Midwifery management of breastfeeding: using the evidence

Strong evidence supports breastfeeding as the appropriate health choice for both mothers and infants. However, the mechanics of breastfeeding are frequently less well understood. This review of both the research and clinical evidence regarding appropriate breastfeeding management is designed to aid the midwife and other health care professionals in providing care and teaching, which will optimize maternal and infant health.     

Breastfeeding and Maternal Medication Use

Drug therapy during lactation requires recognition of several elements, including drug properties, the status of the infant, the mother's milk production, and what is known about particular drugs. It is important to consider the various properties of a drug when evaluating its possible effects in the breastfeeding infant. In addition, the volume of milk the infant receives and its composition can influence exposure levels. Other factors of importance include the infant's age, frequency of feedings, recommended drug dosage, and whether the drug is short- or long-acting. Suggestions are offered for appropriate drug therapy when the mother is breastfeeding, including the safety of drugs commonly administered during lactation and questions to ask when a mother seeks assistance about suggested medication use.     

Swimming Upstream: Breastfeeding Care in a Nonbreastfeedtng Culture

Women once gave birth and began breastfeeding within the cultural context of a traditional system of care; now they begin breastfeeding in a hospital. Historically, hospital care was arranged to fit artificial feeding. Little was known about the science of breastfeeding until recently. Basing our breastfeeding care on the cultural norm of bottle feeding has led to the development of many unfavorable attitudes and practices. Given an opportunity to learn how breastfeeding works and to improve our breastfeeding care skills, hospital nurses can play an important part in current efforts to make breastfeeding the community norm.     

Validation of the Nursing Diagnosis of Ineffective Breastfeeding

Objective: To test the validity of the definition, related factors, and defining characteristics of the nursing diagnosis of ineffective breastfeeding. Also, to test whether defining characteristics relevant to the interruption of breastfeeding may be included in the diagnosis of ineffective breastfeeding.
Design: A methodologic study using a two-stage Delphi process.
Participants: Sixty-six nurses in the first round of the Delphi process and 34 nurses in the second round.
Main Outcome Measures: A Likert-like scale was used to measure nurse experts' opinions as to how reflective each defining characteristic was of ineffective breastfeeding.
Results: The definition of ineffective breastfeeding was simplified, related factors were added, and defining characteristics were clarified. Two characteristics of interruption of breastfeeding were found to be relevant to ineffective breastfeeding, but were considered minor rather than major.
Conclusion: The definition, related factors, and defining characteristics of ineffective breastfeeding have been clarified and validated by nurse experts, but they need further validation by breastfeeding women.