Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
8/5/2013
Image taken by Jennifer DeJong; Breckenridge, Colorado – Walking Down Main Street (restaurant
decoration), Summer 2012.
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
8/5/2013
Image taken by Jennifer DeJong, November 2011. People in photo: My husband, Brad, and our children: Christian, Joseph,
John, and Carolyn DeJong.
Breastfeeding women and their infants have lower healthcare costs compared with those who formula feed (Pugh et al.,
2002). According to Ball and Wright (1999), infants who are not breastfed incur up to $471 more health costs in the first year
compared with infants who are exclusively breastfed for three months ($671 in 2008 dollars) (U.S. Bureau of Labor Statistics.
Inflation calculator, 2009). The U.S. Breastfeeding Committee (2009) reports that for every $1 invested to support and protect
breastfeeding, employers receive a cost savings of $3. This has major financial implications for employers.
Former U.S. Surgeon General David S. Satcher, in the 2001 Public Health Report from the DHHS, wrote:
We must send the message that breastfeeding saves money for families. In a year’s time, families can save several hundred
dollars they might otherwise spend on breast substitutes. They can also save on medical care costs since breastfed infants
typically require fewer sick care visits. (p. 72)
Infants who are fed formula have higher health expenditures for certain acute illness (Pugh et al., 2002). Chronic pediatric
illnesses are very expensive, as are maternal cancers and diabetes. According to Bartick, Stuebe, Shealy, Walker, and
Grummer-Strawn (2009), financial enticements alone may persuade healthcare organizations to seek BF designation. In a
current era of increasing prevalence of uninsured Americans, this finding is especially noteworthy.
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; Carolyn feeding panda bear with bottle, Summer 2011.
Pre-Class Homework:
Assess costs of formula in your community and report back to the class.
Team 1: WalMart
Team 2: Walgreens
Team 3: Target
Team 4: Local Grocery Store
Team 5: Sam’s Club
Team 6: On-line options?
Cost of formula at WalMart (Spring 2011)
◦Parents Choice: $15/24 oz container
◦Good Start: $22/24 oz container
◦Enfamil: $27/24 oz container
◦That means, in the first six months of life parents could spend $2,250 - $4,050 on formula alone!
Section Three: Objectives 6 & 7
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Tuttle and Dewey (1996) compared breastfeeding to formula feeding from the perspective of the U.S. WIC
program among low-income Hmong women in California (n = 838); they projected increased cost savings of
approximately $3 million to $5 million for WIC programs in just one California county if women were to
breastfeed their children at least six months.
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The authors also note:
This analysis, which has considered only direct medical costs, underestimates substantially the burden to
society as a whole associated with our low level of exclusive breastfeeding. The family with a formula-fed
infant incurs direct costs for care, if uninsured, or for co-payments if insured, as well as nonmedical costs such
as family care and transportation to and from the doctor’s office.
Parental absence from work is expensive for both employee and employer. If a parent misses 2 hours of work
for the excess illness attributable to formula-feeding, >2000 hours, the equivalent of 1 year of employment, are
lost per 1000 never-breastfed infants. (p. 875)
In their analysis of two data sets (n = 966 in the Tucson Study; n = 644 Scottish study), it was determined through
Chi square analysis that these additional health care services cost the managed care health system between
$331 and $475 per never-breastfed infant during the first year of life (Ball & Wright, 1999).
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
8/5/2013
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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According to Baby-Friendly U.S.A (2009), full implementation of The Ten Steps to Successful Breastfeeding
profits all children--even those infants not breastfed--by improving mother-baby physical contact and nurseclient educational contact following delivery.
HMOs are also finding that women who are well supported during the susceptible postpartum period are more
likely to become long-term clients of the health institution. In turn, these mothers are also more likely to refer
other family members and peers to the facility, further benefiting the economic outlook of maternity centers
within the exosystem that consistently endorse breastfeeding.
According to Baby-Friendly U.S.A (2009), a substantial community benefit of breastfeeding is that fewer tax
funds are required to provide assistance to children. Families who breastfeed have increased available funds
to purchase goods and services, thereby directly benefiting the local economy.
Breastfed children have lower health-care costs as well, which reduces the financial load on families, thirdparty payers, and community- and government-run medical plans.
Section Three: Objectives 6 & 7
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Image taken by Jennifer DeJong; Vietnam, May 2011.
Not only do employers benefit from decreased employee healthcare costs, but they also profit directly from
breastfeeding because lactating workers have lower rates of absenteeism as a result of an ill child (AAP, 2005;
Association of Women’s Health, Obstetric, and Neonatal Nurses, 2008; Brown, Poag, & Kasprzycki, 2001; Dunn
et al., 2004; Libbus & Bullock, 2002; USDHHS, 2008; Witters-Green, 2003).
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; Vietnam, Summer 2011.
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Infant formula production and distribution requires energy along with many different materials such as paper,
plastic, metals and rubber.
For every 1 million infants who are formula-fed, 150 million formula containers are consumed.
Often infant formula containers, plastic bottles and nipples are not recycled. Plastics take hundreds of years to
break down in a landfill.
Human milk is a valuable, renewable natural resource
Wright (2001) discussed that a plausible explanation for the resurgence of breastfeeding since the 1970s is the
pervasive influence of the natural-childbirth movement. Breastfeeding proponents remind individuals about
the similarities of lactation and “going green” because the use of human milk results in no waste product.
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
Section Three: Objectives 6 & 7
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; Breckenridge, Colorado – Walking Down Main Street (restaurant
decoration), Summer 2012.
Now that we’ve covered the advantages to breastfeeding and the risks of not breastfeeding for the mother
and child, as well as the financial disadvantages of formula feeding to caregivers and healthcare in general -- let’s move on to how lactation occurs: the physiology and anatomy of the breast. Once we’ve covered that
we can move on to the problems that could occur and how to deal with them.
Section Three: Objectives 6 & 7
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Ask the students where prolactin comes from.
Hypothalamus – Anterior Pituitary (Prolactin)
Posterior Pituitary (Oxytocin)
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Prolactin levels rise and fall with breastfeeding. Infrequent breast stimulation (BF or pumping) leads to less
rise and fall, thus lower levels of prolactin.
Suckling or stimulation of the nipple is the most effective stimulus for prolactin release.
Prolactin levels rise as long as stimulation continues.
Prolactin is also thought to have emotional and behavioral functions within the mother as well, promoting
aggression and protection (instinctual protection of baby) (CLC training book, 2005)
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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•posterior pituitary gland
•Waves
•Out
•Contraction
• Suckling stimulates the posterior pituitary to eject oxytocin which stimulates the milk ejection reflex or let down.
• Mother’s can have multiple let downs in one feeding session
• Many Mothers will report different sensations during let down including: tingling/pressure/warmth in the breast,
feeling of euphoria, sleepiness, abdominal cramping (first week pp),
• Oxytocin levels can also be raised by breast massage
• Oxytocin can be temporarily blocked by adrenalin (stress, Pain)
• Oxytocin is also thought to have emotional and behavioral functions within the mother as well, promoting bonding
Released with pectoral stimulation
Surges, lasting about 1-2 minutes
Contracts muscle cells
Uterine contractions
Contracts muscle cells surrounding alveoli
Milk ejection reflex – MER or “let down”
Does not require constant nipple stimulation, much more general response than prolactin.
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Image used by DeJong with permission from Justine MacAurthur on 7/24/2012 via email.
Oxytocin is also released by visual, auditory, tactile, and psychological stimuli
Warmth, massage, skin contact, hand motions of the newborn, hearing baby, thinking about
baby
Stronger surges of oxytocin by babies massaging the breast with their hands than there was from
the baby suckling alone.
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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Image taken by Jennifer DeJong; Florida, Spring 2012.
Oxytocin affects every body system
Results in effects opposite to “fight or flight” response - with lifetime effects
Blood pressure drops
GI hormones increase
Skin sensitivity increases
Brain activity becomes calm and introverted
When a baby is placed skin to skin the mother’s oxytocin levels rise and so do the
baby’s. It leads to contentment, warmth, safety, and signals the mother’s body to
respond to her baby.
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Hormones
Prolactin: Responsible for breast milk Production
Oxytocin: Responsible for getting the milk Out of the breast
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Occurs from day 3 to day 8 postpartum
Triggered by rapid drop off in mother’s progesterone levels (delivery of the placenta)
Prolactin is released from anterior pituitary, oxytocin is released from posterior pituitary.
Mother reports breasts are feeling warm and full.
Onset of copious milk production.
Transition breast milk
Milk secretion begins ~ 36 hours post delivery
Most women are aware of some “drama” by or before 72 hrs postpartum
Breasts become full and firm
Most women aren’t aware of it until about 48 hrs. If by 72 hrs., she has no awareness that something is
happening in her breasts then she has a delay in milk production.
• Foremilk: lower in fat, higher in water content. Excreted in the first half of the breastfeeding session to
satisfy infant’s thirst.
• Hindmilk: higher in fat and calories. Excreted in the second half of the breastfeeding session to help
baby gain weight.
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Image used with permission from B. Wanner, Summer 2012.
The darkest milk is 3 days after delivery, the next 2 are 5 & 6 days after and the white is 2 months
after delivery.
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When is Lactogenesis II Delayed?
Associated with:
Obesity/heavy body build
Diabetes
Exclusive formula feeding
Supplementation
Cesarean births
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Day 1: few drops – 5 ml / fdg
Day 2: 5 – 15 ml / fdg
Day 3: 15 – 30 ml / fdg
Day 4: 30 – 45 ml / fdg
Day 5: 45 - 60 ml / fdg
• This will vary from mother to mother and in affected by many things.
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Infant is active, alert, happy, and satisfied after feedings.
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Output
Day 1: 1 wet diaper, 1 meconium stool
Day 2: 2 wet diapers
Day 3: 3 wet diapers, and 1-3 green stools (transitional stools)
Day 4: 4 wet diapers, 4 loose yellow stools
Day 5: 5-6 wet diapers, 4+ yellow stools
Day 6 – 6 months of age: 6+ wet diapers, 3-5+ loose yellow stools
Initially, stools are classified as meconium (black tar like)
After 3-4 days stools lighten to greenish yellow
BM stool then turns yellow and seedy
Wilson-Clay & Hoover, 2005
• Urine is clear to pale yellow and well saturated in diaper. You can feel the weight of the diaper from
the urine.
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students
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