Our world is facing great health challenges at this time due to the COVID-19 pandemic. Nurses and midwives, along with all other healthcare workers, are at the forefront of the response and we salute them for their tireless and brave work to help save lives. Breastfeeding saves lives and prevents many infections and conditions. Nurses and midwives provide critical support for breastfeeding families. In the context of COVID-19, WHO and UNICEF recommend breastfeeding according to standard infant feeding guidelines while applying all necessary precautions.
We know that when comprehensive and coordinated programmes for the protection, promotion, and support of breastfeeding are in place, breastfeeding rates increase1. Of the three approaches, support for families is effective in meeting the family’s breastfeeding goals, while protection and promotion provide the necessary environment in which support can be provided. Support is needed across the continuum of care during the first 1,000 days, from conception to the child’s second birthday2.
Creating hospital routines for breastfeeding support in Honduras
During the 1980s, long before the Baby-friendly Hospital Initiative (BFHI), Maria worked with a national breastfeeding programme called PROALMA where there was training for all public hospital personnel in public hospitals in Honduras. It became routine to provide breastfeeding support starting from prenatal visits onwards. One public hospital allowed fathers to accompany women in labour, if the fathers took a natural childbirth class offered by the nursing staff. Nurses logged early breastfeeding during the first hour after birth as one of their daily activities. All healthy full-term babies roomed-in with their mothers, often sleeping in the beds with them. Nursing personnel would just make sure that the bed rails were raised. Mothers of babies in the Neonatal Intensive Care Unit (NICU) were encouraged to express their milk and shown how to hand express or use a breast pump as soon as they felt comfortable walking around. The hospital adopted a policy of keeping mothers in the hospital until they could determine that the babies were latching on correctly, and the assessment was carried out by nurses in charge of newborn care. All nursing staff became comfortable with providing support for the successful initiation of breastfeeding.
Nurses and midwives provide a broad range of essential health services, not just to mothers and families, but also to the community. They have essential roles at all levels of health care. Midwifery, where care includes proven interventions for maternal and newborn health as well as for family planning, could avert over 80% of all maternal deaths, stillbirths, and neonatal deaths3. There is an association between receiving midwife-led continuity of care and increased satisfaction with care throughout the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding4. However, in many areas, there simply are not enough nurses and midwives to provide these services effectively. Even where they are present, there remains a lack of ability, training, equipment, and medical supplies to deliver the basic health services we all need to live healthy lives5.
Linking midwives and breastfeeding peer support groups in Japan
Midwife Mihoko has always referred mothers to a local peer support group run by La Leche League. She is also certified as an International Board Certified Lactation Consultant (IBCLC). There are about 950 IBCLCs in Japan in 2020, more than 80% of whom are midwives. Many of them have received communication skills training offered by La Leche League and are providing client-centered breastfeeding support that respects the parents’ breastfeeding needs and goals, and listens to their concerns. Thank you to those midwives who are a vital part of the warm chain of support for breastfeeding in the community, linking families with local peer support groups.
This World Health Day, we all have a role to play in supporting nurses and midwives to enable breastfeeding. We need to acknowledge their role in forming strong multidisciplinary healthcare teams, which in turn has a powerful influence on a family’s decision to breastfeed and on meeting their breastfeeding goals. Nurses and midwives also have an important role in the coordination of breastfeeding support between health facilities and the community.
Building confidence to overcome breastfeeding challenges in the U.S.A.
Sandy’s experience during her third birth with two certified nurse midwives was wonderful. She had learned from prior birth experiences and her training as a La Leche League Leader that she wanted a supportive, flexible birth experience. Finding a midwifery practice and a neighbouring hospital close to her home for backup was key. Prenatal visits were full of encouragement and learning and when the day came, the midwives came to her home. They encouraged her to walk around, did dishes and laundry, and breathed with her, offering emotional support when contractions were especially difficult. This support helped her achieve the birth she wanted. Although baby Brandon was mild to moderately tongue-tied, adding challenges to breastfeeding, the midwives encouraged Sandy to have confidence in her ability to figure out ways to overcome that challenge. He nursed for more than three years until he weaned naturally. Sandy says, “The birth itself was by far the best of my three childbirth experiences—in great part due to the support and encouragement offered by these nurse midwives!”.
WABA’s Warm Chain of Support for Breastfeeding campaign places the breastfeeding dyad at the core and follows the first 1,000 days2 timeline. It strives to link different stakeholders by coordinating efforts at all levels to provide a continuum of care. Consistent messages and proper referral systems throughout the warm chain will ensure that the family benefits from ongoing breastfeeding support and skilled assistance. Therefore, it is essential that the multidisciplinary healthcare teams with midwives receive appropriate training6. Such training will provide the team members with the skills to support breastfeeding, increase knowledge of their roles, and enhance their ability to link with others effectively in the warm chain of support7.
Together, we need to support nurses and midwives and form a warm chain of support for breastfeeding. Find out how you can get involved!
- McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., Veitch, E., Rennie, A. M., Crowther, S. A., Neiman, S., & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews (2). https://doi.org//10.1002/14651858.CD001141.pub5
- 1000 Days. (n.d). 1,000 days. https://thousanddays.org/
- WHO. (2020). 2020 International Year of the Nurse and Midwife Toolkit. https://www.who.int/docs/default-source/documents/yonm-2020/campaign-toolkit.pdf
- Mortensen, B., Diep, L. M., Lukasse, M., Lieng, M., Dwekat, I., Elias, D., & Fosse, E. (2019). Women’s satisfaction with midwife-led continuity of care: an observational study in Palestine. BMJ Open, 9(11), e030324. https://doi.org/10.1136/bmjopen-2019-030324
- Swerts, M., Westhof, E., Bogaerts, A., & Lemiengre, J. (2016). Supporting breast-feeding women from the perspective of the midwife: A systematic review of the literature. Midwifery, 37, 32-40. https://doi.org/10.1016/j.midw.2016.02.016
- Edwards, M. E., Jepson, R. G., & McInnes, R. J. (2018). Breastfeeding initiation: An in-depth qualitative analysis of the perspectives of women and midwives using Social Cognitive Theory. Midwifery, 57, 8-17. https://doi.org/10.1016/j.midw.2017.10.013
- Peven, K., Purssell, E., Taylor, C., Bick, D., & Lopez, V. K. (2020). Breastfeeding support in low and middle-income countries: Secondary analysis of national survey data. Midwifery, 82, 102601. https://doi.org/10.1016/j.midw.2019.102601