Lactation Management Training: From Novice to Expert

Lactation Education Resources Blog


Submit Blog Entry here to submit your essay about why you became a
Lactation Consultant, we can't wait to hear all about it!

Subscribe to this list via RSS Blog posts tagged in exclusive breastfeeding

Posted by on in Uncategorized

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.

Hits: 73
0

We have taken, as gospel, the guideline of weight loss of greater than 5-7% (7-10% in many circles) as dangerous for newborns and requires supplementation – for years.  Is this an arbitrary line in the sand, or serious research?


What do you mean that the research upon which this guideline is based might be flawed?  That data was incompletely gathered, sample sizes were too small, formula supplemented infants were not excluded or the supplementation was not recorded.  Was the weight loss effect of maternal IV fluids during labor considered?  The recent article in the Journal of Human Lactation Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full Term Breastfed Infants questions the foundation of these guidelines.  And this is not the first time the data supporting the weight loss guidelines has been challenged.  Noel-Weiss did so in 2008.


The consequences of over-diagnosing excessive weight loss are many.  The mother’s own breastmilk could be expressed and used as a supplement but often that is not considered, and the handy bottle of formula is offered.  Volumes are often excessive.  That formula bottle contains virtually unlimited amounts of supplement, compared to the volumes the baby would be consuming at the breast, if breastfeeding was going well. 

 
Then there is the disruption to the gut flora.  And the sensitization to cow’s milk through the porous newborn gut wall.  Even one bottle can make a difference.


The possible physical sequela are a concern, but the most serious problem with incorrectly identifying an infant as losing too much weight is the damage done to the mother’s breastfeeding intention.  “Well, from the start, I didn’t get this right”.  So, what does it matter if I offer a bottle when the baby cries and I am tired, or I when I go for my OB check-up, and then one when my home is full of guests and I might be embarrassed, and then when I go out for a while with friends, and then, and then….  It starts a slippery slope.   When a mother hears that her baby is losing too much weight she not only questions the adequacy of her breastmilk but of her mothering capacity.   

So, who will do the research, the right way, and get reliable guidelines?  We then can prevent the serious complications of hypernatremic dehydration in a few infants and preserve the breastfeeding relationship during the dip in weight before the mother’s milk comes in, in many infants.  Research methods have improved, more researchers are looking at these issues and we owe it to our breastfeeding babies and mothers to get this right.

Thulier D.  Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants.  J Hum Lact. 2016 Feb;32(1):28-34.

Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review.  Open Med. 2008;2(4):e99-e110.

Hits: 2395

Posted by on in General

I’ve participated in the Nestle Boycott for more than 25 years now.  And I have been teaching about the dangers of formula discharge packs in every class I have taught the past 25 years, our lactation consultant training program, our Baby-Friendly Hospital program, in live courses, in online courses.

But those are puny efforts compared to the courage and sacrifices of Syed Aamir Raza Hussain who blew the whistle on artificial baby milk marketing practices in Pakistan.

The new film, “Tigers” exposes the aggressive tactics of companies in promoting the use of infant formula in places where its use is inappropriate.  Where there are no facilities for clean water and the cost of formula is exorbitant compared to the poverty in which new parents are living.  When Syed learned about the consequences of his marketing efforts, he quit his job and went on a campaign, with the help of IBFAN, to stop the use of formula where it can cause malnourishment and diarrhea, even death.

I encourage you to seek out where Tigers will be showing near you and make a point to view it.  http://www.babymilkaction.org/tigers#monitoring  You will wonder why you haven’t been doing more.  Like I have.

Hits: 2104
0

Posted by on in General

I heard a quote recently that “Breastfeeding is part of mothering, not the point of mothering”.  And I thought back on all of the mothers I have worked with over the years who desperately wanted to breastfeed but were running into problems; some easy to resolve, others seemingly unsurmountable complications.  There have been mothers who endured sore nipples for months, breastfeeding/pumping/cup feeding around the clock, or repeated bouts of thrush or mastitis.  Hero’s? Yes!

I have, at times, given a mother “permission” to supplement or to stop.  Some have gratefully accepted the out, and others have done so with overwhelming guilt and sadness.  Some have hung in there despite the problems.  It seems some mothers have gotten the message that it is imperative to breastfeed.  Exclusively breastfeed; supplement at your baby’s peril.   Breastmilk is magic, to be sure.  However, pushing moms to the edge is not part of mothering, and it is not the point of lactation consulting.  Suggesting alternatives until we come upon the one that fits for this mom and baby is the point of lactation consulting.

We have a breastfeeding dyad here.  Both must benefit physically and emotionally.  What can we each do to prevent the kind of difficulties that get moms into those unsurmountable complications to start with?  And what can we do to resolve them quickly?  That is the point of lactation consulting.

Breastfeeding is a (REWARDING) part of mothering but, not the point of mothering!

Hits: 2468

Posted by on in Uncategorized

At this time of year, when we are scrambling around to find the perfect present for everyone on our gift list, let’s remember that breastmilk is the gift that lasts for many holiday seasons.

In fact it is a whole pile of gifts for everyone in the family: the baby, mother, and family as well as the community at large.  And these gifts are free!  Now where do you get a gift, that keeps on giving, for free?!

Here is wishing a years’ worth (or more) of breastmilk for every baby, mother, family!

Hits: 2448

Hospitals which are attempting to initiate Baby-Friendly practices have received a lot of press recently.   Not always does the reporter get the details right.  Sometimes the headline is negative, but the story is essentially positive. 

But at least people are taking notice of the movement!  Here is just a sampling of what has been published recently.

Hospital Support for Breastfeeding: On the Cusp of Big Changes, Time to Step It Up

http://altarum.org/health-policy-blog/hospital-support-for-breastfeeding-on-the-cusp-of-big-changes-time-to-step-it-up

'Baby-friendly' hospitals: Moms give new measures mixed reviews

http://www.dailyherald.com/article/20141027/entlife/141029161/

Local hospitals strive to offer a balance of maternity options

http://www.dailyherald.com/article/20141027/entlife/141029160/

UNM Hospital receives prestigious “Baby-Friendly” designation

http://hscnews.unm.edu/news/unm-hospital-receives-prestigious-baby-friendly-designation110414

No Nursery, No Formula, No Pacifier:  Are “baby-friendly” hospitals unfriendly to new mothers?

http://www.slate.com/articles/double_x/doublex/2014/10/baby_friendly_hospitals_promoting_breast_feeding_at_the_expense_of_the_new.html

 In the article published in Slate, the journalist quotes a study that says formula use promotes breastfeeding by relieving maternal stress.  http://www.ncbi.nlm.nih.gov/pubmed/23669513

But she neglects to address the main reason why exclusive breastfeeding is so important, the changes in the newborn gut from even limited amounts of formula.  Here are just a few selected research articles related to the importance of gut flora and how it can be impacted by breastmilk or formula.

Effect of breast and formula feeding on gut microbiota shaping in newborns  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472256/pdf/fcimb-02-00094.pdf

 Effect of formula composition on the development of infant gut microbiota.

http://www.ncbi.nlm.nih.gov/pubmed/21593648

 Maternal factors pre- and during delivery contribute to gut microbiota shaping in newborns.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417649/pdf/fcimb-02-00093.pdf

 Human gut microbiota: onset and shaping through life stages and perturbations.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505007/

 The long-term health effects of neonatal microbial flora

http://www.ncbi.nlm.nih.gov/pubmed/19398905

 I suspect, as more and more hospitals become Baby-Friendly and institute policies that promote exclusive breastfeeding, the rhetoric will heighten even further.

Congratulations to those over 215 hospitals who have achieved Baby-Friendly Hospital designation.  Lactation Education Resources is proud to have been a part in the educational preparation for designation in many of these hospitals.  There are currently 250+ hospitals using the LER training. 

At present, only 9.4 of the births in the US occur in Baby-Friendly hospitals.  Let’s not stop until we have 100%!!

Hits: 2655
0

Posted by on in Uncategorized

Let your imagination go wild!  What would the world look like if breastfeeding was ultimately supported?

  • Every mother has breastfeeding education during pregnancy
  • Pregnant women are encouraged to breastfeed by their friends and family and are offered positive stories
  • All health care workers mention breastfeeding in a positive light
  • Every maternity shop promotes breastfeeding bras, tops and night gowns
  • All new mothers chose to breastfeed and plan on it for at least a year
  • Every hospital makes skin-to-skin care the norm after vaginal and cesarean deliveries
  • Rooming-in is standard in all hospitals
  • Formula and pacifiers are not available in hospitals except for true medical need
  • Visitors are limited in hospitals to “immediate family” only
  • Every mother has erect nipples that are easy for latch
  • Every mother’s milk comes-in in 24-48 hours
  • No breastfeeding mother has sore nipples
  • Mothers are able to breastfeed around the clock as long as their baby requests that and are not tired the next day
  • Engorgement is mild and viewed as a good sign that the milk “is-in”
  • Breastfeeding mothers do no need a support group because everyone is supportive
  • All mothers have an abundant milk supply
  • No mother ever leaks, especially when she is in the company of strangers or co-workers
  • Slings and carriers replace “baby buckets”
  • Most employers have day care facilities in-house and encourage mothers to feed 2-3 times per day
  • Other employers offer private breast pumping facilities
  • Every store, restaurant, office, airport and airplane the breastfeeding mother visits, encourages her to stop, relax and feed her baby
  • All babies gain weight at an appropriate rate (WHO standards)
  • Everyone who encounters the breastfeeding mother says “You are still breastfeeding, aren’t you?”
  • Formula manufacturers are in danger of going out of business
  • There is a rainbow over every breastfeeding mother’s residence

And all babies get the benefit of breastfeeding for at least a year

What would you see in Lactopia?

Hits: 2707

Posted by on in General

Legislation to mandate exclusive breastfeeding?!?  Yes, in the United Arab Emirates.  A new law has been passed mandating women to breastfeed their babies for 2 years, and if they are unable a wet nurse will be provided for them.

The BBC published an online discussion of many leaders around the world about this topic.  http://www.bbc.co.uk/programmes/p01qh9dk, click on the icon next to the picture.

Of course there are supporters on each side,

  • women should not be coerced to do anything with their bodies that they do not choose to do, including breastfeed
  • those who feel that it is such an important health issue, it should be mandated.  There certainly is enough research to back this up.

I agree with both sides.  Law is probably not the best way to promote maternal infant bonding and make women want to breastfeed.

Unfortunately, the discussion left out the important aspect that the birth process plays on initiation of breastfeeding.  Numerous research studies show the impact of immediate skin-to-skin.  Skin-to-skin contact can unlock the new mothers’ desire to nurture her baby and to breastfeed.  Mothers who hold their newborns skin-to-skin after birth have increased maternal behaviors and show more confidence in caring for their babies.  Women, with uninterrupted access to their babies, WANT to be with them and they find separation distressing.  This closeness fosters a good start to breastfeeding and we see that these mothers have a better breastmilk supply and breastfeed for longer duration.  They are more committed to solving any difficulties along the way. 

Skin-to-skin holding at the time of birth helps the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress.  Being skin-to-skin with mother protects the newborn from the negative effects of separation, supports optimal brain development and facilitates attachment.

Let’s start by making the birth process ideal for all mothers and for infants and see what that does for improving breastfeeding initiation and duration rates.

 

Hits: 2636