Lactation Education

2008

Everything you need to know

about breast feeding, pumping,
milk storage, and who-you-gonna-
call…with problems.
 Objectives:
• By the end of the presentation you will know how to:
– Properly store human milk.
– Appropriately dispense and charge for breast pump
kits.
– Use the LATCH scoring tool and when to use it.
– Chart a LATCH Score and breast milk double check.
– Chart intake on a breastfeeding patient.
– Call the Lactation Specialist or a member of the
lactation support team with questions
– Advise on a good pumping schedule.
 Human Milk Storage
• Human Milk Should Be..
• Stored in a hard-sided food grade container.
• Plastic bags and old formula containers are not
recommended because of risk of spills and bacterial
contamination
• Labeled with..
• Patient ID band
• Date and time the milk was pumped
• Or Date and time the milk was fortified
• Stored in..
• The fridge for use within 48 hours
• The freezer if it is not going to be used within 48
hours
 Human Milk Use
• Human Milk Should Be…
– Double Checked..
• At the patient’s bedside.
• Using 2 patient identifiers (not room
#).
• By 2 Staff Members (RN/LPN/PCT).
• Or by the patient’s parent/significant
other (grandma/grandpa/aunt/uncle) if
a staff member is not available.
– If you double check with pt’s mom, write
“with parent / significant other” on flow
sheet.
 To Thaw or Warm Frozen
Human Milk:

• Place frozen milk in the refrigerator.

– This will take at lease 6-12 hours, so prepare ahead of
time!
• At room temperature at the infant’s bedside 4 hours
before feeding.
• In a container with fresh, warm (not scalding hot)
water at the infant’s bedside.
Discard any Human Milk that:
• Is not clearly labeled.
• Left unrefrigerated for
more than 4 hours.
• Fresh and refrigerated for
>48hrs.
• Frozen for more than 3
months in freezer in
nutrition room.
• Thawed & refrigerated for
>24hrs.
• Has been in direct contact
with the patient.
• Leaking from container or
the container is punctured.
Breast Milk Double Check

• Needs to be charted on the nursing

flow sheet.
– Page 2, MISC section, under Breastmilk √
– Have the other staff member initial
there.
Exclusively Breast Feeding?
• Ensure that you are
charting intake for your
patient!
– Have your patient’s mom
record the time (in minutes)
your patient spent breast
feeding.
– Watch your patient’s UOP.
That will be a good
indicator if your patient is
getting enough fluid while
breast feeding.
• A LATCH score must be
charted every shift.
 LATCH Scoring Tool
• Use the
Score 0 1 2
L - Latch • too sleepy or • repeated attempts • grasps breast
reluctant •hold nipple in mouth • tongue down

latch once a
• no latch achieved •stimulat to suck • lips flanged
• rhythmic sucking

shift to
A- Audible • none • a few with • spontaneous and
Swallowing stimulation intermittent pattern
(<24 ۫of age)

identify any • spontaneous and

frequent (>24 ۫of age)

breast T- Type of • inverted

Nipple
• flat • everted (after
stimulation)

feeding
C- • engorged • filling • soft and tender
Comfort of • severe discomfort •mild to moderate
Breast/ • cracked, large discomfort

needs your
•reddened/ small
Nipple glisters, bleeding, or
blisters or bruises
bruises.

pt’s mother
H - Hold • full assist (staff •minimal assist (e.g., • no assist from
(Positioning hold newborn at elebate head of staff
breast bed; place pillows •mother able to

may have. for support) position/ hold newborn

•teach one side,
mother does other
•staff holds and
then mother takes
over
Lactation Specialist
• If you identify a problem during
a weekday, call the lactation
specialist.
• Use Vocera and say “call
Lactation”.
– This will get you the Lactation
Specialist on for the day.
• They will be able to help…
– A distressed mother not
producing enough milk, even
when pumping.
– A mother who has never
pumped or breastfed before.
– A mother who’s milk is
decreasing.
– Anyone with questions on
breastfeeding.
CMU Lactation Support Team
– They are CMU staff • Members:
members with extra – Gretchen
Baumgartner
training re: breast
– Stephanie Sund
feeding and pumping. – Lindsay Moore
– Knowledge to help with – Amber Spillett
breast pump questions. – Melissa Schmidt
– Get missing pump parts – Karen Roylance
– Kerin Hottenstein
for the hospital grade
– Nancy Osmond
pump kits.
– Kam Webb
– Advise pt’s moms with – Tricia Ivison
a good pumping – Dusti Lohmoelder
schedule – Nicole Swenson
 Breast Pump Kits
• Kits are stored in the North
storage room beneath the
pillow boxes.
• Charge the patient for the
pump kit on the daily charge
sheet.
• Kits are $80.01.
– If you don’t charge the patient,
the CMU assumes the charge
and that means our next
Christmas party is at Travis’s
house.
• One (1) kit may be given with
each admission.
– More than one kit will not be
paid for by insurance.
When to Give a Breast Pump
Kit:
• Your pt’s mother has not
pumped or breastfed
for over 4 hours and
doesn’t have a pump of
her own.
• Your pt’s mother is
uncomfortable/
engorged.
• Your pt is in respiratory
distress (resps > 60) and
unable to breast feed.
• Your pt’s mother does
not have her pump at
the hospital.
You gave her a pump kit…now
what???
• Escort your patient’s mother to
the pump room.
– Pump rooms are on G-Pod, across
from L-Pod on CSU, and across
from NICU on 4th floor.
• Ensure that she knows how to use
the hospital grade pump.
• Never encourage a mother to use
the hand pump.
– This is barbaric and unnecessary.
• Ensure your pt’s mother has
plenty of water, nutrition, and
sleep to keep her milk supply up.
• Advise on a good pumping
schedule
 Pumping Schedule
• Give your patient’s mom the LTA
“Breast pumping while your baby is
in the hospital”
• Encourage your patient’s mom to
pump as often as the baby would
normally feed.
• If there is no previous schedule,
maintain her supply by encouraging
your patient’s mom to pump 7 times
a day and once in the middle of the
night.
• Since there is no alarm clock, let
her know you will wake her in the
night to pump.
• Let her know that it is good to take
some time away from the room.
 Information sources:
• LTA: Breastpumping while your baby is in
the hospital
• LTA: Storing breastmilk
• CPG: LATCH Breastfeeding Assessment
Newborn Scoring Tool
• CPG: Human Milk Storage and Utilization
Newborn Pediatric Adult Procedure
• CPG: Breast Pumping Pediatric Adult
Procedure