Beruflich Dokumente
Kultur Dokumente
Management Quandary
Section Editors: Lesley Breech, MD
University of Cincinnati College of Medicine, Cincinnati, Ohio
Elisabeth H. Quint, MD
University of Michigan Health Systems, Ann Arbor, Michigan
2006 North American Society for Pediatric and Adolescent Gynecology 1083-3188/06/$22.00
Published by Elsevier Inc. doi:10.1016/j.jpag.2006.09.004
420 Breech and Qunit: Management Quandary
better how to teach the baby to attach to minimize Ms. Westdahls comments:
discomfort to the mother. As well as reducing the
barriers to breastfeeding, you can highlight the The Healthy People 2010 goal aims for 75% of women
unique benefits of breastfeeding. For teens, the to initiate breastfeeding. Currently only 45% of teens
unique benefits of breastfeeding compared to formula ever breastfeed and only 17% are exclusively breast-
feeding include having a relationship with the baby feeding at 3 months.4 Praise her success and take the
that others cannot usurp, fewer infant sick days, time to explore her concerns. Fatigue and stress can af-
and getting her figure back faster. fect the milk supply. This teen needs help in order to
rest and assure adequate nutrition including sleeping
If this 3-step strategy is repeated at every encounter near her infant to minimize nighttime sleep distur-
you will uncover the complex thinking and weighing bance. Be sure to screen this young mother for signs
of pros and cons that goes into the decision to breast- and symptoms of post-partum depression.
feed. You will have taken advantage of the many op-
portunities to provide education, advice, support, and Every nursing mother needs help, support, and encour-
referrals which specifically address the unique needs agement. Support systems for breastfeeding are ideally
of your patients. This 3-step strategy was designed to set up before they are needed. Adolescent mothers
fit into the time constraints of busy practitioners. have unique needs for support during breastfeeding.
More information about the 3-Step Counseling Strat- Including the babys father and the teens mother in
egy as well as materials, such as Physician/Health the breastfeeding conversations offers an opportu-
Provider Breastfeeding Support kits and Your New nity to address their specific worries and fears that
Life MagazineAn Informative Guide to Breast- might prevent them from supporting the breastfeeding
feeding for Teens and Teen Mothers, is available teen mother. Peer support counselors, young women
from Best Start, Inc.2 who have met the unique challenges of breastfeeding
while returning to school and work, are particularly
At delivery, SC has a prolonged labor with a poorly effective with teen mothers and have been shown to
functioning epidural and a difficult second stage of la- improve initiation and duration of breastfeeding.5
bor. She has a vacuum-assisted vaginal delivery of an
The teen will need to make plans for feeding her infant
8-lb male infant. She suffers a third-degree perineal
while they are separated. Expressing/pumping breast
laceration, which is repaired after delivery. She is milk and having the child care provider feed breast
exhausted and declines an offer to breastfeed the baby milk from the bottle is a good plan. A good quality
in the delivery room. electric pump will make it easier to efficiently express
adequate amounts of milk. Milk expression and stor-
Ms. Westdahls comments: age should begin before the planned separation so that
Immediate mother-baby contact after birth has been there is an adequate supply of milk stored before she
firmly established as evidence-based practice that returns to work or school. Teens often work in environ-
supports breastfeeding.3 Early initiation of breast- ments without access to privacy and milk storage facil-
feeding within the first hour after birth should be en- ities. The teen should explore her work and school
couraged. Early nursing is associated with an environment to assess on-site childcare services and/
increase in the percentage of couples still nursing at or to plan where to pump and to store breast milk.
2e4 months post partum. In contemporary hospital You can reassure her that after separation, breastfeed-
practice there are many routines that interrupt ing will be a good way to re-establish the close connec-
initiation of early and uninterrupted maternal infant tion between her and her baby. Specific strategies for
contact. Many of those procedures can be accom- the mother who is returning to work or school are listed
plished with the infant on the mothers abdomen. If in the Breastfeeding Handbook for Physicians.1 Com-
the teen is unwilling to put the baby to breast, she munity resources which can be very helpful include:
should be encouraged to accept the infant on his/ Peer counseling services through some WIC Pro-
her abdomen for uninterrupted skin-to-skin contact. grams, the La Leche League, support groups through
Often, the infant will find the nipple and areola on pediatric offices, telephone support lines, and private
his/her own during the alert first hour after birth. lactation consultants.
The teens feeling of competence as a mother will As a physician/health care provider caring for adoles-
be enhanced if you point out to her how her baby cent mothers you will have many opportunities to
is looking for her and calms when they are together. promote, support and protect breastfeeding and to
Even after long and difficult childbirth a woman will help young women achieve a satisfying and success-
cuddle and gaze at her baby. This teen should be pro- ful breastfeeding experience.
tected and supported to do just that.3
At her postpartum visit, 6 weeks after delivery, she
says that she is still trying to breastfeed the baby, but References
has found it difficult to manage feedings alone. Her
friends have told her that using formula would be eas- 1. Schanler R, Dooley S. (eds): Breastfeeding Handbook for
ier for her. She complains of fatigue and is worried Physicians. Elk Grove Village, American Academy of
about how much help she will have as she returns to Pediatrics, and the American College of Obstetricians
school and a part-time job. and Gynecologists, 2006
Breech and Qunit: Management Quandary 421
2. Best Start, Inc. Your New Life MagazineAn Informative Survey. Atlanta, US Department of Health and Human
Guide to Breastfeeding for Teens and Teen Mothers. Services, Centers for Disease Control and Preven-
Available: www.beststartinc.org. Accessed November 6, tion, 2005. Available: www.cdc.gov/breasttfeeding./data.
2006. Accessed November 6, 2006.
3. Kroeger M, with Smith L: Impact of Birthing Practices on 5. Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM:
Breastfeeding: Protecting the Mother and Baby Continuum. The CDC Guide To Breastfeeding Interventions. Atlanta,
Sudbury, MA, Jones and Bartlett Publishers, 2004 US Department of Health and Human Services, Centers
4. Breastfeeding: Data and Statistics: Breastfeeding Prac- for Disease Control and Prevention, 2005. Available:
tices Results from the 2004 National Immunization www.cdc.gov/breastfeeding.