My name is Bobbi Jo Hudson and I have worked in a busy pediatric office as a LPN for the past 14 years. I work under 9 providers and we are located in the hospital but a separate practice. The lactation consultants within the hospital stay very busy and can not see all of our nursing moms after they are discharged. The need for lactation services is great due to the volume of patients we have in our practice. First time nursing moms become easily discouraged when there is a breast feeding issue and often times just need to discuss it with a professional. It has become a passion of mine to provide additional assistance to our mothers who are breast feeding and hopefully will be an asset to the practice. I am new to the program and hope to have this complete by May!
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Reaching our Sisters Everywhere (ROSE) holds an annual Summit to engage and educate breastfeeding leaders who are on the front lines of supporting families in their communities. Breastfeeding rates amongst Black and Latinx families are lower than their white counterparts. https://www.cdc.gov/breastfeeding/data/reportcard.htm and https://www.cdc.gov/breastfeeding/resources/breastfeeding-trends.htm
This year’s theme was achieving health equity through breastfeeding
NAPPLSC sponsored a “retreat” prior to the ROSE summit. A retreat sounds nice, right? Discussing real issues facing our communities, being inspired, maybe some self-care involved for lactation support providers. The event was called the Amazing R.A.C.E.: Rejuvenating A Community of Excellence. I should have realized that it would not be what I envisioned, when the organizers told us to wear comfortable shoes!
Teams were randomly chosen and we were told to get to know each other quickly because we would need all the skill sets of our members, to succeed. The goal was to come up with an innovative program to support breastfeeding families. To brainstorm, create a vision, operationalize and implement with measurable outcomes. Final presentation was the next day.
Five people in our group with many years of serving breastfeeding families, this project should have been a piece of cake. HOWEVER, the organizers found creative ways to get us out into the city. They would tempt us with additional funding if we won a contest. They would provide a clue via Facebook LIVE. Our team would need to figure out where the next grant opportunity announcement would be presented, and RUN to that location. To win the funding for the mini-grant, we had to create and upload social media videos, MEMEs or participate in a spoken word competition. Clues were given at all times of the day and night. Therefore, we had to break up into smaller groups to sleep or work on creating those products to win contests.
This experience was a real-life example of how challenging writing grants to fund breastfeeding projects can be. We don’t live in a bubble and exclusively write grants. We have work responsibilities, family
obligations and LIFE. While this event was completely different than what I expected, I had a good time getting to know others from around the country. To listen to each other, add our skill sets and background to create a fantastic final presentation. I can’t wait to see what NAPPLSC will create next year. I hope to see you ALL there!
The International Board of Lactation Consultant Examiners (IBLCE) has announced their plans for a new lactation support credential. The IBLCE is the organization that currently offers the certification credential for lactation consultants, the gold standard in lactation credentials, the IBCLC. The new credential will provide;
- a credential for those who do not wish to pursue the full requirements for IBCLC certification
- a stepping stone for those who seek a credential they can use for employment until they qualify for the IBCLC certification
This new credential will hopefully consolidate the many lactation credentials that are currently being offered by various groups. The United States Lactation Consultant Association has compiled a current list: Who’s Who in Lactation.
This plethora of course credentials is confusing for those aspiring to this field, as well as employers. With training at various levels, it is impossible for national organizations and health ministries who would like to measure the efficacy of breastfeeding services offered by those with differing levels of education and clinical experience.
In 1985, the IBLCE 1) developed a criterion-referenced examination for lactation support providers around the globe based on practice analysis survey (also known as a role delineation study), 2) defined clinical competencies and a scope of practice and 3) administers an accountability system for maintaining quality care. A similar system will be set in place for the second credential. One uniform testing organization will allow the standardizing of content of the curriculum taught to match the skills necessary to be a lactation support provider at both levels, current and proposed. The evidence demonstrates that integrated lactation care, provided by the appropriate provider, will help families meet their goals. The evidence also shows that skilled care provided at the time it is needed will improve national goals for initiation, exclusivity and duration.
There are situations and practice settings where access to an IBCLC is limited. Community health workers, peer support counselors, prenatal lactation educators, hospital bedside care providers all play a role in breastfeeding support. ALL lactation support providers deserve recognition of their education and competence to provide a standard of care which will support breastfeeding families. A global exam and credential created and managed by an organization which has done this for the past 30 years, is a benefit to those who want to provide service at a level below that of the IBCLC.
There are many for whom the IBCLC is out of reach due to the un-availability of training, cost of the college courses and lack of mentors available for clinical training. A entry-level credential will likely meet the needs of many world-wide.
Some are concerned and confused by the new credential. It was reassuring to see IBLCE listening to concerns at the ILCA conference and promising they will continue to dialogue with all stakeholders including IBCLCs, training organizations, government agencies, and health ministries. The creation of a new credential is a process and will not happen overnight. LER supports the IBLCE in their efforts to follow the process to bring a new credential to the landscape of lactation support providers.
This article is full of conjecture as opposed evidence, to get people's attention. To use inflammatory statements like "nursing staff typically refuse exhausted mothers to take care of their babies" and "rigid and rule bound" elicits a negative response to the evidence-informed practices of the international baby friendly designation. Baby friendly is not just about breastfeeding. It is about helping the newborn transition to extra uterine life in the most physiologic appropriate way. ALL babies. Skin to skin, rooming in, listening to the baby, are the what these practices reinforce. For example, rooming in has been the standard of care in military medicine for over 15 years and it is what parents expect. Educating staff members and providing them the skills to support all families is a piece of the process.
This article puts the emphasis on the comfort of the mother, not newborn and his adjustment to life outside the womb. During this critical time in the newborn's life, shouldn't the emphasis be on the baby's needs for care by the most familiar person to him for transition to the new world? Adults can understand, rationalize and make adjustments to their sleep patterns, knowing it is a challenge but temporary. The baby cannot.
Part of the onus of responsibility is upon the obstetric providers to educate mothers during their pregnancy about what to expect in the immediate post-partum phase in the hours and days after delivery. Evidence shows that rooming in allows for MORE sleep by the mother baby dyad. Appropriate education about normal newborn circadian rhythms being OPPOSITE of the mother's in the early days can help them to understand that their baby should wake frequently at night. It's healthy and normal. Understanding the second and third night of life as ones which will entail a wakeful baby and to encourage the mother to plan ahead for this eventuality, will help them to be prepared. Appropriate anticipatory guidance, especially for the families with a history of anxiety and depression, will help them to be proactive in their own self-care and to plan ahead. 24-72 hours after birth, the family needs these skills to help them welcome the new member(s) to their family. Providing them with the supportive environment during this transition and the education they need to care for their baby 24/7, will empower them to do what is best for them and their family AFTER discharge.
It takes a team to support and educate everyone in adapting to their new roles as a family. To blame the baby friendly practices as being mother ‘un-friendly’, doesn't allow for the opportunity for the parent to embrace their new role in a supportive environment. Continuing paternalistic hospital practices from the 1950's, in light of new evidence from around the globe, is a disservice to our families who expect and deserve more. Quoting Dr. Maya Angelou, "I did then what I knew how to do. Now that I know better, I do better". Implementing every aspect of baby-friendly practices helps hospitals to be friendly to all families.
Rounding out our series on the landscape of breastfeeding in the US, we’re shifting our focus northward to Milwaukee, Wisconsin. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.
According to the CDC’s Breastfeeding Scorecard, northern states are trending remarkably well in the measures that are tracked. With the exception of Wisconsin and Michigan, all northern states are outpacing total US are on pace to continue doing so. Overall, Wisconsin is very close to hitting the HP markers, and is on pace to do so by 2020. The state is outpacing total US in every breastfeeding measure except initiation, where it is within 1 percentage point of total US and within 2 points of the Healthy People 2020 goal. The clearer picture emerges as we look at the breastfeeding support measure. Wisconsin lags significantly in almost every measure of support. As we’ve noted in earlier segments of this series, one of the major contributors to a state’s success or lack of success lies within its underrepresented communities and the efforts to close gaps in breastfeeding initiation, duration, education and support within specific swaths of residents. In the case of Wisconsin, we can find exactly that in the efforts of Dalvery Blackwell and the African American Breastfeeding Network (AABN).
Based in Milwaukee, the AABN has enjoyed some tremendous wins in closing the disparity gaps among African Americans, and making lasting change in a community that desperately needs focused support.
Please share a little about AABN’s inception.
The African American Breastfeeding Network was formed in 2008 to (1) address breastfeeding disparities (2) increase awareness of the benefits and value of mother’s milk, (3) build community allies, and (4) de-normalize formula use. Our mission is to promote breastfeeding as the natural and the best way to provide optimal nourishment to babies and young children. Our vision is to live in a world where breastfeeding is the norm within the African American community.
How has the organization grown/evolved since it began?
Next year AABN will be celebrating 10 years! We are very excited about our journey, proud of our accomplishments and are eagerly looking forward to another 10 years of serving families. Our work together with our partners moves the entire state of Wisconsin closer to achieving the 2020 breastfeeding recommendations. Our accomplishments include…
- January 2017: Front Page Feature in the Milwaukee Community Journal
- April 2015: Quoted in Essence Magazine, “10 Things People Are Talking About”
- January 2015: Associated Press news article, photos and video
- August 2014: Featured in CDC Breastfeeding Report Card
- October 2014: Featured in Black Child Development Institute’s Wisconsin report Being Black Is Not a Risk Factor
- February 2012: Featured in Milwaukee Journal Sentinel breastfeeding video
- February 2011: Featured in Milwaukee Journal Sentinel series on infant mortality, Empty Cradles
How is the community better off due to your presence?
The awareness and breastfeeding rates have increased because of our efforts. For the last 9 years AABN has been working diligently to eradicate inequities and disparities though our program hallmark, Community Breastfeeding Gatherings (CBGs). Taking place at two local YMCA sites-- Parklawn and Northside-- CBGs are designed to: 1) increase breastfeeding rates, especially duration and exclusivity, 2) enhance father engagement, 3) increase access to trained lactation support persons of color, 4) provide lactation support services in hospital, home and CBG settings, and 5) enhance referral networks with health care provider systems. By incorporating community-based, culturally tailored health education, leveraging peer support, and engaging the entire support system including fathers, AABN positively impacts breastfeeding rates Clinic. Prenatal and postpartum support is provided by a Father Peer Advocate (FPA) and Community Breastfeeding Peer Counselors (CBPCs). Mothers experiencing lactation challenges are referred to AABN’s International Board Certified Lactation Consultant. Mothers receive support as long as they are breastfeeding. We estimate that at least 500 pregnant and/or breastfeeding mothers have benefited and countless support persons attended through the years, and last year we reached 120 pregnant women! Data collected in partnership with the Center for Urban Population Health reveals the following data:
- 91% initiation
- 30% exclusive breastfeeding at 3 months
- average attendance at the Northside YMCA is 15 families/Average attendance at the Parklawn YMCA is 8 families
- mean age for women is 23 years old
- 76% of pregnant and breastfeeding women attending CBGs live in zip codes of greatest need and having a huge inequality hole in health care access
- 93% of post-CBG survey respondents reported that they were more likely to breastfed or continue breastfeeding after attending a CBG
Could something like the AABN be duplicated elsewhere?
Yes! I believe our model could be duplicated elsewhere. Anyone who is interested, please email firstname.lastname@example.org
AABN’s motto is “together we are building a breastfeeding movement”. As a student or professional lactation supporter, you have an opportunity to make an impact and to reach communities that have a greater need or unique barriers to success. LER is inviting you to join the movement alongside Dalvery Blackwell, TaNefer Camara, Tiana Pyles, Jada Wright-Nichols, Ngozi Walker-Tibbs and all of the dedicated lactivists who are working within their communities to change the face of breastfeeding and to reach those who need it most.
While this series has come to a close, the conversation will continue in various ways as LER will work to prepare the next generation of lactation supporters to be informed and equipped resources to all breastfeeding families. Stay tuned for future blog posts, course additions, and advocacy opportunities as we do our part to impact the landscape of breastfeeding in the US and beyond.
Singing to your baby, or even just listening to soothing music, can make milk miracles! Researchers have found that listening to music while pumping can increase the amount of breastmilk pumped as well as the fat and caloric content. (Keith 2012). Ak (2015) found that in addition to increased pumped milk volume, music decreased the stress levels of NICU mothers who showed decreased serum cortisol levels.
In the earliest study, Feher (1989) found that the milk production of mothers increased 63% after 1 week of listening to a relation and guided imagery audiotape. And the mothers of the smallest preemies increased milk production by 121%.
Recordings of mothers singing to their NICU infants showed better adjustment and bonding scores. Mothers felt strongly that the recordings helped them cope with the NICU stay and infants were discharged 2 days earlier than controls (Cevasco 2008). Nilsson (2009) found that music increased serum oxytocin levels and decreased stress in surgical patients (This study was not conducted in a NICU setting).
Resources for mothers of NICU infants:
Created by Stephen Feher
Hypnosis for Pumping and Increasing breastmilk Robin Frees IBCLC, Newborn Concepts
Ak J, Lakshmanagowda PB, G C M P, Goturu J. Impact of music therapy on breast milk secretion in mothers of premature newborns. J Clin Diagn Res. 2015. Apr;9(4):CC04-6. doi: 10.7860/JCDR/2015/11642.5776. Epub 2015 Apr 1. PubMed PMID:26023551; PubMed Central PMCID: PMC4437063.
Cevasco AM. The effects of mothers' singing on full-term and preterm infants and maternal emotional responses. J Music Ther. 2008 Fall;45(3):273-306. PubMed. PMID: 18959452.
Feher SD, Berger LR, Johnson JD, Wilde JB. Increasing breast milk production for premature infants with a relaxation/imagery audiotape. Pediatrics. 1989. Jan;83(1):57-60. PubMed PMID: 2642620.
Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9. doi: 10.1097/ANC.0b013e31824d9842. PubMed PMID: 22469966.
Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomized control trial. J Clin Nurs. 2009. Aug;18(15):2153-61. doi: 10.1111/j.1365-2702.2008.02718.x. PubMed PMID: 19583647.
Amazon via the LER virtual bookstore $73
Katie Hinde is studying breast milk’s status as the first superfood, providing babies with invaluable microbes custom-tailored to their individual needs, via an incredible and unlikely dialogue between the mother’s enzymes and the baby’s saliva. And in studying the marvels of human breast milk she strongly advocates for a society and health care system that will support the breastfeeding goals of all women.
Katie Hinde Associate Professor, Director of the Comparative Lactation Lab in the Center for Evolution and Medicine and the School of Human Evolution and Social Change at Arizona State University. Click the link below to view her TED Talk.
Maybe her March Mammal Madness can be your inspiration for your next World Breastfeeding Week event! http://mammalssuck.blogspot.com/
"My son was born with a recessed chin, he was jaundice. I didn't understand why breastfeeding was so painful. He latched the best that he could with his recessed chin. I saw countless Lcs and Dr.s who told me that bf would never work for us. I pumped for 6 months, I continued to latch my son several times a day even though there was little to no milk transfer and endless pain even with a shield. At 6 mo my son started to latch with less pain.. We had thrush twice. We have overcome so much so that my sweet boy would have all the amazing benefits of my milk. We are at a year and still going strong. I aspire to become an LC to provide knowledge, experience and support to breastfeeding mothers. I am so passionate about bf and I want to help guide other mothers through their beautiful journey."
Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus westward to Oakland, California. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.
While it’s true that no other area is consistently underperforming as significantly as the South when compared to the CDC’s Breastfeeding Score Card, there is room for improvement in every direction. This is true even on the West coast, where state breastfeeding rates are excellent at a glance. Per the scorecard, California is outpacing the national average in nearly every measure. California has already reached the Healthy People 2020 goals, and is on a trajectory to continue to outpace most states in the coming years. The data highlights some of the many things that are working well in California, such as the high percentage of Baby Friendly Hospitals (which directly correlates to the percentage of babies who receive solely breastmilk during their first two days of life), and childcare regulations that support breastfeeding success in the long run. California gets it right in many ways. However, as much as it is an anomaly, some pockets of California are also plagued by the same obstacles to success that we saw in the deep South and in Appalachia. As we’ve seen, some key factors have a detrimental impact on whether babies get mother’s milk as early, as often, and for as long a duration as is ideal. These factors include race, economic status, and access to quality care. The scorecard shows a significant gap in the number of births to the number of lactation supporters statewide. For example, in terms of free or low cost support, there are only around 2 certified lactation counselors and less than one La Leche League leader per 1,000 live births. Both of these figures are lagging compared to national averages.
So what support is there for parents who need help breastfeeding but may not be in a position to hire an IBCLC? One such solution has been working well in Alameda County, and specifically East Oakland. We caught up with the renowned TaNefer Camara, to discuss her community support group, The Lactation Café (TLC).
California scored well on the last BFing ScoreCard. How does East Oakland compare?
Overall California's breastfeeding rates are impressive and in some areas exceed national averages. In East Oakland, breastfeeding rates do not reflect state averages. East Oakland is an area that is still very much segregated by ethnic and socioeconomic lines. Some areas - particularly the community where The Lactation Cafe is held - are largely Black and Hispanic. While there has been an increase in breastfeeding initiation and duration rates over the past 5 years in Alameda county, there remains pockets of community that could benefit from additional support. Many of the families are receiving the message that breastfeeding is important but they fall short of breastfeeding goals due to work conditions, lack of familial support, medical reasons or misinformation.
Can you tell us a little about the group’s inception and how it has grown/evolved since it began?
The Lactation Cafe began as a pilot program sponsored by First 5 Alameda County. We started off with maybe 4 participants and grew to serve 10-15 moms each group. We collaborated with local health programs, hospitals and clinics to engage new families. The next phase will focus on sustainability and community capacity building. We hope to develop group participants into leaders who will lead and facilitate future groups.
How is the community better off due to your presence?
The Lactation Cafe has been a safe place for families to receive concrete support in times of need, gain knowledge of child development, build social connections and get the support they need to meet their breastfeeding goals. Moms who attend TLC and other groups in our community are able to share what they learn with other mothers, they become advocates for themselves, their children and their community members and they support one another.
Could something like the The Lactation Cafe be duplicated elsewhere?
Absolutely! TLC can be duplicated. We used the Strengthening Families framework as our guide and in alignment with our breastfeeding curriculum. The key to a successful group is outreach, engagement and community partnership. Oh, and good food. Whole some food and nutrition was a major part of our group.
Wherever there are breastfeeding disparities, local activists like TaNefer Camara, Tiana Pyles, Jada Wright-Nichols and Ngozi Walker-Tibbs are rising up to meet the need. Their work is changing the landscape of breastfeeding throughout the United States in real and impactful ways. As a student or professional lactation supporter, you too, have an opportunity to make an impact and to reach communities that have a greater need or unique barriers. We’ll highlight one more group in the North to round out our four cities tour next month and to bring this series to a close. The conversation will continue in various ways as LER works to prepare the next generation of lactation supporters to be informed and equipped resources to all breastfeeding families.
Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus Eastward to Pittsburgh, Pennsylvania. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.
While it’s true that no other area is consistently underperforming as significantly as the South when compared to the CDC’s Breastfeeding Score Card, there is room for improvement in every direction. At a glance, the US Eastern seaboard is packed with major metropolitan cities with large hospitals and no shortage of outpatient lactation support. Once you zoom in a bit inland or into more urban or rural areas, a different story begins to emerge. Many of the same challenges we encountered in the South exist in the East, including lack of access to support, lack of breastfeeding education among parents, and lack of breastfeeding supportive healthcare providers. Adding other factors such as demographics only compounds the issues.
For example, states in the Appalachian Region are woefully underperforming compared to their neighbors. Why? We know that socioeconomic levels directly impact quality of care. Breastfeeding disparities are, therefore, not surprisingly lower in areas that are economically depressed. We also know that race is a further compounding factor that drives breastfeeding disparities. Using almost any breastfeeding metric in the US, White mothers outperform their Latinx and Black counterparts. This is even truer in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Black mothers lag the general US population, white mothers, and Latinx mothers, no matter how you slice the data. This creates a dire situation in cities with large Black populations where ill newborns could be greatly helped by the benefit of mother’s milk, and Black mothers could also be helped by the benefits of breastfeeding. For more on this, see our previous installments in this series.
Having relatable, culturally competent support is a major key to closing the disparity gaps in areas where breastfeeding is not the norm. What does success look like in a major eastern city? Is anyone reaching the families who are doubly hit with economics and race?
Yes. We had the opportunity to speak with Ngozi Walker-Tibbs, co-founder of the Pittsburgh Black Breastfeeding Circle (PBBC) which provides a safe space for encouragement, community and breastfeeding support. In our discussion, she illuminated the breastfeeding support needs in Pittsburgh, and detailed her journey to craft a suitable solution.
Can you tell us a bit about how PBBC was started?
The PBBC began in August 2014 during Black Breastfeeding Week. I had just finished graduate school in May of that year and this vision had been on my heart for many years but I wasn't sure where to start. I was overwhelmed with ideas and vision but lacked insight into how to make it work. As one of only 2 black LC's in the entire city; I was well aware of the lower rates of breastfeeding amongst women of color. I wanted to make a difference. A sister who is an activist in the community approached me and asked me to speak for the BBW 2014. I spoke from my heart as to why breastfeeding matters to us and how we can support each other as a community. After this event, the organizers and I discussed how to keep this momentum going. We had no money but wanted to feed the families. For the most part, we went into our pockets and found a spot, purchased food, and had our meetings. We are so grateful for some food donations that we received early on. We began to meet 1x per month at local libraries and women began to come. We discussed lots of topics including how to practice skin to skin after delivery, avoiding and resolving nipple pain, working and pumping, nursing toddlers and many more. We got our first grant in 2015.
How has PBBC grown or evolved since it first began?
We now meet two times per month and we are bursting at the seams! We have discussed meeting 3x per month and looking for a larger venue. Its a beautiful challenge to have.
How is the Pittsburgh community better off due to PBBC’s presence?
We have been featured twice this year in our local newspapers and the community is responding so positively. Physicians, Midwives, Nurses, LC's and other providers are recommending our circle to mothers in the community. They understand that we are an evidence based organization and mothers are learning about breastfeeding, parenting and bonding with their babies. Mothers in the circle have said they would have stopped nursing if it were not for the support of the PBBC. We know we are making a difference; one mother and baby at a time.
Can something like PBBC be duplicated elsewhere? How?
A black breastfeeding circle can be duplicated anywhere where there is an established need. First, the potential organizer should find what groups are already in operation in town, who do they reach, are there underserved communities? Find providers who are willing to partner with you to make a difference. Be prepared to share data and research. Find a spot, look for other likeminded organizations, talk with them, seek donations for food and space, develop and agenda based on the health needs of the community.
Wherever there are breastfeeding disparities, local activists and parents are rising up to meet the need. Solutions come in various forms, from cafes to library meet ups to online support. We’ll highlight other such groups as this series continues in the coming months.
Meanwhile, PBBC is growing by leaps and bounds, and even supports their group mothers via Facebook in a closed support group that has blossomed to over 300 members. For more information about PBBC, Ngozi can be reached at 412-638-1580.
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I'm in the process of pursuing IBCLC certification. My third baby struggled from day one. I was baffled- I had the benefit of success and experience on my side! This wasn't supposed to happen! With the patient, gracious help of my favorite IBCLC, we persisted. I learned what it is like to live through undiagnosed medical problems (hello, tongue tie!) and supplementation in the face of severe breastfeeding problems. We surpassed every nursing goal I had by breastfeeding until 23 months! I'm a Registered Dietitian. I believed in breastfeeding before I ever had my babies, but through this experience, I learned that I have a great passion for lactation. I am eager to complete my remaining requirements to join the ranks of IBCLCs!
Lactoferrin is one of the miraculous substances found in breastmilk which helps the infant kill bacteria and fight infection. It is the major whey protein in human milk and has its highest concentrations in colostrum. While it is important for all infants, it is especially important in the prevention of necrotizing enterocolitis (NEC) in preterm infants. Lactoferrin has an anti-inflammatory action that may mitigate the pro-inflammatory states present in the gut before the onset of NEC. This highlights the importance of mothers providing early feedings of colostrum and fresh mature milk to prevent necrotizing enterocolitis in their premature infant.
Researchers are experimenting with recombinant lactoferrin use in preterm infants and showing a benefit in reducing NEC. In recombinant DNA, molecules of DNA are recombined into sequences that would not otherwise be found in the genome. Recombining DNA is possible because DNA molecules from all organisms share the same chemical structure. They differ only in the nucleotides, the subunits of DNA and RNA, in the gene sequence.
Lactoferrin is present in cow’s milk in lower levels than found in human milk. And the process of creating formula lowers those levels even further. So, exogenous sources of lactoferrin must be added to formula if it is to match human levels. Recombinant human lactoferrin can now be obtained from yeast, transgenic cows, and rice which have structural similarity to endogenous lactoferrin.
There is already an infant formula manufacturer which is marketing Enspire™ containing lactoferrin in the range found in mature breastmilk. This formula uses bovine sourced lactoferrin and is being marketed for use in any baby, not necessarily NICU infants.
Why are research dollars being spent on developing a protein that mothers can provide to their own infants? Why don’t we spend the research dollars refining our techniques on how to best help mothers of premature infants provide their own lactoferrin, provide the best breast pumps, a place to pump, “rooming in” in the NICU and facilitate lots of skin-to-skin holding? In addition, when the mother is supplying her own lactoferrin, she is also colonizing the newborn's GI tract with beneficial bacteria and lowering stress levels in both herself and her infant.
Liao Y, Jiang R, Lönnerdal B. Biochemical and molecular impacts of lactoferrin on small intestinal growth and development during early life. Biochem Cell Biol 2012 90: 476–484.
Lönnerdal B, Jiang R, Du X Bovine lactoferrin can be taken up by the human intestinal lactoferrin receptor and exert bioactivities. J Pediatr Gastroenterol Nutr 2011 53: 606–614.
Satué-Gracia MT, Frankel E, Rangavajhyala N , German JB. Lactoferrin in Infant Formulas: Effect on Oxidation. J. Agric. Food Chem., 2000, 48:10:4984–4990
Sherman MP, Adamkin DH, Niklas V, Radmacher P, Sherman J, Wertheimer F, Petrak K Randomized Controlled Trial of Talactoferrin Oral Solution in Preterm Infants. J Pediatr. 2016 Aug; 175:68-73.e3
Sherman MP, Sherman J, Arcinue R, Niklas V. Randomized Control Trial of Human Recombinant Lactoferrin: A Substudy Reveals Effects on the Fecal Microbiome of Very Low Birth Weight Infants. J Pediatr. 2016 Jun;173 Suppl:S37-42.
Sherman MP, Pritzl CJ, Xia C, Miller MM, Zaghouani H, Hahm B. Lactoferrin acts as an adjuvant during influenza vaccination of neonatal mice. Biochem Biophys Res Commun. 2015 Nov 27;467(4):766-70.
Sherman MP, Miller MM, Sherman J, Niklas V. Lactoferrin and necrotizing enterocolitis. Curr Opin Pediatr. 2014 Apr;26(2):146-50.
Sherman MP. Lactoferrin and necrotizing enterocolitis. Clin Perinatol. 2013 Mar;40(1):79-91.
Sherman MP, Petrak K. . Lactoferrin-enhanced anoikis: a defense against neonatal necrotizing enterocolitis. Med Hypotheses. 2005;65(3):478-82.
Sherman MP, Bennett SH, Hwang FF, Yu C. Neonatal small bowel epithelia: enhancing anti-bacterial defense with lactoferrin and Lactobacillus GG. Biometals. 2004 Jun;17(3):285-9.b, c
In the initial installment of this series, we discussed the swinging pendulum of breastfeeding rates across the nation, as highlighted by the CDC’s most recent Breastfeeding Report Card. Among the data are outliers on both ends of the spectrum that warrant a closer look. Over the course of the next four installments, we’ll hear from lactation supporters who are in the trenches in four cities that are performing demonstrably different compared to the total US average and compared to the Healthy People 2020 benchmarks. We’ll discuss what is working to reach families in a unique way in each city, then at the end of the series, we’ll explore state and national efforts to increase accessibility to lactation support across the nation.
As we delve into the challenges and victories occurring in various areas, one factor that is hard to ignore is demographics. Do extenuating factors such as the mother’s sphere of influence or race or line of work directly impact breastfeeding? In short, absolutely! Income, age, education, race, and even language spoken impact healthcare experiences. This is consistent with breastfeeding and the types of support that are available in some communities as well. Breastfeeding success today requires a delicate balance of support and encouragement from many parts of a community; access to current, evidence-based information provided by relatable and available sources; and a work environment that supports pumping breaks and milk storage. The absence of any one of these factors can upset the entire system and almost certainly lead to failure.
Without question, the worst performing area in this country in terms of breastfeeding initiation and duration is the deep south. With consistent averages of 10-20 points below the US average of 81.1% of babies ever breastfed, Georgia, Alabama, Louisiana, Mississippi and Tennessee together represent a cluster of states where unique challenges like those listed above create a dearth of support and a veritable first food desert. Take Mississippi, as an example. The Breastfeeding Report Card assessed Mississippi as simultaneously having the lowest breastfeeding rates AND the lowest number of lactation support providers available (both free and paid). Success and support go hand in hand.
In the face of the lowest ratings in the nation, there are some methods that seem to be making progress. Taking a closer look at what is working allows for some insight into some of the tangible challenges, and allows for some exploration of replicating that success in further parts of this region. Looking at Tennessee specifically, we find that breastfeeding initiation rates are trending 10 points behind the national average. Not surprisingly, the data also shows a consistent lag across all the measured categories, including the number of lactation supporters per 1,000 live births. Per the TN.GOV site, some obstacles that exist within the state to prevent mothers who have the intention to breastfeed from achieving success are:
- Lack of experience or understanding among family members of how best to support mothers and babies
- Not enough opportunities to communicate with other breastfeeding mothers
- Lack of up-to-date instruction and information from health care professionals
- Hospital practices that make it difficult to get started with successful breastfeeding
- Lack of accommodation to breastfeed or express milk at the workplace
How Does Race Factor In?
Sadly, breastfeeding trends are often illuminated when broken down by race. Using almost any breastfeeding metric in the US, White mothers outperform their Latina and Black counterparts. This is even more true in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Latino breastfeeding rates lag White mothers, but the gap is narrowed or widened depending on their country of origin and level of assimilation. This layered and complicated phenomenon will be a focus when we turn our attention to the western region.
Black mothers lag behind the general US population, white mothers, and Latina mothers in every breastfeeding metric, from a national to a local level. This creates a dire situation in many majority-Black cities where ill newborns could be greatly helped by the benefit of mother’s milk, and Black mothers could also be helped by the benefits of breastfeeding. Efforts like Black Breastfeeding Week were created to overcome the obstacles that Black mothers face and to highlight breastfeeding within the Black community to normalize it. With a Black population of over 950,000, Tennessee has a need for year-round, focused breastfeeding support that gets to the heart of the Black community and its specific challenges.
BSTARS: Memphis, TN
To gain a first-hand perspective of the impacts this type of focused programming and initiative could have on the lives of mothers at the local level, I had the opportunity to speak with Ms. Jada Wright Nichols, one of the founders of BSTARS in Memphis. She provided insights to better understand her program and the challenges that necessitated its inception. BSTARS’ mission is to support, protect, and promote Black women as they choose to breastfeed. Their work is impacting Black families in Memphis by combatting several of the listed obstacles to breastfeeding success in Tennessee. They are working to build a supportive community armed with confidence and solid information about breastfeeding. The template they have developed is tailor-made to fit the needs of mothers in Memphis, yet is flexible enough to plant elsewhere, and expect similar success.
Can you tell us about the inception of BSTARS?
Breastfeeding Sisters That Are Receiving Support (BSTARS) began in Memphis, TN out of the need to address the low breastfeeding rates amongst mothers of color in the city, while also highlighting those who do breastfeed, but often go unnoticed. Memphis has some of the lowest breastfeeding rates, highest infant mortality rates, highest breast cancer (and diabetes, and obesity) rates, highest poverty rates, and highest segregation rates in the country. We hope that helping to improve breastfeeding rates through consistent and accessible education and support, will also help to bring some of these other social and health issues into balance. We were created through the generous cooperation of the Shelby County Department of Health, Shelby County Breastfeeding Coalition, and Atlanta-based Reaching Our Sisters Everywhere (ROSE).
How has the organization grown/evolved since it began?
We began with a hearty level of interest. At our first official meeting, we had certified lactation counselors, WIC peer counselors, lactation consultants, nurses, and physicians of color all eager to support pregnant and nursing moms.
At each meeting, we discuss a health topic and how it relates to breastfeeding, while also offering skilled breastfeeding support. We have had speakers from the community to address nutrition, exercise, postpartum mood disorders, smoking, birth control, safe sleeping, and family support. We have a solid group of attendees, but as the topics change, so does the make-up of each month's group, depending on the needs and interests of the families. We love being able to support the entire family. We regularly have partners, sisters, mothers, and grandmothers present to hear the same information as the mothers. We always have a lite meal, and an area for children to play or do homework. We are in our second year and growing strong, heading toward becoming our own 501c3 organization.
How is the community better off due to your presence?
Thanks to several of our signature events, Memphis has a greater awareness and appreciation of breastfeeding moms within the city. We have a community baby shower where we distribute pack-n-plays, car seats, nursing pillows, and pumps to 30 families. We have an annual walk along Historic Beale Street and throughout downtown Memphis to promote breastfeeding, health, and sisterhood. We have many community sponsors for this event, including Hooters - our favorite. Perhaps most impactful, we organized a one day breastfeeding symposium, which attracted healthcare providers from 4 states to gather to hear about current research and initiatives in breastfeeding. We were greeted by city officials excited about supporting breastfeeding, and we heard from some of the top voices in the field of lactation. We also have an intimate Facebook group, wherein moms of color ask questions and document, with pride, their breastfeeding journeys.
Could something like BSTARS be duplicated elsewhere?
Absolutely! We are already discussing its replication in a few communities and we are happy to help any others who are interested.
It’s a little too soon to see empirical data on the effectiveness of BSTARS. However, historically, the type of focused attention that BSTARS provides yields notable increases in mother confidence, breastfeeding initiation, and duration. Anecdotally, Memphis physicians have already noted that Black mothers seem to be inquiring more about breastfeeding, and breastfeeding for longer periods since BSTARS launched. There is great promise and potential at the local level for closing gaps in breastfeeding and BSTARS is one shining example of how it can be done. Next up, we’ll look at trends in the Western US and explore a program that is focused on groups that are still challenged, even amid high breastfeeding rates in their state.
If you would like more information about BSTARS, please contact founder and director, Tiana Pyles at email@example.com or Memphis BSTARS on Facebook.
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. ;-)
What an exciting time to be a part of breastfeeding education! The marked shift back toward the breast - after a generation of mothers turned to bottles and formula - is nothing short of amazing. From wide-scale national public health efforts to the tireless determination of grassroots community educators, there is plenty of credit to spread around for the wins that we are seeing. And everyone who has had a hand in this work should be proud of the clear success of the movement. That is not to say, of course, that our work is done. Hardly so. For every hospital that has become Baby Friendly and placed breastfeeding education and support at the forefront of their pre and post-natal offerings, there are several more who still have yet to prioritize increasing their breastfeeding rates. For every pediatrician and obstetrician who advises an expecting parent to consider breastfeeding, there are several more who never mention it or maintain outdated perspectives. And the truth is, for every state that is meeting and surpassing the Healthy People 2020 goals for breastfeeding initiation and duration, there are states that are not even close. While there is cause for celebration, it’s too soon to rest on our laurels. This post is the first in a series that will dig into the current state of breastfeeding in the US, examine the outliers on both ends of the data, and consider how we can continue the work to increase equity in lactation across the country.
According to the CDC’s latest Breastfeeding Report Card, the number of babies who were put to the breast at least once in 2013 is 81.1%. That number is an average across 50 states, plus Washington DC and Puerto Rico. This means there are states faring way better (I’m looking at you, Utah, with 94.4%), and there are those who fared far less (O-Mississippi-G with 52%) being factored in. Once you start to explore the data at a state level, glaring differences like this emerge again and again. How could Utah’s breastfeeding initiation rates be 20-40 percentage points higher than every state in the deep south? Why does every state west of Texas tout initiation rates above the Healthy People 2020 goal of 81.9%, but so few on the east coast have even come close to that benchmark? What is happening differently across the country? How can we help to close to gaps?
The good news is that in most states, there are innovative programs aimed at addressing local challenges to breastfeeding. The services range from grassroots community organizations to statewide coalitions, and everything in between. They provide catered solutions to the specific challenges of the families in those areas. And they are making steady progress. However, huge extenuating factors like economics and race play a particularly significant role in breastfeeding in many of the states that are the most challenged. That means the incredibly important and delicate work of dismantling barriers and mindsets is needed to reverse some of the trends that are being seen. So there is no easy or quick fix. But there are strategies and solutions and communities who are committed to progress.
Helping to remove barriers to breastfeeding in the states where the least number of mothers are putting babies to the breast (and subsequently keeping them at the breast) is a worthy focus because it has the potential to save lives in areas where infant mortality rates are frighteningly high. And it’s where we will pay particular attention as this series progresses. We hope you’ll tune in as we start to look a bit closer at the data and also at the national, state and local efforts that are working to turn some of the statistics around. We’ll also discuss how you can become involved in fostering change to bring about lactation equity in those areas where it’s most needed, and help to push more states across the line from promise to progress.
Next up: North, South, East, West: A Breastfeeding Tale of Four cities
Nikki Killings MPH, IBCLC, CLC, LLLL lives and works in California with her husband and children. She spends her time writing, reading and supporting families in underserved communities.
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!
The attached survey comes from International Board of Lactation Consultant Examiners to investigate the interest in having a new credential available for people working in the lactation field. This potential credential is intended for those individuals who are not IBCLCs, but are interested in being recognized by the IBLCE for the training they have accomplished (40 – 89 hours).
This potential credential is not intended as substitute for the IBCLC but as an enhancement to the IBCLC’s practice. It would be under the auspices of IBLCE who will develop a scope of practice and entry level exam which would complement and mesh with the IBCLC. To avoid the appearance of competing with the IBCLC, we see great advantage to having this new recognition developed by the same organization that has oversight of the IBCLC credential, the IBLCE.
Those who may be interested in this new credential include:
- Those seeking work while completing the rest of the requirements for IBLCE certification
- Those seeking work without the intention of pursuing IBLCE certification in the future
This credential would be equivalent to the Breastfeeding Specialist certificate given by Lactation Education Resources at the present time. It would be renewable and internationally recognized.
We hope all of you will take the time to return this brief survey to IBLCE and tell them of your interest and support. The survey takes less than five minutes to complete and will close on July 29.
If you are not yet an IBCLC, please take this survey.
If you are already an IBCLC, please take this survey
I started Nursing at a very young age and still I have several years to work. My experience includes 30+ years working OB. What a wonderful way to finish my last trimester than helping new Mom's to perfect their God given ability to nourish their babies.