9780763754327

Table of Contents


	Preface	xxi
	Acknowledgments	xxiii
	Contributors	xxiv
SECTION 1	HISTORICAL AND WORK PERSPECTIVES	1
Chapter 1	The Lactation Specialist: Roles and Responsibilities	3
	History	3
	Do Lactation Consultants Make a Difference?	4
	Certification	8
	ILCA	9
	Getting a Job as a Lactation Consultant	9
	Interviewing for a Job	10
	Gaining Clinical Experience	10
	Medical Clinics	11
	Lactation Consultant Education	12
	Lactation Programs	13
	Workload Issues	14
	Developing a Lactation Program	16
	Marketing	18
	The Unique Characteristics of Counseling Breastfeeding Women	19
	Roles and Responsibilities	19
	Stages of Role Development	21
	Lactation Consultants in the Community Setting	21
	Worksite Lactation Programs	22
	Medical Office	22
	Lactation Consultants and Volunteer Counselors	22
	Mentoring and Networking	23
	Reporting and Charting	24
	Narrative Charting	24
	Problem-Oriented Charting	24
	Electronic Health Records	24
	Clinical Care Plans	25
	Legal Concerns	26
	Confidentiality	28
	Intellectual Property Rights	28
	Ethics	29
	Ethical Questions that Come Up in Practice	29
	The WHO Code	30
	Moral Dilemmas	30
	Ethical Dilemmas	30
	Ethics vs. Morality	30
	Principles of Ethics	31
	Ethics and Discipline Committee	31
	Reimbursement	32
	Insurance and Third-Party Payment	32
	Coding	34
	Private Practice	35
	The Business of Doing Business	36
	Payment and Fees	37
	Partnerships	38
	Summary	40
	Key Concepts	40
	Internet Resources	41
	References	41
Chapter 2	Tides in Breastfeeding Practice	45
	Evidence About Breastfeeding Practices	45
	Large-Scale Surveys	45
	Other Evidence	50
	The Biological Norm in Infant Feeding	51
	Early Human Evolution	51
	Early Breastfeeding Practices	51
	Infant Feeding: Alternatives of Maternal Breastfeeding	52
	Wet-Nursing	52
	Hand-Fed Foods	53
	Age of the Infant at Introduction of Hand-Feeding	53
	Technological Innovations in Infant Feeding	55
	The Social Context	55
	The Technological Context	56
	The Role of the Medical Community	57
	Accommodation Between Physicians, Other Health Professionals, and Infant Milk Manufacturers	59
	The Prevalence of Breastfeeding	60
	United States	60
	Non-Western Regions	61
	The Cost of not Breastfeeding	62
	Health Risks of Using Manufactured Substitutes for Human Milk	63
	Economic Costs of Using Manufactured Substitutes for Human Milk	63
	The Promotion of Breastfeeding	65
	Breastfeeding Promotion in the United States	65
	International Breastfeeding Promotion	67
	Private Support Movements	70
	Summary	70
	Key Concepts	71
	References	72
SECTION 2	ANATOMICAL AND BIOLOGICAL IMPERATIVES	77
Chapter 3	Anatomy and Physiology of Lactation	79
	Mammogenesis	79
	Breast Structure	80
	Nipple Size	83
	Areolar Glands (AG)	83
	Variations	84
	Pregnancy	85
	Lactogenesis	85
	Delay in Lactogenesis	87
	Hormonal Influences	87
	Progesterone	88
	Prolactin	88
	Cortisol	90
	Thyroid-Stimulating Hormone	90
	Prolactin-Inhibiting Factor	90
	Oxytocin	90
	Milk Production	92
	Autocrine versus Endocrine	92
	Feedback Inhibitor of Lactation	92
	Galactopoiesis	93
	Galactorrhea	93
	Clinical Implications: Mother	93
	Breast Assessment	93
	Classification of Nipple Function	95
	Concepts to Practice	95
	Newborn Oral Development	96
	The Palate	96
	The Tongue and Lips	97
	The Epiglottis	97
	The Larynx	98
	The Cheeks	98
	Suckling	98
	Breathing, Suckling, and Pacing	101
	Frequency of Feedings	104
	Summary	106
	Key Concepts	106
	References	108
Appendix 3-A	Suck Training for Breastfeeding	112
Chapter 4	The Biological Specificity of Breastmilk	117
	Milk Synthesis and Maturational Changes	118
	Energy, Volume, and Growth	119
	Caloric Density	119
	Milk Volume and Storage Capacity	120
	Differences in Milk Volume Between Breasts	122
	Infant Growth	124
	Color	124
	Nutritional Values	124
	Fat	124
	Lactose	127
	Protein	127
	Vitamins and Micronutrients	128
	Minerals	130
	Preterm Milk	131
	Anti-Infective Properties	131
	Gastroenteritis and Diarrheal Disease	134
	Respiratory Illness	135
	Otitis Media	135
	Controversies and Claims	135
	Chronic Disease Protection	138
	Childhood Cancer	138
	Allergies and Atopic Disease	139
	Asthma	140
	The Immune System	140
	Active versus Passive Immunity	140
	Cells	141
	Antibodies and Immunoglobulins	142
	Nonantibody Antibacterial Protection	143
	Anti-Inflammatory and Immunomodulating Components	145
	Bioactive Components	146
	Enzymes	146
	Growth Factors and Hormones	147
	Taurine	148
	Implications for Clinical Practice	148
	Summary	150
	Key Concepts	150
	Internet Resources	151
	References	151
Appendix 4-A	Composition of Human Colostrum and Mature Breastmilk	161
Chapter 5	Drug Therapy and Breastfeeding	163
	Introduction	163
	The Alveolar Subunit	164
	Drug Transfer into Human Milk	166
	Passive Diffusion of Drugs into Milk	166
	Ion Trapping	167
	Molecular Weight	167
	Lipophilicity	167
	Milk/Plasma Ratio	168
	Maternal Plasma Levels	168
	Bioavailability	168
	Drug Metabolites	169
	Calculating Infant Exposure	169
	Unique Infant Factors	170
	Maternal Factors	171
	Minimizing the Risk	172
	Effect of Medications on Milk Production	172
	Drugs that may Inhibit Milk Production	172
	Drugs that may Stimulate Milk Production	173
	Review of Selected Drug Classes	175
	Analgesics	175
	Antibiotics	177
	Antihypertensives	181
	Psychotherapeutic Agents	181
	Corticosteroids	186
	Thyroid and Antithyroid Medications	186
	Drags of Abuse	187
	Radioisotopes	188
	Radiocontrast Agents	188
	Summary	190
	Key Concepts	191
	References	191
Chapter 6	Viruses and Breastfeeding	197
	Introduction	197
	HIV and Infant Feeding	198
	Exclusive Breastfeeding	198
	Treatment and Prevention	199
	Healthcare Practitioners	200
	Counseling	200
	Herpes Simplex Virus	201
	Chickenpox/Varicella	202
	Cytomegalovirus	204
	Rubella	205
	Hepatitis B	205
	Hepatitis C	205
	Human Lymphotropic Virus	206
	West Nile Virus	206
	Implications for Practice	207
	Summary	207
	Key Concepts	208
	Internet Resources	209
	References	210
SECTION 3	PRENATAL, PERINATAL, AND POSTNATAL PERIODS	213
Chapter 7	Perinatal and Intrapartum Care	215
	Breastfeeding Preparation	215
	Doulas and Childbirth Educators	216
	Prenatal Preparation	216
	Early Feedings	216
	Epidurals and Other Birth Practices	217
	Suctioning	217
	Normal Patterns	217
	Skin-to-Skin (Kangaroo) Care	222
	Pain Medications	223
	Feeding Positions	223
	Latch-On and Positioning Techniques	223
	The Infant Who has not Latched-On	225
	Digital Examination	226
	Plan for the Baby Who has not Latched On	226
	Establishing the Milk Supply	228
	Mother�s Nipples and Breast Problems	228
	Baby Problems that may Cause Difficulty with Latch-On	229
	Late-Preterm Infants	230
	Feeding Methods	231
	Cup-Feeding	231
	Finger-Feeding	232
	Nipple Shields	233
	Hypoglycemia	233
	Cesarean Births	236
	Breast Engorgement	239
	Breast Edema	240
	Hand Expression	241
	Clinical Implications	242
	Breastfeeding Assessment	242
	Discharge Planning	243
	Weight Loss	244
	Basic Feeding Techniques	244
	Signs that Intervention is Needed	245
	Discharge	245
	Summary	246
	Key Concepts	246
	Internet Resources	248
	References	248
Chapter 8	Postpartum Care	253
	Immediate Postbirth Events	253
	First Weeks�Principles and Expectations	254
	Common Problems in the Early Days and Weeks	254
	Baby is not Latching, Sucking or Feeding Effectively	255
	Torticollis	258
	Supplementation Guidelines	259
	Nipple Pain	259
	Treatments for Nipple Pain	261
	Sudden Nipple Pain After a Period of Comfortable Breastfeeding	262
	Engorgement + Milk Stasis = Involution	262
	Milk Stasis	264
	Edema	264
	Milk Supply	265
	Temporary Low Milk Production or Delayed Onset of Lactogenesis	267
	Too Much Milk (Oversupply)	268
	Effect of Pharmaceutical Agents on Milk Supply	268
	Breast Massage	269
	Nausea during Milk Ejection Reflux	270
	Clothing, Leaking, Bras, and Breast Pads	270
	Infant Concerns	271
	Pacifiers	271
	Stooling Patterns	272
	Hyperbilirubinemia Testing	273
	Crying and Colic	274
	Multiple Infants	276
	Full-Term Twins or Triplets	277
	Preterm or Ill Multiples	277
	Putting it All Together	278
	Partial Breastfeeding and Human Milk Feeding	279
	Breastfeeding during Pregnancy and Tandem Nursing	280
	Sleeping, SIDS, and Bed Sharing	281
	SIDS	281
	Smothering	282
	Clinical Implications	283
	Summary	284
	Key Concepts	284
	Internet Resources	285
	References	285
Chapter 9	Breast-Related Problems	291
	Nipple Variations	291
	Inverted or Flat Nipples	291
	Absence of Nipple Pore Openings	292
	Large or Elongated Nipples	292
	Plugged Ducts	293
	Mastitis	294
	Treatment for Mastitis	295
	Types and Severity of Mastitis	296
	Breast Abscess	299
	Breast and Nipple Rashes, Lesions, and Eczema	299
	Candidiasis (Thrush)	300
	Diagnosis	301
	An Alternate View of Candidiasis	302
	Treatment	302
	Breast Pain	305
	Vasospasm	306
	Milk Blister	306
	Mammoplasty	307
	Gigantomastia	307
	Breast Reduction	307
	Mastopexy	309
	Breast Augmentation	309
	Breast Lumps and Surgery	311
	Galactoceles	312
	Fibrocystic Disease	313
	Bleeding from the Breast	313
	Breast Cancer	314
	Lactation Following Breast Cancer	316
	Breast Screening	317
	Clinical Implications	318
	Summary	318
	Key Concepts	319
	Internet Resources	320
	References	321
Chapter 10	Low Intake in the Breastfed Infant: Maternal and Infant Considerations	325
	Introduction	325
	Global Standards for Optimal Growth: The WHO Child Growth Standards	326
	U.S. Growth Curves: Comparison to WHO Child Growth Standards	329
	Onset of Lactation and Newborn Weight Loss	330
	Initial Newborn Weight Loss and Early Weight Gain	333
	Low Intake and Low Milk Supply: Definitions and Incidence of Occurrence: Confusing Terminology and Nonstandardized Research	333
	Abnormal Patterns of Growth: The Baby Who Appears Healthy	337
	Inadequate Weight Gain in the First Month	337
	The Late-Preterm Infant	337
	Oral�Motor Dysfunction (Ineffective Suckling)	338
	Gastroesophageal Reflux, Cow Milk Allergy, and Oversupply	339
	Nonspecific Neurological Problems	342
	Ankyloglossia (Tight Frenulum, Tongue-Tie)	342
	Abnormal Patterns of Growth: The Baby with Obvious Illness	345
	Maternal Considerations: The Mother Who Appears Healthy	346
	Delayed Lactogenesis	346
	Stress	346
	Inverted Nipples	346
	Nipple Shields	346
	Hormonal Alterations	347
	Medications and Substances	347
	Breast Surgery	348
	Insufficient Glandular Development of the Breast	348
	Psychosocial Factors	349
	Maternal Nutrition	349
	Anemia	349
	Maternal Considerations: Obvious Illness	349
	History, Physical Exam, and Differential Diagnosis	350
	History	350
	Physical Examination and Laboratory Tests	350
	Differential Diagnosis	350
	Clinical Management	350
	Determining the Need for Supplementation	350
	Intervention	351
	Reducing the Amount of Supplementation	352
	Family and Peer Support	353
	When Maternal Milk Supply does not Increase	353
	Special Techniques for Management of Low Intake or Low Supply	354
	Breast Massage	354
	Switch Nursing	354
	Feeding-Tube Device	354
	Test Weighing	355
	Galactogogues	357
	Hindmilk	359
	Summary	360
	Key Concepts	360
	Internet Resources	361
	References	361
Chapter 11	Jaundice and the Breastfed Baby	365
	Neonatal Jaundice	366
	Increased Bilirubin Synthesis	366
	Bilirubin Metabolism	367
	Intestinal Metabolism of Bilirubin	367
	Assessment of Jaundice	367
	Postnatal Pattern of Jaundice	367
	Breastmilk Jaundice	368
	Starvation Jaundice	369
	Hyperbilirubinemia	370
	Bilirubin Encephalopathy	370
	Evaluation of Jaundice	372
	Diagnostic Assessment	372
	Management of Jaundice	373
	Acknowledgement	375
	Summary	375
	Key Concepts	375
	Internet Resources	376
	References	376
Chapter 12	Breast Pumps and Other Technologies	379
	Concerns of Mothers	380
	Stimulating the Milk-Ejection Reflex	380
	Hormonal Considerations	383
	Prolactin	385
	Oxytocin	387
	Pumps	387
	Mechanical Milk Removal	387
	Compression	388
	The Evolution of Pumps	389
	A Comparison of Pumps	389
	Manual Hand Pumps	391
	Battery-Operated Pumps	392
	Electric Pumps	393
	Simultaneous and/or Sequential Pumping	395
	Flanges	396
	Pedal Pumps	400
	Clinical Implications Regarding Breast Pumps	400
	Cleaning Pumps	403
	Maternal Concerns and Education Needs	403
	When Pumps Cause Problems	404
	Sample Guidelines for Pumping	404
	Common Pumping Problems	406
	Nipple Shields	407
	Review of Literature	408
	Types of Shields	409
	Shield Selection and Instructions	409
	Weaning from the Shield	411
	Responsibilities	411
	Breast Shells	411
	Feeding-Tube Devices	413
	Lact-Aid (USA)	413
	Supplemental Nutrition System (USA) Medela, Inc	414
	Situations for Use	414
	Summary	415
	Key Concepts	416
	Resources for Mothers	419
	Internet Resources	419
	References	420
Appendix 12-A	Manufacturers/Distributors of Breast Pumps	424
Chapter 13	Breastfeeding the Preterm Infant	425
	Suitability of Human Milk for Preterm Infants	425
	Mothers of Preterm Infants	427
	Rates of Breastfeeding Initiation and Duration	428
	Research-Based Lactation Support Services	428
	Making an Informed Decision	429
	Alternatives to Exclusive, Long-Term Breastfeeding	429
	Models for Hospital-Based Lactation Support Services	429
	Initiation of Mechanical Milk Expression	430
	Principles of Milk Expression	430
	Selecting a Breast Pump	431
	Milk Expression Technique	431
	Milk Expression Schedule	431
	Written Pumping Records	433
	Maintaining Maternal Milk Volume	433
	Expressed Milk Volume Guidelines	433
	Preventing Low Milk Volume	434
	Skin-to-Skin Care	436
	Evidence-Based Guidelines for Milk Collection, Storage, and Feeding	437
	Guidelines for Collection and Storage of Expressed Mother�s Milk (EMM)	437
	Preparing Expressed Mother�s Milk for Infant Feeding	438
	Special Issues Regarding the Feeding of EMM	441
	Volume Restriction Status	441
	Commercial Nutritional Additives	441
	Hindmilk Feeding	441
	Methods of Milk Delivery	442
	Maternal Medication Use	442
	Transmission of Viruses and Other Pathogens Via EMM	443
	Feeding at Breast in the NICU	444
	Suckling at the Emptied Breast	444
	The Science of Early Breastfeeding	445
	Progression of In-Hospital Breastfeeding
	Milk Transfer during Breastfeeding	450
	Discharge Planning for Postdischarge Breastfeeding	456
	Getting Enough: Determining Need for Extra Milk Feedings	457
	Methods to Deliver Extra Milk Feedings Away from the Breast	458
	Postdischarge Breastfeeding Management	458
	Summary	459
	Key Concepts	459
	Internet Resources	460
	References	460
Appendix 13-A	The Preterm Infant Breastfeeding Behavior Scale (PIBBS)	469
Chapter 14	Donor Human Milk Banking	471
	Introduction	471
	Use of Donor Milk	471
	History of Donor Milk Banking	473
	Donor Milk Globally	475
	Safety	477
	Availability	477
	Informal Sharing or Sale of Milk and Wet-Nursing	477
	Informed Decision Making	479
	For-Profit and Not-for-Profit Milk Banking	479
	Milk Banking Procedures	479
	Donor Screening	479
	Storage and Handling of Milk	479
	Processing of Milk	480
	Pasteurization	482
	Storage of Milk in the Milk Bank	482
	Records	482
	Recalls	483
	Research Findings on Donor Milk	483
	Selected Case Studies	487
	Summary	489
	Key Concepts	489
	Internet Resources	490
	References	490
Appendix 14-A	Expressing, Storing, and Handling Human Milk	493
SECTION 4	BEYOND POSTPARTUM	495
Chapter 15	Maternal Nutrition during Lactation	497
	Maternal Caloric Needs	498
	Maternal Fluid Needs	499
	Weight Loss	499
	Exercise	501
	Bariatric Surgery	501
	Calcium Needs and Bone Loss	501
	Vegetarian Diets	502
	Dietary Supplements	503
	Foods that Pass into Milk	503
	Caffeine	503
	Food Flavorings	503
	Heavy Metals and Breastmilk	504
	Allergens in Breastmilk	504
	The Goal of the Maternal Diet during Lactation	504
	Nutrition Basics	506
	Energy	506
	Macronutrients	507
	Micronutrients	508
	Clinical Implications	509
	Summary	513
	Key Concepts	513
	Internet Resources	514
	References	514
Chapter 16	Women�s Health and Breastfeeding	519
	Alterations in Endocrine and Metabolic Functioning	519
	Diabetes	520
	Crohn�s Disease and Inflammatory Bowel Disease (IBD)	521
	Turner�s Syndrome	522
	Thyroid Disease	522
	Pituitary Dysfunction	523
	Polycystic Ovarian Syndrome	523
	Gestational Ovarian Theca Lutein Cysts	524
	Cystic Fibrosis	524
	Acute Illness and Infections	525
	Tuberculosis	525
	Group B Streptococcus	526
	Methicillin-Resistant Staphylococcus Aureus (MRSA)	526
	Dysfunctional Uterine Bleeding	527
	Maternal Immunizations	528
	Surgery	528
	Transplants	529
	Donating Blood	529
	Relaxation	529
	Induced Lactation	530
	Domperidone and Metoclopramide	531
	Herbs	533
	Autoimmune Diseases	533
	Systemic Lupus Erythematosus	533
	Multiple Sclerosis	534
	Rheumatoid Arthritis	534
	Physically Challenged Mothers	535
	Spinal Cord Injury	535
	Epilepsy (Seizure Disorders)	536
	Headaches	538
	Postpartum Depression	539
	Clinical Implications	541
	Medications and Herbal Therapy for Depression	541
	Support for the Mother with Postpartum Depression	541
	Asthma	542
	Smoking	543
	Poison Ivy Dermatitis	543
	The Impact of Maternal Illness and Hospitalization	543
	Summary	544
	Key Concepts	545
	Internet Resources	546
	References	546
Chapter 17	Maternal Employment and Breastfeeding	551
	Historical Perspective	551
	The Effect of Work on Breastfeeding	552
	Facilitators and Barriers to Breastfeeding in the Workplace	553
	Individual Strategies to Manage Breastfeeding and Work	554
	Prenatal Planning and Preparation	554
	Working at Home	555
	Job Sharing	556
	The Day Care Dilemma	556
	Returning to Work	557
	Maintaining an Adequate Milk Supply	558
	Hand-Expression and Pumping	558
	Human Milk Storage	561
	Fatigue and Loss of Sleep	563
	Workplace Strategies to Support Breastfeeding and Work	563
	Lactation Programs in Work Sites	564
	The Employer�s Perspective	567
	Community Strategies to Support Breastfeeding and Work	567
	Healthcare Providers and Lactation Consultants	567
	Breastfeeding Support Groups	568
	National and Global Strategies in Promoting and Supporting Breastfeeding	568
	Legislative Support and Public Advocacy	568
	International Labour Organization	570
	Clinical Implications	571
	Summary	573
	Key Concepts	573
	Internet Resources	574
	References	575
Chapter 18	Child Health	579
	Developmental Outcomes and Infant Feeding	579
	Growth and Development	583
	Physical Growth	583
	Weight and Length	583
	Senses	584
	Reflexes	585
	Levels of Arousal	585
	Theories of Development	585
	Nature versus Nurture	585
	Social Development	589
	Language and Communication	589
	Attachment and Bonding	592
	Temperament	594
	Stranger Distress	595
	Separation Anxiety	595
	Clinical Implications	597
	Immunizations	597
	Vitamin D and Rickets	599
	Dental Health and Orofacial Development	600
	Solid Foods	601
	Introducing Solid Foods	601
	Choosing the Diet	602
	Choosing Feeding Location	604
	Delaying Solid Foods	605
	Obesity	605
	Long-Term Breastfeeding	606
	Weaning	606
	Implications for Practice	607
	Summary	608
	Key Concepts	608
	Internet Resources	609
	References	609
Chapter 19	The Ill Child: Breastfeeding Implications	615
	Team Care for the Child with Feeding Difficulties	615
	Feeding Behaviors of the Ill Infant/Child	615
	What to do if Weight Gain is Inadequate	617
	What to do When Direct Breastfeeding is not Sufficient	617
	Alternative Feeding Methods	619
	Pain Management Concerns	622
	Care of the Hospitalized Breastfeeding Infant/Child	622
	Home from the Hospital: The Rebound Effect	624
	Perioperative Care of the Breastfeeding Infant/Child	624
	Emergency Room	626
	Care of Children with Selected Conditions	626
	Infection	626
	Gastroenteritis	627
	Respiratory Infections	628
	Pneumonia	633
	Bronchiolitis	633
	Otitis Media	634
	Meningitis	635
	Alterations in Neurological Functioning	635
	Hypotonia and Hypertonia	635
	Down Syndrome or Trisomy 21	636
	Neural Tube Defects	636
	Hydrocephalus	637
	Congenital Heart Disease	638
	Oral/Facial Anomalies	639
	Cleft Lip and Palate	639
	Pierre Robin Sequence	642
	Choanal Atresia	644
	Gastrointestinal Anomalies and Disorders	644
	Bloody Vomit or Bowel Movements	644
	Esophageal Atresia/Tracheoesophageal Fistula	645
	Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD)	645
	Pyloric Stenosis	647
	Chylothorax	648
	Imperforate Anus	649
	Metabolic Dysfunction	649
	Rare Amino and Organic Acidemias	649
	Phenylketonuria	650
	Galactosemia	650
	Congenital Hypothyroidism	652
	Type I Diabetes	652
	Celiac Disease	653
	Cystic Fibrosis	654
	Allergies	655
	Food Intolerance	657
	Lactose Intolerance	657
	Psychosocial Concerns	658
	Family Stress	658
	Chronic Grief and Loss	658
	The Empty Cradle ... When a Child Dies	659
	Caring for Bereaved Families	659
	Summary	660
	Key Concepts	660
	Internet Resources	661
	References	662
Chapter 20	Infant Assessment	669
	Perinatal History	669
	Gestational Age Assessment	669
	The New Ballard Score	671
	Indicators of Effective Breastfeeding and Assessment Scales	675
	Breastfeeding Behaviors and Indicators	675
	Breastfeeding Scales and Tools	678
	Summary of Breastfeeding Assessment Scales	679
	Physical Assessment	679
	Transitional Assessment	679
	Skin	680
	Birthmarks	686
	Head	687
	Ears and Eyes	688
	Nose	688
	Mouth	688
	Neck	689
	Chest	690
	Abdomen	690
	Genitalia	690
	Back and Spine	691
	Extremities	691
	Elimination	691
	Behavioral Assessment	692
	Sleep�Wake States	692
	Neurobehavioral Cues	694
	Summary	698
	Key Concepts	698
	References	699
Appendix 20-A	Infant Breastfeeding Assessment Tool (IBFAT)	701
Appendix 20-B	LATCH Assessment Tool	702
Appendix 20-C	Mother-Baby Assessment Scale	703
Chapter 21	Fertility, Sexuality, and Contraception during Lactation	705
	Fertility	706
	The Demographic Impact of Breastfeeding	706
	Mechanisms of Action	706
	Lactational Amenorrhea	707
	The Suckling Stimulus	708
	The Repetitive Nature of the Recovery of Fertility	712
	The Bellagio Consensus	714
	Sexuality	716
	Libido	716
	Sexual Behavior during Lactation	720
	Contraception	722
	The Contraceptive Methods	724
	Clinical Implications	729
	Summary	731
	Key Concepts	732
	References	733
SECTION 5	SOCIOCULTURAL AND RESEARCH ISSUES	737
Chapter 22	Research, Theory, and Lactation	739
	Theories Related to Lactation Practice	739
	Maternal Role Attainment Theory and Becoming a Mother	740
	Parent�Child Interaction Model	740
	Bonding and Attachment Theory	741
	Theory of Darwinian and Evolutionary Medicine	741
	Self-Care Theory	742
	Self-Efficacy Theory	742
	Theory of Planned Behavior and Theory of Reasoned Action	742
	Origins of Research Methodologies	743
	Positivist and Postpositive Perspective	743
	Naturalistic, Humanistic, or Interpretive Perspective	743
	Critical or Emancipatory Perspective	744
	Types of Research Methods	744
	Qualitative Methods	744
	Quantitative Methods	746
	Additional Methods and Approaches for Breastfeeding Research	747
	Elements of Research	749
	Research Problem and Purpose	749
	Variables, Hypotheses, and Operational Definitions	749
	Review of Literature	752
	Protection of the Rights of Human Subjects	752
	Method	753
	Data Analysis	754
	Application of Methods to Qualitative Approaches	754
	Sampling	755
	Data Collection	755
	Data Analysis	755
	Trustworthiness of Qualitative Research	756
	Application of Methods to Quantitative Approaches	756
	Sampling and Sample Size	756
	Data Collection	757
	Reliability and Validity	757
	Data Analysis	760
	Results, Discussion, Conclusions, and Dissemination	764
	Evaluating Research for Use in Practice	765
	Using Research in Clinical Practice	767
	Summary	768
	Key Concepts	769
	Internet Resources	770
	References	770
Appendix 22-A	Research Terms	773
Chapter 23	Breastfeeding Education	775
	Introduction	775
	Educational Programs	775
	The Internet	776
	Learning Principles	776
	Adult Education	777
	Curriculum Development	778
	Health Professional Curricula	779
	Student Attitudes	779
	Case Studies	779
	Textbooks	779
	Parent Education	779
	Prenatal Education	781
	Early Breastfeeding Education	781
	Continuing Support for Breastfeeding Families	783
	How Effective is Breastfeeding Education?	785
	Teaching Strategies	785
	Small Group Dynamics	788
	Multimedia Presentations	788
	Electronic Slides	789
	Transparencies	789
	Videos and DVDs	789
	Visuals	789
	Educational Materials	790
	Continuing Education	791
	Objectives and Outcomes	791
	The Team Approach	793
	Childbirth Educators	794
	Nurses	794
	Lactation Consultants	794
	Physicians	794
	Dietitians	795
	Community Support Groups	795
	Summary	795
	Key Concepts	795
	Internet Resources	796
	References	796
Chapter 24	The Cultural Context of Breastfeeding	799
	The Dominant Culture	800
	Ethnocentrism vs. Relativism	801
	Assessing Cultural Practices	801
	Language Barriers	802
	The Effects of Culture on Breastfeeding	802
	Rituals and Meaning	805
	Colostrum	806
	Sexual Relations	806
	Wet-Nursing	807
	Other Practices	807
	Contraception	807
	Infant Care	808
	Maternal Foods	809
	�Hot� and �Cold� Foods	809
	Herbs and Galactogogues	810
	Weaning	810
	Types of Weaning	811
	Implications for Practice	813
	Summary	813
	Key Concepts	814
	Internet Resources	814
	References	814
Chapter 25	The Familial and Social Context of Breastfeeding	817
	Family Forms and Functions	817
	Family Theory	818
	Social Factors that Influence Breastfeeding	819
	Fathers	821
	The Adolescent Mother	825
	The Adoptive Mother and Family	826
	The Low-Income Family	827
	Lack of Information	827
	Hospital Practices	828
	The Importance of Peer Counselors	828
	The Downside of Family Experience	829
	Violence	829
	Childhood Sexual Abuse	831
	Summary	833
	Key Concepts	833
	Internet Resources	834
	Other Resources	834
	References	835
	APPENDIXES
A	Clinical Competencies for IBCLC Practice	840
B	Scope of Practice for International Board Certified Lactation Consultants	845
C	International Lactation Consultant Association Standards of Practice for IBCLCs	847
D	International Board of Lactation Consultant Examiners Candidate Information	850
E	International Board of Lactation Consultants Examiners Code of Ethics for International Board Certified Lactation Consultants	853
F	Tables of Equivalencies and Methods of Conversion	856
G	Infant Weight Conversion Table	857
H	Breastfeeding Weight Loss Table	858
I	Nursing Best Practice Guidelines	859
	Glossary	863
	Index	877