A Case Study on Using the Via Christi Breastfeeding Assessment Tool in a Clinical Setting

AimsThe goal of this study is to obtain a subjective point of view of the use, benefits, and shortcomings of the Via Christi breastfeeding Assessment Tool in a clinical setting. MethodsThis case study is based on a single yet detailed interview with a lactation consultant who has utilized the Via Christi Breastfeeding Tool in a clinical setting. FindingsAdvantages of the Via Christi Breastfeeding Assessment Tool include that the tool is practical and concrete, encompassing both a subjective dimension and the basic elements of breastfeeding. Shortcomings of the tool include its non-specificity in focus on the feeding technique only and excluding other factors involved with the birth and motherbaby couplet. ConclusionThe Via Christi Breastfeeding Tool serves as a good initial screening of breastfeeding, which in result leads to the recommendation of further and more extensive study of a specific mother-baby couplet breastfeeding measures if needed. BREASTFEEDING CASE STUDY 3 Introduction Breastfeeding is currently recognized as the ideal method of feeding for infants unless it is medically contraindicated. Organizations such as the American Dietetic Association (ADA; 2005), the American Academy of Pediatrics (AAP; 2005), and the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN; 2007) recommend exclusive breastfeeding up to 6 months of age and continued breastfeeding with the addition of complementary foods up to a minimum of 12 months. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) support exclusive breastfeeding for a minimum of 6 months of age and up to 24 months and beyond (WHO, 2001). Despite current recommendations only 73.8% of mothers in the US initiate breastfeeding in the hospital setting. Following discharge 41.5% of infants are breastfeed to any extent at 6 months and only 20.9% at 12 months (CDC, 2004). The highest rates of breastfeeding are among mothers who are Caucasian and have a college education (“Breastfeeding Trends,” 2003). Moreover, mothers over the age of 30 tend to breastfeed more than younger mothers, and married mothers have higher rates of breastfeeding than unmarried mothers. The lowest rates of breastfeeding are seen among women with the following characteristics: African American, maternal age under 20 years, mothers with less than a high school diploma, and those who are not married (CDC, 2004). To date, multiple tools have been developed by scholars to assess various components of breastfeeding in the hospital setting. However, the usefulness of these tools to predict postpartum breastfeeding outcomes is largely unknown. In the following sections, after a brief summary of the known benefits and contraindications of breastfeeding, the strengths and weaknesses of the BREASTFEEDING CASE STUDY 4 most widely known breastfeeding assessment tools will be reviewed. Finally the Via Christi Breastfeeding Assessment Tool will be described and the need for the current pilot study supported. Breastfeeding Benefits and Contraindications Breastfeeding is believed to offer many health benefits to infants. There is strong evidence that there is a significant decrease in the risk of acquiring acute otitis media among infants who breastfeed (Ip et al., 2007). Research has also shown a decrease in the risk of acquiring gastroenteritis and other gastrointestinal infections in breastfeeding infants (Davis, 2001). Maternal milk has been also shown to reduce the risk of necrotizing enterocolitis in preterm infants (Ip et al., 2007). Moreover, breastfeeding has been shown to have an effect on the prevalence of lower respiratory and urinary tract infections (Heinig, 2001). There is some evidence that suggests an association between breastfeeding and a decreased risk of asthma, Sudden Infant Death Syndrome (SIDS), and childhood leukemia (Ip et al., 2007). There is some research that claims an association between breastfeeding and a decreased risk of obesity in later life, but various genetic and environmental factors make the evidence insignificant (Butte, 2001). Similarly, there is an unclear association between breastfeeding and cognitive performance in children because of maternal and environmental confounding factors (Reynolds, 2001). Breastfeeding has also been found to offer health benefits to breastfeeding women. During the postpartum period breastfeeding encourages uterine contractions, which reduce the amount of postpartum blood loss. Breastfeeding mothers also have a reduced risk of developing pre-menopausal breast and ovarian cancer, as well as a decreased occurrence of bladder infections (Labbok, 2001). Breastfeeding mothers who do not have a history of gestational BREASTFEEDING CASE STUDY 5 diabetes have been shown to have a reduced risk of developing type 2 diabetes when compared with those who do not breastfeed (Ip et al., 2007). In addition to the health benefits, breastfeeding has been shown to positively affect the economy. Breastfed infants require fewer medical visits and treatments than formula fed infants. This contributes to decreased health care costs and less absenteeism among working mothers (Ball & Bennett, 2001). In addition, breastfeeding eliminates environmental pathogens that are acquired by introducing contaminated feeding devices (Heinig, 2001). This also leads to decreased health care costs by preventing the resulting medical visits. Breastfeeding is encouraged for most mother-baby dyads. However, there are some situations in which breastfeeding is contraindicated. Women infected with HIV are not encouraged to breastfeed as HIV can be transmitted through breast milk. Mothers infected with the Human T-Cell Lymphotropic Virus are also advised not to breastfeed when safe alternatives are available. Other infectious diseases, such as Herpes Simplex Virus, Varicella-Zoster Virus, Measles, and Tuberculosis, require a temporary cessation of breastfeeding until the disappearance of symptoms or the initiation of maternal therapy. Furthermore, infants diagnosed with the autosomal recessive disorder, galactosemia, should not breastfeed as they are not able to metabolize the sugars found in breast milk (Lawrence & Lawrence, 2001). Promotion of Breastfeeding Breastfeeding rates were at an all time low in 1972, when only 22% of mothers initiated breastfeeding. However, the rates of mothers who breastfed started increasing gradually as a result of increased education about the benefits of breastfeeding. There are several factors that BREASTFEEDING CASE STUDY 6 have contributed to an increase in breastfeeding rates. These include increased hospital, professional, and social support for the mothers (Wright, 2001). As part of promoting breastfeeding, Healthy People 2010 set a goal of increasing the proportion of women who breastfeeding their infants. The goal is to increase the proportion of women who breastfeed to 75% in the early postpartum period, 50% at 6 months, and 25% at 12 months. In order to achieve this goal, several programs have been launched. For instance, the WHO and UNICEF established the Baby Friendly Hospital Initiative (BFHI). This program was established to encourage hospitals to support breastfeeding by providing new mothers with information, training them with skills, and boosting their confidence which could lead to effective and continued breastfeeding (Philipp & Merewood, 2004). Tools to Measure Breastfeeding Assessment of Breastfeeding Several breastfeeding instruments have been designed to assess breastfeeding from the subjective perspective of the mother. The Maternal Breastfeeding Evaluation Scale (MBES) is a tool that measures three factors: maternal enjoyment and breastfeeding role attainment (physical and emotional aspects of breastfeeding), infant satisfaction and growth (infant’s weight gain and growth), and maternal lifestyle and body image (negatively worded about body image, felt tied down). The tool consisted of 56 items in a Likert scale, and was revised into a 30 item tool. It was shown to be a reliable and valid measure of maternal evaluation of a breastfeeding experience (Leff, Jefferis, & Gangne, 1994). A second tool, The Lactation Assessment Tool (LAT), measures the mothers’ subjective experience with breastfeeding specifically as it relates to pain and nipple soreness. It measures the relation between latching and infant positioning and BREASTFEEDING CASE STUDY 7 the incidence of sore nipples. A study using this tool showed that it could not be generalized since the sample was consistent of women who were already experiencing nipple pain. Also, no one element was shown to be the sole cause of sore nipples (Blair et al, 2003). The narrow scope of these tools limits their clinical relevance. Several tools have been developed to assess breastfeeding by measuring infant factors. The Systemic Assessment of the Infant at Breast (SAIB) measures the infant’s contribution of breastfeeding through factors such as audible swallowing and infant body alignment. This tool is used to teach women how to breastfeed. The components forming this tool include alignment, areolar grasp, areolar compression, and audible swallowing (Shrago, 1990). Another tool, the Breastfeeding Assessment Tool (BAT), allows healthcare professionals to document objective observations of breastfeeding such as infant activity, position, and latch on. This tool was beneficial to increasing support of breastfeeding and the staff’s appreciation of the importance of breastfeeding assessment (Bono, 1992). A third tool, The Potential Early Breastfeeding Problem Tool (PEBPT), assesses problems that are faced by breastfeeding mothers. The tool is formed of 23 items, and measures problems including sore nipples, baby falling asleep while feeding, and a fussy baby (Kearney, Cronenwett, & Barrett, 1990). Even though the BAT, SAIB, and PEBPT assess objective factors related to breastfeeding, they cannot accurately measure overall breastfeeding