The nature of health promotion work in midwifery

Health promotion is an essential part of a midwives responsibility; “the nature of health promotion work in midwifery is geared toward promoting the health of the mother and ensuring an optimum environment for mother and baby” (Dunkley, 2000:40). Breastfeeding can be a controversial topic. It can bring about mixed opinions and responses from mothers and midwives. In spite of the message “breast is best” bottle feeding has become part of the culture in Ireland’s society. “Health promotion is predominately a proactive process. It is a process that is done with people not at people, either on an individual basis or within groups. Participation and partnership are key components of the process (Dunkley, 2000:42). This essay will discuss the unique ability of midwives in their contribution to the health promotion of breastfeeding in Ireland.

A general role of midwives is to enthusiastically support and advise a breastfeeding woman. A midwife should help the woman recognise that breastfeeding is a normal life event in every culture. In order to do this a midwife should have a broad knowledge of the anatomy of the breast and sufficient clinical skills. This will ensure the woman receives adequate information and skills on the postnatal ward, or antenatally.

Benefits of Breastfeeding

Firstly the reason for the promotion in regard to breastfeeding is that apart from being economically friendly, it also holds many benefits for the baby and for the mother herself. “Extensive research using improved epidemiological methods and modern laboratory techniques documents diverse and compelling advantages for infants, mothers, families and society from breastfeeding and the use of human milk”. (Chalmers & Kramer 2001). “These advantages include health, nutritional, immunological development, psychological, social, economic and environmental factors” (American Academy of Paediatrics, 1997) Human milk lessens the chances of an infants chance of infections and diseases including bacterial meningitis and respiratory tract infections. This is because breast milk contains anti-infective properties. ” Studies have demonstrated protection from pre-menopausal breast cancer (Buchanan and Sachs, 1998;Enger et al., 1997;Katsouyanni et al., 1996; Michels et al., 1996;UK National Case-Control Study Group, 1993) and pre-menopausal ovarian cancer (Siskind et al., 1997) and a possibility of protection against hip fractures in older age (Department of Health 1998). Breast feeding can also help the mother return to her pre birth weight. “Breast milk has been shown to protect babies against gastrointestinal, urinary, respiratory and middle ear infection” (Howie et al 1990) and atopic disease if there is a family history of atopy” (Burr et al 1989, Oddy et al 1999). Breast milk also contains exactly the right proportion of nutrients a baby requires. From 16weeks gestation the breast will begin to produce a clear fluid known as colostrums. Colostrums is the first feed a breast fed baby will receive. It has higher levels of protein, fat-soluble vitamins and mineral percentages than normal breast milk. It is plentiful in immunoglobulins, macrophages, lymphocytes, neutrophils and mononuclear cells which gives it the high levels of protein. Traditional breast milk holds 90% water with 10% proteins, carbohydrate and fats with vitamins and minerals. “The primary solid constituent is the fatty acid component that provides 50% of the calorific requirements of the newborn.”(Henderson & Macdonald, 2004:595).

Role of the Midwife

The role and responsibility of the midwife is to work with evidence based practice “with good communication to provide advice, support, encouragement and education to facilitate the womans ability to breastfeed (preferably with a ‘hands off’ approach from the midwife” (Johnson & Taylor 2006:346). Support throughout pregnancy can have a long lasting effect no matter the scale the task may be. A good example of this is the midwives role in health promotion and in supporting women in feeding their babies. (Crafter, 1997). “When a woman needs more general sources of advice and social support than those provided through the maternity services, midwives may still play a key role in providing relevant information and advice and referring her to other professionals and organisations for support.”(Cooper & Fraser 2003:939). If the chosen method of feeding an infant is breastfeeding a mother should expect midwives to assist them in the latching on of the child and in the correct way so it is not painful or uncomfortable for the mother. “The baby should be brought up to the breast quickly to ensure correct attachment, rather than the breast brought down to the baby which encourages bad maternal posture and poor attachment” (RCM, 2002). They must also ensure the baby is obtaining sufficient feeds and that water and artificial baby milk is avoided unless medically necessary. If a mother decides to bottle feed she should, however, expect the same level of support and shown how to make up a bottle feed.

Education for a breast feeding mother is essential. In order to prepare the mother for breast feeding, it is more favourable that she understands the process of breastfeeding. The midwife will have a dual role in the first few feeds. First and foremost, she must ensure that the baby is receiving and adequate feed. Secondly the midwife should ensure the mother herself acquires the ability to feed her baby alone. Emotional support by a midwife is important if it is the womans first time breast feeding. Along with physical and emotional support a woman will also require adequate support in the means of information such as leaflets, on a one to one basis, or support groups in the community. A popular support group is La Leche League International. They are non medical breastfeeding counsellors. During the last decade, the average length of hospital stay following birth has been cut almost in half as the health care industry strives to keep costs down; especially in the economic downturn our society is enduring. Women are sent home to grapple on their own and sometimes will not have gotten any advice on breastfeeding from a midwife on the postnatal wards as there is not enough staff and not enough time in the day. “Additional support has a positive effect on the woman’s satisfaction of breastfeeding, demonstrated by a Cochrane database review (Anderson, 1999). La Leche League(LLL) has worked for 35 years offering information and support to women who want to breastfeed, as well as providing continuing education for health care professionals. LLL believes that breastfeeding, with its many important physical and psychological benefits, offers advantages for both mother and child and is the ideal way to initiate healthy family relationships.

Midwives should work within The structure set out in the Ten Steps to Successful Breastfeeding (Saadeh and Akre, 1996: Woolridge, 1994: WHO, 1998) which are as follows:

Have a written breastfeeding policy that is routinely communicated to all the healthcare staff

Train all healthcare staff in skills necessary to implement this policy.

Inform all pregnant women about the benefits and management of breastfeeding.

Help mothers initiate breastfeeding soon after birth.

Show mothers how to breastfeed and how to maintain lactation even if they should be separated from infants.

Give newborn infants no food or drink other than breast milk, unless medically indicated.

Practice rooming-in: allow mother and infants to remain together for 24hours a day.

Encourage breastfeeding on demand.

Give no artificial teats or dummies to breastfeeding infants.

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.

In 1991 the Baby Friendly Hospital Initiative was set up by UNICEF and WHO, in order for hospitals to encourage and be supportive of breastfeeding women (Ten steps). Mothers should hope to get a high standard of care in all ‘Baby Friendly Hospitals’. Hospitals who wish to receive ‘Baby Friendly’ status must adhere to (WHO 1989). In such a hospital a mother should expect a midwife to assist them in the breast feeding soon after birth. This may occur when skin to skin contact occurs. A baby should remain with his mother at all times. Help given with attaching the baby to the breast soon after birth often results in successful breastfeeding (Hytten,1954).


The way forward to the successful return of breastfeeding as a cultural normality lies in the roots of prenatal and postnatal education. Different approaches to this may be in hospitals, postnatal wards, schools and the community. The keen attitude and involvement of midwives is vital to the promotion and practice of breastfeeding to ensure the best possible development of infant and child health. Breastfeeding like, like childbirth, empowers women. This power is not society’s masculine definition of power meaning authority, money, or material goods. It is the power of nurturance, intimacy and attachment.