1. MOTHERS CONCERN ON BREAST FEEDING

2.  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.

3.  Successful breastfeeding is a combination of PatienceGood techniquePerseverance

4.  Why does the concern exist?

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

6.  J Midwifery Womens Health. 2011 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.

7. 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.

8.  Nutritional concerns  Behavioural concerns Behavioural concerns  Health concerns Health concerns  Special concerns Special concerns

9. 1. What to eat 2. What to drink

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

11. 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

12.  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)

13.  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

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

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

16.  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

17.  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.

18.  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

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

20.  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

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

22. 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

23. 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.

24.  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.

25.  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?

26.  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

27.  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

28. 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

29. 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

30.  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

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

32.  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

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

34.  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.)

35.  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.

36.  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 100.4 F degrees and feel “flu-like.”

37.  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.

39. “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

40.  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;

41.  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.

42.  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

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