Postpartum care

Question 1

What is the safest way to suppress lactation in a woman who does not desire to breastfeed?

Answer 1

Breast binding, ice packs and analgesics. Note that hormonal methods (e.g. bromocriptine) are associated with HTN, stroke and seizures.

Question 2

What organism is likely the cause of intense burning pain of the nipples in a breastfeeding woman?

Answer 2

Candiasis - treat with topical antifungal and give baby oral nystatin followed by fluconazole.

Question 3

What is the most common source of maternal fever on postpartum day 1?

Answer 3

The lungs, particularly if the patient had general anesthesia (e.g. C-section). May be due to atelectasis or aspiration pneumonia

Question 4

What are the breastfeeding contraindications?

Answer 4

Active untreated TB, maternal HIV infection, herpetic breast lesions, active varicella infection, chemotherapy or radiation therapy, active maternal substance abuse, and galactosemia in the infant.

Question 5

What are the recommendations surrounding breastfeeding in a hep C or hep B positive mother?

Answer 5

There is no evidence that hep C passes to babies through breastmilk so it is safe to breastfeed. Mothers may also breastfeed if they are hep B positive if the infant has received hep B immunoglobulin and initiation of the hep B vaccination series has occurred. However, mothers should abstain from breastfeeding if their nipples are cracked or bleeding.

Question 6

Is it safe to breastfeed if a woman is taking gentamicin and clindamycin for endometritis?

Answer 6

Yes - gentamicin does not distribute into breastmilk, and clindamycin is safe for infants