Course Content
Perinatal nurses play an extremely important role in the promotion of successful breast-feeding. During the perinatal period, there is a crucial window of opportunity, which enables the nursing staff to successfully provide the support and information necessary for breast-feeding. Understanding the impact that the Perinatal Nurse has upon the mother/infant breast-feeding dyad provides the nursing staff with a great deal of ability to remove the barriers that prevent or sabotage the success of breast-feeding.
One of the Association of Women's Health Obstetric and Neonatal Nursing (AWHONN) recommendations is to keep the mother and healthy newborn together after birth to promote the most optimal outcome of successful breast-feeding. It is very important to ensure that breast-feeding is initiated in the immediate postpartum period whenever possible. During the first hour after birth the infant is in a quiet/alert state and is receptive to breast-feeding. During this state, the infant is able to concentrate on the mother's voice, smell and touch. This is a critical time because the baby will follow a pattern of prefeeding behavior when held on the mother's chest immediately after birth that imprints proper sucking mechanisms. Once the initial latch on takes place, this imprinting effect of this early feeding makes it easier for the infant to later latch on and suck effectively.
Subsequently, the breast-feeding support provided by the nursing staff during the immediate days after birth is extremely important in the establishment of successful breast-feeding. breast-feeding, like any other physiological process, can be assessed. Nursing assessments that are inaccurate, based on assumption, or are completely lacking, may result in an outcome of infant nutritional deficiency, hypoglycemia, dehydration, and failure to thrive. Furthermore, in a clinical study by MacMullen and Dulski, medical procedures, examinations and over stimulation of the newborn lead to shutdown of normal feeding behaviors. As a result of inadequate nursing assessment and support, the maternal affects may include lack of breast stimulation and emptying necessary for adequate milk production, breast engorgement, sore nipples and the maternal feeling of inadequacy and failure.
Nursing assessments should include observation for proper infant positioning, correct latch on, elimination pattern and assisting patient in identifying newborn hunger cues. After milk production, assessment should include signs that milk transfer is occurring, and infant satiation cues can be noted. Potential breast-feeding problems to be identified include factors contributing to a reluctant nurser, inadequate nipple eversion, nipple pain, engorgement, plugged ducts and mastitis. It is imperative that a comprehensive objective nursing assessment is documented/communicated among the health care team in order to provide the support necessary to the mother/infant. The use of a breast-feeding assessment tool that encompasses the elements of breast-feeding will provide consistent guidelines for mother/infant feeding evaluation.
One of the more commonly used breast-feeding assessment tools is called the LATCH tool. This tool can be utilized to assess the mother and infant by further identifying areas where assistance is needed. The components to this tool assess the infants latch (L), audible swallowing (A), the mother's type of nipple (T), comfort with breast-feeding (C), and infant hold (H). A number score is assigned to each of the above letters, which correspond with an objective assessment. The nurse provides the necessary support needed that is identified by using the tool. This tool just offers one aspect available to assist the Perinatal nurse in providing successful support for the breast-feeding mother.
The role of the perinatal nurse in successful promotion of breast-feeding also includes knowledge of breast-feeding. Lack of knowledge and inconsistent advice may result in a negative experience for the mother. Nursing knowledge should encompass the anatomy and physiology of lactation, management of common concerns and problems with breast-feeding, and the benefits of breast-feeding. Collaborative work with lactation specialists and other health care providers should be utilized to optimize the breast-feeding experience for the mother and infant. Integration of culturally appropriate and sensitive patient education is also necessary and should include exploration of concerns, fears and myths that may inhibit successful breast-feeding. Nursing promotion of non separation of mother and infant should occur to provide flexible feedings and allow the mother to learn her newborn's feeding cues. When awake, the newborn should be encouraged to feed 8-12 times per day or even more frequently in order to stimulate breast milk production. Finally, providing information to the patient regarding breast-feeding resources in the community at the time of hospital discharge is essential for the patient to access as necessary. The ability to access community resources will further empower the patient to obtain support needed to ensure success.
Nursing access to information regarding breast-feeding resources is imperative. There are many sources of information and guidelines based on research easily accessible to the Perinatal Nurse. Many of these resources are free or of little cost and can be accessed on the Internet. The following information discussed is easily accessible and represents the tremendous impact a Perinatal Nurse has by supporting the mother/infant in breast-feeding. The professional organization of AWHONN is extremely supportive of breast-feeding and has a nursing "Guideline for breast-feeding Support" and a Clinical Position Statement specifically titled "breast-feeding." The guideline addresses nursing assessments, promotion of breast-feeding and measuring the outcome of successful breast-feeding. The Position Statement discusses AWHONN's support and commitment to continue to working towards increasing the number of breast-feeding women. While acknowledging that the advantages of breast feeding for the mother and infant are numerous and well supported by research, the following advantages are listed by AWHONN:
 |
The protein content of breast milk is digested more easily by the infant than the protein in breast milk substitute. |
|
|
The fatty acid and cholesterol content of breast milk is perfectly suited to the development of the infant's nervous system. In addition, the carbohydrate content of breast milk helps control the growth of bacteria and improve the absorption of important minerals. |
|
|
breast-feeding has been shown to decrease the incidence of certain bacterial and viral infections in babies, as well as decrease the frequency of certain allergic disorders. |
|
|
breast-feeding facilitates the immediate postpartum recovery by promoting uterine involution, thereby decreasing postpartum bleeding. |
|
|
breast-feeding women usually experience an earlier return to prepregnant weight and a delayed resumption of ovulation. |
|
|
Recent research suggests breast-feeding may play a role in reducing a woman's risk for premenopausal breast cancer and ovarian cancer. |
|
|
Well-documented economic benefits of breast-feeding include: significant cost savings compared to formula feeding; and reduction in health care costs with fewer occurrences of childhood illness. |
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists advocates breast-feeding and states "Because Human milk is the ideal food for neonates, mothers should be encouraged to breastfeed. The United Nation's Children's Fund (UNICEF) states that if every baby were exclusively breastfed, an estimated 1.5 million lives would be saved each year. UNICEF and The World Health Organization (WHO) developed the Baby Friendly Hospital Initiative as part of a world wide program to address breast-feeding. UNICEF and WHO advocate that every facility providing maternity services and infant care should practice the Ten Steps to Successful breast-feeding, which are as follows:
1.Have a written breast-feeding policy that is routinely communicated to all healthcare staff.
2.Train all healthcare staff in skills necessary to implement this policy.
3.Inform all pregnant women about the benefits and management of breast-feeding.
4.Help mothers initiate breast-feeding within a half-hour of birth.
5.Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
6.Give newborn infants no food or drink other than breast milk, unless medially indicated.
7.Practice rooming-in; allow mothers and infants to remain together 24 hours a day.
8.Encourage breast-feeding on demand.
9.Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants.
10.Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.
The Perinatal Nurse is a powerful resource and support for successful breast-feeding. Much of the process of successfully preparing and assisting the mother and infant with breast-feeding depends on the nurses established baseline knowledge, periodic review of the basics and staying current published research and information. As noted above, professional organizations have provided a tremendous amount of evidence-based information to impact the support of breast-feeding. The Perinatal Nurse must perpetuate a supportive breast-feeding practice.
Click Here for Post Examination