Maternity Nursing: Postpartum Q 39
As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is one day postpartum. An expected finding would be:
A. Soft, non-tender; colostrum is present.
B. Leakage of milk at let down.
C. Swollen, warm, and tender upon palpation.
D. A few blisters and a bruise on each areola.
Correct Answer: A. Soft, non-tender; colostrum is present.
Breasts are essentially unchanged for the first two to three days after birth. Colostrum is present and may leak from the nipples. There are distinct stages seen in milk production which start before the birth of the baby. The first milk is colostrum which is available after labor. Occasionally, there is pre-colostrum before the postpartum stage. Colostrum is high in protein, sodium, and immunoglobulins while being low in lactose, and this is the first milk produced for the baby. After 30 to 40 hours postpartum, the milk composition changes by an increase of lactose and dilution of other constituents as the volume increases.
Option B: Subsequently, the maintenance of lactation follows an autonomous pattern wherein the sucking of the baby and emptying of the breast are the main factors regulating the milk flow. Baby and maternal factors can influence this bonding. Skin-to-skin contact in the first 2 hours after birth is essential for successful initiation of lactation. The breast crawl, soon after birth, while the baby is alert will initiate the bonding, and it will be an assurance by giving comfort and calm to the mother. The breast crawl is when the baby is placed on the mother’s abdomen after birth; the baby finds its way to the breast to suckle.
Option C: Maternal factors like pain, anxiety, emotional instability, among others should be addressed before and after delivery. Getting a correct latch on the nipple is important. If the latch is not correct due to issues such as lip tie or tongue tie, the mother can develop cracked nipples or pain while breastfeeding. An evaluation by a lactation consultant or other health professional comfortable with diagnosing lip and tongue ties may be helpful.
Option D: Pain and discomfort while breastfeeding is expected. Milk produced can be classified as foremilk and hindmilk. Foremilk contains higher levels of lactose while hindmilk contains a higher proportion of proteins and fats. The baby’s nutritional need controls the milk quantity and components. The knowledge of high lactose foremilk and high fat of hindmilk will help the mother to regulate the feed from both breasts.