Research Paper on Lactation Education

Introduction

The importance of breastfeeding cannot be stressed enough. Most significantly, it benefits both the nursing mother and her infant. Low and middle-income countries have reported more emphasis on the importance of breastfeeding compared to high-income countries. Breastfeeding significantly influences childhood nutrition and immunity and reduces infant mortality rate especially when initiated early. Global sensitization of just how crucial lactation is giving birth to the initiations to educate new mothers by the labor and delivery nurses on this subject. Offering encouragement and support to the new mothers by the nurses through the initiatives improve breastfeeding success. This review aims at establishing the effects; therefore, lactation education has on the effectiveness of breastfeeding by new mothers or the lack thereof.

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The literature for this review is from Google Scholar and CINAHL. Selection of the materials and sources included in this review is with consideration to the inclusion and exclusion criteria. Each study was singularly vetted to ensure it remains within the standards required to describe the subject adequately. The researchers reported varied results through the studies they undertook. Majority of the studies reported an increase in the self-efficacy of breastfeeding in new mothers subjected to lactation education. Other studies suggested that the effect of the initiative was negligible and therefore no definite conclusion could be made. The keywords used in the CINAHL database include 'lactation,' 'breastfeeding,' 'initiation,' 'nursing mothers,' 'lactation education,' 'duration of breastfeeding,' 'lactation consultancy,' 'exclusive breastfeeding,' and 'breastfeeding rates.' This review gives a critical appraisal of the evidence provided by the different studies with regards to the effect of lactation education on new mothers and their breastfeeding self-effectiveness. They were considering the impact on lactation duration as well.

Review of Literature

When studies have been done to investigate the effect of lactation education to new mothers on their effectiveness in breastfeeding after that, they show mixed results. Even though many of the researchers concluded that this kind of consultancy in lactation resulted in increased efficiency, (Carlsen, Kyhnaeb, Renault, Cortes, Michaelsen & Pryds, 2013; Jonsdottir, Fewtrell, Gunnlaugsson, Kleinman, Hibberd, Jonsdottir & Thorsdottir, 2014; Bonuck, Stuebe, Barnett, Labbok, Fletcher & Bernstein, 2014; Wouk, Chetwynd, Vitaglione & Sullivan, 2017; Meredith, Karen & Hayden, 2017), some reported no change in the effectiveness of breastfeeding in new mothers (Tahir & Al-Sadat, 2013).

Throughout all the studies the educators were in constant contact with the subjects, the new moms (Carlsen et al., 2013; Jonsdottir et al., 2014; Bonuck et al., 2014; Wouk et al., 2017; Meredith et al., 2017; Tahir & Al-Sadat, 2013). For some, it was face-to-face in hospitals, at home or over the phone for some. However, most of the researchers relied more on one-on-one contact. The period over which these studies obtained their results was six months. Six months is considered the period for exclusive breastfeeding on a close to universal level. World Health Organization recommend it and other numerous health organizations. Also, a significant number of studies are available on the same.

The U.S. has been the center stage for most of these studies aiming to establish the effects of lactation education on breastfeeding behavior (Bonuck et al., 2014; Carlsen et al., 2013; Wouk et al., 2017; Meredith et al., 2017). Others, however, were carried out in different countries such as Iceland (Jonsdottir et al., 2014), Malaysia (Tahir &Al-Sadat, 2013). Random tests and controlled trials were the most common designs used by many researchers (Bonuck et al., 2014; Jonsdottir et al., 2014; Carlsen et al., 2013), others used retrospective non-experimental designs (Wouk et al., 2017; Meredith et al., 2017). Educational approaches reported far greater success compared to the routine interventions which were characteristic for controlled trials. Also, the sample sizes varied to the design of the study. The random controlled trials accommodated between 200-300 subjects, non- experimental designs used up to more than 500 participants.

A majority of the studies reviewed above registered a conclusion that lactation education increases the breastfeeding self-efficacy of new mothers (Jonsdottir et al., 2014; Carlsen et al., 2013; Bonuck et al., 2014) significantly. They reported that prenatal and postnatal support and education offered by the labor and delivery nurses to new mothers was enough to cause significant changes in breastfeeding outcomes. Ease of accessing this education has been documented to also increase the duration of breastfeeding to more than six months. Some studies, however, concluded that the training did not produce effects significant enough to give a conclusive verdict (Tahir & Al-Sadat, 2013; Wouk et al., 2017). All the studies, however, encourage new mothers to get access to lactation education.

Similarities across the Studies

One of the most important common ground in all the above studies is that all the samples were either pregnant or new mothers. The aim of this review as aforementioned is to establish the effect of lactation education provided by labor and delivery nurses to mothers. The care and support are given before, during and after birth.

All these studies were carried out within the period of the first six months of breastfeeding. As this is the most crucial period of breastfeeding, any changes or new adaptations are easy to notice. Breastfeeding self-efficacy has been reported to be reflective of mother confidence in breastfeeding and can be modified to give better outcomes in breastfeeding.

Another common report in all the studies is the fact that they all document changes in the effectiveness with which new mothers breastfeed after they receive lactation education. Breastfeeding self-efficacy improves. This clearly shows that the information shared with pregnant and new mothers through the lactation educators is enough to change their perspective of breastfeeding and even cause ripples in the rates and duration thereof.

Differences between the Studies

The studies differ in the size of the sample. The randomized controlled trials use samples ranging between 200-300 subjects (Bonuck et al., 2014; Jonsdottir et al., 2014; Carlsen et al., 2013). Non-experimental interventions use more than 500 subjects (Wouk et al., 2017; Meredith et al., 2017). This can be a contributing factor to the variance in results obtained at the end of the researches. The specificity of the sample size does not allow for the generalization across an entire population which is problematic.

The difference in levels of knowledge across the studies. Most of the studies were more concerned with the women who decided to breastfeed. They did not consider those who, even after accessing lactation education, choose not to breastfeed. Also, those who stop breastfeeding along the way are not in the statistics of these studies. This insinuates that there exists a level of bias in the researches.

Some of the studies, (Wouk et al., 2017), seem to deviate from the main aim of establishing whether lactation education affects breastfeeding self-efficacy or not. This study leans more towards the effect of the frequency of the intervention. It aims at determining whether the number of times a pregnant or new mother accesses this information affects the effectiveness with which they breastfeed or the duration of the same. This can be another contributor that caused the conclusions of the studies to differ.

The studies were carried out in different geographic regions. The U.S. (Bonuck et al., 2014; Carlsen et al., 2013; Wouk et al., 2017; Meredith et al., 2017), Malaysia (Tahir &Al-Sadat, 2013), and Iceland (Jonsdottir et al., 2014). The cultural and societal norms are different in these regions which can sway the decision of new mothers about breastfeeding. Social bias in the approaches that allowed self-reporting also affected the accuracy of the results; hence the conclusions drawn.

Review Appraisal

A systematic review cannot be without challenges. One major limitation encountered during the composition of this review is sourcing for the information. Some of the articles required paid or unpaid subscriptions to access their content. This limited the diversity of the content because only published or free journals and reports are available. This sometimes tends to put the reliability of a review in jeopardy. Researchers also tend to have a bias towards good results and therefore have a tendency not to publish negative findings. Differences in research and data analysis methods pose a challenge when attempting to compare studies and present conclusions. Carrying out research and posting the results can take a lot of time. This means that most of the available journals and articles are almost outdated which limits the review.

Randomized control testing is a preferred method of research as is evident through the studies above. It is analytical in its findings. It uses numbers to compare the results obtained from a control group and another test group receiving the lactation education; it can establish how effective the intervention is. In non-experimental methods, on the other hand, the researcher observes, records, interprets, and then draw conclusions from the data obtained. The control of the subjects is limited in this method. This difference in the methodology is a huge factor contributing to the variations in reported results.

All factors considered, most of the studies established that lactation education to pregnant and new mothers positively affects breastfeeding self-efficacy. Mothers who received this education reported better outcomes in breastfeeding. This includes an increased duration of breastfeeding to more than the recommended six months. Improved lactation behavior comes with other benefits such as reducing infant mortality rate, helping with weight loss for nursing moms, and it also empowers the baby's immunity allowing them to develop and thrive.

Conclusion

From the data pooled from the findings of the studies reviewed, it is evident that subjecting pregnant and new mothers to lactation education by the labor and delivery nurses leads to increased effectiveness in breastfeeding. This further shows through the number of women that initiate breastfeeding after the intervention and the increase in the rates and duration of breastfeeding as well. The lack of a standardized method of assessing the participants of any study leads to varying qualities of findings. No research or method can, therefore, pass as the most effective over the others. One study is better in some ways while the other research is better in different ways, but none is entirely independent

Clinical Implications of the Findings

A gap in knowledge exists regarding the effects of creating awareness regarding the importance of breastfeeding. Despite the findings taken from several studies on this matter, it is evident that a large number of new mothers choose to forego breastfeeding. The nursing fraternity must change these statistics. Enhancing access to this information will see a reduction in complications associated with lack of breastfeeding in both infants and their mothers. Research has shown that some mothers quit breastfeeding because they have to return to work, changing medications, and the misconception that they don't have enough breast milk for the baby. Lactation education by the nurses could be a way of changing this point of view.

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