Breastfeeding Assessment, Education & Support

Breastfeeding is ideal for newborn infants and their mothers and is specifically designed to meet an infant’s nutritional and social-emotional needs.^1-3 Aside from its highly digestible properties and delicate nutrient balance, breast milk has been found to impart immunity by transferring antibodies from mother to infant.^{1, 3} As a result, breastfed infants experience fewer emergency room visits, respiratory, urinary and ear infections, bacterial meningitis, and fewer occurrences of other diseases such as diarrhea, asthma, and lower rates of Sudden Infant Death Syndrome.^{1, 3} Further benefits for the infant include: increasing infant cognitive function, promoting the proper development of teeth and speech patterns, and decreasing the risk of later childhood obesity.¹ Breastfeeding also has multiple benefits for the mother, including: enhancing the bond between infant and mother, decreasing recovery time following birth, enhancing maternal self-esteem, reducing the risks of certain cancers, and increased bone density.^4,5

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Breastfeeding Priorities and Recommendations

The American Academy of Pediatrics (AAP) is joined by the Surgeon General and many domestic and international agencies in recommending breastfeeding as the best way to feed infants. The AAP recommends that infants breastfeed exclusively for the first six months of life and, with the addition of appropriate complementary foods starting at six months, breastfeeding should continue until at least one year of age, and thereafter for as long as both mother and child desire. The U.S. Healthy People 2020 national objectives for breastfeeding are to increase the proportion of mothers who breastfeed their babies

• Ever: From 74.0%* to 81.9%
• At 6 months from 43.5%* to 60.6%
• At 1 year from 22.7% to 33.6%
• Exclusively through 3 months from 33.6%* to 46.2%†
• Exclusively through 6 months from 14.1%* to 25.5%†

In addition, the Healthy People 2020 goals include

• Increasing the proportion of employers that have worksite lactation support programs (MICH 22) from 25 to 38%
• Reducing  the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life  from 24.2% to 14.2%
• Increasing the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies from 2.9% to 8.1%

* Source: Centers for Disease Control and Prevention, National Immunization Survey, 2006 data.41
† Source: Society for Human Resource Management Survey, 2009.132

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The California Department of Public Health is dedicated to promoting, protecting, and supporting breastfeeding among all Californians.⁸ The CDPH views breastfeeding promotion as an important public health initiative, likely to reduce, offset, and prevent disease, and to reduce health disparities among ethnic and minority groups. The California strategic initiative to promote breastfeeding was launched in November 1996 with the release of the first Breastfeeding Promotion Committee Report: Breastfeeding: Investing in California’s Future and extended with the publication of the second Committee Report in January 2007.⁷

To achieve these goals, professional organizations and the U.S. Preventive Services Taskforce recommend that pregnant women receive breastfeeding education, counseling, and support beginning early in pregnancy, continuing throughout prenatal care, during hospitalization around the time of birth, and throughout infancy.^5,9

Formal education for mothers and families, direct support during breastfeeding, training for healthcare staff on how to support breastfeeding, and peer support for new mothers are strategies that in combination, increase rates of breastfeeding initiation and its duration.⁹

References

1. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians. 2006.
2. Rabet, L.M., Vos, AP, Boehm, and Garssen, J. Breast-Feeding and Its Role in Early Development of the Immune System in Infants: Consequences for Health Later in Life.  J of Nutr 2008;138:1782S-1790S.
3. American Dietetic Association.  Position of the American Dietetic Association: Promoting and Supporting Breastfeeding. J Am Diet Assoc 2005;105:810-818.
4. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.  Evidence Report/Technology Assessment No.153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No.290-02-0022). AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007.
5. Association of Women’s Health, Obstetric and Neonatal nurses. Evidence-based clinical practical guideline. Breastfeeding Support: Prenatal Care Through the First Year. 2nd Edition.  AWHONN Washington DC.
6. Galson, Steven K, US Surgeon General. Mothers and Children Benefit from Breastfeeding. J Am Diet Assoc 2008;108:1106
7. Breastfeeding Promotion Committee Report to the California Department of Health Services, Primary Care, and Family Health Division. 2007. Available here.
8. California Department of Health Services Maternal and Child Health Breastfeeding Program. DHS Breastfeeding Promotion Policy. Accessed on June 15, 2007. Available here.
9. U.S. Preventive Services Taskforce. Primary Care Interventions to Promote Breastfeeding. October 2

Academy of Breastfeeding Medicine: Educational Objectives and Skills for the Physician with Respect to Breastfeeding (2011) (PDF)

Countermarketing and the WHO International Code of Marketing of Breast-Milk Substitutes Provides rational, evidence and guidelines for professionals working with mothers and infants on standards for marketing and distribution of infant formula. The guidelines were created by the World Health Organization in response to the negative impact on breastfeeding that results from direct marketing of formula to mothers. (PDF)

US Breastfeeding Committee: Core Competencies in Breastfeeding Care and Services for All Health Professionals (2010) (PDF) 

Guidelines for evaluating pamphlets, audiovisuals, posters, handouts, and other media related to breastfeeding. Provides tips to evaluate any media used to promote and support breastfeeding and provides a worksheet to “score” media.

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Prenatal Breastfeeding Assessment: Commonly used prenatal forms such as ACOG, and U.S. General Services Administration have space to record “Breast or Bottle”.  POPRAS and the California Comprehensive Perinatal Services Program forms add information about prior pregnancy and planned duration of breastfeeding.

Providers may benefit from having a form that provides additional “prompts” or questions to assess knowledge of breastfeeding benefits, attitudes and beliefs about breastfeeding, past experience, potential contraindications and intention, as presented in current guidelines.⁵  Supplemental forms need to be supplied to providers to assist in completing a comprehensive breastfeeding assessment.

Prenatal Breastfeeding Assessment Tool Example: A form that can be adapted for use in your clinic to assess breastfeeding knowledge, attitudes, beliefs and intentions. At the onset of prenatal care. The UNICEF Baby Friendly Initiatvie provides a checklist for educational topics to cover towards the end of pregnancy

Hospital and Workplace Breastfeeding Support

California Model Hospital Breastfeeding Policies Toolkit (2007) The California Department of Public Health developed this toolkit to assist hospitals and healthcare providers to meet the state and national public health breastfeeding goals. The toolkit includes resources and web links to materials that may be customized for individual use, with proper attribution to the original authors.

The CDC Guide to Breastfeeding Interventions (2005): This guide reviews evidence-based and promising practices that support the initiation of breastfeeding in hospital settings and maintaining lactation once women return to school or work.

The CDC Lactation Support in the Workplace (2007): This toolkit provides an example of how the CDC planned, implemented and evaluated a comprehensive workplace lactation support program.

LA Best Babies Network Breastfeeding Friendly Workplace Policy This brochure outlines the rationale, benefits, and importance of developing a workplace policy that supports lactation at the workplace; a sample policy is included. The brochure is also available in Spanish.
 

The Business Case for Breastfeeding -U.S. Department of Health and Human Services provides a series of materials including a toolkit with reproducible resources designed to create a breastfeeding friendly work environment.

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Provider & Family Breastfeeding Education

• Physician Lactation Education Collaborative of Washington
• This two CD set provides 10 modules of evidence-based education for physicians and perinatal staff. Available for a small fee to interested parties from other states.
• Breastfeeding Basics – is an academic, non-commercial, short course on the fundamentals of breastfeeding designed primarily for medical practitioners.
• Clinical Management of Breastfeeding- Available for purchase from VIDA Health Communications, Inc. Training curriculum for establishing a multi-disciplinary model of lactation management.
• Mothers and Health Educators –the Mother of 7 Breastfeeding Videos (DVD or VHS) available for purchase the videos provide Mom-to-Mom information, support, techniques and tips through stories and 3-D animation.
• Breastfeeding Task Force of Greater Los Angeles Seminars – Ten seminars provided every year on a myriad of topics related to breastfeeding. Continuing education credits provided.

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• California Department of Public Health
• Breastfeeding Taskforce for Greater Los Angeles
• The WIC Family
• CDPH Common Breastfeeding Questions
• Breastfeeding – Parenting Corner Q&A
• www.GotMom.org is a breastfeeding resource for mothers and families developed by the American College of Nurse Midwives
• Easy Guide to Breastfeeding: Available for download in English, Spanish and Chinese this publication from the Office of Women’s Health in the U.S. Department of Health and Human Services provides information and encouragement to women on breastfeeding

Resources

• Breastfeeding Taskforce for Greater Los Angeles
• The WIC Family
• Maternal Medication and Breastfeeding: Drugs in Pregnancy and Breastfeeding
• Drugs and Lactation Database (LactMed) - A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.
• Medications and Mother’s Milk Newsletter – This free monthly newsletter is put together by Hale Publishing and is emailed to its recipients, providing the latest research articles and news related to breastfeeding
• Hepatitis B & C and Breastfeeding
• American Academy of Pediatrics: Childrens Health topics- Breastfeeding