Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Reference Manual<br />
Underarm position<br />
Side lying position<br />
Figure 11.1. Two positions for breastfeeding. (WHO, 1993)<br />
Management<br />
• Build the mother's confidence.<br />
• Improve attachment <strong>and</strong> continue breastfeeding.<br />
• Reduce engorgement; suggest frequent feeding <strong>and</strong> express breast milk if needed.<br />
• Treat for C<strong>and</strong>ida if the skin is red, shiny, flaky; if there is itchiness or deep pain; or if<br />
soreness persists.<br />
• Advise the mother:<br />
o Not to wash her breasts more than once a day <strong>and</strong> not to use soap or rub hard with a<br />
towel. Breasts do not need to be washed before or after feeds; normal washing as for<br />
the rest of the body is all that is necessary. Washing removes natural oils from the<br />
skin <strong>and</strong> makes soreness more likely.<br />
o Not to use medicated lotions <strong>and</strong> ointments because these can irritate the skin, <strong>and</strong><br />
there is no evidence that they are helpful.<br />
o To rub a little expressed breast milk over the nipple <strong>and</strong> areola with her finger after<br />
breastfeeding; this promotes healing.<br />
o To expose her breasts to the air for brief periods.<br />
o To start the feed on the unaffected breast. This may help if the pain seems to be<br />
preventing the oxytocin reflex. Change to the affected breast after the reflex starts<br />
working.<br />
o To breastfeed the baby in different positions at different feeds.<br />
• If breastfeeding is difficult, help the mother to express the milk.<br />
Breast Engorgement<br />
Breast engorgement is an exaggeration of the lymphatic <strong>and</strong> venous engorgement that occurs<br />
prior to lactation; it is not the result of over-distension of the breast with milk. Engorgement may<br />
occur between days 2 <strong>and</strong> 4, causing the breast to become hard <strong>and</strong> tense <strong>and</strong> the nipples to<br />
become taut, shiny, <strong>and</strong> hard; this usually resolves spontaneously in 24 to 48 hours.<br />
Symptoms of engorgement<br />
• breast pain <strong>and</strong> tenderness<br />
• symptoms occurring 3-5 days after delivery<br />
• hard enlarged breasts<br />
• both breasts affected<br />
<strong>Integrated</strong> maternal <strong>and</strong> newborn care<br />
<strong>Basic</strong> skills course<br />
127