NCLEX Review Guide: Maternal Newborn Health - Postpartum Breastfeeding/Chest-feeding

Hormonal Control

• Prolactin stimulates milk production and is released in response to nipple stimulation and suckling.
• Oxytocin triggers the let-down reflex, causing milk ejection from the alveoli through the ductal system.
• Estrogen and progesterone levels drop after delivery, allowing prolactin to initiate milk production effectively.

Initial Feeding Guidelines

• Initiate feeding within the first hour after birth when the infant is in a quiet alert state for optimal success.
• Position the infant tummy-to-tummy with proper alignment of ear, shoulder, and hip in a straight line.
• Ensure proper latch with infant's mouth covering most of the areola, not just the nipple tip.

1. Position mother comfortably with back support
2. Bring baby to breast, not breast to baby
3. Tickle baby's lips with nipple to stimulate rooting reflex
4. Wait for wide mouth opening before guiding baby to breast
5. Check for proper latch and comfortable positioning

Nipple Problems

• Nipple soreness is often caused by improper latch or positioning and should improve with correction of technique.
• Cracked or bleeding nipples require immediate intervention including proper latch assessment and possible nipple shields.
• Apply expressed breast milk to nipples after feeding for natural healing properties.

Engorgement Management

• Occurs typically 3-5 days postpartum when mature milk comes in and breasts become overly full.
• Frequent feeding every 2-3 hours is the best prevention and treatment for engorgement.
• Apply cold compresses between feedings and warm compresses before feeding to promote comfort and milk flow.

Maternal Nutrition

• Lactating mothers need an additional 500 calories per day above pre-pregnancy requirements.
• Increase fluid intake to 8-10 glasses of water daily, but excessive fluids don't increase milk production.
• Continue prenatal vitamins and ensure adequate calcium intake (1000mg daily) for bone health.

Absolute Contraindications

• HIV infection in resource-rich countries where safe formula feeding is available.
• Active tuberculosis that is untreated in the mother poses infection risk to infant.
• Maternal use of illicit drugs or certain medications that pass into breast milk.

Medication Considerations

• Most medications are compatible with breastfeeding, but always verify safety before administration.
• Lactation Risk Categories help determine medication safety during breastfeeding.
• Time medication doses after feeding when possible to minimize infant exposure.