A nurse is reinforcing discharge instructions with a postpartum client about breastfeeding.
Which of the following statements by the client indicates an understanding of the teaching?

Choice A rationale

This describes the glabellar reflex (or blink reflex), where tapping the bridge of the nose or forehead causes a newborn to blink. However, in newborns, repeated tapping will cause the newborn to continue to blink for the first few taps and then eventually stop or habituate, they do not keep their eyes closed after being tapped.

Choice B rationale

This describes the stepping reflex, where the newborn attempts to 'walk' when held upright with their feet touching a surface. The response described, where the legs flex at the knees and hips when pressure is applied to the soles, is the positive support reflex, which involves extending the legs to bear weight, or the crossed extension reflex, but not the expected finding of a simple application of pressure.

Choice C rationale

Touching the newborn's cheek is meant to elicit the rooting reflex. The expected finding is that the newborn will turn their head toward the stimulus and open their mouth, searching for the breast or bottle. Turning the head away from the stimulus indicates an absent or abnormal rooting reflex.

Choice D rationale

This describes the palmar grasp reflex. When the nurse's finger or an object is placed in the newborn's palm, the newborn's fingers will involuntarily flex and tightly curl around the object. This is an expected and primitive reflex in a term newborn and should be bilaterally symmetrical.

Choice A rationale

This statement is incorrect. While lactational amenorrhea method (LAM) offers some protection, it is only highly effective under strict conditions: amenorrhea, exclusive breastfeeding, and less than six months postpartum. Ovulation can resume even while breastfeeding, so additional contraception is often necessary to prevent unintended pregnancy.

Choice B rationale

There is no scientific evidence to support the claim that taking birth control pills while breastfeeding increases the risk for breast cancer. This statement is false and should not be used to counsel the client. The primary concern with combined estrogen-progestin pills in lactating women is the potential suppression of milk supply.

Choice C rationale

Combined estrogen-progestin birth control pills are generally contraindicated or strongly discouraged during the initial weeks to months of breastfeeding. The estrogen component can decrease the quantity and quality of breast milk, potentially interfering with successful lactation. However, progestin-only pills are considered safe and not contraindicated.

Choice D rationale

Progestin-only birth control pills (the "mini-pill") are the preferred hormonal contraceptive for lactating clients. The absence of estrogen means they are less likely to negatively impact breast milk supply or composition. Progestin-only pills primarily work by thickening cervical mucus and inhibiting ovulation, offering effective contraception while minimizing risks to the breastfeeding infant.