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Want successful breastfeeding? Educate minutes after birth
Create policy, prepare staff to provide hands-on instruction
Good health practices begin within hours of birth when mothers start learning how to properly feed their newborn baby.
It is much healthier for a population if babies are exclusively breastfed for the first six months, says Cynthia Bansen, RN, IBCLC, RLC, a lactation specialist in the obstetrics department at Tahoe Forest Hospital in Truckee, CA. Exclusive breast feeding can decrease obesity, diabetes, heart disease, and some cancers, she explains.
"The studies are so compelling and consistent showing it is a healthier choice," says Bansen.
Officials with the Department of Health and Human Services agree. In January 2011, Surgeon General Regina Benjamin issued a "Call to Action to Support Breastfeeding" urging a nationwide effort to remove barriers to breastfeeding. (Information on how to obtain a copy can be found in the source/resource box, p. 39.) Some of these barriers can be addressed through education.
"Early in the pregnancy is the time to start the conversation about breastfeeding," says Jane Heinig, PhD, IBCLC, executive director of the Human Lactation Center, Department of Nutrition, at the University of California, Davis. In the clinic setting couples need to be told the benefits of breastfeeding and told what to expect, says Heinig. However, the bulk of the hands-on breastfeeding education must take place once the baby is born, sources say.
To make decisions about breastfeeding education, put together a core small group to offer input about the process, content, and support materials, advises Christine Hess, MEd, patient and family education coordinator at WellSpan Health in York, PA. The group could include a nurse educator, a clinical nurse, patient education coordinator, and an experienced breastfeeding mother. The process could look at the preparation for breastfeeding; the support during; the support for follow-up; and when, where, and how it will occur to improve success, says Hess.
Every baby and every mom will have a different experience. Therefore, no matter how many children a woman has, she needs to practice breastfeeding in the hospital, says Heinig. "Many moms can breastfeed with very little assistance. The challenge is for the moms that do need that assistance, they really need it right then and can't wait for several days," she explains.
Tailor to patient needs
To meet the educational needs of each mother at Boston Medical Center, all bedside staff members are trained to teach women how to properly breastfeed, says Genevieve Preer, MD, a pediatrician in the Division of Ambulatory Pediatrics at Boston Medical Center.
For example, if a patient care assistant is taking the mother's blood pressure and notices the baby wants to breastfeed, but the mom is having difficulty getting the baby to latch, she will help the mom. The nurses and the patient's physician help as well. "It is a wraparound approach where we all try to educate mom and give her a consistent message about the importance of putting the baby to the breast on demand and having the right positioning," explains Preer.
Bansen says that at Tahoe Forest Hospital, in Truckee, CA, before policy was set in place to become a Baby-Friendly USA facility, a nonprofit organization that implements the Baby-Friendly Hospital Initiative in the United States, mothers were given inconsistent messages about breastfeeding. She would make follow-up phone calls to women after discharge who told her they were confused about breastfeeding because nurses did not provide the same instruction. "We saw a need to standardize our teaching and Baby-Friendly as a way to get there," she explains.
Breastfeeding education needs to be designed to fit the population served and cannot be a one size fits all. At Boston Medical Center, much of the education is verbal because that is the best way to communicate with the patient population, says Preer. In the heart of a big city, the hospital serves the working poor and diverse cultures. Staff uses interpreter phone services as well as interpreters in the room to communicate when needed. "We do not have a packet of information on breastfeeding. It is not an intervention that will work for many of our patients," says Preer.
She says the delivery of a baby is an overwhelming time for many women served at the health care facility, and they cannot process too much information, plus there are language and literacy barriers. The medical center does have pamphlets and teaching sheets for moms who want written materials.
To determine what type of breastfeeding education program might work, talk to your patients and staff, advises Diane Moyer, BSN, MS, RN associate director of patient education at The Ohio State University Medical Center in Columbus. Look for perceptions and misconceptions, cultural barriers that need to be addressed, and ongoing support available in the community that impacts your patient population.
If a mother says she wants to breastfeed or is considering breastfeeding as soon as the baby is born, teach her how to put the baby to the breast, advises Preer. Hands-on teaching overcomes language, cultural, and literacy barriers, she adds.
For more information about implementing an education program on breastfeeding, contact:
Cynthia Bansen, RN, IBCLC, RLC, Lactation Specialist, Tahoe Forest Hospital, 10121 Pine Ave, P.O. Box 759, Truckee, CA 96160. Telephone: (530) 582-3247. E-mail: email@example.com.
Jane Heinig, PhD, IBCLC, Executive Director, Human Lactation Center, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616. Telephone: (530) 754-5364. Web: lactation.ucdavis.edu.
Christine Hess, MEd, Patient and Family Education Coordinator, WellSpan Health, York, PA 17403. Telephone: (717) 851-5859. E-mail: firstname.lastname@example.org.
Diane Moyer, BSN, MS, RN, Associate Director, Patient Education, The Ohio State University Medical Center, 660 Ackerman Road, Room 667, P.O. Box 183110, Columbus, OH 43218-3110. Telephone: (614) 293-3191. E-mail: Diane.Moyer@osumc.edu.
Genevieve Preer, MD, Pediatrician, Division of Ambulatory Pediatrics, Boston Medical Center, 850 Harrison Ave., ACC 5N-20, Boston, MA 02118. Telephone: (617) 414-5513. E-mail: Genevieve.email@example.com.
Lynn Yonekura, MD, FACOG, Director of Community Benefits, California Hospital Medical Center, 1401 S. Grand Ave., Los Angeles, CA 90015. E-mail: M.L.Yonekura@chw.edu.
The Surgeon General's Call to Action to Support Breastfeeding is available on the web site of the Office of the Surgeon General (www.surgeongeneral.gov/topics/breastfeeding/index.html).
The report mentioned in the executive summary can be downloaded from the California WIC Association website at www.calwic.org/focus-areas/breastfeeding. Select the title: 2011 Hospital Report and County Fact Sheets.