|
||
|
Breastfeeding and the Primary Care Provider Human milk is considered to be the ideal source of nutrition for term and near-term infants, and preemies and "micro" preemies also benefit from fortified human milk. But today, regardless of the many advantages that breastfeeding provides to both mothers and infants, more than one-third of all Iowa mothers choose not to initiate breastfeeding. At the beginning of the 20th century, nearly all hospitalized mothers breastfed their infants. This number gradually declined as mothers began using cow’s milk-based formulas, and the decline accelerated with the introduction of commercially prepared human milk substitutes in the 1920s. By the late 1960s, fewer than 25% of women in the US initiated breastfeeding during the hospital stay. In response to this dramatic decline, public health officials, health professionals, and others concerned about the health of mothers and infants began implementing strategies to promote breastfeeding in the United States. The downward trend was reversed and breastfeeding rates rose over the next decade before dipping again in the mid-1980s. Low levels of initiation, duration In 1989 the United States Public Health Service released Healthy People 2000, whose goals included increasing the rate of breastfeeding initiation to 75%, with special emphasis on high-risk groups among whom breastfeeding rates were as low as 25%. Healthy People 2000 also recommended increasing the length of time that mothers breastfeed. These goals were reaffirmed in Healthy People 2010; however, the most recent data from Iowa indicate that we have not met either goal. In 2000, only 67.2% of all mothers in Iowa began breastfeeding in the hospital, and only 26.7 were still breastfeeding 6 months later. Among WIC mothers, only 55.5% began breastfeeding in the hospital, and only 11.2% were still breastfeeding at 6 months. What we can do As health care professionals, we need to encourage mothers to breastfeed, and to do so for a longer time. Many health care providers have their first encounter with mothers and newborns during their hospital stay. However, most studies indicate that 65-95% of women have decided how they will feed their infants prior to the birth of the baby; many, in fact, prior to becoming pregnant. Clearly, we need to think of breastfeeding as a life cycle event, rather than as something that is decided when the baby is born. The life cycle model focuses on educating girls from childhood on, as well as on significant members of their social network. This means it is important to educate even pre-adolescent girls and boys, in an age-appropriate manner, about the benefits of breastfeeding. As an adult, a woman will rely on a circle of relatives and friends for support and advice; these individuals also need to be identified and informed about the benefits of breastfeeding. It is important to realize that most individuals older than 25 grew up in an era when breastfeeding was very uncommon. They may remember when it was frowned upon or even legally banned in both public places and private businesses. As a result, they may have very little personal experience with or exposure to breastfeeding. Educating them on the benefits of breastfeeding may require some effort, but is important if they are to be supportive of a mother’s desire to breastfeed. Health care providers also need to provide new mothers who want to breastfeed with fundamental information to help them succeed in this most personal of endeavors. A new mother will often need guidance about both her own body (how the milk "lets down," nipple soreness, engorgement) and about her child (how to position her baby and help it suck; how to schedule feedings; how to know if the baby is getting enough to eat). Duration of breastfeeding Healthy People 2000/2010 recommends that breastfeeding continue for five to six months. The American Academy of Pediatrics recommends that women exclusively breastfeed for the first 6 months, and continue at least some breastfeeding for twelve months or as long as the mother desires. So it is discouraging that most women in the United States breastfeed for only six to eight weeks.
One way to assist mothers to breastfeed longer is to inform them about ways to accomplish this. For example, many places of employment offer resources like lactation rooms so that mothers can breastfeed in the workplace. Other working mothers may wish to store their milk so that it can be bottle-fed to their children by day care providers; lactation rooms can also make this easier. Health care providers need to be informed about breast pumps, breast milk storage systems, and storage requirements, and to talk with mothers about them. Health care providers can also act as advocates. They can encourage third-party payers to include breast pumps as a covered item. They can talk with employers and business owners about providing clean, safe lactation facilities at places of employment, shopping malls, and recreational settings. Many resources exist to help health care providers promote breastfeeding:
Resources:
|
||
|
