Wednesday, February 27, 2008

Nurses and Breastfeeding

The American Dietetic Association [ADA] (2005) recommends that all infants be breastfed for the first 12 months of life with the addition of complimentary foods after 6 months of age (Spear, 2005). Yet in the United States, the percent of infants being breastfed for the first 12 months is only 17% to 20%. (ADA, 2005).

Nurses are often the people entrusted to provide lactation education and support to new mothers. Despite this, lactation education can be and often is lacking. More thorough breastfeeding education in nursing schools can help to better equip nurses for providing effective breastfeeding counsel and support (Spear, 2005). Nurses employed in hospitals should advocate for the development of a hospital wide policy regarding breastfeeding (Wallis & Harper, 2007). In addition, nurses involved in caring for new mothers should receive continual training on breastfeeding counseling and lactation through continuing education coursework, clinical experiences and in-service training (US Department of Health and Human Services [USDHHS], 2000). When these strategies are implemented, the nurse, as a client educator, will be effective in increasing exclusivity and duration of breastfeeding, thereby promoting wellness in both mother and infant.

Breastfeeding provides many benefits to both mother and child. Maternal benefits can include reduced postpartum bleeding, decreased uterine involution time, improved bone density and reduced risk of breast and ovarian cancer. Some of the numerous benefits for the child are protection against infectious and non-infectious diseases, decreased risk of childhood obesity, reduced risk for heart disease, enhanced immune system, and decreased risk of diarrhea and respiratory infections (ADA, 2005). Breastfeeding also offers an economic way to provide optimal nutrition to the baby (ADA, 2005). Notwithstanding, there are many barriers to breastfeeding among all populations. Many women do not breastfeed because they lack a full understanding of its benefits. Others refrain because of embarrassment and social disapproval, especially when it comes to breastfeeding in public. Some feel that breastfeeding will make them less attractive, and others feel they cannot breastfeed due to work or school responsibilities (ADA, 2005).

A nurse who has been prepared can help a woman overcome these barriers with information, resources and counsel on breastfeeding. Unfortunately, many nurses do not have the education necessary to be able to educate others on breastfeeding. This is evidenced by a survey done on students who had successfully completed their obstetric nursing courses. Only 22% of surveyed students knew that breast milk has antibacterial properties, 85% did not know that breastfeeding is recommended for the first year of life. Forty-one percent thought that formula and breast milk were nutritionally equivalent (Spear, 2005). In order to correct this educational deficit, students interested in working in obstetrics or pediatrics can be offered breastfeeding and human lactation seminars. These seminars can help students learn to identify and overcome barriers to breastfeeding. Possible seminar supplements include a maternal breastfeeding panel to help students see the mother’s perspective on breastfeeding initiation, and participating in clinical experiences with lactation specialists (Spatz, 2005).

After thorough education on lactation in nursing school, a nurse in the hospital setting can continue to improve breastfeeding success rates by advocating for the development of an effective hospital policy on breastfeeding. All staff should be aware of and follow this breastfeeding policy (Wallis & Harper, 2007). Appropriate policies should address a number of topics including, staff training in the skills needed to implement the policy, early initiation of breastfeeding, education of pregnant women about the benefits of breastfeeding, education of mothers on how to breastfeed and maintain lactation, limited use of any food or drink other than human breast milk, rooming-in, breastfeeding on demand, limited use of pacifiers and artificial nipples, and fostering of breastfeeding support groups and services (USDHHS, 2000).

Once a breastfeeding policy is in place, all involved staff members should receive the necessary training to enable them to follow that policy. Many nurses on staff in maternal and newborn units lack experience, and therefore confidence, in helping a new mother breastfeed. This anxiety can inadvertently be communicated to the mother and be detrimental to the breastfeeding process (Wallis & Harper 2007). One option for this training is through the requirement of continuing education coursework on human lactation and breastfeeding (USDHHS, 2000). Wallis and Harper (2007) reference a hospital that holds three breastfeeding workshops a year; which all employees are encouraged to attend. These workshops focus on practical management of breastfeeding, advantages of breastfeeding, and initiating and maintaining lactation. In addition, a new mother always attends to share her experience with breastfeeding. New staff should receive immediate training on breastfeeding and human lactation as well as on the hospital breastfeeding policy (Wallis & Harper, 2007). This will allow for hospital staff to provide continuity of care to the woman and child.

Breastfeeding is not “popular” in the United States. The nurse, as a client educator, can increase exclusivity and duration of breastfeeding, thus reversing this trend. This will result in improved wellness in both mothers and infants. When nurses receive adequate education on lactation in nursing schools, help develop hospital policy on breastfeeding, and participate in continuous on-the-job training to improve their skill and knowledge in helping women breastfeed, they become more effective at their role in helping mothers initiate and maintain breastfeeding.


a. Intervention 1 -More thorough breastfeeding education in nursing schools.


i. Disadvantage 1 - Offering extra classes will not provide enough education to change the current trends.
Providing extra courses and seminars for those students who plan on going into fields that involve mother and baby will be beneficial to these particular students, if they choose to take them. However, many nurses do not have a specific are of nursing in mind while still in school, but later on will switch to maternal and newborn nursing. Breastfeeding information and training must become a larger part of basic nursing curricula (Spear, 2005). This will help to provide all nurses with the skills and current information to provide support to the breastfeeding mother. If the general nurse is prepared to support mothers in breastfeeding, outcomes for exclusivity and duration will likely improve.

Spear, H. J., (2005). Baccalaureate nursing students’ breastfeeding knowledge: A descriptive survey. Nurse Education Today, 26, 332-337. Retrieved January 3, 2007 from Expanded Academic ASAP database.


ii. Disadvantage 2 - Incorporating more breastfeeding education into the basic curricula will be ineffective with the current general nursing textbooks.
Nursing students have several textbooks that might contain information on breastfeeding such as a maternal and child or nursing fundamentals textbook. Trying to improve students’ knowledge of breastfeeding best practices could be very ineffective with these texts. Phillipp, McMahon, Davies, Santos and Jean-Marie (2007) discovered upon analyzing the breastfeeding information in six maternal newborn nursing textbooks, that many textbooks are deficient in the area of breastfeeding. All of the books that were reviewed had important breastfeeding information that was inaccurate, inconsistent, or omitted. In order for incorporating breastfeeding education in to the basic curricula to be effective, new textbooks with accurate and complete information will need to be used.

Phillipp, B.L., McMahon, M.J., Davies, S., Santos, T., & Jean-Marie, S. (2007). Breastfeeding information in nursing textbooks needs improvement. Journal of Human Lactation, 23(4), 345-349.


b. Intervention 2 –Nurses in hospitals should advocate for a hospital-wide breastfeeding policy.


i. Disadvantage 1 –A policy to give no other food and drinks to newborns besides human milk unless medically necessary is discriminatory.
Contemporary evidence has shown that initiating breastfeeding within the first hour of birth is beneficial to both mother and child. The first days of life for the newborn is when many babies receive colostrum from their mothers. This colostrum is the source of maternal antibodies for the babies and is beneficial to them in many other ways as well. Conversely, in many Asian cultures, colostrums is viewed as old milk and not good for the babies health (Kaeswarn, Moyle, & Creedy, 2003). This cultural conflict can cause difficulty for both the nurse and the new mother who share these cultural beliefs about colostrums. The nurse must put her beliefs aside and do as the hospital policy states. The new mother can be put in a vary uncomfortable situation where she can choose to confirm to hospital rules or defy them and stay true to her beliefs and perhaps be labeled as a difficult patient (Kaeswarm et al., 2003). An effective policy would also need to address the cultural issues surrounding breastfeeding.

Kaeswarn, P., Moyle, W., & Creedy, D. (2003). Thai nurses’ beliefs about breastfeeding and postpartum practices. Journal of Clinical Nursing, 12, 467-475. Retrieved January 31, 2008 from Expanded Academic ASAP database.


ii. Disadvantage 2 –Mothers who choose not to breastfeed can be labeled as poor mothers.
There is much research stating that breast milk is the optimal food for a newborn. Despite this, there are many reasons for which a mother might choose to not breastfeed her child. Even though breastfeeding is best for the child in most cases, the mother still has the right to choose whether she will breastfeed the child. Strict policy against using formula in hospitals can alienated the mothers who do not want to breastfeed. Nurses and doctors, in some instances, have tried to convince the mother to change her mind using tactics that border on coercion. These mothers can be made to think that death will be eminent for her child if she does not breastfeed. All mothers should be educated on the benefits of breastfeeding, but if they choose to use formula they should be provided with information on how to choose formula and successfully nourish her baby. Not providing any type of formula education could actually cause harm to some children (Kent, 2006).

Gerorge, K. (2006). Child feeding and human rights. International Breastfeeding Journal, 1(27).


References
American Dietetic Association. Promoting and supporting breastfeeding (2005). Journal of the American Dietetic Association, 105, 810-818.
Spatz, D.L. (2005) The breastfeeding case study: a model for educating nursing students. Journal of Nursing Education 44(9), 432-437. Retrieved September 24, 2007 from Proquest database.
Spear, H. J., (2005). Baccalaureate nursing students’ breastfeeding knowledge: A descriptive survey. Nurse Education Today, 26, 332-337. Retrieved January 3, 2007 from Expanded Academic ASAP database.
US Department of Health and Human Services. (2000). HSS blueprint for action on breastfeeding. Washington, DC: Author. Retrieved January 19, 2007 from www.4women.gov/breastfeeding/bluprntbk2.pdf
Wallis, M. & Harper, M. (2007) Supporting breastfeeding mothers in hospital: part 1. Paediatric Nursing. 19(7), 48-52. Retrieved September24, 2007 from EBSCO Host database.

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