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MOTIONS Concept Review Committee Marie Beam and Heidy Guzman, Co-Chairs March 23, 2020

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MOTIONS Concept Review Committee Marie Beam and Heidy Guzman, Co-Chairs March 23, 2020 MOTIONS Concept Review Committee Marie Beam and Heidy Guzman, co-Chairs March 23, 2020 Proposed changes to Concepts and Concept Explanations are noted in blue. ============================================================== #1 MOTION: Revise “Mothering through Breastfeeding” Concept Explanation Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby. (Apr 94) Proposed Concept Explanation: Breastfeeding, defined as the baby nursing directly at the mother’s breast, provides a complete way of meeting a baby’s primary needs, which include touch, comfort, warmth and protection, as well as food. Every time a mother puts baby to breast, all of these needs are satisfied. The intimate interaction between the pair deepens as the breastfeeding relationship continues, creating a reciprocal framework which both increases the mother’s capacity to understand the baby and enhances the baby’s responses.(1) Prolactin, often referred to as the “mothering hormone,” is produced in response to the baby’s suckling and further encourages sensitivity to the baby’s needs. The hormone oxytocin assists in milk ejection and enhances trust, nurturing, relaxation, bonding/attachment and healing. In the act of nursing skin-to-skin, the baby’s saliva communicates with the mother’s breast and body to customize the milk’s properties to meet the baby’s current immunological needs and optimize the baby’s microbiome.(2,3) The physical mother-baby connection is integral to maternal sensitivity to the baby, even during sleep.(4,5,6) Mothering through breastfeeding beautifully and automatically satisfies a baby’s primary needs all at the same time. (1) La Leche League International, The Womanly Art of Breastfeeding, 2010. (2) Moossavi, S., et al. (2019). "Composition and Variation of the Human Milk Microbiota Are Influenced by Maternal and Early-Life Factors." Cell Host & Microbe 25(2): 324-335.e324. (3) Azad, M. B., et al. (2013). "Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months." Canadian Medical Association Journal. (4) Wiessinger, D., D. West, L.J. Smith and T. Pitman, Sweet Sleep, La Leche League International, 2014. (5) McKenna, J. J. and L. T. Gettler (2015). "There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping."Acta Paediatr. (6) Blair, P. S., et al. (2020). "Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019." Breastfeed Med. (DRAFT Jan 20) --------------------------------------------------------------------------------------------------------------- Rationale for changes to the Concept Explanation: 1. A definition of “breastfeeding” has been added to clarify that it means the baby is nursing/feeding directly at the mother’s breast. 2. “Acceptance” was deleted because its meaning is unclear; “comfort” and “protection” were added as basic needs. 3. Information about oxytocin was added to recognize that both prolactin and oxytocin play important roles in “mothering through breastfeeding.” 4. Recent research is cited on the evidence that mother’s sensitivity to the baby is enhanced by direct feeding at the breast, an important safety issue when the baby is in bed with the mother. --------------------------------------------------------------------------------------------------------------- Current Concept Explanation: Breastfeeding provides a complete way of meeting a baby’s primary needs, which include touch, acceptance, and warmth, as well as food. Every time a mother puts baby to breast, this whole complex of needs is uniquely and naturally satisfied. The intimate interaction between the pair deepens as the breastfeeding relationship continues, creating a reciprocal framework which both increases the mother’s capacity to understand baby and enhances baby’s responses. Prolactin, often referred to as the “mothering hormone,” is produced in response to the baby’s suckling and further encourages sensitivity to the baby’s needs. Mothering through breastfeeding beautifully and automatically satisfies a baby’s primary needs all at the same time. (rev Mar 19) ============================================================ #2 MOTION: Revise “Childbirth” Concept Proposed Concept: Initiating breastfeeding is easier for mother and baby when birth takes place in a supportive environment where interventions and drugs are minimized. (DRAFT Nov 2019) Current Concept: Alert, active participation by the mother in childbirth is a help in getting breastfeeding off to a good start. Rationale for changes to the Concept and Concept Explanation: “Alert, active participation by the mother in childbirth” was not the norm when this Concept was first articulated decades ago. While it has become standard practice in many places for mothers to remain awake and aware during childbirth, babies and mothers still may have difficulty initiating breastfeeding because of routine interventions. The new Concept wording focuses on factors that have been demonstrated by research to provide optimal circumstances for breastfeeding initiation: having a trusted companion present during childbirth, minimizing interventions and drugs, and preparing for birth and breastfeeding while pregnant. ===================================================================== #3 MOTION: Revise “Childbirth” Concept Explanation Proposed Concept Explanation: Events during labor and childbirth can impact the breastfeeding experience. Improved birth outcomes occur when a companion supportive of the birthing mother’s wishes is present and provides comfort measures that reduce pain, fear and anxiety. Research shows that minimizing interventions and drug use during birth supports the baby’s ability to initiate effective breastfeeding immediately after birth. Although some interventions, such as a cesarean birth, may be lifesaving, it is important to be aware that interventions can significantly affect breastfeeding in the early days. These may affect the baby’s ability to suck, swallow and breathe normally, interfere with immediate skin-to-skin contact, delay the initiation of an adequate milk supply, and impact maternal health and early mothering behaviors. Understanding the physiological process of labor and childbirth, how childbirth is managed, and how interventions may impact breastfeeding can help in planning for giving birth. Preparation for birth and breastfeeding may include attending a class, reading books, talking with someone knowledgeable on these topics, and/or attending La Leche League meetings. Knowledge can help the birthing mother feel confident and make informed decisions during the birth that can contribute to getting breastfeeding off to a good start. Bibliography (1) Beck, C. T., & Watson, S. (2008). Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res, 57(4), 228-236. (2) Bohren, M. A., Hofmeyr, G. J., Sakala, C., et al. (2017). Continuous support for women during childbirth. Cochrane Database Syst Rev, 7, Cd003766. (3) Brimdyr, K., Cadwell, K., Widström, A.-M., et al. (2015). The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth, 42(4), 319-328. (4) Pérez-Escamilla, R., et al. (2016). "Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Maternal & Child Nutrition. (5) Smith, L. J., & Kroeger, M. (2010). Impact of birthing practices on breastfeeding (2nd ed.). Sudbury, Mass.: Jones and Bartlett. (6) World Health Organization (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva, World Health Organization: 200. ----------------------------------------------------------------------------------------------------- Current Concept Explanation: Alert and active participation in childbirth can influence what happens during the birth and can impact the initiation and establishment of breastfeeding afterwards. Minimizing drug use during the birth supports the initiation of breastfeeding and the baby’s ability to nurse effectively immediately after birth. While some interventions, such as birth by cesarean, may be lifesaving, they also can significantly affect nursing in the early days. Having more information about the physiology of childbirth and its relationship to early breastfeeding provides a better idea of what to do in order to minimize the effects of any interventions. (Mar 19) ================================================================== #4 MOTION: Revise “Early and often” Concept Proposed Concept: Mother and baby need to be together early and often to establish a satisfying breastfeeding relationship and reliable milk production. Current Concept: Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply. (Apr 94) Rationale for changes to the Concept: 1. “Satisfying breastfeeding relationship” replaces “satisfying relationship” to clearly define the relationship. 2. “Adequate” was changed to “reliable” to make clear that milk production needs to be both adequate to meet the baby’s needs and also responsive to an increased need for more milk. 3. “Milk supply” was changed to “milk production” to recognize that it is the breasts’ ability to produce milk in response to the baby’s needs that is important, not the amount of milk produced. ========================================================== #5 MOTION: Revise “Early and often” Concept Explanation
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