Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (choose all that apply):

Choice A rationale

Voiding clear, pale urine three times in 12 hours is an appropriate sign of adequate fluid intake and renal function in a newborn. The normal range for voids in the first 24 hours is often at least one, and by day three, six to eight voids are expected. This output does not prevent early discharge as it suggests proper hydration and patent urinary tracts.

Choice B rationale

A birth weight of 3000 g is within the average range for a term newborn (typically 2500 to 4000 g). Weight alone, if within normal limits and stable, is not a factor that would delay discharge. Significant weight loss (over 10% of birth weight) or a weight below 2500 g is more concerning.

Choice C rationale

Significant difficulty with latching and sucking during two initial breastfeeding attempts could indicate problems with the infant's feeding readiness, coordination of suck-swallow-breathe reflex, or maternal technique. Establishing effective feeding is a key criterion for early discharge to ensure adequate caloric intake and prevent hypoglycemia or dehydration.

Choice D rationale

Passing one meconium stool within the first 12 hours of life is a normal and expected finding, indicating a patent anus and gastrointestinal tract function. Meconium passage typically occurs within the first 24 to 48 hours, and this finding is reassuring for discharge. —.

Choice A rationale

Breastfeeding promotes maternal bone health. During lactation, there is a temporary decrease in bone mineral density (BMD), but following cessation of breastfeeding, there is a rapid and substantial recovery, often resulting in an increased lifetime BMD. This protective mechanism contributes to a reduced long-term risk of post-menopausal osteoporosis.

Choice B rationale

Extensive epidemiological research demonstrates that women who breastfeed, especially for longer cumulative durations, have a statistically significant decreased risk of developing certain cancers, most notably breast cancer and ovarian cancer. The mechanism may relate to hormonal changes, such as reduced lifetime exposure to high estrogen levels during lactation.

Choice C rationale

Lactational amenorrhea method (LAM) is an effective form of birth control only when all three conditions are met: the mother is amenorrheic (no period since birth), the infant is exclusively or nearly exclusively breastfed, and the baby is less than 6 months old. It is not reliable for up to 12 months.

Choice D rationale

Breastfeeding requires significant maternal energy expenditure, using about 500-700 extra calories per day for milk production. This metabolic demand enhances the mobilization of adipose tissue stores accumulated during pregnancy, thus facilitating a more rapid and effective return to pre-pregnancy weight compared to non-lactating mothers. —.