Maternity Care Practices and

Maternity Care Practices and

How They Affect Breastfeeding

Elizabeth Powers Moore

Midwife Clinic Lab I

SWTC

Because we all benefit!

Why Breastfeed?

• Saves money

• Easier

• Health benefits, with lower risks of

– Cervical and breast cancers

– Postpartum depression

– Type 2 diabetes

("Why breastfeeding is important | womenshealth.gov“)

Mother

• Immune system booster

• Easier to digest

• Changes as baby grows

• Lower incidences of disease

("Why breastfeeding is important | womenshealth.gov“)

Baby

• Savings of $13 Billion yearly from

unnecessary medical costs

• Parents miss less work due to sick child

• Enviromental impact: less trash

("Why breastfeeding is important | womenshealth.gov“)

Society

Maternity Care

Prenatal Care

• Medical History: Question client about

any history of surgery or disease

regarding breasts or pertinent hormonal

issues (Frye, 2010, p. 552)

• Examination of breasts/nipples for any

findings that could be problematic,

working to find best solution before birth

(Frye, 2010, p. 589)

Nutrition

• Establish a diet that will not only be

optimal for pregnancy, but will support the

extra dietary needs of breastfeeding.

• MORE: Whole grains, fruits, vegetables,

healthy fats, quality proteins, organics

when possible, homemade meals

• LESS: Refined carbohydrates, additives,

fast foods, prepared foods

(La Leche League International, 2004)

But..

Women should know that breastfeeding is

possible with a less than optimal diet, and

that it is not necessary to refrain from some

caffeine, alcohol and medications.

("How does a mother’s diet affect her milk? : KellyMom“)

Points for Discussion

with Clients

Perceived Barriers to

Breastfeeding

• Loss of personal freedom

• Jealousy (paternal/sibling)

• Physical discomfort

• Difficulty returning to work/school

• Lack of confidence in ability to feed baby

with breast milk alone(Moreland M.D. & Coombs P.A.-C, 2000)

(Office of the Surgeon General (US & Centers for Disease Control and Prevention)

More Benefits

• Mother-child bonding

• Promotes uterine involution

• More economical

• Healthier mom and baby

(Moreland M.D. & Coombs P.A.-C, 2000)

Practitioner

• Women may well be influenced about

breastfeeding by their practitioner’s

opinion.

• Many professionals are lacking in current

and/or correct information regarding

breastfeeding.

(Grossman et al., 2009)

A knowledgeable practitioner

can not only promote

breastfeeding more effectively,

but will have a higher

percentage of successful

breastfeeding mothers, both

initially and longer term.

(Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009)

(Grossman et al., 2009)

FOR FAMILIES

Support

SUPPORT• Le Leche League International is composed of

support groups for breastfeeding women, prenatal

attendance is encouraged

("LLLI | About La Leche League International“)

• The Wisconsin Special Supplemental Nutrition Program

for Women, Infants and Children (WIC), “provides

nutrition education, breastfeeding education and support,

supplemental nutritious foods, and referrals to other

healthy and nutrition services.”("Wisconsin WIC - Women, Infants and Children Home Page

)

• International Board Certified Lactation Consultant

(IBCLC)("International Lactation Consultant Association )

AN ONGOING DISCUSSION

Racial Disparities

According to Chapman & Perez-Escamilla,

“The gap between current breastfeeding

practices and the Healthy People 2020

breastfeeding goals is widest for black

women compared with all other ethnic

groups. Also of concern, Hispanic and black

women have the highest rates of formula

supplementation of breast-fed infants before

2 d of life.”

CHILDBIRTH

Breastfeeding and

Induction of LaborPitocin, while sometimes necessary, and indicated, can cause

problems for breastfeeding, including:

• Breast engorgement form its anti-diuretic effect

• Stressed infant, leading to difficulties to include resuscitation and/or

separation from mother

• And, according to Kroeger,

“the strong contractions resulting from induction or augmentation can

put more pressure on the occipital portion of the fetus’ head (back of

the head), potentially increasing the risk for cranial molding,

asymmetry, and cranial base misalignment, all of which could

negatively impact the functioning of the six cranial nerves involved in

sucking and swallowing during breastfeeding.”

("Pitocin Use and Breastfeeding Success - Natural Motherhood“)

A newborn’s initial weight can be inflated by

these fluids, and a false weight loss in the

first 24 hours postpartum can lead to

supplement with formula.

An accurate baseline weight should be

established 24 hours after birth.

(Noel-Weiss, Woodend, Peterson, Gibb, & Groll, 2011)

Maternal IV Fluids

Pain Meds in LaborNarcotic pain meds cross the placenta during labor and can

produce the following side effects in the baby:

• Central nervous system depression

• Respiratory depression

• Altered neurological behavior

• Decreased ability to regulate body temperature

These can all complicate the new breastfeeding

relationship(Cunningham et al., 2005)

Cesarean Section

In addition to the previous problems, surgical birth

has some added issues regarding breastfeeding:

• Difficulty in holding baby in good position due to

incision

• Separation from mother of baby, up to several

hours

• Several more days delay of milk supply coming

in (Evans, Evans, Royal, Esterman, & James, 2003, p. 380-2)

AFTER BIRTH

Immediate Concerns

Contact

• Immediately after birth, or as soon as

possible after, the infant should be placed

skin-to-skin with the mother.

• This contact should be extended, at least

till breastfeeding has begun.

(Fraser, Cooper, & Myles, 2009, p. 793-4)

SuctioningSuctioning of the infant can cause difficulty

with nursing in several ways:

• Muscles receive superstimulus, causing

permanent neural patterning

• Anteroposterior peristalsis from deep or

repeated suctioning can result in tongue

thrust

• Posterior palate irritation reverses the

correct peristalsis needed for suckling

(Frye, 2004, p. 1221)

THE GOLD STANDARD OF CARE

Baby-Friendly USA

.

"Health care systems should ensure that

maternity care practices provide education

and counseling on breastfeeding. Hospitals

should become more “baby-friendly,” by

taking steps like those recommended by the

UNICEF/WHO’s Baby-Friendly Hospital

Initiative.”

Regina A. Benjamin, MD, MBA

US Surgeon General("Baby-Friendly USA“)

Baby-Friendly hospitals and birthing facilities

must adhere to the Ten Steps to receive, and

retain, a Baby-Friendly designation

The Ten Steps to Successful Breastfeeding are:

• Have a written breastfeeding policy that is routinely

communicated to all health care staff.

• Train all health care staff in the skills necessary to

implement this policy.

• Inform all pregnant women about the benefits and

management of breastfeeding.

• Help mothers initiate breastfeeding within one hour of

birth.

• Show mothers how to breastfeed and how to maintain

lactation, even if they are separated from their infants.

• Give infants no food or drink other than breast-milk,

unless medically indicated.

• Practice rooming in - allow mothers and infants to

remain together 24 hours a day.

• Encourage breastfeeding on demand.

• Give no pacifiers or artificial nipples to breastfeeding

infants.

• Foster the establishment of breastfeeding support

groups and refer mothers to them on discharge from the

hospital or birth center.("Baby-Friendly USA“)

Maternity Practices in Infant

Nutrition and Care (mPINC)

Survey

is a national survey of maternity care

practices and policies that is conducted by

the CDC. The survey is administered to all

hospitals and birth centers with registered

maternity beds in the United States and

Territories.

("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)

Survey | DNPAO | CDC“)

CDC calculates scores for every facility and state to

indicate their performance on the mPINC survey. Criteria

includes:

Labor and delivery care

Postpartum feeding of breastfed infants

Breastfeeding assistance

Postpartum contact between mother and infant

Facility discharge care

Staff training

Structural and organizational aspects of care

delivery

("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)

Survey | DNPAO | CDC“)

Responses are scored using an algorithm

developed and reviewed by experts in the

field denoting the evidence and best

practices to promote breastfeeding within

the health care setting. Possible scores

range from 0—100, with higher scores

denoting better maternity care practices and

policies

("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)

Survey | DNPAO | CDC“)

• Margaret, a 29 yo primigravida, 40/4 weeks gestation, is

admitted to the hospital for induction.

• After 6 hours of Pitocin drip, it is decided that her baby

will be delivered by cesarean section.

• The 6lb. 1oz. baby boy needs deep suctioning and tactile

stimulation, before being taken to the nursery for

observation

• Margaret is not able to hold or attempt nursing for six

hours, and she is on narcotic pain meds

What problems might occur during

breastfeeding?

References

Baby-Friendly USA. (n.d.). Retrieved from http://www.babyfriendlyusa.org/

Bartick, M., Stuebe, A., Shealy, K. R., Walker, M., & Grummer-Strawn, L. M.

(2009). Closing the Quality Gap: Promoting Evidence-Based Breastfeeding

Care in the Hospital. Pediatrics, 124(4), 793-802. doi:10.1542/peds.2009-0430

Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care

(mPINC) Survey | DNPAO | CDC. (n.d.). Retrieved from

http://www.cdc.gov/breastfeeding/data/mpinc/index.htm

Chapman, D., & Perez-Escamilla, R. (2012). Breastfeeding Among Minority

Women: Moving From Risk Factors to Interventions. Advances in Nutrition,

3(1), 95-104. Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262621/

Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Gilstrap, L., &

Wenstrom, K. D. (2005). 19. In Williams Obstetric (22nd ed.). San Francisco,

CA: McGraw-Hill.

Evans, K. C., Evans, R. G., Royal, R., Esterman, A. J., & James, S. L. (2003).

Effect of caesarean section on breast milk transfer to the normal term newborn

over the first week of life. Archives of Disease in Childhood-fetal and Neonatal

Edition, 88(5), 380-82. doi:10.1136/fn.88.5.F380

.

Evans, K. C., Evans, R. G., Royal, R., Esterman, A. J., & James, S. L. (2003).

Effect of caesarean section on breast milk transfer to the normal term newborn

over the first week of life. Archives of Disease in Childhood-fetal and Neonatal

Edition, 88(5), 380-82. doi:10.1136/fn.88.5.F380

Fraser, D., Cooper, M. A., & Myles, M. F. (2009). Infant Feeding. In Myles

textbook for midwives (15th ed., pp. 793-4). Edinburgh, Scotland: Churchill

Livingstone.

Frye, A. (2010). Prenatal Concerns. In Holistic midwifery: A comprehensive

textbook for midwives in homebirth practice Volume I (p. 589). Portland, Or.

(7528 NE Oregon St.: Labrys Press.

Frye, A. (2004). When the newborn develops respiratory distress. In Holistic

midwifery: A comprehensive textbook for midwives in homebirth practice

Volume II (p. 1221). Portland, Or. (7528 NE Oregon St.: Labrys Press.

Grossman, X., Chaudhuri, J., Feldman-Winter, L., Abrams, J.,Newton, K. N.,

Philipp, B. L., & Merewood, A. (2009). Hospital Education in Lactation Practices

(Project HELP): Does Clinician Education Affect Breastfeeding Initiation and

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doi:10.1111/j.1523-536X.2008.00295.x

How does a mother’s diet affect her milk? : KellyMom. (n.d.). Retrieved from

http://kellymom.com/nutrition/mothers-diet/mom-diet/

.

International Lactation Consultant Association - International Lactation

Consultant Association. (n.d.). Retrieved from

http://www.ilca.org/i4a/pages/index.cfm?pageid=1

La Leche League International (2004). Nutritional know-how. In The womanly

art of breastfeeding (7th ed.). New York, N.Y: Plume.

LLLI | About La Leche League International. (n.d.). Retrieved from

http://www.llli.org/ab.html?m=1

Moreland M.D., J., & Coombs P.A.-C, J. (2000, April 1). Promoting and

Supporting Breast-Feeding - American Family Physician. Retrieved from

http://www.aafp.org/afp/2000/0401/p2093.html

Noel-Weiss, J., Woodend, A. K., Peterson, W., Gibb, W., & Groll, D. (2011). An

observational study of associations among maternal fluids during parturition,

neonatal output, and breastfed newborn weight loss. International

Breastfeeding Journal, 6(9), 133-142. Retrieved from

http://www.internationalbreastfeedingjournal.com/content/6/1/9

Office of the Surgeon General (US, & Centers for Disease Control and

Prevention (US (n.d.). Barriers to Breastfeeding in the United States - The

Surgeon General's Call to Action to Support Breastfeeding - NCBI Bookshelf.

Retrieved 2011, from http://www.ncbi.nlm.nih.gov/books/NBK52688/

Pitocin Use and Breastfeeding Success - Natural Motherhood. (n.d.). Retrieved

from http://www.natural-motherhood.com/pitocin-use-and-breastfeeding-

success.html

Why breastfeeding is important | womenshealth.gov. (n.d.). Retrieved April 27,

2014, from http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-

important/index.html

Wisconsin WIC - Women, Infants and Children Home Page. (n.d.). Retrieved

from http://www.dhs.wisconsin.gov/wic/