The Importance of Supporting Mothers Who Breastfeed

by Rachel B. Barrientos and Paula Bylaska-Davies

Breastfeeding has always been an important part of infant health; around the
world mothers have been breastfeeding their children since the beginning of the human
race. The American Academy of Pediatrics recommends that children are nursed for at
least the first 12 months of life. Furthermore, the World Health Organization
recommends an even longer period of 2 years (CDC, 2010). According to the Centers
for Disease control, only 22.7% of infants born in 2006 were still at least partially
breastfeeding at 1 year of age (CDC 2010).

There are many health benefits to breastfeeding children such as lower mortality
rates, ideal nutritional values, and long term benefits such as healthy weights and
higher intelligence later in life. The positive aspects of breastfeeding extend to maternal
health as well, such as lower rates of breast and ovarian cancers and decreased
occurrences of post-partum depression. Nurses play an important role in encouraging
and supporting breastfeeding; they have multiple interactions with the mother during pre
and post-natal appointments where they can advocate for breastfeeding through
teaching.

Breast milk is the ideal source of nutrition for growth and development, providing
newborns and infants with nutrients in natural forms. The longer a child is breastfed the
better the results; cessation of breastfeeding before six months increased the risk of
pneumonia, doubled the risk of recurrent otitis media, and resulted in higher urinary
tract infections in female babies. Long term benefits of breastfeeding were found to
include lower blood pressure and cholesterol levels, as well as higher performances on
intelligence tests (Bai, Middlestadt, Peng, & Fly, 2009). Potentially, 1.3 million lives can
be saved each year by mothers that continue to breastfeed beyond six months (Bai et
al., 2009). It is also reported that “early cessation of breastfeeding increases infants'
risks for childhood obesity, gastroenteritis, necrotizing enterocolitis, leukemia, otitis
media, severe lower respiratory infections, sudden infant death syndrome, and types 1
and 2 diabetes” as well as incurring an average of $475 more in health costs in the first
year than those infants exclusively breastfed (Bartick, Stuebe, Shealy, Walker, &
Grummer-Strawn, 2009).

The maternal benefits to breastfeeding include lower risk for breast and ovarian
cancers, type 2 diabetes, and postpartum depression for mothers that

breastfed their infants (Bartick et al., 2009). Emotionally, mothers benefit from
breastfeeding by forming a stronger bond with their baby. A research study reported that
the number one advantage of breastfeeding stated by mothers was “helping bond with
baby” (Bai et al., 2009).

Early cessation of breastfeeding is identified by the Department of Health and

Human Services as a problem. A goal included in Healthy People 2010 and again in
Healthy People 2020 aimed to increase the proportion of mothers who breastfeed their
babies ever, at six months, and at one year (U.S Dept. of Health and Human Services,
2010). Despite frequent contact with health care professionals, the first two weeks of life
require increased breastfeeding education and support, as this is when breastfeeding
has a high cessation rate (Bartick et al., 2009). Identifying factors that affect cessation
of breastfeeding will aid in increasing maternal support and in turn increase child and
maternal health.

Out of all healthcare providers, nurses spend the most time with mothers during
the pre and post-partum period, as well as care for the infants following delivery. Bartick
et al. (2009) reported that the nursing staff at “88% of facilities reported that they taught
most mothers techniques of breastfeeding...” However, 65% advised women to limit
suckling, 45% gave pacifiers to healthy infants, and 24% regularly gave milk
supplements to the majority of healthy infants (Bartick et al., 2009). Nurses can
encourage the advancement of breastfeeding by increasing breastfeeding teaching to
100% and decreasing detrimental practices such as limiting suckling, pacifier use, and
formula supplements. In addition, nurses can provide better teaching and positive
support before birth and after hospital discharge; “...data suggested that many women
had never even considered breastfeeding and often discontinued breastfeeding due to
discomfort, embarrassment, and lack of assistance” (Flower, Willoughby, Cadigan,
Perrin, & Randolph, 2007).
It is important for nurses to explore the positive and negative aspects of breastfeeding
from the mother's perspective. The most frequently reported benefit from breastfeeding
mothers was the emotional bond with the infant formed while breastfeeding (Bai et al.,
2009; Wambach & Cohen, 2009). The other advantages reported in studies were
contributing to the health of the infant, experiencing convenience of breastfeeding, and
saving money (Bai et al., 2009, Wambach & Cohen, 2009). One of the negative aspects
of breastfeeding reported by women had to do with nursing in public, some women had
difficulty finding a place to nurse in public as well as experiencing some embarrassment
when nursing in public (Bai

et al., 2009, Wambach & Cohen, 2009). By advocating for more private
breastfeeding spaces in public areas, nurses can help to reduce one of the major
factors behind cessation of breastfeeding.

Factors related to initiating breastfeeding have been explored by many

researchers (Barona-Vilar, Escriba-Aguir, & Ferrero-Gandia, 2007; Flower et al., 2007,
Wambach & Cohen, 2009). Demographics play an important role in the decision
process for a pregnant woman (Barona-Vilar et al., 2007; Flower et al., 2007). Women
were more likely to initiate breastfeeding if they were educated, married or had a first-
born child (Flower et al., 2007). However, women who returned to work at two months
or received WIC were less likely to initiate breastfeeding (Flower et al., 2007). Social
support also plays a role in a woman's decision to initiate breastfeeding, women in
higher socio-cultural groups relied on the support and opinions from their partners and
healthcare networks, whereas women who were from lower socio-cultural groups
reported friends opinions and support was influential on whether to initiate breastfeeding
(Barona-Vilar et al., 2007). In order to increase support for new mothers, nurses can
extend patient teaching not only to the mother, but to the fathers and other support
systems important to the mother. Brochures and literature highlighting the health and
financial benefits of breastfeeding should be distributed to women to share with any
family members who are unable to attend appointments.

The common reasons reported for stopping breastfeeding before 8 weeks

postpartum included insufficient milk supply, latch problems, personal reasons, returning
to work and medication use/illness of mom or baby (Lewallen et al., 2006). In addition,
pain, nipple soreness and embarrassment related to public breastfeeding were stated
as reasons for discontinuing breastfeeding before 6 weeks postpartum (Wambach &
Cohen, 2009). Prenatal teaching regarding proper techniques should prepare new
mothers as to what to expect when breastfeeding, as well as at the follow-up at well-
baby visits to address additional issues that may arise. This additional support may
increase the longevity of breastfeeding mothers by resolving complications if they arise.
It is necessary for nurses to encourage and support breastfeeding during interactions
with mothers. Nurses should address the discontinuation of breastfeeding by teaching
mothers pre and post-partum how to avoid the pitfalls behind cessation of
breastfeeding, such as pain, discomfort, frustration, lack of support, and the public’s
disapproval. This teaching would include assisting mothers with proper latch techniques
and encouraging mothers to participate in

breastfeeding classes pre-natally as well as breastfeeding support groups during

the post-partum period. Mothers should be taught how to pump, store, and prepare
breast milk as they may re-enter the work force following maternity leave, as well as
reinforcing the benefits of breast milk at well baby visits to encourage the continuation of
breastfeeding. Nurses can also advocate for improved breastfeeding areas for mothers
and infants in public areas and the workplace. By increasing patient teaching as well as
educating the public, the numbers of mothers who initiate breastfeeding as well as the
longevity of breastfeeding by mothers will increase, ultimately improving child and
maternal health and decreasing healthcare costs.