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Case Study: Getting Enough Milk?
History/Description:
Jackie calls you at Public Health requesting your assistance with breastfeeding. She tells you she is worried about her milk supply and is not sure if she has enough. Mary was born vaginally 3 weeks ago at 40 weeks gestation after a long labour requiring instrumental delivery using vacuum. She weighed 3,317g (7lbs 5ozs) at birth, at discharge she weighed 2,976g (6lbs 9ozs) and at her doctor's appointment this week she weighed 3,232g (7lbs 2ozs). Jackie tells you Mary was sleepy in hospital and had some jaundice. She got off to a "slow start" but is now nursing better and is feeding every 2 hours around the clock. Despite great family support, mom is exhausted and worried about her baby.
Discussion Points:
What should you do first and why?
In this case, I will address first the condition of the baby having the signs of being sleepy and having jaundice. In order to do this, I should initially inform the mother that the condition is actually caused by having high levels of bilirubin in the bloodstream of the baby. I will also tell her that being lethargic is actually related to jaundice. It is important that I express therapeutic communication in this situation because I might cause distress to the mother. Instead of giving false assurance that her baby will be fine, I will tell her that this, based on research, is actually common with newborns. Then, I will ask the permission of the mother to further assess the baby and consult this to the healthcare provider. If the physician will order phototherapy, I will, then, inform the mother about the procedure and that her baby will be treated with enough care.
What questions do you need to ask the mother to assess her milk supply?
It was mentioned that the mother is feeling exhausted and worrisome, so before doing the assessment, I will help her relax, first. If she permits, I can also do some therapeutic touches to alleviate her anxiety.
While exhibiting therapeutic communication, I will primarily ask the mother about her perception regarding breastfeeding. This is to know whether the mother is doing it out of compliance or adherence because stress might be induced if she is doing it out of compliance. As a connection, stress is believed to be a factor that influences one’s milk supply. The conduction of a health education is always relevant to breastfeeding mothers.
Next, I will now ask her whether the baby is getting enough milk. If not, there are a lot of factors which might cause it, but I can inform her the proper way for latching or the proper positioning to improve the flow of milk. Regarding the weight loss that the baby experienced after being discharged, this normally happens with newborns and usually, they gain the weight back after a few weeks. I will also ask how she ensures that her baby is being fed enough. There are different signs in which we can determine if the baby is well-fed and some of the objective signs are 6-8 wet diapers, weight gain, relaxed arms and hands. Apart from these, you can also observe if the baby’s cheek is full and if you can see or hear her swallowing. You can also palpate your breast afterwards; the breast should be soft, not hard. Also, I will ask her the technique she uses to feed her baby; whether she uses a pump or she lets the baby do direct latching. If she uses a pump, I will ask, then, ask the quantity of milk she is able to pump. I can also ask if the quantity is consistent or not.
Then, I will ask her what actions she should do to increase her milk supply. For example, the lifestyle changes she made for what she believes will increase her milk supply. I will also ask what kind of foods she usually eats or medications she intakes. Lastly, I will ask her if she is satisfied with her performance in breastfeeding.