8.0 Maternal Challenges
Maternal risk factors
As with infant risk factors, early identification of the dyads that are at risk of premature weaning allows you to allocate your time appropriately to get the best outcome for mothers and babies in your care.
Identified during pregnancy
- breast or nipple abnormalities
- previous breast surgery
- poor lactation history
- acute or chronic illnesses
- obesity
- pregnancy-induced hypertension
- social issues - poverty, lack of support, lack of child-rearing knowledge
Identified during birthing
- intrapartum analgesics or anesthetics
- assisted delivery - forceps or vacuum
- perineal trauma - large episiotomy
- surgical delivery
- post-partum haemorrhage
Identified postpartum
- severe engorgement
- painful, cracked or bleeding nipples
- late-onset of secretory activation (lactogenesis II)
- persistent breast pain
- mastitis
- insufficient milk supply
- postnatal depression
- rigid parenting philosophy
These lists are not complete - every mother has her own, individual issues or obstacles to overcome. Your skills and knowledge, support, understanding, acceptance and good communication skills may be sufficient to help some mothers make possible what they never dreamed they could.
The career you have chosen is infinitely variable, challenging and rewarding. I hope you are able to feel the privledge it is to be able to have a positive influence on the lives of women and children.

Just out of interest ...
Pick a random shift you have worked recently and look at the list of mothers and their infants allocated to your care. Was your time spent proportionately more on the mothers who had risk factors for breastfeeding difficulty?

When a referral is needed
As for the baby with risk factors, don't endanger breastfeeding by delaying referral to a professional who can provide the acute and/or ongoing assessment and guidance appropriate to their condition.
Early referral can prevent problems which may be impossible to retrieve if left too long.
Early referral can prevent problems which may be impossible to retrieve if left too long.

Knowledge and help is now available for nearly all problems you'll encounter.