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Name assessment

By Ida Freeman,2014-04-26 19:38
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Name assessment

    1

Name Today’s date ___________________________

    Due date ___________________________

    Current week of pregnancy ___________________________

    Prenatal Breastfeeding Assessment Form

Breastfeeding history

Were you breastfed? Yes No

    Have you breastfed any of your children? First Yes No

    How many? _______ For how long? ________________________________________ How did breastfeeding go for you?

What problems, if any, did you have?

With this baby will you be working away from home?; No Yes

     What are your plans?

Breasts

    During your life, have your breasts experienced any trauma, burns, or radiation? No Yes

    Did you have a chest tube as a premature baby? ;;;;; No Yes

    Have you had any breast surgery? Date? _________ ;; No Yes

     implants biopsy reduction cysts abscess Other: ____________ Explain:

Any changes in nipple sensation from the surgery?;;;;; No Yes

    Type of incision: axillary periareolar subglandular transumbilical

    Have you noticed your breasts have gotten larger since you became pregnant? Yes No

    Have you noticed your breasts have gotten tender since you became pregnant? Yes No

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107 You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    2

    Breast Anomalies

     extra nipples other: asymmetry

     extra breast tissue;;;;;;;; conical

     hypoplasia

     Draw in surgical scars or other anomalies.

     Space between breasts ________________

     R L

    Nipples Nipple or Areola Anomalies

    At rest With compression skin tag OK;;;

    ;; everted everted;;;; need to remove?;; hair on areola

    ;; flat flat nipple ring double nipples

     dimpled dimpled Explain need to remove.

     inverted inverted other: unusual nipple

     retracting

Breast tissue: inelastic (firm) ;;elastic (soft)

    Nipple tissue: inelastic (firm) ;;elastic (soft)

    Unusually large (big around) or long nipples __________ cm. diameter __________ cm. long

    MESSAGES

    DATE

    _______ You have the perfect breasts and nipples for breastfeeding. Your breasts are rounded, they have increased

     in size since you became pregnant, and your nipple protrudes when compressed.

    _______ As you already know, breastfeeding is the healthiest feeding method for both mother and baby. I hope you

     will choose to breastfeed.

    _______ Learning about childbirth can help get breastfeeding off to a good start. Here is the information about our

     childbirth classes.

    _______ Getting together with mothers who are breastfeeding is a good way to learn about breastfeeding. Here is

     information about the breastfeeding support groups in this area.

_______ Who do you know who has breastfed? Tell me more.

    _______ Who will be helping you at home after the birth of your baby? What does this person know about

     breastfeeding?

    _______ As soon as your baby is born, I will place the baby on your chest so that the baby can start to breastfeed

     whenever the baby is ready.

    _______ The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months and continuation

     of breastfeeding beyond the first birthday.

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    3

    Background Information for the Provider

Dear Provider:

    You can make a difference. When prenatal care providers talk about breastfeeding with women during their pregnancy, more women initiate breastfeeding. The Prenatal Breastfeeding

    Assessment Form for care providers gives you an opportunity to discuss breastfeeding with your patients. Asking questions about breastfeeding lets pregnant women know that you feel breastfeeding is important.

    A woman comes for prenatal care usually 8 to 14 times. There are several messages you can share about breastfeeding with women during their pregnancy. At each encounter you can add an additional piece of information.

    Please do NOT ask the woman how she is going to feed her baby. Simply share with her positive messages about breastfeeding during her pregnancy. If you ask a yes or no question, it becomes difficult to educate. Ask an open-ended question to get a dialog going. For example: What do you know about breastfeeding?

Instructions for the use of this form:

Breastfeeding history

Were you breastfed? Yes No

     If she knows that she was breastfed, it might indicate support from her extended family.

     If she was not breastfed, you might comment: When you were born we did not know as

    much about breastfeeding as we do today. Today there is a lot of support for

    breastfeeding.

Have you breastfed any of your children? Yes No First baby

    How many? ______ For how long? ______ Tell me more about your experiences.

     Hopefully her response will give you information so that you can give her positive

    feedback on her experience. Good for you. What a great job you did breastfeeding your

    baby for ____ months.

Will you be returning to work?;; Yes No

    You might inquire as to whether her circumstances have changed with this pregnancy.

    If she will be returning to work, how long will she be able to be home with her baby?

    Can she return part time for a while? Let her know she can continue to breastfeeding

    when she returns to work and that help is available.

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    4

    How did breastfeeding go for you?

     Hopefully her response will give you information so that you can give her positive

    feedback on her experience. I am glad you enjoyed breastfeeding. It can be a

    very rewarding experience.

What problems, if any, did you have?

     Some problems may recur. It will be important to support her with additional

    information about her problems and how they can be resolved and taken care of this time.

    This means you need to become familiar with breastfeeding and the problems women

    encounter and how to resolve them. Perhaps you could explain: Sorry to hear you had

     problems with ______________. I will see what I can find out to help you for this next

    breastfeeding experience.

     Also reassure her that you will be there for her as she needs it or will provide her with

     someone who will be helpful on an on-going basis.

Breasts

Have your breasts experienced any trauma, burns, or radiation? No;; Yes

    Explain:

Were you ever in an automobile accident?;;;;;;; No;;; Yes

    Did you have a chest tube as a premature baby? ;;;;; No Yes

    Have you had any breast surgery? Date? _______;; No Yes

    implants biopsy reduction cycts abscess

    Other: Explain:

    Any changes in nipple sensation from the surgery?;;;;; No Yes

    Type of incision: axillary periareolar subglandular transumbilical

     If she has not noticed changes in her breast size, has asymmetric, conical-shaped,

    underdeveloped breast, or a large space between her breasts, has had any trauma or

    surgery, the mother should be told to see a lactation consultant and work with her on

    maximizing her milk supply and have the baby weighed twice a week during the first two

    weeks after birth, because we are concerned about her ability to produce a full milk

    supply.

    Why did she get implants? Was it because she had asymmetric breasts or an under

    developed breast/s? If so, this is a concern in terms of her ability to produce a full milk

    supply. Most women with implants can breastfeeding without problems. Reduction

    surgery is the most damaging in terms of ability to provide a full milk supply. The

    location of the incision is significant, with incisions closer to the nipple more likely to

    sever ducts. Mastectomy of one breast should not be a problem. She can breastfeeding

    fully from one breast. Minor surgeries such as cyst removal, etc. are usually not a

    problem for breastfeeding.

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    5

    During your assessment, note the location of the surgical scars. The nerves that lead to

    the nipples come from the back and wrap around the sides of the breast at the 4:00

    position on the left breast and the 8:00 position on the right breast. (See arrows below.)

    Noticing if the surgery has cut across the nerves that lead to the nipple is significant. Ask

    the woman about nipple sensitivity. If her nipples have the same sensitivity now as they

    did before the surgery, then there should not be a problem with minor surgeries. If her

    nipples are not as sensitive as before surgery, the newborn can be closely followed to

    assure appropriate weight gain.

    Have you noticed that your breasts have gotten larger since you became pregnant? ;;;;;; Yes No Other symptoms?

    We would expect that most women would notice an increase in breast size early in

    pregnancy. If not, ask her again when she is 7 to 8 months pregnant. Some women do

    not experience breast growth during pregnancy, but have lots of growth after the birth of

    the baby.

Breast Anomalies

asymmetry

    Most women can identify that one breast is larger than the other. This is normal. If there is a cup size or two difference in her breasts it would be a concern.

     conical

     hypoplasia (underdeveloped)

     Trauma, burns, radiation, surgery, or unusually shaped breasts are indicative of possible

    problems with lactation. The mother needs to know that the baby needs to be carefully

    followed for appropriate weight gain.

extra nipples

     extra breast tissue

     The most common place to find extra breast tissue is under the arms. She needs to be

    reassured that extra breast tissue is not a problem. If she has extra breast tissue, this

    tissue will swell in the early postpartum. The swelling will resolve within the first two

    weeks postpartum, just as the breast swelling resolves for women who do not breastfeed.

    Sometimes extra nipples may leak milk. Again, this will resolve in time. She should not

    stimulate milk removal from these extra nipples.

     Draw in surgical scars or other anomalies.

     R L

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    6

    Nipples

Nipple and Areola Anomalies

At rest With compression ;;

     evert evert;;;

     flat flat

     dimpled dimpled

     inverted inverted

     retracting

    Observe the woman’s nipples at rest and decide if they evert, are flat, or if they are hidden (inverted) or partially hidden (dimpled).

    Next compress the breast between thumb and index finger about 1? inches from the base of the nipple. How does the nipple respond? evert flat dimpled inverted retracting

    Repeat with the other nipple. How does it respond?

    We would expect the nipples to become everted. If it is flat or inverted, it may be difficult for the baby to latch onto the breast.

    If the nipple is inverted or dimpled ask the woman if she can get the nipple to come out. Have her demonstrate this to you. If the skin of the nipple has adhesions and she cannot get the nipple to come out, it would be a good idea for her to apply oil, such as olive oil, to her nipples and try to break the adhesions gradually and carefully. Doing so early in her pregnancy will allow time for her to gradually tear the two skin surfaces apart and allow time for the skin to heal. She will need to continue to bring her nipples out in her daily bath or shower so that the skin does not grow together again. CAUTION: If this woman has preterm labor and you have informed both her partner and her that they may not engage in any nipple stimulation, intercourse, or orgasm because of a possible early labor, then such nipple stimulation would not be recommended.

skin tag need to remove?

    Skin tags that are in the area where the baby’s mouth will come in contact with the breast should be removed during pregnancy allowing plenty of time for healing before the birth of the baby.

nipple ring Explain need to remove.

    Nipple rings should be removed during early pregnancy so that the opening can heal. If she does not want to remove the nipple ring, she will need to remove it each time she breastfeeds the baby and then replace it, but this would not be recommended. Most women find the nipple tissue regenerates and fills in completely; however, some women find the milk comes out of the hole where the ring had been. This is not a problem.

     hair on the areola or along the edge of the areole is perfectly normal. Reassure the woman that this is quite normal and that the photos we see in the centerfold of Playboy, etc. have been

    touched up. Explain that she should not remove this hair for breastfeeding.

double nipples

    Double nipples are unusual, but not a problem for breastfeeding. She will want to position the baby at breast so that the baby can get both nipples into his/her mouth at once.

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

    7

     unusual nipple

    Some nipples have an unusual shape. The important thing is to reassure the woman that her nipples are fine for breastfeeding.

Unusually large (big in diameter) or long nipples

    ________ mm in diameter (measure at the base of the nipple)

    ________ mm long (base of nipple to end of nipple)

    Some babies have difficulty if nipples are larger around than a nickel. Other babies do just fine. The average nipple diameter is 3/8 of an inch, ______mm*.

    If the nipples are large in diameter or long, notify the pediatrician to keep a close eye on the baby and tell the woman to have her baby weighed twice a week during the first two weeks after birth. Sometimes the mother and baby do not “fit” together. The baby may have to grow into the size of the mother’s nipples. In the mean time, she can express her milk with a hospital-grade,

    electric breast pump to establish and maintain her milk supply, feed her milk to her baby, and continue to offer her breasts for comfort until the baby can remove adequate milk for growth. Women with large nipples may need a larger opening in the pump kit flange.

Breast tissue _____ inelastic (firm) _____ elastic (soft)

    Most breast tissue is soft. If the breast tissue is firm, she may have discomfort when the breast tissue swells at a few days postpartum. Removal of milk on a regular basis will be very important to provide as much comfort as possible.

    After assessing the breasts and nipples, the message you want to give the woman is that she has what it takes to provide her baby with plenty of milk.

    If for any reason you suspect that there may be a problem, recheck her breasts again during the th7 month of her pregnancy. If the situation has not improved, inform the mother to set up a prenatal appointment with a lactation consultant to devise a feeding plan that will include:

    1. Feeding the baby without compromising breastfeeding

    2. Establishing and maintaining an adequate milk supply

    3. Making breastfeeding satisfying for both mother and baby.

    Designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health, thDivision of Early Childhood, Youth and Women’s Health, 1101 Market Street, 9 Floor, Philadelphia, PA 19107

    You have permission to photocopy and to change to suit the needs of your setting. Please share your ideas for improvement.

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