Breastfeeding Promotion

This essay is focused on breastfeeding as a key public health issue in health promotion in midwifery practice. After presenting a case study involving a client who has a potential breastfeeding issue, the aim will is to achieve a positive outcome using health promotion models. Relevant theories and literature are then explored and the implications for midwifery practice and care planning critically evaluated. The protection, promotion and support of breastfeeding are one a vital convern in public health throughout Europe. It is widely acknowledged that low rates and early cessation of breastfeeding have important health and social implications for women, children and the community as a whole. As the World Health Organization (WHO) reports, health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. There is strong research support for the claim that breast milk is the most appropriate nourishment for most infants. The benefits of breastfeeding are physical, emotional, and economic. Therefore, mothers should be encouraged and supported to breastfeed, though they should not be made to feel guilty or inadequate if circumstances interfere with their ability to do so. CLINICAL SCENARIO

The chosen scenario involves Sam, a pseudonym to protect her anonymity and thus respect confidentiality (NMC, 2008). Sam is a 22-year-old British primipara currently living with her parents because she is unemployed. However, she has good emotional and economic support from her partner and parents. At the booking interview, which she attended with her boyfriend, she was considered by the midwife as low-risk because she had no previous social, medical or obstetric problems. Both cooperated well, but they clearly didn’t have enough information about the process of motherhood and childbirth; by the time the midwife asked them about breastfeeding, Sam seemed a little disappointed (reluctant?) about it because she thought that her shape would change, and also about how painful the process was going to be. She thought there was no difference between breast and formula milk, so she considered that formula milk feeding her future baby would be the most comfortable choice. WOMEN´S HEALTH NEEDS WHITIN THE CASE STUDY

It is important to consider factors influencing health education, whether socioeconomic, cultural or ethnics, to identify what women want to learn and how they can achieve maximum learning. In this clinical scenario, Sam is English, so clearly language is not an issue in her care provision; she has good emotional and economic support from her family but is unemployed, which has important knock-on effects for her pregnancy and the family’s life thereafter. Sam’s status as a young first-time mother might be a concern, as it is well known that younger woman are more likely to bottle feed their babies. Another point to address is that Sam appeared at the booking appointment not to have any information about the benefits of breastfeeding, and it was important to focus on giving the correct information to help her to make the best decision for her and her baby. Expectant and new parents have the right to full, correct and independent infant feeding information, including guidance on safe, timely and appropriate complementary feeding, so that they can make informed decisions.

ROLE OF THE MIDWIFE and HEALTH PROMOTION (midwifery) THEORIES Breastfeeding is a very important aspect of public health that concerns especially young women. Young women today do not have the necessary information and are not aware of the advantages of breast milk; this is where the midwife has a crucial role, because giving the right support and education promotes breastfeeding and reduces the number of women who choose to feed their children with formula milk because they believe the benefits are the same. “The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period. Conducting births is the midwife’s responsibility, as is providing care for the newborn and the mother. The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units” (International Confederation of Midwives 2005). Marina: check this quote. I had to change it to make it make sense. So either copy it EXACTLY and keep the quotations, OR use quotations only around the quoted bits, O.K? Breastfeeding plays a major role in public health, promoting health in both the short and long term for baby and mother. According to Nice 2008, UK has one of the lowest rates of breastfeeding worldwide, especially among families from disadvantaged groups,including white young women, which is the case of Sam. That is why the role of the midwife regarding breastfeeding is so important, because they need to promote and educate women, working in partnership with them, from start to finish. Giving the correct support could make the difference for a woman at the time of choosing whether to breast feed her baby or not. The continuation of care in midwifery is an important contribution to the quality by supporting the development of meaningful and therapeutic relationships between mother and baby.

Estabrooks et al. 2005; Hodnett, Gates, & Hofmeyr 2007 argue that it also enables midwives to act as a ‘bridge’ across services to integrate care, resulting in improved outcomes. Following the Department of Health (2008), it can be concluded that midwives are expected to be knowledgeable and highly skilled advocates for the women in their care, accountable for the quality of the care they give and the services they manage, and able to measure and articulate the quality of their care. In essence midwives understand that childbirth and raising a family are more than just a medical event and that the outcomes depend on the mother and the family’s social and psychological circumstances as much as on the input of health professionals. (Midwifery 2020, 2010). This is why midwives should work in partnership with women and their families, facilitating decisions about the care they feel they require, and providing personal support, considering each woman as an individual.

In Sam’s case, the most important role of the midwife at the booking interview was to be comprehensive, giving complete evidence-based practice information about breast feeding, encouraging her to do it giving support, and making the appropriate referrals to the specialist community groups that could help her with breast feeding. National and International statistics (WHO 2001), demonstrate that it remains easier to motivate women to initiate breastfeeding than to sustain it. Evidence highlights two motivational factors, women’s lack of confidence and professional support (Avery et al. 1998, Dodgson et al. 2003, Chezem et al. 2003). It was theorized that if midwives’ instruction was confidence-building, women’s persistence would increase. That is one of the reasons the midwife has the role of being confident and close to the client, building trust in the therapeutic relationship and being professional at all times. Effective support on the individual level means that all women should have access to infant and young child feeding supportive services. These services include assistance from appropriately qualified midwives and lactation consultants, peer counsellors, and mother-to-mother support groups.

This role, however, is greatly facilitated where the structure, routines and procedures, counselling in particular, within antenatal care, maternity, neonatal and paediatric wards, as well as other services responsible for follow-up after discharge, consider breastfeeding as a priority and are organised in a baby-friendly way. The impact of breastfeeding on early childhood development is being increasingly recognized. For example, the United Nations Children’s Fund, UNICEF, includes breastfeeding under the broader department dealing with Early Child Development. The WHO defines optimal breastfeeding as exclusive breastfeeding for six months, followed by continued breastfeeding with appropriate complementary feeding up to and beyond two years of age. Breastfeeding is considered a natural act, but it is also a learned behaviour, which is why mothers require active support to establish and sustain appropriate breastfeeding practices. WHO and UNICEF launched the baby-friendly Hospital Initiative in 1992, to strengthen maternity practices to support breastfeeding.

The foundation for the BFHI are the Ten Steps to Successful Breastfeeding described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF Statement. A careful reading of the UNICEF baby-friendly initiatives, it can be said that the ten steps to successful breastfeeding is a very helpful guide to acquiring the knowledge necessary to be able to do breastfeeding promotion and education, as stated in step 3 [inform all pregnant women about the benefits and management of breastfeeding]. The head of the maternity service should require that breastfeeding information be given to most pregnant women in the care of the service. Additionally,the midwife should be aware of any breastfeeding support groups in the local area and, if there are any, refer mothers to at least one of them. It is also important to consider the role of the midwife within breastfeeding promotion. Tannahill´s model was chosen for Sam´s case because it emphasises the principals of education, prevention and protection of health. Tannahill’s model describes the different aspects of health promotion, and is used to critically evaluate how the midwife needs to approach an issue, following the three overlapping circles of activity explained in Tannahill´s model which are health education, prevention and health protection.

Health Education is communication aimed at preventing ill health and enhancing well-being. If it is achieved successfully, knowledge is increased, and beliefs and attitudes are influenced in favour of healthy behaviour. It has been clearly demonstrated than health education was pivotal in Sam’s case as she presented not knowing anything about the benefits or inconveniences of breastfeeding her baby. That is why, at that point, the midwife and student midwife had the responsibility to educate her in an sympathetically, appropriately and comprehensibly, giving her objective information. Naturally, each person has her own individual ways of learning or processing information. The majority learn by thinking, feeling and doing. (Health promotion in midwifery practice). Further to this, health protection includes policies, codes of practice and laws aimed at preventing ill health.

It can be undertaken at various levels such as national, general, individual, legislative or fiscal. As has been described above using Unicef baby friendly initiative, a midwife needs to follow evidence-based practice information when she has to support a client. Midwife and student midwife need to have the knowledge to give advice to the woman, and if the midwife does not have the information or the necessary skills to explain one topic, she needs to be able to make appropriate referrals. With regard to prevention, it has been concluded that it involves specific interventions aimed at avoiding contact with disease-producing risk factors, or reducing the harmful consequences of the disease process. At this point, regarding our clinical scenario, prevention was used when the benefits of breastfeeding, as well as the risk of bottle feed a baby since the first moment of life were explained to the client. The midwife needed to be aware of the woman’s fears about being able to prevent a wrong decision giving the correct information. ACTION PLAN FOR THE DEVELOPMENT OF MIDWIFERY SKILLS

At Sam’s booking interview, the midwife offered her complete information on the concept of breastfeeding, explaining the benefits for herself and the baby and the risks they might have by feeding their baby exclusively by bottle. It was carefully explained to her that body changes in a pregnant woman were totally normal and her breasts wouldn’t change their shape if she decided to breastfeed her baby. The scientific evidence supporting the beneficial effects of breastfeeding have been accumulating over several decades, (Elena Grant, Peter Golightly). For most women, breastfeeding is biologically possible and both babies and mothers gain many benefits from breastfeeding. There is strong research support that breast milk is the most appropriate nourishment for most infants. The benefits of breastfeeding are physical, emotional, and economic. Infants who are breastfed have lower rates of hospital admissions, ear infections, diarrhoea, rashes, allergies, and other health problems than babies who receive infant formulas.

Breastfeeding also benefits the mother as it helps to restore the physical appearance to what it was before the pregnancy, and facilitates weight loss. In addition, suckling stimulates uterine contractions and allows the uterus return to its normal former size. Breastfeeding can also protect against breast cancer; it also has psychological and emotional benefits, as the baby calms down, strengthens the bonds between mother and baby, and provides security for her when caring for her baby. In giving this information, the midwife was able to make Sam think about breastfeeding as an option. However, by doing this and promoting discussion, we enabled Sam to take her own decision and understood that whatever this was, we had to support it, even if we had a different opinion. Midwives are advocates for women and must avoid being judgmental. As another important intervention, breastfeeding antenatal classes were offered to Sam. Antenatal education is a window of opportunity for midwives to empower women and their families to be actively involved in developing decision-making skills in order to make choices. (J. Dunkley 2005).

It has been demonstrated that interactive sessions in groups have a positive impact on long term breastfeeding compliance (Dyson et al, 2005). The group decides the contents of the sessions and the midwife facilitates group discussions, offering information if the need arises and helping new mothers who join the group to settle in. The women not only learn from one another but also develop personal growth by sharing information and supporting each other; they enhance social support, which frequently continues beyond the postnatal period. (Leap 1991). It was explained to Sam that she could attend later on in her pregnancy, when her due date was closer, and at these classes she would be able to have a one to one meeting with a specialist midwife, and also the opportunity to join a group with other women with the same issues and questions. It was explained that antenatal groups consist of many different people from varying social and cultural backgrounds, and that each person has a different point of view about her decision to breastfeed her baby or not, which could be very helpful in making her own decision. It is important to understand and include the baby’s father in the protection and support of breastfeeding.

The role of a father has been shown to be one of the most powerful influences on a mother’s decision to breastfeed. 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. (Sharma M, Petosa R, 1997). At the booking interview one of the midwife’s interventions was to try to involve Sam’s boyfriend and discuss the advantages and disadvantages of breastfeeding. Combining interventions in the antenatal period with partner are influenced by a wide range of people around her; this includes parents, grandparents, and friends (NICE, 2008). Therefore, a positive attitude from Sam’s boyfriend could have a significant impact on her decision because support has been shown to have a positive impact on woman’s views of breast feeding.

In addition, the midwife reinforced all the information given to Sam with leaflets, guides and informative books, tailored to her when possible and aiming to reinforce the information provided (NICE, 2008). The midwife and student midwife provided information on further types of support available, explaining to Sam that there was a wide range of support for breastfeeding mothers either antenatally or postnatally in our community. This includes peer support and access to a breast feeding specialist midwife. Furthermore, in the long term she can have support and advice from the health visitor. It was felt that a strong relationship was built between the client and the midwife from the first moment, working in partnership with her, and answering Sam’s questions with an objective attitude and approach. CONCLUSION

During Sam’s interview, the midwife and student midwife did a good job giving to her evidence-based information, without making judgments, and working in partnership with her, explaining everything in a way that was easy for her to understand all the benefits of the breastfeeding, and referring her to the appropriate professionals for further appointments. Taking a critical view, it is clear that, in this case, the midwife and the student midwife provided the client with the correct support and appropriate information. The midwife and student midwife made the care of the client their first concern, treating her as an individual, respecting her dignity, and providing a high standard of practice and care at all times (the code 2010). On the other hand, Sam was genuinely helpful and listened carefully to the midwife whether her choice to bottle feed was made or not.

At the end of the appointment, she was very grateful for her treatment and told the midwife and student midwife that they had been very helpful, as she hadn’t known anything about the benefits of breastfeeding her baby before, and that, if she were to receive good support from the staff during the postnatal period, she would be happy to breastfeed her baby as well as she could. At this point it is fair to conclude how important it is to provide strong and impartial support and a complete education to women in the breastfeeding issue, having discussed all the benefits for both the baby and the mother. It is imperative to discuss these factors in the antenatal care for the mother to be ready to make a correct decision at the time of delivery. In light of this research and the information presented from different sources reported here, there is no doubt that breastfeeding is the best option to ensure the growth and development of the baby.

REFERENCES:

http://www.healthpromotionagency.org.uk/work/breastfeeding/pdfs/newblueprintprinter.pdf https://nice.org.uk/nicemedia/pdf/EAB_Breastfeeding_final_version.pdf http://www.nice.org.uk/nicemedia/documents/breastfeeding_evidencebriefing.pdf http://www.nhs.uk/conditions/pregnancy-and-baby/pages/breastfeeding-help-support.aspx#close http://www.breastfeeding.see.nhs.uk/

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