Case 1.

Learning objectives  

1. Obtain a focused history relevant to the presenting concerns (eg. medical, surgical, family, social, pregnancy, peripartum, breastfeeding)
2. Obtain a focused medical history of a neonate whose mother has delayed lactogenesis II
3. Perform a focused breast examination for a lactating patient presenting with breast engorgement (Note: the standardized patient will be wearing a realistic breast model)
4. Teach a lactating patient appropriate breast massage techniques to resolve breast engorgement
5. Teach a lactating patient how to hand express her breast milk
6. Communicate a management plan to lactating patient with breast engorgement caused by lactogenesis II

Topics: clinical lactation, pediatrics, breast pump use, out-patient setting, telehealth, urgent and emergency care

Case 2.

Learning objectives  

1. Obtain a pregnancy, peripartum, and breastfeeding history of a lactating patient presenting with bloody nipple discharge
2. Obtain a focused medical history of a neonate whose mother has bloody nipple discharge
3. Perform a breast assessment
4. Instruct the patient to elicit discharge from the nipple
5. Create a management plan based on the history and physical assessment
6. Communicate the management plan to the patient

Topics: clinical lactation, breast surgery, exclusive pumping, out-patient setting, telehealth

Case 3. 

Learning objectives  

1. Obtain a pregnancy, peripartum, and breastfeeding history from the patient
2. Obtain the infant’s medical history from the patient
3. Communicate the potential negative health consequences of breast milk oversupply to the patient
4. Communicate a concise management strategy for breast milk oversupply
5. Screen the patient for clinical signs of maternal perinatal mood and anxiety disorder
6. Provide recommendations for a breastfeeding patient with perinatal mood and anxiety disorder

Topics: clinical lactation, maternal mental health, breast pump use, NICU, out-patient setting, telehealth

Case 4. 

Learning objectives  

1. Counsel a lactating patient regarding expectations of breast milk provision to a hospitalized infant born preterm
2. Teach a lactating patient how to hand express colostrum
3. Teach a lactating patient how to use a double-electric breast pump (multi- or single-user) and a “hands-free” breast pump (either a Willow or Elvie)
4. Teach a lactating patient effective and “hands-on” pumping techniques
   Propose solutions for breast pump-induced trauma to the nipple-areolar complex
5. Teach a lactating patient how to store expressed breast milk

Topics: clinical lactation, pediatrics, exclusive pumping, hospital-based care, NICU

Case 5. 

Learning Objectives:

Learning Objectives for Scenario 1 (First 15 minutes)

1. List the neonatal and maternal health complications associated with suboptimal breastfeeding.
2. Explain how much it costs to train hospital staff in clinical lactation.
3. Elaborate how hospital staff training in clinical lactation will improve patient safety and care.
4. Describe what the return on investment for the hospital would be if hospital staff were trained in clinical lactation

Learning Objectives for Scenario 2 (Last 15 minutes)

1. Describe federal laws and regulations that employers must follow when a lactating mother returns to work.
2. List why employee lactation support would affect employee satisfaction and employee turnover.
3. Outline how to implement accessible lactation spaces throughout the hospital for hospital staff use.
4. Explain why supporting hospital staff with their lactation needs will translate to better patient care.

Topics: clinical lactation, hospital-based care, public health and policy

Case 6.

Learning Objectives:

1. Obtain a comprehensive maternal history
2. Describe normal infant behavior and development during the first week of life
3. Recognize maternal risk factors for low milk production
4. Provide education regarding the clinical changes associated with lactogenesis II
5. Teach the patient how to relieve breast engorgement
6. Employ shared decision-making strategies for inclusive breast milk feeding

Topics: clinical lactation, breast surgery, breast health, pediatrics,  in-patient setting

Case 7.

Learning Objectives:

1. Obtain a comprehensive history of the lactating patient and her infant 
2. Perform a breast assessment
3. Describe normal sleep patterns for infants between 0 and 6 months of age
4. Describe conservative management strategies for inflammatory mastitis
5. List clinical signs associated with infectious mastitis 
6. Describe when it is necessary to avoid breastfeeding or to “pump and dump” following medication, recreational drug, tobacco, and alcohol use
7. Propose a management and follow up plan

Topics: clinical lactation, pediatrics, in-patient setting, urgent and emergency care

Case 8.

Learning Objectives:

1. Obtain a comprehensive history of the pregnant patient
2. Describe characteristics of benign and malignant lesions on the nipple-areolar complex that present during the peripartum period
3. Discuss a follow up plan for a rapidly enlarging lesion on the nipple of a pregnant patient
4. Provide anticipatory guidance regarding breastfeeding and lactation for a pregnant patient 
5. Practice building a trusting patient-provider relationship that ensures the pregnant patient will seek continued care from you

Topics: clinical lactation, breast/chest surgery, health, and cancer, breast pump use/exclusive pumping, maternal mental health, out-patient/ambulatory/clinic setting, pregnancy/prenatal, telehealth

Case 9.

Learning Objectives:

1. Obtain a comprehensive history of the lactating patient and her infant
2. Describe a safe weaning plan for a lactating patient who is exclusively pumping
3. Counsel a lactating, heterosexual female person about options for improving physical intimacy with her male partner
4. Provide a management plan for dyspareunia secondary to hypoestrogenism of lactation

Topics: clinical lactation, breast pump use/exclusive pumping, telehealth

Case 10.

Learning Objectives:

1. Obtain a comprehensive history of the lactating patient and her infant
2. Identify risk factors for contact dermatitis on the nipple-areolar complex
3. Propose a management strategy for contact dermatitis on the nipple-areolar complex
4. Identify risk factors for low milk production
5. Describe strategies for increasing milk production

Topics: clinical lactation, breast pump use/exclusive pumping, out-patient, telehealth

Learning Objectives:

1. Obtain a comprehensive history of the lactating patient and her infant
2. Recognize ineffective newborn positioning and attachment while observing a breast feed
3. Teach a lactating patient how to position a newborn in a cross-cradle hold
4. Teach a lactating patient how to differentiate between a deep and shallow latch while in a cross-cradle
5. Provide a breastfeeding plan to the lactating patient

Topics: clinical lactation, NICU, pediatrics, hospital-based care, out-patient, telehealth