Educating Health Professionals on Breastfeeding 1

Running Head: EDUCATING HEALTH PROFESSIONALS ON BREASTFEEDING

Educating Health Professionals on Breastfeeding

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 Educating Health Professionals on Breastfeeding 2

Educating health Professionals on Breastfeeding

Introduction

Breastfeeding is the mechanism of feeding an infant or young child with milk directly

from female breasts, instead of using a baby bottle or other container. Human breast milk is

regarded as the best source of nourishment for infants. It supposedly helps in preventing them

from diseases and promotes health, thus reduces health care costs. In recent times, artificial

modes of feeding are linked with increase in mortality rates among infants.

The optimal duration of breastfeeding is a cause of dispute between experts. WHO

recommends exclusive dependence on breastfeeding for the first six months and continued

feeding with other diets for up to two years or beyond. American Academy of Pediatrics

differs in their recommendations and suggests at least one year of breastfeeding, for the first

six months they are in harmony with the WHO.

Below are analyzed and summarized a few studies depicting the current trends of

breastfeeding among the mothers. The obvious or the potential hindrances were also

highlighted in these studies.

Synopsis of the article - Johnson,T. S .; Mulder , P. J.; Strube, K. (Jul-Aug 2007). Mother-

Infant Breastfeeding Progress Tool: A Guide for Education and Support of the Breastfeeding

Dyad. Journal of Obstetric, Gynecologic and Neonatal Nursing. Volume 36, Number 4, p.

319-27.

The purpose of the article is to describe the development of the Mother-Infant

Breastfeeding Progress Tool to be used at the bedside by nurses to guide ongoing support and

education for the mother-baby dyad. It is a cross-sectional study done in community hospital

in a Midwestern city. Sample size was sixty-two (n = 62) English-speaking mother-infant

dyads. For this purpose three nurse raters (two per session) independently scored the eight
 Educating Health Professionals on Breastfeeding 3

characteristics on the Mother-Infant Breastfeeding Progress Tool during 81 breastfeeding

sessions.

The purpose of the study was to get the percent agreement between raters and

suggested modifications for the Mother-Infant Breastfeeding Progress Tool.

The results obtained support the use of the tool as a checklist for assessment of the

breastfeeding mother-infant dyad to guide education and support.

The agreement between raters was high for individual items of the Mother-Infant

Breastfeeding Progress Tool. The Mother-Infant Breastfeeding Progress Tool is useful as a

checklist for assessing maternal and infant breastfeeding progress, but still additional research

is needed to support the validity of the tool.

Synopsis of the article - Philipp, B. L.; Merewood, A.; Miller, L. W. Chawla, N.; Murphy-

Smith, M. M. et al. Baby-friendly Hospital Initiative Improves Breastfeeding Initiation Rates

in a US Hospital Setting.

For this study breast feeding initiation rates were compared at an inner-city teaching

hospital, that provides care primarily to poor, minority and immigrant families, before (1995),

during (1998) and after (1999) Baby-friendly policies were in place. The hospital chosen was

Boston Medical Centre.

Two hundred complete medical records, randomly selected by a computer, were

reviewed from each of three years: 1995, 1998 and 1999. Infants were excluded for medical

records missing feeding data, HIV-positive parent, neonatal intensive care unit admission,

maternal substance abuse, adoption, incarceration or hepatitis-C positive mother. All infant

feedings during the hospital postpartum stay were tallied, and each infant was categorized in
 Educating Health Professionals on Breastfeeding 4

one of four groups: exclusive breast milk, mostly breast milk, mostly formula and exclusive

formula.

Maternal and infant demographics for all three years were comparable. The

breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999).

Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999).

Initiation rates increased among US-born African American mothers from 34% (1995) to

64% (1998) to 74% (1999).

Full implementation of the ten steps to successful breastfeeding leading to baby-

friendly designation is an effective strategy to increase breastfeeding initiation rates in the US

hospital settings.

Synopsis of the article - Johnston, M. L.; Esposito, N. Barriers and Facilitators for

Breastfeeding Among Working Women in the United States. Journal of Obstetric,

Gynecologic and Neonatal Nursing. Volume 36, Number 1, p. 9-20.

The objective of the study is to review the literature and describe the barriers and facilitators

to the continuation of breastfeeding for at least 6 months by working women in the United

States. For this purpose a search of PubMed, CINAHL, Sociological Abstracts, ISI,

PsychInfo, and ProQuest was done and twenty studies based on the inclusion criteria

published between January 1, 1995, and January 2006 were found. An ecologic framework,

which includes the individual (microsystem), social support and relationships (mesosystem),

and the workplace environment (exosystem) was used for data extraction.

The findings have shown that when working mothers possess certain personal characteristics

and develop a strategic plan, breastfeeding is promoted. When social support is available and

when support groups are utilized, lactation is also facilitated. Part-time work, lack of long
 Educating Health Professionals on Breastfeeding 5

mother-infant separations, supportive work environments and facilities, and child care

options facilitate breastfeeding.

Health care providers can use the findings of this review to promote breastfeeding among

working women by using tactics geared toward the mother, her social network, and the entire

community.

Synopsis of the article - Lavender, T.; Baker, L.; Smyth, R.; Collins, S.; Spofforth, A.; Dey,

P. (August 2005). Breastfeeding expectations versus reality: a cluster randomized controlled

trial. BJOG: an International Journal of Obstetrics and Gynaecology. Vol. 112, p. 1047–1053.

The objective of this study was to evaluate the affect of an antenatal educational

breastfeeding intervention on women’s breastfeeding duration. For this purpose a cluster

randomized controlled trial design was developed. The primary outcome was the proportion

that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number

of women breastfeeding on discharge and at four months. Data were collected using a series

of questionnaires and diaries.

The research was conducted in a teaching hospital in North West of England. Participants

were women who expressed a desire to breastfeed at the start of their pregnancy.

They were allocated to either routine antenatal education or an additional single educational

group session supervised by a lactation specialist and attended by midwives from their

locality.

Originally one thousand three hundred and twelve women were randomized, with 1249

(95%) women available for analysis. There was no difference between the groups in the

proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI

0.89–1.6; m2 ¼ 1.4, df ¼ 1, P ¼ 0.2; mean cluster size 156, design effect 1.6). There were no
 Educating Health Professionals on Breastfeeding 6

differences between the groups in the uptake of breastfeeding on discharge (OR ¼ 1.2; 95%

CI 0.8–1.7; m2 ¼ 1.1, df ¼ 1, P ¼ 0.3; mean cluster size 163, design effect ¼ 2.0) or

exclusively at four months (OR ¼ 1.1; 95% CI 0.6–1.8; m2 ¼ 0.07, df ¼ 1, P ¼ 0.8; mean

cluster size 156, design effect 1.6).

The provision of a single educational group session supervised by a lactation specialist, and

attended by midwives and women, failed to promote the uptake of breastfeeding. Public

health interventions, which encourage positive attitudes to breastfeeding within the family

and wider community, should be developed and evaluated.

Synopsis of the article - Vittoz, J.-P.; Labarere, J.; Castell, M.; Durand, M.; Pons, J.-C.

(December 2004). BIRTH. Volume 31, Number 4, p. 302-07.

Training programs are commonly viewed as an effective way to improve

breastfeeding-related practices of health professionals. The objective of this study was to

determine whether a 3-day training program for maternity ward professionals was followed

by an increase in duration of any breastfeeding.

A before-and-after study was conducted involving two retrospective random samples

of 308 mothers (n = 308) who had delivered a healthy singleton infant of 37 weeks’ or more

gestation and 2,500 g or more birth-weight in a level 3 maternity ward in a university hospital

in France. Data were gathered from medical records and postal questionnaire.

Study participants included 169 mothers (54.9%) in the pre-intervention sample and

178 (57.8%) in the post-intervention sample. The prevalence of any breastfeeding at birth

was 77.5 percent (70.5%–83.6%) in the pre-intervention sample and 82.6 percent (76.2%–

87.8%) in the post-intervention sample (p=0.24); the median duration of any breastfeeding

was 13 weeks and 16 weeks, respectively (w2 log-rank test=5.8, p=0.02). The decreased risk

of weaning in the post-intervention sample persisted after adjustment for baseline

 Educating Health Professionals on Breastfeeding 7

characteristics (adjusted hazard ratio=0.70 [0.54–0.91]). It was paralleled by significant

improvement in maternity ward practices that are known to affect the duration of

breastfeeding.

An intensive 3-day training program for maternity ward professionals can be followed

by a significant but moderate increase in the duration of any breastfeeding. Multifaceted

interventions involving prenatal components and community support should be planned in

Western countries with low to intermediate prevalence of breastfeeding.

Synopsis of the article - Santo, L. C. E.; de Oliveira, L. D.; Giugliani, E. R. J. (September

2007). Factors Associated with Low Incidence of Exclusive Breastfeeding for the First 6

Months. BIRTH. Volume 34, Number 3 p. 212-19.

The identification of factors that are associated with early cessation of exclusive

breastfeeding is important for defining strategies for the promotion of exclusive

breastfeeding. The objective of this study was to identify the determinants of exclusive

breastfeeding cessation before 6 months, including variables that generally receive little

attention, such as the influence of grandmothers, breastfeeding technique, and sore nipples.

This prospective study follows a cohort of 220 healthy mother-baby pairs (n = 220)

from birth to 6 months, living in Porto Alegre, Brazil. Data were collected at the maternity

unit, during a home visit at 30 days, and by telephone interview at 60, 120, and 180 days.

Breastfeeding technique was assessed and breasts examined at the maternity unit and during

home visits. Cox regression was employed to estimate the degree of association between the

variables and the outcome.

The following factors were associated with cessation of exclusive breastfeeding

before 6 months: adolescent mother (hazard ratio [HR] = 1.48, 95% CI 1.01–2.17), fewer

than six prenatal visits (HR=1.60, 95%CI 1.10–2.33), use of a pacifier within the first month
 Educating Health Professionals on Breastfeeding 8

(HR= 1.53, 95% CI 1.12–2.11), and poor latch-on (HR= 1.29, 95% CI 1.06–1.58 for each

unfavorable parameter).

Activities to promote exclusive breastfeeding should be intensified for adolescent

mothers and for those whose prenatal care was less than ideal. These activities should

reinforce the ill effects of pacifiers and should also include appropriate instruction for these

mothers in correct breastfeeding technique.

Synopsis of the article - Gribble, K. D. (2008). Long-term breastfeeding; changing attitudes

and overcoming challenges. Breastfeeding Review. Volume 16, Number 1, p. 5–15.

The experiences of 107 Australian women (n = 107) who were breastfeeding a child

two years or older were gathered via a written questionnaire with open-ended questions.

Eighty-seven percent (87%) of women had not originally intended to breastfeed long-term

and many had initially felt disgust for breastfeeding beyond infancy.

Mothers changed their opinion about long-term breastfeeding as they saw their child

enjoy breastfeeding, as their knowledge about breastfeeding increased and as they were

exposed to long-term breastfeeding role models. It was common for mothers to be shocked

the first time they saw a non-infant breastfeed but this exposure was also a part of the process

by which they came to consider continuing to breastfeed themselves.

Women often found long-term breastfeeding role models as well as information and

moral support for breastfeeding continuance within a peer breastfeeding support organization

(the Australian Breastfeeding Association).

Previous breastfeeding experiences had assisted women in their current breastfeeding

relationship. Mothers had overcome many challenges in order to continue breastfeeding and

breastfeeding was sometimes discontinuous, with children weaning from days to years before

resuming breastfeeding.
 Educating Health Professionals on Breastfeeding 9

This study suggests that postnatal interventions may be successful in increasing

breastfeeding duration. Such interventions might include: continuing provision of

breastfeeding information throughout the lactation period, facilitation of exposure to long-

term breastfeeding, and referral to peer breastfeeding support organizations.

Synopsis of the article - Bigger, M. T.; Long, A. (March 2008). Breastfeeding education for

health professionals. Journal of Community Nursing. Volume 22, Issue 3, p. 4-15.

This paper presents a study that investigated the efficacy of a three-day University-

based workshop on breastfeeding education for professionals. The paper begins with the

literature review and continues with an overview of the methodology. It concludes with a

discussion on the findings and forwards recommendations for management, education and

professional practice with the aim of promoting the health and well-being of all families

generally and women and their offspring specifically.

A rigorous systematic review of the literature on breastfeeding was conducted up to

March 2003, which encompassed the main electronic sources of medical, nursing and

midwifery literature (CINAHL, MEDLINE, MIDIRS). In addition, hand searching of

essential journals, references of retrieved papers and examination of unpublished 'grey

literature' together with internet searches were carried out to enhance the scope and range of

this literature review.

The search strategy employed a combination of the following key words,

breastfeeding, support, and education. Over 2000 hits were obtained, with 135 hits meeting

the inclusion criteria that had been set to match the research aims.

Only one randomized controlled trial (RCT) was identified in the systematic search,

which evaluated the effectiveness of breastfeeding training for health professionals. Pre-test

analysis indicated that there was no significant difference between knowledge and skills in
 Educating Health Professionals on Breastfeeding 10

the intervention and control groups. In contrast, a significant difference in favor of the

intervention group (p> 0.001) was identified following post-test analysis. Of the respondents,

100 % {n=70) responses were received pre-test and 98.6% {n=69) posttest. The researchers

concluded that the intervention significantly improved clinical and counseling skills for the

support of breastfeeding. The evidence from this small study shows that health professionals

require consistent education and training on breastfeeding, therefore standards should be set,

which ensure that all health professionals who support breastfeeding mothers are continue to

be professionally developed.

Conclusion

The benefits of breastfeeding to both mothers and infants have been widely

acknowledged. Breastfeeding is superior to infant formula feeding because in addition to its

nutritional advantages, it protects against a wide range of illnesses and infections through

specific and non-specific immune factors. It provides long-term positive consequences for

disease later in life. Scientific evidence demonstrates a wide range of benefits for infants to

be breastfed and for mothers to breastfeed.

Overall the evidence supports the practice of exclusive breastfeeding for the first six

months of life in both developing and developed countries.

 Educating Health Professionals on Breastfeeding 11

Reference

Johnson, T. S.; Mulder , P. J.; Strube, K. (Jul-Aug 2007). Mother-Infant Breastfeeding

Progress Tool: A Guide for Education and Support of the Breastfeeding Dyad. Journal

of Obstetric, Gynecologic and Neonatal Nursing. Volume 36, Number 4, p. 319-27.

Philipp, B. L.; Merewood, A.; Miller, L. W. Chawla, N.; Murphy-Smith, M. M. et al. Baby-

friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital

Setting.

Johnston, M. L.; Esposito, N. Barriers and Facilitators for Breastfeeding Among Working

Women in the United States. Journal of Obstetric, Gynecologic and Neonatal Nursing.

Volume 36, Number 1, p. 9-20.

Lavender, T.; Baker, L.; Smyth, R.; Collins, S.; Spofforth, A.; Dey, P. (August 2005).

Breastfeeding expectations versus reality: a cluster randomized controlled trial.

BJOG: an International Journal of Obstetrics and Gynaecology. Vol. 112, p. 1047–

1053.

Vittoz, J.-P.; Labarere, J.; Castell, M.; Durand, M.; Pons, J.-C. (December 2004). BIRTH.

Volume 31, Number 4, p. 302-07.

Santo, L. C. E.; de Oliveira, L. D.; Giugliani, E. R. J. (September 2007). Factors Associated

with Low Incidence of Exclusive Breastfeeding for the First 6 Months. BIRTH.

Volume 34, Number 3 p. 212-19.

Gribble, K. D. (2008). Long-term breastfeeding; changing attitudes and overcoming

challenges. Breastfeeding Review. Volume 16, Number 1, p. 5–15.

Bigger, M. T.; Long, A. (March 2008). Breastfeeding education for health professionals.

Journal of Community Nursing. Volume 22, Issue 3, p. 4-15.