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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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Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus Eastward to Pittsburgh, Pennsylvania. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.

While it’s true that no other area is consistently underperforming as significantly as the South when compared to the CDC’s Breastfeeding Score Card, there is room for improvement in every direction. At a glance, the US Eastern seaboard is packed with major metropolitan cities with large hospitals and no shortage of outpatient lactation support. Once you zoom in a bit inland or into more urban or rural areas, a different story begins to emerge. Many of the same challenges we encountered in the South exist in the East, including lack of access to support, lack of breastfeeding education among parents, and lack of breastfeeding supportive healthcare providers. Adding other factors such as demographics only compounds the issues.

For example, states in the Appalachian Region are woefully underperforming compared to their neighbors. Why? We know that socioeconomic levels directly impact quality of care. Breastfeeding disparities are, therefore, not surprisingly lower in areas that are economically depressed. We also know that race is a further compounding factor that drives breastfeeding disparities. Using almost any breastfeeding metric in the US, White mothers outperform their Latinx and Black counterparts. This is even truer in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Black mothers lag the general US population, white mothers, and Latinx mothers, no matter how you slice the data. This creates a dire situation in cities with large Black populations where ill newborns could be greatly helped by the benefit of mother’s milk, and Black mothers could also be helped by the benefits of breastfeeding. For more on this, see our previous installments in this series.

Having relatable, culturally competent support is a major key to closing the disparity gaps in areas where breastfeeding is not the norm. What does success look like in a major eastern city? Is anyone reaching the families who are doubly hit with economics and race?

Yes. We had the opportunity to speak with Ngozi Walker-Tibbs, co-founder of the Pittsburgh Black Breastfeeding Circle (PBBC) which provides a safe space for encouragement, community and breastfeeding support. In our discussion, she illuminated the breastfeeding support needs in Pittsburgh, and detailed her journey to craft a suitable solution.

Can you tell us a bit about how PBBC was started?

The PBBC began in August 2014 during Black Breastfeeding Week. I had just finished graduate school in May of that year and this vision had been on my heart for many years but I wasn't sure where to start. I was overwhelmed with ideas and vision but lacked insight into how to make it work. As one of only 2 black LC's in the entire city; I was well aware of the lower rates of breastfeeding amongst women of color. I wanted to make a difference. A sister who is an activist in the community approached me and asked me to speak for the BBW 2014. I spoke from my heart as to why breastfeeding matters to us and how we can support each other as a community. After this event, the organizers and I discussed how to keep this momentum going. We had no money but wanted to feed the families. For the most part, we went into our pockets and found a spot, purchased food, and had our meetings. We are so grateful for some food donations that we received early on. We began to meet 1x per month at local libraries and women began to come. We discussed lots of topics including how to practice skin to skin after delivery, avoiding and resolving nipple pain, working and pumping, nursing toddlers and many more. We got our first grant in 2015.

How has PBBC grown or evolved since it first began?

We now meet two times per month and we are bursting at the seams! We have discussed meeting 3x per month and looking for a larger venue. Its a beautiful challenge to have.

How is the Pittsburgh community better off due to PBBC’s presence?

We have been featured twice this year in our local newspapers and the community is responding so positively. Physicians, Midwives, Nurses, LC's and other providers are recommending our circle to mothers in the community. They understand that we are an evidence based organization and mothers are learning about breastfeeding, parenting and bonding with their babies. Mothers in the circle have said they would have stopped nursing if it were not for the support of the PBBC. We know we are making a difference; one mother and baby at a time.

Can something like PBBC be duplicated elsewhere? How?

A black breastfeeding circle can be duplicated anywhere where there is an established need. First, the potential organizer should find what groups are already in operation in town, who do they reach, are there underserved communities? Find providers who are willing to partner with you to make a difference. Be prepared to share data and research. Find a spot, look for other likeminded organizations, talk with them, seek donations for food and space, develop and agenda based on the health needs of the community. 

Wherever there are breastfeeding disparities, local activists and parents are rising up to meet the need. Solutions come in various forms, from cafes to library meet ups to online support. We’ll highlight other such groups as this series continues in the coming months.

Meanwhile, PBBC is growing by leaps and bounds, and even supports their group mothers via Facebook in a closed support group that has blossomed to over 300 members. For more information about PBBC, Ngozi can be reached at 412-638-1580.

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