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2.0 Case Study B (Joanne)

Key Points - Case Study B

Joanne asks you what she can do before the baby is born to help her successfully breastfeed.

The Ten Steps to Successful Breastfeeding, designed by the ExternalWHO and ExternalUNICEF summarise the maternity practices needed to support and encourage breastfeeding.

Topic 2.1: Preparation Before Birth
Inform all pregnant women about the benefits and management of breastfeeding

Joanne's baby Rosie is born by spontaneous vaginal delivery at 37 weeks following a 15-hour labour. She had been given pethidine (meperidine) and an epidural for pain relief during labour. Are there any features of her birthing experience that may affect breastfeeding?

Topic 2.2: Birthing Factors that Affect Breastfeeding
Labour analgesia and near-term birth
Topic 2.3: Management After Birth
Place Rosie in skin-to-skin contact; Encourage breastfeeding on demand; Practice rooming-in, allow Joanne and Rosie to remain together 24 hours a day; Give Rosie no food or drink other than breastmilk, unless medically indicated; Give Rosie no artificial teats or dummies; Show Joanne how to breastfeed and how to maintain lactation even if she should be separated from Rosie.

Rosie is now 24 hours old. Although she seems interested in the breast, she is not attaching well and tends to slip off the breast easily. What is the most appropriate management to suggest at this time?

Topic 2.4: Poor Attachment
Investigate whether there an underlying reason; Maximize breastfeeding opportunities; Protect the milk supply; Feed the baby; Nipple shields may be useful.

Because Rosie has not been feeding well, the hospital staff are concerned that she may develop hypoglycaemia. Is hypoglycaemia likely to occur in a healthy term breastfed neonate?

Topic 2.5: Hypoglycaemia
Healthy full-term infants do not develop symptomatic hypoglycaemia simply as a result of underfeeding.

On day three, just before Rosie and Joanne are to go home, Joanne mentions that Rosie looks jaundiced and asks if it is due to her breastmilk. What is the relationship between jaundice and breastfeeding?

Topic 2.6: Relationship between Jaundice and Breastfeeding
In the early days jaundice in a breastfed infant may be due to inadequate breastfeeding. Breast milk jaundice usually begins after day five, is associated with increasing milk volumes and is thought to be due to as yet unidentified substance in breast milk. It rarely requires investigation or treatment.