An oversupply of milk can make feedings difficult for the mother and infant, and this should be remedied promptly. Offering only one breast per feeding and lengthening the feeding time can help, as can reducing milk volume before feedings by hand expressing. Breast engorgement can occur within the first few days after birth and must be handled properly to prevent plugged ducts and mastitis (infection). Other problems that can occur include a fungal infection (thrush), infant refusing to breast feed (nursing strike), and unhealthy infants. Medical help should be sought if these problems do not resolve quickly. Some women may feel uncomfortable breastfeeding in public, but government and medical organizations urge women to overcome this difficulty on behalf of the infant's and mother's health (Office on Women's Health 2010c). Purchasing loose tops, using slings or breastfeeding blankets, discovering private spaces, and practicing at home can help. Breastfeeding at work poses its own challenges, but many of the potential difficulties can be effectively addressed (Office on Women's Health 2010d). Practicing expressing milk at home by hand or with a pump, storing milk in the refrigerator or freezer, and bottle feeding the infant will prepare the mother and infant for her return to work. During a typical work day the milk will need to be expressed two to three times and refrigerated under sanitary conditions for the next day. A photo of the baby can help trigger let-down and expressing the milk will take about 15 minutes. Since work was cited as the primary reason for women who stopped breastfeeding, overcoming these barriers are important to infant health (Keister, Roberts, and Werner 2008).

Breastfeeding outcomes have been studied extensively, but the research quality is almost uniformly low due to ethical concerns about randomizing women to different treatment groups (Ip et al. 2007). Despite these significant limitations, systematic reviews and meta-analyses have revealed several significant maternal and infant health benefits associated with breastfeeding.

Breastfeeding confers short-term protection against respiratory infections regardless of maternal age and socioeconomic status (Horta and Victora 2013a). In addition, both hospitalization and mortality due to respiratory infections were reduced 57 and 70%, respectively. Middle ear infections (otitis media) were reduced by 23% when comparing 'any breastfeeding' to no breastfeeding and 50% when comparing no breastfeeding to exclusive breastfeeding, but only if exclusive breastfeeding lasted 3 to 6 months (Ip et al. 2007). Infant diarrhea was reduced by 30% when mothers had been exposed to breastfeeding promotion, but infants younger than 6 months of age obtained the greatest benefit (Horta and Victora 2013a). At 6 months, gastrointestinal infections were reduced by almost 40% when comparing 'any' to 'exclusive' breastfeeding (Ip et al. 2007). Breastfeeding was also protective against necrotizing enterocolitis in preterm infants by a small, but clinically-significant margin (5%).

To date, no conclusive evidence has been obtained that shows a significant benefit of breastfeeding for child cognitive performance (Horta and Victora 2013b); however, a recent large study (N = 11,134)

examined the association of breastfeeding with developmental milestones and found 'ever' breastfeeding significantly improved gross motor, fine motor, problem-solving, and personal-social by 32, 60, 20, and 38%, respectively, during the first postnatal week only (McCrory and Murray 2013). Breastfeeding has also been consistently associated with a modest 3.5 point increase in child intelligence (IQ) scores and a 24% reduction in overweight/obesity risk (Horta and Victora 2013b).

The five main reasons why women choose to breastfeed their infants are (1) infant health, (2) natural lifestyle, (3) maternal-infant bonding, (4) convenience, and (5) maternal health, in that order (Hahn-Holbrook, Schetter, and Haselton 2013). The main reasons for choosing to not to breastfeed or discontinue breastfeeding are (1) paternal opposition, (2) infant nutrition worries, (3) career obligations, (4) physically uncomfortable, and (5) concerns about physical appearance. If the published maternal risks associated with suboptimal breastfeeding practices are examined, however, there would have been an excess of 5,000 cases of breast cancer, 28.7 cases of premenopausal ovarian cancer, 4,500 cases of type 2 diabetes, 53,847 cases of hypertension, 14,000 myocardial infarctions, and 4,400 deaths before the age of 70 in 2005, at a cost of $10.5 to $44.5 billion dollars in direct and indirect health care costs (Bartick 2013). From a mental health perspective, increasing the hours of skin-to-skin contact between mother and infant provided significant protection against depression, anxiety, and elevated salivary cortisol levels (Bigelow et al. 2012).

Encouraging the retention of the above information will require the facilitators to be competent teachers. Among the many roles that nurses may encounter in patient education, those most relevant to...

While these activities are important for the learning process the method of instructions also matters a great deal (Banning 2005). A strictly didactic means of transmitting information from the teacher to student is fraught with potential problems, including rote learning, boredom, and minimal investment in the transaction by both parties. A better approach, according to Banning (2005), is a facilitatory teaching style where the teacher helps the student to engage in self-directed learning. The teacher attributes that are needed for this teaching style is a high level of competency in the material being taught, compassion, respect, and flexibility in teaching methods. In addition, the quality of the relationship between the teacher and student is important, which is a significant departure from a didactic teaching style where the teacher and student rarely, if ever, have a personal interaction. The facilitatory teaching style is the chosen method for this workshop, because this method is ideally suited for adult learners and shifts the balance from a teacher-centered approach to a student-centered approach.
The essential requirements for facilitatory teaching are a compilation of learning materials and academic support (Banning 2005). The above discussion of breastfeeding benefits and techniques represent the knowledge base upon which the workshop will be constructed, while the academic support will be provided by a number of tools, including a PowerPoint presentation, leaflets, brochures, and practice dolls.

Learning

Learning is the process of change that can alter an individual's cognitive, affective, and behavioral repertoire in often permanent ways (Braungart, Braungart, and Gramet 2011). The process of learning has been of significant interest to researchers wishing to improve the many forms of education. Accordingly, theories of learning have been developed in an attempt to model the independent and dependent variables involved (Braungart, Braungart, and Gramet 2011). Probably the most basic learning theory conceptually is behaviorism, because it assumes that the environment controls all behavior. Under this model, women attending a prenatal care class are assumed to be passive, reactive participants; therefore, changing the environment will alter prenatal health outcomes. Behaviorism is the least attractive model for a patient-centered approach, because it ignores the patient's emotional and cognitive contributions to learning.

By comparison, cognitive theory assumes that learning occurs primarily by altering cognition (Braungart, Braungart, and Gramet 2011). Under this model, clients and patients are assumed to be primarily rational beings who are influenced to some extent by personality traits. The model most relevant to group prenatal care is social learning theory, because the students learn by interacting with both teachers and classmates. Under this model, the facilitators of a prenatal care class would act as role models, sources of perceived reinforcement, and as agents of influence acting upon the internal processes of the student. A woman's lifestyle choices, past experiences, and current mood are the focus of psychodynamic learning theory; however, an instructor is required to evaluate each student in order to understand how these factors influence the learning process (Braungart, Braungart, and Gramet 2011). Accordingly, psychodynamic theory appears to be more appropriate for individual prenatal care encounters (Levy 1999). Under humanistic learning theory the facilitator would be more of a coach than teacher, which is not appropriate for the aim of this workshop

. The most recent learning theory is not so much a theory as a collection of neuropsychology empirical findings. For example, neuroscientists have discovered that emotions are essential to the learning process, in addition to cognition. Empirical findings also support the relevance of past experiences, cognitive load, sensory modalities, instructional pace, practice, motivation, arousal, and attention, to the learning process.

Based on the above analysis, a group prenatal breastfeeding workshop would benefit from cognitive, social, and neuropsychological learning theories. The main assumptions of cognitive learning theory are: (1) distinct sensory channels, (2) limited cognitive capacity, and (3) learning occurs when attending to sensory information, processing it, organizing it into meaningful categories, and integrating it with existing knowledge (Mayer 2010). The critical component, however, is the concept of 'cognitive load,' which implies that the information processing capacity of working memory is finite. This concept is critical because sensory memories last for a few seconds at best and unless working memory has the capacity to accept the information it will be lost (Khalil et al. 2005). In addition, information…