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Analysis: Importance of Nurse Involvement 

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Analysis: Importance of Nurse Involvement 

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Nurses report that the expectation to support breastfeeding women and families does not match their preparation, especially when attempting to attain the Baby-Friendly hospital designation.

Nurse involvement in this problem is essential. Nurses are expected to deliver quality care to breastfeeding mothers but nurses are reporting that they do not have the tools to do so. Policies that are already in place are not working. Bedside nurses are often the first and only lactation support that new mothers receive so their input is essential to improving breastfeeding rates.

Mueller, K. (2015).

Position of the American Dietetic Association: Promoting and Supporting Breastfeeding. (2005).

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Analysis: Challenges and Barriers to Nurse Involvement. 

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Analysis: Challenges and Barriers to Nurse Involvement. 

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One of the challenges that nurses face is respecting the patient's wishes if they choose to bottle feed but also trying to make sure that the patient is informed in their decision.

Many nurses rely on their personal experiences with breastfeeding rather than following evidence based practice.

Inadequate support and training makes it difficult for nurses to help patients who are having difficulty with latch.

Staffing can be a barrier. When staffing is low it is difficult for the nurse to fully support a new mother who may be having difficulty with latching or feeling confident in her abilities to breastfeed.

ANA ISSUE BRIEF - nursingworld.org. (2010)

Mueller, K. (2015)

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Patient Support and Education

Support patients and build a sense of confidence in their ability to breastfeed their baby.

Provide teaching in the antepartum stage as well the postpartum period.

Take a Leadership Role

Endorse the World Health Organization's recommendations for breastfeeding for six months.

Create lactation teams that can assist mothers who are experiencing difficulty breastfeeding and address more complicated cases such as newborns in the neonatal intensive care unit.

Advocacy

Ensure that women who require assistance obtaining breast pumps are set up with resources such as Women Infant and Children (WIC) prior to discharge.

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What is the problem?

Infants not being exclusively breastfed for the recommended time period of 6 months.

The current recommendation, as outlined by the American Academy of Pediatrics, is that infants be exclusively breastfed until 6 months of age and then supported with breast milk until 1 year of age as age appropriate foods are introduced.

More than 80% of mothers start out breastfeeding their infants in the early postpartum period however, according to the CDC, only 1 in 4 infants continue to be exclusively breastfed by the time they are 6 months of age.

Who is affected?

Non-Hispanic, black women are less likely to continue exclusively breastfeeding their infants until 6 months of age.

Infants whose mothers returned to work after giving birth.

Mothers who did not receive adequate lactation teaching and support during the early postpartum period.

Infants born in the south Atlantic region of the United States.

Infants born to mothers less than 24 years of age.

Low-birth-weight infants.

How?

Exclusive breastfeeding during the first six months of life has been proven to have lasting health benefits that extend into adulthood.

Any formula use in the first 6 months showed an increase incidence of otitis media.

Any formula use in the first three months showed an increased incidence of atopic dermatitis, diabetes, asthma and lower respiratory tract infections.

When?

Although the American Academy of Pediatrics and the World Health Organization recommend breastfeeding until at least 1 year of age, exclusive breastfeeding that is associated with decreased mortality and morbidity rates  in infants occur within the first 6 months of age.

Why?

Factors that contribute to the early cessation of exclusive breastfeeding include breast pain, poor infant weight gain, inadequate lactation support and education, poor latch and lack of a designated area to pump at places of employment.

Breastfeeding. (2018, August 06)

Facts | Breastfeeding | CDC. (n.d.)

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Direct infant health disparities linked to not exclusively breastfeeding

Infants who are not exclusively breastfed for the first 6 months of life have an increased occurrence of otis media, gastroenteritis, child asthma, hospitalization episodes for lower respiratory tract infections, necrotizing enterocolitis, atopic dermatitis, childhood leukemia, sudden infant death syndrome, type 1 diabetes, and obesity

Breast milk contains immunologic properties that protect the newborn against illness.

Sudden Infant Death Syndrome which is twice as great for formula-fed infants compared with breastfed infants.

Children that are breastfed experience an overall 72 percent reduction in the risk of hospitalization due to lower respiratory tract diseases

Economic and healthcare disparities linked to not exclusively breastfeeding

The USDA estimates that at least $3.6 billion could be saved in health care costs if breastfeeding rates were increased from current levels to those recommended by the US Surgeon General.

Facts | Breastfeeding | CDC. (n.d.)

Implementing a Breastfeeding Toolkit for Nursing Education. (2018)

Position of the American Dietetic Association: Promoting and Supporting Breastfeeding. (2005)
Role-In-Supporting (2016)
ANA Issue Brief (2-10)

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With only 3.79 licensed lactation consultants available for every 1000 live births, bedside nurses are the main source of lactation support and education for a new mother. The nurses current role is to educate the new mother on positioning during feedings, latch support, how and when to pump, and promote an overall positive breastfeeding experience so that the new mother can be discharged from the hospital feeling confident in her knowledge and abilities to breastfeed her baby.

The World Health Organization has set up a plan of ten steps for healthcare facilities to follow in order to promote breastfeeding success. Sentara facilities currently use these ten steps as the framework to ensure successful breastfeeding for their patients. Attached below is the World Health Organization's ten steps to successful breastfeeding.
Is it working?

Women who have not been successful with breastfeeding cite lack of support by healthcare professionals as a reason they were not successful at meeting their breastfeeding goals.

Nurses who were polled said that they did not feel adequately trained to successfully support breastfeeding mothers.

Women seek breastfeeding advice from healthcare professionals, yet information provided to them is often inconsistent or conveys conflicting messages that can negatively affect their breastfeeding experiences.

Breastfeeding support is often based on personal experiences versus the evidence or best practice.

ANA ISSUE BRIEF - nursingworld.org. (2010).
Breastfeeding. (2018, August 06)

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Two Circular Concepts
Evidence Based practice

Evidence supports the push for exclusive breastfeeding for the first six months of life.

Infants who are breastfed experience fewer ear infections, a decreased rate of sudden infant death syndrome, decreased rates of childhood obesity and type 1 diabetes.

Exclusive breastfeeding protects the infant against illnesses such as respiratory infections and gastrointestinal infections.

In addition to benefits for the infant, exclusive breastfeeding has added benefits for the mother that include decreased rates of postpartum depression, decreased risk of breast and ovarian cancer and decreased postpartum bleeding.

ANA ISSUE BRIEF - nursingworld.org. (2010)

Mueller, K. (2015)

Measures by nurses that support breastfeeding success contribute to the overall health and well being of both the infant and mother.

Patient support and Advocacy

Patients who were not successful in breastfeeding noted that they did not feel as though they received enough support from medical staff during their hospital stay.

Breastfeeding rates are initially high when patients are discharged from the hospital but take a sharp decline once they've left due to lack of support offered while in the hospital and in the community which contributed to not feeling confident in their ability to carry out exclusive breastfeeding.

New mothers need support and education to successfully carryout breastfeeding. Many mothers feel defeated when breastfeeding is not as easy as they expected. Mothers who must return to work after delivery need someone to advocate for them so that they receive the proper equipment needed to continue offering breast milk to their infant.

Leadership Role:
These two circular concepts that I have learned while I've been a student at SCOHS have empowered me to step into a leadership role in my professional career. Evidence based practice is at the center of nursing practice. Everything nurses do should be based off of evidence and because evidence is always growing and evolving, nursing practice does the same. It is up to nurses to continue their education and create new policies as new evidence is available so that we can always provide quality care to our patients. This goes hand in hand with patient support and advocacy. As an advocate for my patients, I will always want to practice nursing in a manner that follows the most recent evidence available.