Case 1: A mother is three weeks postpartum. She had a normal physiological birth

Question

Case 1: A mother is three weeks postpartum. She had a normal physiological birth at home with no complications. The baby was skin to skin for 2 hours post birth, did breast crawl and had an excellent first feed. He was in near continuous contact with his mother after she took a shower, about two hours post-birth. Her milk came in on day 2-3. Her baby, born at 7# 5 ounces, lost only 2 ounces from birth weight and regained it by day five. The baby is stooling regularly, is sleeping well even though he has his days and nights still mixed up. Mother is getting plenty of rest and feels energetic. She has a postpartum doula helping her at home, her church is bringing meals for another two weeks and her mom comes to help with housework three times per week. She is taking her encapsulated placenta: 2 pills, 3 times per day. She pumps whenever she feels overfull, which is happening regularly. Her chief complaint: “My breasts feel so full my shoulders and back hurts. My bras don’t fit and I have had a plugged duct on one side and I feel like I am getting another on the opposite breast.” Differential lactation diagnosis statement: What is your care-plan for this situation?

Explanation / Answer

Breast Engorgement: Heat and/or cool applications to the breasts, massage from chest wall down to nipple; use synthetic oxytocin nasal spray to enhance let-down reflex; soothe “fussy baby” before latching on the breast, properly position baby on breast/nipple, alternate the side baby starts nursing on, nurse round-the-clock and/or pump with piston-type electric breast pump with bilateral collection chambers at least 8 to 12 times/day.

Nursing diagnosis:- Risk for breast engorgement related to excessive milk and feeling of fullness

Care Plan Goals:

• Remove milk from your breasts

• Decrease breast swelling

Interventions

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