Table 4.

Framework for delivery of postpartum breastfeeding support for primiparous women.

Postpartum timing	Common problems/concerns	Potential considerations for counseling and assistance
First few days	Latching	Evaluation and management of infant and maternal anatomical issues with potential to impact latch Hands-on or observed assistance and return demonstration Review of indications of good latch
Weeks 1–3	Fatigue Engorgement	Anticipatory guidance regarding expectations for onset and improvement/resolution Reassurance of temporary nature If needed, evidence-based management solutions for engorgement
Weeks 4–5	Infant gastrointestinal discomfort	Origin of most gastrointestinal discomfort in infants and relationship to various feeding methods Plan for observation/management if indicated
Weeks 6–8	Unpredictable breastfeeding frequency Breastfeeding upon return to work	Discussion of normalcy and benefits of continued “on-demand” breastfeeding (Baby-Friendly USA, Inc., 2016) Setting reasonable expectations of when greater breastfeeding predictability might be achieved Potential work-arounds for mothers unable to accommodate on-demand breastfeeding Discussion of options/brainstorming solutions for breastfeeding maintenance upon mother’s return to work, considering mother’s breastfeeding goals and workplace constraints
Ongoing	Milk expression/pumping Pain Perception of inadequate milk	Indications for milk expression/pumping Proper use of electric breast pumps Safe storage and use of expressed milk Potential origins of breast/nipple pain Criteria for seeking assistance for pain and available resources Anticipatory guidance regarding timing of lactogenesis stage II, milk regulation, and infant growth spurts Reassurance and evaluation regarding signs of adequate milk transfer and infant satiety