Essay on "Promoting Breastfeeding: Centering Pregnancy Model"

Essay 13 pages (6030 words) Sources: 30 Style: Harvard

[EXCERPT] . . . .

Prenatal Breastfeeding Workshop: Teaching and Learning Package

All credible health authorities, with even a remote interest in maternal and child health outcomes, spend a great deal of effort promoting the benefits of breastfeeding (AAP n.d.). The official policy statement issued and recently updated by the American Academy of Family Physicians (AAFP 2014) encourages family physicians to incorporate breastfeeding education into preconception, prenatal, and postnatal care visits. The AAFP (2014) also recommended that providers encourage family members, especially the father and maternal grandmother, to participate in supporting the mother's intention and commitment to breastfeeding. Although an individualized education approach can be beneficial, the American College of Nurse-Midwives (ACNM 2011) recommends a group prenatal care format. The advantages of this model, aside from preserving clinic resources, include better maternal and infant health outcomes. The model mentioned specifically by the ACNM (2011) was the CenteringPregnancy model, which uses a provider- and co-facilitator-led participatory instruction.

I am a nurse who is working in a hospital obstetrics and gynecology ward in my home country, with a strong interest in patient education. Recently, I decided to provide a free prenatal breastfeeding workshop through my department on a voluntary basis and this report presents the details of the proposed teaching and learning package. The objectives will be to expand my role as a patient educator, improve the quality of patient education, expand the services offered by my department, and improve patient awareness about breastfeeding benefits. The chosen model for the prenatal breastfeeding workshop is group prenatal education, which brings women together at approximately the same gestational age to learn and share during the 2-hour workshop. This report will provide justification for the project and discuss the material that should be included in the teaching and learning package.

Overview of the Prenatal Breastfeeding Workshop

During their first prenatal care visit, women under 20-weeks gestation will be invited to attend the prenatal breastfeeding workshop. They will be given a leaflet containing an overview of the information that will be provided in the workshop, a description of how the workshop will be organized, directions, and contact information. The workshop will be in a group format that encourages active participation with facilitators and the other women attending. The topics covered will include the benefits, techniques, and strategies for breastfeeding. The didactic portion of the workshop will begin with a brief video providing a general overview of breastfeeding (Office on Women's Health 2011). A PowerPoint slide presentation, accompanied by a verbal presentation, will represent the main teaching tools used. Workshop attendees will be asked to complete a breastfeeding knowledge assessment at the end of the workshop, in addition to evaluating the workshop and facilitator performance in written form.

The lesson plan for a 2-hour prenatal breastfeeding workshop will be presented here (Appendix). The rationale for the lesson plan is evidence-based and explained in detail below. The learning modules were adapted from published online information and informed by peer-reviewed research publications. The lesson modules are the following: (1) infant benefits, (2) maternal benefits, (3) how to breastfeed, (4) managing a breastfeeding routine, and (5) breastfeeding in public. What follows is a detailed overview of the information presented in the workshop and a discussion of the relevant learning theories.

Teaching

The information that should be conveyed to pregnant women during prenatal care has been well-established, but the benefits of breastfeeding, while substantial, continue to be elaborated through experimental studies. Current recommendations are for exclusive breastfeeding for the first 6 months of life, followed by at least another year of breastfeeding as the diet is supplemented with liquids and foods (AAP 2012). Beyond that point, continued breastfeeding is optional depending on the wishes of the mother and child. The Office on Women's Health (2010a) within the U.S. Department of Health and Human Services (HHS) maintains an updated information database on best practice recommendations for breastfeeding, including recommended positions, schedules, duration, exclusivity, diet supplementation, and solutions to any problems that may arise. What follows is an overview of this information, which will form the knowledge base for the breastfeeding prenatal workshop.

Patience and practice are the main requirements for breastfeeding, in addition to a safe and relatively stress- free environment (Office of Women's Health 2010a). Women attempting to breastfeed for the first time may experience discomfort and frustration, but with persistence comes skill for both mother and infant. The most important things to remember are that milk will be produced in response to suckling behavior and breasts will adapt to consumption rates. Suckling triggers the maternal release of prolactin and oxytocin, in addition to dilation of the milk ducts. Prolactin causes the breast alveoli to make milk, while oxytocin controls postpartum bleeding and induces uterine muscle contraction.

The release of milk triggered by suckling is called the let-down reflex

(Office on Women's Health 2010a). The length of time that it takes from the start of suckling to milk release can vary from a few seconds to a few minutes, therefore patience may be required. The sensation that accompanies the let-down reflex can vary from no sensation, to tingling, to mild discomfort. The let-down reflex can also be triggered several times during a feeding. Other triggers include hearing your baby cry or thinking about your baby, which may be helpful when expressing breast milk for later feedings.

Mother and infant should be brought together immediately after birth, health permitting, to provide every opportunity for breastfeeding to occur (Office on Women's Health 2010a). How fast the baby will latch onto the mother's nipple will vary, from immediate to several minutes. Typical searching behavior is the infant rolling the head back and forth and searching for a nipple with the mouth and lips. The steps for helping the baby latch onto the nipple are the following: (1) hold baby upright and against the chest just below the chin, (2) support the neck with one hand and the hips with the other, (3) tilt the baby's head back slightly to naturally open the mouth and depress the tongue, (4) lower the baby until the breast naturally rests on the baby's cheek, which will probably cause the infant to search and find the nipple, and (5) support the upper back and shoulders of the infant with one hand and pull the baby in close.

The baby's head should never be held during suckling, since this may interfere breathing (Office on Women's Health 2010a). If the proper position is attained, the infant's nostrils are flared, mouth filled with breast, tongue and chin under breast, areola mostly covered, head straight, chest against torso, swallowing evident, and ears wiggling. This position should be comfortable for both infant and mother. Other useful positions include the following: (1) along the mother's same-side forearm in a cradle hold, (2) on the opposite-side forearm in a cross-cradle hold, (3) with both forearms in a 'football' hold, or (4) while the mother and infant are laying on their sides. Breast pain can be caused by the infant latching onto the nipple and not the breast, which in turn may prevent the release of sufficient milk. The solution is to simply break suction by wedging a clean finger between the breast and the infant's lips and then trying again.

Shortly after birth the number of feedings per day can range from 8 to 12, with each breast being suckled about 15 to 20 minutes (Office on Women's Health 2010a). The best approach is to allow a healthy baby to set the feeding schedule and avoid the use of pacifiers and infant formulas unless it is medically necessary. Sharing the sleeping space with the baby increases the convenience of feeding and reduces the risk of sudden infant death syndrome. Initially, the baby may lose a little weight within the first few days after birth, but this trend should reverse after the first week of life if well-fed. The presence of a sufficient volume of pale urine, adequate bowel movements, post-feeding contentment, post-feeding softer breasts, and a healthy wake/sleep cycle are all indicators of a healthy breastfeeding routine.

Breastfeeding women can encounter many problems, including sore nipples, inappropriate milk volume, plugged ducts, infections, or an atypical nipple (Office on Women's Health 2010b). The primary cause of sore nipples is an improper latch. The only solution to this problem is breaking the suction and repositioning the infant on the breast. A less frequent cause of pain is irritation caused by the development of an abrasion, but if this does not resolve on its own the mother should seek medical care. Getting professional advice is also recommended before the mother attempts to use creams, ointments, nipple shields, and nursing pads.

The primary cause of low milk supply is a lack of experience and knowledge (Office on Women's Health 2010b). With experience the feeding time may shorten to as much as 5 minutes due to increased infant skill. If the baby is content after feeding and otherwise healthy, the length of feeding time is irrelevant. Adaptation to growth spurts will probably require longer and more… READ MORE

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