Improving Breastfeeding Outcomes: Using Appropriate Interventions to Champion an Successful Breastfeeding Relationship for a Mother with Flat Nipples

Sunday, June 16, 2013

Title: Improving Breastfeeding Outcomes: Using Appropriate Interventions to Champion an Successful Breastfeeding Relationship for a Mother with Flat Nipples

Ryman Hall B4 (Gaylord Opryland)
Kathryn E. Low, BSN, RN, CCE, IBCLC , Parent Education and Lactation Services, Christiana Care Health Services, Newark, DE
Debra A. Otto, BSN, RN, CCE, IBCLC , Parent Education and Lactation Services, Christiana Care Health Services, Newark, DE

Discipline: Advanced Practice (AP), Childbearing (CB), Newborn Care (N), Women’s Health (WH)

Learning Objectives:
  1. Demonstrate how to hand express and use an electric breast pump.
  2. Demonstrate how to spoon feed and finger feed a newborn baby.
  3. Demonstrate how to use a nipple shield and supplemental nursing system on a mom with flat nipples.
Submission Description:
Background: Breastfeeding is the undisputed optimal feeding for babies. Healthy People 2020 has recognized this and called for an increase in the number of mothers who have ever breastfed to 81.9%. The Center for Disease Control listed this breastfeeding rate for 2012 as only 76.9%. To accomplish this goal, mothers need excellent breastfeeding support especially when faced with difficulties.

Case:  Studies have shown an overwhelming number of infant health benefits associated with breastfeeding including protection of the infant from: bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late-onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkins disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges, such as flat nipples, that put her at risk for breastfeeding failure.

  In a typical case, a first time mother with flat nipples has difficulty latching her baby. Initially, skin to skin contact and frequent breastfeeding attempts are made.  The lactation consultant (LC) or postpartum nurse teaches her how to hand express so that her baby can receive colostrum. When latch is not achieved within 24 hours of life, the patient is educated on breast pump initiation. During this same time the patient is taught how to spoon and finger feed her newborn. After discharge the patient follows up with outpatient lactation services. Because the newborn is still unable to latch and lactogenesis II has not yet occurred, nipple shield and SNS use is taught and initiated. The mother continues to be followed by her pediatrician and outpatient LC. Once this mother has achieved full milk supply, the SNS is discontinued. Soon after, attempts are made to wean from the nipple shield.

Conclusion:  At 5 weeks post partum the baby is exclusively breastfeeding without any interventions. All mothers with flat nipples who are experiencing breastfeeding difficulties should be given the same opportunity to use every researched based resource available to them.

Keywords:  breastfeeding, flat nipples, interventions

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