Literature Review
Baby feeding is one of the most critically debated areas of maternal and neonatal healthcare (Blincoe 2005). Research has shown that breastfeeding is the superior means of providing nutrition to the newborn. The health benefits to both mother and baby are enormous. It is nutritionally balanced to meet all the infants’ needs (DOH 1997). Breastmilk has the right amount of carbohydrates, fat, protein and antibodies to fight infection. It can also reduce the risk of the newborn baby contracting ear and urinary tract infections, gastroenteritis, respiratory, and eczema (Bick 1999). According to Lang (2001) extensive research on the biology of human milk and on the health outcomes associated with breastfeeding has established that breastfeeding is more beneficial than formula feeding. Breastfed infants experience fewer cases of infectious and noninfectious diseases, as well as less severe diarrhea, respiratory infections, and ear infections (Lang 2001). Mothers' who breastfeed experience less postpartum bleeding, earlier return to pre-pregnancy weight, and a reduced risk of ovarian cancer and pre-menopausal breast cancer (Coad 2001).
The action of breastfeeding helps to develop muscles that assist with the development of the jaw, the positive outcome of this does not generally show until the child is five to seven years old. At that time studies show there is increased protection against dental caries and possible effects on the clarity of speech (Woollridge 1996).
For the mother there are various benefits, various studies have shown that breast and ovarian cancer are linked. Therefore women who breastfeed have a reduced risk of both ovarian and breast cancer (Coad 2001). Involution of the uterus naturally occurs in women after birth. However, research has shown that breastfeeding has a positive effect on this as suckling by the infant releases oxytocin from the mother’s pituitary gland. This hormone signals the breasts to release milk, reduces the risk of post partum blood loss by increasing the rate of uterine contraction (Labbok 2001). There is also research that suggests breastfeeding aids weight loss (Blincoe 2005).
The psychological benefits of breastfeeding for both mother and infant are documented in breastfeeding literature. Breastfeeding helps a mother and baby to form a close, loving relationship which makes the mother feel deeply satisfied emotionally (Anderson 1999). According to Howie (1990) this skin to skin contact plays an important role in strengthening bonding, keeps baby warm, helps to raise blood sugar and helps to get breastfeeding off to a good start. It also helps to calm the infant as he hears his mother’s heartbeat as he did whilst in the womb. This in turn helps to regulate the infants breathing and heart rate (Chapman 2006).
According to Hamlyn et al (2002) a randomized controlled trial found that crying and grimacing in the newborn was reduced by 82% and 65% when the infants were placed skin to skin at birth. Colostrum is present in the breast before delivery and is ready to be given as soon as the baby is born. It continues to be produced in the first couple of days and is all that most babies need until the mature milk is produced (Lawrence 1999). Colostrum has special properties and is important that babies receive it as soon as possible after birth (Ackerman 2005).
New mothers should initiate breastfeeding as soon as possible after birth. When mothers initiate breastfeeding within one hour of birth, the baby's sucking reflex is strongest and the baby is more alert. Early breastfeeding is associated with fewer night-time feeding problems, longer continuation, and better mother/infant communication (Coombs & Moreland 2000). While in hospital, every woman who breastfeeds should be given instructions about breastfeeding. Gagliardi & Sinusas (2001) stated that the mother needs to be counseled on aspects such as positioning, techniques to ensure satisfactory latching on, and sounds from the infant indicating swallowing during feeding. Especially in the case of first time mothers, it is important that a designated health professional talk with the mother after the infant is discharged from the hospital.
The Baby Friendly Policy produced by the United Nations Children’s fund (UNICEF) and the World Health Organisation (WHO) suggests ten key recommendations (UNICEF UK Baby Friendly Initiative 1998). The standards for the maternity services, “Ten Steps to Successful Breastfeeding” suggests that all care staff have the skills necessary to help women to breastfeed successfully and to implement the policy. Women should be provided with positive information about the benefits of breastfeeding, with support and encouragement to help mother’s breastfeed exclusively. Encouraging mothers to hold their baby against their skin as soon as possible after delivery tend to breastfeed longer. Mothers are encouraged to “room in” for the first twenty four hours and not to introduce any food or drink other than breastmilk, breastfeeding on demand is encouraged as this promotes the flow of breastmilk. Step ten of these standards advises supporting breastfeeding mother’s through local support groups to help the continuation of breastfeeding and peer support (UNICEF 1998). These guidelines were primarily introduced to reduce high rates of mortality in the third world countries, but have since been adopted by many developed nations (UNICEF 1998).
On the 26th July 2006 the National Institute for Clinical Excellence (NICE) published the “Best Practice Guidelines” on normal postnatal care. One of the key recommendations was that NHS organisations use the Baby Friendly Initiative as a minimum standard (NICE 2006). This will mean that all healthcare professionals will be trained to support women who want to breastfeed.
A study of Baby Friendly hospitals in Scotland found that their breastfeeding rate at seven days increased by 8.1% between 1990-91 and 1998-99. This was compared to a rise of just 2% among hospitals without a Baby Friendly award (Tappin 2001). Data collected between 1995 and 2002 also showed that babies born in Baby Friendly hospitals are 28% more likely to be exclusively breastfed at seven days postnatal (UNICEF UK).
Hodinott et al (1999) argues that for a choice to be truly informed, a mother must be fully aware of the advantages and disadvantages of the options she has to feed her infant. He also states that the mother should also be provided with un-biased evidence based information to help her to make her own decision. Further evidence shows that continuous support during childbirth strengthens the mothers self esteem and her capacity to interact with and nurture her infant (Ekstrom & Nissen 2006 ).
Reflection
What?
After our “encounter” when Katie fell I began to see Katie at antenatal clinic and found her very easy going and always willing to let me “practice” my newly learned skills on her. Palpating her abdomen was a dream as she would allow my inexperienced hands to probe and fumble away, always insisting that I press harder. Katie made it very clear to me that she wanted me present at her baby’s birth to have some “hands on” experience. It was also very evident that although a student, she trusted me. However, I was always mindful to keep a professional distance to deter any “over friendliness”.
I was glad that the relationship Katie and I had developed over the last few months meant a great deal to her. Katie and I had talked at length regarding the pain of labour. We discussed her relaxing, moving around and to listen to her own body. Katie did all this with much enthusiasm and it helped her labour without the use of any other analgesia except entinox. As Katie and I were acquainted before this pregnancy I believe it strengthened our communication during labour. In retrospect, I accept that caring for a friend or family member may have ethical implications. Based on my experience, I feel that this can be very rewarding for the midwife and the family, providing you are confident in your practice, and remain within your professional remit.
Some studies show that women who are breastfed themselves are more likely to go on to breastfeed their own infants (Callen & Pinelli 2004). There is also evidence that shows social, cultural and economic factors influence women who breastfeed. There have always been differences in infant feeding practices amongst different social groups. A higher proportion of women in the higher social classes, those who are older and with a higher education are more likely to initiate breastfeeding (Sachs & Dykes 2006). The Infant feeding survey (Hamlyn et al, 2002) showed that mothers most likely to initiate breastfeeding are those who reach higher educational levels, are aged over 30 years, and are feeding their first baby.
Support for breastfeeding mothers in the early days is crucial to ensure correct attachment. Breastfeeding is also a skill that needs practice and encouragement (Blincoe 2005). Katie was given support and help with positioning at the hospital and returned to the birth centre on several occasions for breastfeeding support.
So What?
Until I witnessed Katie feeding her infant I had not seen a content, happy breastfed baby. All her education and the support from Jane and the other midwives at the birth centre made this possible. I began to understand the many articles and books that I had been reading on breastfeeding and its benefits to both mother and infant. I watched as the infant was placed over and over again to ensure correct attachment, which is such an important aspect of good feeding and prevents mothers from getting sore, cracked nipples. This support helped Katie gain the confidence that she needed to continue breastfeeding. I also realised that women’s reactions to their birth experiences can influence many aspects of their life such as their emotional well being and their attachment to the infant (DOH 2004). Although Katie had not had the normal birth in the birth centre that she had planned, she felt fully supported by the midwife and had received good continuity of care. This together with her positive intention to breastfeed helped her to gain the confidence to learn the skills that she needed to continue feeding her baby.
Now What?
I am more positive in my efforts to encourage women to breastfeed and the evidence based knowledge to advise them of the health benefits both to themselves and their infants. I am also mindful that not all women wish to breastfeed, and would support their choice of feeding in the same way as I had with Katie. While in hospital, every woman who breastfeeds her infant should be given instructions about breastfeeding. According to Gagliardi & Sinusas (2001), the mother needs to be counseled on aspects such as positioning, techniques to ensure satisfactory latching on, and sounds from the infant indicating swallowing during feeding. This he said was especially so in the case of first time mothers, it is important that a designated health professional talk with the mother approximately 48 hours after the infant is discharged from the hospital.
Conclusion
Throughout her care Katie received continuity with Jane and myself. The quality of interaction between us was of immense value to Katie and helped her transition to motherhood a happy one. At each visit in the ante-natal clinic her questions regarding her pregnancy, birth and chosen feeding method were answered by Jane with the professionalism always shown to her clients. Katie was given all the information that she required to assist her with breastfeeding and was given one-to-one support on her arrival at the birth centre. This support in the early days of breastfeeding is vital to ensure good attachment and feeding techniques. A midwife needs to observe and assess the mother’s ability to respond to her infants feeding demands, as this is much easier when there is already a relationship between the midwife and mother. The best care is often when a midwife suggests to the mother what to do and then watch and guide her in getting the attachment right. Jane was always patient and reassuring to give Katie the confidence that she required to breastfeed successfully. Katie attends the local breastfeeding group every week and has expressed how welcoming she has found the peer support that she receives there. Katie is for myself a good example of how with the right information and support breastfeeding can be a wonderful, fulfilling experience.
Plan of Care
On her arrival home from the local district hospital Katie’s care was handed over to Jane who is the community midwife that attended her antenatal visits. After twenty eight days it will be handed over to the local Health visitor.
Community midwives and health visitors play an invaluable role in the support they provide to new mothers and babies. Over time Katie will grow in confidence with the support she receives from her midwife at the breastfeeding support group and in the comfort of her own home.
References
Ackerman, B. (2005) Infant Feeding IN Henderson, C. MacDonald, S. (13) Mayes’ Midwifery Edinburgh: Bailliere Tindall.
Anderson, T. (1999) “Support for breastfeeding Mothers” Practising Midwife 2 (9): 10-12
Bick, D. (2001) “The Benefits of Breastfeeding for the Infant” British Journal of Midwifery 7 (5):312-319
Blincoe, A.J,. (2005) “The Health Benefits of Breastfeeding Mothers” British Journal of Midwifery. 13 (6): 398-401
Callen, J & Pinelli, J. (2004) “ Incidence and duration of breastfeeding for term infants in Canada, United States, Europe and Australia” Birth 31: 285 – 292
Chapman, V. (2006) The Midwifes Labour and birth handbook Oxford: Blackwell Publishing.
Coad, J. (2001) Anatomy and Physiology for Midwives. Edinburgh: Mosby
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Gagliardi, A. & Sinusas, K. (2001) “Initial Management of Breastfeeding” American Family Physician 64 (6) 981-998
Hamlyn, B Brooker, S. Oleinkova, K. (2002) Infant Feeding 2000. A survey conducted on behalf of the department of Health, the Scottish Executive, the National assembly of Wales and the Department of Health, Social Services and Public Safety in Northern Ireland. London: The Stationary Office.
Howie, P.W,. (1990) “Protective effect of Breastfeeding against infections” British Medical Journal 300: 11-16
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Labbok, M.H,. (2001 “Effects of Breastfeeding on the mother” Lancett 339:261-264
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NMC (2004) The NMC code of professional conduct, standards for conduct, performance and ethics. NMC, London.
NICE (2006) Routine Postnatal Care of Women and their Babies. London: NHS.
Sachs, M. & Dykes, F. (2006) “Infant Feeding Trends: early indicators. The Practising Midwife 9 (10): 15-18
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