Fundamentals of Labor & Delivery Care

About Fundamentals of Labor & Delivery Care

Fundamentals of Labor & Delivery Care provides a comprehensive introduction to the care of the mother and fetus in the L&D Unit. Labor and Delivery is a unique department because obstetrical nurses are responsible for the complete care of two patients; for this reason, Labor nurses should be knowledgeable about the potential complications that may occur with mothers and infants.

To begin with, students will learn how to recognize physical and emotional findings indicative of maternal progress during labor. In addition, nursing implementations for cervical ripening agents and Pitocin, will be discussed. Also, students will learn how to perform ongoing assessments of maternal progress throughout the three stages of labor. Last but not least, students will learn how to appropriately respond to emergent situations, like; umbilical cord prolapse, shoulder dystocia, fetal bradycardia, as well as abnormal fetal heart rate patterns.

Why you should choose NEO for Fundamentals of Labor & Delivery Care

Nurses Educational Opportunities holds a genuine passion for women’s and children’s health. In particular, maternal mortality rates in the United States have steadily increased; in view of this fact, we seek to improve maternal outcomes by preparing nurses on how perform effective obstetrical care. Above all, our goal is to provide nurses with the proper knowledge to help empower mothers throughout the labor journey. Our mission, for one thing, is to deliver passionate teaching without PowerPoint, dull material, and monotonous communication. Accordingly, our instructors will ensure that learners feel ready to carefully assess and prepare mothers for a successful outcome. Lastly, this course will equip you with the knowledge to better respond to a patient’s physiological and psychological needs. For more information on maternal mortality rates, click here. To conclude, Fundamentals of L&D is a valuable class which will greatly contribute to your nursing skills.

Course Information

Course Fee: $115.00

Textbook Included

Awarded 6 Contact Education Hours

Schedule online or call us at 866-266-2229

Orange County

San Diego

Webinar Course

Fundamentals of Labor and Delivery Care

NEO Blog

Nurses Eat their Young

Lateral violence is a form of nurse bullying For instance, lateral violence occurs when another nurse deliberately instills harmful behavior in the workplace to another employee. Most noteworthy, nurse to nurse bullying remains extremely common in various hospitals and healthcare facilities. Nursing remains one of greatest occupations at risk for lateral violence. As a matter of fact, roughly 44% to 85% of nurses reported being victims of bullying (Christie and Jones, 2014). Most notably, 93% of nurses reported witnessing lateral violence in the workplace. In most cases, the experienced nurse served as the perpetrator, whereas the New Grad and Student Nurse served the role of the victim (Jacobs & Kyzer, 2010). Due to it’s prevalence, most cases of lateral violence go under-reported. Astonishingly, many nurses have accepted this type of behavior, and considered it normal, but it is not! It’s time to ask yourself if you will continue to be part of the high percentage of nurse victims and nurse bullies? We hope the answer is, NOT ANYMORE! The nursing profession has consistently ranked #1 in honesty and ethical standards among professionals; which makes the rampant bulling an hazing that persists among nurses much more surprising. The ongoing ubiquity of lateral violence has inspired the creation of the popular term “Nurses Eat their Young.” Coined in 1986, “Nurses Eat their Young” describes the hostility young nurses face at the hands of more experienced co-workers (Colduvell, 2017). Today, new graduates, including new hires still suffer from intense bullying in the workplace. You may be thinking, what causes a nurse to become a bully. Reasons as to why nurses become bullies include: Lack of autonomy, accountability, and control in the workplace (Colduvell, 2017) Management may also contribute to the act of lateral violence Roughly 56% of nurses, in 2014, suffered lateral violence at the hands of a manager or supervisor (Townsend, 2016). According to American Nurse Today, managerial bullying may result from; organizational instability due to downsizing, restructuring, high manager-turnover, and autocratic leadership styles; as well as, oppressed group behaviors; and last but not least, organizations that focus on productivity, plus financial outcomes rather than patient-centered care. Furthermore, managers who bully, in many cases, learned by example. In the past, they themselves were victims or lateral violence and now serve in a position of power. In addition, Townsend, (2016), states that managers who bully tend to have low self-esteem or low clinical competence. Also, managerial bullies often target nurses who demonstrate competence; who remain well-liked by others; and nurses who have received special recognition. There are many reasons why co-workers, supervisors, as well as managers bully others, these are just a few reasons why. Theory of the Nurse as a wounded healer Created by Conti-O’Hare, the Theory of the Nurse as a Wounded Healer states that a nurse’s experience with lateral violence can either transform him or her into an advocate of bullying or a perpetrator of lateral violence. The result of lateral violence, most often pain and fear, can be carried throughout one’s life. The effects of bullying do not automatically resolve. All victims of lateral violence require some form of intervention. In fact, one’s ability or inability to cope with the trauma can profoundly affect one’s capability to care for others. Nurses should recognize their wounds in order to transform their pain and acquire transcendence. In a profession devoted to healing others, such as nursing, requires a nurse to heal him or herself first in order to thrive. Pierre’s Story of lateral Violence Nurses Educational Opportunities provides a RN Refresher course where nurses have shared their experiences with incivility in the workplace. Pierre, a young African-American man was one of several sharing his experience that cost him his license. Pierre served as a doctor in Africa. When he migrated to the United States he chose to pursue a career in nursing and eventually achieved his nursing degree. As a new grad employee, Pierre became the target of verbal and indirect bullying, plus social isolation. A group of nurses banded together to sabotage Pierre by altering his documentation and reporting false accusations. Pierre felt powerless, being that he was a new grad, he felt he had inadequate support. Ultimately the bullying became so severe to the point where the group of nurses began to place stuffed toys of monkeys in his work-space. Pierre personal experience of lateral violence was aggressive, intentional and frequent. Pierre reported his experienced to management to no avail. Management notoriously do not resolve the problem because they can’t or won’t! Since the entire staff was involved, the management couldn’t fire the entire staff. Ultimately nothing was done and Pierre was given the choice to deal with it or transfer to another hospital. Stories like Pierre’s are so common that in 2015,  the Professional Issues Panel on Incivility, Bullying, and Workplace Violence developed a new ANA position statement on this hot topic. Key points of lateral violence by the American Nurses Association (ANA) According to the ANA, the key points are as follows: The nursing profession will not tolerate violence of any kind from any source RN’s and employers must collaborate to create a culture of respect Evidence-based strategies that prevent and mitigate incivility, bullying, and workplace violence promote RN health, safety, and wellness and optimal outcomes in health care The strategies are listed and categorized by primary, secondary, and tertiary prevention The statement is relevant for all healthcare professionals and stakeholders Subtle forms of bulling include: sabotage, withholding information, excluding others, unfair assignments, or downplaying accomplishments. This is referred to as incivility. Even more, The Joint Commission, Division of Health Care Improvement, has condemned lateral violence by stating “bullying has no place in healthcare.” In addition, The Joint Commission released an advisory of safety and quality issues listing the following forms of abusive conduct. These include: Verbal abuse Threatening, intimidating or humiliating behaviors (including nonverbal) Work interference – sabotage – which prevents work from getting done In addition, the five recognized categories of workplace violence include: Threat to professional status (public humiliation) Threat to personal standing (name calling, insults, teasing) Isolation (withholding information) Overwork (impossible deadlines) Destabilization (failing to give credit where credit is due) Types of Lateral Violence Overt lateral violence can include name calling, threatening body language, physical hazing, bickering, fault finding, negative criticism, intimidation, gossip, shouting, blaming, put down, raised eyebrow, rolling of the eyes, verbally abusive sarcasm, or physical acts such as pounding on a table, throwing objects or shoving a chair against a wall. Covert lateral violence is initially more difficult to identity and includes unfair assignments, marginalizing a person, refusing to help someone, making faces behind someone’s back refusing to work with certain people, whining, sabotage, exclusion and fabrication. The effects of nurse to nurse bullying For one thing, lateral violence leads to depression, the inability to focus, anxiety, burnout, post-traumatic stress disorder and sleep disturbances. In addition, victims of bullying have higher rates of work absences, plus lower rates of productivity due to stress and distraction (Townsend, 2016). According to a 2013 study performed by Longo, older nurses suffer the greatest effects of bullying. Older nurses are susceptible to cardiovascular, gastrointestinal, and skeletal disorders, as well as chronic headaches. Furthermore, victims are not the only ones to suffer the consequences of lateral violence. Alternatively, patients may feel the consequences through the lack of communication, teamwork, collaboration and leadership. According to the American Association of Critical-Care Nurses, unhealthy work environments contribute to increased hospital-acquired conditions and readmission’s. In addition, toxic environments promote the likelihood of errors, adverse patient outcomes and mortality. As a result, a hospital may end up with low patient satisfaction scores and decreased financial reimbursement. Lateral violence is often viewed as a “rite of passage” that builds resilience New grads often bypass this type of behavior by trying to build tough skin. However, does having “tough skin” protect the victim from their emotions within. Let’s explore what the new grad or returning nurse might do to avert lateral violence: First, admit to yourself that you’re hurting and something is wrong. Many victims dismiss or minimize the event, or even blame themselves. Resist the temptation. If it feels bad, it is bad. And if you allow this behavior, that person is sure to repeat it, not because he or she a bad person, but because they doesn’t realize their behavior is wrong. Here are five keys to responding appropriately to lateral violence in the workplace: Manage your emotions. Self-awareness is crucial in managing your emotions and your responses. First of all, take time-out and calm yourself. If you try to deal with the perpetrator while upset, you’re likely to behave unprofessionally. Use empathy. Try to find out where the person’s behavior is coming from to help you understand what’s triggering his/her bad behavior. Bad behavior reflect poor self-esteem and serves as a wall to keep others out. Bad behavior is learned behavior. Someone who behaves badly has learned this behavior brings some kind of reward such as power or attention. An appropriate response may be, “I’ve noticed you’ve been more impatient lately. Are you okay? Is there something going on I should know about?” Assert your boundaries. Asserting your boundaries tells others what behaviors are unacceptable. If you say nothing, your silence implies the behavior is acceptable. Rather, tell the person directly that her behavior is inappropriate, such as, “Please lower your voice.” “Did you realize you were yelling?” Make direct request. Tell the person directly how you want to be treated or how the two of you can work together. Try to establish a mutual goal for you both to work on. “Would you tell me how you would like me to do this procedure better rather than reporting me to the unit manager?” “In response, I will try to listen to you and do the procedure in a way that you like.” Reach out to others. Ask others for help. A mediator is someone who may be able to negotiate between to people. Choose a mediator that knows the perpetrator on a personal basis. The mediator will be able to address the situation with empathy and therefore, resolving a difficult situation without creating a war. Be careful, choose the right mediator that can accomplish resolution. The wrong mediator can create a war. Methods to avert workplace bullying Experienced nurses have demonstrated their concerns regarding difficulty communicating with new grads or transitional nurses. These are a few of their concerns: Nurses report that new grads portray a sense of “all knowing.” This is particularly annoying for seasoned nurse who are trying to mentor the new grad. In addition, nurses report that new grads portray a sense of “entitlement.” This is also particularly annoying for seasoned nurses who have earned their privileges. Next, nurses report that new grads are “lackadaisical.”  This is also particularly annoying for the seasoned nurse to mentor a new grad with no enthusiasm and puts forth a half-hearted effort. Lastly, New grads, if you ask for help, be ready. If you’re asking for IV insertion help, have all equipment ready so that the mentor doesn’t have to do the leg-work of retrieving catheters, tubing, arm boards etc. Here are some actions you can take if you are the victim of lateral violence. It’s up to you to set your boundaries. If you fail to do this, you create a situation cloaked in ambiguity. If a clear line isn’t drawn, you’ll never know when it’s crossed, which will cause you grief down the road. By setting a clear boundary and making what is clear to the aggressor, you are removing any possible vagueness that could seep into your interactions. You need to ask yourself “how far is too far?” as well as ask yourself “when exactly does this become bullying?” Parameters need to be identified first to fix any problem – the playing field needs to be clearly marked. If the rules are never clarified, how will anyone know whether the rules have been broken? Document…

How I Survived ACLS

Before I begin to describe how I survived ACLS let me remark on the impact of the initial American Heart Association ACLS class in the early 1990’s As the owner of Nurses Educational Opportunities, a recognized American Heart Association ACLS, BLS and PALS certification provider, I have come across countless of veteran nurses who remain scarred, particularly, by the first-ever Advanced Cardiovascular Life Support class (ACLS). In fact, the trauma many nurses experienced inspired a T Shirt with the statement, I survived ACLS. Aside from my own experience, I often ask nurses what is was that made ACLS so difficult. Reasons why nurses find the ACLS course difficult include: The EKG Interpretation portion of Advanced Cardiovascular Life Support. Testing for a class that is hardly utilized in a specific field. Having physicians teach the course. Further, having to perform skills in front of the entire class while being berated by instructors. ACLS comes with a TON of responsibility Most notably, there is a high expectation that if you are in a cardiac arrest situation, you should know what to do. At that moment of a patient’s care, you need to be confident in your knowledge and skills for the reason that someone’s life is on the line if you are not prepared. Nurses Educational Opportunities understands that not all nurses required to complete the AHA ACLS class actually utilize ACLS. Nonetheless, all nurses, regardless of their chosen field, must be aware of CPR and Advanced Cardiovascular Life Support practices. Rather than teaching a course to get nurses through the day, Nurses Educational Opportunities works hard to facilitate the information to promote long term retention. This is what makes our organization unique. However, not every nurse receives the ACLS experience they deserve. In fact, neither did I prior to opening my own continuing education center. Here is my story. The story of how I survived Advanced Cardiovascular Life Support On the Telemetry Floor, there was Pam. Pam was our charge nurse. She was our matriarch. When she was in charge, all was good. If ever our patients began to deteriorate, she was right there helping us to stabilize the patient. After report she always stated, “OK you guys, let’s GO and SAVE LIVES.” Because of Pam we had the glue that kept us together. One day the “higher ups” sent a memo to the Telemetry Floor announcing that we were to become certified in the dreaded AHA ACLS. We looked at each other with shear fear. “What are we going to do?” we asked each other. Afterwards, we learned of a good ACLS presented at Pomerado Hospital. Therefore, we all decided to sign up for the Pomerado Hospital’s Advanced Cardiovascular Life Support course. When we arrived at the hospital we saw nurses sitting on folding chairs in the middle of a large room. As we approached to find a chair the other nurses said, “You’ll have to get your own folding chair from over there,” pointing to a stack of folding chars. The cluster of nurses grew larger in the middle of the room. A woman appeared and made her way to the middle of the cluster.  She began to speak, “If I say something three times, it is a test question.” Subsequently we began to listen.  Our pencils poised to our notebooks on our laps. Soon there after…. After a dreadful lecture we were given a break then we were to return for the “skills labs.” The first skill station was determining EKG rhythms. Tables and chairs lined the room. We sat facing a large monitor at the front of the room. An instructor prompted when the bell rang a rhythm would be presented and it was our job to determine the rhythm. They had given us 10 seconds to identify the rhythm before the bell would ring again and another EKG rhythm would appear. There were about 25 rhythms to identify. Next, we were instructed to place our answers on the score sheets provided. We then progressed to the Airway Skills Station. Manikin heads lined up along a long table. Everyone went from head to head and demonstrated placement of oropharyngeal and nasopharyngeal airways as well as bag/mask ventilation. Last we had to demonstrate ET tube placement. Upon completion of the skills nurses who successfully performed became “checked off”. Finally… Afterwards, we were directed to another building for our Mock Code Simulation. Upon arriving at the designated building we had to line up single file at the door. By the time I arrived the line extended down the side and around the building. Like lining up to get into a theater. Inside the building we were told that there were three stations. Each station had an instructor to evaluate the nurse on her ability to call the code and recite the interventions of what the instructor was prepared to “nail us with.” We stood in line a long time. “Hey, someone fainted.” While in line, someone alerted the line “Hey, someone fainted.” I stepped out of line to see who fainted. IT WAS PAM!!! As Pam neared the entrance of the door, she panicked and passed out! Holy Cow, if Pam panicked, “What in the world was behind the closed door?” Trembling I entered “the room.” But the instructor was kind or just plain weary from all the nurses to be checked off and I PASSED my first AHA ACLS class!! The goal of this entire event was to inject FEAR. They succeeded this with even the strongest, Pam!! Becoming a BLS Instructor Soon I returned to the Telemetry Floor with a bright and shiny Advanced Cardiovascular Life Support card full of confidence and renewed energy. The CPR Coordinator, Cindy,  sent out a Memo that stated she was hosting a BLS Instructor class for RT’s and if any RT was interested, they should sign up. I wanted to take the class but I wasn’t an RT. I asked Cindy if I could be part of her BLS Instructor Class. “NO,” she snapped, “It’s just for my RTs” “Please” I said,” “No” she snapped, “I said it was just for my RT’s.” I’m kinda a persistent chick, “I’ll try again,” I thought. A week later I approached Cindy again. “Please, please, please, Cindy can I be in your BLS Instructor class?” “No” she again snapped, “I told you that the class was just for my RT’s” “Please Cindy” I said. “I said NO,” she barked. However a week or so later, Cindy sent a Memo to the Telemetry Floor stating that she was planning to place a manikin in a bed in a patient’s room. When the nurse assigned to this patient arrives, Cindy would be sitting in the bedside chair and evaluate the nurse on her skills to “Call the Code.” I had a plan. Putting the plan in play Meanwhile I told the charge nurse “Pull that little scheme on me” “I would shine. “I would make our unit look good, but I have only one request,” I said. “Pull it on me next Tuesday, I will be prepared,” she agreed. Tuesday came and I was prepared.  Reporting and ready for the floor. I Noticed all nurses seemed to be extra quiet. However, I knew why they were quiet. On the other hand they didn’t know that I knew what was about to happen. Down to my last patient I took my report. The report stated: admitted last night from the ER with ‘chest pain and bla bla bla.”  At that point I knew that was the manikin and Cindy was waiting at bedside. Pulling back from my chair I announced “Everyone have a good shift.” Still there was silence. I approached the room to find the door shut! No one ever shut the patient room doors. There was a feeling of nurses watching me. I opened the door. There was Cindy. Without looking at the bed I said, “Well Cindy, welcome back from vacation. How was your vacation?” “Fine, Jane” she said, without a smile. I then looked at the manikin in the bed and jumped into action. “Are you OK, are you OK” as I placed my hands on the manikin. “Code Blue, Code Blue.” Then I went to the door and bellowed “Code Blue, Code Blue.”  I returned to the manikin and began chest compression’s. A nurse came to the room and I told her to Bag the Patient. When another nurse arrived and I told her to hang a big bag of normal saline. Next nurse arrived with the Crash Cart and I told her to hook up the patient to the monitor. When he last nurse arrived and I told her to draw up 1mg of Epi. Cindy gets up from her chair and says, “Well Jane that was pretty good.” “Thank you, Cindy” I said. As Cindy was leaving the floor, I said “Now can I be in you CPR Instructor class?” “I’ll see,” she mumbled and hustled down the hall with her heels clicking on the hardwood flooring and her white coat flapping the breeze. That afternoon Cindy came back to the floor and said “I’ll let you in my BLS Instructor Class.” “Holly crap!” all that just to take a BLS Instructor class!! But, I had become proficient on  how to call the code and designate the task in a Code Blue. Thus becoming a BLS Instructor. On to becoming an Advanced Cardiovascular Life Support Instructor Some time after, the CPR coordinator was later replace by Shelly.  Shelly was an RN that I had worked with on the Telemetry floor.  I found Shelly in an office area of the accounting room – no more room than a closet! Shelly didn’t have the spacious office space that Cindy had. “Shelly,” I said “this is your office?!!” She looked up at me and curled her lip and frowned “I guess.” “What can I do for ya” she asked. “I would like to take your ACLS Instructor Class,” I remarked. “Sure,” she said. “Holy Cow,” I thought, “that was easier than signing up for BLS Instructor class.” I took Shelly’s ACLS class for instructors. When she taught she made the class so fun yet “learn-able.” When she presented the Code Blue call, I remember her with a long over-sized patient robe running around like Abbott and Costello. She was funny, as a result her class was enjoyable. “When I teach ACLS,” I thought, “I want to make my classes enjoyable. Soon there after I became a skills instructor in her classes. Occasionally she was ask me to help instruct along side her.  In conclusion I made myself available for her classes. When working on the Telemetry Floor, we were often asked to “float.” No one liked to float. But I stepped up to the plate when the Charge Nurse announced “Who wants to float to the NICU?” “The NICU is a place where nurses are warm and fussy,” I thought. I floated to the NICU many times and determined this may be a better place for me. When an opening became available in the NICU, I applied. They knew me and I knew them. Progressing to the NICU In the NICU, I had to take NRP (Neonatal Resuscitation). I passed NRP and again wanted to become an instructor for NRP.  The matriarch of the NICU, Marty seemed to have doubts of my ability to teach NRP. Marty was the Queen of the NICU. She had wrapped up 35 years in the NICU. She knew everything. Marty reluctantly agreed to check me off on my presentation.Marty observes my first NRP Skills course.  During the session I became really frustrated because Marty consistently interrupted with her own thoughts. I became so disgruntles with so many interruptions, I said in complete frustrations “You teach this damn class, you seem to want to anyway.” Marty sanctioned me as an instructor! “OMG how did that happen?” During my NICU experience, Cindy called. (Remember Cindy, the CPR Coordinator?) She wanted…

The Baby Friendly Initiative History

Congratulations Southern California Nurses, for your efforts in promoting the Baby Friendly Initiative. Hospitals and Maternal-Child Health departments have set a powerful example for women nationwide. To summarize, in 2007 only 29% of USA hospitals used breastfeeding measures. By 2013, this percentage increased to 54%. Additionally, in California, rates increased to as much as 94% for some breastfeeding and 70% for exclusive breastfeeding. Indeed, the attainment of Baby Friendly designation has proven to be a strenuous, but worthwhile journey. More than one million infants die worldwide every year because they are not breastfed exclusively for 6 months.  If 90% of babies were breastfed exclusively for 6 months, 911 lives could be saved. In addition, $13 billion could be saved in healthcare costs.  What is the Baby Friendly Initiative? The Baby Friendly Initiative was launched worldwide in 1992 in collaboration with WHO and UNICEF as a quality improvement project. This initiative is a global effort that encourages governments to develop and implement a policy on infant feeding. To clarify, hospitals who provide a positive environment for breastfeeding receive the coveted Baby Friendly recognition.  This process is not easy! Hospitals, must work rigorously to implement strict standards as outlined by the Ten Steps to Successful Breastfeeding. Secondly, healthcare staff must ensure that breastfeeding rates remain above a certain percentage to retain Baby Friendly status.  Most notably, the goal is to empower healthcare workers with appropriate education to provide effective breastfeeding counseling. What does it mean to be a Baby Friendly Hospital? Baby Friendly designation means that maternal child health departments have successfully implemented the Baby Friendly Initiative’s Ten Steps to Successful Breastfeeding. In short, these steps include: providing appropriate education to enable mothers to make informed decisions about infant nutrition; also, encouraging skin-to-skin immediately following birth; and offering Lactation Specialist services throughout and beyond the hospital stay. Not only does this initiative help to reestablish optimal infant nutrition, but it has also proven to improve health outcomes in developed countries. In summary, the risks of formula feeding for infants include: an elevated risks of childhood obesity; type 1 and type 2 diabetes; leukemia; and sudden infant death syndrome. Moreover, in women, the lack breastfeeding increases the incidence of: pre-menopausal breast cancer, as well as, ovarian cancer; retained gestational weight gain; type 2 diabetes; myocardial infarction; and metabolic syndrome. Southern California hospitals who implemented the Baby Friendly Initiative It is essential for California obstetrical nurses to continue protecting breastfeeding and maternal-child bonding. The percentages of breastfeeding varied among all California hospitals. Below is a summarized list of Southern California hospitals who have: successfully implemented the Baby Friendly Initiative and Ten Steps to Successful Breastfeeding; or, met the Healthy People 2020 Breastfeeding Objectives; including, hospitals who promote the International Code of Marketing of Breast-Milk Substitutes. California hospital feeding rates are acquired from Genetic Newborn Screenings collected within 24 hours after birth. This data does not accurately reflect ongoing breastfeeding after 24 hours of birth. Alternatively, this data does indeed demonstrate that the proponents of Breastfeeding have been successful in their efforts to communicate the value of Breastfeeding to the community. For more information on breastfeeding rates visit the California’s Department of Public Health website. Hoag Hospital Some breastfeeding = 96% Exclusive breastfeeding = 75% St. Jude Medical Center Some breastfeeding = 93% Exclusive breastfeeding = 63% St. Joseph Hospital Some breastfeeding = 94% Exclusive breastfeeding = 80% UC Irvine Medical Center Some breastfeeding = 91% Exclusive breastfeeding = 70% Community Hospital of  San Bernadino Some breastfeeding = 90% Exclusive breastfeeding = 65% Arrowhead Regional Medical Center Some breastfeeding = 88% Exclusive breastfeeding = 77% Loma Linda University Medical Center Some breastfeeding = 92% Exclusive breastfeeding = 71% Kaiser, San Diego Some breastfeeding = 97% Exclusive breastfeeding = 79% Palomar Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 72% Paradise Valley Hospital Some breastfeeding = 96% Exclusive breastfeeding = 72% Scripps Memorial Hospital, Ecinitas Some breastfeeding = 97% Exclusive breastfeeding = 91% Scripps Memorial Hospital, La Jolla Some breastfeeding = 98% Exclusive breastfeeding = 87% Scripps Mercy Hospital, Chula Visa Some breastfeeding = 96% Exclusive breastfeeding = 83% Scripps Mercy, San Diego Some breastfeeding = 96% Exclusive breastfeeding = 85% Sharp Chula Vista Some breastfeeding = 95% Exclusive breastfeeding = 73% Sharp Grossmont Some breastfeeding = 94% Exclusive breastfeeding = 72% Sharp Mary Birch Hospital Some breastfeeding = 92% Exclusive breastfeeding = 81% Tri-city Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 74% UC San Diego Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 75% The history of breastfeeding The history of breastfeeding is a fascinating topic. In the beginning breast milk was the only available food for infants. Wet nurses served as alternatives when mothers became ill or passed away. Subsequently, the industrial revolution took place and the need to work caused women to separate from their infants. Wet nurses became a commodity and thus desired or required by many people. As a result, the cost of their services increased. As a matter of fact, early in the 20th century, the attainment of a wet nurse served as a status symbol for the wealthy. For disadvantaged mothers, “dry nurses” irrupted. However, dry nurses often fed newborn infants pablum, an inadequate form of nutrition for infants less than six months of age. Furthermore, the proliferation of American Hospitals in the late 1800’s to early 1900’s further caused a divide between mothers and their own breast-milk. During this time hospital’s advertised their environment as a safer and cleaner place to deliver infants compared to midwives. Anti-midwife and wet nurse propaganda further antagonized their reputation. Articles and posters such as these left a bad taste in people’s mouths. Consequently, society began to shift away from longstanding maternal care practices. In addition, advances to formula feeding further led to the substitution of artificial feeding. As a result, formula milk became known as scientifically superior to breast milk and formula companies were born. The Maternalist Movement The Maternalist movement began with a group of women who wanted to “clean up the environment.” Overall, these reformers encouraged wives and mothers to make the world a safer and cleaner place to live in. Technology provided that possibility in regards to infant nutrition. Well-off mothers could take pride in providing the latest nutritional technology for their babies, whereas underprivileged women could not afford bottles or formula milk. Over time, breastfeeding became associated with uneducated and low income women. On the other hand, formula feeding became affiliated with more civilized, well-off, and conscientious mothers, Additionally, maternalists were enthusiastic about scheduling. They encouraged women to run their home in a clean, organized manner with a passion for scheduling babies. In fact, their motto was “A good mother is a scheduling mother.” According to the standards of the movement, Breastfeeding was to occur only during certain hours of the day. For example, they encouraged four hours of rest between feedings and not at all during nighttime hours. Lastly, this movement unknowingly supported formula milk by causing lactation insufficiency, therefore prompting mothers to turn to formula feedings. Formula promotion In the 1960’s and 1970’s aggressive formula promotion led to wide-spread abandonment of breastfeeding. In addition, companies enlisted hospitals and healthcare professionals to distribute formula by providing free samples. Being that formula was expensive, mothers often diluted the compound to make it last longer. Consequently, many infants died of malnutrition and infections. Moreover, the rapid increase of infant mortality rates in 1974 inspired the United Kingdom to publish “The Baby Killer,” which documented the horrific results of formula feeding. In particular, this booklet exhibited graphic images of malnourished infants and starving infants. Even more, in the past, the United States government went to extreme measures to support formula manufacturers and lobbyists; for the reason that it preserved the US economy. The national battle between Breast Milk and Formula Milk Most noteworthy, in response to the associated risks of formula milk the World Health Organization developed the Who Code, also known as International Code of Marketing of Breast-milk Substitutes. To summarize, WHO’s international health policy declares that the advertisement of formula products are unethical and causes harm to infants. Therefore, formula milk sales or free handouts should be legally restricted. Other proposals of the WHO code include: Restriction of free formula samples given by the hospitals Removal of misleading labels that suggest formula is healthier than breast milk Prevention of marketing through healthcare providers that idealize bottle feeding. Furthermore, the Carter administration, which governed from 1977-1981, was pro-code. In contrast, the Reagan administration opposed the policy due to the fact that it would impact American Corporations. In 1981, under the Reagan administration, the U.S cast the only vote against the WHO code. Formula lobbyists were behind the decision to reject the code. As a result, the U.S. became the leader in restricting formula marketing strategies. During this time Nestle was the largest manufacturer of formula products. The international battle between Breast Milk and Formula Milk Each nation had the option to implement or reject The WHO Code. The results were: 118 countries adopted the code. 3 countries abstained 1 country voted against the Code – that was the U.S. Most notably, the United States government argued the WHO code by using the prospect of antibiotics and clean water supplies to continue making safe and viable formula. The U.S. stands alone as the one modern democracy that has not found a way to reconcile its financial, political, and philosophical concerns. The Code does not restrict manufacturing, sales and use of formula, it is only about marketing. Currently, most nations have legislation to enforce the code, while the U.S. does not. In addition, all major formula companies claim to be Code compliant, but according to a watch dog group (IBFAN), none are. How formula makers get around the law Direct marketing through healthcare facilities with free samples is still legal and commonly seen. In actuality, it is not really free. Formula companies simply increase the cost of formula powder to offset the “free samples.” Other examples include: Similac sponsors the web site Enfamil sponsors WebMD Nestle sponsors “World Breastfeeding Week” and all materials are adorned with formula company logos. Moreover, when disasters occur the American Red Cross arrives with formula sponsored by companies to save the day. This cost of formula milk Formula feeding and all that needs to be purchased can consume 25-50% of the family income. These include: The purchase of formula The purchase of bottles and nipples The healthcare cost of childhood conditions that breast milk could have prevented Also, breastfeeding contributes to natural birth spacing which can decrease unwanted pregnancies. Global strategies to improve breastfeeding rates The Global Strategy urges that hospital routines and procedures remain fully supportive of the successful initiation and establishment of breastfeeding through the Baby Friendly Initiative. Including: Reassessment of Baby Friendly designated facilities. Expanding the Baby Friendly Initiative to include clinics, health centers, and pediatric hospitals. Furthermore, all governments should develop and implement a comprehensive policy on infant and young child feeding; in the context of national policies for nutrition, child and reproductive health, and poverty reduction. All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months. In addition, healthcare workers should ensure the timely introduction of adequate and safe complementary foods, certainly, with continued breastfeeding for up to two years or beyond. Healthcare workers should be empowered to provide effective feeding counseling. Additionally, their services should be extended in the community by trained lay or peer counselors. Also, governments should review progress in national implementation of the International Code of Marketing of Breast Milk Substitutes. Similarly, new legislation or additional measures should be created to protect families from adverse commercial influences. Last but not least, governments should enact imaginative legislation protecting the breastfeeding rights of working women, to include, establishing a means for its enforcement in accordance with international labor standards. So far, the best strategy for improving breastfeeding rates has been the Baby Friendly Initiative. Although other strategies exist and…