Breastfeeding and Contraceptive Options - Essay Example

Breastfeeding and Contraceptive Options Name of the Student Name of the University Breastfeeding and Contraceptive Options Women’s health after childbirth has not been a focus of studies until recently. This could be a result of the low status ascribed to postpartum care by both society and healthcare professionals. Moreover, many studies and books take into account only the physical aspects of postnatal care such as abnormalities or ill health, and ignore the emotional and psychological aspects involved in the same. The psychological aspects include the transition to motherhood for a new mother. Pairman, Pincombe & Thorogood (2006), provide Ball’s view of maternity care in their book on midwifery. The primary aim of maternity care should be to help women become successful mothers. In order to achieve this there needs to be an equal amount of emphasis on the physiological, the emotional and psychological aspects of motherhood. They also give the three main objectives of post natal care. Firstly, postnatal care must promote the physical recovery of new mothers from the effects of pregnancy, labour and birth. Secondly, it must aid in establishing good infant-feeding practices and foster strong infant-mother relationships. Lastly, postnatal care must help build the mother’s confidence in herself and her ability to care for the baby in her own social, cultural and family environments. According to Pairman, Pincombe & Thorogood (2006), a consensus workshop on postnatal care in New Zealand brought out a set of desired outcomes of postnatal care. The mother is comfortable physiologically and stable in an environment which is conducive for rest and nourishment. The mother feels in control of the pace of events and their framework. The mother is supplied with enough information specific to her culture on the care that must be given to her child. Information is passed on to family members of the new mother. While the transition to motherhood is the same for all women, each woman experiences different phases at her own pace. Good quality care must recognize this fact and provide correct guidance. Midwives provide education either through indirect or direct learning methods. Indirect education during the post natal period is provided by creating a learning situation and leaving the new mother to use it. For example getting to know the baby and bonding with it is not something that can be taught. Hence an environment that is conducive to such an action is created by the midwives. Other forms of health education are more direct and visible. For example, general baby care, breastfeeding etc do not come naturally to some mothers. It is the duty of midwives to give special training to these mother and help them acquire these skills. Several women have breastfeeding issues. These issues must be handled properly and sufficient information and education must be given to cope with them. Another critical job of the midwife is to design the procedures that must be taught to enable the new mother to learn easily (Anderson, 1979). Out of all kinds of postpartum education, information and accurate education on breastfeeding and the contraceptive options available after childbirth are most important and relevant to new mothers who are in the process of making a transition to motherhood. This is because most women are unaware of the benefits of breastfeeding and the contraceptive options that are available to them during the postnatal period. This can be seen in the following case. A 25 year old international student, sharing accommodation with her fellow students had an unexpected delivery. Her partner and her family were living overseas. She was primiparous with no significant past medical history and had a spontaneous vaginal delivery on the 24th of August 2009. The baby weighed 2.2kg and was kept in a special care nursery for two days. While both mother and baby are doing well, the mother had breastfeeding issues. She had grazed bilateral nipples and lumpy breasts most times although there was a good supply of milk. She was to be discharged on the 30th August 2009 with visiting midwifery service follow up. During the postnatal education however it was found that while the woman was happy to go back home to her family, she was still unsure about breastfeeding and the choice of contraception available to her during the postnatal period. Hence it is very important to include education and special information on breastfeeding and contraceptive options after childbirth as a critical and necessary part of midwifery practice. Breastfeeding has several issues these issues cause much pain and discomfort to new mothers and sometimes even push them to stop breastfeeding. This could cause harm to both the infant and the mother in the long run as the benefits of breastfeeding to both are undisputed. Breastfeeding saves infants’ lives, providing them with the best nutrition possible and early protection against illness and bringing enormous health benefits to mothers (Johns Hopkins Bloomberg School of Public Health). Bilateral and grazed nipples were seen in the case of the 25 year old woman dealt with in the above case study. Bilateral nipples cause the areoles to become red, shiny and flaky. Furthermore her breasts were found to be lumpy due to plugged ducts. She also suffered from grazed nipples which is another one of many issues of breastfeeding. Grazed nipples are a sign of damaged nipples, where the nipple looks red and raw and blisters may be found sometimes, filled with blood or clear fluid. Apart from these two issues mentioned in the above case study, there are many more issues of breastfeeding. Engorgement of breasts occurs when the tissues of the breasts swell up because of increased milk production. This happens early in the postpartum period, when the breasts produce large quantities of milk to feed the infant. Plugged Ducts occur when milk is stagnant in some ducts of the breast and the flow of milk is blocked by plugs of skin cells. When such a condition occurs, women usually suffer from lumps on the breasts due to the plugged ducts. Mastitis usually occurs when the breasts become infected. Mastitis gets formed as a red, tender, swollen area of the breast. Many women develop fever, chills and other symptoms when mastitis occurs. Breast abscess generally develops in women who have a history of breast problems. This results from improper treatment of mastitis when it occurs. The signs of abscess are the same as the signs of mastitis (Women’s Healthcare Topics, 2004). Advice and information must be given to women during the postnatal period to deal with all or some of the above breastfeeding issues. This advice and information must be a critical part of midwifery practice and midwives must take extra care to supply the necessary information on procedures in a well designed format to ensure clear understanding. In the case of the 25 year old woman, management must be done by prescribing a Miconazole (Monistat-Derm) cream 2% to be applied after every feeding. She must also be advised to wash her hand before feeding, wash her bras and other clothing, keep her nipples dry by changing the nipple pads frequently, and clean all pacifiers, pumps, nipple shields, etc properly before and after use. The issue of grazed nipples must be managed by the midwife by providing her with correct information and education on the position of the baby when feeding. The lumps caused due to plugged ducts can be managed by massaging the area gently to remove the lump and by wearing a less constricting bra. Similar to breastfeeding, contraception options during the postnatal period also have various issues associated with it. There are many aspects that midwifery practice must consider when suggesting the kind of contraception open to new mothers. There are several methods of contraception available to new mothers who are breastfeeding. However, the appropriate method must be chosen for each person to prevent further complications or harm to the mother or infant. For instance, with regards to issues concerning Lactational Amenorrhea Method (LAM) or hormonal methods of contraception, the woman’s breastfeeding patterns, current status and plans must be taken into account. “The Lactational Amenorrhea Method (LAM) is presented as an algorithm and includes three criteria for defining the period of lowest pregnancy risk.” (Academy of Breastfeeding Medicine Protocol Committee, (2006). Issues regarding LAM, hormonal methods, intrauterine device insertion and barrier sizing must consider child’s age. For hormonal methods, age is a critical factor. Previous contraception experiences are based on social issues and sensitivity. Culture and social positions have a significant influence on the kind of contraception used before. Breastfeeding patterns, age of the mother, child’s age previous contraceptive experiences, social and economic status, cultural background etc are some of the most critical issues that midwives must deal with when giving contraceptive advice during the postnatal period. The benefits breastfeeding imposes on both mother and infant are undisputed. If women breastfeed regularly, lactation serves as an effective contraceptive method postpartum for at least 6 months. However for women who don't breastfeed -- and there is a majority of them in almost all nations -- there has to be an effective and reliable contraceptive method in place. It is very important to choose both timing and initiation of contraception, a decision that is supposed to be aided by either a clinician or a nurse practitioner. One important aspect of initiation of contraception is that it must not interfere with the lactation process. This wards off any negative effect the same might have on the infant who is breastfeeding. The best method in this case is the nonhormonal method, since if hormones are used, they may interfere with lactation. Outlined below are a few nonhormonal methods of contraception: Intrauterine Devices: These are long-term contraceptive methods with high efficacy. Tubal Ligation: This is another effective method. However since this is conducted under general anasthesia, the mother must breastfeed befor eth procudure is performed. Apart from these methods like condoms, diaphragm, jellies, and spermicidal foams, and copper IUDs provide reversible contraception; though if the woman desires so she can get a vasectomy done which is a permanent method. Implications for midwifery care It has been observed that midwifery is safe and positive and outcomes both in mother and the child are remarkable. There is a great deal of "bonding" involved in midwifery care and outcomes being positive are also attributed to few interventions that they use compared with their physician counterparts. In case of the 25 year old primiparous mother, midwifery care can best be suited since the mother is an overseas person and away from her family and partner. Midwifery care would provide her with the emotional supplementation apart from the general care that she needs. A study by Guise et al. (2003), systematically reviews whether primary care-based interventions improve and increase initiation and duration of breastfeeding. Breast milk supplies optimum nutrition to infants and offers other health benefits and immunity from infections. Maternal benefits of breastfeeding include quick return of postpartum uterine tone and postpartum weight loss, delay of ovulation, and decreased risk of getting ovarian, breast and endometrial cancers. For the above reasons, Department of Health and Human Services' Healthy People 2010 has set its primary goal as ensuring that 75% of new mothers breastfeed during the postpartum period, 50% of women at 6 months and 25% at one year. Statistics show that current rates fall short of these intended percentages and rates are found to be lowest in the vulnerable groups. Randomized Controlled Trials (RCTs) and cohort studies were undertaken in developed countries. For interventions that had not been studied in RCTs, non randomized control trails were used. Two reviewers reviewed all data, and extracted relevant data from the study. The results obtained showed that education and support interventions to promote breastfeeding improved the initiation of breastfeeding and maintenance of up to 6 months. It was found that one woman for every three to five women initiated and maintained breastfeeding for up to 3 months after attending the educational sessions. Another paper by Forster & McLachlan (2007), examines the practices that affect breastfeeding during the intrapartum and postnatal period and provides evidence regarding the same. A study by Donath et al. (2003), revealed that, “Maternal infant feeding intention was a stronger predictor of breastfeeding initiation and duration than the standard demographic factors combined.” However the initiation and maintenance of breastfeeding still widely depends on social class, income and levels of education. This paper explores the practices that affect breastfeeding from two sections, namely, service-wide approaches to enhance breastfeeding which refers to guidelines and education that must be given before and after delivery and considerations for care during each stage of labour. The first service-wide approach to promote breastfeeding is the WHO/ UNICEF initiative called the Baby-Friendly Hospital Initiative (BFHI). This initiative aims to ensure that an environment that protects, supports and initiates breastfeeding is created where babies are born. The BFHI accreditation is obtained through a rigorous system and frequent inspection goes on to ensure the continuity of effective practice. The second service-wide approach is to provide a birth setting that will promote breastfeeding. According to Forster & McLachlan, “The setting in which a woman gives birth may have an impact on her breastfeeding outcomes.” A study in Brazil by Bechara et al. (2005), reviewed the effect of educating maternity staff through the 18-hours UNICEF program on breastfeeding and found a considerable increase in the rate of exclusive breastfeeding in the hospital. A systematic study by Fairbank et al. (2000), examined the effectiveness of interventions to promote breastfeeding and found that breastfeeding initiation increased in hospitals that had a written policy. Staff attitudes were also found to play a role in the initiation of breastfeeding. With reference to the stages of labour, continuous support during labour and birth has a positive effect on breastfeeding success. Many studies and reviews demonstrate that continuous support provided by a trained laywoman (doula) or maybe even a midwife leads to increased rates of breastfeeding (Scott, Klaus & Klaus, 1999). Receiving breastfeeding help in the hospital was also found to increase the initiation of breastfeeding. Breastfeeding behaviors differ widely based on different factors. However there are certain groups of women for who evidence is consistent irrespective of culture o ethnicity and for whom the risk if absence of breastfeeding behaviour is higher. Intrapartum and postpartum healthcare professional and midwives must take extra care for these women and offer advice whenever necessary. A study by Wallace & Kosmala-Anderson (2006), conducts and analyzes a survey on the training needs of doctor’s breastfeeding support skills in England. It was found from the survey and study that practical forms of training were most often welcome. Only 40% of the General Practitioners (GPs) and 62.5% of the pediatricians had access to a local breastfeeding policy. Evident gaps in knowledge on critical aspects of public health policy that could influence local practice were also found. For instance, 50.8% of GPs and 47.5% of pediatricians recognized a younger age for introducing solids than minimum age as per government guidance. All respondents expressed organizational barriers to supporting effective breastfeeding. The study recommended the inclusion of well-targeted training for healthcare professionals and insisted that training must be evaluated alongside effective breastfeeding policies and clinical leadership. Contraception is an issue for many breastfeeding women and women who have just given birth. Most women need advice and education on the methods of contraception that can be used during the postpartum period to avoid another pregnancy. The decisions that have to be made not only concern the methods of contraception that is available but also deciding the best time t initiate the chosen method (King, 2007). According to Truitt et al. (2003), “These decisions may be more complex for breastfeeding women, because both the choice and timing of hormonal methods of contraception may effect both milk production and infant growth and development.” Fraser (2009) says it is the role of the midwife to provide accurate advice to women regarding the contraceptive options available to them during the postnatal period. Lúanaigh & Carlson (2005), agree that advice on contraception options are a part of midwifery postnatal care and it has been included as part of postnatal care. However, relevant guidance for midwives if very limited and there is lack of information on the benefit of any advice given and the optimal timing to give such advice. Hiller (2007), says that postpartum education on contraceptive use and options available is a routine part of discharge formalities within a wide variety of health systems. However this education is based on assumptions with reference to women’s receptivity to contraceptive education in the postnatal period as well as an assumption that women have less access to such education after discharge. Contraceptive Counseling is an important area of healthcare that needs to be addressed by midwives and lactation consultants (LCs). According to Nelson (2006), in her paper on healthy postpartum sexuality, “Counseling related to sexuality in the postpartum can be complex and many factors need to be considered.” Nelson also says that contraception is traditionally discussed during the 6the week of the physical examination. However it is important to consider when a woman and her partner are ready to discuss sexuality and contraception Grecu (2006), says that clinicians and midwives need to consider the technical competence of the client, client’s needs and their personal concerns, spacing, advantages of breastfeeding and combining breastfeeding with modern methods of contraception, cost etc. when giving contraceptive advice to women during the postnatal period. They should also use contraceptive methods that do not adversely affect breastfeeding or health of infants. Resumption of intercourse and frequency must also be a guide when choosing a method of contraception. Hence, contraception advice must be an integral part of midwifery practice and this advice must be given to women in need on time and in a way that is most comfortable with them. In conclusion it can be said that from the above review of literature, the implications for midwifery practice are considerably clear. Information and education on both breastfeeding methods and issues as well as methods of contraception during the postnatal period must be a critical part of midwifery postnatal care. It is found that a majority of new mothers lack sufficient knowledge on breastfeeding and the issues that revolve around it. Women and their partners also lack knowledge on the methods of contraception open to them soon after childbirth, especially when the woman is still breastfeeding. Initiation of breastfeeding and methods of contraception during the postnatal period had proved to be very effective and important and has the most important implication for midwifery practice. This paper and the review of literature undertaken in this paper contribute much towards learning. Firstly, it indicates the importance of training needs for midwives and healthcare professionals with reference to giving education on breastfeeding and contraception methods. This information will contribute toward the betterment of training provided to healthcare professionals. Additionally the results from the studies and surveys that have been conducted so far add to existing knowledge and information regarding the efficacy of information of breastfeeding and contraceptive options available so far and contribute to wards the betterment of the same in the future. References Nelson, A (2006). Contraception and Breastfeeding Healthy Postpartum Sexuality: Part 2. CLCA/ ACCL Independent Study Module. Grecu, A (2006). An Educational Module For Clinicians on Contraceptive Methods Appropriate for Postpartum Use. College of Nursing. University of Arizona. Hiller, J E (2007). Education for Contraceptive Use By Women After Childbirth. Medscape Today. Retrieved September 4, 2009. http://www.medscape.com/viewarticle/485865 King, J (2007). Contraception & Lactation. Journal of Midwifery and Women’s Health. Medscape Today. Retrieved September 4, 2009. http://www.medscape.com/viewarticle/565623 Ó Lúanaigh, P & Carlson, C (2005). Midwifery and Public Health: Future Directions, New Opportunities. Elsevier Health Sciences, 2005 Fraser, D (2009). Myles' Textbook for Midwives. Elsevier Health Sciences, 2009. Johns Hopkins Bloomberg School of Public Health. Breastfeeding Increases Women’s Contraceptive Options. Info For Health. Retrieved September 4, 2009. http://www.infoforhealth.org/pr/l14/5.shtml Pairman, S, Pincombe, J & Thorogood, C (2006). Midwifery: Preparation for Practice. Elsevier Australia, 2006 Anderson, D C (1979). Health Education in Practice. Taylor & Francis, 1979 Academy of Breastfeeding Medicine Protocol Committee (2006). ABM clinical protocol #13: Contraception During Breastfeeding. Breastfeed Med 2006 Spring;1(1):43-51. Guise, J M, Palda, V, Westhoff, C, Chan, B K S, Helfand, M, Lieu, T A (2003). The Effectiveness of Primary Care-Based Interventions to Promote Breastfeeding: Systematic Evidence Review and Meta-Analysis for the US Preventive Services Task Force . Annals of Family Medicine. Medscape Today. Retrieved September 4, 2009. http://www.medscape.com/viewarticle/459914 Donath SM, Amir LHALSPAC Study Team. Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: A cohort study. Acta Paediatr. 2003;92:352-356. Bechara Coutinho S, Cabral de Lira PI, De Carvalho Lima M, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet. 2005;366:1094-1100. Fairbank L, O'Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technol Assess. 2000;4:1-171. Scott K D, Klaus P H, Klaus M H. The obstetrical and postpartum benefits of continuous supports during childbirth. J Womens Health Gend Based Med. 1999;8:1257-1264. Truitt S T, Fraser A B, Grimes DA, Gallo MF, Schulz K F. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2003;2:CD003988. Wallace, L M & Kosmala-Anderson, J (2006). A Training Needs Survey of Doctors’ Breastfeeding Support Skills in England. Maternal and Child Nutrition. Blackwell Publishing Ltd. Read More