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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
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 firstname.lastname@example.org.
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 email@example.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.
Vergie Hughes, RN MS IBCLC FILCA LER Founder
"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."
'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!"'
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:
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:
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;
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.