Breastfeeding Promotion and Support By: Crystal Lindelien, RN, BSN, IBCLC, and Nurse at Options360 in Vancouver, WA and Susan Rutherford, MD, Medical Director at 3W for Women in Seattle, WA and Medical Insights Editor Introduction In order to holistically care for pregnant mothers in the pregnancy medical center setting, we must address the issue of breastfeeding. Many women make the decision to breastfeed early on in pregnancy. (1) Because the World Health Organization and other national, and international, organizations agree that breastfeeding is a public health issue, there have been multiple campaigns to promote breastfeeding. (2) So, where are we now? How are we doing? What affects promotion of breastfeeding and how can we assist in our local pregnancy medical clinics? Pregnancy clinics should have policies in place and train staff to use correct language around breastfeeding. Educational 1 P age
materials must be up-to-date. As we follow-up, we can assess how breastfeeding is progressing and make any necessary referrals to other providers. Samantha DeSanto/PicsArt Promotion and Influences To promote means to further the growth or development of something. (3) If we encourage the decision to breastfeed, what strategies do we have in place to support a mom in her choice? The CDC Breastfeeding Report Card from 2016 shows that many mothers are willing to breastfeed. Initiation rates are good, however, studies show that two-thirds of moms wean earlier than their initial goal. (4) The American Academy of Pediatrics (5), American College of Obstetrics and Gynecologists (6), and other health organizations (7, 8) recommend exclusively breastfeeding for six months, then continuing to breastfeed while adding solid foods to their baby s diet through the first year of life. There are many racial and economic disparities in breastfeeding duration rates, implying that there is lack of longterm support and/or equal access to breastfeeding education. There are many tools available to help pregnancy medical clinics create breastfeeding policies. Ten Steps to Successful Breastfeeding and The International Code of Marketing Breast- Milk Substitutes are two models on how to successfully promote breastfeeding. (9) In order to provide education for moms, centers can seek out assistanace from lactation consultants or 2 P age
partner with local hospitals to provide breastfeeding classes that are instructor-led and offer hands-on learning opportunities. In my experience, the biggest challenge to pregnancy medical clinics would be the exclusions of formula samples for our patients. Instead of an irregular supply that is not guaranteed long-term, we should direct our patients to community resources like WIC to receive formula. Giving out formula samples has been correlated with overall reduced duration of breastfeeding. (10) Also, babies should not be switched from formula-toformula depending on what the mother has access to, as formula composition and cost varies widely. (11) Finally, teaching bottle-feeding and formula preparation is an important part of prenatal education. Most patients receive ready-to-feed samples in the hospital if they choose formula, and this is the most expensive option that does not usually carry-over into everyday life. As we counsel and ask moms about their feeding preference, it is important to remain objective. Personal experiences don t often make for a well-rounded education. The goal is always for the mother to make an informed decision and help her feel confident in that decision. A good starting point is to ask, What have you heard about breastfeeding? rather than Are you going to breast or bottle feed? Other than being vague (as breast milk can be given in a bottle!), if she answers that she chooses bottle-feeding, this leaves the provider in a position to ask the offensive why not breastfeeding? which can lead to misunderstandings. It is important to listen to our patients, and ask them to extend ( can you tell me more about ) or reflect ( so what I hear you saying is ) so we can gather the necessary information to tailor education. Including fathers and grandmothers in the educational process is also important, as partner support is a major predictor of breastfeeding success. (12) Breastfeeding is normal. We do not need to say, breast is best; we can allow the patient to make her own determination about that after learning the benefits of breastfeeding for mother and baby. 3 P age
Conclusion Every woman has a right to make a well-informed decision about how to feed her child. Obstacles can include lack of social or family support, returning to work, and lack of professional advice in the important first few weeks. There is no question among health care professionals that breast milk, especially for the first six months, is the ideal for all babies, especially including preemies. The pregnancy medical clinic has an opportunity to help each woman learn the facts and access the community resources she will need if she chooses to breastfeed. Each clinic should learn about local resources and credible websites to which they can refer patients. This will help women access written evidencebased information, supportive parent-baby groups, lactation consultants with expertise in helping women breastfeed, and also practical assistance. Much like educating a woman about her pregnancy options, we must present breastfeeding in an unbiased, evidence-based way. Every medical clinic, especially one that treats women, should have breastfeeding policies in place, routinely educate staff, make sure materials and prenatal education is up-to-date, and demonstrate good counseling skills when discussing infant feeding goals and obstacles. Resources 1. Dix, DN (1991). Why women decide not to breastfeed. Birth, Volume 18, Issue 4. December 1991, pp. 222 225 2. International Code of Marketing of Breast-Milk Substitutes. Who.int, World Health Organization, www.who.int/nutrition/publications/code_english.pdf. 3. Promotion. (n.d.). Retrieved February 3, 2018, from https://www.merriam-webster.com/dictionary/promotion 4. Stuebe, et al (2014). Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction. J. Women s Health (Larchmt) 2014 May;23(5):404-12. doi: 10.1089/jwh.2013.4506. Epub 2014 Mar 21. 4 P age
5. American Academy of Pediatrics Breastfeeding and the Use of Human Milk. Pediatrics, 129(3) March 2012. www.pediatrics.org/cgi/doi/10.1542/peds.2011-3552 6. American College of Obstetrics and Gynecologists. ACOG Committee Opinion Optimizing Support of Breastfeeding as Part of Obstetric Practice. American College of Obstetricians and Gynecologists, no. 658, Feb. 2016, pp. 235 237. www.acog.org/-/media/committee-opinions/committee-on- Obstetric- Practice/co658.pdf?dmc=1&ts=20180204T0436124683. 7. U.S. Department of Health and Human Services. The Surgeon General s call to action to support breastfeeding. Washington, DC: Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: http://www.surgeongeneral.gov/library/calls/breastfeeding/ca lltoactiontosupportbreastfeeding.pdf. Retrieved September 2, 2015 8. Association of Women s Health, Obstetric and Neonatal Nurses. Breastfeeding support: preconception care through the first year. 3rd ed. Washington, DC: AWHONN; 2015 9. Baby-Friendly USA. 10 Steps and International Code. (2012). https://www.babyfriendlyusa.org/about-us/10-steps-andinternational-code 10. Waite, Whitney M. and Christakis, Dimitri. The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates Breastfeeding Medicine. January 2016, 11(1): 21-25.https://doi.org/10.1089/bfm.2015.0099 11. O'Connor, N. Infant Formula. Am Fam Physician. 2009 Apr 1;79(7):565-570. 12. Tsai, S.-Y. (2014). Influence of Partner Support on an Employed Mother s Intention to Breastfeed After Returning to Work. Breastfeeding Medicine, 9(4), 222 230. http://doi.org/10.1089/bfm.2013.0127 5 P age
Medical Insights Partnership The Medical Insights Journal is a collaborative partnership effort between Women s Health Network National (WHNN) and PMC Network (PMCN). Contact WHNN for more information regarding workflow, patient load, and available product recommendations. WHNN will have an RDMS or Medical Director contact you. www.whnnational.com PMCN is a membership-based organization offering real world education and support for pregnancy medical clinics. PMCN recognizes that PMCs are health care facilities with unique needs, and they assist in securing the future of your organization by helping you meet or exceed federal and state regulations and best practices. www.pmcnetwork.org About the Author CRYSTAL LINDELIEN, RN, BSN, IBCLC Nurse, Options 360 Clinic crystal@options360.org Crystal is a busy wife, mother (of soon-to-be four!), and nurse. She has loved being a nurse for over 10 years in many areas, including critical care, forensics, case management, and maternity. She started volunteering at Options 360 in March of 2016 and became a staff nurse in July 2017. Crystal Lindelien, RN, BSN, IBCLC Her passion has always been women s health, and there have been many stepping stones and opportunities to learn along the way. Breastfeeding quickly became a professional and personal challenge that both intrigues and excites her. She became an International Board Certified Lactation Consultant in 2014. She is so thankful to be able to work with women and show them the value and dignity that is bestowed on them in Jesus. Her mantra for the mothers and babies is whatever you did for one of the least of these you did for Me (Matthew 25:40) and how beautiful on the mountains are the feet of those who bring good news (Isaiah 52:7) 6 P age