Overwhelming evidence shows that breastfeeding has profound effects on a baby’s immune system, overall development and intelligence however “Baby Friendly Hospitals” with trained maternal nurses and educated parents are two important factors that contribute to a successful breastfeeding experience.
Breastfeeding dates back to ancient civilizations and review of anthropological literature estimates an average nursing duration of 3-7 years in some cultures such as Eskimos and Africans. Scientific evidence is well established, breastfeeding offers overwhelming benefits for mothers and babies. La Leche League International (2006) notes that "Breastfeeding has been shown to be protective against many illnesses, including painful ear infections, upper and lower respiratory ailments, allergies, intestinal disorders, colds, viruses, staph, strep and e coli infections, diabetes, juvenile rheumatoid arthritis, many childhood cancers, meningitis, pneumonia, urinary tract infections, salmonella, Sudden Infant Death Syndrome(SIDS) as well as lifetime protection from Crohn's Disease, ulcerative colitis, some lymphomas, insulin dependent diabetes, and for girls, breast and ovarian cancer. (p. 1)
A mother’s decision to breastfeed is influenced by a variety of social and cultural factors such as education, finances, religion, family values and personal preference just to name a few. Feeg (2001) identifies that "Economic and cultural reasons contribute to a mother’s decision not breastfeed and states that many ethnic minorities are of low socio-economic status. It is important to note that many ethnic minorities more often choose to bottle-feed than to breastfeed. While this is partly caused by their busy lives, it also can be due to cultural beliefs, particularly among immigrants from developing countries. In many developing countries, the ability to bottle-feed is a financial status symbol because it is so expensive. In Mali, for example, a can of formula can cost the equivalent of $2 while the average individual earns only $200 a year. Their idea of it as a status symbol is sometimes carried over to their lives in the US." (p. 5)
While it is important for health professionals to respect a mother’s choice, they also have the responsibility to encourage and properly educate parents on the importance and benefits of breastfeeding. Education is the one variable that healthcare professionals can deliver to the diverse population that may influence their decision to breastfeed. Unfortunately, sometimes that does not happen because the healthcare personnel have not been given the appropriate training. According to Spatz (2005) "Health care providers' lack of knowledge, training, and education pertaining to breastfeeding has been well documented. Eden, Mir, and Srinivasan surveyed program directors of every accredited pediatric residency program in the United States and found that 45% of respondents rated the quality of their own breastfeeding education as mediocre or below, and 43% rated their current program as inadequate or in need of improvement." (p. 1)
The CDC (2003) recognizes that a review by the US Preventive Services Task Force in July 2003 determined education on breastfeeding to by the most effective single intervention for increasing breastfeeding initiation and short term duration.” (p.1) According to Clauss & Hall-Harris (1999) "Minimum training content for a new mom should include the assessment of a correct latch and sucking of the infant, management of sore nipples, how to identify mastitis, and how to express and store breast milk." (p 162) Nurses should also provide prenatal counseling and follow-up support programs help facilitate the continued success of new mothers who initiated breastfeeding at delivery.
The World Heath Organization launched an initiative called The Baby Friendly Hospital Initiative (which will be referred to as BFHI) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation. (Anonymous 2006) writes, “The BFHI assists hospitals in giving breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so.” (p. 12) There are very specific guidelines that a hospital or a birthing center must follow to be a Baby Friendly Hospital. One of the criteria is to provide a minimum of 18 hours of training to the nursing staff with the primary responsibility for helping mothers initiate breastfeeding. Nurses should advocate for their facility to become a “Baby Friendly Hospital” so that they are able to reap the benefits of the required training.
In conclusion, nurses should advocate for their facility to become a Baby Friendly environment and increase their knowledge and skills with the goal of delivering quality prenatal counseling and postpartum breastfeeding education to new parents. Nurses that have been trained to properly educate, encourage and support new mothers directly impact the number of women who have successful breastfeeding experience.
References
Anonymous (2006)
Baby-friendly hospitals, Pediatrics for Parents, (22) 4, 12 http://proquest.umi.com/pqdweb?did=992461311&Fmt=3&clientId=3236&RQT=309&VName=PQD
Clauss, J. Hall-Harris, E. (1999)
Development of a breastfeeding support program, Pediatric Nursing, (25) 2, 161-166http://proquest.umi.com/pqdweb?did=41081147&Fmt=4&clientId=3236&RQT=309&VName=PQD
CDC (2003)
The CDC guide to breastfeeding interventions, Educating Mothers. Retrieved May 1, 2007 from http://www.cdc.gov/breastfeeding/pdf/BF_guide_4.pdf
Feeg, V. (Feb 2001)
Assisting new mothers with infant feeding when breastfeeding is not an option Pediatric Nursing, (27) 1, 47-60 http://proquest.umi.com/pqdweb?did=71037316&Fmt=4&clientId=3236&RQT=309&VName=PQD
La Leche League International (July 2006)
Can breastfeeding prevent illnesses, retrieved on May 1st 2007 from http://www.lalecheleague.org/FAQ/prevention.html
Spatz, D.L. (Sep 2005)
The Breastfeeding Case Study: A Model for Educating Nursing Students
Journal of Nursing Education, (44) 9, 432-434
http://proquest.umi.com/pqdweb?did=891458911&Fmt=4&clientId=3236&RQT=309&VName=PQD
Disadvantages to Interventions for Breastfeeding Education
Breastfeeding should be a livable, comfortable, well-informed option for women. Supporting breastfeeding is not a complicated endeavor. It focuses on educating the parents, reiterating support and addressing the barriers that parents face in the early stages of breastfeeding. When lactation consultants are available at birth and parents are present at follow-up visits to communicate with family care providers, success rates rise. Even with all of this available, there are many reasons why breastfeeding may be an unlivable, unsafe, or difficult choice for women, and especially for socially vulnerable women.
a. Intervention 1: Educate the parents about breastfeeding
i. Disadvantage 1: Social attitudes toward the female breast and emotional factors that the mother must consider
There is no disadvantage to educating the parents about breast-feeding, however even the best education in some circumstances can not persuade a mother to breastfeed.
There are many practical reasons (e.g., inconvenience, lack of suitable facilities outside of the home, conflicts at work) why American mothers choose to avoid or limit breastfeeding, but practical concerns are certainly not the only factors. "In Western societies, particularly in the United States, the social and sexual significance of the female breast rivals, if not exceeds its biological significance. As a consequence, the decision to breastfeed, particularly if it exposes the breast and the woman to public scrutiny, involves a complex decision matrix in which social and emotional factors play prominent roles. Although the waxing and waning of social and medical support for breastfeeding has often been justified in terms of its purported medical hazards or benefits, Fildes' comprehensive survey of nursing practices provides many illustrations of how attitudes toward nudity, acceptance of biological urges, and the Western sexualization of the female breast have been far more influential than nutritional concerns." (Forbes 2003)
Even when the parents know and understand that “Breast is best” our society’s attitude along with the mother’s feelings toward breastfeeding in public can render negative feelings about the whole breastfeeding process.
ii. Disadvantage 2: Unsafe breastfeeding conditions, even in one’s own home
"Breastfeeding opens women to be offended, sexualized, and even violent and punitive gazes. Especially within some ethnic subgroups, women who breastfeed at home in front of other family members, including their babies' fathers, risk strong disapproval and even domestic violence. Indeed, many women, especially poor women and women from ethnic groups that tend to live in more communal and crowded spaces, have literally no safe space in which to breastfeed. These are also the very same women who tend to be more vulnerable to sexual abuse and to charges of inappropriate sexual display, and hence may face intensified risks and more complex codes of privacy when breastfeeding. The problem is that while most low-income and minority mothers have domiciles, they do not necessarily have access to domestic spaces. Their home space is less likely to be neatly separated from their work space and from public gathering space, and it is unlikely to be structured by a sentimentalist domestic aesthetic. This means that by the authoritative norms of our culture, particularly those women whose low breastfeeding rates are of such public concern-literally have no socially appropriate, safe space in which to breastfeed." (Kukla 2006)
Without a safe space to nurse a newborn it’s unlikely that the mother will choose to breastfeed, especially if breastfeeding could trigger violence.
b. Intervention 2: Prenatal Counseling and Follow up support programs
i. Disadvantage 1: Scary stories about painful experiences that influence decision making
Prenatal counseling and follow up support from healthcare professionals are two variables that help a new mother make the decision to breastfeed. "Prenatal counseling includes learning about the maternal and infant benefits of breastfeeding, but the stories that circulate outside of the clinic include influential factors such as pain that may be scary to a new mother.
Although most women interviewed did not actually know anyone who had breastfed, beliefs or anticipation about the pain involved in breastfeeding was common, including stories about cracked and bleeding nipples or pain related to breast engorgement. Most women who talked about the pain of breastfeeding believed it was inevitable, and many thought that it would last until they weaned their infant. Pain is involved here, I know, so it's a state of mind a person is just going to have to adjust to. What I've heard, it takes about three months to get over it, but you do get used to it. (18 yr old pregnant woman)" (Bentley et al 2003)
ii. Disadvantage 2: Formula, intensely marketed
Regardless of whether or not a mother has decided to breastfeed she is sent home with free samples of formula when she is discharged. Prenatal and follow up education includes information on supplementing with formula, which certainly lets the mother explore the convenient option.
"In a culture where infant formula is intensively marketed and the federal nutrition support program Women, Infants, and Children (WIC) provides free formula, it may be too easy to give up on breastfeeding."(Hurst 2007)
No woman should be pressured to breastfeed. It is a very individual decision based on many different factors such as culture, religion, income, career, time, knowledge, home environment… and the list goes on.
References
Bentley, M.E., & Dee, D.L., & Jensen, J.L.(2003).
Breastfeeding among low income, African-American women: Power, beliefs and decision making, The Journal of Nutrition (133) 1, 305-310 http://proquest.umi.com/pqdweb?did=281514141&sid=2&Fmt=4&clientId=3236&RQT=309&VName=PQD
Forbes, G.B., & Adams-Curtis, Leah, E., & Hamm, N.R., & White, K.B (2003)
Perceptions of the woman who breastfeeds: The role of erotophobia, sexism, and attitudinal variables, Sex Roles, (49) 7/8. 379-388
http://proquest.umi.com/pqdweb?did=530922831&Fmt=3&clientId=3236&RQT=309&VName=PQD
Hurst, C.G. (2007)
Addressing breastfeeding disparities in social work, Health and Social Work, (32) 3, 207-210 http://proquest.umi.com/pqdweb?did=1327667611&Fmt=3&clientId=3236&RQT=309&VName=PQD
Kukla, R. (2006)
Ethics and ideology in breastfeeding advocacy campaigns, Hypatia, (21) 1, 157-180http://proquest.umi.com/pqdweb?did=971368921&Fmt=4&clientId=3236&RQT=309&VName=PQD
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