ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 205
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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Breastfeeding challenges and the role of family physicians
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Dr Syeda Sadia Farzana2
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Bangladesh Society of General Practitioners, Future Skills Academy, IBLCE, NZLCA, 2New Zealand
Lactation Consultation Association
In her 30s, G1P1, Niva delivered a full-term baby girl four weeks back by normal vaginal delivery in an
established hospital setting without any complications. Baby Cloe weighed 3.5 kg at birth and the
Apgar score was 9/10. She was on formula feeding eight times/day since Day 03. There were five to
six wet nappies/per day. Niva managed to hand express from both breasts occasionally to maintain
the supply but could express out only 20–25 mL per sitting per breast to feed Cloe. Niva had been
struggling to sleep at night since Cloe was born and Cloe did not seem to be a happy baby.
She was concerned to consult her family physician to assist her in re-lactation.
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History
Niva’s family physician ordered lab tests and scans antenatally but not much discussion about
breastfeeding, and no breast examinations were done. She only had the knowledge that breast milk
was the best for babies. Niva had never been to any prenatal classes. She had minimum skin-to-skin
contact throughout the day and no breastfeeding at night. Niva tried to latch Cloe on the left breast
sometimes but never on the right breast from Day 01.
On examination
Niva: BMI was 36, normotensive, no other abnormality detected.
Baby: normal findings, active reflexes.
Observing the dyad: Niva failed to attach and latch Cloe. The baby was uncomfortable while her mum
tried to cradle hold. Cloe was unsettled on mum’s large breasts and was crying out of frustration.
Breast findings: right nipple inverted; breasts large, pendular, soft, not engorged, non-tender.
Goal: ‘Keep the flow, keep the baby fed, keep the baby closer’
Plan:
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Reassurance
Demonstration of different feeding positions, attachment, latching
Breast support
Use of an electric pump to draw out the right nipple and frequent pumping to establish the supply
On-demand feeding, including night feeding
Counselling about myths
Follow up after 7 days
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