••• Chapter 22^ Lactation^229
❍ When is the most common time for a breastfeeding mother to quit?
In the first 2 to 3 weeks. This is the time of greatest adjustment. It also coincides with the first growth spurt at
about 2 weeks, during which the baby may get fussy and nurse often to increase the supply. If she goes beyond
3 weeks, she will generally nurse for 4 to 6 months on the average.
❍ What are some factors that may interfere with successful breastfeeding?
Hypoplastic breast tissue
Nipple abnormalities
Previous breast surgery.
❍ How may hypoplastic breast tissue effect lactation?
Women without sufficient glandular tissue may have no breast enlargement during pregnancy and will produce
little or no milk. As a result, their infants are at risk of early failure to thrive. One indication of the adequacy of
breast tissue is noticeable breast growth during pregnancy.
❍ How does breast augmentation or reduction affect a woman’s ability to breastfeed?
Outcome cannot be predicted in individual cases, but circular incisions around the areola tend to cause the most
damage to ducts, blood supply, and nerves and thus the most potential for difficulty with breastfeeding.
❍ What are Hoffman exercises?
Inverted nipples can be everted if found early in the third trimester, in most cases. One technique is Hoffman
exercises where the fingers are placed at 3 & 9 o’clock at the base of the nipple and is gently stretched, then this is
repeated at 6 & 12 o’clock. The use of a perforated breast shell under the bra will also put pressure at the base of
the nipple and help evert it.
❍ What is the most common cause of sore nipples in the immediate postpartum period?
Improper positioning of the infant at the breast, resulting in abnormal friction or traction on the breast and the
nipple. Poor latch-on by the infant can also cause nipple injury, leading to pain. Improved infant positioning and
latch-on will help resolve this pain.
❍ What is the proper treatment of cracked nipples?
Evaluate the positioning of the baby during nursing and check for pressure points. Vary the positions at each
feeding (Madonna—across the chest, football—under the arm, and on the side). Check the infant’s latch-on,
correcting it if necessary. Evaluate the infant’s oral cavity for abnormalities or ankyloglossia (tongue-tie).
❍ What is the most common cause of delayed nipple soreness?
Yeast. Aggressive, simultaneous treatment of mother and baby is indicated, usually with an antifungal such as
nystatin. During treatment, all objects such as pacifiers and toys that enter the baby’s mouth must be washed
between each use to avoid recontamination.