Saturday, January 19, 2013

Child Development and Public Health-Breastfeeding



            There is widespread agreement among organizations such as the World Health Organization, UNICEF, the American Academy of Pediatrics, the U.S. Department of Health and Human Services, and the Center for Disease Control that breastfeeding is best in most situations.  Numerous studies have been carried out and research indicates and supports “the use of breast milk as the optimal choice for infant nutrition, citing several health benefits to both infant and mother for breastfeeding” (Thurman & Allen, 2008).
            There are many well-known benefits to breastfeeding.  Berger, page 152, in the textbook has an extensive list of benefits to the infant, the mother, and the family (2012).  The baby benefits from nutrition balanced to its age, micronutrients and antibodies in the breast milk, experiences less illness as an infant and as an adult, higher IQ, and a lower incidence of SID’s (Berger, 2012).  The mother enjoys the convenience of and satisfaction from breastfeeding, a natural form of contraception, easier bonding process, and a reduced chance of osteoporosis and breast cancer (Berger, 2012).  Berger lists as family benefits a decreased level of paternal stress, monetary savings, and raised levels of sibling survival due to births occurring further apart (2012).
Breastfeeding raises many different emotions and responses from people depending upon their culture, education, support, and experiences.  In my personal experience I had three children and breastfeed each for different lengths of time and with different rates of success.  My first experience lasted only a couple of months.  My son and I could not seem to get the hang of it.  He had difficulty latching on and as a very new, inexperienced mother I was very concerned with if he was getting enough breast milk for healthy growth and development, so I switched to formula. 
 My second son had no difficulty at all and I was an at-home mother at the time and exclusively breastfed.  At about 9 months I tried to introduce bottle feeding and he would have no part of the bottle.  I continued to breastfeed until one year of age at which time I was encouraged by my pediatrician to take the bottle away and begin whole milk.
 I was working in a child development center when I gave birth to my third son, so worried about refusing a bottle I did introduce breast milk feedings in a bottle occasionally from very early on.  I wanted to be sure he would accept a bottle feeding while I was at work.  We both seemed to do well with this arrangement and it allowed his father to participate in feedings as well.
The rate of breastfeeding in the United States has increased over the years, but has room for improvement.  The U.S. DHHS published a Healthy People 2010 goal which includes reaching a 75% breastfeeding rate just after birth and maintaining a rate of 50% breastfeeding still at 6 months of age (Chertok & Hoover, 2009).  The United States currently recommends exclusive breastfeeding for the first 6 months of life and to continue with breastfeeding for months 6-12 with solid foods as a supplement if needed (Chertok & Hoover, 2009).
During the research of this topic I have come across several areas surrounding the subject of breastfeeding that I found to be especially interesting and relevant.  First is the concern over lack of professional support and information from healthcare providers. Thurman and Allen point out how “misinformation from health care providers and minimal discussion about the process and benefits of breastfeeding compared with formula feeding contribute to low breastfeeding rates and increase maternal frustration and confusion regarding breastfeeding” (2008).  They also state it was the end of the 20th century before “the International Board of Lactation Consultant Examiners was formed, initiating the new professional role of lactation consultant” (Thurman & Allen, 2008).   
A study performed in Puerto Rico by Leavett, Martinez, Ortiz, and Garcia describes a “reported lack of knowledge in areas related to breastfeeding and little practical experience in the management of breastfeeding among both pediatricians and obstetricians in Puerto Rico” (2009).  Examples of this given were that physicians lacked knowledge of the benefits of breastfeeding to raising immunity levels, were known to recommend the combination of breastfeeding and formula, and of breastfeeding contraindications (Leavett, Martinez, Ortiz, & Garcia, 2009).   There is a recent AAP Policy Statement  that makes recommendations to address and correct these concerns (Leavett, Martinez, Ortiz, & Garcia, 2009).
The next study I will address concerns the level of early childhood center staff knowledge on breastfeeding and the need for education uncovered.  Manhire, Horrocks, and Tangiora have concerns over the raised number of infants in out of home childcare arrangements and the impact on the rate of breastfeeding, (2012).  There is limited research done in this area and what has been done led researchers to believe “although there was a supportive attitude by staff, there remained a need for breastfeeding to be considered the norm in terms of administration, staff, and parental expectations” and “there was a need for breastfeeding policy, education about breastfeeding and improvement in physical childcare facilities to better support breastfeeding families” (Manhire, Horrocks, & Tangiora, 2012).  Staff at the centers were open to education on breastfeeding if provided (Manhire, Horrocks, & Tangiora, 2012).  Manhire, Horrocks and Tangiora concluded that “The ideal environment  to support the breastfeeding relationship while returning to paid work needs a three pronged approach:  first, breastfeeding should be well established through a paid parental leave policy; second, there should be a flexible and supportive workplace environment to encourage breastfeeding; and finally, ECC staff who are knowledgeable about breastfeeding are essential” (2012).
There has been much concern over the risk and rate of AIDs transmission through breastfeeding and this led to research into practices to help lower the rate of transmission  (Moland, van Esterik, Sellen, de Paoli, Leshabon, & Blystad, 2010; Coovadia, Rollins, Bland, Little, et al, 2007).  It was thought not long ago that breastfeeding was not a viable choice but research has shown that “existing evidence of the superiority of breastfeeding in terms of infant survival, and the 2010 infant feeding guidelines promoting breastfeeding as the first choice of infant feeding method…replacement feeding has substantial negative unintended consequences for the individual mother, for her infant, for households and for health systems” (Moland, van Esterik, Sellen, de Paoli, Leshabon, & Blystad, 2010).  The study by  Coovadia, Rollins, Bland, Little, et al reinforces the findings supporting exclusive breastfeeding also (2007).  They state:  
Exclusive breastfeeding ordinarily protects the integrity of the intestinal mucosa, which
thereby presents a more effective barrier to HIV.  Exclusive breastfeeding is associated
with fewer breast health problems than is mixed feeding, such as subclinical mastitis
and breast abscesses, which in turn are associated with increased breastmilk viral load.
The effect that small departures from exclusive breastfeeding have on the risk of HIV
transmission is uncertain, although  predominant breastfeeding (the introduction of non-
milk fluids) was associated with reduced transmission in one study.  Why is the
addition of solids especially hazardous?  Perhaps large and complex proteins found
in solid foods precipitate greater damage than do modified cows’ milk proteins to
gastrointestinal mucosa, which ease viral entry between cells, or regulate gut receptors
differently, thereby increasing the likelihood of virus adherence and infection
(Coovadia, Rollins, Bland, Little, et al, 2007).
            Complications surrounding exclusive breastfeeding are that custom calls for the introduction of additional foods and fluids to the infant’s diet; economic circumstances require the mother to work, and there may not be social support from their peers or partner. 
The last study concerns the legislation that led to change in how breastfeeding is viewed and supported in areas of the United States (Chertok & Hoover, 2009).  Not only was breastfeeding not supported as a woman’s right, but it was considered a criminal act of indecent exposure in many states.  Chertok & Hoover list New York as being “one of the first to exempt breastfeeding from being a criminal offense in 1984, and later recognized the inadequacy of the law regarding the support of breastfeeding.  As such, in 1994, the state of New York proceeded to amend its Civil Rights Act to include breastfeeding” (2009).  Many states have gone beyond just addressing the right to breastfeed and making it legal and have passed legislation that will support it.  For example, “accommodating pumping breaks, provision of a private place for pumping, use of refrigerators for the safe storage of milk, and the definition or commendation of supportive employment setting” (Chertok & Hoover, 2009).  There are  allowances for excusal from jury duty when it would interfere with feeding requirements of the infant (Chertok & Hoover, 2009). 
            Each of these studies has looked at different aspects related to the issue of breastfeeding.  The one thing I saw repeatedly was the importance of promoting and accommodating exclusive breastfeeding for at least the first six months of a child’s life.  Each agreed upon the listed positive effects and had very little negative if any, to report.  Each has increased my level of knowledge and understanding of the very critical and personal choice that breastfeeding is.  Increased knowledge and understanding has enabled me to be more supportive and better able to articulate the positive and critical nature of breastfeeding to parents and other professionals I work with. 
 I have eight infants in my classroom at this time and three of the eight were breastfed for at least the first few months of life.  One continued until about 7 months and felt her milk supply was not enough and with her pediatrician made the decision to supplement with formula and ended up switching completely to formula within a few weeks.  I have one infant who has just turned one year old and mom continues to breastfeed.  She has decided to not continue the breast milk at the center and has introduced whole milk and that is what she receives now.  Each has their own reasons and preferences that led to their own personal decisions about breastfeeding.
The children in my care and their parents look to me and depend on me to be educated and knowledgeable about best practices and current research in the field of child development.  They need to be able to count on my using my knowledge to enhance the environment and foster development not only in their child but with them also.  I need to be able to look at issues from many perspectives and be open to new ideas.  The more informed I become, the better able I am to care for and serve the children and families that depend upon me.

References
Berger, K.S. (2012). The developing person through childhood. New York, NY. Worth Publisher.
Chertok, I., &Hoover, M. (2009). Breastfeeding legislation in states with relatively low breastfeeding rates compared to breastfeeding legislation of other states. Journal of Nursing Law, 13(2), 45-53. Retrieved from http://search.proquest.com/docview/206516990?accountid=14872
Coovadia, H., Rollins, N., Bland, R.M., Little, K., et al. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. The Lancet, 369(9567), 1107-16. Retrieved from http://search.proquest.com/docview/199055199?accountid=14872
Leavitt, G., Martínez, S., Ortiz, N., & García, L. (2009). Knowledge about breastfeeding among a group of primary care physicians and residents in puerto rico. Journal of Community Health, 34(1), 1-5. doi: http://dx.doi.org/10.1007/s10900-008-9122-8
Manhire, K.M., Horrocks, G., & Tangiora, A. (2012). Breastfeeding knowledge and education needs of early childhood centre staff. Community Practitioner, 85(9), 30-3. Retrieved from http://search.proquest.com/docview/1039540520?accountid=14872
Moland,K., van Esterik, P., Sellen, D., de Paoli, M.,Leshabari, S., & Blystad, A. (2010). Ways ahead: Protecting, promoting and supporting breastfeeding in the context of HIV. International Breastfeeding Journal, 5(1), 19. doi: http://dx.doi.org/10.1186/1746-4358-5-19
Thurman, S. E., & Allen, P. J. (2008). Integrating lactation consultants into primary health care services: Are lactation consultants affecting breastfeeding success? Pediatric Nursing, 34(5), 419-25. Retrieved from http://search.proquest.com/docview/199436749?accountid=14872

Saturday, January 12, 2013

Childbirth in Your Life and Around the World


I gave birth to all three of my sons in military hospitals.  Each was a natural, vaginal delivery.  By the time I was having my third, the nervousness was gone and what was left was excited expectation of another child.  Each experience was quite positive for me.  I did not have an epidural or pain medications.  I had my mother with me the first time I gave birth and my husband the second and third.  My mother came to stay with us each time and she took care of the other boys while I had the last two.  When I had my third son, my husband was present and right after delivery my mother and two sons came into the delivery room to meet their new baby brother.  I felt very secure being in the hopital with doctors and nurses available to assist in my delivery and see to any medical needs that would arise.  I was never offered a c-section as an alternative since it was not medically necessary.  Through out the birthing process I was informed of what was going on, what would happen next. Each time I gave birth I was able to hold my sons almost instantly.   Each did have some breathing irregularity (fast breathing) but there was nothing dangerous.  I was told it could have been due to their size (they were quite big babies) or the quickness of their arrival.  Once they decided it was time to be born, it did not take long.  I was encouraged to breast feed with each child and given assistance.  It did not work out for my first child and I was not made to feel inadequate.  I spent only a couple of days in the hospital each time and spent the majority of the time with my new infant in my room with me.  My husband and mom were allowed to spend as much time as they liked with us.  It was a very positive and happy experience. 

I feel that because I had a positive birthing experience and received support during my stay in the hospital, I had the confidence to go home with my child and look forward to each day without too much worry or fear.  This had a positive effect upon their development and my feeling of well-being.

The following article describes concerns of maternal and infant mortality.  This is a fear that most of us in the United States do not have unless we already are aware of complications of our pregnancy.  Due to prenatal care, we can often be aware of and prepare for complications or risks.  We have medical knowledge and access to care that is often able to take care of most medical complications.

The article was retrieved from:

http://www.unicef.org/infobycountry/kyrgyzstan_47186.html



 Promoting 'baby-friendly' practices for modern mothers in Kyrgyzstan


UNICEF Image
© UNICEF video/2009
This 26-year-old mother is encouraged to keep her newborn with her after delivery to encourage immediate breastfeeding. Such practises are new to Kyrgyzstan's maternity wards.
This year, UNICEF’s flagship report, ‘The State of the World’s Children’ – launched on 15 January – addresses the need to close one of the greatest health divides between industrialized and developing countries: maternal mortality. Here is one in a series of related stories.
By Guy Degen
BISHKEK, Kyrgyzstan, 15 January 2009 – In a small delivery room at Kyrgyzstan's National Maternal and Child Health Centre, Nargiza Umuralieva is in labour, awaiting the birth of her second child. Her sister Jibek is there for help and support. She quietly massages Nargiza's hand.
The 23-year-old can choose any position for delivery, from the traditional Kyrgyz method of standing with a cotton rope for support to using a large, inflatable rubber ball. Partner-assisted and free-position deliveries are new birth practices in Kyrgyzstan, only recently introduced in hospitals. 
'More like a mother'
Across Kyrgyzstan, better hygiene, skin-to-skin contact immediately after birth and exclusive breast feeding are becoming standard practices. These are just some of the ways hospitals and clinics certified by UNICEF as 'baby friendly' are providing a continuum of care for mothers and newborns.
Aizat Tailobaeva, 26, who has just delivered her second child across the hall from Nargiza, says the modern birth practices make her feel more like a mother.
“This delivery was different. The doctor put my son directly on my chest after birth. Within half an hour he was seeking my breast to feed,” she explains. This is in stark contrast to Aizat’s first delivery, when the nurse took her baby to a different ward immediately after birth.
Today, about one-third of newborns in this country are exclusively breastfed for the first six months of their lives. A higher percentage, close to half, are breastfed and given complementary food as well. About 50 per cent of of Kyrgyzstan's maternity homes are certified as 'baby-friendly hospitals' with UNICEF support, which has led to improvements in baby feeding practices.
Preventing maternal mortality
Retaining trained health professionals in Kyrgyzstan presents a challenge. Many doctors and nurses seek better salaries in Russia or neighbouring Kazakhstan.
Though most mothers in Kyrgyzstan deliver their children at a hospital or clinic, maternal mortality rates remain high. Poor nutrition is a leading cause of birth complications. Around 34 per cent of pregnant mothers suffer from anaemia.  
UNICEF Representative Tim Schaffter said UNICEF is working with health authorities to introduce cost-effective ways to reduce both maternal and infant mortality. 
“We know most maternal deaths are preventable. We know most deaths of newborn children are preventable,” says Mr. Schaffter. “For children, simple techniques to improve sanitation and hygiene to prevent infection, simple techniques to promote breastfeeding [lead to] an amazing reduction in child illness and death.” 
Holistic care for mother and child
Preventable death is a tragedy in every community. The head of maternal heath at the National Maternal and Child Health Centre, Dr. Guldan Duishenbaeva, is confident that new equipment and training of health professionals is making a difference. 
“Doctors in Kyrgyzstan realize the advantages of new technologies. We are training a lot of doctors and nurses to be able to treat mothers and families,” says Dr. Duishenbaeva.
New health policies are now allowing for pregnant women to receive free medical care throughout their pregnancy, and for their children to get care up to the age of five. Gradually, Kyrgyzstan's health system is developing the capacity to provide a more holistic approach to maternal and infant care.

Updated: 25 May 2012
 
 
 
I think one of the big differences I learned about through this assignment is that many of the services we take for granted, are a very overwhelming source of stress on expectant mothers from many other areas of the world and for some here in our own country.  Stress can have very negative effects on the mother and development of the child in addition to any complications that arise due to the lack of prenatal care and adequate medical care during and after childbirth.  What many of us experience as a very enjoyable, exciting time; others have no idea if or how they will survive the same experience.