The Importance of Discharge Education for Mothers & Families
Step 3 of the Ten Steps to successful breastfeeding emphasizes education of the pregnant partner and their family about breastfeeding stating, “Inform all pregnant women about the benefits and management of breastfeeding,” ¹.
The interim guidelines for facilities seeking the BFHI designation divides this step between facilities who have affiliated prenatal clinics and services and those who do not. For those who do have these facilities, education about breastfeeding should begin in the first trimester and should include individual counseling. For those without prenatal services, facilities are directed to “foster the development of or coordinate services with programs that make education about breastfeeding available to pregnant women,” ¹.
All facilities should foster relationships “with community-based programs that make available individual counseling or group education on breastfeeding and coordinate messages about breastfeeding with these programs,” ¹.
What types of services does your facility offer? How do you coordinate what your facility provides with your clinics or with community-based provisions?
Coordinating breastfeeding education with community offerings
Although these evaluation criteria apply to all facilities, those facilities who do not provide prenatal clinics and services “will report that the facility has fostered the development of or coordinated services with one or more of the following programs: in-house breastfeeding education, childbirth education, hospital preregistration visits, hospital tours, and in-patient services,” ¹.
For facilities without breastfeeding services or clinics, there must be a written description of “community-based programs and projects the facility has fostered,” ¹. Who have you worked with in your community to foster breastfeeding-based relationships with? Although Step 10 covers this issue in much greater detail, here are some suggestions of programs, groups, and activities with whom you might want a good working relationship:
- Breastfeeding support groups
- Telephone help lines
- Lactation clinics
- Home health services
- Specialized resource people and locations
- Pediatricians, Obstetricians, and Family Practitioner offices
- Nurse-run help lines
Recommended Discharge Education Topics For Breastfeeding Mothers
Guideline 5.1 of Step 5 of the Ten Steps to Successful Breastfeeding1 details the education all breastfeeding mothers should receive prior to discharge from the birthing facility. In addition to basic breastfeeding techniques of positioning and latch/attachment, this includes:
- The importance of exclusive breastfeeding.
- How to maintain lactation for exclusive breastfeeding for about 6 months.
- Criteria to assess if the infant is getting enough breast milk.
- How to express, handle, and store breastmilk, including manual expression.
- How to sustain lactation if the mother is separated from her infant or will not be exclusively breastfeeding after discharge.
The Breastfeeding Self-efficacy Scale (BSES)
The first Breastfeeding Self-efficacy Scale (BSES) was developed in 1999 by Dennis and Faux2 and although this appears to be a very dated piece of research, it has been replicated and cited multiple times since its development. The use of this scale can assist health care providers to predict high-risk mothers and may “guide the development and evaluation of interventions” for modifiable factors such as maternal confidence.
Based on Bandura’s social learning theory, “self-efficacy is a dynamic cognitive process in which an individual evaluates his or her capability to perform a given behavior”2. Using this scale can be helpful to identify new mothers with low breastfeeding confidence who are likely at high risk for premature weaning and not meeting their own breastfeeding goals.
With knowledge derived from the BSES, hospital or birth facility staff can provide individualized education and follow-up planning for higher risk breastfeeding individuals, possibly increasing breastfeeding initiation, exclusivity, and duration.
Final Thoughts...
One important aspect to discharge education is to individualize it for each new family. Yes, we health care providers may be teaching much of the same information 3 or 5 or 20 times each day to each patient being discharged. However, each new parent is an individual, bringing their own family culture, history, support, environment, and more to this breastfeeding experience. Ask questions, involve the family in the teaching, provide hands-on learning, and plan follow-up for each new dyad. They deserve it!
Keep safe and know that you are valued and appreciated for the work you are doing in the lives of these breastfeeding families. You are making a difference in their world.
Referrences
- Baby-Friendly USA, Inc. (2020). The Baby-Friendly Hospital Initiative. Interim Guidelines and Evaluation Criteria for Facilities Seeking and Sustaining Baby Friendly Designation. https://www.babyfriendlyusa.org/news/bfusa-releases-interim-guidelines-and-evaluation-criteria/
- Baby-Friendly USA, Inc. (2020). The Baby-Friendly Hospital Initiative. Interim Guidelines and Evaluation Criteria for Facilities Seeking and Sustaining Baby Friendly Designation. https://www.babyfriendlyusa.org/news/bfusa-releases-interim-guidelines-and-evaluation-criteria/
- Dennis, C.L. and Faux, S. (2009). Development and psychometric testing of the breastfeeding self-efficacy scale. Research in Nursing & Health;22: 399-409. https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1098-240X(199910)22:5%3C399::AID-NUR6%3E3.0.CO;2-4
