Category: Breastfeeding

After giving birth to a newborn, there are many adjustments you may need to get accustomed to. Aside, from recovering from the delivery a newborn. There is a moment of bonding time for both parents, usually immediately after birth of a newborn. Which may entail mother to breastfeed their newborn for the first time. We as nurses we are able to educate the benefits of breastfeeding newborns, if the mother decides to breastfeed their child. Ultimately it is up to the mother to decided what is best, and we need to support their choices. If the mother decides to breast feed, we can help the mother with proper technique of breastfeeding. Ensuring the newborn has a proper latch to the breast. As well as, showing the mother how to remove the newborn from the breast, to ensure not inflict trauma to the tissue of the nipple.

According to Durham & Chapman the benefits of human milk, “is the preferred source of infant nutrition and provides all the nutritional needs an infant requires. In the short term, infants who breastfed have a decreased risk of: Gastroenteritis, otitis media, hospitalization due to respiratory syncytial virus, necrotizing enterocolitis, sudden infant death and urinary tract infections” (Durham & Chapman, 2019, Pg. 482-483). “Over the long term, breastfed infants are at decreased risk of: asthma, atopic dermatitis, cardiovascular disease, celiac disease, childhood inflammatory bowel disease, obesity and sleep disorders” (Durham & Chapman, 2019, Pg. 483).

There are some contraindications for breastfeeding that nurse should know about, such as, “women with active & untreated tuberculosis; women who are receiving diagnostic or therapeutic radioactive isotopes; women who are receiving antimetabolites or chemotherapeutic agents; women who have herpes simplex lesions on a breast; women who are HIV positive; women who use street drugs; infants with galactosemia” (Durham & Chapman, 2019, Pg. 483-484).

The components of human milk contain, “proteins, carbohydrates and fats are synthesized in the breasts’ alveolar glands. Proteins account for approximately 6% of the calories in human milk and are easier to digest than protein prepared in formula. Carbohydrates account for approximately 42% of the calories in human milk with lactose as the main carbohydrates” (Durham & Chapman, 2019, Pg. 484). “Fats account for approximately 52% of the calories in human milk. Cholesterol, which is essential for brain development, is higher in human milk. Vitamins and minerals are transferred to the human milk from the maternal plasma” (Durham & Chapman, 2019, Pg. 484). “Human milk contains multiple antibodies, enzymes and immune factors that help protect the infant from common infections. It also stimulates the growth of healthy bacteria in the intestinal system, which inhibits growth of bacteria that can cause diseases” (Durham & Chapman, 2019, Pg. 484).

We as nurses are able to properly educate the mother on how to breastfeed correctly. Which includes, “how to hold her infant during the feeding sessions depending on what is comfortable for the infant and mother. Periodically changing the infants’ position on the breast decrease nipple irritation” (Durham & Chapman, 2019, Pg. 487). “Common tools used to asses and document breastfeeding efforts are LATCH, L (Latch) grasps breast, tongue down, lips flanged, rhythmic sucking; A (audible swallowing) spontaneous and intermittent 24 hours old; T (type of nipple) everted after stimulation; C (comfort- breast & nipple) soft and tender; H (hold /positioning) no assist from staff, mother is able to position and hold infant. (Durham & Chapman, 2019, Pg. 488). “Preventing nipple tissue breakdown, painful nipples are a primary reason that women stop breastfeeding. Nipple irritation can lead to skin breakdown, which can cause mastitis. Each breastfeeding mother must be taught to inspect her nipples for signs of: irritation, redness, bruising, and tissue breakdown” (Durham & Chapman, 2019, Pg. 488).

In healthcare as a nurse, we must be properly trained on how to educate new mothers on how to breastfeed. There are many post-partum nurses that are able to assist mothers that may not know how to breastfeed their child or even bottle feed. That is when we can provide education and guidance, so their infant receives proper nutrition. If needed, we are able to provide them with outside resources to help the new mother get accustomed to the changes to having a newborn infant.

References

1. Durham, R. F., & Chapman, L. (2019). Maternal-newborn nursing: the critical components of nursing care (3rd ed.). Philadelphia, PA: F.A. Davis Company.

I am taking this opportunity to address why breastfeeding is the most favorable method to feed an infant. Couples who are about to have a child or currently have a newborn must understand how they can positively impact their child’s life with the power of breastfeeding. I chose this topic because the breastfeeding versus formula feeding debate caught my attention. I can envision a short list of pros and cons for each feeding technique, but I was interested in doing more detailed research. In general, I wanted to see if I could conclude that breastfeeding is a more beneficial process than formula feeding for a child’s development. Therefore, it is imperative to know how breastfeeding affects both parents differently and the child due to all of the health benefits and the strong bond that is created.

First off, let’s talk about why it is so important for a newborn to consume breast milk. According to Carole Lucia and Jessica Hartshorn, a reliable source called the World Health Organization recommends that all babies should be exclusively breastfed for the first six months of their life in an article called “The Benefits of Breastfeeding.” The milk that is made by a woman’s breast right after delivering a baby is called colostrum (Lucia & Hartshorn, 2019). This type of milk is also referred to as “liquid gold” because it is very high in protein and contains the most powerful antibodies (Lucia & Hartshorn, 2019). The specific kind of protein found in breast milk is much easier for a baby to digest than the proteins found in formula milk, causing babies who are breastfed to have fewer bellyaches (Lucia & Hartshorn, 2019). Likewise, Colin Binns, MiKyung Lee, and Wah Yun Low discuss more benefits and statistics that support my argument in a scholarly journal article called “The Long-Term Public Health Benefits of Breastfeeding.” The natural antibodies in breast milk help protect a baby from developing infections and chronic diseases, such as diabetes, hypertension, and a few types of cancer (Binns et al., 2016).

Most importantly, breastfeeding promotes a secure attachment between a mother and their infant because this kind of skin to skin contact gives the baby an explicit sense of assurance that he or she is deeply cared for and loved (Brooks, 2013). I learned more about this concept in The Process of Parenting by Jane Brooks because she points out that if a mother can act as a stable base for an infant to trust, their bond in the future will be even stronger. The secure attachment between a mother and a baby also allows mothers to read their baby’s unique indications to signal that they are full, so mothers will not overfeed them and prevent them from becoming obese in the future (Lucia & Hartshorn, 2019). To further illustrate this fact, “infants who are not breastfed are 33% more likely to become obese children” (Binns et al., 2016).

Moreover, breastfeeding has an immense impact on mothers and can empower them. While producing milk, mothers burn about 300 to 500 calories a day to lose their excess pregnancy weight (Lucia & Hartshorn, 2019). Also, a hormone called oxytocin is released while a woman breastfeeds causing their uterus to contract back to a normal size (Lucia & Hartshorn, 2019). During this period, a woman’s body has the opportunity to heal naturally after delivering their child (Binns et al., 2016). Credible studies have proven that breastfeeding lowers a mother’s risk for ovarian cancer and breast cancer (Binns et al., 2016). In turn, parenting is a process and ‘mothers have the natural capability to nourish their child in a special way (Brooks, 2013). After reviewing the flexible definition of a parent, it is clear that a parent should foster their child’s personal growth and protect them any way they can (Brooks, 2013).

Unfortunately, there is a big misconception surrounding who is involved in the breastfeeding process. Women might have the breasts, but men provide informal support that is as influential as the woman supplying their child with breast milk (Mitchell-Box & Braun, 2012). Kristen Mitchell-Box and Kathryn Braun provides their readers with a lot of unforeseen information about a man’s role in the breastfeeding process in an academic journal called “Fathers’ Thoughts on Breastfeeding and Implications for a Theory-Based Intervention.” As a matter of fact, after surveying fourteen fathers that were randomly selected, Mitchell-Box discovered that men strongly believe that breastfeeding in public is inappropriate, formula feeding is way more convenient, and they feel excluded from the whole process (Mitchell-Box & Braun, 2012). For this reason, I am here to say that men matter in the breastfeeding process. Mitchell-Box highlights this idea by explaining that “expanding the breastfeeding dyad to a triad is crucial to help increase breastfeeding initiation and duration and enable the male partner to have more involvement in the breastfeeding process” (Mitchell-Box & Braun, 2012). This claim illustrates how the mother, father, and infant all play their significant roles. Fathers that play an active part in their child’s life, starting from birth set their children up for success in the future (Mitchell-Box & Braun, 2012). The recommendations I have for fathers might sound like tedious tasks, but they would be alleviating stress off of their partner and child, so they can breastfeed peacefully. Meanwhile, fathers can take care of their other children, put in a load of laundry, and shop for groceries. This knowledge about children’s developmental patterns and unique needs help parents be more sufficient caregivers (Brooks, 2013).

Ultimately, I think it is easy to agree that the research I have shared reiterates the importance of breastfeeding and how it promotes the healthy development of children. The positive emotional, physical, and cognitive effects that breastfeeding has on babies are extraordinary. I will admit, the transition to parenthood and making decisions will be tricky; however, partners must plan how they are going to raise a child respectively (Brooks, 2013). My last recommendation would be to learn more about breastfeeding through a nationwide nutrition program called Women, Infant, and Children (Mitchell-Box & Braun, 2012). This renowned program has a great website and walk-in clinics scattered throughout the United States to help anyone with questions or concerns related to this topic or anything associated with parenting (Mitchell-Box & Braun, 2012). Breastfeeding is a worthwhile commitment that results in amazing outcomes, and I can confidently recommend it to any couple with a newborn baby.

Introduction

The public health issue which is being focused on this essay is breastfeeding and the community of practice that the essay will be based on is Newham, which is my placement area. Breastfeeding is an incomparable way of providing complete food for the healthy growth and development of infants (WHO, 2019). Breastfeeding is also an important part of the reproduction process which has very important effects on the health of mothers who breastfeed, which would benefit the mothers but could also lead to potential risks (WHO, 2019). Evidence has shown, that in terms of a population starting point, breastfeeding exclusively (when the infant does not need any additional food or fluid) for 6 months is the greatest way to feed infants (WHO, 2019).

The data shows that there is a high local count for mothers that have initiated breastfeeding which is 5,907. In the area of Newham, 96.7% of mothers were found to have initiated breastfeeding which compared to the national average (74.5%) is higher. One of the reasons for this high prevalence in Newham is that it is one of the most deprived areas in the London borough. According to Trust for London (2018), 35.6% of employees working in Newham are low-paid, which is the highest percentage in London. The poverty rate was found to be is 37%, which is ten percentage points higher than the London average. Another reason for the high prevalence rate for initiation of breastfeeding in Newham is that breastfeeding is a free alternative of feeding a baby compared to buying formula milk which can be costly, especially if mothers have more than one child to support. The sociodemographic population was also considered as a reason for the high prevalence of breastfeeding initiation. The table below is showing the comparison between the different population groups in Newham and England.

The data shows that the population of Newham is diverse and that 64% of people living in Newham are from the ethnic minority group. The percentage of the ethnic minority group could have an impact on the breastfeeding initiation rates as different cultures highlight the importance of breastfeeding compared to others. A factor in the high prevalence rate is that women are more likely to stay at home and not work due to the difference in culture. In some cultures, the men are financial providers or breadwinners whilst the women look after their children and home. This would, therefore, give the women more time to their children and therefore, breastfeeding can be initiated more regularly. One of the services available to help support mothers with breastfeeding in Newham, which in turn could lead to a high prevalence of breastfeeding is the National Childbirth Trust (NCT). This is a charity for parents that supports parents throughout your whole pregnancy, birth and beyond. If the women would prefer to meet in person, there are antenatal workshops, which is for pregnant women and their partners to see how breastfeeding works. They are usually held at Newham University Hospital and at Newham children centres, during different times of the year. Also, there is a milk bar which could be an opportunity for mothers to come together irrespective of which method of feeding they use. The women would ask questions and meet other people in the area that is going through the same problem, in terms of breastfeeding. There are also options for women who won’t be able to attend in person, such as a breastfeeding line (which is open every day of the year) and the women would be able to seek help from a qualified breastfeeding counsellor, a national breastfeeding helpline which is run by the association of breastfeeding mothers and the breastfeeding network and lastly there is a service called ‘’La Leche League’’ which make great efforts to help mothers to breastfeed through mother to mother support, encouragement, information, and education.

Summary

The assessment of the breastfeeding public health issue was done by coming together as a group of individuals whose community of practice was Newham. Everyone was given a small part of the task to do some research and to put every information and source together into a full presentation as a group. The group members also came together for workshops in order to start putting every idea and information together in a way that would be easy to understand and to explain to our peers. The strengths of this assessment are that there was enough data found concerning the breastfeeding rates in Newham, and how those rates were compared to those of the England value, which was found to be higher due to the several reasons stated above. The limitation of this assessment was finding the right research on how breastfeeding is measured. There were sources which proved to be non-reliable. However, once the right information was found, the prospective/intended methods of measuring breastfeeding were found to be more accurate but too expensive to use in most surveys which are large-scale. Therefore, methods which have already been established (retrospective) were found to be used due to the data already being analysed and published, as well as it being proven to be a less expensive way of measuring breastfeeding. This assessment was great as everyone in the group made an effort to put together and find valuable information concerning breastfeeding initiation rates in Newham, therefore there is nothing that needs improvement.

Risk and benefits of breastfeeding

Breastfeeding is the ideal form of milk for a baby as it is easy for the baby to absorb. It has the ideal components for an infant’s nutrition for the first 6months of their life and provides infants with immunological protection to prevent infections (British Nutrition Foundation, 2018). Breastfeeding has many benefits for the mother and infant, however, there are some risks involved as shown below.

Infant

Benefits

[bookmark: _Hlk10756399]Some of the benefits of breastfeeding an infant are: breastfeeding protects the baby from having infections, which would mean fewer visits to the hospital. There is evidence which is increasing to prove that breastfeeding helps lower the risk of the baby developing cardiovascular risk factors and obesity, such as hypertension and resistance to insulin, in the child’s future life (Public Health England, 2018). Another benefit of breastfeeding is that it provides protection from cot death (sudden infant death syndrome), gives protection allergies, diarrhoea and prevents constipation (UNICEF, 2019). Breastfeeding provides the baby with excellent nourishment and helps with growth. Breastfeeding contains colostrum which contains transferring factor- antibodies (immunoglobin A) and white blood cells, which are transferred to babies and boosts the infant’s immunity (UNICEF, 2019). Colostrum recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth (WHO, 2019). Lastly, breastfeeding provides the baby with vitamins and minerals

Risks

Small amounts of medication could spread to breastmilk and can sometimes cause side effects, for example, codeine- can cause difficulty to breathe. Another risk of breastfeeding for a baby is that it can cause restricted tongue movement (tongue tie). This could result in sore nipples and the baby could lose weight (UNICEF, 2019).

Mother

Benefits

According to NHS (2017), Breastfeeding reduces the risk of breast and ovarian cancer in mothers. It lowers the risk of having postnatal depression, reduces the risk of the mothers having weak bones/ osteoporosis (NHS, 2017).

[bookmark: _Hlk10757535]In terms of neurological/ emotional well-being, breastfeeding helps release oxytocin which leads to affection and builds the mothers emotional attachment to the baby and breastfeeding also increases brain development (NHS, 2017).

Risks

[bookmark: _Hlk10837049]The risks involved with breastfeeding mothers are that the breast can become full of milk (breast engorgement) and become painful. Breastfeeding can cause mastitis which is an infection of the breast and there can also be a poor attachment (NHS, 2017). When the infant is not latched on to the nipple properly, they would not receive sufficient milk, which would reduce milk production, cracked nipples and could even lead to weight loss (NHS, 2017).

Implications for practice

The prevalence of breastfeeding in Newham shows that women are supported by healthcare professionals antenatally and postnatally regarding breastfeeding. Newham University Hospital is currently accredited by the Baby Friendly Initiative as Level 2. This means that all staff working closely with the women are educated on how to support them (Baby Friendly Initiative, 2019). Newham University Hospital would need to work in order to become a Level 3 Baby Friendly Initiative accredited. In order to get to this level, the parent’s experiences of being supported with their infant feeding choices would need to be good as well as being encouraged by health care professionals to develop a loving and close relationship with their infant. The health care professionals would also need to be updated on knowledge concerning the benefits of breastfeeding, different breastfeeding positions and using the acronym CHIN. In terms of the six C’s, midwives can help women breastfeed by having a positive attitude, being aware of the women’s thoughts and feelings and keeping hands off when helping with positioning the baby at the breast- meaning to help women to breastfeed their baby, instead of ‘taking over’ and ‘doing it to them’ (McInnes Rhona; Chambers Julie, 2008).

According to NICE (2015), healthcare professionals should have sufficient time, as a priority, to give support to the mother and baby during initiation and the continuation of breastfeeding. In practice at Newham hospital, every day in the afternoon, on the postnatal ward there is one to one breastfeeding for those who require it. In order to provide woman-centred care, the midwife would need to explore the women’s hopes and expectations around her chosen method of feeding. The midwife would also explore what support the women has in order to give the best care, give factual evidenced-based information as well as practical guidance on how to feed a baby.

Conclusion

Although the hospital environment could be a bit fast paced, midwives have a duty of care to the women that they support, giving time and support to the women and baby in order to help with breastfeeding. This research allowed me to delve further into fully understanding the factors that could affect breastfeeding initiation and how important it is to the mother and baby to have support from trained health care professionals, in order to make sure that the mother feels confident when breastfeeding.

References

1. WHO. (2019). Breastfeeding. Available: https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/. Last accessed 10th May 2019.
2. Trust for London. (2018). Poverty and inequality data for Newham. Available: https://www.trustforlondon.org.uk/data/boroughs/newham-poverty-and-inequality-indicators/. Last accessed 1st June 2019.
3. Public Health England. (2018). Newham. Available: http://www.newhamambition.com/media/3800/3-newham-health-profile-2018.pdf. Last accessed 1st June 2019.
4. British Nutrition Foundation. (2018). Infant nutrition. Available: https://www.nutrition.org.uk/nutritionscience/life/infant-nutrition.html?start=1. Last accessed 1st June 2019.
5. Unicef. (2019). Benefits of breastfeeding. Available: https://www.unicef.org.uk/babyfriendly/about/benefits-of-breastfeeding/. Last accessed 1st June 2019.
6. NHS (2017). your pregnancy and baby guide. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/ ( Accessed 1st June 2019)
7. Baby Friendly Initiative. (2019). Going Baby Friendly Stage 2 – Baby Friendly Initiative. [online] Available at: https://www.unicef.org.uk/babyfriendly/accreditation/maternity-neonatal-health-visiting-childrens-centres/stage-2-an-educated-workforce/ [Accessed 9 May 2019].
8. McInnes, Rhona; Chambers, Julie. (2008). Supporting breastfeeding mothers: qualitative synthesis. Journal of Advanced Learning. 62 (4), 407-427.
9. NICE (2015). Quality statement 5: Breastfeeding | Postnatal care | Quality standards | NICE.[online] Available at: https://www.nice.org.uk/guidance/qs37/chapter/Quality-statement-5-Breastfeeding [Accessed 11 May 2019].

“Breastfeeding is beneficial to the health of both women and infants” (WHO, 2013).

In this essay I will be exploring the current ongoing public health issue that is breastfeeding and the stigma that ensues and surrounds this topic. During my exploration and analysis of this public health issue I will be using epidemiology. Using the Joint Strategic Needs Assessment (JNSA) and the Clinical Commissioning Group (CCG) I will draw conclusions as to whether they benefit breastfeeding as a public health issue or whether they cloud the awareness of the topic. Taking in to account local, national and international policies I will discuss how breastfeeding is stigmatized in certain cultures and the inequalities that women and infants face. While discussing the effects to physical and mental health that it poses and using the ladder of intervention (Nuffield, 2007) and Tannahill’s model (1985) I will debate whether current interventions help raise awareness and the effectiveness this has upon the public health issue. I will explore this public health issue and assess how the interventions have helped improve the acceptance of this issue and the thoughts and ideas that still need to be developed around this area to maintain and enhance health. I will provide current legislative documents and using the World Health Organisation 2020 framework I will discuss how they are reflected.

According to the Royal College of Paediatrics and Child Health (RCPCH, 2019) states that in Europe the UK is one of the countries with the lowest rates of breastfeeding and it decreases quite significantly in the first few weeks following birth. It also states that in a survey undertaken in 2015/2016 73.1% of women breastfed initially but that reduced to 43.2% after 6-8 weeks. (RCPCH, 2019). Another recent report published by Public Health England (2019) states that an average of 47.9% of infants are breastfed at 6-8 weeks across the UK for the first quarter of the 2019/2020 period, this has been on the increase as during the first quarter of the 2018/2019 period 44.9% of infants were breastfed at 6-8 weeks. There is limited research and findings in recent times on breastfeeding statistics due to local authorities taking over the responsibility for commissioning children’s public health in the 0-5 years’ age group from NHS England in October 2015. According to the report by Public Health England (2019) this is because not all local authorities provide their rates of breastfeeding prevalence to be analyzed and submitted in the quarterly reports. Information provided by a 2010 infant feeding survey published by the Royal College of Paediatrics and Child Health (RCPCH, 2019) explains that the rates of breastfeeding are low among younger mothers and lower socio-economic groups it shows that 46% of mothers in the lower socio-economic areas breastfed compared to 65% in the higher socio-economic areas of UK. However, it also states that this can be due to difficulties rather than willingness to breastfeed, some mothers can experience issues establishing breastfeeding, some mothers return to work more quickly than others and find it difficult to upkeep with breastfeeding and expressing. Lack in support can also lead to a decline in the number of mothers who breastfeed as well as public stigma causing mothers to feel embarrassed and uncomfortable breastfeeding in a public setting. The World Health Organisation (WHO, 2017) published that 40% of infants are exclusively breastfed in the under 6-month age range globally. Due to the impacts breastfeeding has shown to the health and survival of children across the globe the World Health Organisation (WHO, 2017)) promote breastfeeding as the most effective way to nourish and protect the health of infants. It is also stated on the World Health Organisation website (WHO, 2013) that breastfeeding is vitally important to the health of infants in the areas of high poverty as it boosts an infant’s nutrition which can help decrease the number of infant deaths caused by malnutrition. It is calculated that half of all infant deaths is due a lack of nutritional intake and this is linked with reduced numbers in breastfeeding.

The Joint Strategic Needs Assessment (JSNA) is a program headed by the local authorities to assess the needs of that area and set in place commissioned models and reports to help develop the health and social care needs and provide better services within the local community and on a national level. The Cheshire west and Chester JSNA (2016/2017) has a strategy to promote infant feeding and nutrition in children from birth to 5 years, one of the vital aims of this is to boost the numbers of infants that are breastfed from birth and to support mothers to breastfeed preferably up until 6 months if possible. The plan set in place aims to support children by giving them the best start in life, the report states that by 2020 Cheshire west and Chester Council want to boost the number of infants being exclusively or partially breastfed from 37.5% to 43.8%. (Cheshire West and Chester JSNA, 2016/2017). The Cheshire West and Chester (2016/2017) breastfeeding council plan produces a summary report for quarterly and annual data, along with this it produces national statistics for the rest of England. This annual data shows that the percentage of breastfed babies is significantly lower in Cheshire West and Chester borough compared to the average Published for England at 34% compared to 43.2%. (Cheshire West and Chester JSNA, 2016/2017). The summary report also discusses the Clinical Commissioning Group (CCG) who are the local authority in charge of implementing the Joint Strategic Needs Assessment (JSNA) in to the local community. The clinical commissioning Group (CCG) need to take in to consideration the needs of the local community and devise a strategy to improve the public health issue within a set time period, their strategy should have set targets that they aim to meet during different time intervals. Quarterly and annual reports should be published to the success or the failings of the strategy. The infant feeding strategy summary report (2016/2017) provides the conclusion that the CCG’s were successful in boosting the percentage of babies being partially or exclusively breastfed in 5 out of 7 of the children’s centers in the borough. Showing that the Cheshire West and Chester JSNA (2016/2017) has had a positive impact upon breastfeeding as a public health issue. They were able to achieve this by being able to provide more breastfeeding support in the area in the form of Bosom buddies, one to one midwives, breastfeeding support workers and Hospital provisions. (Cheshire West and Chester JSNA, (2016/2017).

Tannahill’s model of health promotion, (1985) defines health promotion in to three overlapping categories. Health Education, Health prevention and health protection. In a journal published in 2009 Tannahill revises his health promotion model and states that he sub-categorised the key aspects of the model because health promotion as a whole subject was ‘Meaningless’ he deemed this to be because there are multiple definitions to what health promotion actually means. (Tannahill, 2009).

Health education is aimed at healthy people before they are at risk of developing disease, Health prevention is aimed at people who are at risk of developing the disease. Health protection aims to target already sick people in the hopes to slow down the disease. (Tannahill, 1985).

The baby friendly initiative is a program set up with the support of Unicef and The World Health Organisation (WHO) which aims to enhance the care that mothers, children and their families receive from maternity, neonatal, health visiting and children’s centers services, (Unicef, 2019). Any services who can show that they provide the standards of care set by The Baby Friendly initiative will receive a Baby Friendly award which has been awarded to services in the UK since 1994. (Unicef, 2019). The standards that are set in place by the Baby Friendly Initiative include, putting policies in place that help to support and guide the foundations of the intervention and putting in place up to date and advanced education for all services so they are able to provide high levels of holistic care, (Unicef, 2019). The Baby Friendly initiative also aims to achieve sustainability through four key concepts: leadership, culture, monitoring and progression to ensure that all services who are baby friendly accredited are providing a high standard of care to their service users. (Unicef, 2019). ‘The Baby Friendly Initiative is transforming healthcare for babies, their mothers and families in the UK, as part of a wider global partnership between the World Health Organization (WHO) and Unicef.’ (Unicef, 2019).

My article is about how breastfeeding is publicly shamed and experts think that mothers should be able to breastfeed in public without the worries of people criticizing them for either inappropriate behavior or just for being disgusting. In the article, it states “​Breastfeeding moms have been ​asked to cover up at pizzerias​, ​confronted at malls​, ​singled out on flights​ and ​booted from water parks​.” This shows how breastfeeding is not accepted everywhere. ​My article doesn’t describe one single person but it talks about all breast feeding mothers in general. Some say if you want a baby to be quiet, people should let them eat and many babies eat and get nutrients from their mother’s breast milk. For example, babies tend to cry on flights and it helps them calm down by drinking milk. Many also think breastfeeding in public shouldn’t be allowed since breast are considered private. In my article, it states, “This is a ‘purely cultural belief,’ Escobar said. ‘In a society where breasts are seen as sexual, the sight of a baby feeding at a breast can seem inappropriate.”Many women are shamed for doing these things to help their child grow.

People that are shaming those women probably had breast milk when they were young and how would they like it if they weren’t allowed to have any milk. All states have passed laws saying that breastfeeding in public is totally legal but in some places, breastfeeding is still not publicly accepted.

This scenario is very similar to that in “The Scarlet Letter” by Nathaniel Hawthorne. In the book, “The Scarlet Letter”, Hester is being publicly shamed. In the book, it states, “Puritan, settlement, with all the townspeople assembled, and levelling their stern regards at Hester Prynne—yes, at herself—who stood on the scaffold of the pillory, an infant on her arm, and the letter A, in scarlet, fantastically embroidered with gold thread, upon her bosom…even touched it with her finger, to assure herself that the infant and the shame were real.” This shows how the scarlet letter was a shame to her. She was forced to wear the scarlet letter for life since she committed adultery where she had a child with another man. This was her punishment. In my other article, it shows a very similar case. The mother was punished for breastfeeding in a public Npool area. In the article from the Washington Post, it states, “a lifeguard approached her and asked whether she was breast-feeding. She said when told him “yes,” he responded, “You can’t do that here.” … Shortly after Daugereaux declined to leave, she said, a police officer showed up.” This shows that the women had police called on her because she didn’t leave a public pool for breastfeeding. Even though the Texas law says that “a mother is allowed to breastfeed in any location the mother is allowed to be in.” Not only did the lifeguard violate the mother’s right to breastfeed there, he shamed her for doing such a thing. There were other families she probably knew and by calling the cops, the lifeguard is embarrassing her in front of possible friends and family. In the book, “The Scarlet Letter” instead of shaming Hester in front of friends, she was shamed in front of an entire crowd of people.

Although both of the situation have its similarities, it also has their differences. In Scarlet Letter, Hester is punished to wear it for her entire life. In the book, it states, “ Mistress Prynne to stand only a space of three hours on the platform of the pillory, and then and thereafter, for the remainder of her natural life to wear a mark of shame upon her bosom.” This shows how after she is shamed by standing in front of a lot of people with the scarlet letter, she has to wear it for life. However, in the Washington Post article, the punishment is only temporary since she was just kicked out of the pool, not jailed or anything like that.

I think public shaming is something that should never happen because I don’t think people should judge others based on their actions, especially doing something that is natural. I have learned that many things that happen in life are not publicly accepted nowadays. I do believe that breastfeeding in public should be allowed and the people should be able to accept that fact. It is a natural thing, and even though it might disgust a lot of people, it shouldn’t because that person that is judging probably drank breast milk when they were young. It really has changed the way I viewed public shaming since I really never realized the amount of people that are shamed for such petty things. I think people should focus on the bigger things and try to achieve bigger things in life rather than bring others down. I tend to not judge people about things that they cant really control such as their social status, race, religion and etc. But something people should judge others about are if their actions are wrong since we control our actions.

WORKS CITED

1. Haneline, Amy. “This Is Why Moms Breastfeed on Flights and in Public … Not That We Should Have to Explain.” ​USA Today​, Gannett Satellite Information Network, 1 Aug. 2019, www.usatoday.com/story/life/parenting/2019/08/01/breastfeeding-public-and-flights-explained/1865134001/​.
2. Bever, Lindsey. “A Mother Was Breast-Feeding Her Child at a Public Pool. Then the Police Ca​me.” ​The Washington Post​, WP Company, 11 June 2019, www.washingtonpost.com/lifestyle/2019/06/11/mother-was-breastfeeding-her-child-public-pool-then-police-came/​.
3. http://www.usatoday.com/story/life/parenting/2019/08/01/breastfeeding-public-and-flights-explained/1865134001/
4. http://www.usatoday.com/story/life/parenting/2019/08/01/breastfeeding-public-and-flights-explained/1865134001/
5. http://www.washingtonpost.com/lifestyle/2019/06/11/mother-was-breastfeeding-her-child-public-pool-then-police-came/
6. http://www.washingtonpost.com/lifestyle/2019/06/11/mother-was-breastfeeding-her-child-public-pool-then-police-came/

Introduction

The ‘Infant Feeding Survey’, which looks at breastfeeding across the UK which was last carried out in 2010, explored key findings that at six weeks only 55% of any type of breastfeeding was taking place (Baby Friendly Initiative, 2010). Many women give up breastfeeding even after being aware of the increased benefits there are for themselves and their baby (Coad and Dunstall, 2011). The reasons for stopping breastfeeding can be seen to vary between different age, ethnicity and socio-economic groups however 22-33% of mums experienced their baby rejecting the breast or having sore or cracked nipples causing them to give up (Infant Feeding Survey, 2010). Helping mothers to avoid these complications could result in a rise in the number who prolong breastfeeding (Ingram, Johnson and Greenwood, 2002). Research done by Britton et al (2007) concluded that ‘additional professional support was effective in prolonging any breastfeeding’. Thus, making breastfeeding education, training and awareness momentous. One way in teaching mothers breastfeeding skills is through the hands-off approach. This focuses on teaching newborn positioning and attachment with verbal communication or by using model breasts and dolls rather than manoeuvring the breast or neonate (Schafer and Genna, 2015). Additionally, the hands-off technique is used to facilitate learning (Baghany et al., 2013) by allowing the mother to be actively involved when being taught the new skill. This report examines the guidelines and evidence associated with the hands-off technique whilst exploring the midwife’s role in being able to use the hands-off approach effectively to support breastfeeding mums, creating women centred care. Additionally, this report will look at midwives’ competencies in practice such as being able to successfully assess the skill of breastfeeding.

Guidelines

Within the National Institution for Health and Care Excellence (NICE, 2006) guidelines for postnatal care up to 8 weeks after birth, it states that from the first feed new mums should be ‘given information’ about the advantages of breastfeeding and ‘offered advice’ on how to comfortably position their baby and themselves to ensure correct attachment and prevent poor latch that may result in discomfort or pain. The use of terminology such as ‘information’ which can be defined as using facts (information, 2020) and ‘advice’ which can be explained as guidance or recommendations (advice, 2020) can be seen to imply the use of a hands-off approach due to the focus on teaching and education.

In 1989 the ‘Ten Steps to Successful Breastfeeding’ was created by World Health Organisation (WHO) and United Nations International Children’s Emergency Fund (UNICEF) to establish an encouraging pathway for women to achieve breastfeeding and provide guidance on training for health care professionals (Ten Steps to Successful Breastfeeding, 2013). Step 5 within the 1989 recommendations state that ‘mothers should receive practical support to enable them to initiate and establish breastfeeding and manage common breastfeeding difficulties’. However, in 2017 WHO and UNICEF revised step 5 to become more applicable to all mothers, infants and facilities. Step 5 now recommends to ‘support mothers to initiate and maintain breastfeeding and manage common difficulties’ (UNICEF, 2018). This amendment can be seen to favour a hands-off approach as UNICEF are now focusing on issues of ‘positioning, suckling and ensuring the mother is prepared’ (UNICEF, 2018) rather than the use of ‘practical support’ which is concerned with actions rather than education (practical, 2020).

Evidence

A non randomised prospective cohort phased intervention study, which took place on 1,400 South Bristol mothers who were discharge from hospital breastfeeding, concluded that in the immediate postnatal period if mothers are educated on positioning and attachment using ‘eight key elements’ this becomes an important factor in breastfeeding success at six weeks. The figures found that at six weeks 79% of the mothers in the study were still breastfeeding, which when compared to the control group, can be seen to be affected by the ‘teaching, technique and associated explanations about breastfeeding’ taught to the experimental group. (Ingram, Johnson and Greenwood, 2002). These finding can be seen to correlate to a study were a similar training programme was introduced in Australia. Fletcher and Harris’ (2000) study into the hands-off technique programme in Australia, which assisted staff to teach women about correct position and attachment, found that this method increased breastfeeding rates by reducing the number of reports of postnatal problems. Evidence by Woolridge (1986) examines that the most important factor in preventing postnatal problems such as sore nipples and ineffective feeding is the positioning of the baby to the breast; with ultrasound evidence showing a baby who is feeding correctly has the nipple positioned at the roof of the mouth where is it protected. This further expresses the importance for informing mothers about how to correctly establish breastfeeding for themselves to ensure they can get a comfortable latch in order for them to continue with breastfeeding.

Studies done have also confirmed that when putting your own baby to the breast for the first term results in more successful outcomes for breastfeeding. A survey carried out in Warwickshire found out of 95 first time mothers, only 46% were still breastfeeding at around 6 weeks. However, those mothers who had put their own baby to the breast for the first feed were at a higher percentage (71%) to continue breastfeeding than those who had someone else position the baby for the them (38%) (Napier, 2001). Therefore, similarly showing that when the breastfeeding technique is done by the women but taught by the midwife, the outcome for breastfeeding is more successful. That said, as only one third of the mothers put their babies to the breast for the first time, further research is needed to ensure the differences are statistically significant.

Qualitative research which was carried out by Bäckström, Wahn and Ekström (2010) within Sweden, where the data came from interviewing the women and midwives about their experience with breastfeeding support, found that one woman was distressed about a midwife who had taught a breastfeeding technique in a ‘careless manner’ and who she believed did not help her breastfeed. She reported that the midwife had “torn” at her breast and “pulled” the baby’s head which caused “nothing to be gained” and therefore suggests that a hands-on approach does not benefit women in regard to educating breastfeeding mums. Additionally, another study in Sweden in which 879 women participated in, stated that 38% have experienced the hands-on approach during the first breastfeeding session in which they also reported this as a negative experience (Cato et al., 2014).

However, in more recent years within the ‘Infant Feeding Survey Chapter 4’, (2010) it was found that ‘nearly three quarters of mothers who breastfed initially put their baby to the breast (74%)’ (Infant Feeding Survey, 2010). This demonstrates that a hands-off approach is now being used by more commonly within the UK.

Midwives responsibilities

As stated by the Nursing and Midwifery Council (NMC, 2009) a key competency is to ‘teach women about the importance of nutrition in child development’. Breast milk can be seen to provide the best food for growth, development and increased protection against infectious diseases due to the immune defence aspect (Coad and Dunstall, 2011). For mothers to provide their baby with breast milk essential for their nutrition, it is important they are taught with up to date evidence by midwives who have a knowledge of anatomy and physiology to underpin the findings and guidance they provide for breastfeeding women. Prolactin and oxytocin are the two hormones which directly affect milk production. Prolactin is released by the anterior pituitary gland when the baby is suckling, this stimulates the production of milk for the next feed. Oxytocin is released by the posterior pituitary gland when stimulated by suckling or by seeing, touching or hearing her baby. Oxytocin works to compress the myoepithelial cells which are wrapped around the alveoli causing them to contract in the ‘let down flex’ or milk ejaculation. Oxytocin is inhibited by adrenaline and therefore stress or pain can stop milk flow (Coad, Pedley and Dunstall, 2019). Additionally, Feedback Inhibitor of Lactation (FIL) is a whey protein, that if milk is not removed the inhibitor builds up and prevents the lactocytes secreting anymore. Therefore, by removing breastmilk, FIL is also removed and milk production resumes (World Health Organisation, 2009). When mothers are taught about this it can ensure that they are breastfeeding in the right environment to maintain adequate milk production. This also shows that when in postnatal care, midwives should account for the environment breastfeeding is taking place. NICE (2006) states that this involves making arrangements for ‘24 hour rooming with skin to skin where possible, privacy and having adequate rest without interruption from hospital routine’ and therefore midwives have a responsibility to ensure the women is comfortable which will aid breastfeeding.

Another responsibility for midwives is to assess and monitor the breastfeeding. Ingram, Johnson and Greenwood (2002) stated that successful breastfeeding was described as “pain free”. Neifert (2004) suggested that a poor latch and positioning will prevent successful sucking and sufficient milk removal and therefore it is a midwife’s provision of care to ensure that a good latch is determined. The assessment of a good latch can be done using a numerical scoring system from 0 to 2 with 2 being associated with a grasped breast, tongue down, lips flanged, 1 representing repeating attempts, holding nipple in mouth and 0 correlating to no latch achieved. The assessment of a good latch can be in conjunction with the assessment of audible swallowing, type of nipple, comfort and hold which also uses a numerical score from 2 to 0 (Kumar, Mooney, Wieser and Havstad, 2006). When interviewing midwives in Sweden, they would ask the women to call them over when the baby is signalling for food as this straight away allows the midwife to look at how the baby is lying and being held (Bäckström, Wahn and Ekström 2010). A combination of watching a feed, numerical scoring and talking to the women allows an individual breastfeeding support plan to be made, personalised to individual needs.

Woman centred approach

Hands-off studies suggest that women find this style ‘less objectifying’ and ‘more empowering’, when compared to hands-on approach, which results in self assurance and self confidence (Schafer and Genna, 2015). Various studies, especially in a NICU setting, report that a hands-on approach is correlated with maternal dissatisfaction. In one study, some women felt their breasts ‘did not belong to them’ and they were like an ‘inanimate object’ and additionally felt that the hands-on experience was ‘brutal, unpleasant and violated their integrity’ (Weimers et al., 2006). This demonstrates how a hands-off method allows midwives to act with respect, kindness and dignity by taking into consideration the women’s needs and feelings in relation to breastfeeding. Fletcher and Harris (2000) recognised that it is difficult to change the midwifery culture around breastfeeding into predominantly using a hands-off approach however the advantages for mothers and babies makes it valuable. Within Bristol, it was seen that most staff seemed committed to practice the hands-off approach as they believed it would ‘empower mothers’ and ‘reduce conflicting advice’. The use short pragmatic training sessions in this study were intended to fit into midwives busy schedules and therefore make it easier to implant the technique to benefit mothers (Ingram, Johnson and Greenwood, 2002). Taking this into consideration, a hands-off approach can be seen to increase confidence in the mothers own capacities and therefore can result in a prolonged duration of breastfeeding (Weimers et al., 2006).

Conclusions

80% of mothers who stop breastfeeding would have continued for longer however stated they normally stopped due to difficulties or lack of support (Fox, McMullen and Newburn, 2015). Research has shown that mothers tend to value social support as more important than health service support. This shows that changes are necessary within the health services to recognise the needs of both mothers and midwives (McInnes and Chambers, 2008). Noticeably, it can be seen that a hands-off training programme is beneficial in promoting exclusive breastfeeding. It demonstrates how hospitals need to evolve their polices and replace breastfeeding teaching to a hands-off approach (Baghany et al., 2013) (if they have not done so already) which will move away from mechanical positioning and attachment and instead reinforce a relationship centred breastfeeding experience which incorporates a women’s own breastfeeding capability (Schafer and Genna, 2015). Women’s experiences of hands-on technique demonstrates the necessity to adapt outdated practices to benefits mothers and babies.

Search Strategy

Systematic search was carried out using PsychInfo Database. ‘Advance-Search’ option was used and the resources ‘APA PsychInfo’, ‘Journarls@Ovid Full Text’ and ‘APA PsychArticles Full Text’ were enabled for a more precise search.

Firstly, tittle and abstract searches were carried out for “breast feeding” (4441 results), “breast adj3 feeding” (4901 results), “breastfeeding” (12925 results) and “breast fed” (1883 results). To combine these searches, a Boolean Operator (OR) was used which produced 18305 results.

Secondly, a similar process was done (using .ti,ab function) with the search of “Intelligence” (92165 results). The terms “IQ” (36808 results), “cognitive ability” (10851 results), “cognitive development” (14170 results) and “neurocognitive” (21935 results) was added to allow for a broader search. The combination using OR function produced 168749 results.

I decided to focus on children’s preoperational stage (early childhood), defined as aged around 3 and 7. Tittle and abstract searches for “3 years old” (1029 results), “4 years old” (807 results), “5 years old” (results 2028), “6 years old” (results 1425), “7 years old” (results 866), “age 3” (6051 results), “age 4” (4670 results), “age 5” (results 6378 ), “age 6” (results 5772 ) and “age 7” (results 4129). Boolean Operator OR combined them producing results.

Finally, broad combinations previously done for breastfeeding, intelligence and 3-7 years old were all combined with the AND Boolean Operator which resulted in 36 papers. ‘Additional limits’ option filtered papers published from the past 10 years. This resulted in 26 papers which I scanned manually, selecting 4 studies investigating the relationship between breastfeeding duration and cognitive development in childhood. Studies that focused on low birth weight/preterm babies were excluded as results can’t be generalised to the broader population. An additional paper (Zhous et al. 2007) was selected from Sajjad et al. (2015) reference list as it reported significant evidence.

Literature review

A significant body of literature shows evidence about the short-term benefits of breastfeeding for the infant and mother. Exclusive breastfeeding for 6 months after birth is recommended by the WHO (Horta et al. 2007). However, the relationship between being breastfed in infancy and better cognitive development has been widely explored but it has remained as a subject of debate as evidence found is inconsistent. This review aims to evaluate research that investigated the relationship between breastfeeding duration and cognitive development during early childhood (3-7 years old). Intelligence represents people’s mental ability to learn, to adapt and direct their thinking (Schacter et al. 2011). It is an important predictor of future life outcomes such as health and earnings (Strenze, 2006). Therefore, if a positive dose-response effect is found we could promote an affordable and attainable way of improving future outcomes.

Sajjad, A. et al. (2015) evaluated the association between non-verbal IQ of 3716 participants (aged 6 years old) using the Snijders-Oomen Non-verbal intelligence test and data about breast feeding duration collected from maternal self-report questionnaires. Initially, researchers observed an advantage of 0.32 points every extra month of breastfeeding. However, once the effect of measured confounders were adjusted in a multivariable linear regression model, this was reduced to 0.09 points and associations with breastfeeding duration as a categorical variable dissipate. This alludes, the confounders maternal IQ, parents lifestyle, sociodemographic and child factors could explain this association. Important limitation on this study is that they categorised breastfeeding duration into 10 months instead of recording the exact number of weeks, which could lead to misclassification of the exposure, and that they selectively used people from low income backgrounds.

In contrast, a study showing positive association which also accounted for maternal IQ and other confounders, was done by Belfort et al. (2013). Researchers studied 1312 mother-child pairs (aged 3 to 7), measuring breast feeding duration and exclusivity ,using a questionnaire, and child cognition. They observed, from their adjusted linear regression, that increased breastfeeding duration was associated with higher score in Peabody Picture Vocabulary Test at age 3 (0.21 points per month breastfed) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years (0.35 verbal IQ points and 0.29 nonverbal points per month breastfed). A limitation of this study is that participants had high socioeconomic status and were less likely to be of minority race/ethnicity.

A recent study from Strøm et al. (2019) conducted a prospective observational study to explore breast feeding duration influence on children’s IQ on a sample of 1782 of mother-child pairs. An adjusted linear regression showed an association between results from Wechsler Preschool Scales of Intelligence-Revised and Wechsler Primary on IQ of children at the age of 5 and data on breast feeding which was collected using telephone interviews. Results after taking core confounders into account showed that compared with children breast fed for 1 month or less, breastfeeding for 2-3 months scored 3.06 points higher, 4-6 scored 2.03, 7-9 scored 3.53 and 10 or more 3.28. Therefore, a dose-response relation cannot be concluded. A limitation found in this study is the lack of data on mothers who didn’t breast feed.

The following study by Quigley et al. (2012) grouped a sample of 11101 term and 778 preterm children (aged 5) according to breastfeeding duration, to evaluate their cognitive ability using British Ability Scale tests. A parental interview was carried out 9 months after babies were born, which collected information on socioeconomic and health factors. Once confounders were fully adjusted, researchers observed a 2 point increase in mean score of term children for picture similarity and naming vocabulary when breastfed for 4 and 6 months respectively compared to children who were never breast fed. They also found a 4-points increase for naming vocabulary and picture similarity and a 6-point increase for patter construction in preterm children. Therefore, there is an association between breastfeeding and better cognitive development, especially in preterm babies. +limitation (The main limitation is that the study was not randomized and thus is prone to the problem of confounding. One of the strongest potential confounders is maternal IQ,)

Zhou, Baghurst, Gibson and Makrides (2007) assessed IQ on a sample of 302 children aged 4, using the Stanford-Binet Intelligence Scale. The duration of breastfeeding, the quality of the home environment and other potential confounders were recorded to investigate the relationship between breastfeeding duration and cognitive development. Using a multivariable regression, they found that IQ of children breast-fed for 6 months was only 2.0 point higher than children who had never been breast-fed. Furthermore, a strong association was found between the quality of the home environment (sociodemographic factors) and IQ at the age of 4.

In conclusion

Finally, while breastfeeding is recommended by the WHO for other well-established health reasons, it is still important to allow parents decide without creating unnecessary guilt.

References

1. Sajjad, A., Tharner, A., Kiefte-de Jong, J. C., Jaddoe, V. V., Hofman, A., Verhulst, F. C., Franco, O. H., Tiemeier, H., & Roza, S. J. (2015). Breastfeeding duration and non-verbal IQ in children. Journal of Epidemiology and Community Health (1979-), 69(8), 775-781. http://dx.doi.org/10.1136/jech2014-204486
2. Belfort, M. B., Rifas-Shiman, S. L., Kleinman, K. P., Guthrie, L. B., Bellinger, D. C., Taveras, E. M., Gillman, M. W., & Oken, E. (2013). Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. JAMA Pediatrics, 167(9), 836. https://doi.org/10.1001/jamapediatrics.2013.455
3. Strøm, M., Mortensen, E. L., Kesmodel, U. S., Halldorsson, T., Olsen, J., & Olsen, S. F. (2019). Is breast feeding associated with offspring IQ at age 5? Findings from prospective cohort: Lifestyle During Pregnancy Study. BMJ open, 9(5), e023134. http://dx.doi.org/10.1136/bmjopen-2018-023134
4. Quigley, M. A., Hockley, C., Carson, C., Kelly, Y., Renfrew, M. J., & Sacker, A. (2012). Breastfeeding is associated with improved child cognitive development: a population-based cohort study. The Journal of Pediatrics, 160(1), 25-32. https://doi.org/10.1016/j.jpeds.2011.06.035
5. Zhou, S. J., Baghurst, P., Gibson, R. A., & Makrides, M. (2007). Home environment, not duration of breast-feeding, predicts intelligence quotient of children at four years. Nutrition, 23(3), 236-241. https://doi.org/10.1016/j.nut.2006.12.011
6. Schacter, D., Gilbert, D., Wegner, D., & Hood, B. M. (2011). Psychology: European Edition. Macmillan International Higher Education.
7. Horta, B. L. & World Health Organization. (2007). Evidence on the long-term effects of breastfeeding: Systematic reviews and meta-analyses. World Health Organization.
8. Strenze, T. (2006). Who gets ahead in Estonia and America? A comparative analysis of mental ability and social origin as determinants of success. Trames, 10(3), 232-254.

Having a child is one of the most transformational events a person can undergo. It comes with a rally of new anxieties, surprises, problems and joys, to name a few. One of the many new skills that a new mother may choose is to breastfeed. It is a well-known fact that breastfeeding is the ‘gold-standard’ feeding method for new-borns, providing an optimally nutritious meal packed with developmental and immunologically advantageous substances. This is exemplified by the WHO and American Academy of Paediatrics, who both suggest that a new-born should be exclusively breastfed up until the age of 6 months. The psychological effects of breastfeeding on both mother and child are less well studied and understood, therefore in this essay I will be looking at some studies which try to prove to link between the psychologies of the mother and child and breastfeeding.

I had the pleasure of meeting a first-time mother, Katie and her 5-day-old daughter, Cleo, at the Whittington hospital. At the initial meeting it was clear that Katie and her husband had done extensive research and were both very well prepared for parenthood. Subsequently, we met up again four weeks later, were we asked a few questions on their wellbeing and her experiences as a new mother. It was evident that motherhood was coming very naturally to Katie; she had experienced no major issues, sleeping patterns were developing and there were no issues surrounding breastfeeding. In response to some of our questions she said that breastfeeding had definitely allowed her to become more in tune with Cleo’s action and cries, allowing Katie to begin to understand what Cleo wanted or was asking for She also said that she found the breastfeeding process very relaxing, and said it almost seemed to have a ‘hypnotic’ effect on her. She also mentioned that she noticed a significant difference in how much easier it was to put Cleo to bed after a night feed, and also how much less time she spent feeding night. Further on it the essay, I will explore why Katie might experience of all this and the reasons behind it. All of this made me start to think about the effect on the psyche that breastfeeding might have.

In children, there is a significant amount of brain development between birth and 3 years of age. This highly sensitive process is easily influenced by both exogenous and endogenous factors, one of which may be breastfeeding. Several large-scale studies have found there to be a compelling correlation between being exclusively breastfed and higher IQ levels, memory retention, cognitive function and language development. One study performed by ‘Quinn et al’ followed a group from infancy to 5-years-old. They found that a dose dependent facilitation of breastfeeding duration had an impact on verbal intelligence, measured using the Peabody Picture Vocabulary Test. It found that children who were exclusively breastfed for the first sixth months of their life had the highest verbal intelligence scores, whereas those who were formula fed had the lowest scores. A randomised controlled trial performed by Arch Gen Psychiatry looked at 13,000 mother-child dyads. In this, a group of mothers were randomly selected to increase their breastfeeding schedule seven-fold when the baby was 3 months old. The children were followed up with distinct results showing that the children who had undergone prolonged exclusive breastfeeding showed higher intelligence scores and higher ratings of academic proficiency at 6.5 years of age. It must be mentioned that both of these studies controlled for a range of confounding factors such as education, employment, income, age, delivery method, birth weight, smoking habits to name a few. Although, there was a study performed by ‘Jacobson et al’, which initially found similar results to the above two studies but when adjusting the results for maternal intelligence and parenting skills, the correlation was reduced to an insignificant level.

Other studies looked at the physiological changes and genetic evidence to provide information as to why these correlations may occur. In human breast milk there are two predominant polyunsaturated fatty-acids called docosahexenoic acid and arachidoic acid whose functions are involved in healthy neuronal repair, growth and myelination. New-borns are unable to produce significant amounts of docosahexenoic acid until around 6 months, and therefore are reliant on breast-milk in the meantime. A study by ‘Caspi et al’ looked at the polymorphisms in the FADS2 gene which encodes an enzyme which helps to metabolise the aforementioned fatty acids. Children with the gene variant which led to more efficient processing of these fatty acids displayed the highest intelligence scores overall. This may have something to do with the increased myelination of white matter in the frontal and temporal lobes in babies who were exclusively breastfed, both areas of higher order cognition and socio-emotional functioning.

In terms of the psychological effects in mothers, breastfeeding is associated with reduction in anxiety, negative moods and stress, all indicated by stronger cardiac vagal tone modulation, reduced blood pressure and reduced heart rate. It is also associated with longer (by 45 minutes) and better sleep quality. This improved sleep may be a result of the faster development of the baby’s circadian rhythm which develops partially as a result of hormones. One of the hormones in breast milk is tryptophan, an amino acid used by the body to make melatonin, which helps to induce sleep. The amount of tryptophan is regulated by the mothers own circadian rhythm. Breastfeeding has also shown to facilitate maternal sensitivity and secure the attachment between mother and child, this is probably to the prolonged contact periods and time spent with the new-born. In an extensive MRI study found that exclusively breastfeeding mothers exhibited greater brain activation in several limbic regions when listening to their own infants cries – showing greater involvement of brain systems with emotion.

From the evidence above I think that it is clear to see the defining impacts that breastfeeding may have on both the mother and child. Whether this is in its physiological regard and in relation to cognition development leading to the psychological correlations that have be shown in the above studies; it proves that it is very likely to have a significant link.

The topic we have chosen is Breastfeeding. Breastfeeding is important because it provides babies with the essential nutrients needed for growth and development. Breastfeeding also creates a strong bond between the mother and child. This is why babies who are breastfed are usually calmer because they feel a great deal of safety and security when nursed. Lastly, breastfed babies are less likely to develop certain illnesses that formula fed babies develop. This is because breast milk contains antibodies that are not present in formula. Breastfeeding is an issue of gender because when a women is seen breastfeeding in public or not, she is usually shamed and accused of showing too much.. This is because our society sees the breast as sexual objects as well as a lack of educating about the breast.

Breastfeeding also grants global environmental benefits because human milk is natural renewable food that gives complete nutrition for the first six months of the baby’s life.

Summary

We are interested in breastfeeding because as future public health workers, we want to encourage more women to breastfeed. We both know the basics of breastfeeding and how it is done. However, we want to learn more about breastfeeding. A few goals of ours is to learn the specific illnesses that breastfeeding can help protect against, long-term benefits, and disadvantages if there are any.

Key epidemiologic facts

Some key facts related to breastfeeding are infants who are breastfed have reduced risks of: Asthma, Obesity, Type 1 diabetes, Severe lower respiratory disease, Acute otitis media (ear infections), Sudden infant death syndrome (SIDS) and Gastrointestinal infections (diarrhea/vomiting). Breastfeeding can help lower a mother’s risk of: High blood pressure, Type 2 diabetes, Ovarian cancer and Breast cancer. According to CDC “In the United States, the percentage of babies who start out breastfeeding increased from 73% in 2004 to 84% in 2016”. According to The Surgeon General’s Call to Action to Support Breastfeeding, “In general, exclusive breastfeeding and longer durations of breastfeeding are associated with better maternal health outcomes”(1). Many women may cite that the reason they breastfeed is because of health advantages for herself and her child but also a hope to experience a sense of bonding with their newborn.

According to The Surgeon General’s Call to Action to Support Breastfeeding “There are economic benefits associated with breastfeeding that can be realized by families, employers, private and government insurers, and the nation as a whole. For example, a study conducted more than a decade ago estimated that families who followed optimal breastfeeding practices could save more than $1,200–$1,500 in expenditures for infant formula in the first year alone.20 In addition, better infant health means fewer health insurance claims, less employee time off to care for sick children, and higher productivity, all of which concern employers”(1). In Addition, another important factor to breastfeeding is that increasing rates of breastfeeding can help reduce illnesses which in result medical costs may be lower and infants that are being breastfed have less hospitalization or feeling sick. According to Women’s Health “ Breastfeeding also helps make a more productive workforce. Mothers who breastfeed may miss less work to care for sick infants than mothers who feed their infants formula. Employer medical costs may also be lower.6

Breastfeeding is better for the environment. Formula cans and bottle supplies create more trash and plastic waste. Your milk is a renewable resource that comes packaged and warmed”(1).

Conclusion

Breastfeeding is beneficial to a child because it is the most natural way of providing food for infants and it is a natural way of providing food to infants because of the nutrients. It is an important part of motherhood, and it is the first major decision that is made when it comes to feeding a child. What I hope to learn about breastfeeding is where the idea of breastfeeding infants came from, how it started, and which race of women breastfeed more and why some choose to not breastfeed.

Everyone loves to eat, especially babies and once they are hungry, they must be fed. No matter when, and where they are. Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Breastfeeding is for a woman to feed her own child with milk produced by the breasts. Human breast milk is produced by a woman’s body and is used to feed a baby. It is produced by the mammary glands contained in a woman’s breasts. Babies have a sucking and swallowing reflex allowing them to suck and swallow milk. In modern medicine, breast milk is the healthiest form of baby milk. Breastfeeding has benefits for both the mother and the baby because it helps prevent disease. Breastfeeding has been reported to impact mood and stress reactivity in mothers. Breast milk keeps babies healthy. Children who are breastfed for longer periods have lower infectious morbidity and mortality, fewer dental malocclusions, and higher intelligence than do those who are breastfed for shorter periods, or not breastfed. Reduces the risk of viruses, urinary tract infections, inflammatory bowel disease, gastroenteritis, ear infections, and respiratory infections. However, there are risks of not breastfeeding. For example, it increases the chance of an infant dying from sudden infant death syndrome (SIDS). Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.

Some people will argue that women should never breastfeed in public because it is a sexual act or even say ignorant things such as, “Go feed your baby in the bathroom or a nursing room, far away from where people can see you.” However, people who feel this way are mistaken. Breastfeeding has become so controversial these days. Should women be allowed to breastfeed their baby, when and wherever they want? Yes, Public breastfeeding should be welcomed and Encouraged.

The health benefits of breastfeeding for infants include fewer rates of respiratory tract infections, gastrointestinal tract infections, necrotizing enter colitis, allergic diseases, celiac disease, and inflammatory bowel disease; as well as SIDS, obesity, diabetes, and leukemia. Infants who are breastfed for at least one month, despite differing home environments and SES, also experience cognitive benefits (Stewart and Dunne, 2010). Further, breastfeeding may act as a buffer for a negative relationship between the mother and infant. Also, creates a bond between the mother and the baby. Children who are breastfed for longer periods have lower infectious morbidity and mortality, fewer dental malocclusions, and higher intelligence than do those who are breastfed for shorter periods, or not breastfed. This inequality persists until later in life. Growing evidence also suggests that breastfeeding might protect against overweight and diabetes later in life. In addition to these benefits for infants, breastfeeding can lead to a reduced risk of breast cancer, ovarian cancer, and type 2 diabetes in mothers (Godfrey & Meyers, 2009), as well as, positively affect a mother’s emotional well-being. By supporting breastfeeding as the normative way to feed an infant, the obstetrician-gynecologist can play a powerful role in improving health outcomes across 2 generations. To add on to the benefits, Long-term breastfeeding is often associated with better mental health during childhood and adolescence. Misuse of breastfeeding can, in the extreme, cause deaths from diarrhea in babies in both developed and developing countries. Human breast milk can feed babies up to three years of age and up. The colostrum of the first days, then the mature milk responds naturally (easy digestion, optimal energy supply) to the exclusive diet of the first six months of life of the human newborn, long-term and healthy. Breastfeeding and the combination of breast milk meet the nutritional, immunological and emotional needs associated with optimal growth of infant mutations. Breastfeeding supports the child’s neurological development and immune defenses and provides additional defense against gastrointestinal infections. Breast milk contain Water, Glucides, Lipides, protides, Protein Enzymes, Acides amines, Hormones. The average lipid content in breast milk is around 40 grams per liter. This content can vary significantly (from 3 to 180 grams per liter) depending on the time of day, the child’s age, the volume of the feed, the mother’s constitution and her type of diet. Lipid synthesis is complex and time-consuming, which is why lipids are only concentrated in human milk at the end of each breast feeding. This moment should not be suppressed by short feedings. Lipids in human milk are 98% made up of triglycerides, fats which play a role in the myelination of the nervous system, vision acuity and hormone synthesis6. Human milk also contains phospholipids, cholesterol, beneficial to the cardiovascular and cerebral level. Essential fatty acids (linoleic, linolenic) must be provided to the mother through her diet. Research into the potential impact of breastfeeding on brain development complements and extends work on cognitive development by using methodologies such as electroencephalography (EEG) and magnetic resonance imaging (MRI). One such study measured EEG spectral power longitudinally over the course of the first year of life in a group of typically developing infants and compared between breastfed and formula-fed infants.

Breastfeeding has been reported to impact mood and stress reactivity in mothers. Specifically, breastfeeding mothers report reductions in anxiety, negative mood, and stress when compared to formula-feeding mothers. These findings based on subjective self-report measures are supported by objective physiological measures indicative of a positive effect of breastfeeding on emotional well-being. For example, breastfeeding mothers have stronger cardiac vagal tone modulation, reduced blood pressure, and reduced heart rate reactivity than formula-feeding mothers have, indexing a calm and non-anxious physiological state. Moreover, there is evidence to show that breastfeeding mothers have a reduced cortisol response when faced with social stress.

Risks/ Consequences of NOT breastfeeding

There are significant risks to an infant’s health when human milk is not provided. Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses. Recent studies show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also, infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.

Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome (SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin’s disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American Academy of Pediatrics, 2005). Babies who are not breastfed are sick more often and have more doctor’s visits. For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS)——– Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome. Not breastfeeding increases the chance of an infant dying from sudden infant death syndrome (SIDS). In a 2009 German study, exclusive breastfeeding at one month of age halved the risk of SIDS, and partial breastfeeding at one month of age also reduced the risk.23 Being exclusively breastfed in the last month of life further reduced the risk of SIDS, as did being partially breastfed. Not breastfeeding is also associated with increases in short- and long-term blood pressure. Blood pressure fell significantly by 8.8- and 7.7-mm Hg (systolic and diastolic blood pressure, respectively) with breastfeeding 2 days after birth and at 1, 10, and 25 weeks, falling within the first 10 minutes and continuing for at least 60 minutes. Basal blood pressure decreased through 6 months of breastfeeding. Exclusive breastfeeding is the normative standard for infant feeding. Not breastfeeding increases infant and maternal acute and chronic illnesses, and significantly increases health-care costs. There are many evidences to support the value of human milk and breastfeeding in improving the health of infants and mothers. While breastfeeding initiation rates continue to rise, there is much work to do to improve breastfeeding exclusivity and duration.

Grant A. “I…don’t want to see you flashing your bits around”: exhibitionism, othering and good motherhood in perceptions of public breastfeeding. Geoforum. 2016; 71:52–61. Some people will argue that women should never breastfeed in public because it is a sexual act. However, people who feel this way are mistaken. As Singer-Songwriter Alanis Morrissette said, “I see my body as an instrument rather than an ornament.” Her body is an “instrument” to feed and nourish her baby. When someone asks a woman to cover-up during breastfeeding or move to someplace more private, it is often because this person is sexualizing the act of breastfeeding rather than viewing it as a natural, nurturing act. However, society does not see something wrong with a woman in bikini showing most of their bodies but sees it wrong or “disgusting” when a mother breastfeeds. What people do not realize is that many infants cannot eat while covered up and a nursing mother should not be made to feel embarrassed for feeding her child. “My opinion is that anybody offended by breastfeeding is staring too hard.” » David Allen. If you get dirty looks from onlookers, smile back at them! You are doing what is best for your baby. Be confident!

Many have also said that mother should go to the bathroom or a nursing room, far away from where people can see you. However, the mother has the right to feed her baby where and when she wants. The bathrooms are not sterilized and comfortable place to eat. You and I don’t eat our food in the bathroom, so why should a baby eat there? When A person is hungry, he or she looks for food and is very eager to find food. Babies especially cannot hold their hunger and the mother has no choice. The mother must instantly feed her urging baby no matter where she is, and it is not acceptable to tell her to “feed your child somewhere else.

Overall, we know that there are many health benefits to baby and mother from breastfeeding. Breast feeding also offers health benefits to the mothers and have a reduced risk of breast and ovarian cancer. Moreover, helps fight of things like ear infections, bacteria, and pneumonia. Breast feeding in public should be welcomed and supported. Although public breast feeding has led to backlash, it was the only way to feed children before the development of milk formula. Most people view public breastfeeding positively; however, there is still a perception that breastfeeding women may feel uncomfortable breastfeeding in public. And there are others who don’t like seeing a woman breastfeed. Woman are asked to leave the room or to stop breastfeeding by who do not feel comfortable around them. People should not feel uncomfortable when they see a woman breastfeeding. This is normal and does not need to be hidden. Breasts are viewed as sexual items rather than a natural way of providing nutrients and comfort for a child. Statistics indicate that breastfeeding has the potential to save approximately 1.4 million mortalities among babies. Public breastfeeding is not against the law. We know that a controversy remains as to whether breastfeeding should occur in public at all. Although, breastfeeding is necessary for human survival, mothers who do not feel comfortable can use ways to make her feel more comfortable. Let us strive together to make breastfeeding in public unremarkable because Mothers should never be pushed away because they are breast feeding, a baby has the right to be fed and taken care of.

Work Cited Page

1. J. Bruce German et Cora J. Dillard, « Saturated Fats: A Perspective from Lactation and Milk Composition », Lipids, vol. 45, no 10,‎ octobre 2010, p. 915–923 (ISSN 0024-4201,PMID 20652757, PMCID PMC2950926, DOI 10.1007/s11745-010-3445-9, lire en ligne [archive], consulté le 20 octobre 2017)
2. RA Lawrence et RM Lawrence (2005) Breastfeeding, A Guide for the medical profession6e édition. Philadelphie, Elsevier Mosby.
3. World Health Organization, « The physiological basis of breastfeeding », NCIB,‎ 2009(lire en ligne [archive])
4. Bates CJ, Prentice A. Breast milk as a source of vitamins, essential minerals and trace elements. Pharmacol Therapeut 1994; 62:193-220.
5. Bates, Christopher and Andrew M Prentice. “Breast milk as a source of vitamins, essential minerals and trace elements.” Pharmacology & therapeutics 62 1-2 (1994): 193-220.
6. National Academy of Sciences. Nutrition during lactation. Washington, DC: National Academy Press, 1991.