Tides in Breastfeeding Practice

Mary Margaret Coates and Jan Riordan Throughout the world today, an infant is apt to receive less breastmilk than at any time in the past. Until the 1940s, the prevalence of breastfeeding was high in nearly all societies. Although the feeding of manufactured milks and baby milks had begun before the turn of the century in parts of Europe and North America, the practice spread slowly during the next decades. It was still generally limited to segments of population elites, and it involved only a...

The Costs of Not Breastfeeding Reported by Various Researchers

Over 3 billion annually Weimer, 2001 Over 1 billion annually Riordan, 1997 478 first 12 months per Montgomery & family Splett, 1997 331 to 475 per infant Ball & Wright, first 12 months 1999 Extra 200 first 12 Hoey & Ware, 450- 800 first 6 months Tuttle & Dewey, per family in WIC 1996 United States and Britain general population Arizona HMO Scotland general population Excess Cost of Formula During First Two Months Extra 45 to 70 for first Jarosz, 1993 Hawaii Otitis media, 365 million...

Technological Innovations in Infant Feeding

During the late 1800s and the early 1900s, high infant mortality, even among infants cared for at home, was a major public concern. Physicians and parents recognized that poorly nourished children were more susceptible to illness. Between 1910 and FIGURE 1-3. UNICEF photograph of thriving breastfed twin and his dying bottle-fed sister. (Courtesy of Children's Hospital, Islamabad, Pakistan.) FIGURE 1-3. UNICEF photograph of thriving breastfed twin and his dying bottle-fed sister. (Courtesy of...

Breast Structure

Breast Tissue Schematic Myoepithelium

The basic units of the mature glandular tissue are the alveoli, which are composed of secretory acinar units in which the ductules terminate. Each cluster of secretory cells of an alveolus is surrounded by myoepithelial cells, a contractile unit responsible for ejecting milk into the ductules. Each ductule then merges, without communicating with its neighbors, into a larger duct (Figure 3-1). An ultrasound image of a lactating breast is shown in Figure 3-2, where ducts filled with milk can be...

Pregnancy

During pregnancy, the breasts grow larger, the skin appears thinner, and the veins become more prominent. The diameter of the areola increases from about 34 mm in early pregnancy to 50 mm postpartum (Hytten, 1954), although there is a wide range of areolar width in any population. As the nipples become more erect, pigmentation of the areola increases and the glands of Montgomery enlarge. Serum hormones stimulate breast growth during pregnancy nipple growth is related to serum prolactin levels...

Breastfeeding Rates Percentages and US Healthy People 2010 Breastfeeding Objectives for the Nation

Initiate breastfeeding within the early postpartum period 64 68 75 Breastfeeding at 6 months after birth 29 31 50 Breastfeeding at 12 months of age 16 18 25 Source Available at Accessed March 17, 2002. budget in 2000 of about 4 billion, up from 3.7 billion in 1997. In the late 1980s, the promotion of breastfeeding became an important goal within WIC. The Child Nutrition and WIC Reauthorization Act of 1989 required that a certain proportion of its budget was to be spent on the promotion and...

The Immune System

The body's overall immune system is known as the systemic immune system. Another immune system, the secretory immune system, invokes surfaces of the body (such as the breast) and acts locally. Lymphocytes in the secretory immune system are different from other lymphocytes. Sensitized to antigens found in the gastrointestinal or the respiratory tracts, these lymphocytes travel through mu-cosal lymphoid tissues (e.g., breasts, salivary glands, bronchi, intestines, and genitourinary tract) where...

Lactogenesis

The transition from pregnancy to lactation is called lactogenesis. The first half of pregnancy is characterized by growth and proliferation of the ductal tree and further formation of lobules. During the second half of pregnancy, secretory activity accelerates and the acini or alveoli become distended by accumulating colostrum (Russo & Russo, 1987). After 16 weeks of pregnancy, lactation occurs even if the pregnancy does not progress. An accessory breast may also swell. Just before and...

An Example of a Narrative Note

Rooting and suckling movements noted. Infant latched on breast and suckled effectively until asleep. Breastfeeding assessment score 9 10. 05-22-03 1500 Discussed basic breastfeeding information including normal infant elimination patterns to watch for after discharge. Mother given written materials on sore nipples, engorgement, use of breast pump, and breastmilk storage. 05-23-03 1100 Explained that a follow-up call will be made 2 to 3 days after discharge. Mother...

The Replacement of Maternal Breastfeeding

Wet-nursing may not have been the earliest alternative to maternal breastfeeding, but it was the only one likely to enable the infant to survive. Wet-nursing is common, although not universal, in traditional societies of today and (by inference) among ancient human societies. An already-lactating woman may have been the most obvious choice for a wet nurse, but women who stimulate lactation without a recent pregnancy have been described in many traditional societies (Slome, 1976 Wiesch-hoff,...

Milk Synthesis and Maturational Changes

Major components of human milk (protein, fat, lactose) are synthesized and secreted by the mammary secretory epithelial cells. Cregan (1999) labeled these cells lactocytes. During pregnancy these cells further develop under the influence of pro-lactin. Four of the five milk-secretion pathways necessary for milk secretion are synchronized in the alveolar cell of the mammary gland. In the fifth pathway, the passage of components is between epithelial cells, rather than through them, and is known...

Info

Breastmilk is sometimes referred to as white blood, because it is considered similar to the placental blood of intrauterine life. Indeed, human milk is similar to unstructured living tissue, such as blood, and is capable of transporting nutrients, affecting biochemical systems, enhancing immunity, and destroying pathogens. With the use of sophisticated laboratory techniques, many scientific investigators have substantiated the life-sustaining properties of breastmilk. Organs themselves provide...

Bioactive Components

Hamosh (2001) designates a special group of substances in human milk as bioactive components. These substances promote growth and development of the newborn by special activities that continue after the infant ingests breastmilk. Many are not available to the infant in commercial infant formula. Research on bioactive components is a growing area of investigation. These bioactive components may play a significant role in child health. Mammalian milk contains a large number of enzymes, some of...

Figure

Oxytocin Release Over Time

Fluctuation of human placental lactogen and prolactin serum levels in pregnancy and lactation. (From Battin DA et al. Effect of suckling on serum prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol during prolonged lactation. Obstet Gynecol 65 785-8,1985 Tyson JE et al. Am J Obstet Gynecol 113 14-20, 1972 Speroff L, Glass RH, Kase NG. Clinical gynecology, endocrinology and infertility, 4th ed. Baltimore Williams & Wilkins, 1989 283. are highest in the morning (Cregan,...

Required Competencies for Lactation Practice

Breastfeeding education and advocacy 2. Clinical management of breastfeeding 4. Special knowledge and assistance 5. Professional responsibilities and activities 6. Business practices legal considerations vices on breastfeeding increase the likelihood that the staff will provide consistent information. Although providing in-service education is an important, perhaps even essential, role of the lactation consultant, one can (like the proverbial horse brought to a watering hole) offer but not...

Problem Oriented Medical Records

What the mother herself tells you. Example My nipples feel sore. Note If the charting relates to only the infant, there will be no subjective data. O Objective data. Concrete data you can observe. Examples Infant position at breast, temperature, and infant weight. A Assessment and nursing diagnosis. An assessment of physical and psychosocial factors based upon subjective and objective data what you think is going on. Examples Infant poorly positioned on the breast...

Average Wage and Consult Time of Lactation Consultants

Practice Hourly Initial Length of Setting Wage ( ) Consult ( ) Consult (min) A health-care professional who needs clinical hours to qualify as an applicant to take the LC certification examination should seek out a job where she will work with breastfeeding mothers to accumulate clinical hours. Working on a mother-baby unit is an example. The individual who is still in a school to become a health-care professional can investigate the possibility of taking a supervised clinical practicum as a...

Suckling

Suckling behavior develops early in gestation. Fetuses display a suckle reflex by 24 weeks gestation. By 28 weeks preterm babies can coordinate the suckle swallow breathe cycle at the breast and by 32 weeks can suckle in repeated bursts of more than 10 suckles and maximum suckling bursts of over 30 (Nyqvist, Sjoden, & Ewald, 1999). The precise way in which infants use their oral and facial muscles to efficiently take in nourishment from their mothers' breasts is vital information for health...

Hormonal Influences

Lactation Hormones

Lactogenesis II is triggered following the expulsion of the placenta by a fall in progesterone levels and the continued presence of prolactin. A great deal of information about these hormonal functions during lactation is now known through radioimmunoassay FIGURE 3-7. (A) Gaps between alveolar cells before lactogenesis. (B) Intracellular gaps close tightly to one another following lactogenesis (With permission, Hale T. Medications and mother's milk, 9th ed. 2000 6.) FIGURE 3-7. (A) Gaps between...

Organizations And Events That Promote Breastfeeding

1978 World Health Organization (WHO) 1979 US Department of Health and Human Services (USDHHS) 1995 World Alliance for Breastfeeding Action 1997 American Academy of Pediatrics 1998 United States Breastfeeding Committee 2000 American Academy of Nursing International Conference on Primary Care Healthy People The Surgeon General's Report on Health Promotion and Disease Prevention Promoting Health and Preventing Disease Objectives for a Nation The International Code of Marketing Breast-Milk...

Application of Physiological Principles

Principle from Physiological Research The breast does balance supply to meet the infant's demand for breastmilk. The breast can rapidly change its rate of milk synthesis from one feed to the next. The breasts have the capacity to synthesize more milk than the infant usually requires. Breast production varies from one breast to the other breasts operate independently of each other. The larger the breasts, the greater the milk storage capacity (i.e., the difference between maximum and minimum...

Clinical Implications Mother

Breast Pinch

Usually little attention is given to prenatal assessment of the breast and nipples because of Western cultural inhibitions about the breast and lack of recognition of its importance. As a consequence, after giving birth, mothers may experience feeding difficulties that could have been prevented. Nurses and lactation consultants practicing as primary caregivers are the ideal people to perform a prenatal breast assessment, particularly because physicians (especially males) are often reluctant to...

The Unique Characteristics of Counseling Breastfeeding Women

There are unique aspects of working with breastfeeding women that differ from other aspects of health care. Breastfeeding is an emotion-laden subject that may be viewed as an integral part of human sexuality, not just an infant feeding method. It touches deep-seated feelings that people have about themselves and their bodies that reach back to childhood. This emotional content makes breastfeeding counseling, like sex counseling or childbirth education, unusually sensitive. Health-care workers...

Superbill Lactation Visit Receipt

(With permission, Pat Lindsey, 2003). (Medicare, Medicaid) and managed care organizations (MCOs). Medicare applies to individuals over age 65 and is not applicable for breastfeeding except that insurance companies usually follow Medicare rules for payment. Medicaid is a federal program administered by the states, and state regulations apply to mothers and children who qualify on the basis of poverty. The regulations in various states may differ in billing rules and regulations. About one third...

Randomized Controlled Trials on the Effect of Lactation Consultant and Health Provider Intervention on Breastfeeding

Jakobsen et al., 1999 (Guinea Bissau) Pugh and Milligan, 1998 (United States) Curro et al., 1997 (Italy) Duffy, 1997 (Australia) Gagnon et al., 1997 (Canada) Lactation support visit in the hospital and 7 visits at home Video, explanatory leaflet, discussion and 4 home visits N 400 Individual session at first prenatal visit and until 9 mo N 1154 Hospital session, individual counseling in clinic or at home until 4 mo N 134 Individual session (20 min) N 540 Intervention 1 at birth and at 3 mo...

Preface

I have worked in the field of lactation since the early 1960s, first as a La Leche Leader and later as a lactation consultant when it became a professional practice discipline in 1985. As I look back over those years I am struck both by how different things are now and by how much things have stayed the same. Although the breastfeeding initiation rate in the United States has risen to almost 70 percent a vast improvement from 20 percent in the 1960s it still takes time and patience to help a...

Acknowledgements

I gratefully acknowledge the contributions to this book made by the following individuals Judy Angeron BA, RN, IBCLC, Coordinator, Lactation Services, Via Christi Regional Medical Center, Wichita, Kansas Kathleen G. Auerbach PhD, IBCLC, Ferndale, Washington Suzanne Bentley MSN, CNM, IBCLC, Clinical Nurse Specialist, University of Kansas, Clinical Instructor, University of Kansas, School of Nursing, Kansas City, Kansas Belinda Childs MN, ARNP, CDE, Clinic Research Coordinator, Mid-America...