Breastfeeding Quiz (June 2011)

1: How long does the World Health Organisation recommend breastfeeding for?
To two years of age and beyond.

2: Jessica had a SVD 3 days ago, her baby Chloe has been breastfeeding well, today Jessica is feeling very weepy and her breasts are swollen, tender and Chloe is finding it difficult to latch onto the nipple. What could be happening and what advice would you give?
Engorged as her milk has come in
Advice is to hand express a small amount from the breast to allow Chloe to latch more easily or sit in a warm bath with flannels on the breasts

3: What are the main nutrients found in breastmilk?
protein, fat, lactose, immunoglobuins. Also contained are vitamins, enzymes, certain hormones, growth factors and protective agents

4: Paula has been breastfeeding her baby Jack following a forceps delivery, you are the community midwife visiting at home on day 5. Whilst discussing breastfeeding with Paula she mentions that Jack has been feeding more frequently today and she is concerned she does not have enough milk and wonders if she should give him a bottle of artificial formula milk. What would you suggest and why?
Discuss with Paula that all babies tend to have a growth spurt around day 5, explain about supply and demand and discuss the implications supplementing will have such as; leaky gut, reduction of breast milk supply, engorgement and others

5: Samantha is breastfeeding her first baby following a caesarean section this morning. What additional support may she need and why?
Due to spinal anaesthesia and her c-section wound Samantha will find it difficult to sit up and therefore position baby correctly It may be helpful to discuss other positions for Samantha to try to breastfeed in such as lying down or rugby ball position.

6: What is the Baby Friendly Initiative? When did it begin and what does it recommend?
It began in 1992 and was established in conjunction with UNICEF and the WHO (additional point for mentioning UNICEF and WHO) to encourage hospitals to promote the ‘Ten steps to successful breastfeeding’ and to promote practice that conforms to the ‘International Code of Marketing Breast Milk Substitutes’. It also discusses safe infant formula feeding practises.

7: Sara is 33 weeks pregnant and wants to know why she should breastfeed her baby. What information could you give?
The general benefits to the infant include unlimited access to a milk which is specifically designed for them individually that is always at the correct temperature, had no additives and for which there are no concerns regarding sterility
In terms of cost breastfeeding is environmentally friendly, reducing the use of heat and sterilising resources such as wood and water and limited the use of manmade materials such as tins for formula, plastic and rubber for artificial feeding equipment.
If every child was breastfed it would also reduce the strain on the NHS of treating what have now become considered as 'common' childhood illnesses
Health benefits to the infant include a reduction in the likelihood of contracting illnesses such as gastroenteritis, respiratory tract infections, otis media, asthma, allergies, cardiovascular disease, diabetes types one and two, necrotising entercolitis in the preterm infant and childhood cancers. Breastfeeding also reduces the risks of sudden infant death syndrome occurring
Also benefits to the mother, such as reduced risks of breast cancer, weight loss etc

8: Do breast-feeding women in the UK have any legal rights?
Breastfeeding women in the UK are protected in kind by the Equality Act 2010 which makes it unlawful discrimination for a woman to be asked to stop breastfeeding in a public place This does not mean that it is illegal to ask a woman to stop breastfeeding in public however. This provides protection for women feeding babies less than 6 months of age and in theory women feeding babies over this age are protected by the Sex Discrimination Act
At work employers have a duty to carry out a risk assessment for all breastfeeding mothers returning to work, however there is no legal right for women to have facilities or breaks in order to continue breastfeeding.

9: Beatrice gave birth 2 days ago at home, she has been breastfeeding her daughter Florence but is finding that Florence is feeding little and often, becomes agitated and pulls off the breast following a few sucks. Beatrice’s right nipple is sore and grazed and Beatrice reports it is misshapen when Florence comes off the breast. You decide to observe a feed. What signs would you look for and why?
Looking for good p&a, tummy to mummy, nose to nipple, baby reaching for breast, full cheeks, lip curled under and chin tucked in. Breast moving, no noise, not painful for Beatrice after initial latch. Florence’s arm moving from by her face down to side throughout feed. Sucking pattern, small quick sucks at first followed by longer, slower sucks, baby falling asleep and coming off the breast by herself.

10: The baby friendly initiative does not recommend the use of dummies. Explain why.
It can interfere with the mother recognising cues that the baby wishes to feed therefore jeopardising the supply and demand feature of breastfeeding
Suckling on a dummy is a different way of sucking than at the breast and this can therefore interfere with getting breastfeeding established in the crucial early weeks.

11: What role can Dad’s play in supporting breastfeeding women?
Support partner, fetch drinks, help make her comfortable, advocate her choices to others, offer encouragement, have skin to skin with the baby, bath the baby, do the household chores, cook her a nutritious meal, change nappies (points for anything really as long as question has been thought about!)

BONUS:
The breastfeeding initiation rate in 2010/2011 was 73.7%, whilst the continuation rate was 45.2% at 6-8 weeks. What is the most common reason cited for women stopping breastfeeding and what could you as a student midwife do to support women through this?
Perceived insufficient milk supply
Provide information and support around supply and demand, growth spurts, how to tell if your baby is getting enough milk, expressing, growth spurts, local support groups/peer supporters