Why should nurses who work with women during the intrapartum period be concerned about breastfeeding? Because nurses who care for women during and immediately after birth play key roles in creating a supportive environment for breastfeeding women. This is a particularly important component of intrapartum nursing care. The American Academy of Pediatrics (AAP) (2005) and Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) (2007) both recommend that skin-to-skin contact between infant and mother should be initiated as soon after birth as possible and should continue until the infant has breastfed for the first time. In the United States, nurses are generally encouraged to help women initiate breastfeeding within the first hour after birth; in Canada, the expectation is that mothers will be assisted to breastfeed within 30 minutes of giving birth.
Who Better to Provide an Environment That Fosters Breastfeeding Success Immediately After Birth Than Labor and Birth Nurses?
Intrapartum nurses have cared for the mother during labor, have established a relationship with her, and are aware of any medications the mother may have received during labor and birth that could influence her ability to breastfeed. These nurses are also in the position to delay initial infant assessments and procedures that have historically been done immediately after birth. For example, because mothers are an excellent heat source, skin-to-skin contact can be initiated immediately after the infant is born (unless the infant or mother's condition indicates otherwise). Although this practice might delay some of the usual assessments, this is a period during which the baby is alert and breastfeeding efforts can be enhanced. The AAP (2005) indicated that other procedures, such as bathing, weighing, measuring, providing eye prophylaxis, and administering needle-sticks, can be delayed until the infant has breastfed.
What Can Individual Nurses Do to Increase Breastfeeding Success in Their Institutions?
Nurses have always been advocates for patient care. Consider doing the following:
* Visit the following Web sites and determine how well your institution meets the WHO/UNICEF Baby-Friendly steps:
http://www.who.int/nutrition/topics/bfhi/en/index.html
http://www.babyfriendlyusa.org/eng/index.html
http://breastfeedingcanada.ca/html/contents.html
* Initiate the process to become a Baby-Friendly institution. Sixty-seven hospitals and birth centers in the United States have been designated Baby-Friendly; there are even fewer in Canada
* Become a champion for breastfeeding mothers by challenging traditional ways of doing work
* Collaborate with other healthcare personnel, such as lactation consultants
Solid evidence exists from Murray, Ricketts, and Dellaport (2007) that breastfeeding duration rates were better in women who consistently received multiple supports, including the opportunity to breastfeed within the first hour after birth. Usual practices that discourage breastfeeding immediately after birth need to be changed. I would love to see the number of hospitals that encourage breastfeeding within the first hour after birth triple in both Canada and the United States in the next year. What are we waiting for?
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