The Importance of Health Professionals in Promoting Breastfeeding

Transcription

1 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 1 The Importance of Health Professionals in Promoting Breastfeeding Mike Woolridge, Mother & Infant Research Unit, Leeds, UK The health gains from prolonged, exclusive breastfeeding, are well-documented, widely-acknowledged and profound, even in industrialised cultures. Consequently, all health care professionals have a moral/contractual responsibility to promote exclusive breastfeeding until 4-6 months of age. W.H.A , 1980; 44.33, 1991 With individual women, the key principle is personal empowerment, leading women to have: the knowledge to make an informed choice an understanding of the process (physiology) the manual skill necessary to implement breastfeeding successfully Healthcare workers should aim to promote both: the increased tendency to breastfeed in the individual woman, and increased success in the individual woman who starts to breastfeed Both these principles are entrenched within Step 3 of the Ten Steps to Successful Breastfeeding

2 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 2 Essence of Step 3 is that healthcare workers should: empower individual women to make the informed choice to breastfeed, and enable them to breast-feed successfully, and exclusively for up to 4-6 months With each individual woman, both elements must be effectively targeted. Step 3: Inform all pregnant women about the benefits and management of breastfeeding. Antenatal discussion should include: - the importance of exclusive breastfeeding for the first 4-6 months, - the benefits of breastfeeding, and - basic breastfeeding management. Pregnant women...should confirm that at least two of the following have been discussed with them: nutritional benefits protective benefits bonding health benefits to mother BUT, what mothers remember most are the practical benefits to them personally: helps me get my figure back cheaper more convenient AND they often fail to recall the health gains!

3 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 3 SO, unfortunately, many women focus instead on the perceived practical benefits of bottle feeding: someone else can do it can see what baby is getting b.f. less convenient when out in public CAUTION! A study by Fishman et al (1988) indicated that breastfeeding promotion programmes should be culturally sensitive. An educational programme based on white American values failed to motivate Indochinese women living in California. Social Science & Medicine, 26(11): CAUTION! Theory-based research (in progress) suggests that traditional health promotion messages (e.g. re: health gains) may be ineffective with that sector of the population we most need to reach! (e.g. poor women, living in deprived circumstances and those from ethnic minorities) SO, breastfeeding promotion programmes should also be socio-economically sensitive. Simply pointing out the health gains to women may not be sufficient. Practical, personal issues may often be perceived to outweigh the theoretical gains.

4 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 4...exclusive breastfeeding for 4-6 months This recommendation is based on sound evidence and is very important. BUT, it is also a caveat to previous statement (for women who are unwilling to consider breastfeeding, its exclusivity is irrelevant!)....exclusive breastfeeding for 4-6 months AND women, who are already borderline, may regard the expectation to breastfeed exclusively and till 4-6 months of age as too demanding. This may be perceived as too great a commitment by many women, so should probably remain a healthcare policy target, primarily....exclusive breastfeeding for 4-6 months Step 3 should be about empowering the individual woman, which means that the principal aim should be to establish a personal contract with the mother, which is rational, pragmatic and realistic, not idealistic....basic breastfeeding management. Pregnant women should be able to describe at least two breastfeeding management topics: importance of rooming-in feeding on-demand how to assure enough milk, and positioning and attachment

5 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 5...basic breastfeeding management. Management practices, knowledge of the basis of which empowers women, include the value of: early initiation of feeding rooming-in demand-feeding avoidance of bottle, teats, dummies etc...basic breastfeeding management. Understanding the physiology of breastfeeding empowers women to regulate and manage breastfeeding appropriately. A knowledge of the physiology can relate to: the mother, her infant or to the interaction between the mother and her baby at breastfeeds...basic breastfeeding management. An understanding of physiology should not relate: to the mother in isolation, or to the baby in isolation. BUT to the interaction between the mother and her baby at breastfeeds Essential physiological knowledge relating to: the mother should include: anatomy of the breast central maternal hormones neural pathways leading to release

6 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 6 relating to the infant should include: anatomy of the mouth appetite-control Essential physiological knowledge relating to the interaction at breastfeeds should include: mechanics of milk removal cause of changes in milk fat content how to achieve effective milk removal role of Feedback Inhibitor of Lactation (FIL) Alternatively, understanding of physiology could relate to issues of functional importance: Functionally relevant knowledge might include: avoiding sore/cracked nipples assuring an adequate milk supply assuring a settled baby This approach is more empowering, as these are issues which are directly relevant to the mother Essential physiological knowledge relating to avoiding sore/cracked nipples includes: essentials of positioning and attachment leading to pain-free, effective feeding plus knowledge of possible: - anatomical anomalies - pathogenic erosive agents - chemical irritants Essential physiological knowledge relating to assuring an adequate milk supply includes: role of central hormones & F.I.L.

7 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 7 importance effective milk removal ensuring optimal positioning & attachment role of infant demand (appetite-control) Essential physiological knowledge relating to assuring a settled baby includes: essentials of positioning and attachment how to ensure effective milk removal changes in breast milk fat role of infant appetite (baby-led feeding) Common to all these is an essential knowledge of how to achieve effective positioning and attachment This is a vital skill, which if communicated to the mother effectively can have a profound effect upon her success at achieving pain-free, effective breastfeeding How best can we assure that women acquire the manual skill necessary to implement breastfeeding successfully? Through training or from experience? Long (1995): Br. J. Midwifery 3(10):540-4 Pugin et al (1996): J. Hum. Lact. 12(1):15-19 The ultimate question is: How best can we assure that a woman will breastfeed successfully?

8 Allattamento & Politiche per l Infanzia: Dieci Anni dopo la Dichiarazione degli Innocenti p. 8 The answer to which is: By helping her to breastfeed her first baby successfully! She will then be much more likely to breastfeed her second baby also, and to do so successfully.