BREASTFEEDING PROBLEMS IN NURSING MOTHERS AND TREATMENT(CRACKED NIPPLES ETC)
Nursing mothers often experience Breastfeeding challenges which may be associated with the mother (maternal) or the child. Many of these difficulties are preventable and surmountable if properly managed.
- MATERNAL ASSOCIATED BREASTFEEDING PROBLEMS
- Unwillingness: A mother that is unwilling to breast feed her baby rarely succeeds but if she is handled tactfully and with understanding she may be persuaded to do so.
- Over -anxiety: In cases where breastfeeding has previously failed, or in the older primipara(an individual that has borne only one offspring), the woman's anxiety to succeed may stop/inhibit successful lactation(secretion of milk). On the other hand, the midwife can impart knowledge and try to instill a placid and hopeful outlook.
- General health: Poor health of a breastfeeding woman may affect her performance.
- The breasts: Breastfeeding difficulties may be functional when the breasts are incapable of secreting an adequate amount of milk. Sometimes the supply of milk from the breast is scanty from the beginning, or it fails after two or three weeks . This may be due to mismanagement.
OTHER MATERNAL ASSOCIATED BREASTFEEDING DIFFICULTIES
- ENGORGED BREASTS
The term engorge means to be filled with blood to the point of congestion. This a condition that varies in degree from slight to severe, it commonly boccurs between the third and fifth day of the puerperium(the period between childbirth and the return of the uterus (womb) to its normal size). The breasts are full, heavy and hard, due to venous and lymphatic engorgement and oedema and not to an abundant supply of milk. In this case the muscular mechanism by which milk is expelled is inhibited and when the breast tension rises excessively the cells ceases to produce milk.
a) For Slight Engorgement
The breasts should be bathed in hot water and gently stroked with soapy hands towards the nipple each time before feeding the baby. Put the baby to the breasts for a few minutes and then dispense the remaining milk. Moreso apply ointment (Massé cream) to the nipples and the nursing mother should use a firm supporting brassiére
b) For Severe Engorgement
The baby should not be put to the breast rather manual expression can be employed if the breasts are so tense, hard and swollen that the nipple is flattened that the baby cannot grasp the areola(region of the nipple). Stilboestrol is not prescribed by as many obstetricians(doctors that deals with the birth of children and women before and after giving birth) as formerly.
It is pertinent to also administer analgesics such as Panasorb or Pentazocine (Fortral) 2 tablets at night to relieve pain. The baby is put to the breast as soon as the nipple can be grapsed and an effory should always be made to keep the milk flowing and the breast soft
One major breastfeeding problems is Cracked nipples , the nursing mother should report if her nipples are tender, and if o they should be examined under a magnifying for fissures( a narrow opening or crack). Early diagnosis or recognition and prompt treatment will of course result in more rapid healing. The baby should be taken off for 24 hours if the nipples are tender, and for 48 to 72 hours if they are cracked. In this interval the milk is expressed or dispensed manually. Another measure to be employed to promote healing is by exposing the breast to warmth -an electric lamp 30cm distance or to the air for 20 minutes every six hours.
Other treatments for Cracked Nipples:
Various solutions are advocated and many has been proven successful. Ointments are soothing and should be applied cautiously or else the nipples will become soggy(moist) e.g. Massé cream . Cicatrin cream is considered to effective in preventing infection because it contains two antibiotics. The Rotersept spray is also useful.
NB: It is important to note should that cracked nipples often bleed when it is being suckd and causes melaena; which may result to the infant vomiting blood.
Prevention of Cracked Nipples during the Puerperium (the period between childbirth and the return of the uterus (womb) to its normal size)
- The baby should not be allowed to suck the breasts for longer than three minutes every six hours during the first day, five minutes at each breast during the second day. The mother should know that there is only 4 mls of "milk" in her breast and that the baby will only blister the nipple if he sucks too long.
- It is important that the baby is fixed properly, to avoid bruising the nipple with hi hums. The nostrils of the baby must be clear, or the baby will let go of the nipple in order to breathe, and breathe, and the nipple will be bruised if the baby catches hold of it repeatedly.
- The baby should not be put off the breast when he has finished sucking ; press the cheeks and depress the Lower jaw to avoid trauma to the nipple or lift the outer border of the upper lip to break the suction.; holding the nostril would be unkind. In this case thee nipples should be dried thoroughly after each feed and a soothing ointment such as Massé cream applied during the first weeks, especially in the case of the blonde o red-haired primipara.
- The baby should not be allowed to sleep at the breast in any case, but, if the nipple is in his mouth breathing on it will cause it become excoriated (wear off) in the same that dried hands become chapped.
2. BREASTFEEDING PROBLEMS DUE TO THE BABY
- There are some serious defects that can prevent an infant from sucking the breast milk from the breast but breast milk should be expressed and fed by bottle or spoon in such cases. A sore tongue due to thrush, can also make the child disinclined to feed. Snuffles usually due to nasal infection interferes with breathing when the baby is sucking. Mentally subnormal(less than normal) babies do not use their tongue effectively while feeding.
Asphyxia(state of not being able to breathe) and intracranial injury(injury of the skull) may neccessitate the administration of oxygen for the infant and the baby might be too ill to be moved from the cot. Jaundice (a disease that turns the infant skin yellow) causes lethargy (abnormal drowsiness) and disinclination to suck breast in the infant.
CONTRA-INDICATIONS TO BREAST FEEDING
These are medical conditions or symptoms that negates breastfeeding of the child by the mother. They include
- Psychiatric disorder: In the case of pysciatric disorder in the nursing mother it isimportant that the child is weaned because of the danger of the mother doing harm to her child and because the mother's nutritional wellbeing is particularly important
- Tuberculosis: In cases of active tuberculosis the baby should be isolated from the mother because of the risk of being infected due to handling. If a tuberculosis patient gets pregnant her baby should be weaned.
Mistaken Reasons for Weaning
- When the breast milk looks weak and blue or it dosent agree with the baby
- When the baby is vomiting , crying slot and having green motions
- When the baby begins to lose weight and menstruation has started again
THE SUPRESSION OF LACTATION
This is more easily achievable when treatment is started on the first day of the puerperium (the period between childbirth and the return of the uterus (womb) to its normal size) as when still birth. It is much more difficult to suppress lactation when the baby has been sucking the breast for five or six days.
Many Authorities does not approve of giving oestrogen hormones to inhibit lactation. Women of high parity, over 35 years of age and particularly when having had a major operative delivery are predisposed to having thrombo-embolism(the blocking of a blood vessel by a particle that has broken away from a blood clot at its site of formation).
The baby is taken completely off the breast and shall not be allowed to suck the breast again under any circumstance. Neither manual expression nor extraction of milk by breast pump should be perform even if the breasts are hard, heavy and painful, even if there is temptation is so great but it must be resisted. However the removal of milk either by sucking, expression or extraction will stimulate the production of milk.
To prevent stasis in the dependent areas of the breasts they are elevated by pads of cotton wool and supported by a firm brassiere or binder. It must be applied while the woman lies flat on her back while holding her breast inwards and upwards.
When a firm binder is applied to the breasts, without first elevating , produces stasis in lower region and it may predispose to mastitis (inflammation of the breast or udder usually caused by infection) due to multiplication of the organisms that are inevitably present in the breasts.
Analgesics(pain relief drugs) are administered e.g. Pentazocine (Fortral) or Panasorb tablets (2).
OVER-FEEDING OF THE BABY
This case rarely occurs, but it is occasionally seen towards the end of the first week of delivery. Vomitting may occur and the stools of the infant are usually greenish in color and loose, with undigested food mass(curds), the buttocks becomes excoriated(wears off). The baby behaves as though hungry, cries and sucking his fist, the baby may lose weight because of the indigestion and frequent loose stools.
This condition of overfeeding could also be possibly because the mother is taking too much food; the infant being weighed after sucking for 5,10 and 15 minuites. If he gets adequate/sufficient milk within five minute, subsequent feeds will be limited to that time. The interval between feeds should be lengthened.
UNDER-FEEDING OF THE BABY
A breast-fed baby could possibly be under-fed if:
- The supply of milk is inadequate, he vomits milk
- He does not take the required amount
Positive signs of underfeeding
- The baby usually, but not always, cries a alot and fail to gain weight
- The stools of the baby may be dark green and small, occasionally it contains mucus; and their urine may be insufficient in quantity.
Investigating the baby
- Check if the tongue is clean and if the baby is eager for food
- Does he vomit?
- Are the stools normal?
- The nurse or midwife should supervise a feed, watch if the baby is sucking and swallowing properly.
- Manual expression of both breasts by the mother is carried out to see if the baby has emptied the breasts.
These should be carried out over a period if at least 24 hours. Thus accurate scales are necessary. The baby is weighed with his clothes at the conclusion of the feed, without changing the napkin if it has been soiled. The difference between the two weights indicates the amount of milk obtained from the breast.
Treatment of under-feeding
The mother of the baby should be reassured and complementary feeds given temporarily . If the milk is insufficient, efforts should made to stimulate the breast s to produce more milk. It is pertinent the woman should be having three substantial meals daily with sufficient proteins and vitamin B with an adequate but nor excessive intake. Feeding should be changes to three hourly if the baby is on four-hourly feeding.
Manual expression/dispensing of milk
In this case the midwife should wash her hands and stand behind the woman, who is sitting up; the breast should be lifted up by placing the fingers of the right hand under it and the thumb above, grasping the outer border of the primary areola(region of the nipple). With a deep, inward compressing moovement she squeezes the reservoirs about thirty times per minute, bmoving the areola but nit the fingers and avoiding touching the nipple . The milk flows from a lactating breast in a steady stream.
This method involves giving the baby additional milk immediately after a deficient breast feed to complete it. The milk should not be too sweet, or the baby may prefer it to breast milk. He should be offered 60ml (or more) of modified dried milk, and should be permitted to take as much as he wants
This method involves giving milk in place of breastfeed , and should not be used in cases of underfeeding as it tends to stop the production of breast milk. Occasionally it may be used if breast feeding is well established and the mother not to be present at feeding times.