A Midwife • Must ensure that the baby is adequately fed

at the breast.• Must help the mother to develop necessary

skills to feed her baby by herself.• Must know about the different breast

conditions which may effect on feeding and many complications which can arise after delivery.

Long Nipple

Inverted and Flat Nipple

Short Nipple

Abnormally Large Nipple

• It leads to poor feeding because the baby is able to latch on to the nipple without drawing the breast tissue into his mouth.

• It doesn’t cause any problem as the baby has to form a teat from both the breast and nipple.

•In this case if the baby is small then his/her mouth may not be able to get beyond the nipple and on to the breast.

•Lactation should be initiated by expressing.

• If the nipple is deeply inverted it is necessary to initiate lactation by expressing.

INVERTED NIPPLE FLAT NIPPLE

Using your thumb and index finger, gently squeeze the areola about 1 inch behind the nipple. This technique will make a normal nipple protrude.

The nipple on this breast protrudes normally.

A simple "pinch test" will show you whether your nipple is inverted:

The pinch test will make an inverted nipple pull inward.

Breast Engorgement

Deep breast painCracked &

Retracted Nipple

Mastitis

•Exaggerated normal venous and lymphatic engorgement of the breast which precedes lactation

•Manifests after the milk secretion starts (3rd or 4th day of post-partum)

• Considerable pain & feeling of tenseness or heaviness in both the breasts.

• Generalized malaise or ever transient rise of temperature.

• Painful breast feeding• The breasts are hard – often edematous,

painful and sometimes flushed.

•To avoid pre-lacteal feeds.•To initiate breast feeding early and feeding at frequent intervals)• Exclusive breast feeding on demand.• Feeding in the correct position.

•To support the breast with a binder or brassiere.• Manual expression if any remaining milk after each feed and keeping the interval short between feeds.•Can also use breast pump gently.•Administer analgesics for pain if required.

•The baby should be put to the breast regularly after manual expression of milk.•Milk suppressive drug e.g. Bromocriptine 2.5 mg daily for 2-3 days should be administered in cases where the breast remains tight even after suckling or expression.•Fluid intake should not be restricted.•Cabbage leaves can be applied to the breasts.

•Unclean hygiene resulting in formation of crust over the nipple.

•Retracted nipple.•Vigorous suckling in engorged

breast or associated with depressed nipple or in case having inadequate milk flow.

•Local cleanliness during pregnancy and in the puerperium before and after each breastfeeding to prevent crust formation over the nipple.

• Applying Tincture Benzoin after the night feeding

• Nipples are to be kept dry and exposed to air.• Gentian violet is applied over the nipple as well

as the baby’s mouth if there is oral thrush.• If all these failed to heal up then rest is given to

the affected nipple for 24 hours and breasts are strapped with a tight bandages.

• In severe cases breast feeding has to be suspended to prevent mastitis.

• Manually pulling out of the retracted nipple during last two months of pregnancy is useful to rectify the defect.

• After delivery, nipple is pulled out by suction action of a disposable syringe.

• It is likely to be due to raised intra-ductal pressure caused by inefficient milk removal.

•Very very deep breast pain may be the result of ductal thrush infection.

• Inflammation of the breast.• Non-infective (acute inflammatory)

occurs during early days as a result of un-resolve engorgement

• It may also developed at any time when poor feeding techniques results in the milk not being efficiently remove by the baby from one or more segment of the breast.

MASTITIS

MASTITIS• Infective mastitis is caused by the damage to

the epithelium which allows bacteria to enter the underlying tissues.

• Milk stasis will increase further and ideal condition for pathogenic bacteria to replicate.

CLINICAL FEATURES• Generalized malaise and headache.• Fever with chills and rigor.• Severe pain and tender swelling in one

quadrant of the breast.• Presence of wedge shaped swelling on

the breast with its apex at the nipple.• The overlying skin is hot and flushed• Feels tense and tender.

PROPHYLACTIC TREATMENT• Antenatal care of breast.

• Wash the nipples periodically during last two months to keep the patency of the duct openings.

• Use nipple shield during last three months in cases of depressed nipple.

• Teach the art of manual expression and clearance of colostrum from 36th weeks onwards.

CURATIVE TREATMENT• Mother n baby has to be isolated.

• Breast feeding on the affected breast has to be suspended.

• Cloxacillin 500mg 6 hourly or Cephalosporin should be administered after sensitivity report.

• Analgesic n sedative

BREAST ABSCESS SIGNS N SYMPTOMS

• Flushed breasts not responding to antibiotics promptly.

• Brawny edema of the overlying skin.

• Marked tenderness.• Swinging temperature

TREATMENT

• It is to be drained under general anesthesia by a deep radial incision extending near the areolar margin to prevent injury of the lactiferous ducts.

NURSING DIAGNOSIS• Pain related to cracked/sore nipple

secondary to engorge.• Hyper pyrexia related to infection

secondary to mastitis.• Altered feeding pattern related to

anatomical variation of the breast n complications

• Ineffective bonding related to unable to breast feed secondary to complications.