satisfaction/satiety cues and ways to determine whether the infant is getting enough breast milk (Brandt, Andrews & Kvale, 1998; Hill, Humenick, Argubright & Aldag, 1997; Matthews, Webber, McKim, Banoub-Baddour & Laryea, 1998). McCarter-Spaulding and Kearney (2001) conducted a descriptive correlational study that examined the relationship between parenting self-efficacy and the perception of insufficient milk. The results suggest that mothers who perceive that they have the competence to parent an infant also perceive that they have an adequate breast-milk supply. Self-confidence and the knowledge and skills related to breastfeeding can impact positively on breastfeeding duration (Blyth et al., 2002; Chezem et al., 2003; McCarter-Spaulding & Kearney, 2001). 35 Nursing Best Practice Guideline Recommendation • 3.3 Practice settings are encouraged to develop, adopt or adapt assessment tools encompassing key components for assessment and that meet the needs of their local practice setting. (Level of Evidence III) Discussion of Evidence Several assessment tools addressing various aspects of support and care of the breastfeeding mother and infant have been developed (Bar-Yam, 1998; Dennis & Faux, 1999; Hill & Humenick, 1996; Johnson, Brennan & Flynn-Tymkow, 1999; Matthews et al., 1998; Nyquist, Rubertsson, Ewald & Sjoden, 1996; Riordan, 1998; Riordan & Koehn, 1997; Schlomer, Kemmerer & Twiss, 1999). Furthermore, very little research has been conducted to compare various assessment tools in the area of breastfeeding. Riordan and Koehn (1997) initially compared three tools to measure breastfeeding effectiveness (Infant Breastfeeding Assessment Tool – IBFAT; Mother Baby Assessment Tool – MBA and the LATCH assessment tool) and found that further development/revisions and retesting were needed before recommendations for clinical practice could be made. Subsequently, Riordan, Bibb, Miller and Rawlins (2001) examined the validity of the LATCH tool by comparing it with other measures of effective breastfeeding and by determining its effectiveness in predicting breastfeeding duration to eight weeks postpartum. The results indicate support for the validity of the LATCH, however further testing of construct validity is warranted. Assessment tools also vary from setting to setting based on the time in the preconception to postpartum period in which the nurse is in contact with the mother and/or infant. This points to a need for assessment tools that are either comprehensive to meet the practice requirement at various times or the requirement of specific comprehensive tools for specific stages in the continuum. Additionally, there is a need for user-friendly and short assessment tools in order to facilitate use by practicing nurses. Appendix E provides some details regarding postpartum assessment tools. 36 Breastfeeding Best Practice Guidelines for Nurses Recommendation • 4 Nurses will provide education to couples during the childbearing age, expectant mothers/ couples/families and assist them in making informed decisions regarding breastfeeding. Education should include, as a minimum, the following: benefits of breastfeeding (Level I); lifestyle issues (Level III); milk production (Level III); breastfeeding positions (Level III); latching/milk transfer (Level II-2); prevention and management of problems (Level III); medical interventions (Level III); when to seek help (Level III); and where to get additional information and resources (Level III). The education provided by the nurse must take into account the social, economic and cultural factors of the expectant mothers/couples/families and be based on the principles of adult learning (AWHONN, 2000). Benefits of Breastfeeding (Level of Evidence I) Discussion of Evidence “It has been shown repeatedly in developed countries that one third to one half of women decide how they will feed their babies before they are pregnant” (WHO, 1998, p.23). In the antenatal period, health professionals should cover the importance of exclusive breastfeeding, the benefits of breastfeeding and basics of breastfeeding management, and ensure that women have not received group education on formula {artificial baby milk} feeding (WHO, 1998). The benefits of breastfeeding have been extensively documented in the literature and endorsed by several organizations and, as such, is the preferred method of infant feeding (AWHONN, 2000; CICH, 1996; Canadian Paediatric Society, Dietitians of Canada & Health Canada, 1998; Health Canada, 2000; Ministry of Health Manatu Hauora New Zealand, 1997; WHO, 1998). Breast-milk contains all the fluid and nutrients required for optimal growth (Heinig, Nommsen, & Peerson, 1993; Humenick, 1987; Tyson, Burchfield & Sentence, 1992; Woolridge, Ingram, & Baum, 1990). As discussed in the Background Context, recent studies in developed countries have provided evidence that breastfeeding protects against gastrointestinal infections and otitis media (Beaudry et.al., 1995; Canadian Paediatric Society, Dietitians of Canada and Health Canada, 1998; Howie et. al., 1990). Breastfeeding may 37 Nursing Best Practice Guideline give some protection against Sudden Infant Death Syndrome (SIDS), and a number of studies have suggested an association between breastfeeding and protection against SIDS. However, with the exception