A woman gave birth 48 hours ago to a healthy infant girl.

She has decided to bottle-feed.

During your assessment, you notice that both of her breasts are swollen, warm, and tender on palpation.

The woman should be advised that this condition can best be treated by:

The use of oil of peppermint has been shown in some studies to have an antispasmodic effect on the smooth muscles of the urethra, potentially relaxing the external sphincter and promoting spontaneous urination. The aromatic compounds can also stimulate the parasympathetic nervous system. However, its efficacy is not universally guaranteed.

Choice B rationale

Inserting a sterile catheter is the most invasive but a highly effective last resort intervention when a woman is unable to urinate spontaneously and has a full bladder post-delivery. A full bladder can displace the uterus and prevent proper uterine contractions, increasing the risk of postpartum hemorrhage. Catheterization is a direct method to relieve bladder distension and its associated complications.

Choice C rationale

Analgesics are primarily used for pain relief and do not directly address the mechanical or neurological issues causing urinary retention. While pain can contribute to difficulty urinating, prescribing analgesics is an indirect approach and is not the most effective or immediate solution for an over-filled bladder causing uterine atony.

Choice D rationale

Pouring water over the perineum can be an effective non-invasive technique to stimulate the micturition reflex. The sensation of the water on the external genitalia triggers a parasympathetic response, which can lead to relaxation of the urethral sphincter and promote the urge to void. This is a common nursing intervention used before more invasive measures.

Choice A rationale

This statement is factually incorrect. Prolactin is the hormone primarily responsible for milk production (lactogenesis), not abdominal pain or uterine cramping. While prolactin levels do rise in response to breastfeeding, its main role is to stimulate the mammary glands to produce milk. Oxytocin, not prolactin, is the hormone that causes uterine contractions. The abdominal cramps are a direct result of the uterus contracting, not the release of prolactin.

Choice B rationale

While some women may experience discomfort during breastfeeding, the sensation of abdominal cramping is not due to the process of milk production itself. The production of milk in the mammary glands is a hormonal process mediated by prolactin and does not cause uterine cramping. The cramps a new mother feels while breastfeeding are a separate physiological response, caused by a different hormone, and are a normal part of the postpartum recovery process.

Choice C rationale

The correct explanation is that when an infant suckles at the breast, it stimulates nerve endings in the nipple, which sends a signal to the mother's brain. The hypothalamus then signals the posterior pituitary gland to release the hormone oxytocin. Oxytocin causes the myoepithelial cells around the milk ducts to contract, leading to the milk ejection reflex. Concurrently, oxytocin also acts on the uterine muscles, causing them to contract. These uterine contractions are what a new mother feels as abdominal cramps, which help the uterus return to its pre-pregnancy size.

Choice D rationale

While the position of the baby can affect the mother's comfort, it is not the cause of the internal abdominal cramping. The cramps are an involuntary physiological response to the release of oxytocin, a hormone triggered by the baby's suckling. The baby's weight or position on the mother's abdomen does not directly cause the uterine muscle contractions responsible for the cramps. The cramping sensation is a result of the hormonal action within the body, not external pressure.