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Multiple Choice Questions 3-1 for Breast milk production and maternal mental health

Learning Objectives

  1. Describe signs of adequate breast milk production in the first 4 months postpartum
  2. Describe the normal growth pattern of breastfed infants in the first 4 months postpartum
  3. Identify clinical signs of hyperlactation based on maternal and infant presentation
  4. List the negative pediatric and maternal health consequences of hyperlactation
  5. Describe management strategies for hyperlactation

Question 1

A 28 year old G1P1 who is 2 months postpartum calls the office because she is experiencing bilateral nipple pain. Her pregnancy was without complications. She had premature rupture of membranes at 36 weeks gestation. Delivery was done via emergent C section due to breech presentation and declining fetal heart rate. The newborn was promptly transferred to the NICU for signs of respiratory distress. The mother initiated breast pumping and her infant only received breast milk while in the NICU. The baby was discharged on hospital day 7 and the mother was given instructions to triple feed. The patient has been following these instructions.

She has been able to save about 450 ounces in the freezer for when she goes back to work. The infant is now 2 months old and weighs 12 lbs. The patient expresses frustration that he is still so far away from the 100th percentile. She keeps trying to make him eat more, but lately he has been increasingly fussy during feeds, and often unlatches multiple times during a feed. He can follow objects in his visual field and can hold his head up for short periods of time. He has not yet slept through the night or been able to roll over on his tummy.

The mother is asking if she should supplement her diet to improve the breast milk quality. She is also wondering if adding formula or other foods into the baby’s diet will help him gain weight, sleep better, and be less fussy. What advice should she be given?

 

Question 2

A 28 year old G1P1 who is 2 months postpartum calls the office because she is experiencing bilateral nipple pain. Her pregnancy was without complications. She had premature rupture of membranes at 36 weeks gestation. Delivery was done via emergent C section due to breech presentation and declining fetal heart rate. The newborn was promptly transferred to the NICU for signs of respiratory distress. The mother initiated breast pumping and her infant only received breast milk while in the NICU. The baby was discharged on hospital day 7 and the mother was given instructions to triple feed. The patient has been following these instructions.

She has been able to save about 450 ounces in the freezer for when she goes back to work. The infant is now 2 months old and weighs 12 lbs. The patient expresses frustration that he is still so far away from the 100th percentile. She keeps trying to make him eat more, but lately he has been increasingly fussy during feeds, and often unlatches multiple times during a feed. He can follow objects in his visual field and can hold his head up for short periods of time. He has not yet slept through the night or been able to roll over on his tummy.

The mother adds that she is exhausted because she has to hold the baby upright for thirty minutes after a feed to prevent reflux. What additional information would add to your suspicion that the patient might have breast milk oversupply?

 

Question 3

A 28 year old G1P1 who is 2 months postpartum calls the office because she is experiencing bilateral nipple pain. Her pregnancy was without complications. She had premature rupture of membranes at 36 weeks gestation. Delivery was done via emergent C section due to breech presentation and declining fetal heart rate. The newborn was promptly transferred to the NICU for signs of respiratory distress. The mother initiated breast pumping and her infant only received breast milk while in the NICU. The baby was discharged on hospital day 7 and the mother was given instructions to triple feed. The patient has been following these instructions.

She has been able to save about 450 ounces in the freezer for when she goes back to work. The infant is now 2 months old and weighs 12 lbs. The patient expresses frustration that he is still so far away from the 100th percentile. She keeps trying to make him eat more, but lately he has been increasingly fussy during feeds, and often unlatches multiple times during a feed. He can follow objects in his visual field and can hold his head up for short periods of time. He has not yet slept through the night or been able to roll over on his tummy.

When asked about her breastfeeding habits, the mother states that she pumps after each feed because she was told to triple feed her baby. She still feels full after breastfeeding, as if her baby isn’t emptying her enough. She is worried that he isn’t eating well at the breast. She feeds every 2-3 hours because her breasts get uncomfortably swollen if she waits longer than that. What is a reliable method of determining if there is adequate breastmilk production and neonatal intake?

 

Question 4

A 28 year old G1P1 who is 2 months postpartum calls the office because she is experiencing bilateral nipple pain. Her pregnancy was without complications. She had premature rupture of membranes at 36 weeks gestation. Delivery was done via emergent C section due to breech presentation and declining fetal heart rate. The newborn was promptly transferred to the NICU for signs of respiratory distress. The mother initiated breast pumping and her infant only received breast milk while in the NICU. The baby was discharged on hospital day 7 and the mother was given instructions to triple feed. The patient has been following these instructions.

She has been able to save about 450 ounces in the freezer for when she goes back to work. The infant is now 2 months old and weighs 12 lbs. The patient expresses frustration that he is still so far away from the 100th percentile. She keeps trying to make him eat more, but lately he has been increasingly fussy during feeds, and often unlatches multiple times during a feed. He can follow objects in his visual field and can hold his head up for short periods of time. He has not yet slept through the night or been able to roll over on his tummy.

The mother proudly tells you that she just ordered a deep freezer to store all of the extra breast milk she has because she ran out of room in her freezer last week. What would you like to tell the mother about the negative health consequences of breast milk oversupply?

 

Question 5

A 28 year old G1P1 who is 2 months postpartum calls the office because she is experiencing bilateral nipple pain. Her pregnancy was without complications. She had premature rupture of membranes at 36 weeks gestation. Delivery was done via emergent C section due to breech presentation and declining fetal heart rate. The newborn was promptly transferred to the NICU for signs of respiratory distress. The mother initiated breast pumping and her infant only received breast milk while in the NICU. The baby was discharged on hospital day 7 and the mother was given instructions to triple feed. The patient has been following these instructions.

She has been able to save about 450 ounces in the freezer for when she goes back to work. The infant is now 2 months old and weighs 12 lbs. The patient expresses frustration that he is still so far away from the 100th percentile. She keeps trying to make him eat more, but lately he has been increasingly fussy during feeds, and often unlatches multiple times during a feed. He spits up frequently, is very gassy and produces multiple green, foamy and frothy stools – usually before, during and after feeds. He can follow objects in his visual field and can hold his head up for short periods of time. He has not yet slept through the night or been able to roll over on his tummy.

The mother is not sure if she’s ready to decrease her milk production. She’s worked so hard to get it up after a difficult first few weeks postpartum. What can you tell her about the management approach for oversupply?

 
 
 

Multiple Choice Questions 3-2 for Breast milk production and maternal mental health

Learning Objectives

  1. Understand the clinical approach to a suspected postpartum mood disorder
  2. Distinguish between postpartum blues, postpartum depression and postpartum psychosis
  3. Identify risk factors associated with postpartum mood disorders
  4. Recognize the proper advice to give a patient presenting with a postpartum mood disorder

Question 1

A 35 year-old first time mother is six weeks postpartum. She feels like she’s been starting to adjust to “this new normal,” but reports feeling “like everything is a hazy blur.”  She has been feeling very tired these past few weeks, but attributes it to having to get up so often at night to feed her baby. Otherwise, she has no concerns and says her baby is growing well.

You want to check in with each mother during the postpartum period to assess their mental well-being. What are two questions that are most important to ask?

 

Question 2

A 35 year-old first time mother is six weeks postpartum. She feels like she’s been starting to adjust to “this new normal,” but reports feeling “like everything is a hazy blur.”  She has been feeling very tired these past few weeks, but attributes it to having to get up so often at night to feed her baby. Otherwise, she has no concerns and says her baby is growing well.

The patient says she feels down, like her situation is hopeless, especially during cluster feeding sessions in the evenings when she is trapped on the couch for hours at a time. She knows her partner is trying to help, but the baby only wants her and screams when her husband takes him.  Which of the following additional pieces of information would increase your suspicion for postpartum depression?

 

Question 3

A 35 year-old first time mother is six weeks postpartum. She feels like she’s been starting to adjust to “this new normal,” but reports feeling “like everything is a hazy blur.”  She has been feeling very tired these past few weeks, but attributes it to having to get up so often at night to feed her baby. Otherwise, she has no concerns and says her baby is growing well.The patient says she feels down, like her situation is hopeless, especially during cluster feeding sessions in the evenings when she is trapped on the couch for hours at a time. She knows her partner is trying to help, but the baby only wants her and screams when her husband takes him.

The patient adds that her husband is annoyed that he does not get to spend quality time with his son, given that she’s always breastfeeding. She feels guilty about breastfeeding and was pressured into pumping and allowing the father to bottle feed the baby.  What is the physiological mechanism that explains the protective effect of exclusive breastfeeding in the setting of adequate support against postnatal mood disorder?

 

Question 4

A 35 year-old first time mother is six weeks postpartum. She feels like she’s been starting to adjust to “this new normal,” but reports feeling “like everything is a hazy blur.”  She has been feeling very tired these past few weeks, but attributes it to having to get up so often at night to feed her baby. Otherwise, she has no concerns and says her baby is growing well.The patient says she feels down, like her situation is hopeless, especially during cluster feeding sessions in the evenings when she is trapped on the couch for hours at a time. She knows her partner is trying to help, but the baby only wants her and screams when her husband takes him.  The patient adds that her husband is annoyed that he does not get to spend quality time with his son, given that she’s always breastfeeding. She feels guilty about breastfeeding and was pressured into pumping and allowing the father to bottle feed the baby.

After you ask about a history of mental illness, the patient reveals that in high school she was treated for a major depressive episode and has had no recurrences since. She seems surprised by your question, and wonders why that is relevant. What can you share with her about the epidemiology of postnatal mood disorders that supports the use of this question?

 

Question 5

A 35 year-old first time mother is six weeks postpartum. She feels like she’s been starting to adjust to “this new normal,” but reports feeling “like everything is a hazy blur.”  She has been feeling very tired these past few weeks, but attributes it to having to get up so often at night to feed her baby. Otherwise, she has no concerns and says her baby is growing well.The patient says she feels down, like her situation is hopeless, especially during cluster feeding sessions in the evenings when she is trapped on the couch for hours at a time. She knows her partner is trying to help, but the baby only wants her and screams when her husband takes him.  The patient adds that her husband is annoyed that he does not get to spend quality time with his son, given that she’s always breastfeeding. She feels guilty about breastfeeding and was pressured into pumping and allowing the father to bottle feed the baby.  After you ask about a history of mental illness, the patient reveals that in high school she was treated for a major depressive episode and has had no recurrences since.

The patient bursts into tears and starts to apologize for crying. What do you say to her now?

“I can see that this is difficult for you. Why don’t I give you some time right now to work through your feelings so that we can talk some more?”