Support for breastfeeding mothers
RHL practical aspects by Martis R
FIRST CONTACT (PRIMARY CARE) LEVEL
Ideally, support to breastfeeding mothers should be provided as part of routine health care. This implies the need to train health-care workers, lay and peer counsellors and certified lactation consultants in methods that can help to build and support the mothers’ confidence, improve their feeding techniques, and prevent or resolve breastfeeding problems, thereby encouraging exclusive breastfeeding until the age of six months and prolonging the duration of any breastfeeding.
- To provide appropriate support for breastfeeding mothers, both lay and all health-care professionals need to be trained in all aspects of breastfeeding (1). This training should be tailored to local requirements, which could vary in different communities and primary health-care facilities. The lay people involved in the provision of support need to have the respect of the community and are best chosen via the community infrastructure.
- The training needs to be recurring in order to ensure that the support providers' knowledge is up to date. The WHO/UNICEF and Baby Friendly Hospital Initiative training programmes have been shown to prolong significantly exclusive breastfeeding and should be incorporated into existing educational programmes at the primary care level.
- Peer support groups need to be established for the primary care level to provide support to those providing support to breastfeeding mothers. If possible, the support providers should have access to health-care professionals whenever they need guidance and advice.
- While some visual information materials (e.g. posters) on breastfeeding might be helpful, it is important to understand that commercial hospital discharge packs for breastfeeding women have been shown to lack effectiveness (1).
- A hospital clinical practice guideline needs to be implemented to assist with the process of applying the evidence on support for breastfeeding mothers.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
The above recommendations for the primary care level also apply to this level of care. It is important to emphasize that all health-care professionals who provide care for the breastfeeding mother and her baby should receive the training. This includes paediatricians, neonatologists, physicians, obstetricians, midwives, nurses, neonatal nurses and junior doctors, as well as medical, midwifery and nursing students.
Training for providing support to breastfeeding mothers at this level needs to take into account the special circumstances of each pregnancy: i.e. complications during pregnancy, labour and delivery and the at-risk baby. For example, for women who received general anaesthesia or who suffered eclampsia and whose babies were born premature, have a cleft palate or other genetic conditions, will have more complex needs for appropriate breastfeeding support. Therefore, it is important for everyone involved in the care of women and babies at this level to know how best to provide support for breastfeeding mothers with complex needs.
When lay and health-care professionals work together in providing support breastfeeding mothers, the benefits are substantial. Hence, they should be encouraged to work together at every level of care (1).
AT HOME OR IN THE COMMUNITY
In many low-income countries a considerable number of births still take place in the community, either at the pregnant woman’s house or at the traditional birth attendant’s house. In these settings breastfeeding is the norm and lay breastfeeding support is usually given during postpartum period and beyond.
However, the kind of breastfeeding support that is available in the community differs from settings to settings and depends highly on the experience and cultural beliefs of the lay support-givers. This is in particularly the case with regards to exclusive breastfeeding. Herbal teas, natural medicines, water and other form of breast milk substitutes (e.g. goat's milk) are often given to the baby in the belief the baby will thrive better. In communities where exclusive breastfeeding is not practised, it is important to provide information to lay people, the breastfeeding women, their families and the community at large about the benefits of exclusive breastfeeding and the need for providing support to breastfeeding mothers.
Culturally appropriate training for lay people needs to be implemented. If health-care professionals are involved with maternity care at home or in the community, then the training should include both the lay and the health-care professional in line with the findings of this review. Village and community elders or the appropriate governing infrastructure need to address how this can be implemented effectively. Focus group discussions and peer counselling are valuable methods for breastfeeding education and support of breastfeeding mothers, especially in under-resourced settings (3, 4).
References
- Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Systematic Reviews. Issue 1. Art. No. 2007;CD001141; DOI: 10.1002/14651858.CD001141.pub3.
- Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital discharge packs for breastfeeding women. The Cochrane Database of Systematic Reviews 2000; Issue 2. Art. No.; CD002075: 10.1002/14651858.CD002075.
- Haider R, Ashworth A, Kabir I, Huttly SRA. Effect of community-based peer counselors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000;356:1643-7.
- Haider R, Kabir I, Huttly SRA, Answorth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact 2002;18:7-12.
This document should be cited as: Martis R. Support for breastfeeding mothers: RHL practical aspects (last revised: 26 September 2007) The WHO Reproductive Health Library; Geneva: World Health Organization.