of the baby’s suck and its position/height.
  
• Adjustments will be required to establish the correct flow for the baby.
  

  

  1. Royal College of Midwives (2002).
     Successful Breastfeeding
     . Edinburgh: Churchill Livingstone.
     
  2. Twins and Multiple Births Association (2004).
     Breastfeeding Twins, Triplets or More
     . Guildford: TAMBA.
     
  3. World Health Organization (2004).
     HIV Transmission Through Breastfeeding: A Review of Available Evidence
     . Geneva: WHO.
     
  4. Department of Health (2004).
     HIV and infant feeding: Guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS
     . London: Department of Health Publications.
     
  5. Jackson W (2004). Breastfeeding and Type 1 diabetes mellitus.
     British Journal of Midwifery
     12
     (3), 158–65.
     
  6. De Swiet M (1995). Medical disorders in pregnancy. In: Chamberlain G (ed.)
     Turnbull’s Obstetrics
     , 2nd edn. Edinburgh: Churchill Livingstone.
     
  7. National Institute for Health and Clinical Excellence (2008).
     Diabetes in Pregnancy: Management of Diabetes and its Complications from Pre-conception to the Postnatal Period
     . London: NICE.
     
  8. National Institute for Health and Clinical Excellence (2008). Improving the nutrition of pregnant and breastfeeding mothers and children in low income households. NICE public health programme guidance 11. London: NICE.
     
  9. Wilson-Clay B, Hoover KL (2002).
     The Breastfeeding Atlas
     , 2nd edn. Austin, Texas: LactNews Press.
     

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  CHAPTER 24
  Breastfeeding
  

  704‌‌
  

  Lactation and nutrition
  

  All new mothers need to eat a healthy diet for their own well-being and to help them to replenish stores of certain nutrients that become depleted during pregnancy. They also need a healthy diet to assist them to cope with the demands of a new baby and possibly older siblings. Even if eating a suboptimal diet, either in calories or content, they will still produce high- quality milk which will satisfy their infant’s nutrition requirements.
  

  A healthy diet should be based on the five food groups and a breastfeeding mother should include:
  

• Group 1—Carbohydrates—a portion of bread, rice, potatoes, pasta or other starchy food should be eaten with each meal. Wholegrain should be eaten whenever possible.
  
• Group 2—Fruit and vegetables should be included in each meal aiming for five portions a day.
  
• Group 3—Dairy products—two to three portions of milk, cheese and yogurt should be eaten a day and they can be of low-fat varieties if desired.
  
• Group 4—Protein—meat, fish, nuts, and pulses should be included in two meals per day. Non-meat eaters should ensure they include eggs, nuts, and pulses in their diet on a regular basis.
  
• Groups 5—High fat and sugar foods and drinks—these should be kept to a minimum and the diet basically based on the other four food groups.
  

  Fluids and breastfeeding
  

  Breastfeeding mothers do not need to drink excessive amounts of fluid but should drink to their thirst. A minimum of eight drinks a day is recom- mended and can include a range of sources including water, fruit juice, milk, tea, coffee, and soups. Milk is not necessary to produce breast milk. In hot weather more fluid may be required to quench the mother's thirst.
  

  Food to avoid whilst breastfeeding
  

  Generally women who are breastfeeding do not need to avoid certain
  

  foods, however, there are several recommendations;
  

• Oily fish—can be included in the diet but no more than two servings a week.
  
• Large fish—shark, swordfish, and marlin should be avoided all together as they contain large amounts of mercury.
  
• Alcohol—passes into the blood stream and levels peak at 30–90min after consumption. The recommendation is that daily consumption should not exceed 1 unit per day.
  
• Peanuts—mothers are advised to avoid eating peanuts if they, the infant’s father or siblings suffer from allergic conditions such as hay- fever, asthma, or eczema.
  
• Caffeine—in tea, coffee, cola, energy drinks, and chocolate should be limited as it can make some babies restless and may cause breast pain in some women.
  

  LACTATION AND NUTRITION
  

  705
  

  Mothers who are overweight or obese should not embark on very low-calorie diets while breastfeeding but should eat a balanced diet and limit high fat and high sugar foods. Once breastfeeding is established some regular physical activity of at least 30min on all or most days of the week will help weight loss and women can still breastfeed successfully and lose about 450g (1lb) in weight each week.
  

  Even with a healthy diet it is difficult to get an adequate intake of vitamin D in the UK. Breastfeeding mothers are therefore advised to take 10micrograms of vitamin D each day to prevent vitamin D deficiency in both them and their baby. Vitamin D is needed for bone health and the immune system. Babies of mothers who did not take vitamin D supplements during pregnancy may be born with low levels of vitamin
  

  1. There is a very small chance that these babies may have fits due to low levels of calcium. Older babies and toddlers with very low levels of vitamin D can develop rickets.
     

     

     The NHS Healthy Start vitamins for women contain 10micrograms vitamin D along with 400micrograms folic acid and some vitamin C and are ideal for breastfeeding mothers. The vitamins are free for mothers included within the Healthy Start Scheme (see M www.healthystart.nhs.
     uk). Vegan mothers may need a supplement containing vitamin B
     ₁₂
     and calcium in addition to vitamin D.
     

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     Artificial feeding
     ‌‌
     

     Chapter 25
     

     707
     

     Introduction
     708
     

     Suppression of lactation
     710
     

     Selecting an appropriate substitute
     712
     

     Types of formula milks
     714
     

     Alternatives to modified cow’s milk formulas
     718
     Nutritional requirements of formula-fed babies
     719
     Management of artificial feeding
     720
     

     

     Problems associated with formula feeding
     724
     Disadvantages associated with formula feeding
     726
     Health risks associated with formula feeding
     728
     

     CHAPTER 25
     Artificial feeding
     

     708‌
     

     Introduction
     

     Although breastfeeding is best for mother and infant there will always be some mothers who choose to artificially feed their infants. This is usually for social, psychological, or cultural reasons, but there will be some cases where breastfeeding is contraindicated for medical reasons (b see Contraindications to breastfeeding, p. 661). There will also be mothers who commence breastfeeding but, for a variety of reasons, discontinue earlier than they intended.
     

     All pregnant women should be told of the benefits of breastfeeding but ultimately it is the mother’s choice which feeding method she adopts. If the mother decides to bottle feed, give her guidance to ensure that she does so safely, but do not give her the impression that formula milk is equivalent to breastfeeding, or that it is without risk.
     ¹
     

     

     1
     Royal College of Midwives (2002).
     Successful Breastfeeding.
     Edinburgh: Churchill Livingstone.
     

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     CHAPTER 25
     Artificial feeding
     

     710‌‌
     

     Suppression of lactation
     

     If a mother does not wish to breastfeed her infant, has a late miscarriage or a stillbirth, lactation will still occur and she may experience discomfort for several days.
     

     Aetiology
     

     • The classical theory is that milk secretion is controlled principally by the maternal hormones prolactin and oxytocin.
       
     • However, removal of milk from the breasts has also been found to be a crucial element in milk secretion.
       
     • If milk is not removed from the breast, a chemical (autocrine inhibitor) in the whey protein fraction prevents further production by exerting
       

       a negative feedback control. This is known as the feedback inhibitor of lactation.
       

     • A build-up of this autocrine inhibitor then accelerates the breakdown of milk components already produced.
       

       Management
       

     • If unstimulated, the breasts will naturally stop producing milk.
       
     • The breasts should be well supported, but binding has not been shown to contribute towards suppression of lactation.
       
     • If there is severe discomfort with engorgement, encourage the mother to express very small amounts of milk once or twice. This can help relieve the discomfort without interfering with the regression of lactation.
       
     • Give mild analgesics to assist in relieving the pain and discomfort felt.
       
     • Do not restrict fluids.
       
     • Pharmacological suppression using dopamine receptor agonists is effective, but is not advised for routine use.
       ¹
       

  International code of marketing of breast milk substitutes
  

  In May 1981, the World Health Assembly approved an International Code of Marketing of Breast Milk Substitutes.
  ²
  The purpose of this code was to
  

  protect the practice of breastfeeding and to help control the marketing
  

  of products for the artificial feeding of infants. Nowhere does it seek to enforce breastfeeding, and the code does not prevent mothers from bottle feeding if that is what they choose to do. At present the code is voluntary in the UK, but some countries have chosen to enshrine it in law. Employees in Baby Friendly Hospitals and community healthcare facilities are required to ensure that their practice is in line with the International Code and not just with the UK law.
  ³
  The code has major implications for the work of the midwife. The major recommendations are included in Box 25.1.
  

  SUPPRESSION OF LACTATION
  

  711
  

  

  Box 25.1 Recommendations of the international code of marketing of breast milk substitutes