I am a registered nurse working in a certified nurse-midwifery practice that offers clients a choice of birth center or hospital setting for birthing. We serve a city with a population of 120,000. This population is diverse and becoming more so every day. We are seeing more women with overwhelming social needs and crises during their pregnancies, such as homelessness, mental illness, substance abuse, domestic violence, histories of child abuse, lack of any support systems, and poverty so extreme that there aren’t adequate resources for food or other basic needs.
It is a challenge for us to provide prenatal and delivery care, as well as to refer these women and families to resources for help while guiding them to prepare for the child that will be born.
One of the ways in which our service has adapted to provide this care is to become more holistic in our approach to pregnancy and birth. I have chosen to focus on breastfeeding as a way to fit into this model of care. I provide breastfeeding assessment and education through prenatal visits and classes. There is individual support and education for women who have not felt successful with previous breastfeeding experiences. These are the foundations to work from once the baby is born. This information and support empowers women to trust their ability to breastfeed, and to trust their bodies and their judgment. After the baby is born we offer on-call, in-home (if possible) breastfeeding assistance. This way, women know that if they recognize that something isn’t right, they can get help. Because it might otherwise be a barrier to some families, there is no extra charge for this support.
As mothers, we know that nursing strengthens the bond we have with our babies. The nature of breastfeeding itself—the interdependence of mother and child to create a successful breastfeeding relationship through the demand for, and supply of, human milk—literally establishes a physical bond. This requires that the mother care for the baby and have frequent close contact. I believe that this bonding that breastfeeding fosters can help to prevent child abuse.
To suggest that breastfeeding can solve all of the difficulties of postpartum transition would be naive. But breastfeeding provides so many benefits that it is important not to take them for granted, or, on the other hand, not to give these benefits enough weight when balancing out the pros and cons of breastfeeding in a challenging situation.
Another advantage to breastfeeding is the many well-known health benefits, including: protection from infection; allergy prevention; decreased incidence of diarrheal disease; decreased infant mortality; decreased infant obesity; and decreased dental caries. All of these factors relate to lower health care costs, and healthier, happier babies.
More recent research gives testimony to the miracle of human milk. Studies show breast milk provides protection from major illnesses such as childhood diabetes (insulin dependent diabetes mellitus), gastrointestinal diseases, and some types of cancer (lymphomas). Research on human milk is continuing, giving us more information about its benefits. There are many things that we do not understand about how human milk is protective. I believe that there is more good news still to come.
This article is an introduction to discussions about breastfeeding. In future articles, I will explore other issues in more depth using case histories, examining current practice methods and reviewing new research. Invite readers to write me, in care of Midwifery Today, with ideas, questions and suggestions so we can begin a dialogue about breastfeeding.