Nurses Promoting Breastfeeding

Lynn Jodoin
Due to the increasing number of young mothers and mothers who work outside the home, many new mothers are choosing to bottle feed rather than breastfeed because of lack of knowledge and the convenience of a bottle. Nurses can promote breastfeeding through education, demonstration and support.
According to Spatz (2004), the Department of Health and Human Services deducted that many Americans were not knowledgeable on the length of breastfeeding nor the negative consequences of not breastfeeding. Dobson & Murtaugh (2001), suggests that infants should be breastfeed only for six months and then for at least twelve months of breast milk and complementary foods. The benefits of breast milk are vast and numerous. Advantages are breast milk is the most optimal for the infant due to its unique composition and the right balance of nutrients and it is easily digested (Dobson & Murtaugh, 2001). The infant also profit immunologically because breast milk decreases the incidence of a variety of diseases such as bacterial meningitis and necrotizing enterocolitis because of the ingestion of the antibodies found in breast milk (Gartner & Eidleman, 2005). The mother also gains from breastfeeding. Maternal benefits according to Dobson & Murtaugh (2001), include amenorrhea while lactating, weight or fat loss, less risks of premenopausal breast and ovarian cancer, higher levels of bone remineralization than prelactation and a more optimal blood glucose level in women with gestational diabetes. There are also economic benefits to breastfeeding such as decreased absenteeism from work, savings in healthcare from the reduced incidents of infant illness and since breast milk is a natural resource, there is a reduction in the purchase of infant formula (Dobson & Murtaugh, 2001). Finally, breast milk can also improve the environment since there is no need of packaging and disposal of packages (Dobson & Murtaugh, 2001).
Many hospitals are aware of the numerous benefits of breast milk and are using that knowledge to promote breastfeeding to new mothers by becoming Baby Friendly Hospitals. A program first initiated by UNICEF and WHO in 1991, provides hospitals with guidelines for a best of practice protocol for breastfeeding (Hunt, 2006). The Baby Friendly Initiative not only has guidelines for the hospital and nurses to follow; it also has suggestions that the mother is encouraged to practice. The recommendations include: having a hospital policy regarding breastfeeding and having it accessible to all health care staff, providing training to nurses and staff to implement the written policy; demonstrating to mothers how to breastfeed and to maintain milk supply even if the mother and infant are unable to room together, the encouragement of breastfeeding on demand and to acknowledge breastfeeding support groups and to refer mothers to them if needed at discharge (Spatz, 2004). Nurses can further their own education by becoming more knowledgeable in the physiology of breastfeeding and also by becoming more skilled in the clinical management of breastfeeding (Gartner, 2005). Many hospitals whose nurses have additional training and certifications in breastfeeding are considered lactation consultants and can be an additional resource to both the nurse and new mother (Frick, 2004). Nurse’s can promote breastfeeding in the hospital by promoting and implementing hospital policies and procedures that encourage breastfeeding (Gartner, 2005). Since new mothers rely on the expertise and support of nurses, nurses have an important role in providing education and support to new mothers about breastfeeding. With continued nursing education and skills, nurses can ensure a successful breastfeeding program.
With the training provided by many Baby Friendly Hospitals, nurses can implement those policies by educating and supporting new mothers to breastfeed. Nurses assume many different roles when promoting breastfeeding. Nurses are educators and supporters of breastfeeding (Frick, 2005). According to Gartner (2005), nurses should enthusiastically promote, support and protect breastfeeding due to the numerous benefits of breastfeeding for the infant and mother. Nurses can educate mothers by various methods such as written material, video and demonstrations. For the education to be effective, Wellberry (2006), suggests that all interventions from counseling and early problem solving, should be face to face because interventions that were not in person or too brief proved to be ineffective. Also any problems encountered should be dealt with at that time when the mother has access to nurses and other resources. Gartner & Eidleman (2005), also suggests that an evaluation of breastfeeding including positioning, latching and milk transfer should be conducted by trained nurses at least twice daily and documented. Along with education, nurses also provide emotional support through positive verbal and nonverbal communication (Spatz, 2004). Nurses not only have a responsibility to promote hospital policies of breastfeeding, educating and supporting new mothers about breastfeeding during their hospital stay but also responsible to provide community resources and referrals should the new mother need any additional help.
With so many new mothers being discharged from the hospital in a relatively short amount of time and perhaps unable to retain the many new information given to them, the mother may benefit from additional education and support given to her outside community resources and support groups. Nurses can provide additional education through the use of her familiarity of local breastfeeding resources such as WIC clinics, lactation educators and consultants and support groups (Gartner, 2005). When utilizing home visits, it is more beneficial when a nurse trained in assessment and management of lactation conducts the visit (Dobson& Murtaugh, 2001).
For various reasons, many new mothers are not choosing to breastfeed or are not breastfeeding for an adequate length of time. To increase awareness of the many benefits of breastfeeding, nurses can educate new mothers about the benefits of breastfeeding, demonstrate many techniques to achieve successful breastfeeding and support the new mother so she may attain a successful and lasting breastfeeding regimen. To promote breastfeeding, many hospitals are undertaking the Baby Friendly Initiatives such as having policies regarding breastfeeding and providing educations and training regarding breastfeeding practices to nurses. Many hospitals are now utilizing lactation consultants who are nurses with additional training and certifications in breastfeeding. These practices and nurses are an important resource for new mothers who need support and education about the benefits of breastfeeding. New mothers may be overwhelmed from childbirth to retain any information given by nurses and hospital personnel. To help retain information, nurses can provide written materials, videos and other take home education materials so that the mother can read or watch later after she is settled at home. Nurses can demonstrate various positions and latching techniques and have the mother return demonstrate all the while providing positive support and encouragement. Due to the relative short hospital stays that are common to new mothers, it is important to offer community resources and support groups so that the mother can receive continuing education, guidance and support to continue her success with breastfeeding.

Intervention 1: During the hospital stay, it is a crucial time for the nurse and new mother to develop and implement the importance of successful breastfeeding techniques.

Disadvantage 1: Dobson & Murtaugh, 2001, states that many new mothers seek the advice of nurses so it is crucial that the nurses be knowledgeable about breastfeeding. Nurses can negatively impact breastfeeding behaviors due to the lack of knowledge and inaccurate or inconsistent advice given to new mothers (Mann, et al, 2003). According to Dobson & Murtaugh, 2001, many nurses are willing to support breastfeeding, but many nurses are not adequately trained in breastfeeding, such as being able to recognize problems and the interventions to alleviate the problems. Mann, et al, 2003, states that nurses contribute to ineffective breastfeeding by providing misinformation, lack of prenatal breastfeeding education, inconsistent hospital policies, interrupting the mother and baby during feeding and by promoting and distributing formula at discharge.

Disadvantage 2: The result of inadequate training of nurses on breastfeeding can result in the promotion of using human milk substitutes when a problem with breastfeeding happens (Dobson & Murtaugh, 2001). Many new mothers are told to exclusively breastfeed their infants for the first six months, but this left many new mothers feeling frustrated and panicked that the infant was not getting enough to eat so the mother quits nursing before the recommended six months (Kam, 2006). According to Cropley & Herwehe, 2002, institutions that distribute formula can negatively affect breastfeeding. Many low-income mothers choose formula to breast milk due to personal beliefs such as thinking that breastfeeding is painful, the convenience of formula, a lack of professional and social support and the need to return to work soon (Mann & et al, 2003). According to Mann, et al, 2003, many women who receive advice and assistance from WIC were less likely to breastfeed and more likely to use formula.

Intervention 2: Nurses can promote breastfeeding by being supportive to new mothers. Nurses can also refer unsure mothers to local community resources and support groups to help further success with breastfeeding.

Disadvantage 1: According to Cropley & Herwehe, 2002, breastfeeding rates can be related to demographic factors. The factors include the age of the mother, the education level of the mother, family type and income and the working status (Dubois & Girard, 2003). Mothers who were less likely to breastfeed have been identified as being African-American or Hispanic, aged 25 years or less, average income of less than $10,000 a year, having a grade school education, being a mother for the first time, live in the region of the South Atlantic, have low birth weight babies, are employed full time, enrolled in WIC, have negative attitudes about breastfeeding and have little confidence in their ability to breastfeed (Mann, et al, 2003). In today’s society, breastfeeding is not a cultural norm. According to Kam, 2006, 57% of Americans frown upon seeing mothers’ breastfeed in public. A baby being bottle fed in public is more readily acceptable than seeing a baby being breast fed (Hunt, 2006). A lack of support from family and peers or partners, beliefs and expectations and an absence of peer role models are all barriers to successful breastfeeding practices (Cropley & Herwehe, 2002). Kam, 2006, states that a new mother’s energy and morale is quickly vanquished if she does not feel supported.

Disadvantage 2: Many mothers have difficulty with trying to maintain breastfeeding while working outside the home. 90% of mothers who work outside the home quit breastfeeding before the recommended six months (Kam, 2006). Many low-income jobs do not offer the time or the privacy for mothers to pump at work (Hurst, 2007). In many places, employers are not required to accommodate new mothers with an area of privacy to pump (Kam, 2006). According to Johnson, 2006, a survey conducted by the Society for Human Resource Management concluded that 23% of the companies in the United States offer new mothers a lactation program or an area to breastfeed. Inflexible work hours, lack of breastfeeding or time to pump make it difficult for the mother to maintain a good supply of milk (Dobson & Murtaugh, 2001).



References

Cropley, Lorelei & Herwehe, Jane Casey. “Evolution of institutional support for breastfeeding among low-income women in the metropolitan New Orleans area.” American Dietetic Association. Journal of the American Dietetic Association. 102 (1) (Jan 2002). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Dobson, Brenda & Murtaugh, Maureen. “Position of the American Dietetic Association: Breaking the barriers to breastfeeding.” American Dietetic Association. Journal of the American Dietetic Association. 101(10) (Oct 2001). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 24 May 2006.
Dubois, Lise & Girard, Manon. “Social determinants of initiation, duration and exclusivity of breastfeeding at the population level; The Results of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998-2002).” Canadian Journal of Public Health. 94(4) (Jul/Aug 2003). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Frick, Kevin D., Milligan, Renee A., White, Kathleen M., Serwint, Janet R., & Pugh, Linda C., “Nurse-supported breastfeeding promotion: a framework for economic evaluation.” Nursing Economics. 23.4 (July-August 2005): 165(9). Expanded Academic ASAP. Thomson Gale. Tacoma Community College. 22 Apr. 2007.
Gartner, Lawrence M. & Eidleman, Arthur I. “Breastfeeding and the use of human milk.” (policy statement). Pediatrics (Feb 2005): v115 p496(11). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 22 Apr. 2006.
Hunt, Felicity. “Breastfeeding & Society. (policy).” Pediatric Nursing. 18.8 (Oct. 2006): 24(3). Expanded Academic ASAP. Thomson Gale. Tacoma Community College. 22 Apr. 2007.
Hurst, Carol Grace. “Addressing Breastfeeding Disparities in Social Work.” Health & Social Work. 32(3). (Aug 2007). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Johnson, Heather Moors. “Working and Breastfeeding.” Working Mother. 29(6). (Jul/Aug 2006). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Kam, Katherine. “Why Don’t Women Nurse Longer?”. Baby Talk. 71(6) (Aug 2006). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Mann, Angela R., Reifsnider, Elizabeth, Gill, Sara L., & Ritsema, Melanie. “Health Disparities in Breastfeeding Among Low-Income and Hispanic Women.” Journal of Multicultural Nursing Health. 9 (3) (2003). Expanded Academic ASAP. Thompson Gale. Tacoma Community College. 27 Oct 2007.
Spatz, Diane Z. “Ten Steps for promoting and protecting breastfeeding for vulnerable infants.” Journal of Perinatal & Neonatal Nursing. 18.4 (Oct.-Dec. 2004): 385(12). Expanded Academic ASAP. Thomson Gale. Tacoma Community College. 22 Apr. 2006.
Wellbery, Caroline. “Intervention to increase breastfeeding rates.” American Family Physician. 73.11 (June 1, 2006): 2047. Expanded Academic ASAP. Thomson Gale. Tacoma Community College. 22 Apr. 2007.