1. Maternal Nutrition & Hydration While Breastfeeding
Raissa Ameh, BSN, RN, Sarah Dennis, BSN, RN, Megan Heusinkvelt, BSN, RN, Jessica Xie, BSN, RN
University of Nebraska Medical Center, College of Nursing, Omaha, NE
Background
Major Recommendations for Healthcare Providers Caring for Breastfeeding Women (Clinical Guideline)
Infants should be fed exclusively on breast milk for at least six months
(WHO, 2002)
Benefit of breastfeeding:
Training
Assess personal beliefs toward breastfeeding
Ensure health care professionals working with women of childbearing age have knowledge & skills to give
advice on:
Nutritional needs of all pregnant & breastfeeding women & infants
Importance of a balanced diet while breastfeeding
Benefits of milk intake while breastfeeding
Recommendations & rational for dietary supplements
Strategies for improving eating behaviors
Importance of breastfeeding, benefits of breastfeeding, & barriers to breastfeeding
Food supplementation Program
Healthcare providers should screen all patients to determine need for government assistance
Provide supplemental food to low income women
Diet during lactation
Assess patient’s dietary habits, knowledge, & myths about diet & breastfeeding*
Educate breastfeeding women on consumption of gas producing foods
Educate women & partner about food preparation methods: grilled or baked, not fried
Educate women on limiting high salt & sugar content foods
Educate women on avoiding/limiting caffeine, carbonated beverages, & alcohol
Educate women on the importance of a healthy balanced diet while breastfeeding
Educate women on the importance of milk intake
Nutritional supplements
Educate women on the recommendations of dietary supplements
Vitamin D
Folic acid
Calcium
Multivitamin or prenatal vitamin
Fatty acid
Adequate caloric intake to maintain breast milk supply
Lactating women with a healthy weight need to increase energy intake to 500kcal/day during first 6
months of breastfeeding+
Adequate fluid intake to support milk production
14-50 year old lactating women: 3.8 L/day+
Teach women strategies to improve eating habits
5 portions of fruits & vegetables a day, & 1 portion of oily fish a week*
Obesity
Educate overweight lactating women that restricting their energy intake by 500kcal/day will help them lose
weight while meeting daily dietary requirements-
Best method to weight loss is to decrease intake of foods high in fat & simple sugars & increase intake
of foods high in calcium & vitamin D
Advise women with a Body Mass Index (BMI) over 30 that weight loss during lactation will not affect
quantity of quality of milk*
Encourage exercise
Allergies
Assess women & partner for family history of allergies*
Educate women that breastfeeding may help to prevent or decrease occurrence of allergy development
Advise women to breastfeed for 6 months & to continue to breast feed while introducing solid foods
Support
Consider religious & cultural experiences that may prevent or influence the patient to breastfeed
Assess skills & knowledge of the patient
Provide breastfeeding support program for breastfeeding women
Start breastfeeding education early—during the pregnancy if possible
Provide patients with reliable informational sources—website & print materials
Include the patient’s spouse or significant other during breastfeeding education sessions*
Health care providers should pay extra attention to women who are least likely to breastfeed (i.e. young women, those
from disadvantaged groups, limited education)*
Ensure that patients whose first language is not English have access to interpretation services & print
materials on breastfeeding in their native language*
Have a breastfeeding expert readily available for questions, support & additional education
Medications
Discuss medication needs with breastfeeding mothers*
Ensure safe medications are prescribed that will not affect milk supply
*(NICE, 2008) +(Butte, 2010) -(Lovelady, et. al., 2006) RA, SD, MH,JX
Reduced mortality in preterm infants
Reduced infant morbidity from infections: gastrointestinal, respiratory,
urinary tract & middle-ear
Reduced risk of infections, allergies, & chronic diseases in the infant
Enhanced cognitive development
Breastfeeding women have lower incidence of breast cancer, ovarian
cancer, endometrial cancer & hip fractures
Delay in return of ovulation
Breastfeeding women with return to pre-pregnancy weight more quickly
Reduced health inequalities for low-income mothers & children if breastfed
for 6 months *
*(NICE, 2008) RA, SD, MH, JX
Health Promotion Model
The Health Promotion Model focuses on helping patients develop positive health seeking behaviors by incorporating their personal experiences & individual characteristics. This model acts as a guideline to allow the healthcare provider to make accurate identifications of individual risks & situational factors, so that appropriate behavior change strategies can be suggested.
Improving nutrition during pregnancy & breastfeeding leads to improved health for not only the mother & infant, but also her family. Many barriers, past life experience & situational factors affect a woman's ability to breastfeed. Through individualized education & professional support, many women can be encouraged to change their nutritional habits in order to promote breastfeeding & reduce health disparities .
RA, SD, MH, JX
Guideline Objectives
To increase awareness of dietary needs of pregnant & breastfeeding
women
To improve nutritional status of women during conception, pregnancy,
& the lactation period
To promote breastfeeding
To promote evidence-based practice
RA, SD, MH, JX
Target Population
Area: Southeast Nebraska: Otoe, Nemaha, Richardson, Pawnee, &
Johnson Counties
Mean Household Income: $37,024 (Se. NE) Vs. $47,470 (NE)*
Location: Women, Infants, & Children (WIC) clinics
Population characteristics: All women of childbearing age who are
pregnant or who may become pregnant, especially postpartum women
between the ages of years old
Healthcare professionals who provide care to this population
*(Nebraska City Area Economic Development Corp, 2009)
2 cups, Apples, Bananas, Berries, Cherries, Nectarines, Melons, 100% fruit juice
3 cups, Milk, Cheese
8 ounces, Whole grains, Brown rice, Oatmeal
3 cups, Dark greens, Starchy vegetables, Red & Orange vegetables, Beans & Peas
6 1/2 ounces, Meat, Poultry, Eggs, Seafood, Nuts & Beans
RA, SD, MH, JX
* These amounts are for an average breastfeeding woman
Stakeholders
Physicians
Physician Assistants
Midwives
Registered Nurses
Social Workers
Pharmacists
Public Health Officials
Clinic administrators
Families
Communities
Advanced Practice Nurses
Lactation Consultants
Registered Dietitians
Nutritionist
Change in knowledge & dietary habits of pregnant & breastfeeding women
Improved caloric intake in women who are pregnant & breastfeeding to support milk production
Improved nutrition, well balanced meals & intake of essential vitamins & minerals for all pregnant &
breastfeeding women
Adequate fluid intake during pregnancy & lactation for all pregnant & breastfeeding women
Early identification of women at need of nutritional support
Vitamin/nutritional supplementation provided for women in need
Increase in the breastfeeding rate for patients in this target population
Increase in maternal/child health for patients in this target population
Increased breastfeeding knowledge in healthcare providers working with the target population
Expected Outcomes
RA, SD, MH, JX
Sources
Butte, N. F. (2010). Maternal nutrition during lactation. In S. Abrams & K. Motil (Eds.),UpTo Date. Available from
Lovelady, C.A., Stephenson, K.G., Kuppler, K.M., & Williams, J.P. (2006). The effects of dieting on food & nutrient intake of lactating women. Journal of the American Dietetic Association, 106(6), doi: /j/jada    
National Institute for Health & Clinical Excellence (NICE) (2008). Improving the nutrition of pregnant & breastfeeding mothers & children in low-income households. National Guideline Clearinghouse. Retrieved 6 June, 2011  from  
Nebraska City Area Economic Development Corp (2009). Southeast Nebraska Regional Demographics. Retrieved on 29 June, 2011 from
United States Department of Agriculture (2011). Pregnancy & Breastfeeding. Retrieved on 29 June, 2011 from
World Health Organization,  Infant & young child nutrition: Global strategy on infant & young child feeding. Retrieved from 21 June,  2011
       
                     
RA, SD, MH, JX