Breastfeeding
Breastfeeding is well established in the US (Stokowski, 2007). The extent of breastfed infants was 73% in a survey in 2005. At 6 months, 39% were being breastfed and at 1 year of age, 20% were still enjoying the breast milk. Healthy full-term infants obtain complete nutrition from breast milk (Ip et al, 2007). The latest recommendation by the WHO is to exclusively breastfeed infants up to 6 months.
Formula over breast milk
Breastfeeding is essential for the adequate growth and development of the physical and mental health of infants (Chudasama et al, 2009). Riordan says it in another way; exclusive breastfeeding and complementary feeding methods are essential for the growth and prevention of illness (2005). Exclusive breastfeeding implies that breast milk alone, even the expressed variety, allows the infant to have a series of nutritious materials like “vitamins, minerals or medicines and water, breast milk substitutes”( Chudasama et al, 2009). The breastfed children require very much less medical care when compared to the artificially-fed babies who are known to suffer more illness as formula are believed to be deleterious due to contamination through unhygienic methods of handling it (Riordan, 2005). They do not develop the autoimmune response that is exhibited in infants on breastfeeding and do not contain the health-promoting factors. Research has indicated that regular breastfeeding has reduced the risk of otitis media, gastroenteritis, respiratory infections, atopic dermatitis, asthma, obesity, diabetes mellitus, leukemia, sudden infant death syndrome and necrotizing enterocolitis (Stokowski, 2007). Higher maternal age education, more gestational age of about 37 weeks, mothers with previous experience are the factors affecting mothers. Other factors that cause a hindrance to exclusive breastfeeding are “low family income, low maternal age, primiparity and mothers returning to work” (Chudasama et al, 2009). Breastfeeding incorporates religious, traditional and social patterns. Under-nutrition between the ages of 6 and 24 months occurs due to early substitution of breast milk or late introduction of semi-solid foods. The formula has nutrients not ingested by humans and they may not be in physiologic proportions (Riordan, 2005). The mere act of bottle-feeding could harm the cardio-pulmonary system of infants. Artificial feeding also creates some dangers to mothers. Mothers could develop osteoporosis, breast cancer, or ovarian cancer (Riordan, 2005). Mothers with diabetes have greater relief of symptoms when exclusively breastfeeding. Using artificial formula stretches the purse-strings of the families. The economies of the community and nation become affected too. The cost of bringing up a breastfed child is much less than one with artificial feeds. Artificial feeds for 6 months consist of 150 cans of baby milk; the cost of baby milk for one month is $80. If the child has allergies , the cost shoots up to $300 per month. Lactation allows a faster metabolization of food aided by the water conservation of prolactin. Exclusive breastfeeding has a contraceptive effect: the chance of more frequent pregnancies is a remote possibility. The ignorance about colostrum has led mothers to avoid feeding their newborns this useful first milk. The mothers must be educated on the significance of feeding this rich milk in the initiation of breastfeeding. The families of the child who is exclusively breastfed happen to have longer hours of sound sleep (Doan et al, 2007).
Changing the attitudes of the mothers
The Public Health programs which aim to motivate exclusive breastfeeding must make a head start and target adolescent teenage girls. Among the other adolescent programs, the significance of breastfeeding may be additionally impressed upon the young girls who are to become future mothers. Meeting the ladies in the period before their pregnancies is another apt time to start talking about the health of the breast and the nipple. The antenatal period is another appropriate time to stress the importance of exclusive breastfeeding. Nurses who have been retrained in the subject must make concerted efforts at the various levels during pregnancy, labor, birth, postpartum period and routine infant care visits to motivate the mothers after identifying and overcoming the structural barriers (Cricco-Lizza, 2009). Healthcare providers need the latest information on infant nutrition to share it with new parents who have no end of doubts and questions. Parents consider the nurses as the right choice for seeking information.
Diverse feeding patterns
The breastfeeding patterns may vary from nation to nation and region to region. The diversity is also based on social and traditional values and religious beliefs. The mothers may breastfeed and complement with other foods or they may exclusively breastfeed. The duration of feeding may vary from 6 months to one year. A study found that Hawaiian women had a high breastfeeding initiation rate but native people had only 64% initiation (Dodgson et al, 2007). It was found that the women who exclusively breastfed ensured a feeding period of 6 months and weaned much later. In another study among the Israeli population, it was found that Muslim women were more prone to exclusively breastfeed and continued it for longer periods (Chertok, 2004). However successful outcomes were found for both Jewish and Muslim women. Hispanic mothers have a history of a low level of exclusive breastfeeding (Hernandez, 2006). As the low minority groups of the US have a lesser rate of exclusively breastfeeding, knowing their cultural background helps the nurse identify ways and means to motivate exclusive breastfeeding.
Guidelines for breastfeeding mothers
A well-balanced diet with an adequate intake of calories and proteins with sufficient fruits and vegetables on the “My Pyramid” lines is essential (Morin, 2008). A lactating mother needs to consume 500 more calories (Riordan, 2005). Modern mothers may take less than their recommended intakes in order to lose weight. Nurses must be able to gauge what is happening and share vital information. Breastfeeding mothers produce 750-800 ml. of milk so the maintenance of hydration is significant. Nurses must be able to convince the mothers that they have to drink more water if thirsty, having a dry mouth, scanty urination, or concentrated urine (Morin, 2008). 1000 mg. of calcium may be consumed during lactation or larger amounts of spinach, broccoli and dairy products. The mothers need to be told about the loss of bone mass in pregnancy but which returns to normal after weaning. Some foods that the mother takes affect the child by giving him gastric distress. She has to look out for vomiting, blood, and mucus in stools; they could be allergies. Keeping a record of what causes her child’s symptoms appears essential. The use of a pacifier accounts for some of the oral needs of an infant. However the infant may breastfeed less with the pacifier being used intermittently (Best practice sheet, 2005). The suckling reflex is also satisfied by the pacifier.
Feeding Preterm infants
Mothers have a feeling that premature babies are unable to feed properly due to some physical problems associated with prematurity. Current feeding practice for pre-term babies does not actually detail when bottle feeds are to be started. Infant readiness is one major factor in a premature infant in that this infant may have inadequate reflexes or accompanying defects which prevent its normal feeding habits (Welling and Waszak, 2009). Consistent feeding habits may be necessary to ensure that the child gets its quota of breast milk. Multiple caregivers as when a child is in an institution must share a common language or routine for the feeding. Parents need to be given instructions too. 40% of participants in a study which included 117 nurses, 18 assistants and 7 neonatologists could not indicate the proper features of infant readiness. They relied on gestational age and other indicators. Observed suckling was taken as the indicator for readiness by 59% of the nurses. The new protocol advised by the physician is “nipple per feeding readiness” (Welling and Waszak, 2009). Oral feeds are usually started in 32-34 week premature babies (Lessen, 2009). Lessen studied the effect of the modified version of the Beckman Oral Motor Intervention in premature infants of 29 weeks. The oral stimulation intervention included the response to pressure, movement and control for lips, cheeks, jaw and tongue. The time to reach oral feedings was reduced by 5 days; this meant a lesser hospital stay and lesser burden on the national exchequer by nearly 2 billion dollars annually for 3 days less (Lessen, 2009). Thoyre (2009) found that infants who had a risk for respiratory problems or who were on the ventilator for longer periods, with respiratory distress, continuous positive airway pressure, had taken more days to reach full oral feeding or had oxygen supplementation developed distress symptoms which interfered with proper and early feeding. The lesser feeding pattern is probably due to “behavioral disorganization, swallowing and respiratory dysregulation” (Thoyre, 2009).
Breastfeeding is good for the mothers too
Mothers also had some advantages from breastfeeding: they had lesser risk of diabetes mellitus, breast and ovarian cancers. Postpartum depression was seen in ladies who stopped breastfeeding early. However the researchers have suggested further confirmation of the facts (Stokowski, 2007). Hardly any reason exists for not breastfeeding a healthy infant. However exclusive breastfeeding is yet to take off in many hospitals in the US. Carder (2008), a Lactation Consultant, suggests that “postpartum units and birthing centers should be formula-free” and that “breastfeeding should be the gold standard for infant nutrition”. Exclusively breast-fed infants are less prone to serious illnesses than formula-fed. Many hospitals who accept the donations of free formula have to use them in their units and invariably this is an advertisement. A Baby-Friendly Hospital should use the formula only as medically indicated (Shealy, Li, Benton-Davis, & Grummer-Strawn, 2005). The breastfeeding patterns of most modern mothers depend on their obstetrician’s opinion. This person however does not realize the magnitude of his influence. Nurses are another group who can influence a mother on breastfeeding. To do this, they have to keep up with the latest information to incorporate them into their evidence-based practice (Carder, 2008). Lactation consultants take classes on breastfeeding and distribute supportive materials and they remain accessible following the discharge of the mothers. Mothers are reassured that their infants get specialized care.
How infant nutrition can be provided in palliative care
Mothers must be convinced that infants can be nourished with food and water provided they can ingest them safely (Morin, 2007). Non nutritive suckling on a pacifier meets some of the infant’s oral needs. Mothers would like to know what medically supplied nutrition is. Nurses may have to explain what this is to the mothers: any nutrition given through means other than oral like intravenous or enteral tube feeds is medically supplied nutrition (Ersek, 2003). During palliative care, supplying nutrition to the child becomes a complex situation. The ethical and legal questions may arise when a dying child is given parenteral feeds which are keeping it just alive but suffering longer. Minimizing dehydration can be maintained by “implementing conscientious and meticulous infant mouth care, providing appropriate bedding, addressing temperature changes, and encouraging infant holding by parents and caregivers” (Morin, 2007). Mothers rely much on the information provided by the nursing personnel who need to be sensitive to the needs and emotional status of the parents.
Conclusion
Exclusive breastfeeding needs to be adopted invariably by all nursing mothers. The highly nutritious colostrum and breast milk contain autoimmune substances which enhance the child’s immunity status and nutritious materials which lead to a physically and mentally healthy infant which develops the power to overcome common illnesses of childhood. The mother’s breastfeeding pattern is influenced by social and religious values. The factors affecting a mother’s feeding pattern are higher maternal age education, more gestational age of about 37 weeks, mothers with previous experience are the factors affecting mothers. Other factors that cause a hindrance to exclusive breastfeeding are low family income, the young age of the mother, primiparity and mothers returning to their job.
References
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