1. Infant Feeding Among Low-Income Mothers
Presented by: Caitlin Neilson,LPN, BN student
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2. This presentation is intended for nurses who work directly with breastfeeding mothers
Based on the Canadian Journal of Nursing Research article: Infant-Feeding Among Low- Income Women: The Social Context that Shapes Their Perspective and Experiences (Temple Newhook et al., 2013)
This article was selected for its information which is relevant in the nurses’ role of communication and education about breastfeeding and formula feeding for new mothers
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3. Research question: “What attitudes, beliefs, and values influence mothers’ decision not to breastfeed?” (Temple Newhook et al., p. 31)
This question was based on Newfoundland and Labrador’s low rates of breastfed infants compared to other provinces and territories in Canada (2013)
The purpose of the research was “understanding the reasons for the province's low rates of breastfeeding, with the long-term goal of developing interventions to raise the rates” (2013, p. 31)
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4. This study used a qualitative approach to collect information, with a focus on collecting personal experiences and feelings from the mothers who particpated
The study's “validity and reliability were enhanced by using the participants’ own words” (Temple Newhook et al., 2013, p. 33)
Permission to audio record the women’s conversations was granted with the understanding that the participants “identification information would be removed” (p. 32)
“Ethical approval for the study was obtained from the Human Investigation Committee of Memorial University of Newfoundland” (p. 32)
Image: Kara Bonneau, 2013

5. Major Findings of the Study in Several Different Areas:
# 1Breastfeeding Myths and Misinformation (Temple Newhook et al., 2013, p. 33)
“There is a great deal of conflicting and inaccurate information and many myths about breastfeeding” (p. 33) this inaccurate information is related specifically to the study’s participants and the population they represent: mothers with low-income status, with a high school education or less and a mean age of 26 (p. 32).
Study found prevailing beliefs that some women are “not physically capable of producing enough breast milk” perhaps made worse by “medicalization of breastfeeding”: health professionals’ focus on number of feedings(p. 33)
Value of this on evidence based practice
Nurses who are working with patients who may fit this demographic can implement appropriate teaching
The focus of health care professionals on the infants’ feeding cues verses the amount of feedings can help shift focus from quantity of milk to infant centered care for mothers (p. 34)
Integrating breastfeeding as a “core part of the postnatal experience” can help to build skills and confidence in new mothers (p. 42)

6. Value of this on evidence based practice
# 2 Postnatal Experience and the Medicalization of Birth and Breastfeeding (Temple Newhook et al., 2013, p. 34)
Information was once passed down from generation to generation regarding breastfeeding, however, there has been a “cultural shift in authority” (2013, p. 34) with emphasis on a “biomedical narrative” (2013, p. 34)
Women felt that there was a great deal of emphasis by health care professionals on proper latching, frequency of feedings, baby’s weight; perhaps undermining women’s “confidence in their mothering skills” (2013, p. 35)
Women who had given birth in urban centres often felt that the nurses’ approach to breastfeeding education was “intrusive” and “aggressive” (2013, p. 35)
Value of this on evidence based practice
Nurses can foster and respect the mother’s decisions, and instincts toward breastfeeding
Nurses can provide the mother with information on why nursing measures are taken as well as involve mother in these activities
Nursing practice should focus on developing a warm and supportive environment
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7. # 3 Cultural Expecations Regarding Infant Behaviour (Temple Newhook et al., 2013, p. 36)
Women in the study expressed the importance of having their baby follow a schedule (2013, p. 36) this influenced the use of formula over breastfeeding for many women who believed it to be “more suited than breastfeeding to establish a routine” (2013, p. 37)
Social pressures were apparent in the participants to have a “good baby” who can fit into a specific schedule (2013)
Value of this on evidence based practice
Nurse’s can acknowledge the social pressures that exist regarding “routines” and can provide information on different infant behaviour as well as different supports available for “the challenges of infant care” (2013, p. 37)
Emphasis of nurse on breastfeeding as part of a “holistic approach to infant care” (2013, p.37)

8. # 4 Partner Support and Child- Care Workload (Temple Newhook et al
# 4 Partner Support and Child- Care Workload (Temple Newhook et al., 2013, p. 37)
Many of the women reported that their partners encouraged formula feeding so that they could also be involved with the feeding process (2013)
Partners also preferred feeding to other childcare tasks such as diaper changing
Women reported a “gendered imbalance in parenting expectations and child-care workload” (2013, p. 37) many women found formula feeding lessened this imbalance (2013)
Breastfeeding can require more time than formula feeding (ex: more then one child to care for, other duties) and for some women breastfeeding caused more stress, more workload, and less personal time
Value of this on evidence based practice
Nurse can include partner in discussions regarding breastfeeding
Discussion with patient and partner about family life: chores, responsibilities, workload and expectations, also ways of incorporating “breaks” to manage stress
Focus on supporting and developing open-communication between partners
Nurse acknowledges “that increased child-care assistance is an essential part of supporting women who want to breastfeed” (2013, p. 39)
Image: Gettyimages n.d.

9. Value of this on evidence based practice
# 5 The Cultural Stigma of Breastfeeding (Temple Newhook et al., 2013, p. 39)
The participants had major concerns regarding exposing their breasts for breastfeeding; feelings of judgment and “social pressure not to breastfeed in public” (2013, p. 39) were major contributors for lack of breastfeeding
Lack of exposure to breastfeeding discovered as an important reason why low- income women do not breastfeed
Value of this on evidence based practice
Nurse can recommend options such as a cover or a nursing room to encourage breastfeeding outside the home
Discuss with patient the concerns and the stigma associated with breastfeeding and how women are working to overcome these negative social pressures (2013)

10. Value of this on evidence based practice
The nurse can be aware of the stigma attached with formula feeding and provide a nonjudgmental and warm environment
Providing evidence based information on formula as well as breastfeeding that is supportive of the mother’s choice in either case
Providing information for resources that include breastfeeding clinics, lactation consultants and support groups
# 6 Breastfeeding Equated with “Good Mothering” (Temple Newhook et al., 2013, p. 40)
Participants felt guilty over formula feeding verse breastfeeding (2013) One participant stated health professionals contributed to the guilt of not breastfeeding (2013)
Many women had “internalized the “risk” discourse surrounding formula” (2013, p. 40) leading to feelings of “harming their children by feeding them formula” (2013, p. 40)
Image: Babycenter.com, n.d.

11. References
Bonneau, K. (2013) Mother holding baby beside nurse. Retrieved from Group of mothers and infants. n.d. retrieved from Nurse in foreground. n.d. retrieved from babycenter.com Nurse standing beside new mother in hospital bed. n.d. retrieved from Nurse with mother and infant. (2016). retrieved from Temple Newhook, J., Ludlow, V., Newhook, L.A., Bonia, K., Murphy Goodridge, J., & Twells, L. (2013). Infant-Feeding Among Low-Income Women: The Social Context That Shapes Their Perspectives and Experiences. Canadian Journal of Nursing Research, 45 (3), Retrieved from Thought Equity Motion. n.d. Father with sleeping infant. Retrieved from Gettyimages.com Two mothers feeding their infant. (2014). Retrieved from