4-weeks postpartum: 3rd breastfeeding support session
milk insufficiency, rashes, bowel patterns, weight gain, thrush, colic
ORAL THRUSH, HEAT RASH, THRUSH
The 4-week postpartum visit followed a similar flow to week 2 where the Lactation Specialist observed a feeding, gave feedback on technique, and addressed questions and concerns. All women still reported practicing exclusive breastfeeding at this time. The Lactation Specialist identified fewer issues with latch and positioning, but still made adjustments for some to improve technique. The infant who was unable to latch on at two-weeks was now able to latch on, but had not added as much weight as expected and fed hungrily from expressed milk given in a cup. The Lactation Specialist worked out a plan with this mother for her to give top-ups (around 120 milliliters of expressed breastmilk in a cup) after each breastfeeding.At this time, many women still felt like their infants were feeding a lot and for some this led to continued worries about milk insufficiency. The Lactation Specialist took this opportunity to reassure women by reviewing the breastmilk supply and demand cycle, the reasons why infants cluster feed and infant growth and development. Women were also encouraged by seeing the increase in their infants’ weights over time. According to infant weight gain and the Lactation Specialist’s assessment, no women were suffering from insufficient milk supplies, though she had concern for two infants who had not gained weight as expected. One (described above), was to be given top-ups from the mother’s plentiful milk supply. The other infant, who had also been referred to medical providers at 2-weeks, returned at 4-weeks having gained very little weight and, on assessment, was not breastfeeding well. The Lactation Specialist was also concerned the mother looked detached. She encouraged and coached the mother supporting her to achieve an effective latch and comfortable position with skin-to-skin contact. She also encouraged her to offer top-ups of expressed breastmilk to her baby after each feeding. The Lactation Specialist then referred the baby for an early infant HIV test (normally done at six weeks), which was completed on the following day.Compared to the two-week session, fewer women had concerns about HIV transmission to their babies or “plastic teeth”. Meanwhile, other questions and concerns were wide ranging including concerns about rashes, bowel patterns, colic, crying, the healing of umbilical cords, sleeping patterns, white colored tongues, oral thrush and a few remaining questions about infant HIV prophylaxis medications. The Lactation Specialist addressed women’s concerns by offering information, suggested interventions and referrals as appropriate. For example, she explained normal bowel patterns for breastfed babies, encouraged mothers not to overdress their babies (causing heat rash) and referred some for medications to treat thrush.