Healthy People 2010 Breastfeeding Initiative
Jackie Thurner
Indiana State University
Abstract
This paper will discuss the Healthy People 2010 goal 16-19 “Increase the proportion of mothers who breastfeed their babies” (1998). This paper does not explore alternative feeding methods and does not claim that all women should breastfeed. The Author acknowledges that certain medical conditions prevent breastfeeding. The information presented in the paper highlights some of the benefits of breastfeeding, but focuses on how health care professionals can encourage, support, and educate the public. The goal of this paper is to address practices related to the promotion of breastfeeding.
History of Healthy People 2010 Goal
As nursing is moving toward a preventative model, it has become increasingly necessary to identify behaviors that prevent illness, or lead to overall wellness. Breastfeeding is widely acknowledged by health care providers as having many benefits to both mother and infant. However, the number of women who choose to breastfeed remains relatively low. According to the Department of Health and Human Services (DHHS) (1999) the number of infants who were breastfed in the early postpartum period was 62% in 1997, and by six months of age dropped to 26%. These numbers were improvements over the previous seven years but failed to meet Healthy People (HP) 2000’s goal of 75% and 50% respectively.
Current goals of HP 2010 for early postpartum period and at six months have not changed since HP 2000. However, goals have been added to improve breastfeeding rates through one year of age, and exclusive breastfeeding through three and six months of age (HP 2010, 1998). A progress review revealed that as of February 2010, breastfeeding rates have improved since HP 2000, but continue to fall short of desired goals (CDC, 2010).
Reasons for Achievement or Failure
The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) provides up to date information on the current activities related to health care topics. A 2008 MMWR reported that hospitals across the United States were participating in practices that discouraged successful breastfeeding. These practices go against what is considered evidence based (CDC, 2008). These practices are often to either curb fussiness in a newborn or to ease the new mothers fears of not providing adequate intake or nutrition for their baby (Gatti, 2008).
While the HP 2010 goals have not been met since they were set in place nearly twenty years ago, they cannot be considered a failure. Major increases have been seen. Especially in hospitals that have or are in the process of implementing programs aimed at improving breastfeeding rates.
Review of Literature
Breastfeeding is a woman’s choice. No new mother should feel forced to nourish her child in a manner she is fundamentally uncomfortable with. Expectant parents need accurate, and current information regarding their options in order to make an informed decision on what to feed their infant (Gatti, 2008). This information should not be given in large doses to a woman who has just given birth. A perinatal education approach is best, it allows the mom to receive more information, have time to process the information, come up with questions that she will have time to get answers to, and allows her to share this information with the support people in her life (Griese, 1996).
Infant formula is a source of nutrition, not a substitute for breast milk. When mother and child are in close contact, breast milk self adjusts to the infants needs. It not only adjust in amount, but it changes the concentration of fat, water, proteins, and antibodies, to accommodate a growing baby, exposure to viruses, and the current environment. The breastfeeding relationship is so beneficial because it is specifically designed to be perfect for that child. While some benefits are gained by using donor milk over formula, the optimal choice is milk from the infants’ actual mother. It is produced for the child, based on gestation age and length of time since delivery, making it vital for sick or premature babies. Breastfeeding is also healthy for the mother. It has been proven to reduce the risk of devastating illnesses such as breast and ovarian cancer, and type two diabetes (Godfrey and Meyers, 2009).
The United States Breastfeeding Council (USBC), boasts the many benefits of breastfeeding. Beyond the basic bonding experience and immunological benefits, the economic benefits on the entire healthcare system are impressive. According to the USBC formula fed infants cost US taxpayers billions every year. The council claims, based on its research findings, that Americans spend $2 billion annually on milk substitutes, mostly infant formula. Insurance companies and programs like Medicaid spend $1.3 billion a year more on formula fed babies for sick visits than their breastfed counterparts. The Women, Infant, and Children (WIC) program funded by the United States Department of Agriculture (USDAG) spends $578 million per year to provide infant formula to low-income families. According to the USBC for every 10% increase in breastfeeding among WIC participants the USDAG would decrease costs by $750,000 each year.
Role of Government Agencies
Breastfeeding laws are carried out primarily at the state level. Indiana law (Ind. Code 16-35-6) protects a breastfeeding mother’s ability to breastfeed in public, or express breast milk at work. Maryland makes breastfeeding supplies tax exempt, and New York has developed a breastfeeding mothers Bill of Rights. However, states like Michigan and Alabama only have laws that exclude breastfeeding from public indecency rules. Quite a few states even have laws that allow a breastfeeding mother to be excused from or permitted to postpone jury duty (DHHS, 2009).
A program designed to increase the number of mothers who breastfeed successfully is the Baby Friendly Initiative. Created by a collaboration of groups that work to decrease worldwide health disparities, including the World Health Organization (WHO) and UNICEF. This initiative gives hospitals a set of ten guidelines to promote the decision to breastfeed, and support evidence based practice to minimize breastfeeding problems (Meyers and Turner-Maffei, 2008).
Implication for Nursing
With the many benefits of breastfeeding, and those benefits increasing as they reach the sickest and most fragile neonates the role of the nurse becomes a large factor in the overall success of breastfeeding. Nurses must be patient advocates, they must support and assist the breastfeeding mother whenever possible. In light of the increasing number of mothers who breastfeed, hospital and health care system wide plans should be put in place to support a breastfeeding mother on a medical-surgical unit the same as an obstetric unit. It is important that all nurses be trained for safe medication administration to the breastfeeding mother as well as proper collection and storage of breast milk (Wenner, 2007).
Knowing the nurses role in promotion includes understanding the mothers’ perception and functional ability. Breastfeeding, having a new baby, recovering from delivery, having a sick, early, or small baby are individually exhausting events. When all of these are put together in a short period of time, the new mother needs nursing support even more. Mothers of sick or preterm infants often blame themselves and agree to breastfeed as a way to fix what they feel they have messed up. Nurses must know when to encourage mom to take a break, and need to be aware of their personal values when encouraging breastfeeding. In some cases especially with a sick baby, providing breast milk is the only connection between mom and baby. That should be utilized, not enforced. No mother should be made to feel guilty or inadequate about her decision, only educated and supported (Lee, Lee, and Kuo, 2009).
Role of Support Groups
Support groups can be controversial in breastfeeding. Evidence shows that a support system is vital, but this typically refers to the other parent, grandparents, and others who will be caring for the infant. The perinatal period can seem like everyone in a patient’s life has an opinion on what they should do with their body and their baby. This can be stressful to the mom. One study showed that if mom wanted or sought out peer support it was beneficial to the breastfeeding experience, but was viewed negatively and as an inconvenience when presented unsolicited advice (Dennis, 2002).
Conclusion
Because of the many benefits of breastfeeding, it should be encouraged and supported. Hospitals need to have an evidence based plan to provide education and support to expectant and new parents. Nurses, because of their unique relationship with patients, have the responsibility to assist the new mother in establishing a successful breastfeeding relationship with their child. When the entire healthcare system comes together to support this initiative, breastfeeding rates will rise to meet and likely exceed HP 2010 goals.
Reference:
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