Literature Review in Nursing Research
Literature Review in Nursing Research
For this literature review, a specific nursing topic is chosen and a question formulated out of it. The question belongs to the field of maternity or breastfeeding. Based on five journal articles, this paper will attempt to answer the question of how maternity care and breastfeeding can benefit both mothers and their babies.
The reason for choosing this topic is because mothers are in a difficult time in their pregnancies and would surely need all the support they can get. Maternity care varies in many places and some women do not feel the need for maternity care. Thus, this paper tries to explore the advantages and benefits of maternity care. Breastfeeding on the other hand, is strongly advised for mothers. There are many proven benefits of this and this paper will try to find some of these benefits.
Many women have their reasons in not using maternity care in hospitals or not breastfeeding their baby. Among the reasons for not using maternity care are poor quality of care offered by maternity clinics and mothers having no access to such care. Mothers also do not breastfeed their babies for many reasons, bordering from physical defects on mothers part or being afraid of having their breasts get bigger and saggy from breastfeeding their babies.
Article 1: Nurse-supported Breastfeeding Promotion: A Framework for Economic Evaluation.
The objective of this article is to supplement other recent works describing economic evaluation in nursing. First, cost-benefit and cost-effectiveness evaluations of nursing interventions generally are discussed. Also included is information about how these concepts can be applied in nurse-staffed breastfeeding interventions and lessons learned in evaluating the economic implications of nurse-staffed breastfeeding interventions. Thus, breastfeeding promotion is the exemplar that will aid in the development of a basic understanding of cost-effectiveness analysis applicable for use in any programs involving nurses.
While direct opposition to breastfeeding support (or any nurse-administered intervention to promote positive health behaviors and improve quality of life) is likely to be limited, the degree of support may vary quite substantially depending on how different groups are affected. For breastfeeding, formula manufacturers are the group most likely to lose as a result of a breastfeeding intervention.
Developing clear and strong political support for funding new breastfeeding interventions that will provide additional opportunities for nurses and have a positive impact on public health has the potential to lead to the adoption of strategies in spite of interest group arguments against promotion. Other nurse-administered interventions may have similar political considerations and similar opportunities for adoption if they are strongly economically justifiable.
This article is helpful to mothers especially in making them aware that there are organizations that help promote breastfeeding. Aside from that, these organizations can educate the mothers in the importance of having their babies breastfeed.
Article 2: Breastfeeding Continues to Increase Into the New Millennium.
Breastfeeding has always posed serious difficulties for a tiny minority of women. They or their babies may have been too ill for breastfeeding or may have had a physical defect that made effective nursing impossible. A hypoplastic breast, for instance, has not developed correctly and will not produce milk normally. This usually affects only one breast, however, and nursing is still feasible, albeit lopsidedly. Regardless of how many women could breastfeed, a considerably smaller number actually decide to, and fewer still continue for any length of time.
Despite these many difficulties, there are still some women who continue to breastfeed. In fact, according to a study, these figures are increasing. This study tried to update the reported rates of breastfeeding through 2001 and compare rates in 2001 to those from 1996.
The Ross Laboratories Mothers Survey (RLMS) is a large, national survey designed to determine patterns of milk feeding during infancy. Questionnaires were mailed each month to a representative sample of mothers when their infant was 1 month of age, 2 months of age, 3 months or age, and so forth.
In 1996, approximately 744 000 questionnaires were mailed, and in 2001, 1.4 million questionnaires were mailed. Mothers were asked to recall the type of milk fed to their infant in the hospital, and during each month of age. Two categories of breastfeeding were considered: breastfeeding (human milk or a combination of human milk and formula or cow's milk) and exclusive breastfeeding (only human milk). Rates of breastfeeding and exclusive breastfeeding in the hospital and at 6 months of age were evaluated.
In 2001, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months of age in the United States reached their highest levels recorded to date, 69.5% and 32.5%, respectively. Comparing rates in 2001 and 1996, increases in the initiation of breastfeeding and continued breastfeeding to 6 months of age were observed across all sociodemographic groups but were greater among groups that have been historically less likely to breastfeed: women who were black, younger ( <20 years of age), no more than high school-educated, primiparous, employed at the time they received the survey, and who participated in the Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Breastfeeding in the hospital and at 6 months of age was most common in the Mountain and Pacific states and among women who were white or Hispanic, older, college-educated, and were not enrolled in WIC. Mothers most likely to practice exclusive breastfeeding in the hospital (46.2%) and at 6 months of age (17.2%) had a similar sociodemographic profile as mothers who breastfed their infants.
The results concluded that if increases in breastfeeding continue at the current rate (approximately 2% per year), in-hospital breastfeeding in the United States should meet or exceed the Healthy People 2010 goal of 75% for the early postpartum period. However, the Healthy People 2010 goal for continued breastfeeding to 5 to 6 months of age (50%) may not be reached in every subgroup. To ensure that these goals are achieved, educational and promotional strategies for breastfeeding must be continued to support mothers who are young, less educated, and participating in WIC.
Article 3: Breastfeeding and Infant Growth: Biology or Bias?
Available evidence suggests that prolonged and exclusive breastfeeding is associated with lower infant weight and length by 6 to 12 months of age. This evidence, however, is based on observational studies, which are unable to separate the effects of feeding mode per se from selection bias, reverse causality, and the confounding effects of maternal attitudinal factors.
A cluster-randomized trial in the Republic of Belarus of a breastfeeding promotion intervention modeled on the World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative versus control (then current) infant feeding practices.
In this study, healthy, full-term, singleton breastfed infants (n = 17 046) weighing [greater than or equal to] 2500 g were enrolled soon after birth and followed up at 1, 2, 3, 6, 9, and 12 months old for measurements of weight, length, and head circumference.
Data were analyzed according to intention-to-treat, while accounting for within-cluster correlation. To assess the potential for bias in observational studies of breastfeeding, we also analyzed our data as if we had conducted an observational study by ignoring treatment, combining the 2 randomized groups, and comparing 1378 infants weaned in the first month and those breastfed for the full 12 months of follow-up with either [greater than or equal to] 3 months (n = 1271) or [greater than or equal to] 6 months (n = 251) of exclusive breastfeeding.
From this data, it is suggested that prolonged and exclusive breastfeeding may actually accelerate weight and length gain in the first few months, with no detectable deficit by 12 months old. These results add support to current WHO and UNICEF feeding recommendations. Our observational analysis showing faster weight and length gains with early weaning and slower gains with prolonged and exclusive breastfeeding may reflect unmeasured confounding differences or a true biological effect of formula feeding.
Article 4: Does Breastfeeding Affect the Health of HIV-Positive Women? Studies Disagree.
This article presents two recent studies that yield contradictory findings on whether the decision to breastfeed affects the health of HIV-infected women. In one study, a secondary analysis of data from 397 seropositive new mothers in Nairobi, Kenya, women who were randomly assigned to breastfeed were three times as likely to die within 24 months of delivery as were those assigned to formula-feed. (1) Moreover, infants born to HIV-infected women who died had an elevated risk of dying before their second birthday, even after the researchers controlled for whether the infant was infected with HIV.
The author of a related editorial points out several problems with interpreting the results of this study, including the fact that breastfeeding’s effect on mortality among HIV-infected women was an ad hoc hypothesis; that women randomized to breastfeed had a higher median viral load at enrollment in the study, and that data on women's clinical progress and information on their actual feeding practice--as opposed to the one they were assigned to adopt--are missing. She concludes that the study "would benefit from being complemented by a creative analysis of actual feeding practice to further explore this complex issue.
In the other study, also a secondary analysis, data collected from 566 seropositive mothers in Durban, South Africa, showed no significant difference at the univariate level in mortality by 15 months postpartum between women who chose to breastfeed and those who elected to give their infant formula. (2) Further, multivariate logistic regression found no significant difference in morbidity, even after baseline CD4 counts and hemoglobin levels were controlled for.
The researchers note that their data provide no evidence of "deleterious effects of breast-feeding on the health of seropositive women." They conclude that "the counseling provided to HIV-infected women on feeding choice should continue to be based on current recommendations of UNAIDS.”
Article 5: Breastfeeding, Bonding and the Mother-Infant Relationship.
Researchers have become increasingly interested in the physiological and immunological aspects of breast milk while largely ignoring the psychological experience of breastfeeding. Although nursing mothers report that feedings furnish not only nutritional but also social and psychological nourishment for them and their infants, the possible link of breastfeeding to the development of maternal bonding and the mother-infant relationship has received little research. This study specifically tried to study on this.
The present study addresses the role of breastfeeding compared with bottlefeeding in the development of the maternal bond and the relationship of the mother-infant dyad. Two alternative theoretical models frame the research: the bonding hypothesis and the good-enough caregiving hypothesis. This article describes the experiences of mothers with breastfeeding their babies.
The current study reminds us that maternal care is a complex set of behaviors and attitudes, robust enough to persist and remain adequate despite minor deviations from its original or natural form. These findings are socially relevant for bottlefeeding mothers and nonmaternal caregivers, who may worry about or face criticism regarding their ability to develop high quality relationships with their children.
From the five articles, it can be concluded that there is an increasing number of women who have been breastfeeding their babies. Along with this increase in mothers who breastfeed their babies is also the emergence of organizations that promote and support breastfeeding in women. Among the benefits of breastfeeding that are mentioned in the studies include accelerating weight and length gain of the baby in the first few months. Most importantly, breastfeeding has been seen to help improve the relationship between mothers and their babies.
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