As colostrum. Socially Mary placed herself under

As
for my case study and assignment, I have selected Mary (Pseudonym for
confidentiality, 2015). Mary is a primigravida for whom I provided care for on
the postnatal ward after an instrumental birth. Giving birth to a healthy
child, conceived by means of invitro fertilisation (IVF). Care was provided day
one postnatally and upon her readmission. Due to a rapid birth and process,
Mary was anxious and traumatised. On the ward, she was teary and required to be
assured.

Initially,
the baby was put under a double phototherapy which inflicted distress on her as
the baby was unsettled. Consequently, the experience she received during the
intrapartum and the early postnatal period resulted in Mary being unable to
initially breastfeed. Throughout this assignment, the focus will be on the
psychosocial factors identified and how they may affect breastfeeding. As well
as analysing the midwife’s public health role and multidisciplinary team on
providing safe and effective postnatal care. 

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Mary’s
birth and the effect it had on her breastfeeding are the psychosocial factors
that I will be focusing on in this assignment, analysing the public health role
of the midwife in supporting her. Due to a prolonged second stage and signs of
fetal distress, it was advised that Mary required assistance to facilitate the
safe birth of the neonate. Prior to labour, Mary was already anxious regarding
her pregnancy as assistance was required to conceive and both her and her
husband were overwhelmed by the long- waited chance to become parents.
Therefore, she became very attentive and planned for her labour to also go
well, the forceps birth being rapid and unexpected left her feeling quite emotional.
After the delivery, she was made aware that Jay would be closely observed for
physiological jaundice after the mode of birth and slight bruising that were
sustained. In the postnatal period, Mary was left feeling stressed and
overwhelmed, this impacted upon early lactation and during the initial
postnatal period she was unable to express any amount of colostrum. Socially
Mary placed herself under great pressure as she was breastfed and told it was more
‘natural’. Ultimately, she began to feel like she had failed herself and her
baby.

Working
alongside my mentor, I was able to witness the involvement of the multidisciplinary
team in providing care for Mary. As stated in the guidance published by the Department
of Health & Public Health England (2013), midwives are guided to work in
collaboration with the multidisciplinary team to ensure women with complex demands
can access the support and services required. We liaised with the infant
feeding coordinator, who was able to provide one to one support to Mary and a
breast pump to ensure that her breasts continued to be stimulated. Although, in
accordance with trust infant feeding guidelines, we encouraged Mary to offer
the breast prior to formula feeding (Ellis, 2016). But she would become
restless knowing he would not settle. Being aware that she was unable to
produce any colostrum, we continued to ensure that she was stimulating her
breasts to promote the production. (Rankin,2017). Stimulation was important and
as Mary wished to exclusively breastfeed, in accordance with the code we
referred her to the appropriate professionals (Nursing & midwifery council
(NMC), 2015).

 In addition, we worked in partnership with the
perinatal mental health team who provided the Edinburgh depression scale and
discussions to Mary regarding her mental health and the support available.
10-20% of women are affected by mental health problems during their pregnancy
and within the first-year preceding birth, thus it is paramount to assess Mary
in early postnatal period and work alongside the multidisciplinary team to
provide safe care (Bauer, Parsonage, Knapp, Lemmi & Adelaja, 2014). Offered
to Mary as an option was the access of the afterthought programme, in attempt
to understand her labour and birth experience.

 On readmission day three postnatal, Mary began
to express a few drops of colostrum. To continue encouraging her milk supply
she was advised to routinely spend time in skin to skin with the baby, to produce
more oxytocin and prolactin, a hormone required to facilitate breastfeeding (Crenshaw,
2014). It is noted within the UNICEF Baby Friendly Initiative that skin to skin
provides mothers with early bonding and attachment with the newborn, which is
associated with better health outcomes (UNICEF,2014).  With reference to the midwifery strategy
published by Department of Health & Public Health England (2013), outlines
the duty of the midwife to work in partnership with women and their families,
this is to make sure a smooth transition to parenthood is achieved.
Continuously, the midwife would reassure Mary of the correlation of a stressful
labour and birth with delayed lactation. The emotional support is to eliminate
the feeling of guilt and be able to bond with her baby without fear of failure
in being unable to breastfeed.

Studies
convey how birth interventions can impact the establishing of breastfeeding
within the early postnatal period, with babies being born by assisted delivery
being less likely to breastfeed at two weeks (Brown & Jordan, 2012). A
noted risk factor for a delayed or failed lactogenesis may include stressful or
traumatic labour and birth (Beck & Watson 2008). As the hormones oxytocin which
initiates the let- down reflex may be inhibited by factors such as anxiety or
stress, hence women may experience a delayed initiation of breastfeeding in the
early postnatal period (Rankin, 2017). For this reason, it is important for
midwives to take into consideration our role in providing holistic care and
educating women antenatally. Evidence shows that successful antenatal education
leads to a longer breastfeeding duration (Balogun et al., 2016). In relation to
the case study, Mary was not provided with information regarding possible
complications and factors that may prevent breastfeeding after birth. 

Evidence
shows that home births are associated with more success in exclusively
breastfeeding, as 67% of women initiated breastfeeding after birth 22% of which
continued breastfeeding for the first 6 months (Quigley et al., 2016). This is
due to the lack of intervention experienced in a home setting resulting in
stress and delayed lactation, as the care is one to one and support and time
can be directed in ensuring women get breastfeeding of to a good start.
Furthermore, the study conducted by Birthplace in England (2011) conveyed that
women are less likely to experience intervention when they choose to deliver in
a non-obstetric unit. The rate of women who choose to give birth at home being
transferred to hospital is noted a 7 to 45% (Wilyman & Lackey, 2013).
Therefore, it is clear to state that delivering within the hospital increase
the chance of intervention which may hinder early initiation of breastfeeding. Women
delivering in an obstetric unit are open to more intervention, which creates a
cycle of further intervention (Beech, n.d.). Nonetheless, it is appropriate to
argue that birthing at home also poses a risk for admission into hospital and
complications may arise, thus it is fair to say there is not enough evidence to
definitively claim a link between the birth setting and lactation.

In
the current societal state, it is appropriate to state that maternity care has
increased in the complexity in the caseload we receive today. As a result, it is
in the best interest of the society, for the role of midwife in public health
to be adapted. Department of Health, 2010 within the Midwifery 2020 policy
stated that “midwives will embrace a greater public health role” in aim of
“reducing health inequalities and improving maternal and family health”.  Health inequalities is known as the
difference in morbidity and mortality amongst individuals of higher or lower
socioeconomic background, where these differences are known to be unfair (Edwards
& Byrom, 2009).  It is evident that
breastfeeding is now regarded as a public health issue by (UNICEF) The baby
friendly initiative (BFI), due to the change in view underpinning existing
barriers through a societal level which in turn calls for a consideration of
the public health role of the midwife and how professionals are promoting and
supporting women and families (UNICEF, n.d.). Over 80% of women in the UK wish
to breastfeed (McAndrew et al., 2012), therefore it cannot be claimed the rates
have decreased due to lack of intention. The reinforcement of the public health
role of the midwife is to support these women and families in initiating
breastfeeding, through removing the societal barriers and closing the
inequality gap (Brown, 2017). Ultimately maximising infant and maternal health
in the future.

As
midwives we are in the position to inform women and their families about
breastfeeding, allowing them to decide. Moreover, by being proactive in
supporting breastfeeding and with reference to infant nutrition, the public
health role can be achieved in maximising health outcomes (Department of Health
& Public Health England, 2013). A conducted survey by the National Childbirth
Trust (NCT) affirmed that 77% of midwives provided new mothers with information
regarding breastfeeding (McAndrew et al., 2012). According to the code, it is
the role of the midwife to provide evidence based information to support women
in making an informed decision (NMC,2015). Acknowledging Mary and her
psychosocial factors in terms of public health, provisions were put in place to
establish a support system for Mary in liaising with the infant feeding
coordinator she was provided with the right information and support to ensure
safe care throughout the postnatal period.

Reflecting
upon this experience guided me towards literature and research of evidence
behind the link of a stressful labour and birth with lactation. In the beginning
I saw professionals be dismissive of Mary in her attempt to breastfeed and once
her baby was placed on phototherapy formula milk was naturally provided. This
made me feel angry to witness her decisions not be honoured and no support be
put in place. Early cessation of
breastfeeding has been noted to result in feelings of regret, guilt and some
cases postnatal depression (Lee, 2007). As care providers we ought to aim in
minimising these risk factors and promoting maternal wellbeing. Accordingly, with
statutory framework, midwives are obliged to respect women’s decisions
regardless of their opinion (NMC,2015). From this experience, I have identified
areas of improvement in understanding the importance of being an advocate for
women in our care and exercising all the opportunities available to meet their
needs. As well as ensuring antenatal educating of women regarding the
possibility of care deteriorating from the norm and how support is available in
terms of a debrief, to understand the experience and why the actions were taken.
Furthermore, the importance of working in collaboration with other
professionals was shown during this experience. The midwife alone did not have
the knowledge in other remits to support Mary and accordingly to guidelines she
referred her onto professionals. In the future, I would ensure to take into
consideration the labour and birth period holistically to ensure all factors
that contribute to a safe postnatal period are considered.

To conclude, I have explored the public health role of the midwife in
supporting women with complex health and psychosocial factors. With the use of
the case study I have been able to do this, understanding the role of the
multidisciplinary team and their involvement in promoting safe and effective
postnatal care. Overall, it is crucial as healthcare professionals we assess
our public influence on women’s and their families’ perception of breastfeeding
and the associated factors. This experience has made me aware of the vitality
of the public health role of a midwife, in ensuring the future healthcare for
service users are eliminated of inequality