Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
Section 1
Jennifer L. Bailey DeJong, Ph.D., FNP-BC, CLE, CNE
 Golden Start Breastfeeding Educational Consultant
 Associate Professor of Nursing
 Concordia College Nursing Department, Moorhead, MN
Section One Contents:
 Introduction
 Course Objectives
 Topic
Breastfeeding and lactation supports
are vital to nursing curriculum
2
Introduction
Why study
lactation in
the first
place?
3
 The Curriculum was written by Dr.
DeJong during the 2011-2012
academic year to assist faculty in
teaching undergraduate nursing
students about breastfeeding and
human lactation using a multidimensional team-based and
interactive approach.
 Golden Start Breastfeeding
Education acknowledges that much
of the information in the curriculum
was designed as teaching modules
for The Golden Start Community
Leadership Team by Lactation
Consultant Molly Pessl, BSN, IBCLC,
from Evergreen Perinatal Education,
Washington.
Acknowledgements
 The program was funded by
a grant by the MN
Department of Health.
 Photos were used with
permission from Jane
Stockton, RN, CLC, Iowa
Department of Public
Health, Bureau of Nutrition
and Health Promotion.
 Others are cited on the slide
itself, within the text, or
within the notes section of
each slide.
4
Basis for the
Curriculum
 The writing of this curriculum
was a direct result of the
research conducted at the
NDSU Data Center on
Nurses’ Perception of the
Need for Lactation
Education.
The Study and
Results
You can find the study
and its results here:
http://www.ndsu.edu/sd
c/publications/reports/La
ctationReport_FINAL.pdf
5
Purpose of the Curriculum
 The overall purpose of this curriculum is to
educate nursing students on
breastfeeding and lactation so that they
may become thoughtful and informed
men and women dedicated to providing
evidence-based care to the clients and
communities they serve, in order to
protect, promote, and support
breastfeeding.
6
The following assumptions were presumed by
Dr. DeJong while writing this curriculum:
1. Direct breastfeeding or providing human milk is the
optimal choice for infant nutrition.
2. Almost all mothers have the physiologic capability
to successfully breastfeed.
3. Breast milk is the best feeding option for most
infants, with few exceptions (WHO/UNICEF, 2009).
7
Assumptions
4. Artificial formulas should only be used in
circumstances where human milk is not available
or when medically advised.
5. Lactation offers short- and long-term benefits to
the mother and child that synthetic formula and
cow’s milk cannot.
6. The aim of nurses and other health professionals is
to support individuals, families, and communities in
attaining and sustaining holistic health and
wellness.
8
7. Patients trust nurses to inform them of research findings
that impact their choices.
8. Nurses, educators, and other stakeholders can influence
the health of society through instruction, support, and the
development of policies and procedures that change
practice.
9. Patients and other consumers expect to receive care and
instruction that is consistent with best practice
recommendations based on sound science and not
anecdotal reports.
9
Assumptions
10. Nurses must stay well-informed of current
recommendations in order to maintain
competency in their professional role as provider,
educator, and client advocate.
11. Nurses have an ethical responsibility to the
individual, family, and group as “client” to discuss
health promotion, risk reduction, illness
management, and disease prevention based on
research.
10
Completion of Curriculum
Upon completion of The Golden Start Breastfeeding
Curriculum, nursing students should be able to:
1. Analyze why breastfeeding and lactation research
are vital topics to study in an undergraduate nursing
curriculum.
2. Examine at least three biological advantages of
lactation and breastfeeding for the mother and child.
Image taken by Jennifer DeJong of her nursing
students at Concordia College, Fall 2011.
11
3. Analyze the composition of human milk.
4. Examine at least three risks of not breastfeeding for
the mother and child.
5. Analyze at least two contraindications to
breastfeeding.
6. Analyze at least three advantages of
breastfeeding for the community/environment.
7. Discuss the anatomy and physiology of lactation.
12
8.
Discuss the role of the nurse in assessing and
encouraging the breastfeeding dad.
9.
Compare and contrast various breastfeeding
positions.
10. Discuss the history and current trends of breastfeeding
in the United States and internationally.
11. Discuss best practices as well as “The Code” and “The
Ten Steps to Successful Breastfeeding.”
13
12. Analyze the components of The Breastfeeding
Report Card, Healthy People 2020 Objectives, and
The 2011 Surgeon General’s Call to Action to
Support Breastfeeding.
13. Analyze problem-based case studies.
14. Write appropriate nursing diagnoses for
breastfeeding-related issues.
15. Appraise lactation-related information available
on the internet.
14
16. Role-play selected scenarios with one another.
17. Analyze the role of the registered nurse in providing
support to mothers in a variety of settings.
18. Evaluate how public health programs in particular
impact breastfeeding and education.
19. Examine factors that impact breastfeeding in
communities and discuss ways to support
breastfeeding where you work and live.
Image taken by Jennifer DeJong of her nursing
students at Concordia College, Fall 2011.
15
Objective 1
Image used with
permission from
Lara and her
daughter Carys;
Marissa
Funkhouser’s
Mom’s Group,
Summer 2012.
Image taken on
June 26, 2012.
 Analyze why
breastfeeding
and lactation
research are
vital topics to
study in an
undergraduate
nursing
curriculum.
16
Why take Time to Study
Lactation and Breastfeeding?
 Why is education about lactation
and breastfeeding important for
nursing students?
 What does the evidence say?
17
 Several national
and international
health
organizations have
developed position
statements and
practice guidelines
supporting the
importance of
breastfeeding.
Position Statements and
Practice Guidelines
 The American Academy of Family Physicians
(AAFP);
 The American Academy of Pediatrics (AAP);
 The American College of Nurse-Midwives (ACNW);
 The American College of Obstetricians and
Gynecologists (ACOG);
 The National Medical Association (NMA);
 The Association of Women’s Health, Obstetric, and
Neonatal Nurses (AWHONN);
 The American Public Health Association (APHA);
 The American Dietetic Association (ADA);
 The National Association of Pediatric Nurse
Practitioners (NAPNP);
 The World Health Organization (WHO);
 The United Nations Children’s Fund (UNICEF); and,
 The United States Department of Health and
Human Services (USDHHS).
18
Nurses Play an Important Role

Nurses play an important role in educating the
public and other healthcare professionals about
the significance of breastfeeding, and can
empower mothers and their support systems in
maintaining lactation according to the evidencebased recommendations of HP, the WHO, the
Centers for Disease Control and Prevention
(CDC), the Academy of Breastfeeding Medicine
(ABM), and other leading experts in the field of
lactation.
19
What Does
“Evidence-Based”
Nursing Mean as it
relates to
Breastfeeding and
Lactation?
Image used with permission from Marissa
Funkhouser; Kevin and Addyson in the
NICU, Summer 2012.
20
NCLEX-Type Question
Evidence-based practice means the nurse bases
their practice of professional nursing on:
A. What the unit they work on deems satisfactory
based on patient feedback and confidential
surveys.
B. What the hospital or agency they work for gets
reimbursed for by insurance companies.
C. What they have time for in their practice; it
depends on the shift and how demanding it is.
D. Research-based recommendations and best
practices of leading authorities.
21
Nurses Influence and Change
Practice
 Nurses are in a position to use research
findings from robust investigations to
influence and change practice, to be a
voice for underrepresented populations,
and to educate society about the role
that breastfeeding has in sustaining
health and preventing unnecessary
morbidity and mortality.
22
Health Professionals
and Many Mothers
agree that
Breastfeeding is
Best…
 Then why is
breastfeeding
promotion,
protection, and
support so
difficult?
 Why are some
mothers choosing
formula?
Image taken by Jennifer DeJong; Formula on a
Toys-R-Us store shelf, Summer 2012.
23
Why Do Some Mothers Breastfeed
while Others Choose Formula?
Brainstorm the factors that you think may
impact breastfeeding initiation and duration.
 Who chooses to breastfeed? Imagine a picture
of this mother. Who is she? What does she look
like?
 Who chooses to feed formula? Imagine a
picture of this mother. Where does she live?
What job does she have?
24
 For some answers to this question,
let us turn to The Bailey DeJong
Adaptation of Bronfenbrenner’s
Social Ecological Systems
Framework for Breastfeeding
Mothers Conceptual Framework
(May 2011).
25
26
Definitions of Each System
 Microsystem
 Mesosystem
 Exosystem
 Macrosystem
27
Application to Health
 The Social-Ecological Framework can be readily
applied within the context of health to explain the
levels of bidirectional influence that affect or could
potentially impact personal behavior.
 Numerous variables, besides microsystem-related
influences, exist that may improve or impair the
physical, emotional, or spiritual well-being of a
patient (McLeroy, Bibeau, Steckler, & Glanz, 1988).
28
What Impact does the Mother’s
Significant Other have on Breastfeeding?
 Support from the
father is associated
with increased
breastfeeding rates
nationally and
abroad.
(Alikasifoglu, Erginoz, Gur, Beker, & Arvas, 2001; Bar-Yam &
Darby, 1997; Humphreys et al., 1998; Isabella & Isabella, 1994;
Khoury, Mitra, Hinton, Carothers, & Sheil, 2002; Littman,
Medendorp, & Goldfarb, 1994; Mahoney & James, 2000;
Matich & Sims, 1992; Scott & Binns, 1999).
Image used with permission from Kristine Sandberg;
Marissa Funkhouser’s Mom’s Group. Approval received
on 7/25/2012. Images taken in July 2011.
29
What Impact does a Grandmother have on
a Mother’s Decision to Breastfeed?
 According to Morse and
Harrison (1987), the
attitudes of others toward
the breastfeeding mother
and the support she
received are among the
most important
determinants of
breastfeeding duration.
Image used with permission from
http://wicworks.nal.usda.gov/wicworks/resources/images.html
30
Breastfeeding
mothers
typically tend
to be older.
Image used with permission from:
http://wicworks.nal.usda.gov/wicworks/reso
urces/images.html
What Impact does
the Mother’s Age
have on
Breastfeeding?
31
What Impact does a
Mother’s Social
Network have on
Breastfeeding?
Research
suggests that
the opinions of
others
significantly
affect the
breastfeeding
decisions of
mothers.
Image taken by Jennifer DeJong, Eagle Lake, near
Battle Lake, MN, Summer 2012.
32
What Impact does a Mother’s Educational
Preparation have on Breastfeeding?
 According to Humphreys, Thompson, and Miner
(1998); Roe et al. (1999); Smith (1985); Starbird
(1991); Winikoff (1980); and Wright (1988), women
in the U.S. who have graduated from college are
more likely to breastfeed than their less-educated
counterparts.
 Studies report that more highly educated women
in the U.S. recognize the benefits of breastfeeding
and are more likely to choose breastfeeding as
opposed to bottle feeding.
33
What Impact does a Mother’s Level of
Confidence have on Breastfeeding?
 Buxton and colleagues
(1991) found that, among
mothers who initiated
breastfeeding, significant
predictors of failure to
breastfeed for more than
seven days included lower
confidence in the ability to
breastfeed, delayed first
breastfeeding experience,
and lack of rooming-in with
the baby after delivery.
Image used with permission from Marissa Funkhauser; Daughter
Addyson in the Neonatal ICU, 2011.
34
What Impact does
a Mother’s
Perception of
“Inconvenience”
have on
Breastfeeding?
 How is the bottle
inconvenient?
 How is the breast
inconvenient?
 Discuss both
now.
Image taken by Jennifer DeJong; Christmas 2011.
35
What Impact does a
Mother’s Race have
on Breastfeeding?
 Currently in the U.S., 3 of 4
(75%) of all mothers
breastfeed their infants in
the early postpartum
period and 29% report
feeding any human milk to
their infants at six months.
 However, racial disparities
exist with Black women
breastfeeding at a rate
much lower than that of
White women.
 According to the USDHHS
(2010), only 45% of Black
women initiate lactation
postpartum. At six months,
the breastfeeding rate is
31% for White women
compared with 19% for
Black women and 28% for
Hispanic women.
36
Review the Content of the
Following Websites Now
 African American Breastfeeding Network of
Milwaukee at
http://city.milwaukee.gov/breastfeeding
 View advertising campaign at:
http://www.iwantastrongbaby.com/
 Reaching Our Sisters Everywhere (ROSE) at
http://www.breastfeedingrose.org/
 HHS about to release new campaign called “It’s
Only Natural: Mother’s Love, Mother’s Milk”
37
Watch the Following Video
Campaign Now
 It’s Only Natural:
Mother’s Love, Mother’s Milk found at:
www.womenshealth.gov/itsonlynatural
 What are your impressions?
38
What Impact do Health Care
Professionals have on Breastfeeding?
 Although the decision to breastfeed is a personal one for
every mother, the choice not to breastfeed often results from
a lack of material, informational, or emotional support
(Kong & Lee, 2004; Logsdon, Usui, Birkimer, & McBride, 1996).
 The use of supplemental formula feeding prior to discharge,
or in the first month postpartum when milk supply is being
established, has been associated with breastfeeding failure
and premature weaning (Barber, Abernathy, Steinmetz, &
Charlebois, 1997; Chezem, Friesen, Montgomery, Fortman, &
Clark, 1998; Hill et al., 1997; Perez-Escamilla et al., 1993;
Sheehan et al., 1999).
39
The Impact of Supplementation
 Bartick et al. (2009) reported that, in some
maternity centers, greater than 99% of breastfed
infants receive formula.
 To combat this growing trend, certain progressive
hospitals now handle infant formula the same way
as medications: available only with a provider
order.
 Formula is locked in a medication machine and
strictly regulated.
40
Signed Consent for
Supplementation

Some hospitals require parents and legal caregivers to sign
a consent form, indicating they understand the inherent risk
to their infant’s health, before providing formula for nonmedical reasons (Bartick et al., 2009).

When such measures have been undertaken, the results
speak for themselves. For instance, one hospital-based
intervention to reduce formula supplementation of
breastfed newborns found that breastfeeding at six
months’ duration increased from 66% to 87% when
supplementation was discouraged (Nylander, Lindemann,
Helsing, & Bendvold, 1991).
41
Women’s Early Experiences
 Women’s early experiences with breastfeeding
considerably affect whether and how long they
will continue to breastfeed (Caulfield et al., 1998; Taveras
et al., 2004).
 Lack of support from professionals who report
reluctance to “push” mothers to breastfeed (Bartick
et al., 2009) has been identified as a major barrier to
breastfeeding promotion, especially among
African-American women.
42
 Satcher (2001), former U.S. Surgeon
General, advised, “To encourage
breastfeeding, the health care system
should support the training of health
care professionals on the basics of
lactation counseling and management,
and establish hospital and maternity
center practices that promote
breastfeeding” (p. 72).
43
We Should Make it Easy for
Mothers to Initiate and Sustain BF
 The current Surgeon General, Dr. Regina
Benjamin, concurs with her predecessors’ remarks
on the importance of provider support, writing,
“Hospitals, work sites, and communities should
make it easy for mothers to initiate and sustain
breastfeeding as this practice has been shown to
prevent childhood obesity” (USDHHS, Office of the
Surgeon General, p. 1).
44
Emotional and Educational
Support
 Healthcare providers’ advice and
support have a considerable
influence on a mother’s decision to
breastfeed and on her ability and
desire to maintain breastfeeding (Arora
et al., 2000; DiGirolamo, Grummer-Strawn, and Fein, 2003;
Perez-Escamilla, Pollitt, Lonnerdal, & Dewey (1994). Phillipp,
Merewood, & O’Brien, 2001; Register, Eren, Lowdermilk,
Hammond, & Tully, 2000; Ryan, 1997).
45
Educational Delivery Methods
 According to Sikorski, Renfrew, and
Pindoria (2003), a Cochrane review
indicated that a mostly in-person
intervention significantly increased
breastfeeding duration while an
intervention using mainly
telephone contact did not.
46
Rooming-in Provided by
HealthCare Providers
 Practicing
rooming-in
has been
associated
with a longer
duration of
breastfeeding
(Anderson, Moore,
Hepworth, & Bergman,
2004).
Image taken with permission of subject by
Jennifer DeJong; Vietnam, Summer 2011.
47
The Impact of Skin-to-Skin Contact
Between Mother and Infant:
It’s More than Thermal Regulation
 Immediate skin-to-skin contact between the
mother and infant and practicing rooming-in has
been associated with longer duration of
breastfeeding (Anderson, Moore, Hepworth, & Bergman,
2004).
48
Why Don’t Some Professionals Want to
Actively Support and Promote
Breastfeeding?
 There are concerns about creating anxiety
and guilt.
 Nurses may have difficulty thinking of
breastfeeding like they think of other
healthcare issues.
49
Nurses Should De-Personalize
Breastfeeding Education
 While it may be beneficial
to share personal
breastfeeding stories,
nurses need not have
personal experience in
order to support or
promote breastfeeding.
 This is about the evidence
- not about your attitude,
story, belief, or opinion.
Image taken by Jennifer DeJong; Johnny
Nursing Baby Doll, Summer 2009.
50
Nursing Care of the Breastfeeding
Mothers Need not Focus on
Pathophysiology or Disease
 Breastfeeding assistance and
encouragement has everything to do with
providing individualized care, of which
nurses are educated to do.
 Nurses need to emphasize the 3 P’s in their
individualized CarePlan:
 PERFECT, PLENTY, and PREVENTATIVE
51
Preventative
Health Care
Image
taken by
Jennifer
DeJong,
Summer
2012.
 Breastfeeding
is one of the
best
preventative
health
practices we
have, and we
will talk about
this more in the
slides to come.
52
Nursing Care of the
Breastfeeding Mother is
about Anticipatory
Guidance
 Breastfeeding is “normal”
 Breastfeeding is “do-able”
 You can do this!
Image used with permission from William
Burleson, Office of Statewide Health
Improvement Initiatives, Minnesota
Department of Health on 2/10/2012.
53
What has this child learned about
breastfeeding?
 Nursing Care of
the Breastfeeding
Mother is About
Making it
NORMAL.
Image taken by Jennifer DeJong; West Fargo
– Carolyn Nursing her Doll, Summer 2012.
54
What Impact does a Mother’s
Culture have on Breastfeeding?
Image used with permission: Reinier van Oorsouw, UC Media Producties.
55
 How does your
culture
typically view
the female
breast?
Image used with permission from
http://wicworks.nal.usda.gov/wicworks/resources/images.html
56
 For instance, if
a mother is in
public, does
she have to use
a blanket to
“cover up”
while nursing?
Image taken by Jennifer DeJong, of sisters and her mother at the American
Girl store at The Mall of America, March 2010.
57
Do you live in a culture where
breastfeeding in public is the norm?
Watch the following
videos and discuss.
Image used with permission from
wicworks.nal.usda.gov/wicworks/resources/images.html
58
End of:
Next:
 Intro
 Objective 2:
Advantages
 Objective 1:
Why study lactation
in the first place?
 Objective 3:
Composition
 Objective 4:
Risks of not
breastfeeding
Image taken by
Jennifer DeJong;
Lake Cabin –Amy,
Carolyn, and
Adelyn, Summer
2012.
 Objective 5:
Contraindications
59