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    <meta name="author" content="Denise Fisher" />
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    <title>Case Study B (Joanne)</title>
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      <h1 id="top">2.0 Case Study B (Joanne)</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study B</h3>
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			Joanne asks you what she can do before the baby is born to help her successfully breastfeed.
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			The <cite>Ten Steps to Successful Breastfeeding</cite>, designed by the <img alt="External" src="design/external.gif" /><a href="http://www.who.int/en/" title="External link" target="_blank">WHO</a> and <img alt="External" src="design/external.gif" /><a href="http://www.unicef.org/" title="External link" target="_blank">UNICEF</a> summarise the maternity practices needed to support and encourage breastfeeding.
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		<dl><dt><a href="topic_2-1.html"><cite>Topic 2.1: Preparation Before Birth</cite></a></dt><dd class="topic-paragraph">Inform all pregnant women about the benefits and management of breastfeeding</dd></dl>
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			Joanne's baby Rosie is born by spontaneous vaginal delivery at 37 weeks following a 15-hour labour. She had been given pethidine (meperidine) and an epidural for pain relief during labour. Are there any features of her birthing experience that may affect breastfeeding?
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		<dl><dt><a href="topic_2-2.html"><cite>Topic 2.2: Birthing Factors that Affect Breastfeeding</cite></a></dt><dd class="topic-paragraph">Labour analgesia and near-term birth</dd></dl>
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		<dl><dt><a href="topic_2-3.html"><cite>Topic 2.3: Management After Birth</cite></a></dt><dd class="topic-paragraph">
				Place Rosie in skin-to-skin contact;
				Encourage breastfeeding on demand;
				Practice rooming-in, allow Joanne and Rosie to remain together 24 hours a day;
				Give Rosie no food or drink other than breastmilk, unless medically indicated;
				Give Rosie no artificial teats or dummies;
				Show Joanne how to breastfeed and how to maintain lactation even if she should be separated from Rosie.
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			Rosie is now 24 hours old. Although she seems interested in the breast, she is not attaching well and tends to slip off the breast easily. What is the most appropriate management to suggest at this time?
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		<dl><dt><a href="topic_2-4.html"><cite>Topic 2.4: Poor Attachment</cite></a></dt><dd class="topic-paragraph">
				Investigate whether there an underlying reason;
				Maximize breastfeeding opportunities;
				Protect the milk supply;
				Feed the baby;
				Nipple shields may be useful.
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			Because Rosie has not been feeding well, the hospital staff are concerned that she may develop hypoglycaemia. Is hypoglycaemia likely to occur in a healthy term breastfed neonate?
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		<dl><dt><a href="topic_2-5.html"><cite>Topic 2.5: Hypoglycaemia</cite></a></dt><dd class="topic-paragraph">Healthy full-term infants do not develop symptomatic hypoglycaemia simply as a result of underfeeding.</dd></dl>
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			On day three, just before Rosie and Joanne are to go home, Joanne mentions that Rosie looks jaundiced and asks if it is due to her breastmilk. What is the relationship between jaundice and breastfeeding?
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		<dl><dt><a href="topic_2-6.html"><cite>Topic 2.6: Relationship between Jaundice and Breastfeeding</cite></a></dt><dd class="topic-paragraph">In the early days jaundice in a breastfed infant may be due to inadequate breastfeeding. Breast milk jaundice usually begins after day five, is associated with increasing milk volumes and is thought to be due to as yet unidentified substance in breast milk. It rarely requires investigation or treatment.</dd></dl>
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      <div id="footer"><a href="topic_1-8.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_2-1.html" rel="next" class="next">Next &raquo;</a><br style="clear: both" /><a href="#top" id="topLink">Back to top</a><a href="javascript: window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2011 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: Denise Fisher</p></div>
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      <h1>Breastfeeding Essentials</h1>
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        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li class="current">2.0 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
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