Cultural Diversity and Breastfeeding Sue O’Dell NP-BC, IBCLC Debbie Pierce NP-BC, IBCLC
Cultural Basis of Breastfeeding • Socialization to breastfeed or not • Childhood experiences • Reconcile new behaviors (feed on demand) with cultural norms (scheduled feedings)
Common Themes Policy and medical practice contribute to infant feeding behaviors such as supplementation and early weaning Early patterns may affect the duration of exclusivity and any breastfeeding Education can only go so far, as postpartum support is vital Mothers may not seek support due to lack of awareness, availability or knowledge of an acceptable alternative (formula)
Hispanic Culture • 15% of the population • 80% ever breastfeed • Little exclusivity • Highest incidence of obesity • Initiation highest when less acculturated
Hispanic Culture • Influenced by previous experience • Tolerance for crying “no llora con hambre” • “Los dos” • Return to work or separation from mother • Embarrassed to feed in public • Colostrum may be considered dirty or “stale” • Stress may sour the milk
Asian Culture • “Doing the month”-addresses the imbalance caused by blood and heat loss at birth • Encouraged to stay in • Influenced by husband and mother-in-law • Belief that supplements are beneficial
African American Culture • Lower initiation • Shorter duration • Fears about pain • Inadequate time • Uncomfortable • Incompatible with personal health habits (smoking)
What Can We Do? • It is important to provide someone who speaks the language • All women have the same fears, concerns, frustrations and insecurities • Member needs to be heard before we attempt to fix the problem
What can we do? • Provider encouragement prenatally • Discuss benefits of breastfeeding for mom and baby • Include influential family members in discussions about breastfeeding • Ask about “los dos” • Discuss risks of formula
Questions to Ask • How are your feeling about your baby’s breastfeeding pattern? • How are you feeling about breastfeeding? • How do you feel about the suggestions I have made today?
Resources • Academy of Breastfeeding Medicine • Protocols in English, Spanish, Japanese, Korean, German and Chinese on various topics • www.bfmed.org
Resources • La Leche League • www.lalecheleague.org • Click on appropriate language in the welcome heading • Go to country heading for more information in a different language • This link is being added to the AVS under the breastfeeding information.
Resources Breastfeeding Support Line: 303-636-2929 PHHC
Resources Needed • We are looking for KP staff to become CLCs! • No medical training needed • Allow increased postpartum support to members of all cultures • Provide expertise at Breastfeeding Support Groups
What’s the Confusion? Deep, radiating breast pain and burning nipple pain is yeast-right? It’s on the internet! It’s thrush-OR IS IT???
Symptoms of Thrush Burning pain Itching Shiny, flaky skin on the nipples/areola Deep, shooting pain in the breast BUT. . .
These symptoms can also be: Poor latch Sucking issue in the baby Tongue tie Vasospasm Raynaud’s phenomenon Eczema Allergic dermatitis Psoriasis Bacterial infection Damage from pumping
American Academy of Breastfeeding Medicine • Clinical Protocol #4-Mastitis • Information on burning nipple pain is evolving • May be candida • Diagnosis is difficult • Exam may be normal • Milk culture not reliable • Staph aureus may be present
Does Candida and/or Staphylococcus Play a Role in Nipple and Breast Pain in Lactation? Amir, L, et al., BMJ, March 2013
Candida Mastitis: A Case Report Hanna and Cruz, The Permanente Journal, Winter 2011
A Prospective Study of Fluconazole Treatment for Breast and Nipple Thrush Moorhead, Amir, O’Brien and Wong, Breastfeeding Review, November 2011
The Absence of Candida Albicans in Milk Samples of Women with Clinical Symptoms of Ductal Candidiasis Hale, Bateman, Finkelman, BF Medicine, June 2009.
History, Physical and Laboratory Findings and Clinical Outcomes of Lactating Women Treated with Antibiotics for Chronic Breast and/or Nipple Pain Eglash, et al., Journal of Human Lactation, 2006.
Kaiser Permanente Breastfeeding Coalition Recommendations Have patient consult with IBCLC/CLC at clinic, hospital, or PHHC to evaluate latch, feeding, nipples, breasts and infant for signs of thrush
Acute Mastitis Dicloxicillin first choice Clindamycin Vancomycin or Septra if MRSA suspected
Cracked Nipples Consider trial of oral antibiotics if deep cracks or fissures lasting several weeks or months May trial All Purpose Nipple Ointment available from the Kaiser Permanente Compounding Pharmacy
Continued Pain and/or Signs of Thrush Treat both mom and baby Oral Nystatin for infant Nystatin ointment for mom’s nipples QID after nursing for both mom and baby
If All Else Fails. . . Diflucan 150 mg po every other day for a total of 6 or more capsules OR Diflucan 200-400 mg PO STAT followed by 100-200mg daily for 2-3 weeks
Other Treatments Gentian Violet ½% aqueous solution applied to nipples and infant’s mouth QD for 3-7 days Good handwashing, boiling of items that come into contact with baby’s mouth, breast shields, shells, pump equipment Encourage mom to decrease sugars and yeast in diet. Encourage yogurts/acidophilus; Kefir-like probiotic drinks
Stay Tuned! Your Kaiser Permanente Breastfeeding Coalition will update you if new evidence comes forward to shed light on this very difficult and controversial issue for lactating women.