Understanding the Postpartum Period: Changes, Care, and Breastfeeding

📚 Postpartum Period: A Comprehensive Study Guide

Source Information: This study material has been compiled and organized from lecture slides (PDF/PowerPoint text) and an audio lecture transcript.

---

1. Introduction to the Postpartum Period

The postpartum period, also known as the puerperium, is a critical phase following childbirth. It typically spans the first six weeks after delivery, during which a woman's body undergoes significant physiological and psychological adjustments to return to its non-pregnant state. This guide aims to explain these changes, outline essential nursing interventions, and provide knowledge about breastfeeding, including common challenges and their solutions.

1.1. Purpose By the end of this course, students will be able to explain the physiological and psychological changes occurring in the postpartum period and gain knowledge about the necessary nursing interventions.

1.2. Objectives ✅ Describe physical adaptation in the postpartum period by systems. ✅ Explain psychological adaptation in the postpartum period. ✅ Identify the care and education needs of the mother and baby. ✅ Understand the roles and responsibilities of nurses in successful breastfeeding. ✅ Know breastfeeding issues and their solutions.

2. Terminology & Duration

📚 Key Terms:

• Puerpera: A woman who has just given birth.
• Postnatal: Pertaining to the period after childbirth.
• Puerperal woman: A woman in the puerperium.
• Postpartum: The period after childbirth.
• Puerperium: The period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition.

⏳ Duration:

• Often referred to as the "4th Trimester."
• Typically lasts for 6 weeks postpartum.

3. Changes in the Postpartum Period

The postpartum period involves both progressive (e.g., lactation) and retrogressive (e.g., organ involution) changes across various body systems, alongside significant psychological adjustments.

3.1. Systemic Adaptation

3.1.1. Reproductive System

• Uterus Involution 🔄

  • Definition: The process by which the uterus returns to its pre-pregnancy size and position.
  • Initial State: Immediately after birth, the uterus is about the size of a 16-week gestation. Within 1-2 hours, the fundus rises to the level of or slightly above the umbilicus.
  • Rate: Rapid in the first few days, descending approximately 1-2 cm every 24 hours.
  • Position: By postpartum days 5-6, the fundus is midway between the umbilicus and symphysis pubis. After a week, it regains its place in the pelvis. After 9 days, it is typically not palpable abdominally.
  • Mechanism:
    1. Chorionic Estrogen Withdrawal: Leads to an autolytic process in the myometrium where protein synthesis stops, amino acids are broken down, and breakdown products (e.g., nitrogen in urine) are produced. This causes nutritional deficiency in the endometrium.
    2. Uterine Contractions: Act as "live ligatures" in the myometrium, causing contraction anemia. This leads to the shedding of decidua compacta and spongiosa as lochia, followed by regeneration in the basal layer, forming a natural defensive barrier.
  • Factors Delaying Involution (Subinvolution):
    • Difficult and prolonged labor
    • Administered anesthetic agents
    • Older age multiparas
    • Full bladder
    • Placental retention
    • Infection
    • Multiple pregnancies, polyhydramnios, fetal macrosomia
  • Factors Accelerating Involution:
    • Lactation
    • Type of birth (vaginal vs. C-section)
    • Infant feeding practices (early and frequent breastfeeding)
  • Early Postpartum Contractions: In the first 1-2 hours, uterine muscles may be tired, leading to few and irregular contractions. Exogenous oxytocin is often administered immediately after placental expulsion (IM/IV) to aid contractions.

• Involution of the Placental Region

  • Endometrial regeneration begins within 3 days postpartum and is completed by the 3rd week.
  • Regeneration at the placental site is completed by the 6th week.
  • ⚠️ Warning: If regeneration is impaired, puerperal hemorrhage may occur.

• Lochia 🩸

  • Definition: Postpartum vaginal discharge consisting of blood, tissue, and mucus.
  • Evaluation: Monitored for quantity, odor, and presence of clots. Excessive and large clots should be noted.
  • Amount: Should not be excessive (approx. 6 pads/day). Bleeding more than 1 pad per hour is significant.
  • Transitions:
    • Lochia Rubra: Red, lasts 3-4 days.
    • Lochia Serosa: Pinkish-brown, lasts 4-10 days.
    • Lochia Alba: Whitish-yellow, lasts 10 days to 6 weeks.

• Cervix

  • Immediately postpartum, it appears like a sac under the corpus, soft, edematous, and lax.
  • The external os is 2-3 cm open (1 cm open during the first week), and the internal os closes by day 8-10.
  • Involution completes in 6 weeks, but consistency and form return in 4-5 months.
  • Lactation delays cervical mucus production.
  • Emmet's Tear: A common cervical laceration that may occur during childbirth.

• Ovaries

  • Breastfeeding Women: Ovulation often returns around 6 months postpartum, suppressed by increased prolactin.
  • Non-breastfeeding Women: Ovulation can occur as early as 27-28 days, averaging 7-9 weeks postpartum. About 70% menstruate by 12 weeks. Prolactin levels return to normal by the 3rd postpartum week.

• Vulva and Vagina

  • Initially velvet-like (soft), edematous, smooth, dark red, bruised, and abraded.
  • Rugae (vaginal folds) reappear after the 3rd week and are fully restored after the 4th week.
  • Temporary atrophy occurs in weeks 3-4; lubrication begins at weeks 6-10.
  • Vaginal mucosa remains atrophic until menstruation in breastfeeding women.
  • Slightly open vaginal orifice and labia.
  • Muscle fibers are loose and elastic, recovering by weeks 1-2, fully healing by weeks 6-8.

• Episiotomy or Laceration Repair

  • Erythema and edema around the repair site are common.
  • Healing follows the same process as any surgical incision.
  • Initial healing occurs within 2-3 weeks, with complete healing in 4-6 months.
  • Hemorrhoids regress and shrink by 6 weeks.

• Pelvic Floor

  • Recovery of tone in pelvic floor support tissues stretched or torn during birth may take up to 6 months.

• Postpartum Hemorrhage (PPH) 🩸

  • Definition: Blood loss exceeding 500 ml in the first 24 hours following birth.
  • Severe PPH: Blood loss exceeding 1000 ml.
  • Causes:
    • 90% due to uterine atony.
    • 7% due to genital tract trauma.
    • 3% due to placental retention and coagulation issues.
  • Significance: Leading cause of maternal mortality. Anemic patients have a higher risk of death from PPH.

3.1.2. Breasts

• Hormonal Changes: Immediately after birth, there's a decrease in estrogen, progesterone, HCG, prolactin, cortisol, and insulin levels.
• Lactation:
  • Feeling of fullness in the breasts with lactation.
  • Colostrum transitions to mature milk in 72-96 hours, making breasts heavier and fuller.
  • As milk production increases, blood and lymphatic flow to the breast also increase.
  • Breast Engorgement: Occurs around 24-48 hours postpartum, characterized by hot, tense, and tender breasts.

3.1.3. Cardiovascular System

• Cardiac Output:
  • After placental separation, there's a sudden increase in venous return and stroke volume.
  • Cardiac output decreases by 30% in 2 weeks and returns to pre-pregnancy levels in 3-4 weeks.
• Blood Volume:
  • Normal birth: ~500 ml blood loss.
  • Cesarean section: ~1000 ml blood loss.
  • Within 12-48 hours, 900-1200 ml of extracellular fluid enters the circulation, causing blood volume to increase temporarily.
  • Postpartum diuresis helps reduce this.
  • Blood volume returns to normal after an average of 4 weeks.
• Blood Pressure:
  • Minimal changes are normal in the first postpartum week.
  • Bradycardia: Temporary, typically 50-60 bpm, occurs in the early postpartum period, continuing for 6-8 days and returning to pre-pregnancy status within 3 months.
  • Tachycardia: May indicate cardiac problems, pain, anxiety, excessive bleeding, or infection.
• Blood Components:
  • Leukocytosis and increased thrombokinase ferment (first 2 weeks).
  • Fibrinogen is high (first 1 week).
  • Plasma proteins return to normal at 2-3 months.
  • Hemoglobin 10-11.4 gr/dl (variable) on day 2.

3.1.4. Respiratory System

• Structural Changes:
  • Uterine pressure on the diaphragm resolves.
  • Separation of the placenta leads to decreased progesterone production.
  • Breathing becomes easier.
  • Thoracic capacity and residual volume increase.
• Recovery: Changes in the respiratory system are normal at 1-3 weeks. Complete recovery may take up to 6 months.

3.1.5. Endocrine System

• Placental Hormones:
  • With the expulsion of the placenta, estrogen and progesterone levels decrease significantly, reaching their lowest level 1 week after birth.
  • In non-breastfeeding women, estrogen levels return to high levels in the 2nd week and are higher than in breastfeeding women by day 17.
• Pituitary Hormones:
  • Prolactin: Stimulates milk production. In lactating women, prolactin is maximum in the 1st month after delivery, influenced by breastfeeding frequency, duration, supplementary feeding, and sucking strength. In non-breastfeeding women, prolactin levels decrease and return to pre-pregnancy levels by the 3rd postpartum week.
  • Oxytocin: Responsible for milk ejection (let-down reflex).
• Metabolic Changes:
  • hPL, estrogen, cortisol, and insulinase levels decrease, resolving the diatogenic effect of pregnancy.
  • The thyroid gradually returns to normal 3 months after birth. Thyroxine and triiodothyronine levels normalize within 4 weeks.
  • Increased risk of transient autoimmune thyroiditis in the postpartum period.

3.1.6. Urinary System

• Kidney Function:
  • Postpartum steroid levels affect renal function.
  • Kidney function becomes normal after 6 weeks.
  • Pregnancy-induced hypotonia, enlargement of the ureters and renal pelvis return to normal after 8 weeks.
  • ⚠️ Warning: Prolonged changes (3 months or longer) increase the risk of urinary tract infection.
  • Renal glycosuria disappears after 1 week. Lactosuria may occur in breastfeeding women.
  • Blood urea nitrogen and plasma creatinine levels return to normal after 6 weeks.
  • Proteinuria resolves by 6 weeks after birth.
• Fluid Loss:
  • Within 12 hours, excess accumulated tissue fluid is lost.
  • Estrogen diuresis, disappearance of venous pressure in the lower extremities, and a decrease in blood volume contribute to this.
  • 2-3 days postpartum, urine output can be 3000 ml/day or more.
  • Excessive sweating also occurs for 2 to 3 days.
• Urethra-Bladder:
  • Birth-related trauma, increased bladder capacity, anesthesia effects, and vaginal-perineal tears can decrease the urge to urinate.
  • Decreased voiding combined with postpartum diuresis may cause bladder distention.
  • ⚠️ Warning: An overly distended bladder increases the risk of bleeding and infection.
  • Normal bladder tone returns after 5-7 days.
  • Stress Urinary Incontinence (SUI) may occur after normal birth.

3.1.7. Gastrointestinal System (GIS)

• Bowel function, stomach, and intestinal tone return to normal within 3-4 days.
• Pre-birth enemas, reduced intake in the last 1-2 days, inactivity, and perineal pain can lead to constipation.
• Third- and fourth-degree perineal tears involving the anal sphincter may increase the risk of anal incontinence.

3.1.8. Skin (Integumentary System)

• Melasma/Chloasma: Usually fades postpartum but may persist in 30% of women.
• Hyperpigmentation: Of the areola and Linea nigra may not regress completely; darker pigmentation may be permanent.
• Striae Gravidarum (Stretch Marks): On breasts, abdomen, hips, and thighs may lighten but rarely disappear completely.
• Angiomas and Palmar Erythema: Regress with decreasing estrogen, though angiomas may not always resolve completely.
• Hair Loss: Common within the first 3 months postpartum.
• Nails: Regain their pre-pregnancy strength.

3.1.9. Musculoskeletal System

• Abdominal Wall: Relaxation occurs within the first 2 weeks. It takes about 6 weeks for the abdominal wall to return to its pre-pregnancy state, influenced by previous muscle tone, exercise, and amount of adipose tissue.
• Diastasis Recti Abdominis: Women may experience discomfort due to separation of the rectus abdominis muscles.
• Joints: Stabilize 6-8 weeks after birth (excluding feet, which may increase in size).

3.1.10. Neurological System

• Headaches: Common in the first week postpartum, often bilateral and frontal.
• Other Symptoms: Neurological symptoms usually resolve after delivery. Nasal congestion, tinnitus, and laryngeal changes resolve within a few days.
• Posture: Lumbar lordosis and kyphosis normalize.
• Sensory: Numbness, pain, tingling, and cramps disappear.

3.2. Psychological Changes

The postpartum period is a time of significant emotional and psychological adjustment for both parents.

3.2.1. In the Mother

• Emotional Sensitivity: Due to sudden hormonal changes, mothers often experience increased sensitivity and emotionality.
• Sleep & Anxiety: Disrupted sleep patterns and baby-related events can lead to anxiety and loss of energy.
• Mild Postpartum Depression (Baby Blues): 😔
  • Characterized by feelings of inadequacy, tears over minor events, and insomnia.
  • Usually lasts 1-2 days.
  • 💡 Insight: If symptoms persist for a long time, medical assistance and positive support from spouse and family are crucial.
• Motherhood Role Development:
  • Mothers often model their behavior after their own mothers or other role models.
  • The process involves developing one's own style, finding comfort, and earning one's role.
  • This process typically develops over 3-10 months.
  • Factors Affecting Role Development: Age, personal characteristics, social support, socio-economic status, and features of the newborn.

3.2.2. In the Father

• Fatherhood Role:
  • Involves helping the mother with childcare and household chores.
  • Entertaining the baby and introducing them to the outside environment.
  • Factors Affecting Role Development: Personal characteristics, experiences, relationship with his wife, satisfaction from the baby, and family happiness.

3.2.3. Parenting Role

• Anticipation Phase: Occurs during the gestational/pregnancy period.
• Happiness Phase: Occurs during the postpartum period, involving first contact and communication with the baby, intense emotions, joy from baby’s responses, and strengthening bonds.

3.2.4. Negative Influences

• Unhappy marriage, unwanted pregnancy, gender disappointment, pregnancy outside of marriage, or negative influence from close surroundings can negatively impact family relationships and the approach to the baby.

4. Normal Postpartum Nursing Care

Nursing care is paramount for the well-being of both mother and baby during the postpartum period.

4.1. Monitoring During the Postpartum Period

• Close Observation: Critical in the first hours, especially the first 1-2 hours.
• ⚠️ Watch for Postpartum Hemorrhages!
• 🌡️ Prevent Hypothermia: By warming the mother.

4.2. Vital Sign Monitoring

• Frequency:
  • First hour: every 15 minutes.
  • 1-2 hours: every 30 minutes.
  • 2-6 hours: once an hour.
  • Next hours: every 4 hours.
  • From the first day postpartum: twice daily if no need for increased frequency.
• Pulse: Should be rhythmic, around 80 beats/min. If higher than 80 beats/min, it may indicate bleeding or puerperal infection.
• Temperature: "Milk fever" (a slight temperature elevation) may occur around the 3rd-4th day.

4.3. Fundus Monitoring and Pad Tracking

• Frequency:
  • First 30 min: every 5-10 min.
  • 30-60 min: every 15 min.
  • 1-2 hours: every 30 min.
  • Next hours: every 6 hours.
  • Daily observation in subsequent days.
• Fundal Assessment:
  • Immediately after birth: between the umbilicus and symphysis pubis.
  • After 12 hours: at the level of the umbilicus (U-0 or U-1).
  • 3rd day: U-2 or U-3 (2-3 fingers below umbilicus).
  • Day 7: 2 fingers above the symphyseal pubis.
  • 10th-12th days: non-palpable.
• Uterine Atony: If the fundus is found to be soft, fundal massage should be performed immediately with small circular movements. A soft uterus combined with frequent bleeding indicates uterine atony.
• Lochia Evaluation: Assess quantity, odor, and presence of clots. Excessive bleeding (more than 1 pad per hour) and large clots are significant.

4.4. Postpartum Abdominal Pain

• Often called "afterpains."
• Relieves after 48 hours.
• Breastfeeding releases oxytocin, which causes myometrial contractions, intensifying the pain.
• This is a normal state-transition process.
• 💡 Tip: Lying in a prone position can help relieve pain.

4.5. Early Mobilization

• Encourage mobilization in the first 1-2 hours after normal delivery.
• Benefits:
  • Prevents venous thrombosis.
  • Speeds involution process.
  • Prevents constipation.
  • Facilitates urination.
  • Encourages lochia flow.

4.6. Thrombophlebitis Assessment

• Homans’ Sign: Assess for pain in the calf on dorsiflexion of the foot, which can indicate deep vein thrombosis.

4.7. Postpartum Exercises

• Should continue for 6-8 weeks.
• Benefits:
  • Strengthens abdominal and pelvic tone.
  • Regulates breathing.
  • Improves circulation.
  • Promotes proper body mechanics.
  • Prevents thrombophlebitis.
  • Enhances psychological well-being.

4.8. Perineum and Episiotomy Care

• Assessment: If episiotomy or laceration repair is present, carefully evaluate sutures, healing status, redness, edema, ecchymosis, and discharge.
• Initial Care: Apply cold packs in the first 1/2-1 hour post-birth to reduce swelling.
• Ongoing Care: Warm sitz baths (three times daily, 10-15 minutes at 38-40°C) to improve circulation and promote healing.

4.9. Sexual Function

• Intercourse may resume 6 weeks postpartum.
• Ensure episiotomy or laceration is healed.
• Wait until lochia has ceased.
• ⚠️ Warning: Prevent infection.

4.10. Birth Control

• Methods:
  • Lactation Amenorrhea Method (LAM) (effective for the first 6 months if breastfeeding exclusively).
  • Barrier methods (condom, spermicide, diaphragm).
  • Intrauterine device (IUD).
  • Surgical sterilization (vasectomy, tubal ligation).
  • Progesterone-only methods.
  • Combined contraceptive methods (oral contraceptives, monthly injections) – after >42 days postpartum, and in category 2 if breastfeeding.

4.11. Postpartum Nutrition

• Emphasis: Nutrient-rich foods.
• Vegetables & Fruits: Plenty for vitamins, minerals, and to relieve constipation.
• Iron-rich Foods: Red meat, liver, molasses to prevent anemia.
• Hydration: Consume at least 2000-2500 ml (8-12 glasses) of water daily.
• Dieting: Avoid dieting; increase meal frequency or consume milk between meals.
• Avoid: High-fat fast foods, excessive tea, coffee, salt, and sugar.
• 💡 Insight: Inform the mother that gas-producing foods may affect the baby’s digestion through breast milk.

5. Breastfeeding

Breastfeeding is a cornerstone of postpartum care, offering significant benefits for both mother and baby.

5.1. Maternal Breastfeeding Reflexes

• Ferguson/Let-down Reflex: Triggered by sucking, other stimuli, or even thinking about breastfeeding, causing milk ejection.
• Milk Production: Stimulated by prolactin.

5.2. Infant Reflexes that Aid Breastfeeding

• Searching (Rooting): Baby turns head towards stimulus on cheek.
• Sucking: Rhythmic sucking motion when nipple is in mouth.
• Swallowing: Coordinated with sucking.

5.3. Time, Duration, and Frequency of Breastfeeding

• Initiation: Early sucking increases prolactin secretion. Initiate within the first 30 minutes immediately after birth (or 4 hours after C-section, 30 minutes after epidural anesthesia).
• Initial Feeds: In the first days, 5 minutes from each breast. Duration increases to 10-15 minutes over days.
• Frequency:
  • Every 2-3 hours for the first few days (whenever the baby cries).
  • For the first 3-4 months, whenever the baby desires (on demand).
• Important: Feed from both breasts, ensuring complete emptying. Milk production is directly related to frequent breastfeeding.
• 💡 Tip: Since the first breastfed breast receives the strongest stimulus, the next feeding should start from the breast that was last fed.

5.4. Benefits of Breastfeeding

• For the Baby (Breast Milk):
  • Excellent nutrient content.
  • Easy to digest, effective to use.
  • Protects from diseases.
  • Provides better brain development.
• For the Mother (Breastfeeding):
  • Helps establish mother-baby attachment.
  • Delays new pregnancy.
  • Protects maternal health (aids uterine involution, prevents anemia, reduces risk of certain cancers, less urinary infections).
  • Cheaper and effortless.
• Psychological Benefits:
  • Fills with love, provides emotional satisfaction.
  • Less crying in babies, faster development.
  • More compassion for the baby, less abuse.
  • Fewer complaints about nighttime feeding.

5.5. Types of Milk

• Colostrum (First Vaccine): 💉
  • Secreted for the first few days.
  • Rich in antibodies: Protects from infection and allergy.
  • Rich in white blood cells: Protects from infection.
  • Bowel cleanser: Removes meconium, prevents jaundice.
  • Growth factors: Aid in intestinal maturation, prevent allergy and intolerance.
  • Rich in vitamin A: Prevents severe infections and eye diseases.
• Transitional Milk:
  • Begins after colostrum and continues for about 2 weeks.
  • Levels of elements are generally between colostrum and mature milk.
  • Higher phosphorus level than colostrum and mature milk.
  • Total protein content decreases compared to colostrum.
• Mature Milk:
  • Formed towards the 4th week of lactation.
  • Alone meets the baby's nutritional needs for the first 6 months, with no need for additional foods.
  • 📊 Note: Breast milk has different iron content compared to cow's milk, which is better absorbed by infants.

5.6. Adequacy of the Milk Ejection Reflex

• Indicators:
  • Tingling in the breasts just before/during breastfeeding.
  • Milk leakage from the other breast when the baby cries or when thinking about breastfeeding.
  • Uterine contractions felt as pain during breastfeeding (in the first days).

5.7. Insufficient Milk Ejection Reflex: Management

• Before Milking/Feeding:
  • Giving a warm drink (excluding coffee).
  • Warming breasts with a warm, moist, or dry application.
  • Stimulating the nipples.
  • Gently massaging the breasts.
  • Massaging the back.
• Psychological Support:
  • Building confidence in the mother.
  • Reducing stress factors like pain.
  • Developing positive thoughts about the baby and breastfeeding.
  • Utilizing supportive factors.
  • Increasing skin-to-skin contact with the baby.

5.8. Breastfeeding Technique

• Mother's Position: Sitting upright or lying down.
• Mother’s Methods of Holding the Baby:
  • Cradle Hold
  • Football Hold (under the arm)
  • Cross-Cradle or Modified Cradle
  • Side-lying
  • Upright Position
• Help with Positioning:
  1. Baby's head and body in a straight line.
  2. Face towards the breast, nose aligned with the nipple.
  3. Body close to the mother.
  4. Support the buttocks when holding a newborn.
• Supporting the Breast:
  1. Fingers resting under the breast.
  2. Index finger supporting the breast from below.
  3. Thumb on top of the breast.
  4. Fingers kept away from the nipple (forming a "C" shape).
• 💡 Insight: Father's support, such as pillow positioning, can aid comfort.

5.9. Evaluation of Breastfeeding

• Baby Indicators:
  • Weight gain: 115-225 g/week (400-800 g up to 6 months, average 500 g/month).
  • Sleeps comfortably, not restless, sleeps well after feeding and burping.
  • Feeds 8-12 times daily until 6-8 weeks old.
  • Frequent swallowing reflex while sucking.
  • Frequent bowel movements (2 or more mustard-yellow, soft or grainy stools).
  • Urination 5-6 times daily.
  • Body weight loss of less than 8%.
  • Good skin turgor, sufficient fontanel fullness.
  • Active, loud crying.
• Maternal Indicators:
  • Fullness in breasts before breastfeeding.
  • Milk leakage from the other breast while breastfeeding.
  • Uterine contractions felt during breastfeeding in the first days after birth.
  • Mild nipple pain and tingling sensation in breasts.
  • Absence of pathological fullness in breasts.

5.10. Breast Problems

5.10.1. Breast Infections

• Monilial Infection of the Breast
• Mastitis
• Breast Abscess
• Dermatitis of the breast
• Paget's Disease of the Breast
• Herpes simplex infection in the breast
• Nipple Vasoconstriction (Raynaud’s Phenomenon)

5.10.2. Structural Problems of the Breast

• Flat or Inverted Nipple
• Engorgement
• Insufficient Milk Production
• Milk Retention
• Nipple Cracking
• Painful Nipple

5.10.3. Treatment & Management Strategies

• Engorgement Treatment:
  • Warm application to the breast before breastfeeding (warm compresses, warm showers).
  • Manually expressing a small amount of milk before breastfeeding.
  • Massaging the breast during breastfeeding.
  • Cold application to the breast after breastfeeding or pumping (ice packs, gel packs, cold compresses).
  • Cold cabbage leaves.
  • Breast massage, emptying the breast by hand or with a pump.
  • Anti-inflammatory medications as recommended by a physician.
  • Acupuncture and acupressure under professional supervision.
• Mastitis Treatment:
  • Frequent breastfeeding and emptying of the milk ducts.
  • The affected breast should be emptied first to stimulate the let-down reflex.
  • Correct positioning and latch.
  • Manual expression if breastfeeding is not possible.
  • Adequate fluid intake and nutrition.
  • Analgesics (paracetamol, ibuprofen) and antibiotics as recommended by a physician.
  • Breasts should be supported with a bra.
  • Cold application for mothers who cannot breastfeed and feed their babies with a bottle.
  • Warm application to the affected breast before breastfeeding or pumping for breastfeeding mothers.
• Specific Aids:
  • Nipple Shields: Can be used for flat/inverted nipples or severe nipple pain.
  • Cabbage Leaves: Applied cold to reduce engorgement.
  • Breast Massage: Helps with milk flow and engorgement.
  • Syringe for Flat/Inverted Nipples: Used to draw out the nipple before feeding.

5.11. Breast Care

• Support & Hygiene: Support the breasts with a broad-strapped bra (should lift but not be tight, can be used at night) and maintain daily hygiene.
• Washing: Daily washing of the breasts in the shower. Avoid washing with soapy water before or after breastfeeding.
• Drying: Keep breasts dry and not moist. Allow breasts to air dry after breastfeeding.

---

References:

• Olshansky, D.L.M.C.C.S.P.K.A. E. (2020). Maternity and Women's Health Care (12th ed.). Elsevier Health Sciences (US).
• Feldman-Winter et al.,.Feldman-Winter L., Burnham L., Grossman X., et al: (2018). Weight gain in the first week of life predicts overweight at 2 years: A prospective cohort study. Maternal Child Nutrition 2018; 14:pp. 1-8
• American Academy of Family Physicians, 2012.American Academy of Family Physicians : Breastfeeding policy statement.
• Isley and Katz, 2017.Isley M.M., and Katz V.L.: (2017).Postpartum care and long-term considerations. In Gabbe S.G., Niebyl J.R., and Simpson J.L. (eds): Obstetrics: Normal and problem pregnancies, 7th ed. Philadelphia:: Elsevier.
• Raynor, M. D., & Catling, C. (2017). Myles Survival Guide to Midwifery (3rd ed.). Elsevier Health Sciences (US).
• Coşkuner Potur, D., Kanığ M., (2022). Meme Bakımı ve Sorunlarında Tamamlayıcı Bakım Uygulamaları. In Güngör Satılmış,İ., Sarı E. (eds): Emzirme Destekleyici ve Tamamlayıcı Uygulamalar, İstanbul Tıp Kitabevi.pp 74-94
• Kızılaya Beji, N. (2015). Kadın Sağlığı ve Hastalıkları. İstanbul: Nobel Tıp Kitabevi.
• Coşkun, A.M. (2012). Kadın Sağlığı ve Hastalıkları Hemşireliği El Kitabı. İstan…