Care of the breastfeeding mother in medical-surgical areas

MedSurg Nursing, April, 2007 by Lori Wenner

A plugged duct is a blockage in a milk duct caused by accumulated milk or cast off cells (Riordan, 2005). Symptoms include tenderness, heat and possible redness in one area of the breast, or a palpable lump with well-defined margins without a generalized fever. Poor drainage from physical obstruction, such as tight-fitting or underwire bras or incomplete emptying of the breasts, may cause plugged ducts. Treatment includes frequent feedings starting on the affected breast to promote drainage, massaging the affected breast before and during feedings, applying warm compresses prior to feedings, and positioning the infant with nose pointing toward the plugged duct during the feeding.

Mastitis is usually a benign, self-limiting infection of the breast (Lawrence, 1997; Riordan, 2005; WHO, 2000). Symptoms include fatigue, localized breast tenderness, headache, and flu-like muscle aches followed by fever, rapid pulse, and a hot, reddened tender area on the breast. It usually is limited to one breast. Risk factors include stress, fatigue, cracked nipples and/or nipple pain, plugged ducts, a decrease in the number of feedings, and engorgement. Treatment includes 10-14 days of antibiotic therapy, analgesia for pain, moist heat to the affected area, frequent nursing or pumping of the affected breast, increased fluids, and bed rest. It is safe and advisable for the mother to continue breastfeeding on the affected breast (Lawrence, 1997; Riordan, 2005; WHO, 2000).

Maternal contact with the health care system need not result in premature weaning or unnecessary supplementation. The support and advocacy of nurses empowered with accurate breastfeeding information and resources are essential to the breastfeeding mother. Extra time and care will positively influence the health and well-being of infant and mother.

References

American Academy of Family Physicians. (2001). American Academy of Family Physicians policy and position statement on breastfeeding. Leawood, KS: Author.

American Academy of Pediatrics (AAP), Committee on Drugs. (2001). The transfer of drugs and other chemicals into human milk. Pediatrics, 108, 776789.

Biancuzzo, M. (2003). Breastfeeding the newborn: Clinical strategies for nurses. St. Louis, MO: Mosby, Inc.

Department of Health and Human Services (DHHS), Office on Women's Health. (2000). HHS blueprint for action on breastfeeding. Washington, DC: Author.

Garner, L.M., Morton, J., Lawrence, R.A., Naylor, A.J., O'Hare, D., Schanler, R.J., et al. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506.

Hale, T.W. (2006). Medications and mother's milk. Amarillo, TX: Hale Publishing.

Hale, T.W., & Berens, P. (2002). Clinical therapy in breastfeeding patients. Amarillo, TX: Pharmasoft Medical Publishing.

Jones, F., & Tully, M.R. (2006). Best practice for expressing, storing, and handling human milk in hospitals, homes, and child care settings. Raleigh, NC: Human Milk Banking Association of North America, Inc.

Lawrence, R.A. (1997). A review of the medical benefits and contraindications to breastfeeding in the United Sates (Maternal and Child Health Technical Information Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health.