You Sure Can Tell
by Hila J. Spear, RN, PhD, IBCLC
© 2003 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in The Birthkit Issue 40, Winter 2003.]
[Painting by Kiki Metzler]
Breastfeeding sunflower mom
Whether obstetric nurses practice at the bedside or as midwives, they are privileged to work with women during the profound and important life events of childbirth, establishment of the mother/infant bond and the process of breastfeeding. It is valuable to reflect on actual experiences and perspectives of childbearing women to gain insight as to how we can better meet their needs. The following narrative related to breastfeeding summarizes a personal experience of a new mother admitted to a hospital postpartum unit. Based on this account, I discuss some reminders about the importance of support and how nurses are in a unique position to either empower or sabotage new mothers who choose to breastfeed their infants.
My daughter Lori recently gave birth to my first grandchild, a beautiful and healthy baby girl. Her labor and delivery experience for the most part was a very positive one with supportive nurses and physicians in attendance. Within about 30 minutes after delivery, she was able to put her newborn baby to breast. Once she was transferred to the postpartum unit, Lori found that most of the nurses were kind, friendly and generally supportive of her desire to exclusively breastfeed her baby. A few of her observations and experiences, however, revealed that some nurses were not so encouraging of breastfeeding.
For example, without Lori's permission, her baby was brought to the room with a pacifier in the crib. Also, as a first-time mother, she found it less than helpful when some of the nurses made comments like, "Oh, I think she's going to need a pacifier" and "You might need to supplement her with formula" in response to some of her questions about breastfeeding. Lori asked me, "If the nurses knew that I was breastfeeding, why did some of them suggest that I use a pacifier?" While some nurses were quick to offer a pacifier, others did not. Lori told me, "Mom, you sure can tell which nurses are in favor of breastfeeding." She pointed out that several of the nurses were very helpful and positive about breastfeeding. When Lori told one of the nurses that she did not want her baby to have a pacifier, the nurse immediately responded to her request by posting a sign on the baby's crib that stated, "Do not give artificial nipples."
As a former labor and delivery nurse and certified lactation consultant, I like to think that nurses are educated about the well-documented superiority of breastfeeding and, despite personal history or preferences, careful to provide the needed support and encouragement for mothers who choose to breastfeed their infants. Further, not only should nurses provide encouragement and up-to-date information for novice as well as experienced breastfeeding mothers, they need to make a concerted effort to provide consistent teaching and guidance. New mothers, particularly first-time mothers, are overwhelmed with information and stimulus overload as they make initial adjustments to motherhood and begin to establish a nurturing relationship with their newborn.
Knowledge about the benefits of breastfeeding and a positive attitude are related. In my research, I have found that the more knowledgeable nurses are about breastfeeding, the more positive their attitudes are about breastfeeding (Spear, in press). Others have noted the need for nurses to provide accurate information about breastfeeding practices and the relationship between nurses' knowledge about breastfeeding and supportive behavior (Bernaix 2000; Monzingo et al. 2000; Patton et al.1996). The following statement by Patton et al. (1996) is still applicable to nursing practice today: "Nurses need support and continuing education to identify personal bias and knowledge deficits which hinder breastfeeding promotion" (111).
Obstetric nurses and midwives are rightfully expected to be knowledgeable advocates for the successful initiation and maintenance of breastfeeding. Also, to increase the likelihood of long-term breastfeeding as recommended by the American Academy of Pediatrics, it is important for parents to select a pediatrician who is supportive and knowledgeable about breastfeeding. Parents need the support of a pediatrician who will not be inclined to suggest switching to infant formula at the first sign of feeding challenges or problems, which often can be easily addressed and remedied with one-on-one support of the mother.
Patients may view those nurses who provide misinformation or who suggest activities that may impede successful breastfeeding as unsupportive or less than knowledgeable about the practice. Regardless of the patient's interpretation of the nurse's behavior and attitudes related to breastfeeding, it is important for nurses to acknowledge the critical role that they play in assisting mothers to establish and maintain the fine art of breastfeeding. Undoubtedly, nurses are in a position to make a positive difference if they make it a priority to be informed and if they provide women who choose to breastfeed with support, encouragement and accurate information.
Hila J. Spear, RN, PhD, IBCLC, has been a nurse since 1975 and is a professor and director of graduate nursing education at Liberty University. Her research focus is women's health with an emphasis on adolescence and pregnancy. She maintains clinical practice as a lactation consultant at Virginia Baptist Hospital.
- Bernaix, L.W. (2000). Nurses' Attitudes, Subjective Norms and Behavioral Intentions toward Support of Breastfeeding Mothers. Journal of Human Lactation 16 (3): 201-209.
- Mozingo, J. N. et al. (2000). It Wasn't Working. Women's Experiences with Short-term Breastfeeding. American Journal of Maternal Child Nursing, 25 (3): 120-126.
- Patton, C. B. et al. (1996). Nurses' Attitudes and Behaviors That Promote Breastfeeding. Journal of Human Lactation, 12 (2): 111-115.
- Spear, H. J. (in press). Nurses' Attitudes, Knowledge and Behaviors Related to the Promotion of Breastfeeding among Women Who Bear Children during Adolescence. Journal of Pediatric Nursing. Slated for publication late 2004.
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