Thursday, March 28, 2024

Counseling the Breastfeeding Mother

Overview

Breastfeeding always has been the criterion standard for infant feeding. Prior to the advent of commercial formulas, breastfeeding was, in truth, the only way to feed an infant. The 20th century brought with it a dramatic change in the way an infant could be fed; for the first time in the evolution of mankind, nonhuman milk formulas were created and mass produced in such a way that allowed infants to survive and reach adulthood.

In the 21st century, despite marked improvements in the composition of such formulas, breastfeeding remains the superior form of infant nutriture and also serves as an extrauterine directive of immune development.
The issues relevant for lactation success have changed as the world has changed. The ability to counsel breastfeeding women and a multiprong approach significantly impact her success, particularly in urban, low-income women.

A Cochrane Database review of 52 studies of 56,451 mother-infant pairs supports this claim. Results of the review show that all forms of extra support showed an increase in the length of time women continued to breastfeed and the length of time women breastfed without introducing any other types of liquids or foods. Both professional and lay supporters had a positive impact on breastfeeding outcomes. Face-to-face support was significantly more effective compared with telephone support.

Separately, in February 2015, results of an online survey of 12 World Health Organization Western Pacific offices revealed that the most commonly reported reason women did not breastfeed was return to work (44%).

With the reemergence of breast milk as the ideal source of infant nutrition, more and more women are choosing to breastfeed. However, a lack of community knowledge about breastfeeding and shorter hospital stays has led to more breastfeeding failures, a phenomenon that continues to this day.

Women and their infants are now being discharged earlier (12-24 h postdelivery); therefore, the tradition of the first follow-up at age 2 weeks has been replaced with 2-3 days after discharge with more carefully planned assessments of the breastfeeding mother–infant dyad. Pediatricians have significant role in ensuring the success of breastfeeding. Such early follow-up makes lactation success more likely and leads to a healthier infant. Successful follow-up depends on the healthcare provider’s knowledge of the mechanics of breastfeeding, the evaluation of successful lactation, and the interventions required if difficulties develop. If appropriate, the mother can be referred to a certified lactation support individual.

A 2012 Cochrane review recommended exclusive breastfeeding for the first six months of life in both developing and developed countries.

This article reviews the mechanics of breastfeeding, correct breastfeeding techniques, and sufficient versus insufficient milk supplies. A discussion of early follow-up of the breastfeeding mother–infant dyad and the warning signs of difficulties in that dyad are also included. Emphasis is placed on assessing the breastfeeding neonate and determining when neonatal jaundice, more common in breastfed infants, is pathologic. Finally, common breastfeeding problems are discussed, with emphasis on their early recognition and management.

For more information about the physiology of lactation and about the structure and biochemical features of human milk, please see the Medscape Drugs & Diseases article Human Milk and Lactation. Another good resource is the following: Lawrence RA, Lawrence RM. Breastfeeding. A Guide for the Medical Profession. 6th ed. St. Louis, MO: Mosby, Inc; 2005.

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