Management Strategies for Promoting Successful Breastfeeding

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Abstract
Clinicians can promote a successful breastfeeding experience by providing support, anticipatory guidance and practical information. This article presents the components of early follow-up and guidelines for assessment. Management strategies for common problems are discussed, such as nipple soreness, cracked nipples, plugged ducts and mastitis, insufficient infant weight gain, perceived inadequacy of milk supply, breast-milk jaundice, sexual adjustment and failure at breastfeeding. Breastfeeding guidelines for employed mothers and adoptive mothers are indicated.Support, anticipatory guidance, and information on the management of common problems are needed for clinicians to promote successful breast feeding. They should take a thorough history prenatally to learn what problems to anticipate. The history should include whether the patient had a previous infant with slow weight gain, problems with conception, thyroid dysfunction, endocrinopathy, and history of prior breast surgery. Clinicians should also examine the breasts for size, symmetry, and shape as well as the nipples. They should discuss with the mother common breast-feeding techniques that are comfortable for both the mother and the baby. Formula and water supplementation should be avoided until an adequate milk supply has been established. Generally, nutrition supplements are not needed for breast-fed infants under 6 months old. Clinicians should encourage women to put their newborn to the breast immediately after delivery, unless the Apgar score is less than 6, the infant is premature, or the mother is heavily medicated. Professional assistance during the first few weeks postpartum increases the duration of breast feeding. Common problems that clinicians should address include nipple soreness, insufficient infant weight gain, perceived inadequacy of milk supply, breast milk, jaundice, and sexual adjustment. The article has guidelines to help clinicians with each of these problems. Fatigue, engorgement, and breast soreness tends to decrease the libido. High prolactin levels further complicate the situation by reducing vaginal lubrication. Employed mothers can successfully breast feed. They should return to work no earlier than 4-6 weeks postpartum, however, to allow enough time for establishment of the milks supply and proficient breast feeding by the infant. Working mothers can express breast milk at work and store it in a cold environment. Clinicians should provide sensitive and caring support for mothers who wanted to breast feed but could not. Adoptive mothers wanting to breast feed should prepare for induced lactation up to 2 months before the adoption.

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