Organizing and Documenting Lactation Support of NICU Families

A documentation tool designed for use by lactation consultants in the neonatal intensive-care unit provides an efficient and complete method for recording the progress of the mother and infant. It incorporates the research base into interventions that begin during the early postpartum period and continue through the preterm infant's hospital stay. The system for using this tool helps consultants in giving comprehensive and timely lactation support.     

New Diagnosis: Interrupted Breastfeeding

Interrupted breastfeeding was approved by the membership to be added to the NANDA taxonomy in 1992. The diagnosis was developed to name the response that occurs when a breastfed baby cannot be put to breast for some or all of the feedings. Two examples of life processes/events, premature or sick infant and maternal employment, illustrate the application and use of the diagnosis. Nursing interventions for each situation are discussed. A comparison describing the differences between interrupted breastfeeding and ineffective breastfeeding is included to address the controversy of whether or not the diagnoses are the same. A sample diagnosis/care plan is added to demonstrate use of the diagnoses in clinical practice.     

Hyperlactation: How Left-brained ‘Rules’ for Breastfeeding Can Wreak Havoc With a Natural Process

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief.     

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

ABSTRACT: Background: A woman’s decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. Methods: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4‐hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding‐related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. Results: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03–1.69). Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates. (BIRTH 36:1 March 2009)