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You get a call from a prenatal client who discloses that she is living with HIV. She asks you whether she can safely breastfeed her baby. Do you know how to answer?
On a new client history form, a mother includes antiretroviral therapy (ART) on her medication list. She tells you she is feeding her baby her milk but would like to also feed formula. Do you know whether this is a safe option?
An exclusively breastfeeding client asks for your help with sore and damaged nipples. She tells you she is HIV positive, and she’s worried that her damaged nipples may put her baby at risk for HIV transmission. Do you know how to counsel her?
Dayna Hall, BS, IBCLC, ICCE, ATC, a researcher with extensive experience working at a hospital in Africa in an area where one-third of the population was living with HIV and the instructor in a new Lactation Education Resource class shares some information and strategies with lactation consultants here.
What does U = U mean?
When a person undergoes antiretroviral therapy (ART) and effectively suppresses their viral load to the point that the virus cannot be detected, they can no longer transmit HIV to another person via sexual contact. In 2016, a campaign was launched that assigned the shorthand “U = U” to this concept (standing for “undetectable equals untransmittable.”) The term has been accepted by 800 groups, governments, and organizations in more than 100 countries.
“For people taking ART as prescribed and achieving and maintaining viral suppression, there is effectively no risk of transmitting HIV through sex,” Hall says.
Does U = U apply to breastfeeding?
Unfortunately, the answer is not an automatic yes—it’s more nuanced than that. “The U = U campaign, for the time being, is specific to sexual transmission,” Hall says. “People living with HIV, adhering to their ART, can safely conceive because the virus is suppressed. But ART is not a cure.”
What do major health organizations recommend?
At the moment, that depends on what organization you ask.
WHO and UNICEF recommend that parents living with HIV exclusively breastfeed their infants for six months and continue breastfeeding for at least 12 months or longer while being fully supported for ART adherence.
The CDC, however, recommends that parents with HIV in the United States not breastfeed their babies at all. National organizations in Britain, Australia, and Canada have similar policies.
Why the discrepancy?
Simply put, WHO has adjusted its recommendation based on ART, while others have not.
Recommendations by the CDC and others are still based on the concept that when safe formula feeding is possible, it is less risky than breastfeeding with HIV, regardless of ART treatment and viral suppression.
“This is in marked contrast to the WHO, which recognized that the demonstrated gains in the availability and use of ART in all resource settings warranted a change to their global recommendations for infant feeding,” Hall explains.
What is the bottom line?
With the availability and effectiveness of ART, the balance of risks and benefits of breastfeeding with HIV has dramatically changed, according to Hall, and lactation support provider’s recommendations need to reflect that new reality—while always considering the entire picture for each unique family and collaborating carefully with the family’s entire care team.
Says Hall: “It is ethically justifiable and frequently safer for providers to participate in a shared decision-making process to develop a feeding plan that may include exclusive breastfeeding for infants whose mother is living with HIV.”
Hall offers an in-depth look at the complex, ever-changing landscape of lactation and HIV and outlines the science and politics behind conflicting recommendations in “WHO Says What,” a new course at Lactation Education Resources. To learn more, register for the full class here.
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Posted by on in Diversity in Breastfeeding
Image credit NPR

Many watched in agony as George Floyd was mercilessly killed at the hands of police last week.

He’s one of the most recent in an untold number of Black Americans whose lives were cut short by state-sanctioned violence since this country’s inception. The list includes the enslaved, the free… the old, the young…in all walks of life... at work and in play.

Breonna Taylor was asleep in her bed. Tamir Rice was playing in the park. Atatiana Jefferson was babysitting her nephew at home.

Countless others have narrowly escaped harm, or have suffered from the psychological effects of surviving or witnessing these repeated and devastating events at the hands of a society that sees them as unequal and unworthy of justice.

At LER, we want to center the voices of those who have lost loved ones, who live under the crushing grip of fear, who feel this burden the heaviest in this moment. Those whose anger is palpable and whose indignation is most righteous.

We stand in solidarity with our Black employees and students and their loved ones. We hear their grief and honor the ways they, time and time again, embody resilience in the face of oppression. We stand behind our partner organizations, ready to act in the ways they tell us are most appropriate at this time.

We commit to doing more, doing better. In the coming days, we’ll unveil some key new programs specifically for Black aspiring lactation consultants. It’s the least we can do to help stem the tide of anti-Blackness and oppression in our field.

But now, in this moment, we amplify the voices of the unheard. And we state unequivocally that Black. Lives. Matter.

#saytheirnames #Blacklivesmatter #amplifymelanatedvoices

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Is your community ready to support infant and young child feeding in emergencies? The emergence of COVID-19 has shone a light on the need for advance planning to ensure the wellbeing of the youngest people during natural and man-made disasters.
Here are six questions to explore in your community:
Can your community define IYCF-E?
IYCF-E stands for “infant and young child feeding in emergencies,” and it refers to meeting the nutritional needs of children from birth to 2 years old during a disaster. Disasters can be natural or manmade, and they can be personal or public. Examples range from hurricanes and earthquakes to the sudden homelessness of one family due to changing financial circumstances. “These various types of emergencies are similar in that they completely disrupt daily life and one’s ability to meet basic needs,” explains Malaika Ludman, MPH, CLC, doula, and instructor for Infant Ready: Infant and Young Child Feeding in Emergencies, a new online course.
Does your community have an IYCF-E plan?
Although it is often ignored in a country, state, city or province’s disaster preparedness plan, IYCF-E is critical. Globally, the total mortality rates for children under one year of age in emergencies are as high as 53 percent.
“We find that the disease and death rate among infants and young children in emergencies is high,” Ludman says. “The leading causes of illness and death are respiratory illness, diarrhea, and malnutrition. . IYCF-E merits a lot of attention, because many children are living in areas affected by emergencies. In the US, emergency response training and preparedness do very little to address infant feeding.”
Infants and young children are uniquely vulnerable in emergencies for three reasons:
  • They are very susceptible to illnesses
  • They can’t care for themselves
  • and
  • They have very specific nutritional needs
Does your community hold misconceptions about breastfeeding during emergencies?
The absolute safest food for a baby during an emergency is his or her own parents’ milk. Unfortunately, misconceptions about breastfeeding during a crisis abound, and families are likely to receive these messages from the media and other sources. They may hear that parents who are under stress cannot or should not breastfeed, that malnourished mothers won’t make enough milk, and that infant formula is a better choice. If breastfeeding has been interrupted by the emergency, they may be told it can’t be started again. If a baby develops diarrhea, the family may be told to stop breastfeeding.
Does your community know the impacts of protecting breastfeeding during emergencies?
A baby who gets breastmilk during a crisis receives disease protection from a safe, accessible food source. It offers complete nutrition at the perfect temperature, keeping the baby warm and reducing stress. On the other hand, formula-fed babies are at much higher risk of infection during an emergency, due to the risk of contamination of the water, surfaces, or supplies used to mix the formula.
Take the stunning example of a flood in 2005 in Botswana. After the flood, there was an outbreak of diarrhea that took the lives of more than 500 children, most under 5 years old. Formula-fed babies were 30 times more likely to present for hospital treatment for diarrhea than breastfed babies. In one village, 30 percent of formula-fed babies died, while no breastfed babies died.
Overall, “hundreds of formula-fed babies died, compared to only a handful of breastfed babies,” Ludman says. “We assume that none of the breastfed infants in this village died because of the protective nature of breastmilk and because these infants were not exposed to contaminated formula, water, or surfaces.”
Is there a plan for assessing and supporting safe formula use?
While doing all you can to advocate for and support breastfeeding during a disaster, you also need to be prepared to effectively help non-breastfeeding families to safely feed their babies and young children. Very often, as a lactation support provider, you will have more knowledge of safe formula feeding practices than anyone else on site. “Caregivers of formula-fed infants need special attention and support because babies who cannot be breastfed during emergencies are at greater risk.”
The first step is to help the family determine whether formula feeding is necessary. When disaster strikes, unsolicited donations of breastmilk substitutes often pour in, making formula readily available and potentially attractive. But it’s important to make sure other options have been exhausted.
“Families should receive help in assessing their feeding options,” Ludman says. “The cleanest and safest food for a baby in an emergency is its mother’s own breastmilk, first from the breast, and second, from a feeding implement. The second safest choice is donor breastmilk. The third safest choice is liquid formula … and the least safe choice is powdered formula, because of the risk of infection.”
When formula is needed, lactation support professionals need to be prepared to educate families on why ready-to-use formula is safer than powdered in emergencies; supply appropriate feeding implements, clean water, fuel, and education; and offer healthcare and monitoring.
Ready to learn more?
With the New Orleans Breastfeeding Center’s 1.5-hour class, Infant Ready: Infant and Young Child Feeding in Emergencies, you will learn the basics of how to support breastfeeding and formula feeding families in any kind of crisis.
Taught by Malaika Ludman, MPH, CLC, and doula, and by Latona Giwa, BSN, RN, IBCLC, co-founder of the New Orleans Breastfeeding Center, the class delves deeply into how lactation professionals and first responders can support both breastfeeding and non-breastfeeding families during an emergency, using real-world examples and lessons from several global disasters.
The course is ideal for first responders, emergency managers, public health departments, medical volunteers, WIC offices and staff.
Infant Ready: Infant and Young Child Feeding in Emergencies
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Posted by on in General

Dear LER community member:

As we move into 2020, I want to take this opportunity to catch you up on changes for me, Doug, and the Lactation Education Resources (LER) community.

As you may know, Doug and I retired this year. After more than 30 years of educating future lactation consultants, we are grateful for the opportunity to enjoy this new phase of our lives together. (If you are in the Maryland area, you might catch a glimpse of me enjoying a morning kayak trip!)

Before we could make this transition, it was important to us to ensure that the LER community was in capable hands. We were thrilled when Kirra Brandon stepped forward with her desire to lead and support LER’s students and instructors.

Kirra Brandon is a physician and, like so many of us in the field, inspired by her own breastfeeding experience (she has nursed all five of her children for more than 113 months and counting!). She also brings considerable experience with online education. She and her husband, Gus Stern, bring experience in providing online education for health care professionals. As LER’s Medical Director, Kirra will be focused on expanding lactation education for all through increasing access around the globe and to a wide variety of health care professionals. We are so grateful that she has chosen to lead LER into the years to come. You can reach her at kbrandon@lactationtraining.com.

Of course, Kirra holds a deep commitment to LER’s mission, vision, and core values. She has been working closely with staff to make sure there has been a seamless transition of the high quality education and customer service that have always been central to the LER community.

Many of you may already know Angela Love-Zaranka, BA, IBCLC, RLC, who has worked with LER for over 15 years. She brings her deep knowledge of the profession to her new role as LER’s Program Director. In her role, Angela will continue the work I started in 1990. You can reach her at alove@lactationtraining.com.

I hope you will join me in welcoming Kirra to LER. I have no doubt that her leadership means that you will continue to enjoy the education and support for which LER is known.

Finally, I would like to share my gratitude with you for being a part of the LER community. Our students, instructors, advisors and staff together have provided evidence-based support to countless families thanks to your shared commitment to education. Thank you for all that you do on behalf of lactating families.

Sincerely,

 

Vergie Hughes, RN MS IBCLC FILCA LER Founder

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"It was going natural as well as with my 1st baby, but things did not seem to be well. Lots of pain, suffering with each feed, frustration and upset most of the time wondering what's going on? It was an easy issue with chronic suffer. It was poor latch. This tiny baby of 35 wks gestation couldn't latch appropriately causing crushing of the nipples and inducing sever pain. Thanks God it was resolved within few days after correction. After 10 months, I received a training of breastfeeding management I found that it was poor latch. Here came the passion to help other moms who are suffering for nothing and decided to become an IBCLC."

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'I became a pediatrician because I wanted to help children and their families. After almost a decade spent in private practice, I realized that I would never have enough time to properly support my breastfeeding babies and their mothers in a busy practice. Ten minutes per appointment is not enough, especially for a newborn or infant who is having problems breastfeeding! I decided to become Board Certified as a Lactation Consultant. Now, I have a job where I get to spend one hour with new babies and their mothers and can have appropriate follow ups. I feel amazing that I can help mothers not give up on breastfeeding and give their babies all of the benefits we know they get through breastmilk, or "liquid gold!"'

Tagged in: Guest Blog
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We all know what it takes to support a milk supply and help a baby grow.  When creating a care plan for families, we follow the sage advice from the pioneers of the profession, such as Barbara Wilson-Clay and Kay Hoover in their book the Breastfeeding Atlas:

  1. Feed the baby – ideally with human milk
  2. Protect the milk supply with expression
  3. Preserve the breast focus
  4. Fix the problem (my addition)

Rigid, structured “triple feeding” is exhausting for parents and is unsustainable for very long.

When a baby is having difficulty with weight gain or is born prematurely, many clinicians will suggest that a parent feed the baby every two hours, supplement the baby with X number of ounces at every feed and pump every two to three hours.  While the evidence to support the individual points of this care plan are well documented, my question is, “when does this end”?  A better question is “why start with such rigid recommendations”?

I work in both an in-patient and outpatient setting.  Occasionally, I am the last resort for families who are exhausted, sad, angry and want to stop breastfeeding or any work towards providing breastmilk.  I hear their frustration.  I believe there is a better way to provide competent care and empower them to do what is right for their family.

First, the suggestion to feed every two to three hours does not take into account the circadian rhythms of the baby.  In the first few weeks, many babies are nocturnal, and prefer more frequent contact and feeding at night.  A rigid schedule does not consider the times when a baby may be hungry or tired or overstimulated.  A baby who is ready for a feeding will be more efficient than one who is told when they are “supposed to” feed.  Teach parents about baby behaviors, including feeding cues, that will help parents decode their baby’s signals and empower them to be responsive to their baby.

 

Second, the recommendation to feed a baby X number of ounces at every feeding is to help a baby grow, our number one priority.  While this recommendation may be to ensure baby receives enough calories throughout the day, it does not allow for the rhythm of the baby’s hunger.  Granted, there are times a compromised baby is not obtaining enough calories and we need to temporarily override a baby’s lack of desire to feed.  While unusual, this situation is important to address.  Providing families with the goal of a total number of ounces per 24 hours is a more empowering suggestion.  For a majority of families, the baby and parent can decide when and how many additional ounces at each individual feeding.  They can gauge when the baby seems more or less hungry and adjust the volumes accordingly.  Some babies who are directly breastfeeding will consume more milk early in the morning or in the middle of the night and do not require supplementation.  The parents can reserve that milk and provide a bit more later in the day if the baby appears hungrier.  Providing a goal of X number of ounces per 24 hours can also help families who may be unintentionally overfeeding their baby find a more reasonable volume for appropriate growth. 

 

The third recommendation to pump 20-30 minutes, every two to three hours, is untenable.  While this schedule may work initially, keep in mind all the steps involved:

  • Find a good, private location to be comfortable and set up the pump
  • Wash hands
  • Gather all the pieces for the pump and put it together
  • Adjust vacuum/speed. This may need to be adjusted several times during a session
  • Implement techniques to elicit multiple milk ejection reflexes (MER), such as:
    • Massage (hands, baby brush)
    • Warm compresses (re-heating as needed)
    • Auditory stimulus (music or the baby’s cry)
    • Visual stimulus (pictures of baby or relaxing scenes)
    • Olfactory stimulus (smelling baby’s clothes or blanket)
  • Once pumping has ended, transfer milk into appropriate storage containers
  • Label milk
  • Wash pump parts

How long do you think it takes to do each of these steps?  Many of my clients report it can take anywhere from 30-45 minutes, EACH session.  They have 75 minutes between pumping to care for themselves (shower, eat, sleep) or attend to family needs.

A more reasonable recommendation is to pump 6-8 times in 24 hours, including once at night, for those who are exclusively pumping.  While this may appear to be the same suggestion, it empowers parents and provides them with more control over the exact timing of the milk expression sessions.  Many find it more effective to pump more frequently during the day/waking hours and allow for a longer sleep stretch at night.

Fixing the problem can be quite complex.  It usually includes a way to supplement the baby to provide the least interference to breastfeeding.  The recommendation should consider the parent’s desires and capacity to supplement in that manner for days or weeks.  Supplementing at the breast with a tube, syringe or supplemental device is what many clinicians recommend because it provides stimulation to the breast and helps the baby to equate the breast with nurturing and nutrition.  Cleaning these devices may take a bit more time than a bottle because of the size of the tubing, etc.  Parents need to know if there are special tools to keep everything clean.  Plus, these devices may need to be replaced frequently.  Is there a convenient and affordable way for parents to obtain replacement parts?  The solution for “how to” supplement the baby is to empower the parents to decide what method is best for them.  A shared decision-making model provides the parents with the pros and cons of different methods.  It allows them to pick and choose what method will work during different times of the day and the flexibility if they choose to go out with the baby.

Follow-up is crucial.  Providing the family with several opportunities for evaluating and modifying the care plan is important to increase the duration of breastfeeding.  Discharging a family without appropriate support is a disservice to the family.  Refer them to resources in the community for support, weight checks, and to providers who are covered by insurance. 

Provide families reasonable recommendations.  Many families are relieved and grateful to gain more control over their lives when the burden of a rigid structure is lifted.  Empower them to meet their breastfeeding goals.  Learning more about how to be responsive to their baby will aid their self-efficacy as parents.  Parenting is a marathon, not a sprint!  Giving them the tools to succeed will have long-lasting effects!

 

Resources:

Wilson-Clay B & Hoover K.  The Breastfeeding Atlas. 6th ed. Manchaca, TX: LactNews Press, 2017, p115.

Baby Behaviors from the California WIC Association, in collaboration with UC Davis Human Lactation Center. https://www.cdph.ca.gov/Programs/CFH/DWICSN/CDPH%20Document%20Library/Families/FeedingMyBaby/970027-Getting-To-Know.pdf

Campbell SH, et al. Core Curriculum for Interdisciplinary Lactation Care, 4th ed. Burlington, MA: Jones and Bartlett, 2019, pp. 427-437.

Stanford Medicine. Maximizing Milk Production with Hands-on Pumping. https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

 

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Now parents are overwhelmed with well-meaning advice from a variety of sources on infant care as well and breastfeeding, before they leave the hospital.  As lactation consultants, we want to tell parents they are doing a good job.  We know that encouragement from a health care provider improves breastfeeding initiation and duration rates.  Yet many families worry about whether or not their babies are “getting enough”.  It is a common concern amongst mothers across the world.  Parents want to know what things to watch for in the early weeks and how to know they are being successful.  Lactation Consultants need to listen to parents concerns.  There are articles and blogs on the internet that scare parents about breastfeeding.  Their concerns are real and should not be dismissed as a “nervous new parent”.  After we listen, we can support them by providing the appropriate anticipatory guidance to give parents objective standards, so THEY can evaluate if their babies are “doing great”.

What does that mean?  Instead of saying, “you’re doing great, mom” as a parent is discharged from your hospital, describe to them what you see and how they compare to these objective measures.  Some scripts many nurses and lactation consultants find helpful are:

Evaluate hydration

*Show them how their baby is hydrated, “see how the baby’s mouth is wet and moist”.  Or “notice how your baby’s pee doesn’t smell like urine?  That is exactly what we expect.” Or “today your baby is one day old and you noticed those uric crystals.  You should not notice them when you are home.  If you do, you may want to contact your pediatric provider or lactation consultant”.

*“Continue to write down the pees and poops to know if your baby is transferring colostrum.  Remember, what goes in, comes out!  If the baby has >3-4 wet and >3-4 bowel movements per 24 hours, that is a good sign that the baby is transferring well.   The poop should be yellow in color by day four. Keep a chart by the changing table or use an app, which is shared by all who are caring for the baby, to help you keep track. Everyone is tired and may become forgetful in the first few days you are home.”

*“If, during the first week of life, the baby goes more than 24 hours without a bowel movement, contact the pediatric provider or lactation consultant.  It may be a sign that the baby is not sucking in a way to transfer the milk.” It is highly correlated in the research that if, during the first week of life, a baby does not have a bowel movement in 24 hours, the baby is not transferring adequately, and thorough evaluation is necessary.

 

Evaluate swallowing

*Show them how to tell WHEN their baby is swallowing, indicating a nutritive suck.

*Tell them HOW you know the baby is transferring appropriately.  “We expect babies to lose weight in the first few days.  Your baby has lost 5% of birth weight, which is in the range of normal weight loss.  The baby may continue to lose weight for the next 24 hours.  It is ok and we expect a baby to begin to regain birth weight around day 4 or 5”.

 

Sleeping patterns

*” The first night or two when the baby is home, it is normal for the baby to be awake at night.  Their circadian rhythms are opposite of yours.  They are a bit jet lagged! Expect the baby to wake at night and feed almost every hour on the hour.  It doesn’t mean that your baby isn’t getting enough.   The output is what tells you that.  Their wakefulness shows you they are ready for a feeding.  They will get into a better schedule to be up more during the daytime soon.”

 

Nipple pain

Nipple pain and trauma are a top reason why people stop breastfeeding.  Many families want a skilled nurse or lactation consultant to evaluate the latch prior to discharge or in the early days.  Instead of saying “the latch looks good to me”, explain how it looks appropriate:

* “You seem to be in a comfortable position to bring the baby to the breast.”

* “The pillows you are using have brought the baby up to the level of the breast.”

* “Keeping the baby’s nose near your nipple will help the baby to open more widely.”

* “Notice how your baby’s mouth is open wide before you bring the baby to the breast.”

* “Holding the baby’s neck with your hand can help to guide the baby to the breast.”

* “Creating a sandwich of your breast with your hand can help to orient the breast to the baby’s mouth and allow for a wide latch.”

* “You should feel tugging and pulling of the breast and nipple but not pain.”

 

If a mother is in pain, it doesn’t matter that the latch “looks good to you”.  It matters what it feels like to her.  Nipple discomfort in the early days is common but not normal.  She needs to find a solution otherwise, she will stop breastfeeding, either temporarily or permanently. Please refer to the appropriate lactation consultant for a more thorough evaluation.

 

Empower parents

Show them how they are capable to care for their baby.  Telling them they are doing a good job without demonstrating how you know it, puts their need for an evaluation into someone else’s hands.  Give them the tools they need to be successful.

 

What are some of the things that you say to parents to give them the confidence they need to know they are doing well with breastfeeding?

 


 

Provider encouragement increases initiation and duration rates:

https://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF

https://www.researchgate.net/profile/Sharlene_Gozalians/publication/295102563_Evaluating_the_impact_of_provider_breastfeeding_encouragement_timing_Evidence_from_a_large_population-based_study/links/57b5ef6f08aede8a665bb8b2/Evaluating-the-impact-of-provider-breastfeeding-encouragement-timing-Evidence-from-a-large-population-based-study.pdf

 

Concern about whether baby is “getting enough”.

https://www.npr.org/sections/goatsandsoda/2017/06/26/534021439/secrets-of-breast-feeding-from-global-moms-in-the-know

 

International Lactation Consultant Association: Guidelines for the Establishment of Exclusive Breastfeeding (2014) (Can be found at ILCA.org)

https://breastfeedingusa.org/content/article/diaper-output-and-milk-intake-early-weeks

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I am a birth coach, Lactation Consultant, physician, a mother of two. I failed to breastfeed my first born, despite of all my resolves and intentions. It was a matter of great disappointment for me being a physician to not be able to breastfeed. When my next child was born, the situation was the same. Luckily, there was internet then & I found great info and read stories of women who like me had struggled with breastfeeding. All this info and my efforts finally made me feed my younger child exclusively on the breast for six months. I and she decided to wean when she was almost three. My own experiences with breastfeeding made me volunteer to support fellow moms and I started helping other women breastfeed successfully. This led me to formally study breastfeeding and certification as an LC.

Tagged in: Guest Blog
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I was a breastfeeding mother. I have two children who are now 10 & 8. What motivated me to do the CLC course was the fact that I got loads of advice from everyone but many of it was wrong information. I wanted to go out and help other moms like me by giving them the right information and helping them when they need it. I also realized there was not much help in this field in my country, India. I would like to help mothers make an informed choice of what is best for them and their babies.

Tagged in: Guest Blog
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"Given a chance, I could have been a Lactation specialist right from the word go. 
Having an exposure with HIV positive mothers for over seven years,and I could discharge HIV negative breastfed babies from the program, I wanted to empower all moms regardless of the HIV status to make informed decisions about how to feed the baby. Impact with the breastfeeding goals, armed with good and adequate information, and most of all, with compassion and love."

Tagged in: Guest Blog
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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!

Tagged in: Guest Blog
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Posted by on in Diversity in Breastfeeding

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!

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Posted by on in General

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.
http://uslca.org/wp-content/uploads/2017/07/2-page-Whos-Who-updated-July-2017-Watermark.pdf


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.

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https://womensmentalhealth.org/posts/baby-friendly-mom-unfriendly/ 

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.

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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 aabn@ymail.com

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.

Tagged in: diversity underserved
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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

       https://www.dropbox.com/s/weyg6uw68u7plnm/Breastfeeding%20for%20Premie%20Infants.m4a?dl=0

Hypnosis for Pumping and Increasing breastmilk Robin Frees IBCLC, Newborn Concepts

       http://www.newbornconcepts.com/products.html#pumping_cd

 

References

 

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.

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The Core Curriculum for Lactation Consultant Practice, Third Edition, is now out of print and limited supplies of the existing copies are all that is available until the new edition is released in mid 2018.  If you wish a copy to use for studying for the IBLCE exam, or for your reference, purchase it quickly before supplies run out.

The publisher  Jones and Bartlett  $124
 http://www.jblearning.com/catalog/Details.aspx?isbn13=9780763798796

Amazon via the LER virtual bookstore $73
https://www.amazon.com/Core-Curriculum-Lactation-Consultant-Practice/dp/0763798797/ref=as_sl_pc_tf_til?tag=lactaeducares-20&linkCode=w00&linkId=6c676a1909a26ccdf7bfba6d1f5b69e6&creativeASIN=0763798797

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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.

https://www.ted.com/talks/katie_hinde_what_we_don_t_know_about_mother_s_milk

Maybe her March Mammal Madness can be your inspiration for your next World Breastfeeding Week event!  http://mammalssuck.blogspot.com/

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"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."

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