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Article Excerpt
The U.S. Department of Health and Human Services' (DHHS) Healthy People 2010 initiative has set a goal of having 75% of mothers initiate breastfeeding immediately postpartum, 50% continuing breastfeeding at 6 months postpartum, and 25% breastfeeding at one year (DHHS, 2000). Additionally, numerous national planning guides (Satcher, 2001; Shealy, Li, Benton-Davis, & Grummer-Strawn, 2005; World Health Organization, 2007) and the American Academy of Pediatrics (AAP) policy statement on breastfeeding (Gartner et al., 2005) support the use of breast milk as the optimal choice for infant nutrition, citing several health benefits to both infant and mother for breastfeeding. Of babies born in the U.S. in 2004, only Alaska, California, Hawaii, Montana, Oregon, Utah, Vermont, and Washington achieved all three of Healthy People 2010's breastfeeding goals (DHHS, Centers for Disease Control and Prevention [CDC], 2007). Thus, there is a disparity between best infant nutrition practice guidelines and actual breastfeeding rates in the U.S. For this reason, effective interventions that promote and prolong the duration of breastfeeding are needed to achieve optimal infant nutrition and improve maternal and child health.
Factors Affecting Breastfeeding Rates
Mothers do not initiate breastfeeding or discontinue breastfeeding early for a variety of reasons. Ahluwalia, Morrow, and Hsia (2005) found that mothers stopped breastfeeding in the first month postpartum because of sore nipples, infant difficulty with latch, and perceptions that they were not producing enough milk to satisfy their infants. Societal barriers to breastfeeding, such as working outside the home, length of maternity leave, and embarrassment of breastfeeding in public, have been identified as factors affecting breastfeeding initiation and duration (Moore & Coty, 2006).
Gartner et al. (2005) list "lack of timely routine follow-up care and postpartum home health visits, ... lack of family and broad societal support, media portrayal of bottle feeding as normative, ... misinformation, and lack of guidance and encouragement from health care professionals" (p. 498) as some of the many obstacles mothers face when attempting to initiate and continue breastfeeding. The lack of familial support, as well as lack of opportunity to observe breastfeeding in societies, can make it difficult for new mothers to attempt to breastfeed (Enkin et al., 2000). Moreover, 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 (Moore & Coty, 2006).
Breastfeeding Support by Health Professionals
Breastfeeding support offered by knowledgeable professionals can enable mothers and families to overcome breastfeeding obstacles and is often cited in the literature as a way to promote breastfeeding (Britton, McCormick, Renfrew, Wade, & King, 2007; de Oliveira, Camacho, & Tedstone, 2001; Guise et al., 2003; Wambach et al., 2005). The CDC Guide to Breastfeeding Interventions (Shealy et al., 2005) defines professional support as any "counseling or behavioral interventions to improve breastfeeding outcomes, such as helping with a lactation crisis or working with other health care providers" (p. 23). Shealy et al. (2005) further identify professional support as an evidence-based intervention that effectively increases the proportion of women who continue breastfeeding for up to six months. A Cochrane review of support for breastfeeding mothers found that professional support by medical, nursing, and allied health professionals, including nutritionists, was effective in prolonging breastfeeding and concluded that more research into the appropriate training for professional supporters is needed (Britton et al., 2007).
Breastfeeding initiation and breastfeeding maintenance benefit from the skills and assistance of a supportive experienced individual (Britton et al., 2007; de Oliveira et al., 2001; Guise et al., 2003). Research studies analyzing the outcomes of professionals who support breastfeeding identify a wide spectrum of professionals with very diverse training and backgrounds. Some professionals who support breastfeeding, including nutritionists (Froozani, Permehzadeh, Motlagh, & Golestan, 1999), hospital midwives (Di Napoli et al., 2004), and registered nurses (Albernaz, Victora, Haisma, Wright, & Coward, 2003), received training from World Health Organization/UNICEF intensive breastfeeding techniques and management curriculum (World Health Organization, Division of Diarrhoeal and Acute Respiratory Disease Control & UNICEF, 1993). Other professionals who support breastfeeding ranged from bachelor of science in nursing-prepared nurses with a minimum three years experience in maternal-child health (Gagnon, Dougherty, Jimenez, & Leduc, 2002) to "lactation consultants" with no listing of educational background or training (Lynch, Koch, Hislop, & Coldman, 1986; Pinelli, Atkinson, & Saigal, 2001; Quarles, Williams, Hoyle, Brimeyer, & Williams, 1994).
Is one type of health professional better educated and clinically trained than another to provide effective breastfeeding support? Humenick, Hill, and Spiegelberg (1998) state, "Lactation consultants gave significantly more positive encouragement (98%) (p = 0.01) than either nurses (75%) or physicians (68%) did" (p.305). Physicians are not often adequately prepared for the breastfeeding management role in either medical school or residency (Bunik, Gao, & Moore, 2006). Similarly, nurses have reported breastfeeding training and management as lacking in their educational programs (Hellings & Howe, 2000; Register, Eren, Lowdermilk, Hammond, & Tully, 2000).
The role of the lactation consultant was developed to provide high-quality, competent, comprehensive consultation in breastfeeding and lactation management (International Lactation Consultant Association, 2006). However, the title "lactation consultant" is used liberally in the literature (Aidam, Perez-Escamilla, & Lartey, 2005; Brent, Redd, Dworetz, D'Amico, & Greenberg, 1995; Kools, Thijs, Kester, van den Brandt, & de Vries, 2005; Lieu et al., 1998; Lynch et al., 1986; McKeever et al., 2002; Pinelli et al., 2001; Quarles et al., 1994), often referring to people involved in breastfeeding-support activities who do not have board-certified lactation consultant credentials. While there have been specialists and supporters of breastfeeding in the U.S. and elsewhere for many years, there was no unifying standard of care or profession for individuals dedicated to breastfeeding support until the end of the 20th century. To date,...
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