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    <meta name="author" content="Denise Fisher" />
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      <h1 id="top">6.6 Discharge planning</h1>
      <div><p class="listTitle">The goal of discharge planning is two-fold</p><ul><li>to prevent common problems, and</li><li>to enhance maternal self-esteem and self-confidence<sup><a href="#note1">1</a></sup></li></ul><br />It is the duty of care of the health professionals caring for the mother-baby dyad to ensure that all mothers, particularly those who have not had prenatal education, know how to recognise wellness in their baby and adequate transfer of milk and to react quickly when anything abnormal occurs.</div>
      <div class="section" id="Preventing_common_problems"><h2>Preventing common problems</h2>
    <div class="section" id="Timing_of_follow-up"><h3>Timing of follow-up</h3>
      <div>
        <p>
			Routine follow-up with a qualified health care provider must be confirmed with the parents prior to discharge. A Clinical Practice Guideline recommends the following appointment schedule (AAP Subcommittee on Hyperbilirubinemia, 2004).
		</p>
        <table class="grid">
          <thead>
            <tr>
              <th>Age of infant at discharge</th>
              <th>Should be seen by</th>
            </tr>
          </thead>
          <tbody>
            <tr class="row0">
              <td>Before 24hr old</td>
              <td>72 hrs (3 days)</td>
            </tr>
            <tr class="row1">
              <td>From 24 - &lt;48 hrs</td>
              <td>96 hrs (4 days)</td>
            </tr>
            <tr class="row0">
              <td>From 48 - 72 hrs</td>
              <td>120 hrs (5 days)</td>
            </tr>
            <tr class="row1">
              <td colspan="2">For some newborns discharged before 48 hours, 2 follow-up visits may be required, the first visit between 24 and 72 hours and the second between 72 and 120 hours.</td>
            </tr>
          </tbody>
        </table>
      </div>
    </div>
    <div class="section" id="Critical_warning_signs"><h3>Critical warning signs</h3>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/warning.png" class="icon" alt="" /><h3 class="warning"></h3>
        <div><h3>The 3 Red Flags!</h3>Optimal birth circumstances and good post natal breastfeeding care will significantly reduce the incidence of infant problems. Each of these signs is an indicator that there may be a breastfeeding problem or something more serious.<br />Any of these signs need immediate medical attention.<br /></div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      <div>
        <h3> #1. Baby's output is less than expected. </h3>
        <p> Review the table <a href="topic_6-2.html">6.2 Breastfeeding Messages</a> </p>
        <p><span class="aside"> Do all mothers have a copy of that table to take home? </span> . <br /> </p>
        <p> Output is a direct indicator of intake - ensure that you can accurately describe normal urine and stool output of the breastfed infant. Ask about the pinkish/rusty stain on a nappy/diaper which is urates in urine. This is normal <strong>until</strong> baby is 72 hours old (3 completed days). Secretion of urates in urine is a direct function of the serum uric acid concentration (ie blood levels). It is normal to see urates on a nappy/diaper with a scant volume of urine until Day 4. As the milk intake increases on Day 4 urates should no longer be seen. </p>
        <p> A note of caution to health professionals who provide only telephone consultations ... your image of a wet nappy/diaper, or a reasonable bowel action may not match the mother's impression. Urine should be clear and each nappy/diaper heavy. Although not a pleasant image, it is helpful to describe a 'handful' size as being a good volume of stooling. This is a very clear picture and will help the mother understand that scant frequent stainings are inadequate. <br /> </p>
        <p> If there is any doubt at all you must organize for the baby to have medical review urgently. </p>
        <h3>#2. Breastfeeding is painful. </h3>
        <p> Breastfeeding should not be painful. </p>
        <p> Pain during feeding, misshapen or damaged nipples or pain continuing after the feeding are all indicators that baby is poorly latched and milk transfer will be compromised. A hot or inflamed painful breast is a sign of severe engorgement, or mastitis with reduced milk transfer as a result. Painful breastfeeding is abnormal! </p>
        <p> Immediately seek help from an expert in breastfeeding. </p>
        <h3>#3. Increasing jaundice </h3>
        <p> Jaundice is a physiological state and is an expected developmental state for the majority of breastfed babies. Jaundice peaks at about Day 3 then gradually fades over the next few weeks. Jaundice should not be seen below the level of the umbilicus. <br /> </p>
        <p> However, increasing jaundice causes sleepiness and poor feeding; conversely, poor feeding causes increased jaundice. <br /> </p>
        <p> Teach parents to check for jaundice by observing their baby in natural daylight and putting finger pressure on their baby's forehead, upper chest, arms, abdomen, upper legs and watching for blanching. <br /> </p>
        <p> Instruct parents that jaundice below the umbilicus is to be reported immediately to their baby's health professional. </p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/warning.png" class="icon" alt="" /><h3>Return for immediate assessment</h3>
        <div>
          <ul>
            <li>Urine and stool output less than normal or urates persist after the 3rd completed day </li>
            <li>Nipple damage, pain; painful or inflamed breasts</li>
            <li>Jaundice below the level of the umbilicus</li>
          </ul>
        </div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/books.png" class="icon" alt="" /><h3>Workbook Activity 6.6</h3><p>Complete Activity 6.6 in your workbook.</p></td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/tip.png" class="icon" alt="" /><h3></h3>
        <div><p> These symptoms are the most important for the parents to remember and seek help with if they develop. <br /></p>Some instructions tell parents to count a minimum number of feeds per day, or to be concerned about sleepy babies, etc, however, if these markers become a problem then one or more of the above symptoms will also be occurring. <br />Succinct instructions will more likely be remembered by parents. Ensure they know to seek <span style="font-weight: bold;">urgent</span> review by their health care provider whenever any of those points are abnormal.</div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    </div>
    <div class="section" id="Contraception"><h3>Contraception</h3>
      <div class="columns"><div class="column" style="width: 50%">
          <div>
            <p> Preventing an unwanted pregnancy is important to women, and adequate child-spacing is important to the mother's health and the health of the new baby. Breastfeeding is also of paramount importance to the health of both mother and baby. <br /></p>
            <p>It is preferable for the mother to recover her nutritional status following the demands of pregnancy and lactation. Recovery of these stores prior to a subsequent pregnancy is important for her health - a recuperative period of less than 6 months between the end of breastfeeding and the next pregnancy is associated with depletion of maternal nutrient stores.<sup><a href="#note2">2</a></sup><br /></p>
            <p> Mothers therefore require counselling on selection of a contraceptive method that is <br /></p>
            <ul>
              <li>highly effective in preventing pregnancy, and <br /></li>
              <li>does not interfere with breastfeeding. </li>
            </ul>
            <p> The Lactational Amenorrhea Method (LAM) of contraception has been extensively studied and found to be more effective than the progestin-only contraceptive pill. Additionally all forms of hormonal contraceptive have the potential to adversely affect breastfeeding. </p>
          </div>
          <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><a href="http://www.waba.org.my/resources/lam/FBPF.htm" target="_blank"><img src="design/article.png" class="icon" alt="" /></a><h3><a href="http://www.waba.org.my/resources/lam/FBPF.htm" target="_blank">Contraception for breastfeeding mothers</a></h3>
            <div>
              <p> To read more about other contraceptive methods during lactation click on the icon on the left, print the page and file it with your course notes. From this page you'll find further links and references. </p>
            </div>
          </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
        </div><div class="column" style="width: 50%">
          <div class="captionBox"><img width="400" height="478" src="images/algorithm.jpg" alt="Using the Lactational Amenorrhea Method of contraception" /><p>Using the Lactational Amenorrhea Method of contraception. <br />Graphic &copy;  Health e-Learning</p></div>
        </div></div><br style="clear: both" />
      <div>
        <p> The quality of contraceptive/fertility counselling given to a woman significantly influences its effectiveness. When giving advice about any contraception ensure you understand it completely. </p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/books.png" class="icon" alt="" /><h3>Workbook Activity 6.7</h3><p>Complete Activity 6.7 in your workbook.</p></td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    </div>
  </div>
      <div class="section" id="Consolidating_learning"><h2>Consolidating learning</h2>
    <div>
      <p class="listTitle">Practical skills should be reinforced by educational materials which must be</p>
      <ul>
        <li>accurate,</li>
        <li>consistent within themselves and with previous verbal teaching,</li>
        <li>written at an appropriate reading-age, and</li>
        <li>free from commercial advertising.</li>
      </ul>
    </div>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/group.png" class="icon" alt="" /><h3>Resource materials for mothers</h3>
      <div>
        <p> Form a group to look at ALL the materials that are given to mothers. Each one should be discussed and explained to the mother as it is given. Are all the materials necessary? Are all staff familiar with the materials? </p>
        <p>"The critical warning signs" handout is the most important - does it stand out from the brochures? Perhaps you could start a working group to design/update this vital parent information page?<br /></p>
      </div>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    <div>
      <p> Discharge packs DO influence actions, particularly in regard to breastfeeding. Artificial formula company sponsored packs reduce the likelihood of exclusive breastfeeding<sup><a href="#note3">3</a></sup> and therefore for the health and safety of mother and baby they should not be distributed by any health care facilities. </p>
    </div>
    <div class="section" id="Referral_to_mother-to-mother_support_network"><h3>Referral to mother-to-mother support network</h3>
      <div class="section" id="Baby_Friendly_Step_10_and_Point_7"><h4>Baby Friendly Step 10 and Point 7</h4>
        <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3></h3>
          <div><span style="font-weight: bold;">Step 10</span> of the Ten Steps to Successful Breastfeeding, and <span style="font-weight: bold;">Point 7</span> of the Seven-point Plan for Sustaining Breastfeeding in the Community state:</div>
          <blockquote>
            <div><span style="font-weight: bold;">Step 10</span>:<span style="font-style: italic;"> Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.</span></div>
          </blockquote>
          <blockquote>
            <div><span style="font-weight: bold;">Point 7</span>:<span style="font-style: italic;"> Promote co-operation between health care staff, breastfeeding support groups and the local community. </span></div>
          </blockquote>
        </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      </div>
      <div>
        <p>Attendance at mother-to-mother support groups or follow-up by peer counselors has demonstrated significant increases in maintaining exclusive breastfeeding. <sup><a href="#note4">4</a></sup> Strategies that depend mainly on face-to-face support appear more effective than those that rely primarily on telephone contact. <sup><a href="#note5">5</a></sup> Parents should be given information about the location and availability of these services with encouragement to use the services. </p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/group.png" class="icon" alt="" /><h3>How is the information provided?</h3>
        <div>Does your Unit have a list of all the available breastfeeding support groups and networks in your area? Is it up-to-date with current phone numbers and meeting places and dates? Are representatives from these groups welcome to meet with mothers in your Unit? <br /></div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    </div>
  </div>
      <div class="captionBox">
        <img width="450" height="653" src="images/ABA_support_poster450.jpg" alt="" />
        <p> <br />&copy; Australian Breastfeeding Association</p>
      </div>
      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/remember.png" class="icon" alt="" /><h3></h3>
      <div>
        <ul>
          <li>The 3 critical warning signs that indicate potential infant danger.</li>
          <li>The consequences of these warning signs if left unattended.</li>
          <li>The contraceptive choices and actions which can be offered safely for breastfeeding mothers.</li>
          <li>How to contact your local mother-to-mother support group.</li>
        </ul>
      </div>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
  </div>
      <div class="section" id="Self-test_Quiz"><h2>Self-test Quiz</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3></h3>
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	new MCQ('To prevent problems and ensure that mothers know when to make an urgent appointment with their health professional you would discuss all of the following, EXCEPT:', [{text:'baby must be breastfeeding 8 - 10 times per day',feedback:'Some babies will thrive on 6 breastfeeds a day, and others will be feeding INEFFECTIVELY 10 times per day. Therefore this is not an adequate guide that the baby is doing well.',score:1},{text:'after Day 4 baby should be having at least 6 - 8 thoroughly wet, with clear urine, diapers/nappies per day.',feedback:'This is an excellent guide to adequate intake, when baby is exclusively breastfed and something you would definitely discuss.',score:0},{text:'the mother has comfortable breasts and no nipple damage',feedback:'Painful breasts and/or damaged nipples are a sign that latching is poor, and therefore milk transfer will be ineffective.',score:0},{text:'how to tell the degree of jaundice in the baby',feedback:'You would discuss this, and that they should seek urgent review if it extends below the umbilicus.',score:0}]),
	new MCQ('Following the birth of her first infant, a mother tells you she wants to use the most effective contraceptive that is safe while breastfeeding. Which of the following would be the BEST choice for her?', [{text:'diaphragm use combined with a spermicide',feedback:'No. The mother will have a 16% chance of getting pregnant using this method (as commonly used).',score:0},{text:'male condom',feedback:'with common usage there is a 15% chance of pregnancy with this method',score:0},{text:'lactational amenorrhea method',feedback:'This is the best choice. With common usage there is a 2% chance of pregnancy.',score:1},{text:'progestin-only oral contraceptive pills',feedback:'No. In common usage this has a failure rate of 8% and some mothers report a reduced milk supply following commencement of this method.',score:0}]),
	new MCQ('36 hours after birthing a mother decides to go home from the hospital. As a part of her discharge education you would make an appointment for her and her baby to be seen by a health professional by what age, at the latest?', [{text:'2 days',feedback:'No, they should both be OK for at least the 12 hours after you last see them.',score:0},{text:'3 days',feedback:'While you may organise to see them at this time, you could leave it a little longer if necessary.',score:0},{text:'4 days',feedback:'Yes. It\'s important mother and baby are both assessed again by this age, or earlier if she has noted any of the critical warning signs prior to this.',score:1},{text:'7 days',feedback:'This is too late. Early problems may have developed into a near-disaster by now. They should be seen again prior to this.',score:0}]),
	new MCQ('To assist the mother\'s transition to motherhood, give her confidence in her mothering ability and increase the chance of her breastfeeding for longer you would...', [{text:'suggest she attend peer-support meetings.',feedback:'That\'s correct. Mother-to-mother support offers mothers a dimension to parenthood that health professionals cannot provide.',score:1},{text:'offer frequent phone follow-up from your clinic.',feedback:'This is helpful in problem-solving, but there is a more effective way.',score:0},{text:'give her the contact for her community-based health care organisation.',feedback:'You would do this too, but to meet the criteria in the question this is less likely to be effective.',score:0},{text:'include the mother\'s mother in educational sessions.',feedback:'This is an excellent idea, if she is available, and the mother would like it. But discussion with her peers is the most effective method of support for mothers.',score:0}])
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    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
  </div>
      <div class="section" id="Assessment_Quiz"><h2>Assessment Quiz</h2>
    <div>
      <p>
		When you are happy that you've understood all the information in this topic you will be ready to complete the Module 6 Assessment. To do this, go to the course opening page, scroll down to the Assessment section and choose Module 6.
	</p>
    </div>
  </div>
      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#frie04" title="See full details">#</a> Friedman MA et al. (2004) Discharge criteria for the term newborn.</li>
          <li id="note2"><a href="references.html#merc90" title="See full details">#</a> Merchant K et al. (1990) Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals.</li>
          <li id="note3"><a href="references.html#donn04" title="See full details">#</a> Donnelly A et al. (2004) Commercial hospital discharge packs for breastfeeding women</li>
          <li id="note4"><a href="references.html#hodd06" title="See full details">#</a> Hoddinott P et al. (2006) Effectiveness of a breastfeeding peer coaching intervention in rural Scotland</li>
          <li id="note5"><a href="references.html#siko04" title="See full details">#</a> Sikorski J et al. (2004) Support for breastfeeding mothers</li>
        </ol>
      </div>
      <div id="footer"><a href="topic_6-5.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_7-0.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; 2012 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>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li>2.2 <a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li>4.3 <a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li>6.1 <a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li>6.5 <a href="topic_6-5.html">Psychological support</a></li><li class="current">6.6 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li>9.4 <a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</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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