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

[NewBeee]

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.

[~Mi Vida Loca~RN, ASN, RN]

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!

I got the mobility thing from the person OP

[~Mi Vida Loca~RN, ASN, RN]

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.

I managed to nurse my child just find after having abdominal surgery either upright or semi upright. The football hold never worked for me.

[Nurse SMS, MSN, RN]

We also follow the ABCs and Maslows. Given that breastfeeding is not an essential life function for the mother, I would go with something more essential and medically concrete. From Tucker's Patient Care Standards:

Pain r/t surgical incisions

Inffective breathing pattern r/t discomfort and postsurgical status

Impaired skin integrity r/t surgical incision

Consitpation r/t NPO status and manipulation of pelvic and abodminal structures during surgery

Knowledge deficit r/t lack of information about procedure and precesarean delivery care

Altered cardiopulmonary and peripheral tissue perfusion r/t interruption of flow secondary to postoperative immobility

Altered urinary elimination r/t (postremoval of Foley catheter) manipulation or trauma secondary to cesarean birth

Risk for infection or injrury r/t surgical procedure

Breastfeeding would be way low on the list of priorities from the ABCs and Maslow's standpoint.

[rbytsdy]

I managed to nurse my child just find after having abdominal surgery either upright or semi upright. The football hold never worked for me.

So you are saying that you had a csection and within a couple hours you were breastfeeding your baby? Or you had some other type of abd surgery and breastfed a baby that was already established in breastfeeding? Based on your wording, I'm guessing the latter. I always found that the football hold works best with neonates.

In general, you do not want to recommend that a mom put the baby on top of her scar in order to breastfeed. You can try putting lots of pillows etc to make that work but, in general, the football hold works. You have a mom in new pain and a new baby trying to figure out how to breastfeed. It's not usually a good combination, especially if mom has never breastfed before and doesn't know what to expect.

I'm glad to hear that breastfeeding wasn't an issue and having the baby place pressure on your scar didn't bother you. It may work for a lot of women and I'd ask a mom what she is comfortable with! But if you want to help most post csection moms be successful in breastfeeding, I'd highly recommend that a nurse try to avoid placing the patient in more pain.

[~Mi Vida Loca~RN, ASN, RN]

So you are saying that you had a csection and within a couple hours you were breastfeeding your baby? Or you had some other type of abd surgery and breastfed a baby that was already established in breastfeeding? Based on your wording, I'm guessing the latter. I always found that the football hold works best with neonates.

In general, you do not want to recommend that a mom put the baby on top of her scar in order to breastfeed. You can try putting lots of pillows etc to make that work but, in general, the football hold works. You have a mom in new pain and a new baby trying to figure out how to breastfeed. It's not usually a good combination, especially if mom has never breastfed before and doesn't know what to expect.

I'm glad to hear that breastfeeding wasn't an issue and having the baby place pressure on your scar didn't bother you. It may work for a lot of women and I'd ask a mom what she is comfortable with! But if you want to help most post csection moms be successful in breastfeeding, I'd highly recommend that a nurse try to avoid placing the patient in more pain.

Well first, a scar would entail it's healed. it wasn't healed, one of my abdominal surgeries I had, my baby was 4 months old, much older and bigger then a new born, but my incision was well protected and the baby wasn't laying right on it. It was a surgery with just as much done as a C Section, actually worse, my incision and stuff done entailed a LOT more then what's entailed in a C-section. Which I have seen 2 C-sections.

I don't see why a newborn would need to be resting on the incision, I guess if the mothers breasts are down really low I can see that maybe happening, but I have very large breasts and it was never an issue for me. My newborns, where they were much smaller, didn't rest on my abdomen either. I held them up to my breast and had a boppy or pillow under for support. I never once recommended anyone placing the baby on top of an incision. What do people do when they splint after an abdominal surgery? They put something (folded blanket, Pillow) over the area and put pressure there while they cough or what not. Everyone person is different and their experiences are different obviously, I had my own issues nursing my children that came actually a few weeks later after birth, and the football hold never felt normal or comfortable to me. I did not propose anything dangerous, and I have breast fed 4 children. When I was in a semi fowlers position, the baby wasn't on my stomach at all, the head was at my waist and legs angled under my other breast. The mom isn't out for a great length of time either, I mean yeah you have to avoid heaving lifting and all that for a while and they tell you not to lift anything heavier then your baby, but it isn't like you can't move at all, you just have to be careful in your movements.

I have had many friends that had C-Sections and breastfeed. I can say that with each kid I had breastfeeding because far more painful from the uterine contractions. By the 4th kid I had to be on painkillers the first week when I nursed because the pain was so bad and I can tolerate a lot of pain.

[rbytsdy]

I'm pleased to hear that you breastfed and I'm really glad that your abd surgery 4 months post birth didn't affect that.

However, I am a been-there-done-that mom. I had a c-section with my first baby and breastfed.... for 3 years. There was no way in heck I could have had my baby putting any pressure on my incision (btw - a scar is a healing wound or injury or the fibrous tissues destroyed by injury but thank you for trying to correct me. ).

You can advise your patients whatever you want. But I stand by my suggestion that you talk to the patient about the football hold and using a side lying position to breastfeed the neonate in the hospital. New moms are often fumbling about trying to figure out what to do and breastfeeding can initially cause a lot of discomfort (not for all moms but many). If you add any more pain to that, moms will give up more easily. Semi-fowlers (particularly with a couple pillows over the scar) may work just fine. But I would not assume that with any c-section patient. I never said that semi-fowlers wouldn't work. I just suggest that assuming it would work for all csection moms might not be a great idea.

My 2nd baby was a lady partsl birth and the first position I breastfed in was semi-fowlers. Much easier! Considering I went through nearly 2 days of drug free labor, I'm pretty confident that I have a good pain tolerance as well. :)

Anyway, I'm getting way off topic in trying to defend how to breastfeed after a csection. I originally posted to say that in my school, a primary NANDA should focus on ABCs. While I think breastfeeding is super important, ABCs should probably come first. :)

[~Mi Vida Loca~RN, ASN, RN]

Yikes, not sure why you are getting so defensive, I was giving my experience no different then you giving yours. I can assure you, breast feeding a much older baby, that is bigger and weighs more then a new born with an incision that goes from one side on the hip to the other side on the hip is not any easier then breastfeeding right after a C-section. In fact, I would think that it is much more difficult since you are working with a much bigger wound and a much bigger baby and I would say a lot more pain but pain is subjective so..... We were taught that a scar is what comes after the incision heals, I am fully aware of what kind of tissue it is, but never have I ever heard an open wound or incision refereed to as a scar. I know when we are documenting incisions we are not saying the "scar is approximated and 5 inches long, 3 cm deep etc etc." Very odd. I was thinking maybe it was an area thing but I have lived all over the country. Maybe it's a cultural thing. I dunno, anyway.

I wasn't debating YOU with my original post, I was giving my OWN opinion to the original poster from what THEY had listed. Given where they do the incisions of majority of the C-Sections today, I still don't even see how the baby would be resting on the incision. But that is neither here nor there. That is great you had your baby drug free, I had a couple like that also. Childbirth definitely wasn't the hardest or most painful thing I have been through, it wasn't a walk in the park by any means, but been through worse.

[rbytsdy]

Not getting defensive. Just giving my experience and my suggestions. I don't think a surgery 4 months post partum is equivalent to having a surgical birth. I don't think it's irrelevant; I just don't think it's as similar as you think it is. You can think whatever you want! You don't think any of the things I brought up should even be an issue with breastfeeding. I thought they were. And since I've been through it, I'll go with my opinion. All others can decide for themselves But I will say that the worst nurse I had post partum was the one who tried to tell me what to do without recognizing that I was in pain and that her barking orders at me only made things worse.

[~Mi Vida Loca~RN, ASN, RN]

Not getting defensive. Just giving my experience and my suggestions. I don't think a surgery 4 months post partum is equivalent to having a surgical birth. I don't think it's irrelevant; I just don't think it's as similar as you think it is. You can think whatever you want! You don't think any of the things I brought up should even be an issue with breastfeeding. I thought they were. And since I've been through it, I'll go with my opinion. All others can decide for themselves But I will say that the worst nurse I had post partum was the one who tried to tell me what to do without recognizing that I was in pain and that her barking orders at me only made things worse.

*sigh*

"Anyway, I'm getting way off topic in trying to defend how to breastfeed after a csection." I don't know where I got the defensive thing from.

I never ONCE said to place a baby on an incision like you have implied that I have. I never once said things you brought up should never be an issue, like you just said in your post.(I said I didn't understand a few things but I didn't say that meant they couldn't be true) I only gave my experience. I never once said how someone should tell a mom to nurse after an c-section, but you did dissect myfirst post to the OP by saying this,

"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."

Unless you have gone through the same major abdominal surgery I have (which also required 2 jackson pratt tubes in place for a week) and breast feed an 18 lb baby right after, I guess you also can't know what it's like, or imply it doesn't compare. I can tell you at the time, I wished my baby was the 8lbs he was at birth. As far as your last line, which I am sure you will say isn't a dig towards me, I don't bark orders at my patients and I take their pain very serioulsly, so much so, I put my butt on the line as a student advocating for a pt I knew was in pain but couldn't talk, to a nurse that thought a Tylenol suppository should be sufficient, because she felt pain meds were too overused in the hospital. In the breastfeeding with or without c section situation I would have the mom try many different holds and have her decide which one was most comfortable to her, like I did for a few of my friends that were new to Bf'ing and came to me for advice that had C Sections.

With that, I am done having this discussion with you, it's hard to have a discussion when things keep being twisted around and things that weren't said are being added into the conversation as if they were.

Edited to add, :D :|

[rbytsdy]

Good for you!!! :) :) You are the one that decided to quote me and explain how you know what it's like to breastfeed after a csection (even though you haven't actually done that). I tried to point out that maybe it's not the same thing. You still seem to believe that what you went through is either the same or perhaps even worse. In fact, you specifically decided to disagree with 2 posters and explain how you know because you've had abd surgery. I stand by my suggestions. :) Maybe it comes from being involved with La Leche League and ICAN for the past 4 years. * shrug *Too bad you don't agree and too bad you won't even give any merit to my suggestions since you know better but good luck with your patients! :) :) :)