How can pharmacists support mothers to establish breastfeeding in the community?
Denise is an experienced Midwifery clinician, educator and researcher. Denise and her colleagues in UCD School of Nursing, Midwifery and Health systems have recently completed a national study exploring the knowledge, attitudes and practices of GPs, GPNs and GP trainees in relation to breastfeeding. This research is in collaboration with the HSE.
Written by Denise McGuinness, RGN RM RNT IBCLC FFNMRCSI MSc Research, Assistant Professor/Lecturer in Midwifery at the School of Nursing, Midwifery and Health Systems, University College Dublin
This article presents an overview of the importance of breastfeeding for women, infants, children and their families; in addition to some practical supports and advice to assist the pharmacist support breastfeeding mothers in the early days and weeks following birth. The World Health Organisation (WHO) recommends that all infants are exclusively breasted for the first six months of life and breastfeeding is continued with the introduction of complementary foods until two years or beyond (WHO, 2023).
Breastfeeding rates are low in Ireland in comparison to International standards. The HSE/ HPO (2024) Perinatal Statistics Report describes some fluctuations to breastfeeding rates according to county in Ireland. Higher breastfeeding rates are reported in Cork, Kerry and Kilkenny, while lower breastfeeding rates <35% are reported in Louth. Maternal age influences breastfeeding choice with higher breastfeeding rates noted among mothers in the 35-39 year age group.
Research has identified the importance of breastfeeding and the risks of not breastfeeding. Infant benefits include less overweight and obesity, less asthma and allergy (Azad et al. 2020), reduced incidence of type 2 diabetes (Horta et al.2015) and improved cognition/IQ (McGowan and Bland, 2023). Exclusive breastfeeding for 90+ days is associated with reduced childhood morbidity (Murphy et al. 2023).
Maternal benefits include the protective effect of breastfeeding against breast cancer (Stordal, 2022) and ovarian cancer, reducing the risk of type 2 diabetes, hypertension, cardiovascular disease (Nguyen et al. 2019., Rajaei et al 2019) and osteoporosis. Breastfeeding beyond the period of lactation contributes significantly to improved health outcomes for both mother and child (Victora et al. 2016).
The cost of not breastfeeding is high. The Lancet series on breastfeeding advised that >800,000 child deaths globally were attributed to not breastfeeding according to the WHO recommendations (Victora et al. 2016).
The knowledge, attitudes and practices in relation to breastfeeding and lactation of the GP, Public Health Nurse, Dietitian and Pharmacist can greatly enhance the support offered presently to breastfeeding families in the community (Walsh et al. 2023; Brown 2016; Doherty et al. 2020).
What is the International Code of Marketing of Breastmilk Substitutes?
The International Code of Marketing of breastmilk substitutes is a set of recommendations developed to protect and support breastfeeding which in turn will stop inappropriate marketing of breastmilk substitutes. The code covers commercial infant formula milks, bottles and teats. The aim of the code is to provide safe nutrition for infants and young children. Further information is available here: https://assets. hse.ie/media/documents/ncr/ policy-breastmilk-substitutesmarketing.pdf
What are the signs that a newborn infant is feeding well?
The baby will feed 8-12 times in a 24 hour period. Babies are generally calm and relaxed while feeding and content following the feed. After initial rapid sucks the baby will take deep rhythmic sucks. Swallows may be less audible until a mother’s milk comes, approximately Day 3-4 following birth. The length of each feed will vary but generally baby will feed between 5-40 minutes. Both breasts are offered. The baby’s urine and stooling pattern is appropriate to age. The baby has a normal skin tone with no signs of jaundice.
What is “a good latch” for breastfeeding?
The key principles are as follows-
o CLOSE – The baby is held close
o HEAD FREE – tilt back, chin leading
o IN-LINE – head and neck (alignment)
o NOSE – opposite the nipple
Infant Feeding
What is the difference between full breasts and engorged breasts?
It is normal for breastfeeding mothers to feel a degree of fullness between days 3-5 following birth, as a full milk supply is established. The breastfeeding mother should continue to feed the baby responsively, 8-12 times during a 24 hour period.
Treatment for engorgement
Apply cold compresses to the breast. Hand express to release milk. A technique called reverse pressure softening is also supportive. Reverse pressure softening allows the mother to move excess fluid away from the areola and enable the baby to latch. Here is information on reverse pressure softening that the mother can work with.
Reverse pressure softening technique
How to express by hand
Full Breasts
Breasts are warm, firm, tender and heavy
The milk flows easily
The mother will not have a high temperature
How to teach a mother hand expression
Hand washing before starting.
The mother carries out the following technique.
- Gentle message of both breasts
- Place the thumb on the edge of the areola at the 12 o’clock position.
- Place the 2nd and 3rd fingers opposite at the 6 o’clock position.
- The hand forms a C shape. Compress and release and repeat the process.
- The position of the fingers can be rotated around the breast.
- Move to the 2nd breast, gentle massage, compress and release.
Here is further information from the HSE https://www.youtube.com/ watch?v=bnIY2BqshCE
Babies are most effective at draining the breast by direct breastfeeding.
What is mastitis and what advice can I offer to a breastfeeding mother with symptoms of mastitis?
Mastitis is an inflammation of the breast. It can occur in one or both breasts. Conservative measures used initially are-
• Ensure correct position and attachment at the breast, with effective feeding.
• Continue to breastfeed as normal.
• Apply ice/cold compresses.
• Avoid aggressive massage of the breast as this may worsen symptoms.
• Anti-inflammatory medication/ pain relief as indicated.
If symptoms have not subsided in 24 hours, or symptoms deteriorate rapidly, advise the mother to seek a medical review. Antibiotics will be indicated. A mother with infective mastitis will experience flu like symptoms, a high temperature of 38.3C and will feel generally unwell.
What additional HSE, private and community volunteer breastfeeding supports are available in the community?
https://www2.hse.ie/babieschildren/breastfeeding/
The Public Health Nurse
La Leche league Cuidiu
Friends of Breastfeeding
International Board Certified Lactation Consultant (IBCLC)
Suppression of lactation following infant loss
The following information will support a bereaved mother following infant loss i.e. stillbirth, if the mother wishes to suppress lactation. Some mothers may choose to continue expressing breastmilk and donate their breastmilk to a human milk bank.
• Wear a support bra.
• Apply cold compresses or ice packs to the breasts
• Do not stimulate the breasts.
• Analgesia and anti-inflammatory medication as indicated.
• Hand express a small amount of milk for comfort, if the breasts are very painful.
• Do not use a breast pump.
• Medication is available on prescription to suppress lactation.
• If a bereaved mother was expressing milk regularly with an electric breast pump, for example, a sick or premature infant, it will be important to advise the mother to reduce her milk supply slowly. The mother can reduce the duration of pumping and number of times to pump in a 24hr period, gradually over a few days.
I’m interested in breastfeeding. Is there a university breastfeeding course that pharmacists can participate in?
Yes. The UCD Professional Certificate in Breastfeeding and Lactation is open to all healthcare professionals registered with a professional body. The next six month course commences in January 2025. It is a blended learning programme. Further information available here: https://hub.ucd.ie/usis/!W_ HU_MENU.P_PUBLISH?p_ tag=PROG&MAJR=X946
References and further reading available upon request
