Hyperlactation: How Left-brained ‘Rules’ for Breastfeeding Can Wreak Havoc With a Natural Process

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief.     

Bacterial Vaginosis Screening and Treatment in Pregnant Women

The American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the US Preventive Services Task Force recommend against routinely screening asymptomatic pregnant women for bacterial vaginosis (BV). Although asymptomatic BV has been associated with preterm birth, there is insufficient evidence demonstrating that treatment of asymptomatic BV improves outcomes. Conversely, women who have symptomatic BV should be treated to relieve their symptoms. This brief report provides an overview of BV, reviews the evidence regarding screening and treating BV in pregnant women, and summarizes treatment recommendations for pregnant women who have symptomatic BV.     

New Diagnosis: Interrupted Breastfeeding

Interrupted breastfeeding was approved by the membership to be added to the NANDA taxonomy in 1992. The diagnosis was developed to name the response that occurs when a breastfed baby cannot be put to breast for some or all of the feedings. Two examples of life processes/events, premature or sick infant and maternal employment, illustrate the application and use of the diagnosis. Nursing interventions for each situation are discussed. A comparison describing the differences between interrupted breastfeeding and ineffective breastfeeding is included to address the controversy of whether or not the diagnoses are the same. A sample diagnosis/care plan is added to demonstrate use of the diagnoses in clinical practice.     

Maternal, obstetric variables, perceived stress and health-related quality of life among pregnant women in Macao, China

Objective

to identify associations between demographic, socio-economic and obstetric variables and health-related quality of life with perceived stress among Macao Chinese pregnant women.

Design

a cross-sectional, exploratory quantitative study.

Setting

an antenatal clinic of a university-affiliated regional public hospital in Macao.

Participants

a community-based sample (n=1151) of pregnant women in the second trimester of pregnancy.

Measurements

perceived stress was measured using the Perceived Stress Scale, and health-related quality of life was measured using the standard Short Form-12 Health Survey.

Findings

a multiple linear regression analysis revealed that pregnant women who were younger (β=0.085, p=0.002), single, divorced, separated or cohabiting (β=0.067, p<0.009), had a lower level of education (β=0.079, p=0.003), worked long hours (β=0.102, p<0.001) or who had an unplanned pregnancy (β=0.063, p=0.014) with late initiation of antenatal care (β=0.066, p=0.008) or poor physical (β=−0.501, p<0.001) or mental (β=−0.115, p<0.001) health-related quality of life had higher levels of perceived stress.

Conclusion

preliminary information was provided about Macao pregnant women who had higher perceived stress during pregnancy that was associated with the demographic, socio-economic, obstetric and health-related quality-of-life variables.

Implications for practice

the development of a checklist or structured questions for clinical situations is necessary, and programmes of stress management should be tailor made during pregnancy.     

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

ABSTRACT: Background: A woman’s decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. Methods: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4‐hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding‐related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. Results: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03–1.69). Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates. (BIRTH 36:1 March 2009)