Oxford Handbook of Midwifery (141 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

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  • Prolactin levels are higher at night, and a breastfeed at night will result in a greater prolactin surge than would occur with a feed given during the day. Night feeds therefore ensure good milk production.
    12
  • Exclusive breastfeeding that incorporates night feeds raises prolactin levels which, in turn, inhibits luteinizing hormone release, this prevents ovulation.
    12
  • Frequent feeds, including night feeds, help to prevent/reduce engorgement when the milk first comes in.
  • There is a soporific effect on the mother, which improves the quality of sleep. This results from the release of dopamine, which is believed to be involved in the mechanism of oxytocin release.
    13
    Rooming-in
    Rooming-in, which allows mother and babies to remain together for 24h a day, has been shown to:
  • Improve breastfeeding outcomes, especially duration; this is partly because rooming-in facilitates demand feeding
    14
  • Improve mother–baby relationship, regardless of feeding method
  • Be preferable to nursery care for both mother and baby.
    14
    Common reasons to not room in, e.g. it interferes with the mother’s sleep, do not appear to be valid.
    14
    Staff training
    Healthcare professionals who have not been trained in breastfeeding man- agement cannot be expected to give mothers effective guidance and to provide skilled counselling. It is necessary to increase their skills to enable their knowledge to be used appropriately. Education and training sessions need to incorporate elements that enable health professionals to address
    bias that will hinder breastfeeding.
    In-service training needs to be mandatory to be successful and requires a strong policy supported by senior staff.
    14
    Inconsistent or conflicting information and advice disempowers women, reducing their self-confidence and ability to breastfeed successfully.
    15
    Breastfeeding and growth monitoring
    NICE
    16
    recommends that GPs, paediatricians, midwives health visitors, and community nursery nurses should:
  • As a minimum, ensure babies are weighed (naked) at birth and at 5 and 10 days, as part of an overall assessment of feeding. After this healthy babies should be weighed (naked) no more than fortnightly and at
    2, 3, 4, and 8–10 months in their first year. Ongoing weekly weighing is unnecessary for healthy babies who give no cause for concern.
    Unnecessary weighing may lead to an inappropriate intervention and undermine parents’ confidence.
  • Ensure infants are weighed using digital scales which are maintained and calibrated annually, in line with medical devices standards (spring scales are inaccurate and should not be used.
    CHAPTER 24
    Breastfeeding
    668
    • It is important that support staff are trained to weigh infants and young children and to record the data accurately in the child health record held by the parents.
      Breastfeeding patterns of growth
    • Breastfed babies show a different pattern of growth from formula fed babies.
    • Growth rate is not constant and slowed growth is not always indicative of growth failure.
    • Breastfed infants grow more quickly in the first few weeks and more slowly from about 4–5 months than formula fed infants. The difference is on average ½ to 1 centile channel.
      17
      New UK growth charts, based on breastfed babies, were introduced in May 2009 to plot the weight, height, and head circumference of children from birth to 4 years of age.
      18
      These charts should be used for all new births and new referrals to health professionals. The UK90 Growth charts will continue to be used for children born before this date and for children over 4 years. Fact sheets about the new charts are available at the Royal College of Paediatrics and Child Health website (M www.growthcharts.
      rcpch.ac.uk).
      Weight loss of more than 10% from birthweight should be a cause for concern. Check that the baby is having plenty of wet and dirty nappies. Poor urine and stool output indicates the need for the baby to be weighed naked on digital scales even if outside the recommended weighing guidelines. A breastfeeding history should be taken and a breastfeeding assessment form recorded prior to advice being given for strategies to improve feeding. Weight loss of 15% or more requires urgent investigation, paediatric referral, and experienced breastfeeding support.
      MANAGEMENT OF BREASTFEEDING
      669
      1. UNICEF UK Baby Friendly Initiative.
        Step 4
        —
        Help Mothers Initiate Breastfeeding Soon After Birth
        . Available at:
        www.babyfriendly.org.uk/page.asp?page=64 (accessed November 2009).
      2. Righard L, Frantz K (1992).
        Delivery Self Attachment
        . California: Video Giddes Productions.
      3. Perez-Escamilla R, Pollitt E, Lonnerdal B, Dewey KG (1994). Infant feeding policies in maternity wards and their effect on breastfeeding success: An analytical overview.
        American Journal of Public Health
        84
        (1), 89–97.
      4. Righard L, Alade MO (1990). Effects of delivery room routines on the success of first breast- feed.
        Lancet
        336
        , 1105–7.
      5. Colson S (2007). A non-prescriptive recipe for breastfeeding.
        Practising Midwife
        10
        (8), 42, 44,
        46–47.
      6. Baby Friendly Initiative (2009).
        The Baby Friendly Initiative’s Position on Biological
        Nurturing: Statement 18 February 2009
        . Available at: M www.babyfriendly.org.uk/items/item_detail.
        asp?item=558 (accessed November 2009).
      7. UNICEF (2004).
        Breastfeeding Management Course Workbook.
        London: UNICEF.
      8. Renfrew M, Dyson L, Wallace L, D'Souza L, McCormick F, Spiby H (2005).
        Breastfeeding for Longer
        —
        What Works?
        Systematic review summary. London: NHS National Institute for Health and Clinical Excellence. Available at: http://www.nice.org.uk/nicemedia/pdf/breastfeeding_
        summary.pdf (accessed 19.1.11).
      9. Renfrew MJ, Woolridge MW, McGill HR (2000).
        Enabling Women to Breastfeed: A Review of Practices Which Promote or Inhibit Breastfeeding
        —
        With Evidence-Based Guidance For Practice
        . London: The Stationary Office.
      10. Woolridge MW, Baum JD, Drewett RF (1982). Individual patterns of human milk intake during breastfeeding.
        Early Human Development
        7
        , 265–72.
      11. Henschel D, Inch S (1996).
        Breastfeeding: a Guide for Midwives.
        Hale: Books for Midwives Press.
      12. Howie PW, McNeilly AS, Houston MJ, Cook A, Boyle H (1982). Fertility after childbirth: Infant feeding patterns, basal prolaction levels and postpartum ovulation.
        Clinical Endocrinology
        17
        , 315–22.
      13. Bourne MA (1982). Sleep in the puerperium.
        Midwives Chronicle and Nursing Notes
        , March, 91.
      14. World Health Organization (1998).
        Evidence for the Ten Steps to Successful Breastfeeding.
        Geneva: WHO.
      15. Simmons V (2002). Exploring inconsistent breastfeeding advice.
        British Journal of Midwifery
        10
        (10), 616–19.
      16. National Institute for Health and Clinical Excellence (2008).
        PH11 Maternal and Child Nutrition: Guidance.
        London: NICE.
      17. Cole TJ, Paul AA, Whitehead RG (2002). Weight reference charts for British long-term breastfed infants.
        Acta Paediatrica
        91
        (12)1296–1300.
      18. Royal College of Paediatric and Child Health. Available at: M www.rcpch.ac.uk/Research/
        Growth-Charts (accessed November 2009).
        CHAPTER 24
        Breastfeeding
        670‌‌
        The 10 steps to successful breastfeeding
        1
        The ‘Ten Steps to Successful Breastfeeding’ are the foundation of the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). They are a summary of the maternity practices necessary to support breastfeeding. The BFHI was developed to promote the implementation of the second operational target of the Innocenti Declaration.
        2
        Every facility providing maternity services and care for newborn infants should:
        • Have a written breastfeeding policy that is communicated routinely to all health care staff
        • Train all health care staff in skills necessary to implement the policy
        • Inform all pregnant women about the benefits and management of breastfeeding
        • Help mothers initiate breastfeeding within half an hour of birth
        • Show mothers how to breastfeed, and how to maintain lactation even if they are separated from their infants
        • Give newborn infants no food or drink other than breast milk, unless
          medically
          indicated
        • Practice rooming-in: allow mothers and infants to remain together 24h a day
        • Encourage breastfeeding on demand
        • Give no artificial teats or pacifiers (also called dummies or soothers) to breastfed infants
        • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
          Evidence in support of the above steps can be found in the WHO publication
          Evidence for the Ten Steps to Successful Breastfeeding
          .
          2
          The seven-point plan for the protection, promotion, and
          support of breastfeeding in community healthcare settings
          All providers of community healthcare should:
        • Have a written breastfeeding policy that is communicated routinely to all healthcare staff
        • Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy
        • Inform all pregnant women about the benefits and management of breastfeeding
        • Support mothers to initiate and maintain breastfeeding
        • Encourage exclusive and continued breastfeeding, with appropriately timed introduction of complementary foods
        • Provide a welcoming atmosphere for breastfeeding families
        • Promote cooperation between healthcare staff, breastfeeding support groups, and the local community.
      The UNICEF UK Baby Friendly Initiative University Standards programme
      This is an accreditation programme aimed at university departments responsible for midwifery and health visitor/public health nurse education.
      THE 10 STEPS TO SUCCESSFUL BREASTFEEDING

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