Oxford Handbook of Midwifery (142 page)

• 671
  

  The purpose of the programme is to ensure that newly qualified midwives and health visitors are equipped with the knowledge and skills needed to support breastfeeding effectively. Accreditation is awarded to an indi- vidual course, not to the institution itself. Higher education institutions (HEIs) can apply for accreditation for each of the courses they provide for the training of midwives or health visitors/public health nurses.
  

  

  1. World Health Organization (1989).
     Protecting, Promoting and Supporting Breastfeeding: The Special Role of the Maternity Services
     . Geneva: WHO.
     
  2. World Health Organization (1998).
     Evidence for the Ten Steps to Successful Breastfeeding, Division of Child Health and Development
     . Geneva: WHO.
     

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     Breastfeeding
     

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     Support for breastfeeding
     

     The support the woman receives from her partner, family members, friends, health professionals, and support networks can affect the uptake and continuance of breastfeeding. Emotional support as well as prac- tical support is needed to empower mothers to breastfeed successfully. Various levels of support may be required by breastfeeding mothers, depending upon their social circumstances. Caregivers may find it easier to support breastfeeding mothers effectively if they have had the opportu- nity to come to terms with their own breastfeeding experiences.
     ¹
     

     Partners
     

     • The male partner has a strong influence upon the choice of infant feeding method.
       ²
       
     • The partner’s positive attitude to breastfeeding is important for the mother initiating and continuing to breastfeed.
       ³
       
     • Women need to talk to their partners antenatally about breastfeeding, as a woman’s guesses about her partner’s ideas of breastfeeding have often been found to be inaccurate.
       ⁴
       
     • Partners need to be informed of the benefits of breastfeeding for both baby and mother.
       
     • Partners should be involved in antenatal preparation for breastfeeding whenever possible.
       
     • Partners are invaluable in providing emotional and practical support for breastfeeding mothers.
       
     • Partners wishing to undertake shared care of the baby should be encouraged to look at alternatives to feeding, e.g. bathing the infant, skin-to-skin contact.
       

       Family and friends
       

     • Family and friends exert a strong influence on a mother’s decision about breastfeeding.
       

       •
       About one in four mothers are helped by a relative or friend when they
       

       have problems breastfeeding.
       

     • First-time mothers are more likely to turn to relatives and friends for assistance.
       
     • Breastfeeding mothers who were breastfed themselves are more likely to be breastfeeding at 4 weeks than those who had been bottle fed.
       
     • Breastfeeding mothers whose friends mostly bottle fed are more likely to discontinue in the first 2 weeks postnatally.
       ⁵
       

  Peer support
  

  NICE
  ⁶
  recommends that there should be easily accessible breastfeeding peer support programmes and that appropriately trained breastfeeding peer supporters should be part of a multidisciplinary team. It is also rec- ommends that breastfeeding peer supporters should contact mothers directly within 48h of their transfer to the community and offer them ongoing support according to their individual needs. This could be via tel- ephone, texting, face-to-face, local support groups or the internet.
  

  SUPPORT FOR BREASTFEEDING
  

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  Breastfeeding peer support projects have been shown to:
  

Specialist infant feeding advisors

Many maternity units now employ specialist infant feeding advisers. Their role varies depending upon the needs of the local population and the requirements of the maternity units. There is very little research related to the role of the specialist feeding advisors but they can improve the care and support breastfeeding women receive by:

Their role is not to deskill the health professional, by taking over the carer

role for breastfeeding women, but to develop their skills and increase their knowledge base to ensure that all breastfeeding women are provided with evidence-based, sensitive, and consistent information and support.

Voluntary groups

There are a number of breastfeeding voluntary organizations, or organiza- tions that have expertise in supporting breastfeeding mothers in special circumstances in the UK, including:

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These organizations supply information and support, by telephone and in leaflets and books. Mothers should be offered leaflets or cards giving details about support organizations prior to leaving the postnatal ward.

1. Smales M (1998). Working with breastfeeding mothers: the psychosocial context. In: Clement S (ed.)
   Psychological Perspective on Pregnancy and Childbirth
   . Edinburgh: Churchill Livingstone.
   
2. Losch M, Dungy CI, Russell D, Dusdicker LB (1995). Impact of attitudes on maternal decisions regarding infant feeding.
   Journal of Pediatrics
   126
   (4), 507–14.
   
3. Fraley K, Freed GL, Schanler RJ (1992). Attitudes of expectant fathers regarding breast-feeding.
   

   Pediatrics
   90
   , 224–7.
   

4. Freed GL, Fraley K, Schanler RJ (1993). Accuracy of expectant mothers predictions of fathers’ attitudes regarding breastfeeding.
   Journal of Family Practice
   37
   (2), 148–52.
   
5. Bolling K, Grant C, Hamlyn B, Thornton A (2007).
   Infant Feeding Survey 2005.
   London: The Information Centre.
   
6. National Institute of Health and Clinical Excellence (2008).
   PH11 Maternal and Child Nutrition: Guidance.
   London: NICE.
   

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Practices shown to be detrimental to successful breastfeeding

Inconsistent information

Despite efforts to ensure that appropriate advice and information are given to breastfeeding mothers, there is still evidence that, for many mothers, difficulty in establishing breastfeeding is compounded by incon- sistent advice.
¹
Conflicting advice does exist and persist, mostly as inac- curate information and practice.

Conflicting advice and information:

• Reinforce a mother’s lack of self-confidence in her ability to breastfeed
  
• Disempower women.
  ²
  

  In order to prevent inconsistent advice, midwives need to:
  

• Have in-depth knowledge and understanding of the physiology of lactation
  
• Be able to communicate effectively
  
• Acknowledge their own subjective bias
  
• Provide consistent information and support in line with the best available evidence.
  ²
  

  An authoritarian approach to communication is unhelpful and even detrimental.
  

  Use of pacifiers
  

  The use of pacifiers (dummies) has become a widespread cultural practice in the UK. They are used to settle, soothe, or otherwise occupy a fretful or distressed baby.
  

  Reasons given for using pacifiers have included:
  ³
  

• Mothers who used them were more sensitive to their baby’s crying than mothers who did not use them
  
• Mothers used them to space feeds, which they perceived to be too
  frequent
  
• They were used in the past to reduce the number of breastfeeds as
  

  part of the weaning process.
  

  The use of pacifiers has been implicated in:
  

• Reducing the duration of breastfeeding
  ⁴
  
• Increasing the risk of otitis media
  ⁵
  
• Oral candida infection
  ⁶
  
• Reduced jaw muscle activity
  ⁷
  
• Reduced intellectual attainment
  ⁸
  
• Greater incidence of abnormal jaw development.
  ⁹
  

  No research to date explores the effect of bottle teats and/or pacifiers on the initiation of breastfeeding. However, there is concern by health professionals that their use may adversely affect initiation and establishment of breastfeeding. Conversely some evidence suggests that the use of pacifiers can reduce the incidence of cot death.
  ¹⁰
  

  PRACTICES DETRIMENTAL TO BREASTFEEDING
  

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  The use of nipple shields
  

  The use of nipple shields is sometimes advocated as treatment for sore nipples; however, little evidence is currently available to support this practice.
  

  The use of nipple shields:
  ¹¹