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Why an LC?
I read everything I could about breastfeeding before the birth of my first child. He would not nurse in the hospital, and I was told I was starving my baby. At one point he was brought to me and spit up formula, despite me having told them he was to be exclusively breastfed. My anger which I was unable to articulate at that time turned to research and study about breastfeeding. I nursed my son for a year. I’ve dedicated my professional career to breastfeeding women and their babies. It is great to see the progress that has been made.

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"My name is Maria. When I had my child 26 years ago, I had a little experience about breastfeeding since I was living in Cuba. When I came to the U.S in 2001, I was hired a year after, I'm start knowing how beneficial in breastfeeding a baby beyond a year, I felt regret that I couldn't do it. My reward was my daughter who I educated her while she was pregnant with her first baby. After knowing all the great benefits, she was determine to breastfeed and yeah she did for 19 mo. My grand baby has very strong immune system, smart and a bright girl. That's the reason that motivated me to dream to became Lactation Consultant and also be able to help my community."

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After years of ousting breastfeeding moms, calling security and generally harassing women who breastfeed in their stores, Target now has a Breastfeeding Policy that is exemplary.

Breastfeeding Guests may openly breastfeed in our stores or ask where they can go to breastfeed their child.  When this happens, remember these points:

  • Target’s policy supports breastfeeding in any area of our stores, including our fitting rooms, even if others are waiting
  • If you see a woman breastfeeding in our stores, do not approach her
  • If she approaches you and asks for a location to breastfeed, offer the fitting room (do not offer the restroom as an option).
  • If you have any questions, partner with your leader.

OMG, did a LC write this?!

Now the rest of you retailers, follow Target’s lead.  They have hit the target on this one!

Tagged in: breastfeeding
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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 had the privilege of helping mothers and babies for approximately 28 years now. I always share with my Moms that the reason I most likely became an IBCLC is because of the bad experience I had with struggling to breastfeed my first child (now age 30). I was a young mom and although I had read about breastfeeding, I like so many other people believed breastfeeding is a natural thing - you just put the baby at the breast and it sucks. How hard can that be?

As a young mom in the hospital I was trying my best. My nipples were cracked and bleeding and as I was crying and trying to nurse my baby my nurse said, "You are starving that poor baby...give her a bottle.” As a result, we struggled for months with low supply. I was determined no other new mom should ever feel that way!

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For me, becoming an LC was a natural evolution. Growing up I only once saw a woman breastfeeding. Yet, coming of age in the time of Women's Liberation and starting as a Nurse Practitioner in a rural mountain community, it seemed the natural, healthy and right thing to do. I was blessed with two babies who latched on with ease and never gave me a minute's trouble until, when my second child was 17 months old, an abscess and surgery brought an abrupt, sorrowful end to breastfeeding. I had the pleasure of knowing, being assisted by and learning from a fabulous role model - Mary Rose Tully. There is nothing more rewarding than the joy on a Mom's face, and Dad's too, when together we solve a problem, Mom is no longer in pain, their baby eats with gusto and then looks deeply into Mom's eyes.

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In 1985, I was a La Leche League Leader of 11 years and knew that some mothers needed another level of care in addition to what I was providing. The development of IBLCE occurred as I was choosing to re-enter the work force. My life has been so enriched by the mothers I have helped, the support of my peers and the other professionals who accepted my expertise. I hope it will continue to evolve to the original plan: A stand-alone profession such as physical therapy or optometry, which can provide expert care unequaled by any other health care profession.

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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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In February, I had my first child and knew very little about breastfeeding. From the first time I held her, she latched on perfectly. I then became very passionate about making sure every mother and baby had the same opportunity that we had.

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When I had my third baby, I wasn't successful with breast feeding my first two, so I decided not to even attempt it. All over my medical record, "Formula" was written.  As if my son understood, as I was holding him, he turned his head and latched on through the hospital gown and began suckling. I said "OK, if that is what you want to do!" I took one day at a time, like the 12-step program, and breastfed him for 13 months. It was the best experience that only another breastfeeding mother could appreciate. This is where I got my passion. I made a difference in his life but he changed mine forever too. I went on to have a fourth child and she breastfed for a year too.

 

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a maximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

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I remember babysitting my younger cousins every summer when I was in high school.  Every year my aunt would be sitting on the couch breastfeeding the newest baby while I watched the rest of the kids.  It seemed so natural and easy.  She could direct the play and work of the rest of us from her seat.

When I had my own baby my mother, always the practical one, said “that’s what they’re there for”.   And she helped me through those first weeks when the formula discharge bag was sitting there so handy.  So I went on to breastfeed each of my children for several years.

Years later, when I returned to work as a pediatric nurse, I was always assigned to the babies on the unit, especially the breastfeeding babies.  I wasn’t afraid to care for them as many of the younger nurses without children were.   And some I could actually help.  I transferred to the Milk Bank and then my interest in everything to do with lactation, breastmilk and breastfeeding really took off.  I took the IBLCE certification exam in 1985, the first year it was available, and have been working in the field (devotedly) ever since.

Vergie Hughes RN MS IBCLC FILCA

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a maximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

Why I Became a Lactation Consultant

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Those working towards the Baby-Friendly Hospital Initiative often find it is a complex, sometimes harder road, than they anticipated.  Picking some of the easy “low hanging fruit” and getting some early successes can help the staff working on this project move forward with enthusiasm.

Implementing skin-to-skin care (Step 4) as one of the first strategies often does not meet with much resistance, and can yield impressive results in initiation of breastfeeding and patient satisfaction scores.  McKeever found that infants in skin-to-skin care did not become hypothermic, most breastfed within an hour and they continued to successfully breastfeed the second day.  In addition mothers remarked on the bonding effects (McKeever).  Mothers who did not experience immediate skin-to-skin care demonstrated more roughness in their behaviors with their infants, difficulty with latch-on and infants showed a lack of wakefulness during breastfeeding (Dumas).

Easier to implement steps may include Step 3 (inform pregnant women about breastfeeding), and Step 5 (show mothers how to breastfeed), and Step 8 (encourage breastfeeding on demand).  Provide breastfeeding information in childbirth and lactation classes.  Encourage prenatal clinics and offices to recommend breastfeeding to their clients.  Hospital staff is already showing mothers how to position and latch-on babies.  Technique can be improved to be more effective through staff education.  And flexibility in feeding schedules is probably in place, but can be encouraged. So start with these steps, then tackle the more difficult ones: Step 1 (breastfeeding policy), Step 6 (give nothing but breastmilk) and Step 7 (rooming-in) (Semenic).

Most managers implementing Baby-Friendly practices find that a gradual and step-wise approach works best.  Make the most of the “easy to change behaviors” to get some momentum going and the rest will follow, eventually.

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a meximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

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References:

Dumas L, Lepage M, Bystrove K, et al.  The influence of skin to skin contact and rooming-in on early mother-infant interaction: A randomized control trial.  Clin Nurs Res.  August 2013;22(3):310-336.

McKeever J, St Fleur R.  Overcoming barriers to baby-friendly status.  J Hum Lact.  Aug 2012:28(3):312-314.

Semenic S, Childerhose JE, Lauzière J, Groleau D.Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.  J Hum Lact. 2012 Aug;28(3):317-34.

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I’ve participated in the Nestle Boycott for more than 25 years now.  And I have been teaching about the dangers of formula discharge packs in every class I have taught the past 25 years, our lactation consultant training program, our Baby-Friendly Hospital program, in live courses, in online courses.

But those are puny efforts compared to the courage and sacrifices of Syed Aamir Raza Hussain who blew the whistle on artificial baby milk marketing practices in Pakistan.

The new film, “Tigers” exposes the aggressive tactics of companies in promoting the use of infant formula in places where its use is inappropriate.  Where there are no facilities for clean water and the cost of formula is exorbitant compared to the poverty in which new parents are living.  When Syed learned about the consequences of his marketing efforts, he quit his job and went on a campaign, with the help of IBFAN, to stop the use of formula where it can cause malnourishment and diarrhea, even death.

I encourage you to seek out where Tigers will be showing near you and make a point to view it.  http://www.babymilkaction.org/tigers#monitoring  You will wonder why you haven’t been doing more.  Like I have.

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(Addressing the Healthy Beginnings Partnership of Greater Prince William VA & Alexandria VA Breastfeeding Promotion Committee celebration, April 7, 2015)

There is a perspective you achieve having been in the lactation field for most of a career; for me it has been more than 30 years.  I took the IBLCE certification exam the first time it was offered, in 1985.  Back then there were no pre-requisites, just a desire to offer breastfeeding support.  Eat your heart out - those of you who are taking 90 hours of training and hundreds of hours of clinical practice!  But the changes have been good for the profession as there is so much more to know now, and we hit the ground running as a new IBCLC with a much better background.

Thank you to the La Leche League Leaders here who kept the torch burning during the years when breastfeeding rates hit their low point and the medical professionals were seduced by the claims of the artificial baby milk companies.

We have since developed organizations to foster information sharing and program collaboration; The International Lactation Consultant Association (ILCA) and the United States Lactation Association (USLCA) for lactation consultants.  The Academy of Breastfeeding Medicine (ABM), is specifically for physicians.

We have international organizations also working to promote breastfeeding and limit the use of artificial breast milk worldwide.  The World Alliance for Breastfeeding Action (WABA) promotes World Breastfeeding the first week in August each year.   And the International Baby Food Action Network (IBFAN) keeps track of compliance with the World Health Organization Code of Marketing of Breastmilk Substitutes.  The “Code” limits the marketing of artificial baby milk.

The Baby Friendly Initiative has made huge strides in promoting the hospital conditions that promote the successful initiation of breastfeeding.  There are now 250 hospitals designated as Baby Friendly which amounts to about 12% of babies being born in “ideal” breastfeeding circumstances.  So there is certainly work to be done here as more hospitals address their policies and procedures to improve breastfeeding support.

The Office of Women’s Health (part of the Federal Government’s Health and Human Services) has primarily supported employed breastfeeding mothers and encouraged employers to provide facilities and time to enable breast pumping at work.

The Centers for Disease Control (CDC) has developed a “Breastfeeding Report Card” benchmarking policies and procedures in hospitals.  This allows administrators to compare their services and outcomes to other hospitals in their state and the nation.

Back in the day, we used to lament that there was no research on breastfeeding issues.  That has certainly turned around.  Now there is so much lactation related research in so many health science journals, it is hard to keep up.

Breastfeeding Coalitions, sponsored by the United States Breastfeeding Committee and the CDC, are active in all states and sometimes several coalition and workgroups are active in an area.  I congratulate you in your efforts here in Northern Virginia to expand breastfeeding advocacy and support.

Laws ensuring the right of a breastfeeding mother to feed her baby in any public place have been enacted in almost all states.  Congratulations to you for moving this through the Virginia legislature.

So, over the past 30 years, there have been tremendous changes in the breastfeeding landscape that is gratifying to see.  I am sure I have not mentioned all of the groups involved or activities of concerned professionals.  When you have a bad day, you encounter an “uneducated” health professional or a breastfeeding mother who did not receive the support she needed at the time she needed it, just think about all the improvement that has occurred over the past 30 years and keep the faith.  Working together we are making progress!  

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I heard a quote recently that “Breastfeeding is part of mothering, not the point of mothering”.  And I thought back on all of the mothers I have worked with over the years who desperately wanted to breastfeed but were running into problems; some easy to resolve, others seemingly unsurmountable complications.  There have been mothers who endured sore nipples for months, breastfeeding/pumping/cup feeding around the clock, or repeated bouts of thrush or mastitis.  Hero’s? Yes!

I have, at times, given a mother “permission” to supplement or to stop.  Some have gratefully accepted the out, and others have done so with overwhelming guilt and sadness.  Some have hung in there despite the problems.  It seems some mothers have gotten the message that it is imperative to breastfeed.  Exclusively breastfeed; supplement at your baby’s peril.   Breastmilk is magic, to be sure.  However, pushing moms to the edge is not part of mothering, and it is not the point of lactation consulting.  Suggesting alternatives until we come upon the one that fits for this mom and baby is the point of lactation consulting.

We have a breastfeeding dyad here.  Both must benefit physically and emotionally.  What can we each do to prevent the kind of difficulties that get moms into those unsurmountable complications to start with?  And what can we do to resolve them quickly?  That is the point of lactation consulting.

Breastfeeding is a (REWARDING) part of mothering but, not the point of mothering!

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I remember my experience following around Lactation Consultants at Georgetown University Hospital over 20 years ago. Those LC’s made a huge impression on me and I made several decisions about how I would or would not practice from those experiences.

Recently, I started working with Lactation Education Resources and began taking interns. Sometimes I think we see students as a burden, as rounding will take more time and there are always questions to answer etc. But, I have to say our experiences with these interns has been amazing. They are so excited and interested in what we are doing and beam when they have made progress. It made me remember that this his is how I was in the beginning too, and sometimes it’s hard to get that energy back.

These interns really remind us why we do this job of helping breastfeeding couplets. Our interns say thank you to us every single day and also say they have found that niche they have been looking for. They also keep me up on my reading research articles, looking at new products and  going to seminars.  If you want to get your enthusiasm back, support an intern- You won’t be disappointed.

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I know I am contributing to this video going viral - https://www.youtube.com/watch?v=Me9yrREXOj4. The marketing of infant formula has hit a new mark.  A video that goes viral, everyone sees it. That’s not really advertising, is it? And the maker has a tasteful ad at the end with a link to its FaceBook page.  What could be more welcoming than the FaceBook page for the Sisterhood of Motherhood.  Parent your own way.  Sounds great, doesn’t it? I can ignore the research evidence for breastfeeding if it suits me. I can ignore the recommendations regarding breastfeeding from every organization that has anything to do with maternal-infant health.

The video hits on all of the hot button topics for new families these days: breast or bottle, cloth or disposable diapers, daddy care givers, employed moms, slings or strollers, and attachment parenting.   But when a common crisis unites them all, nothing else matters but the infant’s safety. True…

Now, don’t I feel warm and grateful to this company who says I can parent any way I want to?  But it’s not about me!

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We all know how important skin-to-skin (STS) contact is for a newborn and his mother.  Most hospitals are moving towards immediate skin-to-skin for all newborns (breastfeeding mothers or not) in our delivery rooms!   But what about the operating rooms? 

At a time when families are under the additional anxiety of a surgical delivery, skin-to-skin care increases family togetherness and satisfaction with the birth.  We have known for years that a cesarean delivery delays lactogenesis II and negatively affects breastfeeding duration.  With a cesarean rate of 33% in many areas, this is an issue that affects many families. 

A systematic approach makes this change more acceptable to all involved: nurses, obstetricians, anesthesiologists and lactation consultants.  An organized process of planning, testing a pilot protocol, staff training will reduce the anxiety of all staff.  Involve stakeholders from all disciplines in planning and executing the changes.  An influential champion can provide the leadership to engage staff and create enthusiasm for the process of change.   Finally, implement a preliminary protocol and refine it as needed, then make it policy.

Continual surveillance is needed to assure that the procedural changes are incorporated into practice and maintained and that there is no back-sliding into old habits.  Analyzing the improvement in Quality Assurance measures can reinforce the hard work of the staff.

How this skin-to-skin procedure is implemented will vary from hospital to hospital depending on their facility and their staff.  But Moms, infants and families will benefit as skin-to-skin becomes a normal and routine practice.

Want to explore this further?

Facilitating Skin-to-Skin Contact in the Operating Room After Cesarean Birth.

Stone S, Prater L, Spencer R.  Nurs Womens Health. 2014 Dec;18(6):486-99.

Early skin-to-skin after cesarean to improve breastfeeding.

Hung KJ, Berg O.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24

An interprofessional quality improvement project to implement maternal/infant skin-to-skin contact during cesarean delivery.

Brady K, Bulpitt D, Chiarelli C.  J Obstet Gynecol Neonatal Nurs. 2014 Jul-Aug;43(4):488-96

Skin-to-skin contact after cesarean delivery: an experimental study.

Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P.  Nurs Res. 2010 Mar-Apr;59(2):78-84

Postcesarean Section Skin-to-Skin Contact of Mother and Child.

de Alba-Romero C, Camaño-Gutiérrez I, López-Hernández P, de Castro-Fernández J, Barbero-Casado P, Salcedo-Vázquez ML, Sánchez-López D, Cantero-Arribas P, Moral-Pumarega MT, Pallás-Alonso CR.

J Hum Lact. 2014 May 20;30(3):283-286

Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature.

Stevens J, Schmied V, Burns E, Dahlen H.  Matern Child Nutr. 2014 Oct;10(4):456-73.

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At this time of year, when we are scrambling around to find the perfect present for everyone on our gift list, let’s remember that breastmilk is the gift that lasts for many holiday seasons.

In fact it is a whole pile of gifts for everyone in the family: the baby, mother, and family as well as the community at large.  And these gifts are free!  Now where do you get a gift, that keeps on giving, for free?!

Here is wishing a years’ worth (or more) of breastmilk for every baby, mother, family!

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Hospitals which are attempting to initiate Baby-Friendly practices have received a lot of press recently.   Not always does the reporter get the details right.  Sometimes the headline is negative, but the story is essentially positive. 

But at least people are taking notice of the movement!  Here is just a sampling of what has been published recently.

Hospital Support for Breastfeeding: On the Cusp of Big Changes, Time to Step It Up

http://altarum.org/health-policy-blog/hospital-support-for-breastfeeding-on-the-cusp-of-big-changes-time-to-step-it-up

'Baby-friendly' hospitals: Moms give new measures mixed reviews

http://www.dailyherald.com/article/20141027/entlife/141029161/

Local hospitals strive to offer a balance of maternity options

http://www.dailyherald.com/article/20141027/entlife/141029160/

UNM Hospital receives prestigious “Baby-Friendly” designation

http://hscnews.unm.edu/news/unm-hospital-receives-prestigious-baby-friendly-designation110414

No Nursery, No Formula, No Pacifier:  Are “baby-friendly” hospitals unfriendly to new mothers?

http://www.slate.com/articles/double_x/doublex/2014/10/baby_friendly_hospitals_promoting_breast_feeding_at_the_expense_of_the_new.html

 In the article published in Slate, the journalist quotes a study that says formula use promotes breastfeeding by relieving maternal stress.  http://www.ncbi.nlm.nih.gov/pubmed/23669513

But she neglects to address the main reason why exclusive breastfeeding is so important, the changes in the newborn gut from even limited amounts of formula.  Here are just a few selected research articles related to the importance of gut flora and how it can be impacted by breastmilk or formula.

Effect of breast and formula feeding on gut microbiota shaping in newborns  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472256/pdf/fcimb-02-00094.pdf

 Effect of formula composition on the development of infant gut microbiota.

http://www.ncbi.nlm.nih.gov/pubmed/21593648

 Maternal factors pre- and during delivery contribute to gut microbiota shaping in newborns.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417649/pdf/fcimb-02-00093.pdf

 Human gut microbiota: onset and shaping through life stages and perturbations.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505007/

 The long-term health effects of neonatal microbial flora

http://www.ncbi.nlm.nih.gov/pubmed/19398905

 I suspect, as more and more hospitals become Baby-Friendly and institute policies that promote exclusive breastfeeding, the rhetoric will heighten even further.

Congratulations to those over 215 hospitals who have achieved Baby-Friendly Hospital designation.  Lactation Education Resources is proud to have been a part in the educational preparation for designation in many of these hospitals.  There are currently 250+ hospitals using the LER training. 

At present, only 9.4 of the births in the US occur in Baby-Friendly hospitals.  Let’s not stop until we have 100%!!

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