Case Study - Clinical Scenario

As it was emphasized by the World Health Organization (WHO) and the AmericanAcademy of Paediatrics (AAP), breast-feeding is essential for both mother and a child. These organizations recommend natural breast-feeding at least for the first six months of life because breast milk strengthens the immune system of a new-born child. IgA antibodies that are consumed by the baby with breast milk are in charge of microorganisms in the infant´s organism. All these microorganisms that come into infant´s body during the first months of its life help to create a strong immune system for the whole life. It was observed byscientists (Horton, Sanghvi, & Phillips, 2006) that children that were naturally fed got ill less frequently than those fed with artificial formulas. Moreover, breast-feeding reduces the risk of infections. For example, a 2004case-control study(Marild, 2006, pp.164-168) found that “breastfeeding reduced the risk of acquiringurinary tract infectionsin infants up to seven monthsof age, with the protection strongest immediately after birth.” Furthermore, it is determined (Chung & Raman, 2007) that successful breast-feeding reduces sudden infant death syndrome, risk of diabetes, allergic diseases, and the risk of extreme obesity in children.

It was already mentioned above that successful establishment of breast-feeding has its benefits for mothers. During breast-feeding hormones such as oxytocin and prolactin that relax a woman and make her feel more bonded to her child, are released into mother´s bloodstream. This helps to strengthen the maternal bond (Horta, Bahl, & Martines, 2007, p.13). Furthermore, breast-feeding helps mothers to lose weight that was gained during pregnancy.

This paper examines the clinical scenario of Elizabeth and her new-born child, Susan. Difficult labour led to some health problems of the mother and her child. These complications can cause further health problems and make establishment of breast-feeding that is so essential for them both unsuccessful. Therefore, this paper identifies potential issues that can impair breast-feeding and provides midwifery strategies to support the mother in her decision to breast-feed.

The first issue that may impair establishment of breast-feeding is the problem of placenta. It remained in situ for too long and had to be removed in a theatre. This can considerably reduce the production of milk by Elizabeth as it begins with the delivery of placenta, which in this case was removed later.

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The second disturbing issue is separation of a mother from a child with an aim to provide necessary treatment. It can cause reduction of mother´s oxytocin level that leads to a poor milk supply. However, when the mother cannot provide the appropriate amount of milk to her child, the stuff should not persuade the mother to breast-feed. The condition and pain of the mother must be taken into consideration even if the increase of breast-feeding can help a child to get better. The personnel should not use teats and dummies when feeding a child as it can impair success of further breast-feeding. It is better to use nasogastric tube before starting to feed a child with a breast (Richard & Alade, 2007, pp.116-120). Moreover, using artificial teats can impede development of child´s sucking skills.

In addition, Elizabeth was administered with Pethidine during labour for pain relief. Pethidine provides many advantages, which include lessening the pain and maintaining the ability to feel contractions. This is different from Epidural, which blocks all sensation (Wright & Drummond, 2009, p. 275). Nevertheless, this medicine has its disadvantages. If administered too close to delivery, it can affect baby´s state making the child sleepy for the first few days. This makes it difficult to establish breast-feeding successfully as well as affects breathing of a new-born.

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Successful establishment of breast-feeding is vital for every new-born child, especially in cases of unhealthy children as in our case. Before considering midwifery strategies for promoting successful breast-feeding, it is important to mention the skills that nurses should possess to provide appropriate care to both: a mother and a baby. First, nurses should be well informed about physiology of lactation and about benefits of breast-feeding for a mother and her child. They can receive this information in different additional trainings and seminars. Secondly, they should treat every mother with sensitivity and empathy. Supporting and encouraging mothers and their new-born children during and after labour are two factors essential for mothers in this critical time. In addition to this, nurses must also possess technical skills. First of all, this means that they must help a mother to find an appropriate position for breast-feeding. If mother’s position is uncomfortable, a baby cannot suckle properly since it impedes the flow of milk when a baby sucks.

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It is important to further consider and discuss optional midwifery strategies that may promote successful breast-feeding to protect the mother-baby dyad. According to Wuitchik and Bakal (2008), “in terms of reducing the pain during labour, women should be informed to follow such behavioural strategies as controlled breathing, relaxation (for example, Laura Mitchell progressive muscular relaxation), employing upright and forward postures, and more recently massage. (p.186)”

The first thing that midwives should do after childbirth is to put the baby to the breast as soon as possible, which helps to avoid many problems, including mastitis. The AAP breastfeeding strategy (Gartner, 2005) is: “Delay weighting, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. (p. 456)”

Elizabeth should feed with both breasts every time till the baby is satisfied. AmericanAcademy of Paediatrics (Paediatrics, 2005) claims: “At each feed the first breast offered should be alternated so that both breasts receive equal stimulation and draining. (p.496)” After some time passes and if everything is good with the baby and Elizabeth, feeding can be reduced to 8 times per 24 hours. However, breast-feeding should be well observed by nurses since during rapid growth, the baby may need more milk.

As described in the case, Susan loses her weight rapidly. This can lead to serious health problems. To prevent these problems nurses should create a time-table for breast-feeding. Verity (2010) says that “small, frequent or continuous feeds may be better tolerated than longer, more infrequent feedings.” This can help Susan to put on appropriate weight for her age.

Donor milk can be also a solution to this problem. Of course, it is not as good and beneficial for a baby as her own mother´s milk, but still, it is natural and brings more benefits than artificial bottle-feeding. For the period that Elizabeth is in a theatre, Susan can be fed with milk from human milk bank. This way of feeding is safe because milk is controlled according to national guidelines for quality control of screening and testing of donors. It is recommended to start with exclusive feeding as early as 4 months of age. According to Schanler (2011), “Fortification of expressed human milk is indicated for many very low weight infants.” (p.207)

Moreover, Susan should be given a range of vitamins that she needs to protect her health and build a strong immune system. According to the AmericanAcademy of Paediatrics (2006), “all breastfed infants should receive 1.0 mg of vitamin oxide intramuscularly after the first feedings is completed and within the first 6 hours of life.” (p.191) Furthermore, Gartner claims that “all breastfed infants should receive 20 IU of oral vitamin D drops daily during the first 2 months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is 500 ml.” (2008, p.908)

A balanced diet and an adequate liquid intake of about 2 litters per day should also be encouraged. Mothers must refrain from excessive intake of tea and coffee because they can inhibit milk production (Hanson & Superstore, 2009). If lactation is diminishing, then increasing the number of times she expresses to 8, 10, or even 12 times per day can help stimulate the supply. This, however, can be very difficult for the mother (Lehman, Hollenbeck, & Maize’s, 2006, p.349). Midwives should always talk to mothers about their milk expression and check of it is hard for them. Sometimes they should advise mothers to reduce the number of feeding times per day. Moreover, for successful establishment of breast-feeding midwives should recommend a suitable diet for a mother. General instructions for mothers include avoidance of eating fish high in mercury, as it is determined by the AmericanAcademy of Paediatrics (Myers, 2009, p.116).

In addition to this, the baby should be under close supervision of professionals during considerable period of time after labour. Mothers and babies should visit a paediatrician on 3rd to 5th days of age as it was determined by AAP (Riordan, 2005). A baby should be examined and weighted. Furthermore, the evaluation of breast-feeding, including milk transfer, position during feeding, and latch, should also be conducted. The second ambulatory visit should take place on 2nd to 3rd weeks of age during which mother and the baby should not only be examined, but also supported and encouraged by personnel of a hospital.

In conclusion, it is possible to say that successful establishment of breast-feeding is essential for both: mother and a child. However, the case under consideration was not simple as it had some additional factors (Methadone, removal of placenta, and child´s separation from the mother) that could impair establishment of breast-feeding. Several midwifery strategies that can help to promote successful establishment were suggested. They are: bringing Susan to her mother as soon as possible, frequent breast-feeding, using donor milk, giving Susan a range of vitamins, following a balanced diet by Elizabeth, and ensuring prolonged professional control.

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