Indicator 5 – Who needs to know about breastfeeding?


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Should everyone know about breastfeeding? Or just some people? Which people? What should they know?

Indicator 5 of the Assessment Tool is primarily concerned with the initial and ongoing education and training of health professionals with respect to breastfeeding and infant and young child feeding.

The indicator requires, first and foremost, that health professionals (including social and community workers) who could be expected to care for breastfeeding women or infants/children in their daily work have some education and training about breastfeeding included in their pre-registration curriculum.

Which seems to make sense:  we would expect that health professionals likely to provide care for people with, for example, diabetes – had a solid understanding of it.   They would then better understand how the rest of a person’s health care might be affected by this ongoing condition.

Although breastfeeding is a health behaviour rather than a chronic disease, it still needs to be considered as part of a woman or child’s broader health context in order for individualised and holistic care to be provided, and for breastfeeding to continue.

While there are obvious situations where this knowledge would be needed, such as when nurses are working in paediatric settings, general hospitals also often provide care for women who are breastfeeding as well.

What exactly should these health professionals know about breastfeeding?  The WBTi provides a comprehensive education checklist to guide curricula.

Indicator 5 also promotes the dissemination of the principles of Mother-friendly Care in any healthcare setting, but maternity settings in particular. You can read this here.

These mother-friendly principles consider the impact that obstetric interventions and the separation of mother and baby have on breastfeeding.  The principles are aimed at optimising women’s physiological responses to labour and birth as well as minimising unnecessary and non-evidence based interventions.  These include routine episiotomy and non-medically indicated Caesarean section.  Keeping mother and baby together in close proximity is also a priority of Mother-friendly Care.   The indicator argues powerfully for institutional policy that reflects mother-friendly care and for staff who are:

“trained to understand that the health and well-being of the mother, her fetus, her newborn, and the successful initiation of breastfeeding, are all part of a continuum of care.”

This indicator requires that relevant health professionals are educated about their responsibilities to the country’s national policies regarding the WHO Code for the Marketing of Breastmilk Substitutes.  There is also a requirement for health professionals to receive consistent professional development about specific areas of infant and young child feeding, including diarrhoeal disease, HIV/AIDS, well-child care, nutrition, the Code and breast cancer.  There needs to be an assurance that in-service education programmes are provided across the nation.

The indicator finally requires that there are child health policies that ensure that mother and baby are kept together when either of them is unwell.

This emphasis on mother-baby closeness to ensure the well-being of the mother-baby dyad underpins Indicator 5. This closeness ensures the well-being of breastfeeding mothers and babies when they are being cared for in the healthcare system.

About The Author

Jen Hocking has been a midwife for 20 years.  Always interested in helping women to breastfeed their babies, her best teacher turned out to be her first baby – Eva.  Initial difficulties with sore and damaged nipples led on to a pleasing and successful breastfeeding relationship and may have reached an apotheosis in Jen’s current doctoral research into the work of International Board Certified Lactation Consultants.