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1.0 Case Study A (Joanne)

Key Points - Case Study A

Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.

Would you discuss breastfeeding at this visit?

Topic 1.1: Discussing breastfeeding
It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.

What information would you give?

Topic 1.2: What information to give
When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.

Why do breastfeeding alternatives have different effects?

Topic 1.3: Effects of Breastfeeding alternatives
These effects are due in part to the presence in breast milk of substances and systems that act against infections and inflammation.

What are mothers' common and valid concerns about breastfeeding?

Topic 1.4: Common breastfeeding concerns
Exploring her concerns and providing information and reassurance is useful in allaying anxiety and prepares the parents for their changing role.

Would you examine her breasts at this visit?

Topic 1.5: Breast examination
Examine Joanne's breasts now and again in the third trimester. Examining a mother's breasts and nipples early in pregnancy emphasises the importance of breastfeeding, provides reassurance for most women that they are 'normal', allows the identification of any variations that may cause problems.

What are the contraindications to breastfeeding?

Topic 1.6: Contraindications to breastfeeding
There are very few conditions when women should be discouraged from breastfeeding, including active tuberculosis, HIV, human T-cell leukaemia virus Type 1, brucellosis, some medications, illicit drug use and classic galactosaemia and some inborn errors of metabolism in the infant.

What conditions may be related to poorer lactation outcomes?

Topic 1.7: Conditions related to lactation outcomes
Common problems are previous lactation failure, hormonal problems and obesity.

Joanne's sister-in-law developed hyperthyroidism when she had been breastfeeding her last baby and was told that she would have to wean so that she could commence taking medication. Joanne asks you whether it is common for women to have to wean to be treated for medical conditions. What would you tell her about medication use in breastfeeding women?

Topic 1.8: Medications
There are very few medical conditions for which a mother needs to cease breastfeeding so that she can be adequately treated. In nearly all situations a mother can continue to breastfeed while she is on medication.