Maria calls the OB desk the next day and states she and Juan are doing better. She asks if someone can make sure they are " doing it right." She states she is getting too much "help" from her mother. Maria's mother takes the baby from her and gives him a bottle whenever they struggle even for a few minutes. "How do I know if Juan is getting enough milk from me?" (Juan is now 4 days old). SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:
a)"Juan should have 6-8 wet diapers of light-yellow urine every 24 hours. It's a good idea to write them down to help you remember."During the early days of breastfeeding, keeping a feeding diary can be helpful. Data from the diary provide evidence of the effectiveness of breastfeeding. The infant's output is highly indicative of feeding adequacy. As the volume of breast milk increases, urine becomes more dilute. Infants should have at least 6-8 wet voids/24 hours. Urine output is more consistent than bowel movements.
b)"By the 4th day, Juan should have at least 3 yellow-green stools and they should be looser than the dark green stools he had on the first few days."If the newborn is still passing meconium stool by the 4th day, breastfeeding effectiveness and milk transfer should be assessed. The number of stools for breastfed infants is more variant than urinary output.
c)"Juan latches easily, has bursts of suck/swallows, you hear him swallow, easily releases the breast after 15-20 minutes, and appears content at the end of the feeding."These are other signs of breastfeeding effectiveness. Infant behaviors are more consistent than maternal sensations so this instruction should be next.
d)"You feel Juan tug at the breast but no pain, you have some uterine contractions and maybe a little bit of vaginal bleeding during the feeding, you are thirsty and feel relaxed, and your breasts feel lighter or softer at the end of the feeding "The mother may or may not have one or all of these sensations during and after breastfeeding. These are also signs of effective breastfeeding.
e)"You can bring Juan into the clinic for Baby Weigh-In and have his weight checked. You can also talk to the lactation consultant. She can observe a feeding to help you."Newborns typically lose 5-10% of body weight after birth before they begin to gain weight. Weight loss of more than 7% during the first 3 days needs to be investigated. After the mature milk has come in, the infant should gain 0.7-1 oz per day for the first 3 months. Lactation consultants will assess breastfeeding and provide education and counseling as well as weigh the neonate.