Lactation Education Resources Blog


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Lactation Education Resources has exciting plans for enhancing our Lactation Consultant Training Course beginning in January 2017. We will add micro-learning sessions – short 5-15 minute classes on a focused topic available live as well as archived for viewing later. Another welcome addition will be Virtual Teaching Assistants. VTAs will be available to students to discuss topics and answer questions about the lessons or give career advice.


There will be a tuition increase beginning January 2017. The 90-hour Lactation Consultant Training Program will increase to $975 and the other courses will increase proportionately. We have not had an increase in tuition for over 5 years. If you, or a friend, were planning on taking the Enriched Lactation Consultant Course, you might want to sign-up before the price increase. Just a head’s up. ;-)

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We, along with breastfeeding supporters around the world, mourn the passing of Miriam Labbok MD, MPH, IBCLC. Miriam was a friend and supporter at the inception of our Lactation Consultant Training Course at Georgetown University Hospital in 1990.  Those of us who had the good fortune to have worked closely with her in those early years, know of her influence on the breastfeeding world. Those who come to this work in the future will not know her personally, but will also be strengthened by her tireless work in support of breastfeeding.

Dr Labbok had a distinguished career beginning at the University of Pennsylvania and Tulane Medical School. She served as Director of the World Health Organization Collaborating Center of Breastfeeding, and was the Chief of Nutrition and Maternal Health, Division of the Agency of International Development (USAID). She was UNICEF’s Senior Advisor on Infant and Young Child Feeding and Care.

Most recently she was the founder and a professor at the University of North Carolina Gillings School of Global Public Health and Director of the Carolina Global Breastfeeding Institute. She was a favorite speaker at hundreds of breastfeeding conferences and won many achievement awards related to breastfeeding promotion throughout her career.

Dr Labbok’s vision and commitment to protect, support, and promote breastfeeding has had worldwide influence on the health of mothers and infants!

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We have taken, as gospel, the guideline of weight loss of greater than 5-7% (7-10% in many circles) as dangerous for newborns and requires supplementation – for years.  Is this an arbitrary line in the sand, or serious research?


What do you mean that the research upon which this guideline is based might be flawed?  That data was incompletely gathered, sample sizes were too small, formula supplemented infants were not excluded or the supplementation was not recorded.  Was the weight loss effect of maternal IV fluids during labor considered?  The recent article in the Journal of Human Lactation Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full Term Breastfed Infants questions the foundation of these guidelines.  And this is not the first time the data supporting the weight loss guidelines has been challenged.  Noel-Weiss did so in 2008.


The consequences of over-diagnosing excessive weight loss are many.  The mother’s own breastmilk could be expressed and used as a supplement but often that is not considered, and the handy bottle of formula is offered.  Volumes are often excessive.  That formula bottle contains virtually unlimited amounts of supplement, compared to the volumes the baby would be consuming at the breast, if breastfeeding was going well. 

 
Then there is the disruption to the gut flora.  And the sensitization to cow’s milk through the porous newborn gut wall.  Even one bottle can make a difference.


The possible physical sequela are a concern, but the most serious problem with incorrectly identifying an infant as losing too much weight is the damage done to the mother’s breastfeeding intention.  “Well, from the start, I didn’t get this right”.  So, what does it matter if I offer a bottle when the baby cries and I am tired, or I when I go for my OB check-up, and then one when my home is full of guests and I might be embarrassed, and then when I go out for a while with friends, and then, and then….  It starts a slippery slope.   When a mother hears that her baby is losing too much weight she not only questions the adequacy of her breastmilk but of her mothering capacity.   

So, who will do the research, the right way, and get reliable guidelines?  We then can prevent the serious complications of hypernatremic dehydration in a few infants and preserve the breastfeeding relationship during the dip in weight before the mother’s milk comes in, in many infants.  Research methods have improved, more researchers are looking at these issues and we owe it to our breastfeeding babies and mothers to get this right.

Thulier D.  Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants.  J Hum Lact. 2016 Feb;32(1):28-34.

Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review.  Open Med. 2008;2(4):e99-e110.

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That’s right! Initiating skin-to-skin and breastfeeding in the OR after a cesarean section is becoming the standard of care in many places.

Step 4 of the Baby-Friendly Hospital Initiative has helped moved this idea forward. Mothers are loving it! And providers are finding that is easy enough to do.

Step 4:  Help mothers initiate breastfeeding within a half-hour of birth
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

We have known for a long time that holding an infant skin-to-skin immediately after birth improves the physiologic stability for both mother and baby and increases maternal bonding behaviors. It is also the optimal start for breastfeeding. 

The nine instinctive stages of newborn behavior, first described by Anne Marie Widstrom, unfold during the first hour after birth while the infant is in skin-to-skin.

  1. Birth cry - This distinctive cry occurs as the infant’s lungs expand.
  2. Relaxation – Mouthing movements begin and the hands are relaxed.
  3. Awakening – The infant moves his head, opens his eyes, and shows some mouth and shoulder activity. This begins at about 3 minutes after birth.
  4. Activity – Mouthing and sucking movements increase as the rooting reflex becomes more obvious.  Eight minutes after birth.
  5. Resting – Periods of resting are interspersed with activity.
  6. Crawling – The infant approaches the breast with crawling and thrusting movements. Begins about 35 minutes after birth.
  7. Familiarization – The infant begins licking and nuzzling the nipple. Begins at 45 minutes after birth and may last for 20 + minutes.
  8. Suckling – The baby self-attaches to the breast and suckles.
  9.  Sleep – Both mother and baby fall asleep. Usually about 1 ½ to 2 hours after birth.

Interruption of skin-to-skin holding can interfere with the normal progression of the infant through these nine stages. He then has to “start-over” delaying his first attempt at breastfeeding.

I highly recommend the article by Philips for a full discussion of the benefits of skin-to-skin and very practical steps to initiate these procedures in the OR**.

 

References:

Burke-Aaronson AC.  Skin-to-skin care and breastfeeding in the perioperative suite.  MCN Am J Matern Child Nurs. 2015 MarchApr;40(2);105-9.

Grassley JS, Jones J.  Implementing skin-to-skin contact in the operating room following cesarean birth.  Worldviews Evid Based Nurs. 2014 Dec;11(6):414-6.

Hung KJ, Berg O.  Early skin-to-skin after cesarean to improve breastfeeding.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24.

** Phillips R.  The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth.  Newborn & Infant Nursing Reviews.  June 2013Volume 13, Issue 2, Pages 67–72

http://www.researchgate.net/publication/257612445_The_Sacred_Hour_Uninterrupted_Skin-to-Skin_Contact_Immediately_After_Birth

Sundin CS, Mazac LB.    Implementing Skin-to-Skin Care in the Operating Room After Cesarean Birth.   MCN Am J Matern Child Nurs. 2015 Jul-Aug;40(4):249-55. 

Widstrom AM,  Aaltomaa-Michalias P, Dahllof A, Lintula M, Nissen E.  Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.  Acta Paediatr 2011.  Jan:100(1): 79-85.

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I have been watching the Kid President videos on YouTube, haven’t you?  He is the cutest little guy and has some good things to say  https://www.youtube.com/watch?v=l-gQLqv9f4o.

Let’s be awesome.  No matter where we are, not matter what we do. Be awesome.

We all have opportunities, every day, to be awesome to many new moms and babies.  And let’s not forget to be awesome to each other.  Give the people you encounter a reason to dance!

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