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The surgeon general’s call to breastfeeding action-policy and practice implications for nurses

  • Diane L. Spatz
    Correspondence
    Corresponding author: Dr. Diane L. Spatz, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104.
    Affiliations
    Expert Panel on Breastfeeding for the American Academy of Nursing, Washington, DC

    University of Pennsylvania School of Nursing, Philadelphia, PA

    Children's Hospital of Philadelphia, Philadelphia, PA
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      The lack of breastfeeding in the United States is a public health crisis. The World Health Organization, the American Academy of Pediatrics, and multiple other professional organizations all recommend that infants are exclusively breastfed for the first 6 months; in the United States, however, only 13.6% of infants receive exclusive human milk for this time period.

      World Health Organization Fifty-fifth World Health Assembly. Infant and young child nutrition: Global strategy on infant and young child feeding, Report by the Secretariat. Available at: http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf. Accessed March 1, 2011.

      • Gartner L.M.
      • Morton J.
      • Lawrence R.A.
      • et al.
      Breastfeeding and the use of human milk.

      Center for Disease Control and Prevention. Breastfeeding Report Card 2009, United States: Outcome Indicators. Available at: http://www.cdc.gov/breastfeeding/data/reportcard/outcome2009.htm. Accessed March 1, 2011.

      A 2010 study in the United States reported that 911 infant deaths could be prevented if breastfeeding rates were improved.
      • Bartick M.
      • Reinhold A.
      The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis.
      On January 20, 2010, with the release of the Surgeon General’s Call to Breastfeeding Action, the US government released the most comprehensive plan to date of what needs to occur to improve breastfeeding outcomes and the health of our nation.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      As the part of the largest health care profession in the United States, totaling 3.1 million professionals, nurses play an absolutely critical role in changing breastfeeding behaviors. In many capacities, nurses live and work in the community where they influence families and families’ health throughout the lifespan. Nurses have the power to influence the health promotion and disease prevention behaviors of their patients. In fact, nurses are often the sole health care provider available to assist and support the initiation and maintenance of breastfeeding.
      The Surgeon General’s Call to Breastfeeding Action does not explicitly speak to the critical role of nurses in the provision of lactation education, care, and support. Our role is essential in helping women and their families achieve their personal breastfeeding goals. The Call to Action outlines 20 specific action items, and I have provided some targeted recommendations to these as follows:
      Action 1: Give mothers the support they need to breastfeed their babies.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Breastfeeding is not the predominant cultural norm in the United States; therefore, mothers need consistent positive reinforcement when making the decision to begin breastfeeding, as well as throughout their entire breastfeeding experience.
      Action 2: Develop programs to educate fathers and grandmothers about breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Nurses are poised to educate family members.
      Action 3: Strengthen programs that provide mother-to-mother support and peer counseling.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Consider providing financial or other support to organizations such as La Leche League or nursing mothers groups.
      Action 4: Use community-based organizations to promote and support breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Refer mothers to national and local resources such as the government’s web resources (http://www.womenshealth.gov/breastfeeding) or La Leche League (http://www.llli.org).
      Action 5: Create a national campaign to promote breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      As policy leaders in the Academy, Fellows could be at the forefront of such a campaign.
      Action 6: Ensure that marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Ensure that institutions with which you are affiliated do not market infant formula.
      Action 7: Ensure that maternity care practices throughout the United States are fully supportive of breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      There are currently only 105 Baby Friendly Hospitals in the United States. Nurses should be at the forefront of ensuring evidence-based maternity practices.

      Baby Friendly USA, Inc. US Baby Friendly Birth Facilities (as of Jan 2011). Available at http://www.babyfriendlyusa.org/eng/index/html. Accessed March 1, 2011.

      Action 8: Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Nurses are in the ideal position to ensure continuity of care.
      Action 9: Provide education and training in breastfeeding for all health professionals who care for women and children.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      All nurses, regardless of whether they plan to work with childbearing families or infants, should receive basic education regarding breastfeeding and human lactation. Nursing Outlook (2007) published an article on how human milk and breastfeeding education can be incorporated into the nursing curriculum.
      • Spatz D.L.
      • Pugh L.C.
      American Academy of Nursing Expert Panel On Breastfeeding. The integration of the use of human milk and breastfeeding in nursing curricula.
      Action 10: Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Those nurses who work with families need specific education either through their undergraduate nursing program
      • Spatz D.L.
      The breastfeeding case study: a model for educating nursing students.
      or continuing education resources such as those by the March of Dimes
      • Pugh L.C.
      • Spatz D.L.
      Breastfeeding the Healthy Newborn.
      or Association of Women’s Health Obstetric and Neonatal Nurses.
      Association of Women’s Health, Obstetric, & Neonatal Nurses
      Breastfeeding Support: Prenatal Care through the First Year.
      Action 11: Ensure access to services provided by International Board-Certified Lactation Consultants (IBCLCs).

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      IBCLC’s can be found by accessing the International Lactation Consultant Association website (www.ilca.org).

      International Lactation Consultant Association-Find a Lactation Consultant Available at: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432. Accessed March 1, 2011.

      Action 12: Identify and address obstacles to greater availability of safe-banked donor milk for fragile infants.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Learn about donor-milk banking through the Human Milk Banking Association of North America.

      Human Milk Banking Association of North America. Available at: www.hmbana.org. Accessed March 1, 2011.

      Action 13: Work toward establishing paid maternity leave for all employed mothers.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Nurses can advocate for improved maternity leave.
      Action 14: Ensure that employers establish and maintain comprehensive, high quality lactation support programs for their employees.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Teach employers to utilize “Business Case for Breastfeeding” free resources available from the Health Resources and Services Administration website.

      U.S. Department of Health and Human Services, Health Resources and Services Administration. Available at: http://www.ask.hrsa.gov/detail_materials.cfm?ProdID=4135. Accessed March 1, 2011.

      Action 15: Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Advocate for onsite childcare at employers in your community.
      Action 16: Ensure that all childcare providers accommodate the needs of breastfeeding mothers and infants.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Make providers aware of the free resources from the US Department of Agriculture.

      United States Department of Agriculture-Ten Steps to Breastfeeding Friendly Child Care Centers. Available at: http://riley.nal.usda.gov/nal_display/index.php?info_center=14&tax_level=4&tax_subject=264&topic_id=1364&level3_id=5168&level4_id=10015. Accessed March 1, 2011.

      Action 17: Increase funding of high-quality research on breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Increased National Institutes of Health (NIH) funding is warranted.
      Action 18: Strengthen existing capacity and develop future capacity for conducting research on breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Requests for proposals from the NIH could achieve this goal.
      Action 19: Develop a national monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      An interagency governmental organization that partners with the United States Breastfeeding Committee is warranted.
      Action 20: Improve national leadership on the promotion and support of breastfeeding.

      U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      Increased funding, awareness, and leverage of the United States Breastfeeding Committee could achieve this goal.
      I urge all of you to find ways to promote breastfeeding and help women and their families to achieve breastfeeding success. Educated nurses should be the first level of intervention for all breastfeeding women and their infants.

      References

      1. World Health Organization Fifty-fifth World Health Assembly. Infant and young child nutrition: Global strategy on infant and young child feeding, Report by the Secretariat. Available at: http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf. Accessed March 1, 2011.

        • Gartner L.M.
        • Morton J.
        • Lawrence R.A.
        • et al.
        Breastfeeding and the use of human milk.
        Pediatrics. 2005; 115: 496-506
      2. Center for Disease Control and Prevention. Breastfeeding Report Card 2009, United States: Outcome Indicators. Available at: http://www.cdc.gov/breastfeeding/data/reportcard/outcome2009.htm. Accessed March 1, 2011.

        • Bartick M.
        • Reinhold A.
        The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis.
        Pediatrics. 2010; 125: e1048-e1056
      3. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at: www.surgeongeneral.gov.

      4. Baby Friendly USA, Inc. US Baby Friendly Birth Facilities (as of Jan 2011). Available at http://www.babyfriendlyusa.org/eng/index/html. Accessed March 1, 2011.

        • Spatz D.L.
        • Pugh L.C.
        American Academy of Nursing Expert Panel On Breastfeeding. The integration of the use of human milk and breastfeeding in nursing curricula.
        Nursing Outlook. 2007; 55: 257-263
        • Spatz D.L.
        The breastfeeding case study: a model for educating nursing students.
        J Nurs Educ. 2005; 44: 432-434
        • Pugh L.C.
        • Spatz D.L.
        Breastfeeding the Healthy Newborn.
        2nd ed. March of Dimes, New York, NY2007
        • Association of Women’s Health, Obstetric, & Neonatal Nurses
        Breastfeeding Support: Prenatal Care through the First Year.
        2nd ed. Association of Women’s Health, Obstetric, & Neonatal Nurses, Washington, DC2007
      5. International Lactation Consultant Association-Find a Lactation Consultant Available at: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432. Accessed March 1, 2011.

      6. Human Milk Banking Association of North America. Available at: www.hmbana.org. Accessed March 1, 2011.

      7. U.S. Department of Health and Human Services, Health Resources and Services Administration. Available at: http://www.ask.hrsa.gov/detail_materials.cfm?ProdID=4135. Accessed March 1, 2011.

      8. United States Department of Agriculture-Ten Steps to Breastfeeding Friendly Child Care Centers. Available at: http://riley.nal.usda.gov/nal_display/index.php?info_center=14&tax_level=4&tax_subject=264&topic_id=1364&level3_id=5168&level4_id=10015. Accessed March 1, 2011.