2 weeks postpartum: 2nd breastfeeding support session
milk, fatigue, burping, infection, pains, colic pains, breast milk, rashes
ENGORGEMENT, INFECTION
At around two weeks postpartum, women met with the Lactation Specialist and Research Coordinator again, this time with their babies in arm, and all women reported exclusively breastfeeding. After observing the participant breastfeeding, the Lactation Specialist assisted nearly all women to improve their breastfeeding technique including by helping women to adjust their baby’s latch and position to optimize comfort and effective milk exchange. Many women suffered from painful or cracked nipples, a result of poor latch. Several women also struggled with breast engorgement or babies preferring to nurse on only one side. The Lactation Specialist supported these women by assisting them to express milk from their engorged breast and by helping them find a comfortable latch and position for their baby on the non-preferred side. The Lactation Specialist also assisted one mother, whose baby was not able to maintain an effective latch, to express milk into a cup and feed her baby.A majority of women were concerned that they may not have enough milk or that their babies were feeding too much, and many were already facing pressure from others to begin introducing complementary feeding. Thus, reviewing infant stomach sizes, signs of sufficient milk intake, the importance of feeding on demand and the benefits of breastfeeding exclusively for the first six months was important encouragement offered by the Lactation Specialist at this time. Despite concerns, based on her assessment and the infants’ weights, the Lactation Specialist did not identify any women with insufficient milk. For two babies, whose weight was less than expected at two weeks despite adequate milk (including the baby mentioned above who struggled to latch on), the Lactation Specialist made referrals to medical providers for further assessment, monitoring and care.As women fed their babies during the session, the Lactation Specialist showed women the change in color and consistency between the foremilk and hindmilk by expressing a few drops of each onto a gloved hand. This was a powerful visual tool that surprised many women and showcased the two components of breast milk (hydration and nutrition). For some women, this demonstration facilitated continued exclusive breastfeeding because it was convincing evidence that providing water to breastfeeding babies was unnecessary.In addition to the aforementioned breastfeeding concerns, a quarter of the women continued to have worries about “plastic teeth”. Many women also continued to worry about HIV transmission to their babies. In addition, most women sought support for at least one of a variety of other infant health concerns, the most common being rashes and concerns about crying or perceived colic pains. To address these concerns, the Lactation Specialist was able to examine the babies and reassure women that their babies had no “plastic teeth.” She was also able to advise about skin care, review the importance of burping babies to reduce gas pains, and make referrals to primary care doctors as needed. Finally, she eased worries about HIV transmission by reinforcing the importance of maternal and infant adherence and addressed follow-up or repeated questions about administering infant HIV prophylaxis medication.At this time, some women also had questions about personal health concerns including infection of the cesarian section wounds, general exhaustion and fatigue. The Lactation Specialist advised on breastfeeding postures to reduce pressure on painful incisions and encouraged mothers to hydrate frequently and ask for help from supporters whenever possible. Women that needed additional medical attention were referred to relevant medical practitioners.