Introduction
Historically, the breast-feeding promotion had its own share of waxes and wanes, but with the support of the World Health Organization (WHO) it has got a great impetus in the last 20 years. This initiative got a boost when scientific evidence suggested a number of benefits that are associated with breast-feeding; particularly related to immunologic advantage and birth weight control in later life. That is, of course, apart from the scientifically validated evidence that it is a very simple, cheap and the most sterile form of nutrition for a baby.
Breastfeeding ensures numerous benefits to both infant and the mother, from a long term as well as a short-term perspective. Improved nutritional, developmental, immunological, and social outcomes are associated with benefits for mothers and infants who are associated with breastfeeding (Persad D M, Mensinger L J, 2008). The reasons for choosing such topic is that breastfeeding is emerging as one of the most important health promoting and disease preventing activity both from immediate and long term effects. The consciousness of community, health professionals, social workers, care centres throughout the world are promoting breast-feeding initiation and long time duration.
One of the ongoing interests in breast-feeding is its efficacy in managing the burden of postpartum illnesses in women, notably depression. This is attributed to the presence of psychotropics in breast milk. But since reports pertaining to this are single or isolated case histories, there are still some questions raised with regard to such claims. One of the current debates with regard to breast-feeding benefits is its encouraged use and consequently excessive promotion among mothers diagnosed as HIV-positive (Nduati R et al., 2001). This is believed to improve survival chances of infants.
Breastfeeding does not only result in health benefits for mother and child but also has a deep impact on the community in terms of economic benefits and promotion of cultural values among the different classes of people. Rich economies have observed a deteriorating trend in breastfeeding while poor income groups have high rate of breastfeeding, however awareness needs to be created. Total annual cost of not breastfeeding is approximated to $1.186 to $1.301 billion annually. Economically, increasing breastfeeding in Australia could add $3.4 billion to the national food output almost equal to an extra 0.7% of the GNP. (Smith, 1997).
As far as legislation is concerned, many countries have not imposed any kind of rule or regulations regarding breastfeeding, such countries have a low rate of breastfeeding due to lack of awareness and related benefits like Canada who have no rules in comparison to Uk and Us where due to norms and strict regulations breastfeeding rates are higher..Breast-feeding legislations are intended to express women’s right to breast feed, say at select locations in public places. To breast feed is every woman’s constitutional right. As stated by the U.S. Supreme Court, “Nourishment is necessary to maintain the child’s life, and the parent may choose to believe that breastfeeding will enhance the child’s psychological as well as physical health. In light of the spectrum of interests that the Supreme Court has held specially protected we conclude that the Constitution protects from excessive state interference a woman’s decision respecting breastfeeding her child.” 650 F.2d at 787.
The critical role in breastfeeding is played by the nurses and medical practitioners who interact with parents right from the pregnancy stage till the routine infant care visits to impart information about the pre -pregnancy and post pregnancy issues such as breastfeeding.
Literature Review
Breastfeeding is supposed to be the best method of infant feeding worldwide because it is very strongly correlated with the nutritional, psychosocial and immunological benefits. Breastfeeding affects the emotional development of a child (Marquis S G, 2005). Many organizations such as American Academy of Pediatrics, WHO, etc have supported the fact that breastfeeding benefits in reducing respiratory tract infections, and reduces delays in gross motor skills, language and development process.
Short term benefits to breastfeeding start after delivery, when repeated suckling of the baby helps in release of oxytocin from the mother’s pituitary gland which further releases milk to the infant and at the same time generates contractions in uterus that prevents postpartum hemorrhage and promote uterine involution. Breastfeeding mothers are also benefited in delayed periods, apart from this the amount of iron a mother’s body consumes in milk production is much less than the amount she would lose from menstrual bleeding. It is also seen that breastfeeding is a natural contraceptive which helps to delay pregnancy for almost six months.
For an infant breast milk provides immunity and is an ideal nutrition. Breastfeeding reduces risk of gastroenteritis, ear infection, childhood cancer, celiac disease, ulcerative colitis, atopy and many other disorders during infancy. (Laurie Barclay et al, 2006)Studies have also disclosed an important linkage between breastfeeding and reduced infant mortality rate (Villalpando S, Hamosh M. 1998) , The infant mortality rate among less developed countries is 70/1000 live births, this figure can be reduiced to 5.5/1000 if breastfeeding is encouraged.
Long term benefits of breastfeeding can even be seen when extended towards the toddler years as they draw a significant amount of calorie, proteins and immune factors from the breast milk. Moreover, leptin which is present in the breast milk helps in gaining weight and controlling appetite of the toddler and at the same time helps in reducing mother’s weight as in comparison to non breastfeeding mother.
Even the WHO has recommended the breastfeeding for an age appropriate upto 24 months, as evidences are found that an increased feeding can reduce obesity rates in children in future. Researches have even supported the fact that women who breastfeed the infants or apply the skin to skin contact provide the best form of analgesia to the babies (Naughten F. 2005). Breastfeeding benefits are even extended to the vulnerable infants who require special care or infants who come under the cadre of ill and preterm babies. For such infants, providing breast milk is of crucial physiologic benefit that can be extended to the little one.
From the long term scenario, many researchers have supported the fact that breastfeeding helps in mitigation of various kinds of future health issues. One such study was conducted by Singhal A, (2006) where protective effects of breastfeeding were observed on atherosclerosis heart disease. In future breastfeeding does affect in reduction of metabolic syndromes in the infant at a later stage of life. Inflammatory bowel diseases are transformed by genetic and environmental factors. Results have proved that if the maternal diet is high in n-6 PUFA (Polyunsaturated Fatty Acids), there is a correspondence increase in n-6 PUFA via the placenta and increased level of the same in the breast milk as well which leads to an increased inflammatory response to gastrointestinal challenges in future (Innis M S, Jacobson K, 2007).
Lactation also helps in restoring the calcium lost and reduces the risk of osteoporosis. Further breastfeeding provides an eternal bond between mother and child; an automatic, skin-to-skin closeness or kangaroo care cannot be replicated by a bottle feed (Mallet I, Bomy H, Govaert N, Goudal I, Brasme C, Dubois A, Boudringhien S, Pierrat V, 2007). The child’s suckling at the breast secretes a special hormonal called milieu for the mother that helps to keep her calm and serene at the time of emotional upsets due to the new responsibility of motherhood. Response to adrenaline is less intense in breastfeeding mothers (Dermer A. 2001).
Women who have sick newly born face more problems as they receive insufficient support and education from the health providers but positive outside influences can help in encouragement and promotion of breastfeeding. In the study, 100 mothers were intervened where almost 67% mothers wanted to breast-feed exclusively due to variant such as age, education, parity, smoking and marital status etc. 78 mothers initiated pumping. Duration of breast-feeding was linked with education, marital status, ethnicity, income, assistance from nurses and lactation consultants(Lessen R, Crivelli-Kovach A, 2007). Cooperative neonatal intensive care unit environments can help in breast-feeding their ill child Lessen R, Crivelli-Kovach A, 2007. Special emphasis should be laid on care of neurologically impaired infants, where the mothers of such infants need additional support in breastfeeding, health care team should support the mother and the family emotionally, psychologically and medically (Danner SC, 1992).
WHO guidelines recommend exclusive breast-feeding from the time of baby’s birth till six months of age in order to help baby receive minerals, vitamins and micronutrients properly. This feeding includes expressed breast milk.
Recent studies have demonstrated that breastfeeding has positive effects on the mother also by marking a significant reduction in the blood pressure both systolic and diastolic blood pressures during a breastfeeding session and pre-breastfeeding blood pressure also decreases during the first 6 months of onset of breastfeeding. 66 normal delivery cases were observed where a fall in systolic and diastolic blood pressure was noticed to 8.8 (SD = 11.00) and 7.7 (SD = 9.3) mm Hg, respectively. There was a significant fall in basal blood pressure during the 25-week follow-up period. At the same time corresponding to individual breastfeeding session’s blood pressure showed a remarkable fall. The decreases were consistent throughout the entire study period (W. Jonas, E. Nissen, and A.-B. Ransjo-Arvidson, I. Wiklund, P. Henriksson, K. Uvnas-Moberg, 2008).
Infants who are born to diabetic women are prone to higher risk of developing obesity and impaired glucose tolerance in later stages of life, studies have reflected that, breast-feeding can be a protective measure against obesity and diabetes in later life as breast milk has contents of increased glucose and insulin which can help in controlling of diabetes (Stage E, Nørgård H, Damm P, Mathiesen E, 2006).
Recent studies also highlight areas such as protective effect of breastfeeding towards enhancement of maturation of the intestinal mucosal barrier aiding in strengthening oral tolerance. However further studies and researches need to be done to confirm the protective effect (Jackson M K, Nazar M A. 2006).
Studies have confirmed that it is of vital importance for an infant to gain nutrition especially premature ones however, mothers generally face problems when breastfeeding preterm infants. Nursing practices must facilitate confidence in breastfeeding in order to improve their success rates and help in prolonging the practice of breastfeeding (Yang CL, Kuo SC, 2007). However, the role that should be exhibited by the primary centers was not very promising as only 8 surveys were sent to center and program directors, 6.9 percent of the centers had no program or protocol for the promotion of breast-feeding, nor did they seek the collaboration of support groups. Only 28.8 percent centers carried out activities to support mothers, whereas in 74.5 percent of the centers, health professionals were given no specific training on the subject. (Fernández A N et al).
On the whole it could be assessed that most of the prime care centers did not promote the activity, collaboration which is essential with other support groups or other resources was not considered a viable option nor adequate training is imparted in breastfeeding to the centers’ health professionals. Prime care centers need to change their nursing practices in order to exhilarate the sluggish pace of feeding exercise.
Another major benefir of beastfeeding is prevention of asthma .which is promoted in a analysis done by Fernández A N, Valdearcos S, Simó B, Fuster P, Gimeno P, Soler A, Julve F, Barceló L. 2001).
There is a dire need for social workers to render help in the communication practices with parents in different hospitals, to delve deeper into the essence of the social issue a research was undertaken by Black K, (2005) where a sample of 32 physicians and 74 nurses was collected by utilizing tool of a self administered questionnaire. Collaboration of social groups and professionals help in clarification of disclosure of information, discussions about treatment options, interaction with near relatives and family members etc. results confirmed that.social workers have unique skills in advancing communication process in breastfeeding (Becker et al. 2005).
Implications for Health and Nursing Care
From establishing a milk supply to putting the baby to the breast, nurses play a very vital role, as the complete family relies on them for correct for information, instruction, and encouragement. The main issue underlying the breastfeeding concept is the role of nursing intervention required in generating awareness and encouraging the process of breastfeeding in order to have a positive impact on the mother and the child, family, and the entire society socially and economically.
Breastfeeding and its issues have been in discussion for a variety of reasons, sometimes due to emotional issues or may be due to the social obligations. Many past researched reflect on such issues where a major impact of external environment is observed in carrying out the breastfeeding or deciding to discontinue it. In one of the researches done, maternal employment was regarded as the most prominent barrier in initiating and continuing breastfeeding for infants. To proceed with the study, samples of 462 women in 5 corporations were undertaken. The study intended to understand weaning practices. As per the results it was found that many women wean early due to problems like lack of adequate knowledge, non supportive work culture, problems in pumping breast milk etc, however out of the given data, 97.5% women initiated breastfeeding. Studies also reveal that mothers who return to work full time, breastfeed their babies for shorter periods. (Ortiz J, McGilligan K, Kelly P, 2004).
From the study, the health and nursing implications which could be drawn reflected on the dire need of education and knowledge that must be imparted by the health care providers to influence the mother’s feeding decision. An important intervention of certified lactation consultant CLC is proved to be the best measure via mothers can be helped to accomplish their breastfeeding goals. In resource-rich countries like Canada and the U.S. maternal characteristics are not universal. In fact, in low-resource countries, breastfeeding is more common among the poor and less educated (Marquis S G, 2005).
Role of nursing in generating awareness and influencing females to encourage breastfeeding is certainly imperative. Nursing interventions requires making parents aware the necessity of breastfeeding, further the mother must be assisted with the establishment and maintenance of a milk supply along with an in-depth understanding of correct breast milk management techniques; like providing skin-to-skin care (kangaroo care) and opportunities for non-nutritive sucking at the breast. It is of vital importance that nurses should prepare the family with an appropriate follow up care (Spatz DL, 2004).
Breastfeeding is not only an important consideration for the child or the parents but it has long term health consequences for society as well. Breastmilk is the best option to protect a child from cold, infections, diarrhea, allergies, asthma, cancer and many other health problems. (Tidsskr Nor Laegeforen. 2007). Healthy eyesight, sharp intelligence, reduced risk of ovarian and breast cancer in future all are linked with breastfeeding. Social justice issues regarding infant feeding have been in discussion from past years for which the government is trying its best to bridge the disparity levels between the rich and the poor class people (Hurst G C, 2007).
Even cultural attitudes and barriers have a significant impact on the breastfeeding. For instance, Hispanic groups are found with high breastfeeding rates (Hurst G C, 2007 ) inspite of low income due to the prevailing culture. Social workers have a central role in spreading the need for breastfeeding among the new generation however; very little social work is evident in the contemporary health practices.
Social workers can collaborate with other professional in generating awareness and consciousness regarding breastfeeding. Breastfeeding peer counseling programs, lactation consultancies can be promoted by the social worker with a constant support by the medical practitioners. After all breastfeeding is a physiological behavior affected by the social, psychological and cultural influences (Hurst G C, 2007).
There is supportive evidence to link breastfeeding and long term cardiovascular health. the research in the current field would certainly aid in the reduction of CVD (Cardio Vascular Disease) which is one of the major causes of death prevalent in western culture especially in the lowest socio economic income group (Singhal A. 2006). To study the impact of sociodemographic and behavioral factors on breastfeeding, research was initiated where 33000 children varying in the age group 6 to 71 months were observed keeping in mind the unadjusted and adjusted state breastfeeding rates to conduct a multilevel analysis so as to find out the socio economic impact on the whole procedure.
As a result a high intensity of variation in breastfeeding initiation was found in western and northwestern states with a difference of almost 25 to 30 percent. In southern states, the cases of non breastfeeding were higher to almost 5 times due to absence of breastfeeding legislation in the states (Kogan D M, Gopal K, Dee L D, Belanoff C, M. Grummer-Strawn M L, 2008).
The statistics reveal that only Today, only 56 hospitals and birth centers in the U.S currently adopt a proper guideline for breastfeeding. The main causes which have been explored for non breast-feeding mainly attribute to absence of support from friends/family, inadequate knowledge among medical professionals, general maternity hospital practices, cultural behavior, and an increasing number of women in the work force (Weimer P J.2001).
Hence, considering such issues, it becomes utmost important for the nursing implications applied in the hospital to change the current practices and improve a mother’s likelihood of continuing to breastfeed after delivery. Nursing interventions should encourage breastfeeding within 1 hour of delivery, should keep the newborn with the mother, and avoid any supplementation such as water etc, pacifier use in the hospitals should be prevented, and immediate help for breast-feeding must be available even after the discharge of the mother and the child.
Another aspect for promoting breastfeeding is the economical perspective, the current U.S figures disclose that there exist 64 percent mothers in hospital and 29 percent at 6 months postpartum who are interested in breastfeeding in comparison to the required rate by the surgeons which is 75 and 50 percent, if the targeted rate is achieved then a total amount of $3.6 million could be saved both in terms of direct and indirect costs such as clinic costs, lab and hospital costs etc.
Collaborations can be effective in enhancing the campaign when health care providers, corporate administrators, State and Federal policymakers, people in general together are able to promote and support breastfeeding; however this arena requires further research and development to ensure effective channels for introducing a collaborative effort. An in-depth research on health and cost benefits from breastfeeding is essential (Weimer P J.2001).
Application of collaborative practices needs to be encouraged, as per the publication of the Health of the Nation document in 1992, collaborative practice has assumed to be on the threshold of health services transformations. Nursing profession in particular needs to adopt a change; they need to be aware about the presence and importance of teams and agencies that are a part of the health promotion activities and acknowledgement of the client as a part of the team. Adequate and constant training sessions, education, shared learning outcomes are the key for promoting collaborative nursing practices (Whitehead D, 2001).
The impact of breastfeeding crosses a wide spectrum. While protection against diseases that develop later in life, such as insulin-dependent diabetes mellitus, inflammatory bowel disease, and childhood cancer, has been reported, however a indepth studies are required in order to confirm these observations. Similar studies are essential in order to ascertain the small but consistently reported higher cognitive ability of breast-fed infants.development, and improves immunity and long term health. For the family, breastfeeding saves on formula costs, less parent time off work and saves on energy consumption, for a community as a whole less health care costs. Less absenteeism, and less harm to the environment are few major impacts that breastfeeding can support.
References
Becker et al. 2005. Prevention strategies for asthma: primary prevention. JAMC: 173 (6).
Black K. 2005. Advance directive communications practices: social worker’s contributions to the interdisciplinary health care team. Soc Work Health Care. 40(3):39-55.
Danner SC. 1992. Breastfeeding the neurologically impaired infant. AACOGS Clin Issu Perinat Womens Health Nurs. 3(4):640-6.
Dermer A. 2001. A Well-Kept Secret Breastfeeding’s Benefits to Mothers. New Beginnings Vol. 18 No. 4, 124-127.
Fernández A N, Valdearcos S, Simó B, Fuster P, Gimeno P, Soler A , Julve F, Barceló L. 2001. Primary care centers and breast-feeding. An Esp Pediatr. 55(3):225-9.
Hurst G C. 2007. Addressing Breastfeeding Disparities in Social Work. Health & Social Work; 32, 3; 207.
Human milk, immune responses and health effects, Tidsskr Nor Laegeforen. 2007; 127(18):2395-8.
Innis M S, Jacobson K. 2007. Dietary lipids in early development and intestinal inflammatory disease. Nutrition Reviews; 65(12); 188-193.
Jackson M K, Nazar M A. 2006. Breastfeeding, the immune response, and long-term health. JAOA; Vol 106(4); 203-207. Web.
Hoey, Christine, Ware J. 1997. Economic advantages of breast-feeding (sic) in an HMO setting: A pilot study. Am J Man Care 3:861-65.
Kogan D M, Gopal K, Dee L D, Belanoff C, M. Grummer-Strawn M L. 2008. Multivariate Analysis of State Variation in Breastfeeding Rates in the United States, American Journal of Public Health, Vol 98, No. 10.
Lessen R, Crivelli-Kovach A. 2007. Prediction of Initiation and Duration of Breast-feeding for Neonates Admitted to the Neonatal Intensive Care Unit. Journal of Perinatal & neonatal Nursing. Vol 21(3); 256.
Laurie Barclay et al, Full Breast-feeding May Lower Hospitalizations for Infections During First Year of Life, Pediatrics. 2006;118:e92-e99.
Mallet I, Bomy H, Govaert N, Goudal I, Brasme C, Dubois A, Boudringhien S, Pierrat V. 2007. Skin to skin contact in neonatal care: knowledge and expectations of health professionals in 2 neonatal intensive care units. Arch Pediatr. 14(7):881-6.
Naughten F. 2005. The heel prick: how efficient is common practice? RCM Midwives: 8(3); 112-114.
Nduati R et al., Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial, Lancet, 2001, 357(9269):1651-1655.
Ortiz J, McGilligan K, Kelly P. 2004. Duration of Breast Milk Expression among Working Mothers Enrolled in an Employer sponsored lactation program. Pediatric Nursing; 30, 2; 111.
Stage E, Nørgård H, Damm P, Mathiesen E.2006. Long-Term breast-feeding in women with type 1 diabetes, Web.
Singhal A. 2006. Early nutrition and long term cardiovascular health. Nutrition Reviews, 64 (5):44 – 49.
Spatz DL. 2004. Ten steps for promoting and protecting breastfeeding for vulnerable infants. J Perinat Neonatal Nurs: 18(4); 385:96.
Marquis S G. 2005. Breastfeeding and its impact on child psychosocial and emotional development, Web.
Persad D M, Mensinger L J. Maternal breastfeeding attitudes: association with breastfeeding intent and socio-demographics Among Urban Primiparas. J Community Health (2008) 33:53–60.
Villalpando S, Hamosh M. 1998. Early and Late Effects of Breast-Feeding: Does Breast-Feeding Really Matter. Biology of the Neonate; 74, 2; 177.
Weimer P J.2001. The Economic Benefits of Breastfeeding A Review and Analysis, FANRR- 13, Economic Research Service, USDA.
W. Jonas, E. Nissen, A.-B. Ransjo-Arvidson, I. Wiklund, P. Henriksson, K. Uvnas-Moberg. 2008. Breastfeeding Medicine. 3(2): 103-109.
Whitehead D. 2001. Applying collaborative practice to health promotion. Nurs Stand. 15(20):33-7.
Yang CL, Kuo SC. 2007. Assisting mother with preterm infant breastfeeding, Zhi Z L H, 54(4): 61-6.