Case 2: This mother is six weeks postpartum. She was induced at 40 weeks because

ID: 126325 • Letter: C

Question

Case 2: This mother is six weeks postpartum. She was induced at 40 weeks because the doctor did not want the baby to get “too big for her pelvis.” She had pitocin for 12 hours, an epidural for 10 hours and she pushed for two hours. She was confined to bed for most of her labor, which she describes as excruciating in spite of the epidural. She had a third degree tear on her perineum. Her baby was 7# 3 ounces at birth and left the hospital weighing 6# 10 ounces. Mother has been using a nipple shield since day four and her milk did not fully come in until day five. She supplemented with formula starting on day 2 and has continued supplementing since then. The baby receives 10 ounces of cow milk based formula per 24 hours by off brand bottle. The baby has gained 1# 8 ounces. Her chief complaint: “My milk supply is low. I want to increase my milk supply and exclusively breastfeed for at least 6 months.” Differential lactation diagnosis statement: What is your care-plan for this situation?

Explanation / Answer

The following are the nursing care plan for this case:

Nursing diagnosis

Plans/objectives

Interventions

Expected outcomes

Ineffective breastfeeding – Dissatisfaction of mother related to breastfeeding process

The mother will be able to adopt new habits for breastfeeding process or be able to cope up with the current breastfeeding problems

Assess the general condition of the mother – whether the presence of conditions and factors that preclude breastfeeding like presence of any breast infections, maternal drug therapy, etc.

Assess the condition of mother’s breast and nipple structure.

Evaluate the current feeding patterns including the ability of the mother to position correctly, assisting with infant’s adaptation.

Evaluate the infant’s ability to continue with breastfeeding like sucking reflex, swallowing patterns, ability to adapt, etc.

Provide comfort and relaxed position to alleviate pain and anxiety.

Provide support to mother breastfeed properly.

If effective breastfeeding is not achievable, assist the mother to learn and adapt to a new alternative method to feed the infant.

Achieving effective breastfeeding habits

Developing and manifesting positive self-esteem related to infant’s breastfeeding process

Mother verbalizes and/or demonstrates correct technique for breastfeeding or to cope up with breastfeeding problems

Mother demonstrates alternate method of infant feeding if she is unable to continue exclusive breastfeeding

Ineffective coping - Fear and anxiety related to breastfeeding of baby

The mother will be able to develop coping, problem-solving and decision-making abilities and verbalize these effectively.

Analyse the cause of ineffective coping strategies like poor body image, lack of support, lack of knowledge, etc.

Use empathy, communicate effectively and make the mother to verbalize her feelings.

Encourage family members to actively participate in the care process.

Provide appropriate physical and mental activities to the mother within her limits.

Teach the mother relaxation techniques to cope with stress.

Direct or refer to counselling services if required.

Demonstrates problem-solving, decision making and coping behaviour patterns related to breastfeeding.