Question

The nurse on the mother-baby unit is caring for Johanna, a 37-year-old primipara who gave birth to a baby girl by emergency cesarean 3 days ago. During the morning assessment, the nurse observes that Johanna's breasts are engorged. Johanna sent the baby to the nursery during the night for feeding because she was exhausted. The engorgement seems to have happened overnight while Johanna was sleeping. Johanna is scheduled for discharge today.

Assumptions—What assumptions can be made about the following issues?

a) Johanna's commitment to breastfeeding

b) The infant's ability to feed effectively

c) What implications and priorities for nursing care can be identified at this time?

Answer 1

a). Engorgement of breast is a normal thing happening in post natal mothers during the initial days, usually because of stasis of milk. The body will be adjusting to the production of milk, so when the feeding is delayed for a few hours also, the breast gets engorged with milk. This happens for most of the new mothers.

Johanna has undergone caesarean just three days back, she is just recovering from the pain and stress of it. She might be busy caring the baby past few days and must be really tired of pain and lack of sleep. So she might have sent the baby to the nursery. Here the commitment of the mother towards breast feeding is less questionable.

The engorgement happened over night according to the nurse. That means the previous day, she was feeding the baby regularly, so no engorgement noted. Also the engorgement means the breast is getting full with milk, which usually happens with proper breast feeding from the day of delivery onwards, as letting the milk out is a hormone mediated mechanism.

Here the mother must have asked the nurse to get the baby after 3 hrs of sleep, and can feed the baby and send her to nursery, so that she can rest again. This is a concern because she is getting discharged today, and if she denies to feed the baby at home, it will be difficult.

b) The infant's ability to feed effectively is proven by the engorged breasts of her mother. The breast will become full with milk, only if the baby sucks it properly. The baby might have sucked very well , that the milk production has become sufficient. And that's why, it got engorged overnight. So the baby can suck properly if she is put to her mother's breasts.

c) The nurse's priorities include

• the baby has to be fed every 2 hourly or according to the demand
• promote breast feeding as long as possible
• educate the mother on the needs of feeding the baby, baby's stomach capacity and the frequency of feeding
• educate the mother on the benefits of breast feeding to the baby
• elaborate on the maternal benefits of breast feeding
• teach how to prevent engorged breasts
• advise to apply warm pack before feeding, for easy flow of milk
• teach how to apply cold packs on the breast after feeding, to relieve from discomfort or pain or engorgement.