Education is key here regardless of whether the mother wants to breastfeed or formula feed. I think helping the mother see the benefits of breastfeeding is important but also helping her know that she will be supported regardless is also important. Also, providing the mother with education on signs and symptoms of malnutrition such as the amount of wet diapers is important so that she knows what to look for and when to notify a provider should these symptoms start to occur. Situations like this can also cause a lot of stress on the mother and feelings of inadequacy can occur so assessing the mother carefully for any signs of post-partum depression or discouragement is also important as you mentioned. Helping the mother to know that there any many resources available to her is also important.

2-Because of the mother’s reluctance to breastfeed, the first assessment I would do immediately is to determine the status of the infant. Checking to ensure adequate hydration by asking about the number of wet diapers and checking the infant for lethargy or dry mucous membranes would be the first priority.

After determining the safety of the infant, I would utilize the rest of the information gained from the functional health assessment to determine the needs and decisions the mother would like to made.

In either case, I would be interested to know if she has adequate support systems in place, including child care and the nature of her employment because breastfeeding can be impacted by these situations both for timing of feeding, milk supply, and opportunities for pumping. If the mother has decided to breast feed, a lactation consultant might be a good resource for support and education. A website such as womenshealth.gov/breastfeeding could also be given as a resource if there is available access to the internet.

The newborn’s health will be a priority regardless of her decision. Education concerning development will be important, and it would be important to determine the level of understanding the mother has about feeding an infant and what her body requires to provide an adequate and healthy milk supply. Adequate nutrition and hydration through breastfeeding is determined by output and weight gain. Nutritional status of the mother is an important consideration. Referral to public assistance programs specifically geared towards the nutritional health of breastfeeding and pregnant women and children such as the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) would be an important consideration if there is financial concern in the family. In a longitudinal study Sonchak determined that this program did not decrease breastfeeding initiation, and in fact increased breastfeeding (2017). The health benefits of breastfeeding for the infant should be discussed as being the best option for feeding the baby, but without pressure, blame, or shame if that is not a viable option for this mother or family.

For formula feeding, the developmental milestones and health status would be the same. The method of preparing the feeding would need evaluation to see if education is needed. In feeding formula, the type of formula and the method of preparation are two areas that frequently need education. Cow’s milk should not be an option until after the child is 1 year of age, and the proper concentration of formula must be emphasized in order to ensure the child is receiving the appropriate number of calories and nutrition. WIC will also help provide formula if the mother has a financial need, and dilution of the formula to save money would be less likely.

Finally, the emotional component should be assessed and addressed. Mothers frequently feel guilt, regardless of their choice of method to feed their baby. By providing education on what the baby’s needs are and what the signs and symptoms are for adequate nutrition as well as what to look for if there is a problem, the mother can alleviate guilt by providing the best nutritional plan for whichever method she chooses. By focusing on the health of the infant she will be able to clearly decide how to best meet the nutritional needs in a way that works for her, her budget, and her lifestyle.

References

Sonchak, L. (2017). The impact of WIC on breastfeeding initiation and gestational weight gain: Case study of South Carolina Medicaid mothers. Children And Youth Services Review, 79115-125.

U.S. Health and Human Services, (2018). Breastfeeding. [HTML] Retrieved from https://www.womenshealth.gov/breastfeeding 

3-If I found out that the mother of the newborn infant was reluctant to breastfeed her baby, I would get more information from the mother. I would ask the mother if she’s fearful, is it any religious beliefs, does she think it’s painful, or is it because she doesn’t have much information about breastfeeding. It’s important to assess her knowledge of breastfeeding prior to beginning any education to see what areas need further education. Assessing her ability and willingness to learn is also important. After understanding why, she is reluctant to breastfeed, I would educate her on the benefits of breastfeeding. It is easier for babies to digest breast milk than it is to digest formula. Breast milk contains antibodies that help the baby fight of viruses and bacteria later in life. It helps builds the infants immune system and infants tend to get sick less often. “Breast milk has all the nutrients an infant needs to grow. Breastfeeding lowers the infants risk for developing asthma and allergies” (WebMD, n.d.). Breastfeeding is a way that the mother and infant can bond.

It is during infancy that their nutrient requirements per pound of body weight are proportionally higher than any other time during their life cycle (United States Department of Agriculture, 2009). It is important to know if the baby is getting the proper amount of nutrients if the mother breastfeeds or bottle feeds. It is common for a mother who breastfeeds to worry about her infant getting enough because there is no way to measure the breast milk if the infant is drinking from the breast. Unfortunately, this will discourage mothers from breastfeeding. As nurses we can reassure the mother that there are ways to confirm that the baby is receiving enough nutrients needed. If the infant is gaining weight each visit or if the infant is soaking 6 diapers or more in a 24-hour period. If the infant stops eating, isn’t fussy, and seems satisfied than he/she is getting enough to eat. When infants are bottled fed, you can look for these signs to tell you if the infant is getting enough.

As a nurse, our main priority is to always show support with whatever decision our patients. Making sure the new mothers have all the resources available to them is important. As nurses, we can encourage our new mothers to breastfeed and it is important that we are readily available to them when and if they have any questions or concerns.

Department of Agriculture. (2009). Infant nutrition and feeding.

Retrieved 3/26/2018, from https://wicworks.fns.usda.gov/wicworks//Topics

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