Nurses Role In Breastfeeding Success: Attendance At A Nurse-Led Breastfeeding Or Standard Lactation Support Group

Nurses Role In Breastfeeding Success: Attendance At A Nurse-Led Breastfeeding Or Standard Lactation Support Group

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Introduction

Epidemiological studies show significant health impacts related to breastfeeding of the infant during the postpartum period. It confers substantial benefits associated with both nutritional and immunological to the children as well as l as physiological and social gains (Christoffers, 2014). The analysis of the benefits of the breastfeeding outlines reduction of incidences of obesity, diabetes, upper respiratory problems, and otitis media. Although the rates of breastfeeding are high in developed countries, the exclusive breastfeeding drops substantially in the first three months of birth (Allen & Schafer, 2015).

Breastfeeding is regarded as a powerful preventive modality for the healthcare service providers in reducing the common causes of morbidity of infants (Edwards et al. 2017). Breastmilk is equipped with the enzymes, hormones, and water that work jointly to enhance the digestion of the infant. Early breastfeeding is influenced by biophysical factors, motivation, intentions of delivery, knowledge of breastfeeding, and confidence (Thomas, 2016). The cessation rate of breastfeeding is always high in the first month of giving birth; therefore, postpartum forms the most critical of the nurses to identify problems associated with lactation and provide measures in establishing breastfeeding to avoid early cessation. Since breastfeeding is a natural process, it requires teaching and learning on the informational support as well as instrumental support during the period of postpartum (Rouse, 2015).

The research project provided a comparison between the two groups of breastfeeding mothers with infants of 2-6 months who gave birth at a local hospital in the Midwest. The research question:  Is there a significant difference in success and satisfaction of breastfeeding between the nurse-led breastfeeding support and the standard support group? Through the identification of the resources of breastfeeding, health care providers can influence the level of perceived self-efficacy by providing education and positive enforcement (Mancini,2016).

Literature Review

The background literature search for this review was conducted through nursing and academic edition and the keywords such as outpatient support on lactation and breastfeeding used in combined multiple manners. Several articles have reviewed the inclusion of the quantitative and qualitative studies, guidelines, and the statements of the policy with regards to breastfeeding in the USA.

An evaluation of the articles, the matrix method was used, enhanced discoveries and organization in the chronological order to describe the areas of interest. Seven resources were retrieved, and the evaluation is undertaken. The research articles on the outpatient lactation were outlined. The underlying theme on the provision of the professional support related to lactation during the postpartum period in ascertaining the breastfeeding objectives was identified in the research articles.

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Background/ problem statement

First time breastfeeding mothers have been experiencing challenges in breastfeeding their infants. Lactation is associated with several difficulties in mothers during postpartum periods. The difficulties may include breast engorgement, latching, mastitis, and low infant weight (Christoffers, 2014). For postpartum mothers, the experience of having their milk coming in happens after discharge from the hospital while they are at home, and mothers may or may not have access to professional assistance when questions arise regarding breastfeeding (Edwards et al. 2017). Recovering from delivery, learning to breastfeed, balancing hospital visitors, infant care, and sleep deprivation, new parents can easily be overwhelmed in the first few days of their infant’s life.

According to Thomas (2016), breastfeeding mothers may not have support from family members to breastfeed their infant. Generations of women are lacking breastfeeding experience and may not know how to support a breastfeeding mom since they did not have that experience for themselves (Edwards, et al. 2017). Breastfeeding mothers need accurate, supportive, persistent, and kind assistance for success in their breastfeeding goals. Successful breastfeeding is also dependent on infant response. If the infant is sleepy at the breast, experiences hypoglycemia or hyperbilirubinemia, tongue-tie, has an ineffective latch or poor suckling effort, mothers may become frustrated with breastfeeding and resort to alternative feeding methods (Allen & Schafer, 2015).

Unfortunately, breastfeeding mothers receive conflicting information. One of the frustrations mothers experienced was receiving conflicting advice from different health care providers, which ultimately affected their confidence in breastfeeding and breastfeeding intentions. Enhancing communication between health care providers and mothers who are breastfeeding can help mothers attain breastfeeding goals (Christoffers, 2014). The challenge is the development of cost-effective, consistent, and timely interventions that can enhance breastfeeding mothers’ satisfaction with the breastfeeding experience (Thomas, 2016). Therefore, education provided to mothers after delivery more beneficial than before delivery with comments from mothers referencing how they prefer to be shown how to breastfeed rather than be told (Rouse, 2015).

Purpose

The literature is lacking in what breastfeeding mothers perceive as supportive in the postpartum period to assist them in achieving their breastfeeding goals. The policy statements, guidelines, and recommendations for breastfeeding success set forth by political and professional groups are published and publically advertised (Allen & Schafer, 2015). However, a lack of published literature related to the perspective of the breastfeeding mother exists. Through this proposed research, the researcher hopes to identify resources mothers use to be successful in their goals for breastfeeding (Rouse, 2015).

Search Method

The target population was mothers who delivered at a local Midwest hospital 2-6 months prior to survey distribution and were breastfeeding at the time of discharge from the hospital. The survey was used for data collection, which was a written survey with closed and open-ended questions. The written survey was developed by identifying the data desired for this study while still protecting personal information (Christoffers, 2014). The written survey was piloted by volunteers who chose to complete the study and offer feedback regarding the questions. The written survey collected limited demographic information, including whether this was her first time breastfeeding, length of maternity leave, whether she pumped breastmilk, where she received breastfeeding education or support, and if she attended a breastfeeding support group.

The survey also provided quantitative data collection using the Maternal Breastfeeding Evaluation Scale (2014). The MBFES measures maternal satisfaction with a breastfeeding experience and has been tested for validity and reliability. The MBFES measures the positive and negative factors of breastfeeding. As the MBFES was developed, the researchers found women describing the quality of the breastfeeding experience more critical than the duration of breastfeeding. Besides, satisfaction with their breastfeeding experience was multifactorial. The MBFES can be used in its entirety or broken down into three subscales, specifically looking at infant satisfaction/growth, lifestyle/maternal body image, or maternal enjoyment/role attainment.

The target population was mothers who are (or were) breastfeeding their infant and are now coming into the clinic setting of a local Midwest hospital for a two, four, or six-month well-baby check-up. Clinic managers were educated to the survey distribution process, the IRB approval that had been received, and the request to have receptionists aid in survey distribution. When mothers were checking-in for their infant’s appointment, the mother was asked if she provided breastmilk to her infant and if she would be interested in filling out a survey regarding her breastfeeding experience. The mother was given the consent form regarding the written survey and the opportunity to accept or decline to participate in the survey.

Data collected was organized and coded using a spreadsheet format with no personal identifying factors recorded. The primary goal of the qualitative breastfeeding survey was to delineate mothers who attended the breastfeeding support group and those who did not attend. Other questions were placed on the survey to elicit additional information that may help guide the research question. An interesting pattern appeared in the questions on the written survey: “What was your main source of breastfeeding education?” and “What was your main source of support in breastfeeding?

Results

Data collected was organized and coded using a spreadsheet format with no personal identifying factors recorded. The primary goal of the qualitative breastfeeding survey was to delineate mothers who attended the breastfeeding support group and those who did not attend (Rouse, 2015). An interesting pattern appeared in the questions on the written survey: “What was your main source of breastfeeding education?” and “What was your main source of support in breastfeeding?

The two-page survey data was coded and recorded in a spreadsheet. The primary purpose for the qualitative, first page of the survey was to delineate the two groups of mothers: those who attended the nurse-led breastfeeding support group and those who did not. The quantitative, second page of the survey (MBFES) was intended to measure the mother’s evaluation of breastfeeding. The MBFES can be analyzed in its entirety (all 30 items) or using the three subscales. The Maternal Enjoyment/Role Attainment Subscale consists of items 1, 2, 6, 9, 11, 12, 16, 17, 18, 20, 21, 23, 25, and 30. The Infant Satisfaction/Growth Subscale consists of items 3, 4, 7, 10, 15, 19, 24, and 28. The Lifestyle/Maternal Body Image Subscale consists of items 5, 8, 13, 14, 22, 26, 27, and 29. Items worded negatively are reflected for scoring. These are items 3, 5, 8, 13, 14, 15, 19, 22, 27, 28, and 29. Scores on the MBFES (and the subscales) are summed for a range of 8-40 after reverse-scoring of negative items.

Analysis of the collected data was conducted using the Statistical Package for Social Sciences software (SPSS). With n=53 for complete surveys returned, 27 breastfeeding mothers attended the nurse-led support group, and 26 breastfeeding mothers did not attend the group. No significant differences in maternal breastfeeding satisfaction were determined in the t-test procedure. The three MBFES subscales did not show any statistical difference in breastfeeding satisfaction between mothers who attended the breastfeeding support group and those who did not. The average score for breastfeeding mothers who did attend the support group was 118.6.

Primary sources of support and education

Christoffers (2014) explains that the first question asked the mothers specifically about their breastfeeding source of education and the second question asked the mothers specifically about their breastfeeding support. Thirty-six (68%) mothers placed husband/significant other as their primary source of support in breastfeeding. Thirty-two (60%) mothers placed lactation nurse/class as their primary source of education in breastfeeding. Twenty-two (42%) mothers placed husband/significant other as their primary source of support and lactation nurse/class as their primary source of education in breastfeeding. The responses from two questions on the written survey were tabulated and are included in the table below.

Discussion

No statistical significance in breastfeeding satisfaction between mothers who attended a nurse-led breastfeeding support group and those who did not was found. The lack of statistical significance could be related to the small sample size. First time breastfeeding mothers and mothers with experience breastfeeding were included in the statistical analysis. Mothers who have breastfed a previous infant and were choosing to breastfeed again most likely did not need assistance or professional support in their current breastfeeding experience (Rouse, 2015). Another consideration for the lack of statistical significance between the two groups of mothers can be seen in the comments received in the surveys.

Supporting breastfeeding mothers

Husbands/significant others can be instrumental in positioning baby and mother for latching, becoming educated in the breastfeeding process, and offering moral support when breastfeeding doesn’t go as planned (Christoffers, 2014). Pender’s health promotion model describes how social support and expectations of others influence a person’s behavior Husbands/significant others influence a mother’s decision to breastfeed and for how long (Mancini, 2016).

An essential factor to keep in mind is the uniqueness of each mother/infant dyad and how the support that is helpful for one dyad may not be useful for the next dyad (Rempel & Moore, 2012). In Pender’s health promotion model individual experiences, personality, and situational influences will affect a person’s behavioural choices. Some mothers are very shy and uncomfortable with another person assisting them in breastfeeding and do not desire support in that fashion, but they may be very open to attending a class and asking questions. One of the mothers in the surveys received was very accessible (but anonymous) about her previous history of sexual abuse.

Breastfeeding education

In the survey responses received, sixty-percent of mothers (32 surveys) looked to lactation nurses as their primary education resource for breastfeeding information. Lactation nurses from a local Midwest hospital agreed that education is a critical step in a successful breastfeeding experience (Christoffers, 2014). Comments from the completed breastfeeding surveys echo sentiments of adequate knowledge by “taking advantage of the resources around you and learn all you can about breastfeeding (Thomas, 2016).

Conclusion

Overarching evidence-based policies, certifications, and credentialing can assist birthing centers in promoting breastfeeding. Education for breastfeeding mothers must be consistent among staff members (Rouse, 2015). Anticipating breastfeeding difficulties with adequate follow-up after discharge from the hospital is crucial for breastfeeding success. A nurse-led breastfeeding support group is helpful to mothers who desire that form of support, but alternative methods of support must be made available for mothers who choose not to attend a breastfeeding support group. Methods of breastfeeding support need to be reputable, consistent, and evidence-based (Coster et al. 2018). By understanding what resources are most beneficial to breastfeeding mothers, health care providers can provide evidence-based guidance that has the potential to impact national breastfeeding statistics and the health of the general public.

Limitation and Recommendations

This project was limited by the small sample size and the initial method of survey distribution. The second method of survey distribution (mass mailing) had a moderate 32% response rate but still left 68% of mothers who received a survey as unresponsive. The researcher is an employee of the participating local Midwest hospital, which could be seen as a limitation in unbiased data collection and analysis. The research functioned on data collection and but did not unduly influence the project like a hospital employee.

While this project did not show a statistical difference in maternal breastfeeding satisfaction among mothers who attended a nurse-led breastfeeding support group and those who did not, the larger sample size may produce different results in further studies. Recommendations are to continue to identify resources breastfeeding mothers find supportive. Organizations and professionals promote the benefits of breastfeeding for mothers and infants, but promotion is not effective until breastfeeding mothers feel supported in achieving their breastfeeding goals. When organizations and professionals understand what support is vital to breastfeeding mothers (and implement or grow that support), then breastfeeding rates would be expected to increase.

With several professional agencies recommending breastfeeding as the primary source of infant nutrition, more research is needed on the best methods to assist mothers in achieving their breastfeeding goals. Obstacles to breastfeeding are multifactorial and often require personalized assessment by a professional trained in the art of breastfeeding to overcome these obstacles. Mothers desire to do what is best for their baby and want to know they are doing a “good” job in caring for their baby. Further research is therefore recommended with regards to resources breastfeeding mothers find helpful in achieving their breastfeeding goals.

Reference

Baby-Friendly Hospital Initiative (BFHI). (2014). Retrieved from: https://www.babyfriendlyusa.org/about-us

Christoffers, C. (2014). Maternal breastfeeding satisfaction: attendance or non-attendance at a nurse-led breastfeeding support group.

Rempel, L. A., & Moore, K. C. (2012). Peer-led prenatal breastfeeding education: A viable alternative to nurse-led education. Midwifery, 28(1), 73-79.

Edwards, R., Peterson, W. E., Noel-Weiss, J., & Shearer Fortier, C. (2017). Factors influencing the breastfeeding practices of young mothers living in a maternity shelter: A qualitative study. Journal of Human Lactation, 33(2), 359-367.

Allen, M., & Schafer, D. J. (2015). Nurses Improving the Health of Mothers and Infants by Dancing the 10 Steps to Successful Breastfeeding. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(s1), S52-S52.

Rouse, C. L. (2015). Increasing initiation and exclusivity of breastfeeding in the hospitalized, postpartum dyad. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(s1), S49-S49.

Thomas, J. V. (2016). Barriers to exclusive breastfeeding among mothers during the first four weeks postpartum.

Coster, S., Watkins, M., & Norman, I. J. (2018). What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. International journal of nursing studies, 78, 76-83.

Mancini, K. (2016). Body Image, Eating Attitudes and Breastfeeding Intention in Breastfeeding MothersCompared to Non-Breastfeeding Mothers (Doctoral dissertation, Adelphi University).