Helen, baby Peter, and Sven.

Helen and Peter left the hospital when Peter was 2 days old.  They have been home for 2 days.

Peter breastfeeds every 2 ½  hours and is having the 6 wet and 3 dirty diapers a day that the Dry Baby Alert sheet she got from hospital says he should have.  Breastfeeding went well in the hospital but now Helen has sore nipples.  Her mother told her it is because Peter feeds too often and too long.  She is starting to dread each breastfeeding session, especially the night ones, since Peter does take a long time and doesn’t settle until he is asleep at the breast.

Helen doesn’t have stitches.

She is used to having lots of energy, and is starting to get discouraged because she is so tired and can’t seem to fit in the “me” time that her prenatal instructor talked about. 

The house is tidy.  She and Sven are eating gourmet meals every night since Sven is home for a while and loves to cook.

They have had lots of company.  Friends have offered to help but Helen and Sven are too ashamed to take them up on it.

Helen knows that a PHN will call her 24 to 72 hours after her discharge - she is hoping that the PHN from HBHC can tell her how to cure her sore nipples.

The PHN calls that day.

• Purpose of T.C.
  • thorough assessment

• health promotion education
•  support re: breastfeeding skills,
•  link to community resources.
• PHN continues with postpartum assessment
  • Baby’s health
  • Mothers physical & emotional health
  • Includes teaching 
    • SIDS (risk prevention)
    • Infant safety
    • Doctor’s appt – if no FP (common in Kingston) will give after hours clinic and COPC info and encourage mother to get on a waiting list by contacting Health Care Connect
    • Breast care – blocked ducts, mastitis, drying up (formula)
    • Nutrition
    • Sexuality/birth control
    • Tobacco use (Ask, Advise, Assist)
    • Baby Blues/PPMD
    • During the assessment other concerns are brought up:
      • Baby won’t settle until asleep at the breast – long feedings
        • Explore how Helen and Sven feel about this
        • Next day - Helen & Sven - Babytalk drop-in
          • Lactation Consultant (LC) or PHN
            • Assesses
            • Observes Peter latching and feeding,
            • Determines
              • although latch looks good,
                • Peter not taking in enough areola. 
              • Teach slightly different latch
              • Helen’s pain, after 1^st few sucks - relieved immediately.
        • Important to teach both Helen & Sven
        • Unfortunately, not all breastfeeding difficulties solved so easily.
          • Mothers can come back as often as necessary
        • Other topics can also talk to mothers about:
          • growth and development,safety,mother’s emotions, and
          • parenting issues.

• If Helen’s needs can’t be met by the TC and community resources
  • PHN will arrange to home visit.
• first thing that comes out in the telephone assessment is Helen’s sore nipples
• Through further assessment, PHN determines:
  •  cause - poor latch. 
• PHN intervention/teaching:
  • informs Helen – poor latch is most common cause
  • discusses strategies;
    • correct the latch &
      • relieve soreness.
  • Refers to KFL&A Babytalk booklet given in hospital
  • informs Helen - Babytalk drop-ins
    • PHN or LC can observe latch
      • make further suggestions
• Helen states that she can go to a drop-in the next day.
  • meanwhile she will try PHN’s suggestions.
  • If couldn’t,
    • PHN would try to make HV to help with latch.
• PHN informs re: other community resources.
  • Child & Babytalk telephone info line
    • PHN answers questions
  • Telehealth Ontario
    • RN provides health advice & info
    • free and confidential - 24/7.
  • Breastfeeding Buddies
    • Qualified volunteers, who have breastfed, provide telephone support to mothers during their first few months of breastfeeding.
  • La Leche League
    • Supportive organization for breastfeeding mums
  • Motherisk - Telephone line at Sick Kids in TO
    • counsellors provide guidance & support re: safety of meds and other substances in pregnancy & breastfeeding using researched based data.
• PHN intervention/teaching con’d:
  • reviews signs – dehydration which is risk due to poor latch
  •  & when to seek medical attention
• If PHN assesses an emergency:
  •  
    • e.g.,: baby very jaundiced,
    • very drowsy,
    • inadequate output
  • will tell Helen to seek medical attention immediately:
    • family doctor for urgent appt.,
    • afterhours clinic
    • COPC at HDH(Children’s Out-patient Center)

•  
  •  
    • If Helen shows interest - discuss strategies to help baby learn to sleep on own – patting, rocking, putting in crib drowsy but awake
• Helen starting to get discouraged because she is so tired and can’t seem to fit in the “me” time
  • Discuss strategies:
    • Have Sven do laundry, make simple meals, take baby out for a walk
    • Ease up on the housecleaning for now
    • Take up friends offers: groceries, cut grass
    • Limit visitors
• At end of TC assessment PHN ensures:
  • Helen’s questions answered
  • Knows where to go in community for help.
  • HV not needed
  • give info on Community supports
  •