Pain
Common Concerns
Return to Work & Resources
Medications/
Substances
Substances
100
PPD#2: Breastfeeding is super painful - What is going on?
What is a shallow latch?
Ask about latching, timing/nature of pain, observe nipples and latch if possible
Help with a deeper latch: Supportive measures: warm salt water soaks, cream/oil, hydrogel pads, antibiotic ointment for deep cracks
100
PPD #2: I want to breastfeed but my baby won't latch
What is...Watch the baby feed and try to help with position & latch
How to supplement, maintain supply in the meantime...
100
Prenatal Visit: I'm going to do both breast and bottle because I'm going back to work
How can you support mothers who are returning to work?
Counsel why exclusive breastfeeding is important (infant health, establishing supply)
Discuss workplace laws, speaking to employer, provide pump Rx
Making it Work Toolkit: https://www.breastfeedingpartners.org/images/pdf/ForMomsFINAL.pdf
100
POD #3 - I'm afraid to breastfeed because I'm taking pain medication
What is the best postpartum pain management to support breastfeeding?
maximize ibuprofen
hydrocodone>oxycodone>codeine (not recommended)
ABM Protocol #15 & #28
200
PPD#3: My breasts are super painful and my baby can't latch on... What's going on? What can I do?
What is Engorgement
Prevention/Treatment:
*frequent nursing/milk removal*
Breast massage: (1min & 3min)
Reverse Pressure Softening
Motrin, cold compress, lying supine
200
Postpartum Day 1-7: The pediatrician said my baby is doing well but I don't think I have enough milk
What is PERCEIVED low milk supply?
How to reassure mom?
When would you worry about low supply? What are risk factors?
200
2 months postpartum: I went back to work and my supply dropped so I bought lactation cookies.
What are reasons for a drop in milk supply?
What can mothers do to increase their production?
200
I don't want to get pregnant again - I plan to restart my regular birth control pills after I deliver
What birth control is NOT recommended with breastfeeding?
No Estrogen
What is recommended?
-non-hormonal, progesterone-only pills or LARC (shared decision making for immediate postpartum LARC)
ABM Protocol #13
300
6 weeks postpartum: My nipples are getting painful again especially after latching and when I get out of the shower.
What is vasospasm?
What else should we think about?
Treatment: as per UNC pain protocols: https://www.mombaby.org/wp-content/uploads/2016/04/lactation_pain_june_2018.pdf
& ABM Protocol #26
300
6 weeks postpartum: Baby is choking and my breasts are painful. I have a freezer stash for when I return to work.
What is oversupply?
vs. Overactive let-down
Risk for plugged ducts, mastitis
How to prevent/manage?
300
Prenatal visit: I didn't have enough milk for my first baby so I'll probably have to do both.
What is prenatal breastfeeding support?
explore prior breastfeeding experiences
.prenatalclasses - refer by 30 weeks
BreastBeginnings and Birth&Beyond Apps
300
I might use alcohol, marijuana and nicotine occasionally.
What are substances where the benefits of breastfeeding likely outweigh the risks of occasional use?
Up to 3 cups caffeine is okay
400
6 weeks postpartum: My right breast is red and painful and I feel like I have the flu.
What is mastitis? (symptoms, treatment)
What else should we think about?
Engorgement, Plugged duct, abscess
400
1. I have a UTI and the ER told me to stop breastfeeding for 2 weeks
2. I was diagnosed with cancer and need to start chemotherapy
3. My baby is 9 months old and we want to try for another
What is a reason to wean? #2
1. Does she truly need to wean or is medication/procedure actually safe - check LactMed or infantrisk.com
2. Rapid wean - pseudafed, cabergoline, estrogen
3. Gradual wean - drop one feeding/pumping every 1-3 days, parsely/sage