lactation room design

SECTION 2: THE PRENATAL PERIOD

CHAPTER 6BREASTFEEDING

AND THE PREGNANT WOMEN

BABY FRIENDLY HOSPITAL INITIATIVE

THIS SECTION WILL ADDRESS STEP #3

INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS AND MANAGEMENT OF

BREASTFEEDING

Part One

AT THE CONCLUSION OF THIS SECTION, YOU WILL BE ABLE TO:

IDENTIFY APPROACHES TO BREASTFEEDING PROMOTION THAT HAVE A POSITIVE IMPACT ON WOMEN IN THE PRENATAL PERIOD

The Baby Friendly Hospital Initiative

The World Health Organization (WHO) and UNICEF, specialized health agencies of the United Nations, and have recognized the health of all children as a global priority. One of their many activities is to advocate for and promote programs to increase rates of exclusive breastfeeding. The Baby Friendly Hospital Initiative is part of their program.

Improved breastfeeding alone could save the lives of more than 3,500 children every day, more than any other preventive intervention.

INNOCENTI DECLARATION On the Protection, Promotion and Support of Breastfeeding

July 30 - August 1, 1990, Florence, Italy

WHO/UNICEF held a policymakers' meeting on "Breastfeeding in the 1990’s: A Global Initiative”. The Innocenti Declaration was produced and adopted by the participants at this meeting.

The INNOCENTI DECLARATION states that

• Breastfeeding is the global goal for optimal maternal and child health and nutrition

• Reinforcement of a "breastfeeding culture“ is needed

• Obstacles to breastfeeding within the health system, the workplace and the community must be eliminated

• All women are to be adequately nourished for their optimal health

• All governments should develop national breastfeeding policies

• All national authorities are further urged to reinforce all actions that protect, promote and support breastfeeding

Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding

November 22, 2005, Florence, Italy

The WHO/UNICEF reconvened on the 15th Anniversary of the Innocenti Declaration.

They declared that this document remains valid and these actions are urgent and necessary to ensure the best start in life for our children.

International Supportfor Breastfeeding

The World Health Organization (WHO) recommends that children should continue to be breastfed for up to two years of age or beyond, while receiving nutritionally adequate and safe complementary foods.

The World Health Organization (WHO) felt so strongly about breastfeeding they conducted an intensive world-wide study between 1997 and 2003 to develop growth charts based on the breastfed child as the biological norm for growth.

The WHO Multicentre Growth Reference Study assessed the physical growth, nutritional status and motor development in ~8,500 children from six countries. The U.S. site was located at the University of California at Davis.

The new growth charts can be accessed at: http://www.who.int/childgrowth/en/

United States agencies who support and promote Breastfeeding

US Department of Health and Human Services (DHHS)

Centers for Disease Control and Prevention (CDC) (USDA)

Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Breastfeeding Promotion and Support Is a Health Care Priority

As part of the US Healthy People 2010 Objectives, the national health objectives for breastfeeding are to increase the percentage of women who breastfeed to:– at least 75% at birth – 50% at six months– 25% at 12 months postpartum

The 2010 Objectives for exclusive breastfeeding are currently: – 40% through three months – 17% through six months.

The current breastfeeding patterns are far from the recommended levels.

UNICEF. Breastfeeding and complementary feeding; 1990-2000.

US Surgeon General’s Perspectives

“A fundamental aspect of the protection and promotion of health is to ensure individuals are able to make informed decisions in supportive environments. We have an ethical responsibility to ensure that mothers are fully aware of the health consequences of their infant feeding decisions. Breast milk is the best source of infant nutrition. When a mother chooses to breastfeed, we also have a responsibility to protect and support her decision by providing an environment that enables her to be successful.”

THE 25TH ANNIVERSARY OF THE SURGEON GENERAL’S WORKSHOP BREASTFEEDING AND HUMAN LACTATION: THE STATUS OFBREASTFEEDING TODAY, Steven K. Galson, MD, MPH RADM, USPHS Acting Surgeon General, Public Health Reports / May–June

2009 / Volume 124:356-358

HHS Blueprint for Action on Breastfeeding

U.S. Department of Health and Human Services Office on Women’s Health, 2000

This ‘Blueprint for Action’ establishes a comprehensive breastfeeding policy for the nation.

“Significant steps must be taken to increase breastfeeding rates in the United States and to close the wide racial and ethnic gaps in breastfeeding. This goal can only be achieved by supporting breastfeeding in the family, community, workplace, health care sector, and society.”

National Media Campaign

The Department of Health and Human Services(DHHS) and The Ad Counsel developed a print and television ad campaign to promote breastfeeding.

Launched June 2004, Ended April 2006

Professional Organizations Support Breastfeeding

The American Academy of Pediatrics (AAP)

The American Academy of Family Physicians (AAFP)

The American College of Obstetricians and Gynecologists (ACOG)

The International Lactation Consultant Association (ILCA)

American Dietetic Association (ADA)

Academy of Breastfeeding Medicine (ABM)

American Public Health Association (APHA)

American College of Nurse-Midwives (ACNM)

American Academy of Pediatrics (AAP) Policy on Breastfeeding

February 2005

“Exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child. “

AMERICAN ACADEMY OF PEDIATRICS (AAP)POLICY STATEMENT

The AAP goes to say in their policy statement that all pediatricians need to “promote, support, and protect

breastfeeding enthusiastically”. And that breastfeeding needs to be viewed as the “cultural norm” for infant feeding.

“Evidence continues to mount regarding the value of breastfeeding for both women and their infants. The American College of Obstetricians and Gynecologists strongly support breastfeeding and calls on its Fellows, other health care professionals caring for women and their infants, hospitals, and employees to support women in choosing to breastfeed their infants. Obstetrician-gynecologists and other health care professionals caring for pregnant women should provide accurate information about breastfeeding to expectant mothers and be prepared to support them should any problems arise while breastfeeding.”

American College of OB-GYNACOG Committee Opinion

Committee on Health Care for Underserved WomenCommittee on Obstetric Practice

February 2007

Pediatricians and the Promotion and Support of Breastfeeding Lori B. Feldman-Winter, MD, MPH; Richard J. Schanler, MD; Karen G.

O’Connor, BS; Ruth A. Lawrence, MD Arch Pediatr Adolesc Med. 2008;162(12):1142-1149.

However, in a recent study of Pediatrician’s attitudes toward breastfeeding, the results showed that their attitudes have deteriorated.

The ‘Guilt’ Factor

Many health care providers worry that if they advocate for breastfeeding, they will make parents feel guilty. Research actually shows that parents will feel less guilt if they have had the opportunity to make a fully informed decision on how they will feed their baby. (1)

“Marketing” by Health Care Providers

Health care providers have been aggressively solicited by manufacturer’s of human milk substitutes to market their products and develop brand loyalty. The use of ‘free’ give-away’s, such as conferences, free samples, patient literature, office supplies with their logo, have been shown to “decrease breastfeeding rates and increase premature weaning”. (2)

BREASTFEEDING PROMOTION

AN EARLY AND CONSISTENT MESSAGE ON THE POSITIVE HEALTH BEHAVIOR OF

BREASTFEEDING NEEDS TO COME FROM ALL HEALTH CARE PROVIDERS

In support of breastfeeding, ACOG and the AAP developed a

“Breastfeeding Handbook for Physicians” in 2006.

“As leaders of the medical team, both play a role in promoting breastfeeding to their patients. But numerous studies have shown that lack of knowledge and training in lactation issues prevents them from doing so.

According to ACOG and AAP, the handbook will encourage physicians to become champions of breastfeeding and to be able to teach, promote, and support the practice.”

Promotion and support from the healthcare team

Studies have shown that the physician's recommendation to breastfeed increases breastfeeding initiation and duration rates.

Ongoing parental support through in-person visits and phone contacts with health care providers results in increased breastfeeding duration.

Fathers

The role of a father has been shown to be one of the most powerful influences on a mother’s decision to breastfeed in

the United States. To support and increase breastfeeding initiation and

continuation, the opinion, attitude, and the father’s knowledge about

breastfeeding and his relationship to his baby and the baby’s mother must

be considered.

Extended Family Support

Encouragement from the maternal grandmother is an important factor in the initiation of breastfeeding.

What Can Be Done to Help Mothers Breastfeed Successfully?

“There are many opportunities for creating a supportive environment for breastfeeding through the media, the health care system, the workplace, our community support systems, and all levels of our educational system. By investing in efforts to eliminate barriers, we can ensure that all children will have the very best start in life.” (21)

Basic breastfeeding education is needed in professional

education so all health care providers can educate, support,

and appropriately refer their patients (19-21)

*

Despite growing evidence of the health risks of not breastfeeding, research shows that physicians do not receive adequate training about supporting breastfeeding. (22, 23)

Health Care Systems play a central role in the promotion

and support of breastfeeding. A mother’s experiences during preconception and prenatal

visits, the hospital stay, postpartum and pediatric visits

can potentially contribute to her infant feeding decisions and,

ultimately, to her breastfeeding success. (24-28)

Breastfeeding can be established as the norm by incorporating infant feeding education into the health and science curricula in public education at all levels.

Mother-to-mother supportAll pregnant and

breastfeeding women should have access to

effective, culturally appropriate breastfeeding

support from mothers, who are their peers, families,

and communities.

Workplace All businesses and educational centers must create an environment that fully

supports breastfeeding mothers.

Many studies have shown that women who are employed while their children are young initiate breastfeeding at the same rate as unemployed women, but they stop exclusive breastfeeding sooner and wean earlier. (29-36)

Health care providers are in a unique position to enhance a mother's breastfeeding success as she transitions back into the workplace. (37)

Proposed National Legislation to Support Working Mothers

US Rep. Carolyn Maloney from New York, has been an advocate for employed women for many years.

On Thursday June 11, 2009, she reintroduced the Breastfeeding Promotion Act

(H.R. #2819 - 2009 version) on Capitol Hill.

US Senator Jeff Merkley from Oregon

simultaneously introduced a companion Senate bill (S. #1244).

The Proposed Breastfeeding Promotion Act includes five provisions:

(1) To amend the Civil Rights Act of 1964 to protect breastfeeding in the workplace. This would ensure that women cannot be fired or discriminated against in the workplace for expressing milk or breastfeeding during lunch or breaks.

(2) To provide tax incentives for businesses that establish private lactation areas in the workplace. With more than half of mothers with infants (< one year of age) in the work force, it is important to promote a mother-friendly work environment. The bill would encourage employers to set up a safe, private, and sanitary environment for women to express (or pump) breast milk by providing a tax credit for employers who set up a lactation location, purchase or rent lactation-related equipment, hire a lactation consultant or otherwise promote a lactation-friendly work environment.

(3) To provide for a performance standard for breast pumps. The bill would require the Food and Drug Administration to develop minimum quality standards for breast pumps to ensure that products on the market are safe and effective based on efficiency, effectiveness, and sanitation factors.

(4) To allow breastfeeding equipment to be tax deductible for families. The bill would amend the tax laws to include breastfeeding equipment and services as deductible medical care expenses.

(5) To protect the privacy of breastfeeding mothers. The bill would require employers to provide break time to express breast milk as well as make reasonable efforts to provide a private place for mothers to do so.

Breastfeeding is recognized by the international, national, and professional community as a desired health behavior for all mothers and their children. As health care providers, we need to continue our efforts to promote, protect and support breastfeeding.

Question

The U.S. Healthy People 2010 Goals are:

a) 100% at birth, 75% at 6 months and 50% at 1 yearb) 75% at birth, 50% at 6 months and 25% at 1 year

(*correct answer: These are the goals set for 2010.)

a) 50% at birth, 25% at 6 months and 15% at 1 yearb) 75% at birth, 40% at 3 months and 17% at 6 months

Question

A national breastfeeding policy has been developed and can be found in the:

a) Academy of Breastfeeding Medicine Policyb) American Academy of Pediatrics Policyc) HHS Blueprint for Action on Breastfeeding (* correct answer: The Blueprint for Action is the U.S. Policy on Breastfeeding)

a) American College of Ob-Gyn Policy

Question

Initiation of breastfeeding is important to the mother when support comes from all of the following, except:a) The maternal grandmotherb) Father of the babyc) American Medical Association (* correct answer:

The AMA is in support of breastfeeding, however they are not a direct influence on a mother’s initiation of breastfeeding)

d) Her health care provider

QuestionTo create a supportive breastfeeding environment

in the U.S., we need to:

a) Encourage all businesses to support breastfeedingb) Provide for mother-to-mother community supportc) Incorporate breastfeeding into the health/science curriculum of

public educationd) Have health care systems provide evidence-based women’s

health caree) Integrate a breastfeeding curriculum into HCP’s professional

educationf) All of the above (* correct answer)

Bibliography

1. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical professional. 6th ed. St. Louis: Mosby, 2005.2. Gartner LM, Morton J, Lawrence RA, et al., for the American Academy of Pediatrics Section on Breastfeeding. Breastfeeding

and the use of human milk. Pediatrics. 2005;115(2):496-506.)3. .Jones G, Steketee RW, Black RE, et al. How many child deaths can we prevent this year? Lancet 2003;362:65–71.4. Horta BL, Bahl R, Martinés J, et al. Evidence on the longterm effects of breastfeeding: systematic reviews and metaanalysis.

2007. (http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf )5. Bentley M, Caulfield L, Gross S, et al. Sources of influence on intention to breastfeed among African-American women at

entry to WIC. J Hum Lact 1999; 15(1):27–34.6. U.S. Preventative Services Task Force. Behavioral Interventions to Promote Breastfeeding: Recommendations and Rationale.

Agency for Healthcare Research and Quality, Rockville, MD, 2003.7. Sikorski J, Renfrew M, Pindoria S, Wade A. Support for breastfeeding mothers: A systematic review. Paediatr Perinatal

Epidemiol 2003;17(4):407–417.8. de Oliveira M, Camacho L, Tedstone A. A method for the evaluation of primary health care units’ practice in the promotion,

protection, and support of breastfeeding: Results from the state of Rio de Janeiro, Brazil. J Hum Lact 2003;19(4):365–373.9. Lu MC, Lange L, Slusser W, Hamilton J, Halfon N. Provider encouragement of breast-feeding: evidence from a national

survey. Obstet Gynecol. 2001;97(2):290-295. 10. Velillas JJ, et al. A breastfeeding e-learning project based on a web forum. Breastfeeding Medicine. 2007;2(4):219-228. 11. Bunik M, Gao D, Moore L. An investigation of the field trip model as a method for teaching breastfeeding to pediatric

residents. J Hum Lact. 2006;22(2):195-202.12. Rogan WJ. Pollutants in breast milk. Arch Pediatr Adolesc Med. 1996;150(9):981-990. 13. Littman H, Mendendorp SV, Goldfarb J. The decision to breastfeed. The importance of the father’s approval. Clin Pediatr

(Phila). 1994;33(4):214-219. 14. Scott JA, Binns CW, Aroni RA. The influence of reported paternal attitudes on the decision to breast-feed. J Paediatr Child

Health. 1997;33(4):305-307. 15. Sharma M, Petosa R. Impact of expectant fathers in breast-feeding decisions. J Am Diet Assoc. 1997;97(11):1311-1313. 16. Mahoney MC, James DM. Predictors of anticipated breastfeeding in an urban, low-income setting. J Fam Pract.

2000;49(6):529-533. 17. Moxley S, Kennedy M. Strategies to support breastfeeding. Discarding myths and outdated advice. Can Fam Physician.

1994;40:1775-1781. 18. O'Campo P, Faden RR, Gielen AC, Wang MC. Prenatal factors associated with breastfeeding duration: recommendations for

prenatal interventions. Birth. 1992;19(4):195-201.

Bibliography

19. Naylor AJ, Creer AE , Woodward-Lopez G, Dixon S. Lactation management education for physicians. Semin Perinatol 1994;18:525-31. 20. Satcher DS . DHHS blueprint for action on breastfeeding. Public Health Rep 2001;116:72-3.21. “Investing in California’s future” Breastfeeding Promotion Committee , California Department of Health Report to the Services Primary

Care and Family Health Division, January~2007. 22. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National assessment of physicians' breast-feeding knowledge, attitudes,

training, and experience. JAMA. 1995;273(6):472-476. 23. Freed GL, Clark SJ, Curtis P, Sorenson JR. Breast-feeding education and practice in family medicine. J Fam Pract. 1995;40(3):263-269. 24. Lewallen LP , Dick MJ, Flowers J, et al. Breastfeeding support and early cessation. J Obstet Gynecol Neonatal Nurs 2006;35:166-72. 25. Labarere J, Gelbert-Baudino N, Ayral AS , et al. Efficacy of breastfeeding support provided by trained clinicians during an early, routine,

preventive visit: a prospective, randomized, open trial of 226 mother infant pairs. Pediatrics 2005;115:e139-46. 26. Chapman DJ, Damio G, Young S, Perez-Escamilla R. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina

population: a randomized controlled trial. Arch Pediatr Adolesc Med 2004;158:897-902.27. Coutinho SB, de Lira PI , de Carvalho Lima M, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive

breastfeeding. Lancet 2005;366:1094-100.28. Bonuck KA, Trombley M, Freeman K, McKee D. Randomized, controlled trial of a prenatal and postnatal lactation consultant intervention

on duration and intensity of breastfeeding up to 12 months. Pediatrics 2005;116:1413-26. 29. Greiner T. Factors associated with the duration of breastfeeding may depend on the extent to which mothers of young children are

employed. Acta Paediatr. 1999:88(12): 1311-1312.30. Lindberg LD. Women’s Decisions about Breastfeeding and Maternal Employment. Journal of Marriage and Family. 1996:58(1):239-252.31. McLeod D, Pullon S, Cookson T. Factors influencing continuation of breastfeeding in a cohort of women. J Hum Lact. 2002:18(4):335-342.32. Novotny R, Hla MM., Kieffer EC, Park CB, Mor J, Thiele M. Breastfeeding duration in a multiethnic population in Hawaii. Birth.

2000:27(2):91-96.33. Roe B, Whittington LA, Fein SB, Teisl MF. Is there competition between breast-feeding and maternal employment? Demography.

1999 :36(2) :157-171. 34. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with

breastfeeding discontinuation. Pediatrics. 2003:112(1):108-115.35. Vogel A, Hutchison BL, Mitchell EA. Factors associated with the duration of breastfeeding. Acta Paediatr. 1999:88(12):1320-1326.36. Yinyam S, Morrow M. Breastfeeding practices among employed Thai women in Chiang Mai. J Hum Lac. 1999:15(3):225-232.37. Angeletti , MA, Breastfeeding Mothers Returning to Work: Possibilities for Information, Anticipatory Guidance and Support from US

Health Care Professionals Journal of Human Lactation, May 1, 2009, Vol. 25, No. 2, 226-232 (2009)