Lactation Management Training: From Novice to Expert

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In the initial installment of this series, we discussed the swinging pendulum of breastfeeding rates across the nation, as highlighted by the CDC’s most recent Breastfeeding Report Card.  Among the data are outliers on both ends of the spectrum that warrant a closer look. Over the course of the next four installments, we’ll hear from lactation supporters who are in the trenches in four cities that are performing demonstrably different compared to the total US average and compared to the Healthy People 2020 benchmarks. We’ll discuss what is working to reach families in a unique way in each city, then at the end of the series, we’ll explore state and national efforts to increase accessibility to lactation support across the nation.

As we delve into the challenges and victories occurring in various areas, one factor that is hard to ignore is demographics. Do extenuating factors such as the mother’s sphere of influence or race or line of work directly impact breastfeeding? In short, absolutely! Income, age, education, race, and even language spoken impact healthcare experiences. This is consistent with breastfeeding and the types of support that are available in some communities as well. Breastfeeding success today requires a delicate balance of support and encouragement from many parts of a community; access to current, evidence-based information provided by relatable and available sources; and a work environment that supports pumping breaks and milk storage. The absence of any one of these factors can upset the entire system and almost certainly lead to failure.

The South

Without question, the worst performing area in this country in terms of breastfeeding initiation and duration is the deep south. With consistent averages of 10-20 points below the US average of 81.1% of babies ever breastfed, Georgia, Alabama, Louisiana, Mississippi and Tennessee together represent a cluster of states where unique challenges like those listed above create a dearth of support and a veritable first food desert. Take Mississippi, as an example.  The Breastfeeding Report Card assessed Mississippi as simultaneously having the lowest breastfeeding rates AND the lowest number of lactation support providers available (both free and paid). Success and support go hand in hand.

In the face of the lowest ratings in the nation, there are some methods that seem to be making progress. Taking a closer look at what is working allows for some insight into some of the tangible challenges, and allows for some exploration of replicating that success in further parts of this region. Looking at Tennessee specifically, we find that breastfeeding initiation rates are trending 10 points behind the national average. Not surprisingly, the data also shows a consistent lag across all the measured categories, including the number of lactation supporters per 1,000 live births. Per the TN.GOV site, some obstacles that exist within the state to prevent mothers who have the intention to breastfeed from achieving success are:

  • Lack of experience or understanding among family members of how best to support mothers and babies
  • Not enough opportunities to communicate with other breastfeeding mothers
  • Lack of up-to-date instruction and information from health care professionals
  • Hospital practices that make it difficult to get started with successful breastfeeding
  • Lack of accommodation to breastfeed or express milk at the workplace

How Does Race Factor In?

Sadly, breastfeeding trends are often illuminated when broken down by race. Using almost any breastfeeding metric in the US, White mothers outperform their Latina and Black counterparts. This is even more true in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Latino breastfeeding rates lag White mothers, but the gap is narrowed or widened depending on their country of origin and level of assimilation. This layered and complicated phenomenon will be a focus when we turn our attention to the western region.

Black mothers lag behind the general US population, white mothers, and Latina mothers in every breastfeeding metric, from a national to a local level. This creates a dire situation in many majority-Black cities 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. Efforts like Black Breastfeeding Week were created to overcome the obstacles that Black mothers face and to highlight breastfeeding within the Black community to normalize it. With a Black population of over 950,000, Tennessee has a need for year-round, focused breastfeeding support that gets to the heart of the Black community and its specific challenges. 

BSTARS: Memphis, TN

To gain a first-hand perspective of the impacts this type of focused programming and initiative could have on the lives of mothers at the local level, I had the opportunity to speak with Ms. Jada Wright Nichols, one of the founders of BSTARS in Memphis. She provided insights to better understand her program and the challenges that necessitated its inception. BSTARS’ mission is to support, protect, and promote Black women as they choose to breastfeed. Their work is impacting Black families in Memphis by combatting several of the listed obstacles to breastfeeding success in Tennessee. They are working to build a supportive community armed with confidence and solid information about breastfeeding. The template they have developed is tailor-made to fit the needs of mothers in Memphis, yet is flexible enough to plant elsewhere, and expect similar success.

Can you tell us about the inception of BSTARS?

Breastfeeding Sisters That Are Receiving Support (BSTARS) began in Memphis, TN out of the need to address the low breastfeeding rates amongst mothers of color in the city, while also highlighting those who do breastfeed, but often go unnoticed. Memphis has some of the lowest breastfeeding rates, highest infant mortality rates, highest breast cancer (and diabetes, and obesity) rates, highest poverty rates, and highest segregation rates in the country. We hope that helping to improve breastfeeding rates through consistent and accessible education and support, will also help to bring some of these other social and health issues into balance. We were created through the generous cooperation of the Shelby County Department of Health, Shelby County Breastfeeding Coalition, and Atlanta-based Reaching Our Sisters Everywhere (ROSE).

How has the organization grown/evolved since it began?

We began with a hearty level of interest. At our first official meeting, we had certified lactation counselors, WIC peer counselors, lactation consultants, nurses, and physicians of color all eager to support pregnant and nursing moms.


At each meeting, we discuss a health topic and how it relates to breastfeeding, while also offering skilled breastfeeding support. We have had speakers from the community to address nutrition, exercise, postpartum mood disorders, smoking, birth control, safe sleeping, and family support. We have a solid group of attendees, but as the topics change, so does the make-up of each month's group, depending on the needs and interests of the families. We love being able to support the entire family. We regularly have partners, sisters, mothers, and grandmothers present to hear the same information as the mothers. We always have a lite meal, and an area for children to play or do homework. We are in our second year and growing strong, heading toward becoming our own 501c3 organization.

How is the community better off due to your presence?

Thanks to several of our signature events, Memphis has a greater awareness and appreciation of breastfeeding moms within the city. We have a community baby shower where we distribute pack-n-plays, car seats, nursing pillows, and pumps to 30 families. We have an annual walk along Historic Beale Street and throughout downtown Memphis to promote breastfeeding, health, and sisterhood. We have many community sponsors for this event, including Hooters - our favorite. Perhaps most impactful, we organized a one day breastfeeding symposium, which attracted healthcare providers from 4 states to gather to hear about current research and initiatives in breastfeeding. We were greeted by city officials excited about supporting breastfeeding, and we heard from some of the top voices in the field of lactation. We also have an intimate Facebook group, wherein moms of color ask questions and document, with pride, their breastfeeding journeys.

Could something like BSTARS be duplicated elsewhere?

Absolutely! We are already discussing its replication in a few communities and we are happy to help any others who are interested.

 

It’s a little too soon to see empirical data on the effectiveness of BSTARS. However, historically, the type of focused attention that BSTARS provides yields notable increases in mother confidence, breastfeeding initiation, and duration. Anecdotally, Memphis physicians have already noted that Black mothers seem to be inquiring more about breastfeeding, and breastfeeding for longer periods since BSTARS launched. There is great promise and potential at the local level for closing gaps in breastfeeding and BSTARS is one shining example of how it can be done. Next up, we’ll look at trends in the Western US and explore a program that is focused on groups that are still challenged, even amid high breastfeeding rates in their state.

 

If you would like more information about BSTARS, please contact founder and director, Tiana Pyles at tpyles@bstars.org or Memphis BSTARS on Facebook.  

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Lactation Education Resources has exciting plans for enhancing our Lactation Consultant Training Course beginning in January 2017. We will add micro-learning sessions – short 5-15 minute classes on a focused topic available live as well as archived for viewing later. Another welcome addition will be Virtual Teaching Assistants. VTAs will be available to students to discuss topics and answer questions about the lessons or give career advice.


There will be a tuition increase beginning January 2017. The 90-hour Lactation Consultant Training Program will increase to $975 and the other courses will increase proportionately. We have not had an increase in tuition for over 5 years. If you, or a friend, were planning on taking the Enriched Lactation Consultant Course, you might want to sign-up before the price increase. Just a head’s up. ;-)

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What an exciting time to be a part of breastfeeding education! The marked shift back toward the breast - after a generation of mothers turned to bottles and formula - is nothing short of amazing. From wide-scale national public health efforts to the tireless determination of grassroots community educators, there is plenty of credit to spread around for the wins that we are seeing. And everyone who has had a hand in this work should be proud of the clear success of the movement. That is not to say, of course, that our work is done. Hardly so. For every hospital that has become Baby Friendly and placed breastfeeding education and support at the forefront of their pre and post-natal offerings, there are several more who still have yet to prioritize increasing their breastfeeding rates. For every pediatrician and obstetrician who advises an expecting parent to consider breastfeeding, there are several more who never mention it or maintain outdated perspectives. And the truth is, for every state that is meeting and surpassing the Healthy People 2020 goals for breastfeeding initiation and duration, there are states that are not even close. While there is cause for celebration, it’s too soon to rest on our laurels.  This post is the first in a series that will dig into the current state of breastfeeding in the US, examine the outliers on both ends of the data, and consider how we can continue the work to increase equity in lactation across the country.

According to the CDC’s latest Breastfeeding Report Card, the number of babies who were put to the breast at least once in 2013 is 81.1%. That number is an average across 50 states, plus Washington DC and Puerto Rico. This means there are states faring way better (I’m looking at you, Utah, with 94.4%), and there are those who fared far less (O-Mississippi-G with 52%) being factored in. Once you start to explore the data at a state level, glaring differences like this emerge again and again. How could Utah’s breastfeeding initiation rates be 20-40 percentage points higher than every state in the deep south? Why does every state west of Texas tout initiation rates above the Healthy People 2020 goal of 81.9%, but so few on the east coast have even come close to that benchmark? What is happening differently across the country? How can we help to close to gaps?

The good news is that in most states, there are innovative programs aimed at addressing local challenges to breastfeeding. The services range from grassroots community organizations to statewide coalitions, and everything in between. They provide catered solutions to the specific challenges of the families in those areas. And they are making steady progress. However, huge extenuating factors like economics and race play a particularly significant role in breastfeeding in many of the states that are the most challenged. That means the incredibly important and delicate work of dismantling barriers and mindsets is needed to reverse some of the trends that are being seen. So there is no easy or quick fix. But there are strategies and solutions and communities who are committed to progress.

Helping to remove barriers to breastfeeding in the states where the least number of mothers are putting babies to the breast (and subsequently keeping them at the breast) is a worthy focus because it has the potential to save lives in areas where infant mortality rates are frighteningly high. And it’s where we will pay particular attention as this series progresses. We hope you’ll tune in as we start to look a bit closer at the data and also at the national, state and local efforts that are working to turn some of the statistics around. We’ll also discuss how you can become involved in fostering change to bring about lactation equity in those areas where it’s most needed, and help to push more states across the line from promise to progress.

Next up: North, South, East, West: A Breastfeeding Tale of Four cities

Nikki Killings MPH, IBCLC, CLC, LLLL lives and works in California with her husband and children. She spends her time writing, reading and supporting families in underserved communities.

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We, along with breastfeeding supporters around the world, mourn the passing of Miriam Labbok MD, MPH, IBCLC. Miriam was a friend and supporter at the inception of our Lactation Consultant Training Course at Georgetown University Hospital in 1990.  Those of us who had the good fortune to have worked closely with her in those early years, know of her influence on the breastfeeding world. Those who come to this work in the future will not know her personally, but will also be strengthened by her tireless work in support of breastfeeding.

Dr Labbok had a distinguished career beginning at the University of Pennsylvania and Tulane Medical School. She served as Director of the World Health Organization Collaborating Center of Breastfeeding, and was the Chief of Nutrition and Maternal Health, Division of the Agency of International Development (USAID). She was UNICEF’s Senior Advisor on Infant and Young Child Feeding and Care.

Most recently she was the founder and a professor at the University of North Carolina Gillings School of Global Public Health and Director of the Carolina Global Breastfeeding Institute. She was a favorite speaker at hundreds of breastfeeding conferences and won many achievement awards related to breastfeeding promotion throughout her career.

Dr Labbok’s vision and commitment to protect, support, and promote breastfeeding has had worldwide influence on the health of mothers and infants!

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The attached survey comes from International Board of Lactation Consultant Examiners to investigate the interest in having a new credential available for people working in the lactation field.  This potential credential is intended for those individuals who are not IBCLCs, but are interested in being recognized by the IBLCE for the training they have accomplished (40 – 89 hours).  

This potential credential is not intended as substitute for the IBCLC but as an enhancement to the IBCLC’s practice.  It would be under the auspices of IBLCE who will develop a scope of practice and entry level exam which would complement and mesh with the IBCLC.  To avoid the appearance of competing with the IBCLC, we see great advantage to having this new recognition developed by the same organization that has oversight of the IBCLC credential, the IBLCE.

Those who may be interested in this new credential include:

  • Those seeking work while completing the rest of the requirements for IBLCE certification
  • Those seeking work without the intention of pursuing IBLCE certification in the future

This credential would be equivalent to the Breastfeeding Specialist certificate given by Lactation Education Resources at the present time.  It would be renewable and internationally recognized.

 We hope all of you will take the time to return this brief survey to IBLCE and tell them of your interest and support.  The survey takes less than five minutes to complete and will close on July 29. 

If you are not yet an IBCLC, please take this survey.

 https://www.surveymonkey.com/r/J79YTH5

If you are already an IBCLC, please take this survey

https://www.surveymonkey.com/r/J82VTPQ

Vergie Hughes RN MS IBCLC FILCA
Program Director
Lactation Education Resources
V 443-203-8553
F 410-648-2570
programdirector@lactationtraining.com

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I started Nursing at a very young age and still I have several years to work. My experience includes 30+ years working OB. What a wonderful way to finish my last trimester than helping new Mom's to perfect their God given ability to nourish their babies.

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I was a 22 yr old, first-time parent in 1988. My own mom told me that breastfeeding was "just a fad" --but the price of formula- at SIX dollars a can was too much for my budget.


The only support I got was from one kind nurse. I can still see her eyes smiling above her mask. She had a slight German accent and reminded me of my grandmother.


My first child breastfed for 13 months despite my return to difficult full-time work 8 weeks postpartum. Later, WIC hired me to assist the Deaf and Hard of Hearing community as a peer counselor and eventually to help staff the first Government- funded Breastfeeding clinic in the Southwest.

I became a proud IBCLC in 1999.
My mom is now grandmother to 3 healthy breastfed grandkids and a vociferous proponent of this "fad". :)

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Although we do this work because we love what we do and know it makes a difference in the health of mothers and babies we serve, most of us can’t be volunteers.  We want to provide expert lactation support, while we make our car payments, rent or mortgage, and buy food too. 

Many lactation consultants are employed in hospitals, where salary ranges are similar to those of Registered Nurses.  Others work in physician’s practices, WIC or public health clinics where salaries may be a bit lower.  Others start a private practice.   This is very driven by your local area and salary scales.  It also depends on the availability of lactation consultants in the area.  Are there open jobs or are there very few opportunities?

Those who also have a credential as a registered nurse will find the easiest to find a job in a hospital. Some hospitals require the lactation consultants they hire are also RN's, although non-nurses are sometimes also hired in certain hospitals.  Other employment opportunities may not have the RN requirement.

Many lactation consultants choose to work part time to meet their other obligations at home.  Others may work two part-time jobs in order to find full employment.

These websites can provide some data on salaries across the nation.

http://work.chron.com/lactation-specialist-make-21656.html

http://www1.salary.com/Lactation-Consultant-Salaries.html

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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.

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My first baby, born in 1975, was premature at 34 weeks gestation, cared for in an excellent NICU for its time. There was little communication to parents, no visits into the unit, no contact with baby until discharge, no mention of how you might intend to feed your baby. It was understood that breastfeeding was too hard for premies, and no mention of breastmilk by pumping. After 18 days, I took home a tiny "puker", allergic to most formula tried in the first year. I became an NICU nurse in 1978, began to hear about benefits of breastmilk, was exposed to a two day course on brestfeeding in 1999, that led to my becoming certified. That was only the open door. Lactation affords me opportunity to support breastfeeding, mother the mom, and fulfill my mission to God for this calling.

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I breastfed my first 2 children with ease for almost 9mo each. When I had my third child I got a very serious nipple wound from improperly pumping. Every time I nursed my daughter it would tear open and bleed. I didn't know what to do or how to help myself. I kept thinking that if I just placed her properly on my breast it would heal.I was up day and night, reading, researching and trying to figure out how to help myself but it kept getting worse. I remember calling LLL and asking if someone could come out and help me, they could offer me phone advice but I needed someone to come to me. I was too tired to go out and get help. I did get that help, and went on to nurse my daughter for over a year. I became an IBCLC to help women in their homes, but am still based in the hospital!

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Breastfeeding prevents allergies.  No it doesn’t.  Breastfeeding helps prevent obesity.  No it doesn’t.  Breastfeeding babies have higher IQs later.  No they don’t.   It is dizzying to follow the research reports on the benefits of breastfeeding.  Just when there are several studies showing a certain benefit, there comes along one that demonstrates otherwise.  What in the world is going on? 

I think that “Summarizing the health effects of breastfeeding” gives a good clue to what is going on.   http://onlinelibrary.wiley.com/doi/10.1111/apa.13136/epdf.  The act of breastfeeding is so complex in terms of how long, how much, supplements given, pumped breastmilk, timing of feedings, mother’s supply, feeding method, and so on.  The milk is so complex in terms of daily variations, monthly variations, variations over the course of breastfeeding, genetic variations, and so on.  The family in which the breastfed baby grows up is so complex in terms of maternal nurturance, life style, socio-economic influences, parental education and so on.  The variables in any research study are enormous and although researchers attempt to mitigate those variations in the design of the study, it is virtually impossible to take them all into consideration.   So we get research that is contradictory.  If the new research not outright contradictory, at a minimum, it may draw differing conclusions.

So, just when you feel comfortable making a claim about a facet of the superiority of breastmilk, know that some research will come out that says something different.   Studies that are replicated and come out with similar results are the most reliable.  Be critical when you read research.  Are there variables that were not considered in the study design?  Who funded the study?  Do the results support the conclusion?

Don’t be shaken by the fluctuations in published literature.  Breastfeeding is more art than science.

Tagged in: breastfeeding IBCLC
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“Be the change you wish to see in the world” This statement has been my go to through many times throughout my life, so it seemed only natural that I looked to it when I sat and thought...what do I want to do with my life? What change do I want to see in the world?
It was when I was two months postpartum with my second child that this answer came flooding into my life. My best friend had just had her first child and there she was sitting on the couch with her newborn with the look of defeat plastered all over her face. The same dreaded face that I have come to recognize all too quickly with many of my patients ... Her son would not latch onto the breast. Though I had a few months of breastfeeding under my belt, I lacked the education, verbiage, and overall counseling techniques to get her through this hurdle. I was at a loss as how I could help. I knew that I loved breastfeeding my child more than anything, the look of contentment, sedation, love and purity that came from him each time he fed, I knew that I wanted her to experience that same feeling, especially since she wanted it so badly. Be the change...I decided then that she was my muse to my new found path. I delved right into how I could be the change I wanted to see in this world, where women who chose to breastfeed had the support, guidance, alliance and encouragement they needed to reach their goals. I earned a BS in Maternal and Child Health with a concentration in Human Lactation; from there I earned my IBCLC. I became the change I wanted to see in this world, and now my new mantra to each patient I see has become, "my goal is to help you achieve yours, whether its three days, three months or three years, I will support you”. Never would I have thought that a profession could feed your soul as much as this one does, but each day I am reminded of that enrichment by the sighs of relief after a successful feeding, a mother’s soft gaze into her newborns eyes and the empowerment she feels when our consult ends. I have become what I set out to be!

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At the age of 24, I delivered my twins at 37 weeks. I thought I would "try" breastfeeding like so many moms say they will. Babies were expensive and so was formula. Luck was on my side, I had a wonderful nurse who helped me get off to a great start. After we were home, a public health nurse came weekly to visit and offer assistance. Sometimes she'd just sit in my living room; her presence was enough to give me the confidence I needed to feed my babies. I watched them grow and thrive on my milk. By the time they were 8 months old I knew I wanted to help other women like the nurse that had helped me. Breastfeeding wasn't just feeding, it was a way of parenting. I couldn't imagine things any other way. With the nurses support, I became an LLL Leader & 3 years later an IBCLC.

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Why an LC?
I read everything I could about breastfeeding before the birth of my first child. He would not nurse in the hospital, and I was told I was starving my baby. At one point he was brought to me and spit up formula, despite me having told them he was to be exclusively breastfed. My anger which I was unable to articulate at that time turned to research and study about breastfeeding. I nursed my son for a year. I’ve dedicated my professional career to breastfeeding women and their babies. It is great to see the progress that has been made.

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"My name is Maria. When I had my child 26 years ago, I had a little experience about breastfeeding since I was living in Cuba. When I came to the U.S in 2001, I was hired a year after, I'm start knowing how beneficial in breastfeeding a baby beyond a year, I felt regret that I couldn't do it. My reward was my daughter who I educated her while she was pregnant with her first baby. After knowing all the great benefits, she was determine to breastfeed and yeah she did for 19 mo. My grand baby has very strong immune system, smart and a bright girl. That's the reason that motivated me to dream to became Lactation Consultant and also be able to help my community."

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After years of ousting breastfeeding moms, calling security and generally harassing women who breastfeed in their stores, Target now has a Breastfeeding Policy that is exemplary.

Breastfeeding Guests may openly breastfeed in our stores or ask where they can go to breastfeed their child.  When this happens, remember these points:

  • Target’s policy supports breastfeeding in any area of our stores, including our fitting rooms, even if others are waiting
  • If you see a woman breastfeeding in our stores, do not approach her
  • If she approaches you and asks for a location to breastfeed, offer the fitting room (do not offer the restroom as an option).
  • If you have any questions, partner with your leader.

OMG, did a LC write this?!

Now the rest of you retailers, follow Target’s lead.  They have hit the target on this one!

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That’s right! Initiating skin-to-skin and breastfeeding in the OR after a cesarean section is becoming the standard of care in many places.

Step 4 of the Baby-Friendly Hospital Initiative has helped moved this idea forward. Mothers are loving it! And providers are finding that is easy enough to do.

Step 4:  Help mothers initiate breastfeeding within a half-hour of birth
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

We have known for a long time that holding an infant skin-to-skin immediately after birth improves the physiologic stability for both mother and baby and increases maternal bonding behaviors. It is also the optimal start for breastfeeding. 

The nine instinctive stages of newborn behavior, first described by Anne Marie Widstrom, unfold during the first hour after birth while the infant is in skin-to-skin.

  1. Birth cry - This distinctive cry occurs as the infant’s lungs expand.
  2. Relaxation – Mouthing movements begin and the hands are relaxed.
  3. Awakening – The infant moves his head, opens his eyes, and shows some mouth and shoulder activity. This begins at about 3 minutes after birth.
  4. Activity – Mouthing and sucking movements increase as the rooting reflex becomes more obvious.  Eight minutes after birth.
  5. Resting – Periods of resting are interspersed with activity.
  6. Crawling – The infant approaches the breast with crawling and thrusting movements. Begins about 35 minutes after birth.
  7. Familiarization – The infant begins licking and nuzzling the nipple. Begins at 45 minutes after birth and may last for 20 + minutes.
  8. Suckling – The baby self-attaches to the breast and suckles.
  9.  Sleep – Both mother and baby fall asleep. Usually about 1 ½ to 2 hours after birth.

Interruption of skin-to-skin holding can interfere with the normal progression of the infant through these nine stages. He then has to “start-over” delaying his first attempt at breastfeeding.

I highly recommend the article by Philips for a full discussion of the benefits of skin-to-skin and very practical steps to initiate these procedures in the OR**.

 

References:

Burke-Aaronson AC.  Skin-to-skin care and breastfeeding in the perioperative suite.  MCN Am J Matern Child Nurs. 2015 MarchApr;40(2);105-9.

Grassley JS, Jones J.  Implementing skin-to-skin contact in the operating room following cesarean birth.  Worldviews Evid Based Nurs. 2014 Dec;11(6):414-6.

Hung KJ, Berg O.  Early skin-to-skin after cesarean to improve breastfeeding.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24.

** Phillips R.  The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth.  Newborn & Infant Nursing Reviews.  June 2013Volume 13, Issue 2, Pages 67–72

http://www.researchgate.net/publication/257612445_The_Sacred_Hour_Uninterrupted_Skin-to-Skin_Contact_Immediately_After_Birth

Sundin CS, Mazac LB.    Implementing Skin-to-Skin Care in the Operating Room After Cesarean Birth.   MCN Am J Matern Child Nurs. 2015 Jul-Aug;40(4):249-55. 

Widstrom AM,  Aaltomaa-Michalias P, Dahllof A, Lintula M, Nissen E.  Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.  Acta Paediatr 2011.  Jan:100(1): 79-85.

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I have had the privilege of helping mothers and babies for approximately 28 years now. I always share with my Moms that the reason I most likely became an IBCLC is because of the bad experience I had with struggling to breastfeed my first child (now age 30). I was a young mom and although I had read about breastfeeding, I like so many other people believed breastfeeding is a natural thing - you just put the baby at the breast and it sucks. How hard can that be?

As a young mom in the hospital I was trying my best. My nipples were cracked and bleeding and as I was crying and trying to nurse my baby my nurse said, "You are starving that poor baby...give her a bottle.” As a result, we struggled for months with low supply. I was determined no other new mom should ever feel that way!

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For me, becoming an LC was a natural evolution. Growing up I only once saw a woman breastfeeding. Yet, coming of age in the time of Women's Liberation and starting as a Nurse Practitioner in a rural mountain community, it seemed the natural, healthy and right thing to do. I was blessed with two babies who latched on with ease and never gave me a minute's trouble until, when my second child was 17 months old, an abscess and surgery brought an abrupt, sorrowful end to breastfeeding. I had the pleasure of knowing, being assisted by and learning from a fabulous role model - Mary Rose Tully. There is nothing more rewarding than the joy on a Mom's face, and Dad's too, when together we solve a problem, Mom is no longer in pain, their baby eats with gusto and then looks deeply into Mom's eyes.

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