Challenges to Breastfeeding Initiation and Nursing Implications for Intervention

Challenges to Breastfeeding Initiation and Nursing Implications for Intervention Falynn Beauford & Tiffany Frencher Research Sponsor Elizabeth P. Anderson RN, PhD Background: Breast milk provides optimal nutrition for babies, provides them with antibodies for improved health outcomes, and lowers chances of Sudden Infant Death Syndrome. However, many mothers may not be receiving the support needed to initiate and continue breastfeeding for at least six months as recommended by the American Academy of Pediatrics. Objectives: To explore the influential factors identified to impact whether or not a mother decides to initiate and continue breastfeeding after giving birth at a BFH-I facility. Explore what interventions are conducive to increase breastfeeding rates in the United States. Method: An integrative literature review was conducted utilizing the framework of Whittemore and Knafl (2005). Twelve research studies were analyzed to identify common themes in the literature related to the objectives and the state of the literature. Results: Three recurring themes were identified as influential factors that impact breastfeeding initiation. First theme focused on: impact of maternal sociodemographic factors on breastfeeding. Maternal factors found to increase breastfeeding initiation: educational attainment \u3e 12 years, married, Mexican minority, private insurance, not born in the United States, non-involvement in Women, Infants, & Children organization (WIC), and \u3e25 years of age. Second theme identified: the impact of lactation support on breastfeeding. Factors included: breastfeeding education in the first trimester, behavioral educational interventions to overcome breastfeeding challenges; employment accommodation, and post discharge follow up from provider regarding questions and addressing a mother’s embarrassment and discomfort from breastfeeding. The third theme is the impact of BFH-I facility intervention adherence to the Ten Steps on Breastfeeding. Adherence entailed helping mothers: breastfeed within one hour of birth, maintain lactation when separated from their newborn, and not giving newborns a pacifier. Having the BFH-I designation did show an increase in breastfeeding initiation rates and continuation for at least four weeks for mothers with 12 years or less of education. Conclusion: Major limitation: lack of theoretical conceptual framework (10/12 studies). However, an outlier was found in 3 studies with low scores in representativeness due to bias towards racial disparities. The researchers of this IRL noted that the communities where studies took place were underprivileged. The BFH-I was found to be most beneficial in communities where a potential racial bias may be detrimental for planning future programs and studies. Results indicate future research should focus on mothers regarding breastfeeding experience once discharged from hospital. Recommendations: 1) OB/GYNs provide breastfeeding education every trimester and care plans for mothers most likely to not breastfeed. 2) Postpartum lactation support resources outside of the clinical setting. 3) BFH-I facilities enforce the Ten Steps to Successful Breastfeeding. 4) Measurable interventions to assess BFH-I efficiency. 5) Cultural sensitivity training. 6) Updated conceptual model with cultural consideration. Keywords: Baby-Friendly Hospitals Initiative, breastfeeding initiation, intervention, factors, disparities, and prenatal education