MOTHERS CONCERN ON BREAST FEEDING

INTRODUCTION

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.

COMMON PROBLEMS & CONCERNS ABOUT BREASTFEEDING

Successful breastfeeding is a combination of

Patience

Good technique

Perseverance

Why does the concern exist?

ASSESSMENT IS KEY TO PROBLEM SOLVING

OBSERVE THE

FEEDING

PHYSICAL ASSESSMEN

T

ASK OPEN ENDED

QUESTIONS

VALIDATE MOTHER’S FEELINGS

1 2

3 4

J Midwifery Womens Health. 2011 Jan-Feb;56(1):2-7.

Women's prenatal concerns regarding breastfeeding: are they being addressed?

Archabald K, Lundsberg L, Triche E, Norwitz E, Illuzzi J.

Source Department of Obstetrics and Gynecology,

Brown University School of Medicine,Women and Infants' Hospital, USA.

PURPOSEWhether they had concerns about breastfeeding while making their

decisions about feeding their infants,

METHODS A structured interview with both open-ended and closed-ended

questionsSAMPLE

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

RECOMMENDATIONstrongly suggests that providers are not adequately addressing

women's concerns about breastfeeding.

CONCERNS

Nutritional concerns Behavioural concerns Health concerns Special concerns

NUTRITIONAL CONCERNS

1. What to eat2. What to drink

BEHAVIOURAL CONCERNS

1. Fatigue2. Smoking3. Contraception4. Should breastfeeding feel this good?

HEALTH CONCERN

1. If there is a cold2. Vegetarians and vitamin supplements3. Medications4. Over-the-counter drugs5. Prescription drugs (e.g., bromocriptine.

Cyclophosphamide. Cyclosporine, doxorubicin, ergotamine, lithium, etc)

6. Non-prescription drugs7. Herbal remedies

SPECIAL CONCERNS

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)

WHEN EARLY CONCERNS ARE NOT ADDRESSED OR RESOLVED

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

CONCERNS OF BREASTFEEDING MOTHERS

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

OBJECTIVES

1. INVERTED OR FLAT NIPPLES

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

PREVENTION/TREATMENT

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

2. ENGORGEMENT

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.

PREVENTION/TREATMENT 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.

3. SORE NIPPLES

REASON nipple trauma

improper positioning of the baby.

temporary latch-on soreness.

PREVENTION/TREATMENT

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

4. THRUSH

REASON fungal infection

moist conditions - breasts and nipples

Taken or are currently taking antibiotics

Cracked nipples from poor latch-on or positioning

Symptoms

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

TREATMENT/ HOME CAREAssess

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.

 

5. PERCEIVED INSUFFICIENT MILK SUPPLY

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?

PERCEIVED INSUFFICIENT MILK SUPPLY 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

SUPPLEMENT IS NOT NEED FOR

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

IN SUFFICIENT MILK SUPPLY VALID MEDICAL REASON TO SUPPLEMENT

BABY CONCERNS MATERNAL CONCERNS

Hypogycemia

Joundice

Weight loss of 7 – 10% within the 1st 3 to 4 days of life

Breast feeding is contraindicated

Severe illness

Intolerable pain during feedings

SUPPLEMENTATION CAN BE STARTED

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

HOW MUCH TO SUPPLEMENT?

1st day – 5 to 15 cc per feeding

2nd day up to 30 cc per feeding

3rd day up to 45 cc per feeding

To allow for appropriate stomach accommodation

WHAT TO SUPPLEMENT?

Quality in order to preference

Mother’s expressed breast milk

Pasteurized donor breast milk

Hydrolyzed formula

Cow or soy formula

DOCUMENTATION

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

6. PLUGGED DUCTS

Reason

Incomplete emptying

continued pressure on one or more ducts.

feel a hard, lumpy, painful area on your breast.

PREVENTION/TREATMENT

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.)

 

CONTD- 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.

7. MASTITIS 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.”

PREVENTION/TREATMENT: 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.

RESEARCH ABSTRACT

J NURSE MIDWIFERY. 1988 MAR-APR;33(2):62-6.

“Postpartum concerns of breastfeeding mothers”.

(Graef P, McGhee K, Rozycki J, Fescina-Jones D, Clark JA, Thompson J, Brooten 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;

CONTD- 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.

CONCLUSION 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 1st week of life can prevent many breast feeding problems

TAKE HOME MESSAGE!

SING ALONG

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

THANK YOU!!