'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!"'
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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:
- Feed the baby – ideally with human milk
- Protect the milk supply with expression
- Preserve the breast focus
- 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!
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
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:
*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.
*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”.
*” 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 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.
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:
Concern about whether baby is “getting enough”.
International Lactation Consultant Association: Guidelines for the Establishment of Exclusive Breastfeeding (2014) (Can be found at ILCA.org)
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.
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.
"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."
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!
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.
We need your Feedback! How did you do on the various topics? If we know the weak spots, we can improve coverage of these areas.
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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.
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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
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