mothers concern on breast feeding. increased mobility of families and shorter hospital stays have...
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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!!