Fundamentals of Midwifery: A Textbook for Students (90 page)

British Journal of Midwifery
7 (1), pp.26–31.Sinha, S., Miall, L., Jardine, L. (2012).
Essential Neonatal Medicine
, 5th edn. Oxford: John Wiley & Sons. Steele, D. (2007) Examining the Newborn: Why don’t Midwives use their skills?
British Journal of Midwifery
15, pp. 748–752.Steen, M., Macdonald, S. (2008) A review of baby skin care. Midwives [online] Available: http://www.rcm.org.uk/midwives/in-depth-papers/a-review-of-baby-skin-care/Tappero, E.P., Honeyfield, M.E. (2003)
Physical Assessment of the Newborn. A Comprehensive Approach to the Art of Physical Examination
, 3rd edn. California: Nicu.Ink.Thorngren-Jerneck, K., Herbst, A. (2001) Low 5-minute Apgar Score: A Population-Based Register Study of 1 Million Term Births.
The American College of Obstetrics and Gynaecologists
98 (1), pp. 65–70.Townsend, J., Wolke, D., Hayes, J., et al. (2004)
Health Technology Assessment
8 (14), Health Technology Assessment NHS R&D HTA Programme.Trotter, S. (2010) Neonatal skin care. In: Lumsden, H., Holmes, D. (eds) (2010)
Care of the Newborn by Ten Teachers
. London: Hodder Arnold.Trotter, S. (2008)
Baby Care – Back to Basics
. Troon: TIPS Ltd.UK Newborn Screening Centre (2012) Guidelines for Blood Spot Sampling. London: UK NSC.Walters, R.M., Fevola, M.J., LiBrizzi, J.J., Martin, K. (2008) Designing cleansers for the unique needs of baby skin.
Cosmet Toilet
123 (12), pp. 53–60.World Health Organization (WHO) (2012) Guidelines on Basic Newborn Resuscitation. Geneva: WHO. WHO (2006)
Pregnancy, Child Birth, Postpartum and Newborn Care
, 2nd edn. Geneva: WHO.WHO (1997) Thermal Protection of the Newborn: A Practical Guide. Geneva: WHO:Wylie, L. (2010) Newborn screening and immunization. In: Lumsden, H., Holmes, D. (eds) (2010)
Care of the Newborn by Ten Teachers
. London: Hodder Arnold.Zupan, J., Garner, P., Omari, A.A.A. (2012) Topical umbilical cord care at birth.
The Cochrane Collaboration
.Chichester: John Wiley & Sons.
209
Chapter 10‌
Infant feedingLouise Lewis
University of Hull, Hull, UK
Liz Mason
Women and Children’s Hospital, Hull, UK
Learning outcomesBy the end of this chapter the reader will be able to:

apply the Baby Friendly Initiative best practice standards to clinical practice

recognise why breastfeeding is important for mother and baby

understand the basic anatomy of the breast and physiology of lactation

recognise the bio-psycho-social needs of mothers in their infant feeding choices

identify how midwives and other healthcare workers can support mothers to initiate and sustaineffective breastfeeding

identify and manage common breastfeeding problems

explain the principles of safe formula feeding.

Infant feeding choices are entrenched within an array of social, cultural and political factors and

are influenced by knowledge, expectations and the support received. Consequently infant feeding seems to elicit emotive responses in mothers, healthcare professionals and society. It is central to the role and responsibilities of a midwife to ensure that babies are receiving ade- quate nutrition and hydration, and that mothers are receiving information and educational intervention which supports effective infant feeding. This chapter provides evidence-based knowledge and practical skills to apply in maternity care, supporting the principles of safe infant feeding with the use of professional standards and relevant evidence.

, First Edition. Edited by Louise Lewis.

© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion website: www.wileyfundamentalseries.com/midwifery

Breastfeeding is an interdependent relationship between the mother and baby, often described

as a dyad. It is viewed as the gold standard for infant nutrition during the first 6 months of life (Godfrey and Lawrence 2010). The benefits to both mother and baby of breast over formula milk are universally acknowledged, with well-developed evidence quantifying the risks of not breastfeeding for both the baby and the mother. Breastfeeding the baby is associated with a reduction in acute otitis media, gastrointestinal disease, respiratory disease, dermatitis, asthma, obesity in later life, type 1 and 2 diabetes mellitus, childhood leukaemia, sudden infant death syndrome and necrotising enterocolitis in the pre-term baby (Fewtrew 2004; Ip et al. 2007; Riordan 2010; Lawrence and Lawrence 2011). More recent studies have demonstrated breast- feeding is related to improved neurological development (Herba et al. 2012; Quigley 2013) and an increased chance of upward social mobility (Sacker et al. 2013), with increased risk of poorer cognitive development and behavioural problems in children who are not breastfed (Heikkilä et al. 2011).

The World Health Organization (WHO) recommends exclusive breastfeeding from birth to six months of age, with breastfeeding continuing to be part of the infant’s diet until at least two years of age (WHO 2002). However, some mothers may make an informed choice to express their breastmilk and feed it to their baby by a bottle and teat; practitioners also need to be knowledgeable in supporting mothers who choose this method. Although the benefits to mothers are not as well-researched, there is enough evidence to confirm that women who breastfeed up to and beyond one year can have reduced risk of breast cancer, type 2 diabetes, cardiovascular disease, some reproductive cancers, rheumatoid arthritis (Godfrey and Lawrence 2010; Lawrence and Lawrence 2011) and postnatal depression (Donaldson-Myles 2011). Other studies have demonstrated that infant suckling at the breast reduces the short-term response against stress in the mother (Heinrichs et al. 2001), and encourages more oxytocin pulses in the early postpartum period leading to increased uterine contraction (Matthiesen et al. 2001). Breastmilk is also easily accessible, a low cost option and environmentally friendly.

Economic implications and potential health risks associated with not breastfeeding has prompted service planners and government policy makers to improve breastfeeding rates, with the aim of reducing health inequalities. It has been estimated in a report commissioned by UNICEF (2012b) that if there were a moderate increase in breastfeeding rates, over £17 million could be gained per annum by treating fewer cases of acute conditions in infants and breast cancer in mothers. All pregnant women should be given the opportunity to discuss the impor- tance of breastfeeding and recognising and responding to their baby’s needs (UNICEF 2012a).

Despite the benefits of breastfeeding being well-documented, the most recent Infant Feeding Survey identified the United Kingdom as having one of the lowest breastfeeding rates in Europe (McAndrew et al. 2012). Although the initiation rates of breastfeeding have risen, there are still ongoing issues with high rates of early cessation and low rates of exclusive breastfeeding up to 6–8 weeks (McAndrew et al. 2012). Breastfeeding rates are typically low amongst disadvantaged white women, particularly teenage women, first time mothers or lone parents (Dyson et al. 2006; McAndrew et al. 2012).

It is reported that breastfeeding mothers still continue to experience conflicting advice, intrusive assistance, and under resourced postnatal wards affecting their experiences of breast- feeding (McInnes and Chambers 2008; Care Quality Commission 2013). Lack of knowledge and understanding about the mechanisms of breastfeeding; perceived insufficient breastmilk

211

212

supply; infant feeding too frequently; inadequate family support; painful breasts or nipples; social norms and the sexualisation of breasts portrayed in the media; all shape a woman’s deci- sion whether to initiate and continue breastfeeding (Burns et al. 2010; Brown et al. 2011; Andrew and Harvey 2011; Dodds 2013). This suggests infant feeding decisions are deep rooted in socio- cultural-economic influences, shaped by opportunities, experience, personal confidence, levels of self-efficacy and the support available.