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      <h1 id="top">1.1 Discussing breastfeeding</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study A</h3>
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			Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.
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			Would you discuss breastfeeding at this visit?
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		<dl><dt><a href="topic_1-1.html"><cite>Topic 1.1: Discussing breastfeeding</cite></a></dt><dd class="topic-paragraph">It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.</dd></dl>
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			Would you discuss breastfeeding at this visit?
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		Yes. While it is ultimately the mother who makes a decision regarding the method of infant feeding, she should make an informed decision with evidence-based information. Many women decide before or early in their pregnancy how they will feed their infant and the earlier they decide that they will breastfeed, the more likely they are to initiate and continue to breastfeed.<sup><a href="#note1">1</a>,</sup><sup><a href="#note2">2</a></sup>
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		<strong>Intention to breastfeed</strong>,<sup><a href="#note2">2</a>,</sup><sup><a href="#note3">3</a></sup> and <strong>intended length of breastfeeding</strong> <sup><a href="#note2">2</a>,</sup><sup><a href="#note4">4</a></sup> are the most powerful predictors of duration of breastfeeding. Additionally, there is a link between a doctor providing breastfeeding information, support and encouragement to women during the antenatal period and the rate of breastfeeding initiation <sup><a href="#note5">5</a>,</sup><sup><a href="#note6">6</a>,</sup><sup><a href="#note7">7</a></sup> and duration <sup><a href="#note6">6</a>,</sup><sup><a href="#note8">8</a>,</sup><sup><a href="#note9">9</a></sup>. Therefore, it is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.<sup><a href="#note10">10</a></sup>
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		The positive influence of doctors and other health professionals on breastfeeding initiation and duration is only effective if there is overt support and encouragement. Neutrality is perceived by mothers as simply disguised indifference to how the baby is fed and has a similar effect on breastfeeding initiation and duration as overtly negative views.<sup><a href="#note7">7</a>,</sup><sup><a href="#note11">11</a>,</sup><sup><a href="#note12">12</a></sup>)
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		Attending antenatal breastfeeding education  either as a separate class or as part of an antenatal education course, also increases breastfeeding initiation <sup><a href="#note13">13</a>,</sup><sup><a href="#note14">14</a></sup> and duration <sup><a href="#note15">15</a>,</sup><sup><a href="#note16">16</a></sup>. The inclusion of specific segments on correct positioning and attachment of the baby at the breast reduces the incidence of nipple pain and trauma.<sup><a href="#note15">15</a></sup> Providing women with a list of classes in their area, and encouraging them to attend, is recommended.
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        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#hegn03" title="See full details">#</a> Hegney D et al. (2003) The Toowoomba infant feeding support service project: Report on phase1 - A longitudinal needs analysis of breastfeeding behaviours and supports in the Toowoomba region.</li>
          <li id="note2"><a href="references.html#scot01" title="See full details">#</a> Scott JA et al. (2001) Factors associated with breastfeeding at discharge and duration of breastfeeding</li>
          <li id="note3"><a href="references.html#heat02" title="See full details">#</a> Heath A-LM et al. (2002) A longitudinal study of breastfeeding and weaning practices during the first year of life in Dunedin, New Zealand</li>
          <li id="note4"><a href="references.html#digi05" title="See full details">#</a> diGirolamo A et al. (2005) Intentions or experience? Predictors of continued breastfeeding</li>
          <li id="note5"><a href="references.html#lumc01" title="See full details">#</a> Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey</li>
          <li id="note6"><a href="references.html#lilz04" title="See full details">#</a> Li L et al. (2004) Factors associated with the initiation and duration of breastfeeding by Chinese mothers in Perth, Western Australia</li>
          <li id="note7"><a href="references.html#bent99" title="See full details">#</a> Bentley ME et al. (1999) Sources of influence on intention to breastfeed among African-American women at entry to WIC</li>
          <li id="note8"><a href="references.html#tave03" title="See full details">#</a> Taveras EM et al. (2003) Clinician support and psychosocial risk factors associated with breastfeeding discontinuation</li>
          <li id="note9"><a href="references.html#utak05" title="See full details">#</a> Utaka H et al. (2005) Breastfeeding experiences of Japanese women living in Perth, Australia</li>
          <li id="note10"><a href="references.html#brod07" title="See full details">#</a> Brodribb W et al. (2007) Identifying predictors of the reasons women give for choosing to breastfeed.</li>
          <li id="note11"><a href="references.html#digi03" title="See full details">#</a> DiGirolamo AM et al. (2003) Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions?</li>
          <li id="note12"><a href="references.html#coun83" title="See full details">#</a> Counsilmann JJ et al. (1983) Bivariate analyses of attitudes towards breast-feeding</li>
          <li id="note13"><a href="references.html#desh00" title="See full details">#</a> Deshpande AD et al. (2000) Breast-feeding education and support: association with the decision to breast-feed</li>
          <li id="note14"><a href="references.html#giug94" title="See full details">#</a> Giugliani ER et al. (1994) Effect of breastfeeding support from different sources on mothers' decisions to breastfeed</li>
          <li id="note15"><a href="references.html#duff97" title="See full details">#</a> Duffy EP et al. (1997) Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.</li>
          <li id="note16"><a href="references.html#pugi96" title="See full details">#</a> Pugin E et al. (1996) Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?</li>
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      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li class="current">1.1 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
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