Breastfeeding: the nurse's role

Breastfeeding has been proven to have many positive outcomes on the child. It has been shown to have effects on the child’s intelligence, immunologic development, weight, social development, and overall health.
There are many positive results on the mother as well. Because research shows many positive effects of breastfeeding, nurses should include breastfeeding education in both prenatal care and when teaching new mothers. Nurses can implement the following strategies to address this issue: involving lactation consultants in prenatal care, making it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period, and making follow-up home health appointments with nursing standard during the puerperium period.
Historically, the popularity of breastfeeding has had its ups and downs. Like many other things, it has faded in and out of favor by people throughout the years. This partially could have been due to the fact that people didn’t know or fully understand all of the effects of breastfeeding. However, enough is now known about breastfeeding that the benefits are no longer debatable. In every situation (but very few cases) it is the best option for the baby. Not everyone is educated enough about the subject to understand the strong case for doing it. Most people understand it’s good for the baby, but they may not understand just how good it is and the numerous effects it will have on that child throughout its lifetime.
Involving nursing lactation consultants during prenatal care or even prior to pregnancy is extremely beneficial. It helps the woman (or couple) make a more informed choice about breastfeeding. “A woman’s decision about the method of infant feeding is made before pregnancy; thus it is essential to educate women of childbearing age about the benefits of breastfeeding” (Hockenberry, Lowdermilk, Perry, Wilson, Wong, 2006, p. 277). Doing so earlier could make a huge difference. Making comprehensive breastfeeding education a standard part of prenatal care would impact the number of people that decide to breastfeed. Most people at this point know that breastfeeding is good for the baby, but they may need more thorough education by nursing to understand the vast number of ways that it is beneficial for the baby throughout its lifetime.
Having nursing lactation consultants present very soon after birth is very helpful for the woman. It provides her with the education, support and encouragement that are necessary when beginning to breastfeed. “Mothers often identify support received from healthcare providers as the single most important intervention the healthcare system could have offered to help them breastfeed” (CDC, 2006, p. 1). This immediate education and attention by the nurse lactation consultant would start the woman “off on the right foot” when it comes to breastfeeding. It would give them an opportunity to spend time with someone who is focused solely on the success of their breastfeeding experience. Implementing a policy by the hospital’s nursing committee, which makes it standard practice to have nursing lactation consultants present for education and coaching during the first breastfeeding experience, could make a significant difference in a woman’s breastfeeding experience. Research has shown a “positive relationship between delivering at a hospital that employed IBCLCs (International Board Certified Lactation Consultants) and breastfeeding at hospital discharge” (Castrucci, Hoover, Lim, Maus, 2006, p. 6).
It is recommended by the American Academy of Pediatrics that breastfeeding be done for at least 12 months. Follow-up home health visits by nurses are a great way to help mothers accomplish this goal and a very positive addition to breastfeeding education. Surveys conducted by the CDC in 2004 have shown that 73.8% of babies were ever breastfed, 41.5% were still being breastfed at 6 months of age and 20.9% were still being breastfed at 1 year. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice” (Krueger, Sheehan, Sword, Watt, 2006, p. 1). Continuing to provide constant professional nursing support has been shown to increase the number of women who continue to breastfeed, despite experiencing a perceived breastfeeding barrier or lactation crisis. This support, for many women, needs to include education on continuing breastfeeding even after returning to work. The lactation consultants coach women on how to use breast pumps, how to store the milk or anything else that could be a potential breastfeeding barrier. Home health visits by lactation consultants could have a significant impact on breastfeeding duration.
Breastfeeding is extremely beneficial for both mother and baby. Mothers who breastfeed have been shown to have lower rates of some types of ovarian and breast cancers, hip fractures and osteoporosis after menopause as well as other health conditions (U.S. Department of Health and Human Services, 2005). Breastfeeding also helps mothers lose their “baby weight.” Babies who are breastfed have lower rates of asthma, ear infections, SIDS, diabetes, leukemia, lymphoma; the list of benefits for babies goes on and on (U.S. Department of Health and Human Services, 2005). There are societal benefits as well, the greatest being that breastfeeding saves on healthcare costs because breastfed babies need less medical care than those who aren’t breastfed. The three outlined nursing strategies: involving nursing lactation consultants in prenatal care, in the immediate puerperium period and in home health visits during the postpartum period would make a significant impact on the number of women who not only initiate breastfeeding, but also those who choose to continue.

References –

Castrucci, B., Hoover, K., Lim, S., & Maus, K. (2006). A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants. Journal of Public Health Management and Practice, 12 (6), 578-585. Retrieved April 29, 2007 from Expanded Academic ASAP database (A154690153).

Centers for Disease Control. (2006, August). The CDC guide to breastfeeding interventions: Professional support. Retrieved on May 29, 2007 from http://www.cdc.gov/breastfeeding/pdf/BF_guide_5.pdf

Davies, B. & Edwards, N. (2003, September). Breastfeeding best practice guidelines for nurses. Retrieved on May 7, 2007 from http://www.rnao.org/bestpractices/PDF/BPG_Breastfeeding.pdf

Hockenberry, M., Lowdermilk, D., Perry, S., Wilson, D. & Wong, D. (2006). Nursing care during pregnancy. In Maternal Child Nursing Care (pp. 277-278). Third Edition. St. Louis: Mosby Elsevier.

Krueger, P., Sheehan, D., Sword, W., Watt, S. (2006). The impact of a new universal postpartum program on breastfeeding outcomes. Journal of Human Lactation, 22 (4), 398-408. Retrieved May 28, 2007 from Expanded Academic ASAP database (A152872149).
U.S. Department of Health and Human Services, (2005, October). womenshealth.gov: Benefits of Breastfeeding. Retrieved on February 18, 2008 from http://www.4woman.gov/breastfeeding/index.cfm/index.cfm?page=227


Intervention #1 - Involving lactation consultants in prenatal care.

Disadvantage #1 – One disadvantage of this intervention would be cost. It would be a struggle to get insurance companies to cover this in addition to the other things that are covered in prenatal care. And many people would not be able to afford to pay for this out of their pocket or more accurately would not choose to spend their money on this. The only way this intervention could truly be successful is if it was something that was standard for everyone. This intervention is aimed at educating those who aren’t planning to breastfeed and those who belong to groups of people that typically don’t breastfeed. Even though the long-term benefits far outweigh the cost and even though the insurance companies have the potential to save themselves a significant amount of money down the road, convincing the insurance companies of this would not be such an easy sell.

Disadvantage #2 – Another disadvantage of this intervention would be that it would not be able to address many of the problems that arise that cause women to stop breastfeeding. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice.” (Krueger, Sheehan, Sword, Watt, p. 1). It would be extremely valuable to start educating parents on the many benefits of breastfeeding as soon as possible, however, because this education happens so early it could not focus on helping mothers solve some of the problems that arise during breastfeeding, mothers that want to breastfeed but end up stopping early because of problems doing it.

Intervention #2 - Making it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period.

Disadvantage #1 - One disadvantage of this intervention would again be cost. It would be difficult to convince insurance companies to cover this in addition to other costs associated with having a baby or convincing hospitals that it’s in their best interest to have a lactation consultant on staff. “The odds of breastfeeding at hospital discharge for a women delivering at a facility that employed an IBCLC were more than 2 1/4 times higher than women delivering at a facility that did not employ an IBCLC.” (Castrucci, Hoover, Lim, Maus, p. 6). Despite the fact that the initial cost would be minimal, I suspect insurance companies would still just view this as another cost, as opposed to viewing it as paying a little now to save big later. The same goes for the hospital, they may not see it as their responsibility to address the breastfeeding issue and therefore a cost that’s not in their best interest to spend.

Disadvantage #2 - Another disadvantage of this intervention would be that most people have made up their minds by then whether or not to breastfeed. If they have decided to breastfeed they would be very receptive to this additional education, however, if they have decided not to breastfeed they would most likely not be very receptive to receiving this education. They may actually perceive it as disrespectful if they have already made their plans known. This intervention would probably not be able to make much of an impact on breastfeeding initiation, but it could potentially effect breastfeeding duration.