Submitted by The Importance of Supporting Mothers Who Breastfeed by Rachel B. Barrientos, Student Nurse, and Paula Bylaska-Davies, RN, MS, Assistant Professor, Massachusetts College of Pharmacy and Health Sciences
Breastfeeding has always been an important part of infant health; around the world mothers have been breastfeeding their children since the beginning of the human race. The American Academy of Pediatrics recommends that children are nursed for at least the first 12 months of life. Furthermore, the World Health Organization recommends an even longer period of 2 years (CDC, 2010). According to the Centers for Disease control, only 22.7% of infants born in 2006 were still at least partially breastfeeding at 1 year of age (CDC 2010).
There are many health benefits to breastfeeding children such as lower mortality rates, ideal nutritional values, and long term benefits such as healthy weights and higher intelligence later in life. The positive aspects of breastfeeding extend to maternal health as well, such as lower rates of breast and ovarian cancers and decreased occurrences of post-partum depression. Nurses play an important role in encouraging and supporting breastfeeding; they have multiple interactions with the mother during pre and post-natal appointments where they can advocate for breastfeeding through teaching.
Breast milk is the ideal source of nutrition for growth and development, providing newborns and infants with nutrients in natural forms. The longer a child is breastfed the better the results; cessation of breastfeeding before six months increased the risk of pneumonia, doubled the risk of recurrent otitis media, and resulted in higher urinary tract infections in female babies. Long term benefits of breastfeeding were found to include lower blood pressure and cholesterol levels, as well as higher performances on intelligence tests (Bai, Middlestadt, Peng, & Fly, 2009). Potentially, 1.3 million lives can be saved each year by mothers that continue to breastfeed beyond six months (Bai et al., 2009). It is also reported that “early cessation of breastfeeding increases infants' risks for childhood obesity, gastroenteritis, necrotizing enterocolitis, leukemia, otitis media, severe lower respiratory infections, sudden infant death syndrome, and types 1 and 2 diabetes” as well as incurring an average of $475 more in health costs in the first year than those infants exclusively breastfed (Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009).
The maternal benefits to breastfeeding include lower risk for breast and ovarian cancers, type 2 diabetes, and postpartum depression for mothers that breastfed their infants (Bartick et al., 2009). Emotionally, mothers benefit from breastfeeding by forming a stronger bond with their baby. A research study reported that the number one advantage of breastfeeding stated by mothers was “helping bond with baby” (Bai et al., 2009).
Early cessation of breastfeeding is identified by the Department of Health and Human Services as a problem. A goal included in Healthy People 2010 and again in Healthy People 2020 aimed to increase the proportion of mothers who breastfeed their babies ever, at six months, and at one year (U.S Dept. of Health and Human Services, 2010). Despite frequent contact with health care professionals, the first two weeks of life require increased breastfeeding education and support, as this is when breastfeeding has a high cessation rate (Bartick et al., 2009). Identifying factors that affect cessation of breastfeeding will aid in increasing maternal support and in turn increase child and maternal health.
Out of all healthcare providers, nurses spend the most time with mothers during the pre and post-partum period, as well as care for the infants following delivery. Bartick et al. (2009) reported that the nursing staff at “88% of facilities reported that they taught most mothers techniques of breastfeeding...” However, 65% advised women to limit suckling, 45% gave pacifiers to healthy infants, and 24% regularly gave milk supplements to the majority of healthy infants (Bartick et al., 2009). Nurses can encourage the advancement of breastfeeding by increasing breastfeeding teaching to 100% and decreasing detrimental practices such as limiting suckling, pacifier use, and formula supplements. In addition, nurses can provide better teaching and positive support before birth and after hospital discharge; “...data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance” (Flower, Willoughby, Cadigan, Perrin, & Randolph, 2007).
It is important for nurses to explore the positive and negative aspects of breastfeeding from the mother's perspective. The most frequently reported benefit from breastfeeding mothers was the emotional bond with the infant formed while breastfeeding (Bai et al., 2009; Wambach & Cohen, 2009). The other advantages reported in studies were contributing to the health of the infant, experiencing convenience of breastfeeding, and saving money (Bai et al., 2009, Wambach & Cohen, 2009). One of the negative aspects of breastfeeding reported by women had to do with nursing in public, some women had difficulty finding a place to nurse in public as well as experiencing some embarrassment when nursing in public (Bai et al., 2009, Wambach & Cohen, 2009). By advocating for more private breastfeeding spaces in public areas, nurses can help to reduce one of the major factors behind cessation of breastfeeding.
Factors related to initiating breastfeeding have been explored by many researchers (Barona-Vilar, Escriba-Aguir, & Ferrero-Gandia, 2007; Flower et al., 2007, Wambach & Cohen, 2009). Demographics play an important role in the decision process for a pregnant woman (Barona-Vilar et al., 2007; Flower et al., 2007). Women were more likely to initiate breastfeeding if they were educated, married or had a first-born child (Flower et al., 2007). However, women who returned to work at two months or received WIC were less likely to initiate breastfeeding (Flower et al., 2007). Social support also plays a role in a woman's decision to initiate breastfeeding, women in higher socio-cultural groups relied on the support and opinions from their partners and healthcare networks, whereas women who were from lower socio-cultural groups reported friends opinions and support was influential on whether to initiate breastfeeding (Barona-Vilar et al., 2007). In order to increase support for new mothers, nurses can extend patient teaching not only to the mother, but to the fathers and other support systems important to the mother. Brochures and literature highlighting the health and financial benefits of breastfeeding should be distributed to women to share with any family members who are unable to attend appointments.
The common reasons reported for stopping breastfeeding before 8 weeks postpartum included insufficient milk supply, latch problems, personal reasons, returning to work and medication use/illness of mom or baby (Lewallen et al., 2006). In addition, pain, nipple soreness and embarrassment related to public breastfeeding were stated as reasons for discontinuing breastfeeding before 6 weeks postpartum (Wambach & Cohen, 2009). Prenatal teaching regarding proper techniques should prepare new mothers as to what to expect when breastfeeding, as well as at the follow-up at well-baby visits to address additional issues that may arise. This additional support may increase the longevity of breastfeeding mothers by resolving complications if they arise.
It is necessary for nurses to encourage and support breastfeeding during interactions with mothers. Nurses should address the discontinuation of breastfeeding by teaching mothers pre and post-partum how to avoid the pitfalls behind cessation of breastfeeding, such as pain, discomfort, frustration, lack of support, and the public’s disapproval. This teaching would include assisting mothers with proper latch techniques and encouraging mothers to participate in breastfeeding classes pre-natally as well as breastfeeding support groups during the post-partum period. Mothers should be taught how to pump, store, and prepare breast milk as they may re-enter the work force following maternity leave, as well as reinforcing the benefits of breast milk at well baby visits to encourage the continuation of breastfeeding. Nurses can also advocate for improved breastfeeding areas for mothers and infants in public areas and the workplace. By increasing patient teaching as well as educating the public, the numbers of mothers who initiate breastfeeding as well as the longevity of breastfeeding by mothers will increase, ultimately improving child and maternal health and decreasing healthcare costs.
Bai, Y. K., Middlestadt, S. E., Peng, C. J., & Fly, A. D. (2009). Psychosocial factors underlying the mother's decision to continue exclusive breastfeeding for 6 months: an elicitation study. Journal of Human Nutrition and Dietetics, 22, 134-140. doi: 10.1111/j.1365-277X.2009.00950.x
Barona-Vilar, C., Escriba-Aguir, V., & Ferrero-Gandia, R. (2007). A qualitative approach to social support and breast-feeding decisions. Midwifery, 25,187-194. doi: 10.1016/j.midw.2007.01.013.
Bartick, M., Stuebe, A., Shealy, K. R., Walker, M., & Grummer-Strawn, L. M. (2009). Closing the Quality Gap: Promoting Evidence-Based Breastfeeding Care in the Hospital. Pediatrics, 124(4), 793-800. doi: 10.1542/peds.2009-0430.
Centers for Disease Control and Prevention (2010). Breastfeeding. Retrieved from http://www.cdc.gov/breastfeeding/index.htm.
Flower, K. B., Willoughby, M., Cadigan, R. J., Perrin, E. M., & Randolph, G. (2007). Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach. Maternal Child Health Journal, 12, 402- 414. doi: 10.1007/s10995-007-0248-6.
Lewallen, L. P., Dick, M. J., Flowers, J., Powell, W., Zickefoose, K. T., Wall, Y. G., & Price, Z. M. (2006). Breastfeeding Support and Early Cessation. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35, 166-172. doi: 10.1111/J.1552- 6909.2006.00031.x.
U.S. Department of Health and Human Services (2010). Developing Healthy People 2020: Maternal, Infant & Child Health. Retrieved from http://www.healthypeople.gov/hp2020/Objectives.
Wambach, K. A., & Cohen, S. M. (2009). Breastfeeding Experiences of Urban Adolescent Mothers. Journal of Pediatric Nursing, 24(4), 244-254. doi: 10.1016/j.pedn.2008.03.002.