MOTHERS CONCERN ON BREAST FEEDING

 Increased mobility of families and shorter hospital stays  have added to the adjustment difficulties  of new mothers, and  lack of an adequate support system  may cause the mother  to end breast feeding.

 Successful breastfeeding is a combination of PatienceGood techniquePerseverance

 Why does the concern exist?

OBSERVE THE FEEDING PHYSICAL ASSESSMENT ASK OPEN ENDED QUESTIONS VALIDATE MOTHER’S FEELINGS 12 34

 J Midwifery Womens Health Jan-Feb;56(1):2-7. J Midwifery Womens Health.  Women's prenatal concerns regarding breastfeeding: are they being addressed?  Archabald K, Lundsberg L, Triche E, Norwitz E, Illuzzi J. Archabald KLundsberg LTriche ENorwitz EIlluzzi J  Source  Department of Obstetrics and Gynecology, Brown University School of Medicine,Women and Infants' Hospital, USA.

PURPOSE Whether they had concerns about breastfeeding while making their decisions about feeding their infants, METHODS A structured interview with both open-ended and closed-ended questions SAMPLE 130 English-speaking or Spanish-speaking postpartum women SETTING at Yale-New Haven Hospital. RESULTS 81.5% of women identified at least 1 concern. Of these women, only 25.4% reported that this concern was addressed by the provider during prenatal care RECOMMENDATION strongly suggests that providers are not adequately addressing women's concerns about breastfeeding.

 Nutritional concerns  Behavioural concerns Behavioural concerns  Health concerns Health concerns  Special concerns Special concerns

1. What to eat 2. What to drink

1. Fatigue 2. Smoking 3. Contraception 4. Should breastfeeding feel this good?

1. If there is a cold 2. Vegetarians and vitamin supplements 3. Medications 4. Over-the-counter drugs 5. Prescription drugs (e.g., bromocriptine. Cyclophosphamide. Cyclosporine, doxorubicin, ergotamine, lithium, etc) 6. Non-prescription drugs 7. Herbal remedies

 cesarean birth  premature baby  twins and triplets  allergic baby  adopted baby  baby with special needs (Babies with cleft lip/cleft palate, cystic fibrosis, celiac disease, neurological impairments, and other medical problems)

 Inverted or Flat nipples Inverted or Flat nipples  Engorgement Engorgement  Sore Nipples Sore Nipples  Thrush Thrush  Nipple Preference Nipple Preference  Decreased Milk Supply Decreased Milk Supply  Plugged Ducts Plugged Ducts  Mastitis Mastitis

How to cope with some of the worries a nursing mother may face?. OBJECTIVES

 Initial feedings may be more difficult with flat or inverted nipples, but successful breastfeeding is achieved by most women.

 wearing special nipple cups called breast shells between feedings may help draw their nipple out.  hand expression or pumping  Do not roll, twist or pull on your nipple. These actions can cause nipple trauma.  Consult a lactation specialist for additional assistance

 Reason  skipped feeding, or limited feeding time, the breasts may become tender and engorged.  may flatten the nipple and make it more difficult for the infant to latch-on.

 apply cold compresses to both breasts.  warm shower; hot washcloths on the breasts  Massage  hand expression of milk to soften the areola just before latch-on.  Feed the baby on demand, approximately every one to three hours for at least 15 minutes of suckling on each breast.  Do not skip feedings.  Wear a supportive bra and get in a comfortable and supported position for feedings.  Consult a lactation consultant for additional assistance.lactation consultant

REASON  nipple trauma  improper positioning of the baby.  temporary latch-on soreness.

 Assist with correct positioning and latch  Skin to skin may allow the baby to ‘reboot’  Moist wound care and pain relief  Refer to lactation to consultant if sore nipples are sever or persist

REASON  fungal infection  moist conditions - breasts and nipples  Taken or are currently taking antibiotics  Cracked nipples from poor latch-on or positioning

Pain!  Nipple Itching, flaking, redness,shyness and white patches  The baby has  white patches on his/her tongue or inside the mouth.  yeast diaper rash and fussy

Assess  Both the mother and the baby at the same time & treat(2 Weeks)  Take care of the environment  Items that come in contact with baby's mouth or mother's nipples (boiled daily for 20 minutes).  Boil the milk (if it is expressed)to destroy the yeast.  Keep the breasts as dry as possible.

 Use disposable bra pads  use hot, soapy water.  All items should be thoroughly dried in the sun light.  use paper towels for hand drying and use bath towels only once before laundering.

 Why does mother think there is no milk?  Her breast are soft  She thinks these milk comes in later  Baby is fussy  Baby breast feeds frequently  Baby takes a bottle after breast feeding  Her family think this  Additional reasons?

 How can you address those concerns?  Validate her feelings and provide education  Stomach size  The value and volume of colostrums  The value skin to skin  How to calm her fussy baby  How cluster feeding is normal?  Sucking on a bottle is a response to the hard nipple and flow of formula, not hunger  Teach her family also

 Colostrol phase  let the mother rest or sleep  quiet a fussy baby  wake up a sleepy baby  a big baby  a little baby  prevent sore nipple  teach baby to take bottle

BABY CONCERNSMATERNAL CONCERNS  Hypogycemia  Joundice  Weight loss of 7 – 10% within the 1 st 3 to 4 days of life  Breast feeding is contraindicated  Severe illness  Intolerable pain during feedings

When  Mother may insist  Medically indicated  Need to teach mother  If baby is supplemented, mother needs to pump and / or hand express to protect her milk supply

 1 st day – 5 to 15 cc per feeding  2 nd day up to 30 cc per feeding  3 rd day up to 45 cc per feeding  To allow for appropriate stomach accommodation

 Quality in order to preference  Mother’s expressed breast milk  Pasteurized donor breast milk  Hydrolyzed formula  Cow or soy formula

 If infant is supplemented, the nurse should:  Inform - potential risk  Type of expression the mother has been taught, i.e., hand, pump.  Reason - in the infant’s medical record

Reason  Incomplete emptying  continued pressure on one or more ducts.  feel a hard, lumpy, painful area on your breast.

 Apply warm, moist towels to your breasts before feeding.  Massage your breasts - painful area.  Feed more frequently, as often as every one and a half hours if possible.  Breastfeed in  different positions. Place your baby's chin in the direction of the plugged duct.  on the side with the plugged duct first. (Remember, babies suck hardest on the first breast.)

 Get plenty of rest and adequate fluids.  Avoid - restrictive clothing, sleeping on abdomen &  wearing tight and/or underwire bras while breastfeeding  Continue examine breasts daily to check for plugged ducts.  contact a lactation specialist for assistance.

 is a breast infection leads fatigue  Occasionally, a plugged duct will become infected or bacteria will enter the breast through another route, such as an open sore on the areola or nipple.  Usually, a red, hard, hot and painful area will be present on the breast.  mother will have a fever greater than F degrees and feel “flu-like.”

 Immediate medical attention is needed to treat mastitis.  Don't wait for the mastitis to go away by itself.  Contact health care provider immediately for treatment with antibiotics.  It is very important that continue frequent nursing during this time.  milk is not infected and will not harm your baby.  complete the entire treatment of antibiotics (seven to 10 days) to avoid a recurrence.  contact lactation specialist to learn about how to prevent reoccurrence of the mastitis.

“Postpartum concerns of breastfeeding mothers”. (Graef P, McGhee K, Rozycki J, Fescina-Jones D, Clark JA, Thompson J, Brooten D).Graef PMcGhee KRozycki JFescina-Jones D Clark JAThompson JBrooten D

 Purpose - to identify the postpartum concerns of breast feeding mothers from time of discharge through the 1st postpartum month.  sample - 32 women, aged 20-38, who had uncomplicated vaginal deliveries, were released from hospital by the 3rd day, and were breast feeding for the 1st time.  Methods - They were telephoned daily during the 1st 2 weeks and twice a week for the 3rd and 4th week.  Inclusion criteria - 78% were primigravidas. 97% of the women reported a total of 210 concerns about the infant;

 53% - (baby concern) crying or fussy behavior following feeding and during family dinner - 1st week and 41% during the 2nd week. (physical state of the infant included wellness and growth, temperature, cord care, bilirubin level, infection, and bowel movements)  81% -. Maternal concern (themselves). (Physical concerns included breast soreness, nipple pain and blisters, uterine bleeding and cramps, episiotomy pain, muscle pain, and hemorrhoids.)  18 % - emotional concerns, particularly fatigue.   6 % - interactions with family and friends, including lack of help from the father and pressure from visits by friends and relatives.  The greatest number of concerns expressed in this study were related to the infant.

 Many mothers have early concerns that are easily addressed.  With encouragement, support and education But,  Still some mothers will need referral to a lactation specialist and  Proper management of breast feeding in the 1 st week of life can prevent many breast feeding problems

 Breast feed early  Breast feed often  Breast feed long  Breast feed exclusively  Breast feed well