Postpartum care and breast-feeding.

Scientific studies investigating the postpartum period are scarce, and observational studies greatly outnumber controlled trials. Many studies are biased in their assumptions about the social roles of women and men and in the interpretation of observations and treatment strategies. The published literature is fragmentary; few researchers have attempted a comprehensive, biopsychosocial system-oriented view of postpartum health. More research is needed on the occurrence and treatment of such common postpartum problems as urinary incontinence, sexual dysfunction, and back pain. Widespread application of what is already known about support for breast-feeding, prevention of fatigue and depression, contraception, and maintenance of healthy lifestyles will require innovations in healthcare delivery, professional practices, and social policy, particularly in the occupational arena. Many postpartum problems have been found to be iatrogenic and responsive to changes in the routine care of mothers and newborns. Finally, it is clear that women of lower education and socioeconomic status and those with less social support are consistently at higher risk for postpartum and parenting problems; great benefits are likely from interventions that enhance the well-being of these mothers and infants.

Breastfeeding the infant with a cleft defect.

Infants with cleft defects should be assisted to feed at the breast whenever a mother chooses this as the method of feeding. This is an ideal choice for such infants because it encourages normal, physiologic muscular involvement of the mouth and face, it benefits speech development, and it provides protection against upper respiratory infections, particularly otitis media. Successful breastfeeding helps normalize the infant to the family. Unfortunately, the attitude that infants with cleft defects cannot be breastfed often has been the first and most consistent response that the parents and families receive from their health care providers. Health care professionals must provide interventions to facilitate breastfeeding and thus normalize and empower these infants. The first days of life are extremely important for imprinting and learning what position works best.

Breastfeeding the neurologically impaired infant.

Care of neurologically impaired infants usually is complex and challenging. Mothers of these infants who want to breastfeed should be supported, given sound information, and assisted to set realistic expectations. The health care team can provide guidance while continuously assessing the infant's status. When and if the infant will feed from the breast cannot be predicted, but the lactation consultant and other members of the health care team should support the mother to do what she can and wants to do for her infant.

Sucking disorders in neurologically impaired infants: assessment and facilitation of breastfeeding.

Neurologically impaired infants have immature, damaged, or abnormally developed nervous systems that may cause abnormalities of sucking and swallowing, among other problems. Sucking abnormalities usually present as absence of the sucking response, weakness or incoordination of sucking and swallowing, or some combination of these problems. More investigation of the responses of these infants to various stimuli and training techniques is greatly needed. Although training neurologically impaired infants to breastfeed may present a challenge to even the most experienced neonatal nurse, physician, or therapist, most infants improve and can learn to suckle at the breast. If a mother has intended to nurse her infant, she should be encouraged to do so, even when the infant has abnormalities of sucking, except in the rare and most severely affected infants who remain dependent on gavage or gastrostomy feedings. Various techniques of stimulating, positioning, and progressive weaning to the breast can be helpful in teaching mother and infant to breastfeed. Encouraging support should be provided by all professionals involved with the mother and infant, as well as by a team experienced in helping with such problems. Most importantly, mother and staff must be patient, because the rewards for both the infant and mother are worth the effort.