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 17-25 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 http://www.uptodateonline.com 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), 908-912. doi: 10.1016/j/jada.2006.03.0007     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 http://guidelines.gov/   Nebraska City Area Economic Development Corp (2009). Southeast Nebraska Regional Demographics. Retrieved on 29 June, 2011 from http://southeastnebraska.org/index.php/living-in-se-nebraska/regional-demographics United States Department of Agriculture (2011). Pregnancy & Breastfeeding. Retrieved on 29 June, 2011 from http://www.choosemyplate.gov/mypyramidmoms/foods_to_choose.html World Health Organization, 2002.  Infant & young child nutrition: Global strategy on infant & young child feeding. Retrieved from 21 June,  2011 http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf                               RA, SD, MH, JX