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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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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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Lactoferrin is one of the miraculous substances found in breastmilk which helps the infant kill bacteria and fight infection.  It is the major whey protein in human milk and has its highest concentrations in colostrum.  While it is important for all infants, it is especially important in the prevention of necrotizing enterocolitis (NEC) in preterm infants.   Lactoferrin has an anti-inflammatory action that may mitigate the pro-inflammatory states present in the gut before the onset of NEC.  This highlights the importance of mothers providing early feedings of colostrum and fresh mature milk to prevent necrotizing enterocolitis in their premature infant.

Researchers are experimenting with recombinant lactoferrin use in preterm infants and showing a benefit in reducing NEC.  In recombinant DNA, molecules of DNA are recombined into sequences that would not otherwise be found in the genome.   Recombining DNA is possible because DNA molecules from all organisms share the same chemical structure. They differ only in the nucleotides, the subunits of DNA and RNA, in the gene sequence.

Lactoferrin is present in cow’s milk in lower levels than found in human milk.  And the process of creating formula lowers those levels even further.  So, exogenous sources of lactoferrin must be added to formula if it is to match human levels.  Recombinant human lactoferrin can now be obtained from yeast, transgenic cows, and rice which have structural similarity to endogenous lactoferrin. 

There is already an infant formula manufacturer which is marketing Enspire™ containing lactoferrin in the range found in mature breastmilk.  This formula uses bovine sourced lactoferrin and is being marketed for use in any baby, not necessarily NICU infants.

Why are research dollars being spent on developing a protein that mothers can provide to their own infants?  Why don’t we spend the research dollars refining our techniques on how to best help mothers of premature infants provide their own lactoferrin, provide the best breast pumps, a place to pump, “rooming in” in the NICU and facilitate lots of skin-to-skin holding? In addition, when the mother is supplying her own lactoferrin, she is also colonizing the newborn's GI tract with beneficial bacteria and lowering stress levels in both herself and her infant. 

Liao Y, Jiang R, Lönnerdal B.  Biochemical and molecular impacts of lactoferrin on small intestinal growth and development during early life. Biochem Cell Biol 2012   90: 476–484.

Lönnerdal B, Jiang R, Du X  Bovine lactoferrin can be taken up by the human intestinal lactoferrin receptor and exert bioactivities. J Pediatr Gastroenterol Nutr 2011 53: 606–614.

Satué-Gracia MT, Frankel E, Rangavajhyala N , German JB.  Lactoferrin in Infant Formulas:  Effect on Oxidation.  J. Agric. Food Chem., 2000, 48:10:4984–4990

Sherman MP, Adamkin DH, Niklas V, Radmacher P, Sherman J, Wertheimer F, Petrak K Randomized Controlled Trial of Talactoferrin Oral Solution in Preterm Infants.  J Pediatr. 2016 Aug; 175:68-73.e3

Sherman MP, Sherman J, Arcinue R, Niklas V.  Randomized Control Trial of Human Recombinant Lactoferrin: A Substudy Reveals Effects on the Fecal Microbiome of Very Low Birth Weight Infants.  J Pediatr. 2016 Jun;173 Suppl:S37-42.

Sherman MP, Pritzl CJ, Xia C, Miller MM, Zaghouani H, Hahm B.  Lactoferrin acts as an adjuvant during influenza vaccination of neonatal mice.  Biochem Biophys Res Commun. 2015 Nov 27;467(4):766-70.

Sherman MP, Miller MM, Sherman J, Niklas V.  Lactoferrin and necrotizing enterocolitis.   Curr Opin Pediatr. 2014 Apr;26(2):146-50.

Sherman MP.  Lactoferrin and necrotizing enterocolitis.  Clin Perinatol. 2013 Mar;40(1):79-91.

Sherman MP, Petrak K. .  Lactoferrin-enhanced anoikis: a defense against neonatal necrotizing enterocolitis.  Med Hypotheses. 2005;65(3):478-82.

Sherman MP, Bennett SH, Hwang FF, Yu C.  Neonatal small bowel epithelia: enhancing anti-bacterial defense with lactoferrin and Lactobacillus GG.  Biometals. 2004 Jun;17(3):285-9.b, c

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