Could impaired breastfeeding be a primary Nanda for a c-section patient?

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My instructor would like us to select a primary nursing diagnosis for our patient. Could "impaired breastfeeding related to deficient knowledge about breastfeeding" be a primary Nanda for a c-section patient? My patient is a post-op cesarean section. I am inclined to think that the primary nursing diagnosis should be related to her incision. However, it should NOT be a "risk for" as this is never a primary diagnosis. So, perhaps "impaired mobility related to cesarean section as evidenced by inability to sit up or roll over in bed" would be more appropriate? I like "impaired breastfeeding" the best as I actually assisted the patient with this matter. However, I'm confused as to which one is a bigger priority - or if either of these are a high priority.

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Pain comes to mind to me as a primary problem for a fresh post-op c-section! And pain can impair the ability to breastfeed, mobility... etc. Usually when you have a problem that can snowball into others, that's your primary.

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Unfortunately, our instructors get very upset when we use nandas such as pain, constipation, and impaired skin integrity. While these are great nandas, they feel we aren't thinking outside of the box. In addition, everyone ends up using the same nanda for a c-section patient. Thanks for your help! I'll keep trying and see if I come up with something.

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unfortunately, our instructors get very upset when we use nandas such as pain, constipation, and impaired skin integrity. while these are great nandas, they feel we aren't thinking outside of the box. in addition, everyone ends up using the same nanda for a c-section patient. thanks for your help! i'll keep trying and see if i come up with something.

if your instructors get upset by this, then all i can say is that they have obviously never had a c-section! i have had 2, and i was glad that my nurses made pain management a #1 priority for me!

other priorities could be infection or blood clots. and, imo, just because a pt is "at risk for" something doesn't make it any less of a priority. think of it in terms of prevention, which is ultimately the best thing you can do for your pt. as far as breastfeeding goes, it is certainly difficult for a sectioned mom to do, since it can be difficult to find a comfortable position to place the baby in, and mom can have difficulties in milk production, but i don't know if i would consider it to be a first priority.

hope that helps! :heartbeat

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It all depends on the patient.. Take me for example, mobility and pain were NOT an priority at all luckily. However Breastfeeding was a struggle with my second child. Breastfeeding issues, especially if the mother really wants to can lead to PPD which is a huge problem. So I feel it's a priority, an often overlooked one in fact. My instructors would most likely take it if in consideration pain, mobility, etc were all no issue KWIM??

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Breastfeeding issues, especially if the mother really wants to can lead to PPD which is a huge problem.

Ooh...I didn't think of that! That's a good one!

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Specializes in Emergency Dept. Trauma. Pediatrics.

I am having trouble seeing the correlation, the mom wouldn't have to roll over to feed the baby, and you can sit up if you have had a C-Section. In fact, someone shouldn't just be laying flat being immobile after having a C-section, but put that aside, the HOB can be put in a semi fowlers position and the mom can nurse.

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Specializes in Emergency Dept. Trauma. Pediatrics.

What about something dealing with the risk of ripping open her sutures by not splinting or something, I am having a blank of the spelling of the exact word.

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I am having trouble seeing the correlation, the mom wouldn't have to roll over to feed the baby, and you can sit up if you have had a C-Section. In fact, someone shouldn't just be laying flat being immobile after having a C-section, but put that aside, the HOB can be put in a semi fowlers position and the mom can nurse.

The difficulty nursing doesn't have to do with mobility.. Difficulty nursing is a problem all it's own but it's worsened because often you have to position the baby in special ways to avoid putting pressure on your abdomen. Also it is common for c-section baby's to be "sleepy" thereby having trouble getting them to wake and nurse as often as they should. There's a multitude of problems that contribute but none of them have to do with the mom laying flat or being immobile!

Also to note.. Semi Fowlers isn't really a great position for most to feed in at first, usually it's MUCH easier slightly sitting forward which is definitely NOT really possible after a section! That's my own personal experience anyways from bf'ing 2 kiddos :):)

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In addition, I think where you pulled the suggestion of mobility issues from is a seperate suggestion for a dx as mobility is often an issue for a post op section as it can be VERY difficult to ambulate the first few days!

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If it's a primary NANDA, I'd go with the ABCs. Airway should be fine assuming she suffers no immediate effects of the surgery. A woman who just had major abd surgery has a respiratory/breathing risk due to the fact that it's difficult to take deep breaths and she cannot move easily. Atelectasis (sp?) can be an issue. Assess her breath sounds and make sure you give a post c-section mom an incentive spirometer.

After that, look at circulatory. If she is not ambulating, circulation can be an issue. I never had compression boots on but I've talked to recent c-section moms who did get the boots to prevent DVTs.

After that, pain management is the primary issue. Then I'd focus on breastfeeding.

Oh, and you definitely DON'T want to put a post c-section mom in semi-fowlers to breastfeed. I'm in pain just thinking about that. You'd really want to think about high-Fowlers and putting baby in a football hold to avoid having the baby put pressure on the incision. Putting mom in a chair and having her breastfeed in a football hold is even better. She can also breastfeeding in a side lying position but you may need to prop the baby up on a pillow for this.

I don't know how your instructors operate but our primary NANDA must focus on ABCs followed by Maslow's hierarchy. We do 3 NANDAs per care plan so the 2nd or 3rd one could be related to breastfeeding.

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Specializes in Emergency Dept. Trauma. Pediatrics.
The difficulty nursing doesn't have to do with mobility.. Difficulty nursing is a problem all it's own but it's worsened because often you have to position the baby in special ways to avoid putting pressure on your abdomen. Also it is common for c-section baby's to be "sleepy" thereby having trouble getting them to wake and nurse as often as they should. There's a multitude of problems that contribute but none of them have to do with the mom laying flat or being immobile!

Also to note.. Semi Fowlers isn't really a great position for most to feed in at first, usually it's MUCH easier slightly sitting forward which is definitely NOT really possible after a section! That's my own personal experience anyways from bf'ing 2 kiddos :):)

I am not new to BF'ing, I have breast fed 4 babies ;) and sitting semi fowlers or fowlers was the most comfortable for me, I also have had major abdominal surgery and know the positions you can take, my scar is from one hip to my other hip.

The OP post said something about doing the BF diagnosis because of the C section AEB inability to sit or be mobile. That is why I said having a C Section you shouldn't have to stay flat or immobile. It's not good for anyone to stay immobile after surgery with some exceptions of course.

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