1 Has mother noted an increase in milk supply? Has she experienced engorgement?
Do her breasts feel full before feeding and softer after • feeding?
Does she leak milk from her breasts?
Does the baby feel full and satisfied after a feeding? •
If no, are there any risk factors for delay in lactogenesis • (ie, none of the above by 72 hours)? Risks include cesarean deliver y, maternal obesity, large for gestational age (primiparous), long stage 2 labor, and inverted or flat nipples
Delay in lactogenesis can be supported with frequent • breastfeeding as long as the newborn has normal voiding and stooling pattern and is not dehydrated 2 Does baby latch onto breast without dif ficulty?
Latchon can be improved with proper positioning and • effective hold 3 Does mother hear the baby swallow her milk during feedings?
No audible swallow may be a sign of poor milk transfer
• 4 Does mother experience signs of milk ejection reflex such as tingling in breast, cramping of uterus during the first week, dry mouth, or sleepiness during feeding?
Any of these signs is reassuring that the mother is able • to relax and let ox ytocin act on the myoepithelial cells necessar y for milk transfer 5 Does the mother have nipple pain or pinching during feedings ? Nipple pain is a sign of poor latchon that may be caused • by poor positioning, hypotonic suckle, or ankyloglossia
Poor latchon results in poor milk transfer, low milk • supply, and early breastfeeding termination
Refer to person with expertise in obser ving latchon •
A Clinician’s Guide: Suggested Questions to Assess Breastfeeding in Primary Care Practice
Breastfeeding Support Tools for Clinicians 6 Does the newborn feed at least 8 to 12 times per day? (Counsel mom to tally feeds per day)
Infrequent feeds (< 8 times/day) are associated with • increased risk for jaundice and poor weight gain 7 Does the newborn feel full and satisfied after feeding?
Does the newborn complete most feedings within 15 to • 45 minutes? (Feedings that are too short or too long may indicate inadequate milk transfer)
Does the baby selfdetach from the breast after most • feedings?
Does the baby sleep at least 1 hour between most • feedings?
If not full and satisfied after feeding and mother’s milk is • in, refer to expert in breastfeeding 8 Is the baby having appropriate weight pattern ? Calculate percent loss as current weight divided by birth • weight multiplied by 100 (aim is < 8 % –10 % loss)
The goal is to return to birth weight by 10 to 14 days
Watch for no additional weight loss after day 4, with • minimum 15 to 30g weight gain per day once milk supply is in 9 Is the baby having adequate elimination patterns ? Six voids and 3 to 4 stools per day by day 5 of life
• 10 What are the mother’s breastfeeding plans/goals ? How long does she want to exclusively breastfeed or continue to do any breastfeeding?
Ending with openended questions enables mothers to • raise additional concerns and to identify community