Maha is a 24-year-old office manager and part-time aerobics instructor who has delivered vaginally, without complications, a healthy, full-term son, Rani. With a birthweight of 3200 grams (7 lb), Rani...

Maha is a 24-year-old office manager and part-time aerobics instructor who has delivered vaginally, without complications, a healthy, full-term son, Rani. With a birthweight of 3200 grams (7 lb), Rani is the first child for Maha and her husband. Maha is 162 cm(5 ft 4 in) tall with a prepregancy weight of 56.8 kg (125 lb). She gained 25 kg (55 lb) during her uncomplicated pregnancy and has been a lacto-ovo vegetarian for 5 years. After a 12-hour stay in a birthing center, Maha and her husband bring Rani home. At 4 days postpartum, Maha, her husband, and her mother-in-law bring the baby to the health care center for his first follow-up visit. Maha and her husband are very concerned about whether their son is getting adequate nourishment, so the dietitian is called to see the family. During nutrition assessment, the following information is documented. Rani weighs 3,000 grams (6 lb 6 oz). The parents report that Rani nurses vigorously about every 1½ to 2 hours and never sleeps for more than a couple of hours. Maha says that her milk “came in” on the second postpartum day and that she feels like all she does is nurse. Her nipples are tender, but not uncomfortably sore. She reports that Rani has at least six to eight wet diapers and two to three very loose stools each day. She wonders if she has enough milk and worries about how she will ever return to work in 2 months. She also wants to lose the excess weight she gained during the pregnancy and is eager to return to her aerobics classes. Her husband and mother in-law are supportive, but they worry about the baby. The dietitian’s nutrition assessment of the infant concludes that Rani is a healthy infant with no nutritional problems. The family is referred to their pediatrician for further follow-up. Questions 1. What factors put Maha at high risk for early termination of breastfeeding? 2. What factors indicate that Rani is getting adequate nourishment? 3. What concerns do you have about Maha’s diet? What advice would you give her about her weight-loss plans and eagerness to return to exercise? Do Maha or Rani need any vitamin/mineral supplements? 4. If Maha lived in your community, what resources would be available for help and support for breastfeeding mothers? 5. What steps can Maha take to continue successful breastfeeding when she returns to work in 2 months?