6-weeks postpartum: 4th breastfeeding session
milk, myths, flu-like, pain, weight gain, milk insufficiency, thrush
ENGORGEMENT, COLD, THRUSH
At the six-week postpartum visit, all the women in our cohort still reported exclusively breastfeeding and the Lactation Specialist made very few adjustments to women’s position or latch. Of the two infants who struggled to breastfeed and gain weight at previous visits, both had gained weight as expected. One mother continued to express her milk after feeds and provide it in a cup to her baby. The Lactation Specialist worked with this mother to increase top-ups to continue to meet her growing baby’s needs. The other participant, whose baby was referred for early PCR testing, was still waiting on the test results, but showed improvements including a better latch, steady weight gain and more effective milk exchange.Primary concerns of mothers at this time were cluster feeding (feeding too much/ too frequently) and perceived milk insufficiency. For women with these concerns, infant weights and assessments did not reveal milk insufficiency and the Lactation Specialist continued to provided reassurance and reviewed information about feeding patterns. In fact, the Lactation Specialist noted that a number of women were producing more than enough milk on one or both sides, and for some this led to engorgement. She assisted women to express milk, and made recommendations for warm compresses to relieve pain and in one case cold compresses to reduce milk production on one side. Only one infant had not gained weight as expected at this time. Upon assessment, the Lactation Specialist noted the mother still had foremilk after her baby had been feeding for around 30 min. The Lactation Specialist recommend the mother try expressing about 30 milliliters of foremilk before feeding her baby so that her baby would take in more hindmilk. She also recommended the mother apply gentle manual compression during feeding to stimulate increased milk ejection allowing her baby to take in more milk during each feed.As with the 4-week visit, infant health was also a prominent concern for women at 6-weeks. Women asked about rashes, flu-like illnesses, infant’s tongue being white, gas/colic, thrush and baby’s bowel patterns—stool consistency, color and frequency and what to do when bowel patterns change. There were a small number of myths and cultural practices mentioned by women at this time including a persistent worry for some about “plastic teeth”. The Lactation Specialist continued to provide information, reassurance and referrals to women as needed. For example, she explained that a white tongue is often normal for a breastfeeding baby and requires no intervention.