1. Maternity Care Practices and
How They Affect Breastfeeding
Elizabeth Powers Moore
Midwife Clinic Lab I
SWTC

2. Because we all benefit!
Why Breastfeed?

3. • Saves money
• Easier
• Health benefits, with lower risks of
– Cervical and breast cancers
– Postpartum depression
– Type 2 diabetes
("Why breastfeeding is important | womenshealth.gov“)
Mother

4. • Immune system booster
• Easier to digest
• Changes as baby grows
• Lower incidences of disease
("Why breastfeeding is important | womenshealth.gov“)
Baby

5. • Savings of $13 Billion yearly from
unnecessary medical costs
• Parents miss less work due to sick child
• Enviromental impact: less trash
("Why breastfeeding is important | womenshealth.gov“)
Society

6. Maternity Care

7. Prenatal Care
• Medical History: Question client about
any history of surgery or disease
regarding breasts or pertinent hormonal
issues (Frye, 2010, p. 552)
• Examination of breasts/nipples for any
findings that could be problematic,
working to find best solution before birth
(Frye, 2010, p. 589)

8. Nutrition
• Establish a diet that will not only be
optimal for pregnancy, but will support the
extra dietary needs of breastfeeding.
• MORE: Whole grains, fruits, vegetables,
healthy fats, quality proteins, organics
when possible, homemade meals
• LESS: Refined carbohydrates, additives,
fast foods, prepared foods
(La Leche League International, 2004)

9. But..
Women should know that breastfeeding is
possible with a less than optimal diet, and
that it is not necessary to refrain from some
caffeine, alcohol and medications.
("How does a mother’s diet affect her milk? : KellyMom“)

10. Points for Discussion
with Clients

11. Perceived Barriers to
Breastfeeding
• Loss of personal freedom
• Jealousy (paternal/sibling)
• Physical discomfort
• Difficulty returning to work/school
• Lack of confidence in ability to feed baby
with breast milk alone
(Moreland M.D. & Coombs P.A.-C, 2000)
(Office of the Surgeon General (US & Centers for Disease Control and Prevention)

12. More Benefits
• Mother-child bonding
• Promotes uterine involution
• More economical
• Healthier mom and baby
(Moreland M.D. & Coombs P.A.-C, 2000)

13. Practitioner
• Women may well be influenced about
breastfeeding by their practitioner’s
opinion.
• Many professionals are lacking in current
and/or correct information regarding
breastfeeding.
(Grossman et al., 2009)

14. A knowledgeable practitioner
can not only promote
breastfeeding more effectively,
but will have a higher
percentage of successful
breastfeeding mothers, both
initially and longer term.
(Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009)
(Grossman et al., 2009)

15. FOR FAMILIES
Support

16. SUPPORT
• Le Leche League International is composed of
support groups for breastfeeding women, prenatal
attendance is encouraged
("LLLI | About La Leche League International“)
• The Wisconsin Special Supplemental Nutrition Program
for Women, Infants and Children (WIC), “provides
nutrition education, breastfeeding education and support,
supplemental nutritious foods, and referrals to other
healthy and nutrition services.”
("Wisconsin WIC - Women, Infants and Children Home Page
)
• International Board Certified Lactation Consultant
(IBCLC)
("International Lactation Consultant Association )

17. AN ONGOING DISCUSSION
Racial Disparities

18. According to Chapman & Perez-Escamilla,
“The gap between current breastfeeding
practices and the Healthy People 2020
breastfeeding goals is widest for black
women compared with all other ethnic
groups. Also of concern, Hispanic and black
women have the highest rates of formula
supplementation of breast-fed infants before
2 d of life.”

19. CHILDBIRTH
Breastfeeding and

20. Induction of Labor
Pitocin, while sometimes necessary, and indicated, can cause
problems for breastfeeding, including:
• Breast engorgement form its anti-diuretic effect
• Stressed infant, leading to difficulties to include resuscitation and/or
separation from mother
• And, according to Kroeger,
“the strong contractions resulting from induction or augmentation can
put more pressure on the occipital portion of the fetus’ head (back of
the head), potentially increasing the risk for cranial molding,
asymmetry, and cranial base misalignment, all of which could
negatively impact the functioning of the six cranial nerves involved in
sucking and swallowing during breastfeeding.”
("Pitocin Use and Breastfeeding Success - Natural Motherhood“)

21. A newborn’s initial weight can be inflated by
these fluids, and a false weight loss in the
first 24 hours postpartum can lead to
supplement with formula.
An accurate baseline weight should be
established 24 hours after birth.
(Noel-Weiss, Woodend, Peterson, Gibb, & Groll, 2011)
Maternal IV Fluids

22. Pain Meds in Labor
Narcotic pain meds cross the placenta during labor and can
produce the following side effects in the baby:
• Central nervous system depression
• Respiratory depression
• Altered neurological behavior
• Decreased ability to regulate body temperature
These can all complicate the new breastfeeding
relationship
(Cunningham et al., 2005)

23. Cesarean Section
In addition to the previous problems, surgical birth
has some added issues regarding breastfeeding:
• Difficulty in holding baby in good position due to
incision
• Separation from mother of baby, up to several
hours
• Several more days delay of milk supply coming
in
(Evans, Evans, Royal, Esterman, & James, 2003, p. 380-2)

24. AFTER BIRTH
Immediate Concerns

25. Contact
• Immediately after birth, or as soon as
possible after, the infant should be placed
skin-to-skin with the mother.
• This contact should be extended, at least
till breastfeeding has begun.
(Fraser, Cooper, & Myles, 2009, p. 793-4)

26. Suctioning
Suctioning of the infant can cause difficulty
with nursing in several ways:
• Muscles receive superstimulus, causing
permanent neural patterning
• Anteroposterior peristalsis from deep or
repeated suctioning can result in tongue
thrust
• Posterior palate irritation reverses the
correct peristalsis needed for suckling
(Frye, 2004, p. 1221)

27. THE GOLD STANDARD OF CARE
Baby-Friendly USA

28. .
"Health care systems should ensure that
maternity care practices provide education
and counseling on breastfeeding. Hospitals
should become more “baby-friendly,” by
taking steps like those recommended by the
UNICEF/WHO’s Baby-Friendly Hospital
Initiative.”
Regina A. Benjamin, MD, MBA
US Surgeon General
("Baby-Friendly USA“)

29. Baby-Friendly hospitals and birthing facilities
must adhere to the Ten Steps to receive, and
retain, a Baby-Friendly designation
The Ten Steps to Successful Breastfeeding are:
• Have a written breastfeeding policy that is routinely
communicated to all health care staff.
• Train all health care staff in the skills necessary to
implement this policy.
• Inform all pregnant women about the benefits and
management of breastfeeding.
• Help mothers initiate breastfeeding within one hour of
birth.

30. • Show mothers how to breastfeed and how to maintain
lactation, even if they are separated from their infants.
• Give infants no food or drink other than breast-milk,
unless medically indicated.
• Practice rooming in - allow mothers and infants to
remain together 24 hours a day.
• Encourage breastfeeding on demand.
• Give no pacifiers or artificial nipples to breastfeeding
infants.
• Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from the
hospital or birth center.
("Baby-Friendly USA“)

31. Maternity Practices in Infant
Nutrition and Care (mPINC)
Survey
is a national survey of maternity care
practices and policies that is conducted by
the CDC. The survey is administered to all
hospitals and birth centers with registered
maternity beds in the United States and
Territories.
("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)
Survey | DNPAO | CDC“)

32. CDC calculates scores for every facility and state to
indicate their performance on the mPINC survey. Criteria
includes:
Labor and delivery care
Postpartum feeding of breastfed infants
Breastfeeding assistance
Postpartum contact between mother and infant
Facility discharge care
Staff training
Structural and organizational aspects of care
delivery
("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)
Survey | DNPAO | CDC“)

33. Responses are scored using an algorithm
developed and reviewed by experts in the
field denoting the evidence and best
practices to promote breastfeeding within
the health care setting. Possible scores
range from 0—100, with higher scores
denoting better maternity care practices and
policies
("Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care (mPINC)
Survey | DNPAO | CDC“)

34. • Margaret, a 29 yo primigravida, 40/4 weeks gestation, is
admitted to the hospital for induction.
• After 6 hours of Pitocin drip, it is decided that her baby
will be delivered by cesarean section.
• The 6lb. 1oz. baby boy needs deep suctioning and tactile
stimulation, before being taken to the nursery for
observation
• Margaret is not able to hold or attempt nursing for six
hours, and she is on narcotic pain meds
What problems might occur during
breastfeeding?

35. References
Baby-Friendly USA. (n.d.). Retrieved from http://www.babyfriendlyusa.org/
Bartick, M., Stuebe, A., Shealy, K. R., Walker, M., & Grummer-Strawn, L. M.
(2009). Closing the Quality Gap: Promoting Evidence-Based Breastfeeding
Care in the Hospital. Pediatrics, 124(4), 793-802. doi:10.1542/peds.2009-0430
Breastfeeding: Data: mPINC: Maternity Practices in Infant Nutrition and Care
(mPINC) Survey | DNPAO | CDC. (n.d.). Retrieved from
http://www.cdc.gov/breastfeeding/data/mpinc/index.htm
Chapman, D., & Perez-Escamilla, R. (2012). Breastfeeding Among Minority
Women: Moving From Risk Factors to Interventions. Advances in Nutrition,
3(1), 95-104. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262621/
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Gilstrap, L., &
Wenstrom, K. D. (2005). 19. In Williams Obstetric (22nd ed.). San Francisco,
CA: McGraw-Hill.
Evans, K. C., Evans, R. G., Royal, R., Esterman, A. J., & James, S. L. (2003).
Effect of caesarean section on breast milk transfer to the normal term newborn
over the first week of life. Archives of Disease in Childhood-fetal and Neonatal
Edition, 88(5), 380-82. doi:10.1136/fn.88.5.F380

36. .
Evans, K. C., Evans, R. G., Royal, R., Esterman, A. J., & James, S. L. (2003).
Effect of caesarean section on breast milk transfer to the normal term newborn
over the first week of life. Archives of Disease in Childhood-fetal and Neonatal
Edition, 88(5), 380-82. doi:10.1136/fn.88.5.F380
Fraser, D., Cooper, M. A., & Myles, M. F. (2009). Infant Feeding. In Myles
textbook for midwives (15th ed., pp. 793-4). Edinburgh, Scotland: Churchill
Livingstone.
Frye, A. (2010). Prenatal Concerns. In Holistic midwifery: A comprehensive
textbook for midwives in homebirth practice Volume I (p. 589). Portland, Or.
(7528 NE Oregon St.: Labrys Press.
Frye, A. (2004). When the newborn develops respiratory distress. In Holistic
midwifery: A comprehensive textbook for midwives in homebirth practice
Volume II (p. 1221). Portland, Or. (7528 NE Oregon St.: Labrys Press.
Grossman, X., Chaudhuri, J., Feldman-Winter, L., Abrams, J.,Newton, K. N.,
Philipp, B. L., & Merewood, A. (2009). Hospital Education in Lactation Practices
(Project HELP): Does Clinician Education Affect Breastfeeding Initiation and
Exclusivity in the Hospital? Birth-issues in Perinatal Care, 36(1), 54-9.
doi:10.1111/j.1523-536X.2008.00295.x
How does a mother’s diet affect her milk? : KellyMom. (n.d.). Retrieved from
http://kellymom.com/nutrition/mothers-diet/mom-diet/

37. .
International Lactation Consultant Association - International Lactation
Consultant Association. (n.d.). Retrieved from
http://www.ilca.org/i4a/pages/index.cfm?pageid=1
La Leche League International (2004). Nutritional know-how. In The womanly
art of breastfeeding (7th ed.). New York, N.Y: Plume.
LLLI | About La Leche League International. (n.d.). Retrieved from
http://www.llli.org/ab.html?m=1
Moreland M.D., J., & Coombs P.A.-C, J. (2000, April 1). Promoting and
Supporting Breast-Feeding - American Family Physician. Retrieved from
http://www.aafp.org/afp/2000/0401/p2093.html
Noel-Weiss, J., Woodend, A. K., Peterson, W., Gibb, W., & Groll, D. (2011). An
observational study of associations among maternal fluids during parturition,
neonatal output, and breastfed newborn weight loss. International
Breastfeeding Journal, 6(9), 133-142. Retrieved from
http://www.internationalbreastfeedingjournal.com/content/6/1/9
Office of the Surgeon General (US, & Centers for Disease Control and
Prevention (US (n.d.). Barriers to Breastfeeding in the United States - The
Surgeon General's Call to Action to Support Breastfeeding - NCBI Bookshelf.
Retrieved 2011, from http://www.ncbi.nlm.nih.gov/books/NBK52688/

38. Pitocin Use and Breastfeeding Success - Natural Motherhood. (n.d.). Retrieved
from http://www.natural-motherhood.com/pitocin-use-and-breastfeeding-
success.html
Why breastfeeding is important | womenshealth.gov. (n.d.). Retrieved April 27,
2014, from http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-
important/index.html
Wisconsin WIC - Women, Infants and Children Home Page. (n.d.). Retrieved
from http://www.dhs.wisconsin.gov/wic/