MATERNAL AND CHILD NURSING lecture

CAESARIAN BIRTH

o Avoid hitting the placenta

INTRODUCTION o It leaves a wide skin scar and could
rupture during labor
• Low Segment Incision (bikini style)
• Latin word (Caedore) which means to cut
o Incision made horizontally over the
• Named after Julius Caesar because there symphysis pubis and horizontally across
was a belief that he was born by caesarian the uterus just over the cervix.
birth. o Most common type used
• This birth is more than surgical procedure. o Less likely to rupture in following
• Reasons for Caesarian Birth labor
o Mother Factors o Less blood loss and gastrointestinal
Cephalic Disproportion problems
Obstructive benign or o Decreases post portals uterine
malignant tumor Previous infection
Caesarian birth Cervical o Easier to suture.
Cerclage
PREOPERATIVE DIAGNOSTICS
o Baby’s Factor
Low birth weight • CBC, urinalysis, Blood typing, serum
Fetal distress electrolytes. Coagulation profile, Sonogram
Hydrocephalus
Transverse fetal lie PREOPERATIVE TEACHINGS
o Placenta • Anxiety is one of the fears to toughest
Umbilical prolapses overcome.
Placenta previa Premature • Educating the mother is the way to overcomethe
separations of placenta anxiety. It includes by orientating her of the
procedure, equipment, measures (skin
preparations, eating nothing before surgery, and
TYPES OF CAESARIAN BIRTH pre-op meds) managements that would prevent
post-op complications (Deep breathing
• Scheduled caesarian Birth
exercises, Incentive Spirometry, triggered by
o To save from strain of labor
inhalation not exhalation), Turning prevent
o Convenient birth
circulatory and respiratory statis, and
o Easy way to painless childbirth
Ambulation to stimulate lower extremities.
o Vaginal birth has a lesser risk than
caesarian birth
PREOPERATIVE INTERVIEWS
o Avoid stress incontinence
o About 60% of mothers today have • Ask patient Allergies in foods and medicines,
vaginal birth after a caesarian section past surgeries, illnesses, and present
• Emergency Caesarian Birth medications.
o Performed due to abruptio placenta, • Include also knowledge about the procedure,
placenta previa, failure to progress in length of hospital stays, post-operative gadgets
labor and fetal distress. such as IV and catheter.
o No advanced health teaching and
preparations of the surgery.
o Emotionally ang physically
exhausted from a long labor.
•

TYPES OF CAESARIAN INCISION

• Classic Caesarian Incision
o Incision made vertically on both
abdominal skin and uterus
PREOPERATIVE RISK o Must be inserted before the surgery
and to the non-dominant hand
• Poor Nutritional Status (obese mothers, heart • Pre-surgery Checklist
problems, and lack of protein) o It will serve as a guide all pertinent
• Age Variations – Young and Vit C and D – measures (pre op preparation) are
responsible for new cell formation. Adult is executed and must be signed.
excellent candidate for surgery. While 40 Indicates that all are complete.
years old are considered slightly high risk. • Transport to Surgery
• Altered General Health – Mothers who has o Check patient name tag
secondary illnesses such as heart problems, o Advise her to lie on her left side
anemia, DM, kidney, and liver problems. during transfer
• Fluid and Electrolyte imbalance – Mother o Assist her in transferring from bed to
who will be in surgery, may developed a stretcher
lower-than-normal blood volume. o Put the siderails up to ensure safety
Management: Intravenous Therapy o Make sure that the checklist is inside
then patient’s chart.
• Fear – Help mother acknowledge her fear.
Keep her informed
IMMEDIATE CARE MEASURES
IMMEDIATE PREOPERATIVE MEASURES
• Administration of Anesthesia
o Operating Room Nurse will help the
• Informed Consent
mother transfer from stretcher to OR
o MD’s responsibility and nurse may be
table and stay with her while giving the
asked to witness, be certain that it was anesthesia
informed consent. Should be
Epidural Catheter –
within mother’s level of
Administered with mother in a
understanding.
lying position.
• Preoperative Preparations
o Be careful not to be removed during
o Admitted on the morning of surgery
transport. Advise her to stay on her
o Bathed at home
side and place a support under her
o Upon arrival provide mother with
hospital gown right hip to keep her slightly tilt to
o Put long hair on ponytail and provideOR avoid supine hypotension
cap. Spinal Anesthesia – Nurse will
o Remove nail polish, jewelries, contact assist the anesthesiologist the
lenses and dentures. back of mother would be placed
• Gastrointestinal Preparations in a curve position to separate
o Enema may be ordered by the doctor(to thevertebrae and introduce the
empty mother’s bowel and allow itto rest spinal needle. Stay with mother
for some days after the surgery) and talk to her while doing the
o Administer it in a gentle gravity procedure.
pressure. • Skin Preparation
o Offer bedpan or remain to mother and o Skin preparations from umbilicus
assist her to the comfort room. below pubic area.
o Gastric emptying medicine such as o Shaving the abdominal hair
Reglan-to-speed emptying time and o Wash it with an antiseptic solution
Zantac-histamine blocker and lowered • Surgical Incision
stomach secretions. o After given the anesthesia, positionthe
• Hydration mother and apply drapes.
o Ensure mother sufficient fluid o Cover is places at her shoulder level
replacement by administering with a drape to block the bacteria from
intravenous fluids such as Lactated the lungs the operative site
Ringer’s solution using (gauge 18-20 o Scrub the incision site with antiseptic
needle) solution and appropriate covers and
only the incision site is exposed.
 BIRTH OF THE BABY • Empty the bladder
• Fully dilated cervix
• Retractors are slipped in the operative site.
• Ruptured membrane
• Uterus is the cut
• Not CPD case
• Suction mouth and nose by hand bulb
• Check the fetal heart rate before doing
syringe
forceps delivery
• Administer oxytocin thru IV by the
• Check baby that there’s no facial palsy or
anesthesiologist as the baby and placenta
subdural hematoma.
• Cut the umbilical cord
• Inform the mother that forceps delivery can
• Membranes and placenta removed manually
cause mark on the baby’s cheeks that wouldlast
• Uterus, subcutaneous and skin incisions are
for 1-2 days known as erythematous.
then closed
• Observed the amount of (abdominal
manipulations) PUERPERIUM
• Introduction of the newborn
o Show baby to the mother
• Postpartum Care POSTPARTUM
o Increase in difficulty bonding with the
baby • Latin word Puer (child) and Perere (bring
o Transfer mother from OR table to forth)
post anesthesia unit care • 6 weeks or 1 ½ weeks after delivery of the
• Discharge Planning baby
o Discuss home care management • Maternal changes such as:
o Aware of her restrictions o Progressive
o Teach her to identify possible post op Renewal of the usual
complication. Such as: Abdominal pains, menstrual period Start
Frequency or burning sensation in of parenting role
urination. Manufacture of milk for
breastfeeding
FORCEPS DELIVERY o Retrogressive
Involution (return to pre
• Steel instruments made of two blades that slide pregnant status) of the uterus
together at their shaft to form a handle. and vagina.
First blade is inserted into the mother’s vagina to
the baby’s head and the secondblade to the
other side of the head. PHYSIOLOGIC CHANGES DURING POST- PARTUM PERIOD
• The doctor brought together the blades tothe
center and hold the handles together. • Systemic Changes
• Pressure is applied on the handle and by
hand pulls the baby out of the birth canal. CIRCULATORY CHANGES
• Forceps delivery is rarely used because
• First and second week blood volume returnsto
urinary stress incontinence in mothers.
its pre-pregnant status.
• Indications:
• Decrease in the blood volume is due to blood
o Abnormal position of the baby
o Baby is in distress loss (300-500 ml-NSD) & (500-1000ml-CS)
o Unable to push during contraction inthe during and diuresis during 2nd and 5th day
pelvic division of labor postpartum.
• Types of forceps Delivery • Continues production of fibrinogen during
o Low forceps delivery – used when postpartum period because it is necessary to
fetal head is at +2 station and more control hemorrhage. However, it suggests risk of
o Mid forceps delivery – fetal head is thrombus formations during the 1st postpartum
engaged but at less than +2 week.
• Things to remember before doing forceps
delivery:
NURSING MANAGEMENT
• Advise mother to walk 4-8 hours, after delivery. • Increased in size of the ureter remain presentfor
Assist mother while walking. The nurse should about four weeks after delivery.
hold on tothe patient. • Presence of lactose in the urine in
• Massage is recommended postpartum stage are the same during pregnancy
• After the placental delivery, this is most delicate because in preparation for breastfeeding
part in postpartum. Because the 30-50%
increase in the cardiac volume during pregnancy HORMONAL SYSTEM
will be absorbed only by the mother. • FSH stay low 12 days and will start to
increase as new menstrual cycle
INTEGUMENTARY SYSTEM
• Hormones responsible for pregnancy will
• Striae Gravidarum – seem reddened and decrease after placental separations
even more protuberant • HCG and HPL are almost insignificant by 24
• Chloasma and Linea Negra – hardly hours.
noticeable in 6 weeks
• Abdominal wall and ligaments that supports the REPRODUCTIVE SYSTEM
uterus will return back in 6 weeks’ time toits pre- • Cervix
pregnant status. o Do not return back the same as of the
• Advise mother to do modified sit-ups help pre-pregnant state.
toughen abdominal muscles and regain back o After NSD the external of usually stays
abdominal support during the prepregnant a bit open and looks like a slit.
status. • Vagina
o Diameter is greater the normal size,
GASTROINTESTINAL SYSTEM with few rugae and soft
o Vaginal outlet stays a bit more
• Bowel movement may be difficult due to distended than previously
sutures or hemorrhoids. Advise mother to do Kegel’s
• Bowel sounds are present however, bowel exercises, to strengthen and
movement may be slow tone up the vagina.
• Mothers feels thirsty and hungry due long • Perineum
period of being on nothing by mouth. o Edema and tenderness due pressure
• Absorption and digestion will resume again exerted during delivery
after birth. o Labia majora and minora are soft and
atrophic after delivery
URINARY SYSTEM o Ecchymosis may appear due to
ruptured capillaries during delivery
• Extensive diuresis starts to occur right after • Uterus
delivery to release excessive fluid o 2 process involve in the involution of
accumulation during pregnancy. the uterus
• Normal level of about 1500-3000ml/day of Placenta was implanted is
fluid output occurs from 2nd – 5th day sealed off after delivery
postpartum. It pinches the blood vessels
• With NSD, fetal head exerts pressure on the and stops bleeding
bladder causing loss of tone, edema aroundthe Organ is reduced to its pre-
urethra, decreases a mother’s ability to feel pregnant size
when she has to urinate o It will never completely return to its
• With Epidural, spinal or general anesthesiano original size.
sensation until the effect of the anesthesia o After delivery it weighs about 1000g
subsides or disappears however at the end of the first, it
• Check always the abdomen often after delivery measures 500g and on the 6th week it
to prevent permanent damage to thebladder weighs 50g
from overdistention
 o Fundus of the uterus after delivery is CARDINAL SIGN CHANGES
located at the halfway between the
umbilicus within 24 hours. Then after: • Inner adjustment that happens to the
1st postpartum day – one mother’s body takings to its pre-pregnant
finger breadths below the status
umbilicus • Temperature
2nd postpartum day – two o It is always taken by mouth or ears.
fingerbreadths below the o Slightly elevation within first 24-hour
post-partum due dehydration
umbilicus
o Advise mother to increase fluid
3rd postpartum day – three intake to lower down temperature
fingerbreadths below the o Elevated temperature after 24 hours
umbilicus (38C) – postpartum infection may be
9th – 10th post-partum day – it considered
can no longer palpated • Pulse
because it is located behind o Increase stroke volume reduces the
the symphysis pubis. pulse rate to 60-70 bpm
• Lochia o End of the first week the pulse rate
o Uterine discharges consisting of will return to normal
fragments of decidua, mucus, white o Carefully check pulse rate during the
blood cells, blood and some bacteria. postpartum period because possible
Delayed of the return of the uterus in its that the fast pulse may indicate
pre-pregnant status are due to postpartum hemorrhage.
hydramnios, multiple babies, difficult
birth, and physiologic effects of • Blood Pressure
analgesia. o Check the blood pressure during
o Afterpains is a normal situation during postpartum because decrease in the
postpartum period due the uterine pressure may indicate postpartum
contraction and the uterus goes back to hemorrhage
its pre-pregnant state. And it would last o Decrease in the pressure may
for 3 days. You maygive her cold indicate postpartum hemorrhage
compress and pain reliever. o An increase in pressure may indicate
o Similar to menstrual flow postpartum induced hypertension
Pattern (RSA) (unusual case)
Rubra – first 3 days o Oxytocin administration can increasethe
postpartum red colored blood pressure. If the BP is 140/90, do
not give the medicine and inform the
discharges
doctor immediately.
Serosa – 4-9 days postpartum
o To avoid the increase in BP, always
pinkish to brownish colored
check the pressure first before givingthe
discharges decreasing in medicine.
amount and leukocytes startsto o Structuring new tissues needs
invade balance nutrition.
Alba – 10th day – 6 weeks o Advise her to take foods which are
postpartum colorless or white cell building during the 6 weeks
colored discharges postpartum period.
• Irrespective of the type • Lactation
of delivery, all mothers o Formation of milk
will experience lochia o 3rd postpartum day, breast becomes
andwith the same full and tense or tender as it forms
pattern within the breast duct.
• Should not be o On the 3rd-4th day postpartum, feeling of
tension and hot with tender pain in the
offensive
breast called Engorgement
 NURSING MANAGEMENTS • Sexual Activity
o May be begin again by the third or
• Warm compress if the mother is planning to fourth week postpartum if no
breastfeed problems.
• Cold compress if she does not want to o Decreased in the libido are projectedfor
breastfeed the first 3 months postpartum because
• She may still breastfeed her baby even if she of hormonal fluctuations and emotional
has sore nipples. Advise mother to use nipple factors.
shield, nipples should be exposed to air dry or
20 watts bulb to 12-18 inches awayfor 10-15 PSYCHOLOGICAL CHANGES DURINGPOSTPARTUM PERIOD
minutes.
• Instructs the mother to wear firm – fitting
brassiere for good care • It is an internal process experienced
• Movement from one situation to another
PHYSIOLOGY OF MILK PRODUCTION • Evolution on how they would respond to
• After the placental separation > decrease change
level of estrogen and progesterone > • Parents tries out new role and to meet their
stimulates the anterior pituitary glands to expectations.
produce Prolactin, thus milk production
occurs (it subsides as the baby sucks the
PHASES OF THE PUERPERIUM
breast and empties breasts of milk) • Taking in Phase (2-3 days) recalls their
• As the baby sucks effectively the breast of the pregnancy, labor, and delivery
mother > causing continues milk production > o Dependent to the healthcare workers
and release oxytocin > which causes the due to exhaustion from the event, after
contraction of muscle (milk duct) pains and somewhat from her doubts in
– (after pain is felt by the mother) caring her baby.
• > pushes milk forward to cause > Led Down o Thinking about her new role as
Reflex… mother
o Contraceptives are not advisable if o In this phase mother is resting to
mother is breastfeeding because it restore back her energy.
inhibits milk production. o Encourage her verbalize her feelings
and assist her to fit
o Regardless of the type of delivery,
milk will be found • Taking – Hold Phase
o Due to the presence of estrogen and o Mothers start to initiate perform
progesterone during pregnancy it inhibit activities and show independence
manufacture Prolactin. o Mother is now showing little interestin
caring for her baby
o Discuss family planning
MENSTRUAL CYCLE o Demonstrate to her on how to care
for her baby and ask her to
• As soon as the placenta is delivered, the
redemonstrate it you
placental estrogen and progesterone stops.
o Acknowledge her efforts
• Because of the decrease in hormone the • Letting-Go Phase
Anterior Pituitary Gland will be stimulated togive o She finally acknowledges her new
rise to the FSH. Which will initiate a newusual role as mother
menstrual cycle. o Gives up her role of having no child
• Breast feeding mother, menstrual flow willnot and fantasizing image
resume for 3 or 4 months (lactation o Readjustment’s period
amenorrhea)
• Non-breast-feeding mother, menstrual flowwill
resume 6-10 weeks postpartum.
• Mother may not be menstruating, but she can
still get pregnant, because she may ovulate
before menstruation resumes.
 DEVELOPMENT OF PARENTAL LOVE o Managements:
Focus on the baby’s good
• Touching and sparing much time with the points
baby will strengthen the bonding of both Offer support that tips the
parents. scale towards acceptance
• Starting a strong bonding with baby is just a Handle baby warmly
problem only by a first-time parent. Show that the baby is special
• Progressively as the mother embraces her • Abandonment
baby more, she develops more warmth and o Many are asking about the infant
eventually kisses then nose, cheeks, hands, instead asking first the mother
and feet of the newborn. o Newborn is now the center of interest
• Maintaining direct eye contact with the babyis o Father is much concern and gives alot
known as in face position of time with the baby
• Nursing Management: o Managements:
o Provide a supportive presence and offer Allow mother to verbalize her
anticipatory guidance if needed. feelings
• Rooming in Concept Both parents should
o The baby stays with the mother compromise for the welfare of
inside her room instead in the the baby
nursery
o Usually, the mother stays in the
hospital within 1-3 days
POSTPARTUM INSTRUCTIONS
o 2 types of Rooming-in • Rest
Complete – the baby stays o Mothers must have at least one rest
with the mother 24 hours period every day and must get enough
Partial – the stays with the goodnight sleep.
mother for some time then be • Hygiene
brought to the nursery for the o Cleanse her perineum front to back
remaining time. o Continue applying topical care as per
doctor’s order
MATERNAL CONCERNS AND FEELINGS o Mothers should take a shower
o No vaginal douches until her last
DURING POST-PARTUM post-partum check up
• Contraception
• Postpartum Blues o Mothers should use contraception onthe
o Feelings of overwhelming sadness first contact.
o Hormonal changes o Oral contraceptive begun about 2-3
weeks after birth
o Low self-esteem due to exhaustion
o Sudden crying episodes are normal o IUD may be inserted immediately
reactions after delivery or on the first
o Not all mother cries because they postpartum check up
have baby blues. (Husband may be • Work
laid off from work, parent must be o Avoid straining or heavy works at
sick, or her house may have been least the first 3 weeks after birth
damaged etc.) o Advise mother not to return to work
after 3-6 weeks after birth
• Disappointment
• Exercise
o It’s difficult for the parents to feel good
immediately about a child whodoes not o Limit using stairways in going up forthe
first week
meet their expectation
o Continue muscle strengthening
exercises.
• Sexual Activity
o Mother’s lochia returned to alba
o Episiotomy
 POSTPARTUM COMPLICATIONS o Management:
Maintain calm environment
• Postpartum Hemorrhage Stay with the mother
o Blood loss more than 500 ml within24 Inform her of the baby’s
hours after delivery
condition
o Considered the most dangerous
because of the unprotected part left Inform her that she will be
after the placental separation. staying in the DR longer than
the usual time
4 FACTORS OF EARLY HEMORRHAGE If appears hard to repair,
regional anesthesia is be
• Uterine Atony
administered in order to avoid
o Unable to maintain a contracted
condition pain and to relax the uterine
muscle
o Poor uterine tone
o Watch out for signs of uterine • Vaginal Lacerations
bleeding o Rare case
o Observe the pads of the mother (5 o Easier to assess because it is easy to
see
pads soaked within 30 minutes
o Hard to repair because some oozing
compared to 5 pads soaked within 8
often happens after vaginal restoration
hours is completely different)
o Management:
o In measuring the vaginal discharges,get
the weight of the pads before andafter Put vaginal pack to maintain
using by subtracting the difference. pressure on the suture
o Management: Note the time inserted and
Massage the uterus (must be removed packing after 24-48
firm) hours
Apply cold compress Insert foley catheter (packing
Administer oxytocin as per can interfere with urinating)
doctor’s order • Perineal Lacerations
Removal of placental o Occurs when woman in lithotomy
fragment by the physician position due to increase tension inthe
perineal area.
Surgical removal of the uterus
o Episiotomy is to be performed
(last option)
o Management:
Blood transfusion (check the Increase fluid
details carefully) Stool softener may be given
• Lacerations as per doctor’s order
o Small cuts of the birth canal are a
normal consequence. However, large CLASSIFICATIONS OF PERINEAL
cuts can be a problem.
o Locations of lacerations LACERATIONS
Cervical lacerations
o Difficult to repair
o Intense bleeding • 1ST – Vaginal membrane and skin of the
o Hard to view perineum extends to fourchette
o Doctors must have sufficient space • 2nd – Vagina, skin of the perineum, facia, and
o More sponges and sutures materials perineal body
are needed • 3rd – whole perineum, and extends the
o There must be adequate light external sphincter of the rectum
• 4th – whole perineum, rectal sphincter, and
some of the mucous membrane of the rectum
RETAINED PLACENTAL FRAGMENTS ENDOMETRITIS
• Incomplete delivery of placenta • Inflammation of the lining of the Uterus
• Bleeding occurs • Experience abdominal discomforts and
• Check placenta is complete afterpains
• Blood sample may be taken to check for the • Managements:
presence of HCG (check if placental fragments o Ambulation and position fowlers
are still present) (drain out secretions)
• Management; o Get a sample of secretions (culture
from vagina and not from a pad)
o Dilatation and curettage (D&C)
o Increase fluid intake (lower body
o Instruct mother to observe the colorof temp)
her vaginal discharge
o Culture the secretions
DISSEMINATED INTRAVASCULAR COAGULATION o Administer oxytocin and analgesics

• Problems in clotting factor due to vascular INFECTION OF THE PERINEUM

injury
• Laceration repair
SUBINVOLUTION • An opening for bacteria
• Management:
• Partial return of the uterus from its originalsize o Remove the suture and drain
and shape secretions
• Uterus still soft and large even up to the 6th o Apply topical antibiotics
week of postpartum period o Give analgesic
• Vaginal discharges (lochia) still present o Change pads more often
• Management:
PERITONITIS
o Methergine 0.2 mg PO 4 x times a day
as per doctor’s order • Infection of peritoneal cavity
o Educate mother regarding the • Infection starts from lymphatic system or tothe
patterns of lochia fallopian tube
• Can interfere fertility (will leave adhesion and
PERINEAL HEMATOMA
scars)
• Accumulation of blood in the subcutaneous • Management:
layer of tissue of the perineum o Insert NGT (avoid vomiting)
• Injury to blood vessels in the perineum o Intravenous fluid
during delivery o Total parenteral nutrition
• Due to perineal varicosities o Analgesic as pain killer
• Laceration repair
• Pain in the perineum
THROMBOPHLEBITIS
• Purple colored skin and presence of • Inflammation with the formation of blood
inflammation clots
• Management: • Obese are more from thrombophlebitis
o Provide ice compress • Management:
o Give analgesic as per doctor’s order o Walking
o Open the incision site to drain out o Limit time mother remains in stirrups
secretions. (Packed gauze is placed for o Wear support hose for 2 weeks after
24-48 hours instead of re sutured. delivery

POSTPARTUM INFECTION
• Occurs rupture of BOW, pathogens can enter
• Trauma and tissue edema are present
• Management:
o Culture and sensitivity
o Administer antibiotic
FEMORAL THROMBOPHLEBITIS • Management:
o Broad spectrum of antibiotics
• Popliteal veins are involved o Continues breast feeding to empty
• Diminishes arterial circulation to the leg. breast and helps to prevent bacteria
• Sign and Symptoms o Cold compress
o Pain, redness in the affected in leg for o Good supportive bra
10 days after delivery, chills, and o Warm compress to reduce
elevated temperature inflammation
o Skin is stretched
o Positive HOMAN’S SIGN – pain in the URINARY RETENTION
calf of the leg on dorsiflex of the foot
• Result from inadequate bladder emptying
o Doppler ultrasonography to confirm
diagnosis • Bladder edema due to pressure of birth
o Breastfeeding mother can receive • Management:
heparin] o Insert an indwelling catheter
• Management:
URINARY TRACT INFECTION
o Bed rest
o Apple warm compress • Bacteria may be introducing into the bladder
o Administer anti-coagulant during catheterization
o Inspect for bed wrinkle • Sign and Symptoms
o Give good back, buttock, and heel o Frequency of urination
care o Pain in urination
o Do not massage o Hematuria
o Burning sensation while voiding
PULMONARY EMBOLUS o Abdominal pain
• Obstruction of the pulmonary artery by a o Fever
blood clot • Management:
• Sign and Symptoms: o Sulfa drugs (not recommend mother
o Sudden sharp chest pain, tachypnea, can cause jaundice to baby)
cyanosis, tachycardia, and orthopnea o Administer ampicillin
• Management: o Increased fluid intake (flush
o Administer oxygen (emergency infection).
cases)

MASTITIS
• Inflammation of the breast on the 7th day
postpartum day
• Enters cracked nipples
• Use the other unaffected nipple for
breastfeeding
• Comes from the nasal and mouth cavity ofthe
infants
• Untreated can cause localized abscess
• Measures to prevent cracked nipple:
o Wash hands before touching the
breast
o Exposure of nipples to air
o Grasp both the nipple and areola
o Remove grasp on the nipple before
removing the infant from the breast