Clinicians in the Trenches: Francisca Orchard from Santiago, Chile

Screenshot 2014-10-20 10.41.26

By Francisca Orchard, CNM, IBCLC

I became a certified midwife 20 years ago, assisting women in labor since my early adult days. I came into this field with an eye toward low intervention birth and respect for mothers, with special emphasis on the humanization of birth. This was probably because, during my internships in hospitals, I saw very little respect for women and a lot of poor treatment of them.

In the 1990s, I worked in a neonatal intensive care unit where the promotion of breastfeeding in preterm infants was a priority. Later, I also received doula training in the U.S. and earned a diploma in infant massage in London.

In 2011, I achieved my goal of becoming an International Board Certified Lactation Consultant® (IBCLC®). The road was not easy for me. The year I took the exam was the first time in Chile the exam was given at the same time as in the rest of the world.

Since then, I have been working in breastfeeding promotion, and consulting in support of perinatal health professionals. I began a prenatal education program for pregnant women and their families that promotes breastfeeding and respectful delivery to reduce the number of caesarean section deliveries in Chile, and to increase our prevalence of exclusive breastfeeding to 6 months of life.

In Chile, we have 43% of mothers still breastfeeding at 6 months, but there is a huge disparity in breastfeeding rates related to women’s income.  We have an urgent need to follow mothers during the first days after maternity hospital discharge, where most abandon exclusive breastfeeding. We also struggle with  health professionals who, due to their lack of knowledge about breastfeeding, are perhaps our biggest barrier to breastfeeding duration. Most pediatricians encourage the use of artificial supplements instead of working with mothers and babies early to help them continue breastfeeding.

Currently, I am a member of the Chilean Committee on Breastfeeding and the Lactation Committee of the Chilean Society of Pediatrics. Some months ago, I collaborated with a multidisciplinary team of psychologists and photographers on a project called “Breastfeeding Mothers.” We created a space where women of different ethnicities and Chilean places were professionally photographed in different breastfeeding situations.  It is a beautiful work with more than 50 photographs. We are awaiting funding to publish it for breastfeeding promotion in Chile.

In my daily work, I consult with women and babies with breastfeeding difficulties and write articles of interest to our community.As of this writing, I am one of only 2 IBCLCs in Chile. During World Breastfeeding Week, I traveled to different cities in Chile to participate in breastfeeding promotion activities. Additionally, I work on an advisory team of the ministry of health. We are working toward implementing the Baby Friendly Hospital Initiative in Chile during 2015. The Chilean government is also discussing the approval of human milk banks.

It is an exciting time in Chile with so much going on to support and promote breastfeeding. I am thankful for the International Lactation Consultant Association’s® resources that help me inform my community about the competencies and value of IBCLCs, and to increase our numbers throughout Latin America.

chiliPhoto via the author

Posted in Breastfeeding Around the Globe, Clinician in the Trenches, IBCLCs around the globe | Tagged , , , , , , | 2 Comments

FREE Access the Journal of Human Lactation and other SAGE Journals

JHL feb coverEach October, SAGE Publications, the publisher of the International Lactation Consultant Association’s® (ILCA’s®) quarterly, peer-reviewed Journal of Human Lactation (JHL), invites the global research community to visit their journals platform and sign up for October Free Access to all 750+ SAGE journals.  Last year, more than 18,000 individuals and librarians world-wide signed up for for their October 2013 campaign.

We’d like to encourage you to take advantage of this offer – and especially to access the incredible research and commentary in JHL – so you can browse all SAGE journals of interest.

To access this offer, simply:

Do you like what you see? Consider ILCA membership.

As an ILCA member, you will receive the print version of JHL, consistently rated as a top benefit of membership, in your mailbox four times a year and have 24/7 digital access both on JHL’s website and mobile platform.

Join Nowrenew now button

Posted in JHL News | Tagged , , , , , | Leave a comment

NEW Benefit from ILCA: Earn FREE CERPs!

ILCA Membership BLOG HEADER (1)You were clear in the recent Member Survey: you want and need quality, accessible continuing education.

International Board Certified Lactation Consultants® (IBCLCs®) are required to recertify every five years and are expected to be up-to-date on the latest in evidence-based lactation care.

Get the CERPs you need in the format that works best for you.

To help our members meet this need, the International Lactation Consultant Association® offers many ways members can obtain Continuing Education Recognition Points (CERPs), including: our annual conference, live webinars, recordings of conference and webinar sessions, and learning modules from the Journal of Human Lactation (JHL).

While the conference and webinars are live, you can also access a selection of our recorded content and the JHL modules at your convenience on the CERPs on Demand portal.

2015 members: earn your free CERPs here

Beginning 1 January 2015, members will be eligible to earn up to 10 free CERPs per year. The list of free CERPs was developed from ILCA’s online bank at the CERPs on Demand portal so that you can complete the CERPs at the time that best meets your needs.

This list was specifically chosen to provide content on a variety of issues that impact the IBCLC community worldwide. We also chose a variety of session types, including conference presentations, webinars, and JHL study modules. The offerings, all of which will be active for the entire 2015 calendar year, include:

Breastfeeding Education for NICU Staff (1 CERP): This session, presented by Anita Moorhead, RN, RM, IBCLC; Annette Auld, IBCLC, RN; and Judith Russell, RN, RM, IBCLC, is a great overview of the implementation of a breastfeeding educational program in the NICU. It also reviews the successes and challenges of providing breastfeeding support to NICU mothers by educating staff. It also raises concern about the need for breastfeeding benchmarks in the NICU.

Vulnerable Population Groups (1 CERP): This presentation, by Kirstin Lock, IBCLC, BSN, CMC, looks at the use of group perinatal care in vulnerable populations. Populations addressed include obese and young mothers, as well as the Chinese, Arabic and the Aborigine populations. It includes a description of the presenter’s local hospital statistics on breastfeeding and exclusive breastfeeding results and how the programs impacted those rates in the vulnerable populations they were serving.

Breastfeeding the High-Risk Infant (1 CERP): This thought-provoking session offers both a historical perspective and day-to-day challenges faced by members of the neonate’s health care team and is presented by Shakira Lita Ismay Henderson, MPH, RNC-NIC, IBCLC. It reviews common barriers to breastfeeding, benefits of breastfeeding for these infants. In addition, Henderson presents practical strategies and approaches to encourage breastfeeding the high-risk infant. It offers practical ways to speak the language of the NICU team and evidence based practices to back-up interventions that address their concerns.

Racial Disparities in Infant Mortality, Breastfeeding, and Sleep (1.5 CERPs): This presentation, by Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA, highlights the disparities in infant mortality for ethnic-minority populations as well as identifies the physiological effects of discrimination on women’s health in general and during pregnancy. The session also explores current policies on bedsharing, unsafe sleep, and breastfeeding rates and the impact they have on infant mortality within these populations.

Milk Sharing: Comparative Risks and Biomedical Ethics (1 CERPs): Dr. Karleen Gribble presents on one of the hottest topics in our field: peer-to-peer milk sharing. Participants in this session will be able to describe the types of risks associated with milk sharing as well as the risks of formula feeding. Mitigation of these risks is also discussed along with the principles of biomedical ethics as they apply to peer-to-peer milk sharing.

Determinants of 6-Month Maternal Satisfaction (1.5 CERPs): This JHL Study Module focuses on the paper by José Labarère, MD, et. al, exploring maternal breastfeeding satisfaction. Although a personally defined experience, successful breastfeeding is usually measured with regard to duration. This study investigated the determinants of maternal satisfaction with breastfeeding experience for 907 mothers enrolled in a prospective cohort study. Eliciting the mother’s expectations regarding breastfeeding duration may help the lactation consultant in providing appropriate guidance.

Maternal Request for In-Hospital Supplementation (1 CERP): Written by Katie DaMota, MAS, IBCLC, et. al, this paper, and accompanying JHL Study Module, seeks to understand the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period. It explores the impact of a lack of preparation, prenatally, for breastfeeding and advocates for interventions to address mothers’ real and perceived barriers.

Ultrasound Imaging of Infant Sucking Dynamics (1 CERP): This paper, written by Vanessa S. Sakalidis, BHlth Sc (Hons), et. al, explores the dynamic process of breastfeeding. Nipple diameters, tongue movement, nipple position, and suck rate were measured during nutritive sucking and non-nutritive sucking from ultrasound scans of the intra-oral cavity during breastfeeding. Milk intake and LATCH scores were also recorded.

Help us choose the final CERP!

studentWe’ve heard your desire to have a say in ILCA decisions that directly impact you and we are giving you the opportunity! We’ve chosen 9 units of CERP offerings and we need YOU to help choose the final one. You can vote in the poll below, which will be open until 23 October 2014. The CERP with the most votes will be added to the final list and become available as a free CERP for members on 1 January 2015. Your choices are:

Plugging In: Listening to the Needs of Mothers: This session is the first of a 4-part series, presented by Cathy Carothers, entitled “Making the Connection: Counseling and Communication Workshop.” It takes an interactive approach to assisting mothers with their infant feeding decisions through the concept of “connection before content.” Communication strategies include rapport-building techniques, emotional triggers that enhance effective and powerful relationship-building with new families, and ways to create a safe environment for women to receive and act on educational messages.  The evidence-based communication principles are so effective they can be used not only with new mothers/clients, but also with difficult co-workers, and even your family! Members will have the opportunity to purchase the 3 additional sessions.

Today’s Mothers are All Thumbs: Cultural Competency for Digital Motherhood: It is no surprise that communication styles have changed drastically over the past years, moving from print media, TV, and discussions among friends to Facebook, podcasts, and blogs.  The mothers we support are HIGHLY engaged online and often seek their health information, including breastfeeding information, from web sources before their health care providers. This presentation, by Amber McCann and Jeanette McCulloch, will identify characteristics of mothers of the “Millennial Generation” and their methods of communications as well as help us to understand the basics of popular social media platforms such as Facebook, Twitter, and Pinterest. This is the first of a four-session series. The remaining sessions of the series will be available for purchase.

Previous Breastfeeding Difficulty: Supporting the Multiparous Woman to Successfully Breastfeed: With Cynthia Peterson, RM, C&FHN, IBCLC, this session explores how to provide support and guidance to families who have had previous breastfeeding difficulties. This can include exploring their previous experience as well as providing counseling support and referrals.


UPDATE!

Our poll is now closed and you OVERWHELMINGLY choose Cynthia Peterson’s Previous Breastfeeding Difficulty: Supporting the Multiparous Woman to Successfully Breastfeed to be added to our list of FREE available CERPs for 2015 ILCA Members. Thank you for taking part and we appreciate all of your votes!


 

We truly believe that this new benefit will have a significant impact on our field by equipping and educating IBCLCs all over the world. We’ve heard positive feedback from you already and look forward to hearing how you put the things you learn from these sessions into practice. Join or renew now so that you won’t miss out on this incredibly opportunity.

Join Now

renew now button


Fine Print: While we understand that we are offering sessions that have been previously available to ILCA members, we will not be making any substitutions to this list. If you previously purchased an included session, no refunds will be given or substitutions made. We are providing this benefit to all members (with the exception of short-term trial members). All sessions must be completed by 31 December 2015 to receive the free benefit.

Posted in ILCA News | Tagged , , , , , , | 4 Comments

Last Chance – JHL Photo Contest Closes 15 Oct

JHL PhotoContest

Every year, the Journal of Human Lactation (JHL) hosts a photo contest for the coveted cover spot on each edition. The JHL is a quarterly, peer-reviewed journal publishing original research, insights in practice and policy, commentaries, and case reports relating to research and practice in human lactation and breastfeeding. The annual photo contest is your opportunity to contribute to the journal and highlight your community. We’ve invited the JHL staff to tell us more about how you can join in the contest.

JHL staff have let us know that, as we approach the submission deadline, they are especially seeking photographs depicting research.

The four photos on JHL’s cover are changed annually. JHL is your journal, and we want to feature your photos! The four photos portray the broad field of human lactation, from the IBCLC helping new mothers (picture the caring professional with a breastfeeding mother, teaching a class, etc.) along with the harder science of lactation (picture test tubes of milk, microscope slides, etc.).

Please send us your photos! We are looking for shots representing a range of backgrounds, contexts, and cultures.

Guidelines:

  • Keep photo clear with minimal background interference
  • Photos should be jpeg files: 300ppi .jpg; at least 2100 pixels wide x 1500 pixels high
  • Email photos to: jhlphotocontest@gmail.com
  • We may not be able to respond to each message separately, but as confirmation of your submission, you should receive an auto response message
  • Include your name (assuming you are the photographer) and full contact information with preferably a second email address

Rules:

  • Deadline – October 15, 2014: NO EXCEPTIONS
  • If a recognizable person features in the photo (e.g., the face of a mother/baby/clinician etc.) you must have a photo consent form.
  • If your photo is a contender for publication, we will require subjects to sign a specific consent form, so only send photos if you know you can obtain permission from the subject.
  • As the photographer you will need to sign non exclusive copyright – in other words, you allow JHL to use the photo, but you are free to use it elsewhere as you choose.
  • If we believe the photo is a potential winner, we will contact you again before the deadline to talk to you and ensure we have the correct forms.

Questions? Email jhlphotocontest@gmail.com

Posted in JHL News | Tagged , | Leave a comment

NOW is the Time! Registration Open for 2015 Membership

ILCA Membership BLOG HEADER (1)

Today is the day!

Registration is now open for 2015 membership with ILCA. 

Join Now

renew now button

ILCA is committed to world health transformed through breastfeeding and skilled lactation care. It is our highest priority to promote the professional development, advancement, and recognition of International Board Certified Lactation Consultants® (IBCLC®) WORLDWIDE for the benefit of breastfeeding infants and their families.

We encourage all ILCA members to also join their regional or national affiliates.

ILCA Offers You MORE in 2015!

The new membership package for 2015 includes benefits that allow you to:

Join or Renew Now!

If you are new to ILCA and are joining for the first time, you can receive up to 3 months FREE by joining as soon as possible. As soon as you join, you will have full access to all of ILCA’s member benefits.

Join Now

If you are a current ILCA member, your membership expires on 31 December 2014. If you would like to continue your membership and receive the new benefits for 2015, including access to earn up to 10 FREE CERPs, you must renew by 1 January 2015.

renew now button

In addition to our standard membership, also consider our Student membership and Retired membership. Each comes at a reduced cost to encourage all those supporting breastfeeding families to be an ILCA member. Click HERE for more information.

Want to take advantage of our GROUP discounts? These offer you a 10% discount for each individual participating in a group. Group memberships require a minimum of five (5) people to submit their membership applications via mail to the ILCA Office.

If you have any questions, please contact membership@ilca.org.

Posted in ILCA News | Tagged , , , , , , | Leave a comment

ILCA Offers You MORE in 2015: Membership Details

ILCA Membership BLOG HEADER (1)

You shared your needs with us in our 2014 Member Survey, and we listened! Based on what you told us you needed most, we have developed your new membership package for 2015.

First and foremost, ILCA is committed to world health transformed through breastfeeding and skilled lactation care. It is our highest priority to promote the professional development, advancement, and recognition of International Board Certified Lactation Consultants® (IBCLC®) WORLDWIDE for the benefit of breastfeeding infants and their families.

ILCA Offers You MORE in 2015!

The new membership package for 2015 includes:

Earn FREE CERPs (NEW in 2015):

All ILCA members are eligible to earn up to 10 FREE CERPs. As you know, IBCLCs are required to recertify by CERPs or exam every five years. Be sure to take advantage of this benefit: over the course of five years, you can secure up to two-thirds of your required CERPs for the recertification process. You won’t want to miss this benefit!

The Journal of Human Lactation (JHL):

Guide your practice by reading the research you need in  three ways: on paper, online, and mobile. In addition to the print edition that will arrive in your mailbox, you can also read full articles online at the JHL website, on your computer, or your mobile device. Use your ILCA membership number and password to log in.

Find A Lactation Consultant (FALC) Listing:

New families who are in need of breastfeeding support want to find YOUR contact information. Our FALC directory connects families seeking support to the gold standard in lactation support: IBCLCs. The FALC helps them find you: a verified IBCLC in their community.

Build Your Practice Toolbox:

Inside Tracks are exclusively for ILCA members. Get evidence-based handouts for families on topics like tongue-tie, returning to work, Vitamin D supplementation, hand expression, and more. Available for printing or sharing as PDFs with your clients. Check out the full list HERE.

Stay Connected:

Receive weekly email updates which includes information about educational opportunities, advocacy efforts, techniques to improve your practice, and the latest in lactation research through our ILCAlert. In addition, join us on Facebook, Twitter, Pinterest, and LinkedIn. And, as always, be sure to check out Lactation Matters, the official blog of ILCA, for in-depth analysis of research, highlights of innovative programs, and new ideas to incorporate into your practice.

Save Money:

Get significant discounts on all of ILCA’s continuing educational opportunities, webinars, CERP modules, the ILCA bookstore, and our annual conference!

And MORE!:

Access our translations of practice documents and relevant research.

When do I need to join or renew?

If you are a current ILCA member, your current year membership expires on 31 December, 2014. If you would like to continue your membership and receive the new benefits for 2015, including access to earn up to 10 FREE CERPs, you must renew by 1 January 2015. You can do so online, starting 1 October, 2014, HERE.

If you are new to ILCA and are joining for the first time, you can receive up to 3 months FREE by joining as soon as possible after the membership registration opens on 1 October 2015. As soon as you join, you will have full access to all of ILCA’s member benefits. Go HERE, starting 1 October, 2015 to register.

What will this cost me?

We have recently made changes to the membership structure for our members from Australia, New Zealand, Canada, and the United States.

Previously, members in these areas were required to join both the international organization (ILCA) and their respective regional organizations (USLCA, CLCA, and LCANZ). Their membership fee was divided between the two groups and members received the benefits of both, independently administered, organizations.

That is now changing and the requirement of membership in both the international and regional organization has been lifted.

As a part of the change in structure, your membership fee will also change. We have taken into account the concern expressed by our members that these changes would lead to a significant increase in the cost of membership. We are glad to announce our new fees for 2015 represent only a $2 (USD) increase over the portion of last year’s fee that came directly to ILCA.

As before, your membership fee varies based on your home country. You can find complete information about our 2015 membership fees HERE.

Still not sure?

Did you know that you can try ILCA FREE for 30 days? Want to figure out a bit more of what ILCA is about? Just email membership@ilca.org with your contact information (name, mailing address, email, and phone numbers) and you will receive a login and password that will be good for a 30 day ONLINE TRIAL membership.

Do you support and promote breastfeeding? Then you are a valued member of our community. You do not need to be an IBCLC to be a member!

If you have any questions, please contact membership@ilca.org.

Posted in ILCA News | Tagged , , , , , , | 4 Comments

Announcing a NEW Membership Structure for ILCA

ILCALogo_full_text (2)As the International Lactation Consultant Assocation® (ILCA®) prepares to begin our campaign for our 2015 Membership year, we want to make you aware of changes to our membership structure. We deeply value all members of the lactation field and we have put significant effort into identifying and delivering the services most important to you. We are also evolving to meet our vision of “World Health Transformed through Breastfeeding and Skilled Lactation Care.”

Up until now, ILCA members who lived in the United States, Canada, Australia, or New Zealand had their membership “bundled” with one of our Partner Affiliate organizations (In the U.S., you are bundled with the United States Lactation Consultant Association (USLCA); in Canada, with the Canadian Lactation Consultant Association (CLCA); and in Australia and New Zealand, with the Lactation Consultants of Australia and New Zealand (LCANZ)).

This means that, when a member joined ILCA, they automatically received membership in the national or regional organization in their area. For example, our Canadian members were automatically signed up for both ILCA and CLCA. The membership fee was divided between the two groups and members received the benefits of both, independently administered, organizations.

That is now changing. Members living in the areas served by our Partner Affiliates will no longer be required to join both the international organization (ILCA) and their respective regional organizations (USLCA, CLCA, and LCANZ).

Recognizing the potential benefits, ILCA and the Partner Affiliates have considered this action for some time. The primary rationale for this decision is to provide our existing members the opportunity to freely choose membership based on their needs and objectives and to provide potential members greater latitude to join like-minded local, national and/or international organization(s) that are within their budget. This new option will allow all the organizations to run more effectively and meet the unique needs of their particular region.

Additionally, the ILCA Board of Directors has renewed our commitment to strengthen and expand our affiliate relationships WORLDWIDE. Until now, ILCA has been intently focused on our three Partner Affiliates, often to the detriment of organizations and International Board Certified Lactation Consultants (IBCLCs) in other countries. This renewed commitment to emerging IBCLC institutions will allow ILCA to help elevate these organizations to the world stage by providing much needed organizational support.

Of course, ILCA remains strongly committed to our current affiliates and the needs of IBCLCs in those countries. If we are to truly embrace our vision of world health transformed through breastfeeding and skilled lactation care, we will need effective partnerships with both established and emerging affiliates. And most importantly, we need you: individuals committed to advancing the IBCLC profession worldwide through leadership, advocacy, professional development, and research.

Finally, we strongly encourage everyone to join both ILCA and your local or national professional association, in order to support efforts to advance the IBCLC profession both worldwide and in your community.

Together, these steps to remove the membership requirement and to strengthen ILCA’s global outreach are major initiatives with far-reaching benefits.  We look forward to continuing to serve you and hope you will renew your upcoming membership and partner with us to meet these exciting goals. Look for additional information about your membership renewal coming to you soon.

Sincerely, on behalf of the ILCA Board of Directors,

DSC03591Decalie Brown, RN, CM, IBCLC, CFHN, BHMtg
President (2014-16)

Posted in ILCA News | Tagged , , , , , , | 6 Comments

Incorporating New Research In Your Practice: Guest Post By Sue Cox, IBCLC

3

In part one of this series Sue Cox, AM, BM, IBCLC, FILCA, presented research to inform our discussions around how milk handling (including shaking expressed milk and/or breast massage) changes the components of the milk, including fat distribution.

In part two Sue presents research on other common questions, including whether to feed on one side or both and interventions including nipple shields and nipple creams.

Both breasts at each feed? Research: One or both breasts at each feed

In 1984 we carried out research (Cox, 1984) to find out whether mothers followed the suggested feeding regime or whether they developed their own. At that time mothers were told to only offer the breast five times each day. They were also told to always use both breasts at each feed-time.

Length of breastfeeds was strictly regimented. Mothers were told to only allow their baby to breastfeed for:

2 minutes, on the birth day, then

3 minutes on the second day,

5 minutes on the third day,

7 minutes on the fourth day, 

10 minutes on the fifth day,

And from then on just offer 10 minutes.

Mothers stayed in hospital for 5-7 days and rooming-in was rare. When the babies returned to the nursery on the third and fourth day we noted that many of them had very wet and dirty nappies (diapers), they vomited excess milk, and they sucked their hands and cried.

We had read of some of the newest research from the UK (Baum, 1980) which showed changes (increases) in fat levels from the beginning to the end of a feed. Therefore, we decided to suggest to the mothers that if their breasts were feeling really tight on the second or third day, or if they had used one breast per feed with a previous baby, that they might like to try just using one breast at each feed until they recognized their baby wanted more milk and/or their breasts were less firm.

Our findings showed that of the 155 mothers: 3% were discharged early; 27% fed from both breasts at all feeds; 8% fed from one breast during the period when their breasts were distended and were discharged feeding from both breasts; and 62% fed from alternate breasts at each feed before and after discharge (Cox, 1988).

Following further research on breast capacity (Daly et al., 1993; Cregan & Hartmann, 1999) and research on breast hypoplasia (Huggins et al., 2000) we now understand that we cannot give advice about one or both breasts per feed or the frequency of feeds because this is dependent on an individual mother’s breast capacity.

Point baby’s chin towards the area of the blocked duct? Research: ensure good breast drainage over every 24 hour period instead of concentrating on angle of baby’s mouth

Ultrasound studies of breast anatomy (Ramsay, 2005) show that the ducts do not radiate out through a breast segment in an organized way, but instead begin under the areola and travel out through the breast in a randomized fashion.

Nipple creams and lanolin? Research: short term relief only

In 1988 mothers were dissuaded from using anhydrous lanolin as pesticides were found in the lanolin. A purer form of lanolin later became available, but only one prospective controlled clinical trial has been done to support its use (Abou-Dakn, 2011.) This study indicates that it may be helpful in comparison to expressed breast milk in the first three days of treatment.

In my experience 1,800 mothers who birthed in our maternity unit annually chose to breastfeed their babies. After we stopped using lanolin and other nipple creams in 1988, our maternity staff became very skilled in finding the cause of nipple pain and strategies to prevent and/or treat nipple trauma and pain were developed instead of using the “quick fix” of lanolin.

Rubber nipple shields prevented weight gain in infants? Research: use of silicone shields in a small percentage of mothers could be effective if appropriate follow-up is conducted

The main nipple shield used 20 to 30 years ago was made of rubber.  Following research to quantify milk transfer, it was found that the poor areolar stimulation through the rubber shield led to only 42% of available milk being transferred to the baby (Woolridge at al.,1980).

In the hospital where I practiced as an IBCLC, two incidences of babies having been admitted to the pediatric ward with poor weight gain at 6 weeks of age led to further exploration of the issue of rubber nipple shield use. Both mothers had been given a rubber nipple shield during their maternity stay. Following discussions with staff, it was decided that nipple shields would no longer be distributed. This increased the midwives’ skills at assisting mothers with breastfeeding.

Some years later, following much discussion in the literature, we decided to do a pilot study to quantify how many mothers and babies could be helped by using the newer, thin silicone nipple shields (Cox & Paine, 1997). We found that silicone nipple shields were an advantage to 2.2% of mothers and their infants as long as they were followed up to ensure adequate output and that weight gain was continuing during all the time they were using a nipple shield.

These experiences confirmed for me that developing new policy and procedures should always be supported by current research.

Finally, Sue recommends that IBCLCs consider their rationale before making alterations to their current clinical practice or before creating new policies and procedures. Using new clinical skills and techniques can be extremely beneficial, and we should strive to remember that they are “in development” until the qualitative or quantitative research is produced to support them.  In fact, as a profession we are called to propose and conduct research in collaboration with other disciplines to further our ability to assist mothers and babies. Sue leaves us with this reminder: “Development and growth of a respected profession is based on evidence. Listen to new ideas and seek validation of what you hear from the evidence.”

Abou-Dakn M et al., (2011) Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol, 24(1):27-35.

Baum JD, (1980) Flow and composition of suckled milk. Medica Amsterdam

Joanna Briggs Institute (2009) The Management of Nipple Pain and/or Trauma Associated with Breastfeeding Best Practice, Evidence based information sheets for health professionals, 13(4).

Cox SG (1984 ) One breast per feed: A solution for the crying baby. Proceedings of the International Confederation of Midwives conference, Sydney, Australia.

Cox SG (1988) Why do some babies prefer only one breast at each feed? Breastfeeding Review 13:85-6.

Cox SG & Paine K (1997) The importance of follow-up of infants when the mother is using a nipple shield for breastfeeding. Unpublished data.

Cregan, MD & Hartmann PE (1999) Computerized breast measurement from conception to weaning: clinical implications. J Hum Lact 15(2):89-96

Daly SE, Owens RA, Hartmann PE. (1993) The short-term synthesis and infant-regulated removal of milk in lactating women. Exp Physiol, 78(2):209-20.

Huggins KE, Petok ES & Mireles O (2000) Markers of Lactation Insufficiency: A study of 34 mothers. Current Issues in Clinical Lactation, 25-35.

Kent JC et al., Breast volume and milk production during extended lactation in women. Exp Physiology, 84(2):435-47.

Ramsay DT et al., (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. J Anat, 206(6):525-34.

Woolridge MW, Baum JD, Drewett RF (1980) Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev, 4(4):357-64.

Posted in Breastfeeding, Research | Tagged , | Leave a comment

Shaken Or Stirred? How Does Handling of Breastmilk Impact Composition? Guest Post by Sue Cox, IBCLC

2

Incorporating new evidence-based information about putting lactation into practice is a critical component of the role of the IBCLC.  As additional information becomes available, it is a challenge to place it in the context of what has already been established both in the field of lactation and in the broader fields of anatomy and physiology. 

Our guest blogger Sue Cox, an IBCLC since 1985 and the author/presenter of over 80 papers, addresses the research in hot topics in the IBCLC profession today, including questions about breastmilk composition when shaken, agitated, or left in the breast between long feedings. Watch for part two of this post next Wednesday where she will share her reflections on the research on other commonly asked questions about breastfeeding.

On Listening, Then Reviewing/Pondering What We Read and Hear

In this blog post, I will be commenting on some of the discussions I have read on the Internet and heard in professional conversation lately. I hope these quotes – on which I have based my professional life as an IBCLC – will help guide your thinking.

. . . Continued learning requires that we seek new knowledge and [accept] the challenge that takes place when our own interpretations on ways of doing things are questioned by others. That is the price we must pay if we are to hone our skills, increase our knowledge and strive to keep to the best of our abilities for those women who seek our assistance and depend upon us for guidance.

Kathleen Auerbach, (1987) J.Hum Lact 3(4).

Receptiveness to what we hear is vital, but what we hear needs always to be backed up by physiological/biochemical/ anatomical/endocrinological and/or psychological understandings.

Sue Cox 2014.

Note from the editor: Much recent research has addressed how best to handle expressed human milk, with the goal of maintaining the integrity of the milk components and more evenly distribute the components within the liquid. This has, in turn, generated conversation about ways to more evenly distribute nutrients, especially human milkfat, throughout milk during breastfeeding. Read on for the research that Sue provides to further discussion in each of these areas.

Will agitating a syringe of expressed breastmilk for infusion to premature infants homogenize the milk?

Ultrasound has previously been shown to homogenize cow milk (Ertugay & Sengul, 2004).

Ertugay, FM, Sengul, M (2004) Effect of Ultrasound Treatment on Milk Homogenisation and Particle Size Distribution of Fat. Turk J Vet Anim Sci 303-308.

In the recent study by Garcia-Lara and colleagues (2014) the researchers sought to extend knowledge of the most appropriate routine to decrease fat loss in infused expressed breastmilk for premature infants. The word homogenization occurred in the title: “Type of homogenization and fat loss during continuous infusion of human milk.” Three methods were used to mix the milk in the syringe: baseline agitation, hourly agitation and ultrasound. The first two methods simply reconstituted the milk but did not make every drop the same as in homogenization. 

Garcia-Lara et al., (2014) Type of homogenization and fat loss during continuous infusion of human milk. J Hum Lact  0890334414546044, first published on August 13, 2014 as doi:10.1177/0890334414546044.

Could shaking the breast homogenise milk?

Breastmilk in the alveoli is a suspension of fore- or skim- milk with small amounts of fat suspended in it, but most of the fat is bonded to the epithelial lining of the alveoli.

If breastmilk were to be homogenised it would require a “factory setting” in which it would be altered from a suspension to an emulsion where every drop would be the same.

Homogenisation is a process in which the fat droplets are emulsified and the cream does not separate http://www.oxforddictionaries.com/definition/english/homogenize

Even after centrifuging, all of the fat globules do not separate and fat is seen in the skim fraction of the milk (Czank et al, 2009)

Czank, C, Simmer K, and Peter E Hartmann, PE  (2009) A method for standardizing the fat content of human milk for use in the neonatal intensive care unit. Int Breastfeed J. 2009; 4: 3.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678083/

Could shaking the breast or breast massage increase the fat content earlier in the feed?

Whittlestone (1953) hypothesised that the fat globules adhered to the walls of the alveoli and ducts.

Whittlestone WG (1953) Variations in the fat content of milk throughout the milking process. J Dairy Res 20: 146–153

Foda (2004) found that when samples of expressed milk were taken within 30 minutes  before Okatani massage and then the breast was fully hand expressed after massage that there were increased fat levels in the post-massage breastmilk but this only occurred after lactation was well established which in that study was after three months. No reference was made to the effect that the massage may have had on milk ejections occurring which increase fat levels in milk, nor was there mention of degree of fullness or time since the previous feed.

Foda et al., (2004) Composition of milk obtained from unmassaged versus massaged breasts of lactating mothers. J Pediatr Gastroenterol Nutr.;38(5):484-7.

Morton et al (2012) found that when mothers who were expressing for their premature babies used hand expression and breast compression during pumping that their milk exceeded normal fat and energy levels after the first week postpartum.

Sue notes here that the breasts would have been well drained at each expressing and pumping session.

Morton J, et al., (2012) Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants.  J Perinatol. 32(10):791-6

Would altering breastmilk so that the infant received creamier milk earlier in the feed be an advantage to the baby?

Karatas (2011) suggested that the weight patterns in healthy breastfed infants at their second and fifth months is based on the satiety from changes in breastmilk ghrelin, leptin, and fat levels between the foremilk and hindmilk.

Karatas Z et al., (2011) Breastmilk ghrelin, leptin, and fat levels changing foremilk to hindmilk: is that important for self-control of feeding? Eur J Pediatr. 2011 Oct;170(10):1273-80.

Various theories have been suggested about how/why the fat detaches including: the decrease in surface area as the alveoli are being drained of milk during a feeding (Atwood & Hartmann, 1992; Neville, Allen & Watters, 1983; Hytten, 1954); the effect of hormones oxytocin and prolactin and/or alteration in gene expression as the alveoli is drained (Hassiotou et al., 2012; Hall, 1979) .

Atwood CS, Hartmann PE (1992) Collection of fore and hind milk from the sow and the changes in milk composition during suckling. J Dairy Res 59: 287–298.

Neville MC, Allen JC, Watters C (1983) The mechanisms of milk secretion; Neville MC, Neifert MR, New York and London: Plenum Press. 49–102.

Hytten FE (1954) Clinical and chemical studies in human lactation. I. Collection of milk samples. Brit Med J 23: 175–182.

Hassiotou F, Geddes DT, Hartmann PE (2012) Cells in human milk: State of the science. J Hum Lact 29: 171–182.

Hall B (1979) Uniformity of human milk. American Journal of Clinical Nutrition 32: 304–312.

Does milk separate in the breast if there are long gaps between feeds?

The greater portion of the milk is stored in the alveoli until required (Geddes, 2009). High-resolution ultrasound images (Geddes, 2009) show the flow of milk as the ducts dilate in the breast following oxytocin-mediated milk ejection (shown by flecks in the milk in the duct as the milk is ejected as well as in the infant’s oral cavity). When milk removal ceases the residual milk returns to the alveoli.   

Geddes D (2009) The use of ultrasound to identify milk ejection in women – tips and pitfalls. Int Breastfeed J. 2009; 4: 5. doi:  10.1186/1746-4358-4-5

Hassioto et al., (2013) found that when milk was expressed before, after and then at 30- minute intervals for three hours after breastfeeds that the highest fat levels were found 30 minutes after the end of milk removal. This supports the utrasound findings of Geddes (2009) that showed how residual fat returns to the alveoli after milk removal.

Hassiotou F, et al., Breastmilk cell and fat contents respond similarly to removal of breastmilk by the infant. PLoS One. 2013; 8(11): e78232. Published online Nov 6, 2013. doi:  10.1371/journal.pone.0078232

In conclusion, the suggestion that homogenization can be achieved by simply shaking or agitating breastmilk in the breast or in another receptacle is an incorrect use of the word homogenize. The use of the word homogenize in the context of human lactation and breastfeeding requires scholarly review.

Watch for Sue’s next guest post, where she presents the research on other key areas of breastfeeding practice today.

Posted in Uncategorized | 15 Comments

Breastfeeding and Racial Disparities in Infant Mortality: Celebrating Successes and Overcoming Barriers

As a part of Black Breastfeeding Week, Lactation Matters is reprinting (with permission) two editorials from Clinical Lactation, the official journal of the United States Lactation Consultant Association. Up today: a focus on the successes so far and places where IBCLCs can support change. Throughout the post, check out additional links that author Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA, has asked Lactation Matters to highlight as additional resources for our community.

Many exciting changes occurred in 2013 in the breastfeeding world. One of the best trends was the increase in breastfeeding rates in the African American community. The CDC indicated that increased breastfeeding rate in African American women narrowed the gap in infant mortality rates. As the CDC noted:

From 2000 to 2008, breastfeeding initiation increased . . . from 47.4% to 58.9% among blacks. Breastfeeding duration at 6 months increased from . . . 16.9% to 30.1% among blacks. Breastfeeding duration at 12 months increased from . . . 6.3% to 12.5% among blacks.

Much of this wonderful increase in breastfeeding rates among African Americans has come from efforts within that community. In 2013, we saw the first Black Breastfeeding Week become part of World Breastfeeding Week in the U.S. Programs, such as A More Excellent Way, Reaching Our Sisters Everywhere (ROSE), and Free to Breastfeed, offer peer-counselor programs for African American women.


Check out the Black Mothers’ Breastfeeding Summit


We can celebrate these successes. But there is still more to do. Although the rates of infant mortality have dropped, African Americans babies are still twice as likely to die. In addition, although rates of breastfeeding have increased among African Americans, they are still lower than they are other ethnic groups.

For each of the 2000–2008 birth years, breastfeeding initiation and duration prevalences were significantly lower among black infants compared with white and Hispanic infants. However, the gap between black and white breastfeeding initiation narrowed from 24.4 percentage points in 2000 to 16.3 percentage points in 2008.

Barriers to Overcome

In order to continue this wonderful upward trend in breastfeeding rates, we need to acknowledge possible barriers to breastfeeding among African American women. Here are a couple I’ve observed. They are not the only ones, surely. But they are ones I’ve consistently encountered. They will not be quick fixes, but they can be overcome if we recognize them and take appropriate action.

1) Pathways for IBCLCs of Color. In their book, Birth Ambassadors, Christine Morton and Elayne Clift highlight a problem in the doula world that also has relevance for the lactation world: most doulas (and IBCLCs) are white, middle-class women. And there is a very practical reason for this. This is the only demographic of women that can afford to become doulas (or IBCLCs). The low pay, or lack of job opportunities for IBCLCs who are not also nurses, means that there are limited opportunities for women without other sources of income to be in this profession. Also, as we limit tracks for peer-counselors to become IBCLCs, we also limit the opportunities for women of color to join our field. I recently met a young African American woman who told me that she would love to become an IBCLC, but couldn’t get the contact hours needed to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.

2) We need to have some dialogue about how we can bring along the next generation of IBCLCs. We need to recognize the structural barriers that make it difficult for young women of color to enter our field. ILCA has started this dialogue and held its first Lactation Summit in July to begin addressing these issues.

These discussions can start with you. Sherry Payne, in her recent webinar, Welcoming African American Women into Your Practice, recommends that professionals who work in communities of color find their replacement from the communities they serve. Even if you only mentor one woman to become an IBCLC, you can have a tremendous impact in your community. If we all do the same, we can change the face of our field.

3) Bedsharing and Breastfeeding. This is an issue that I expect will become more heated over the next couple of years. But it is a reality. As we encourage more women to breastfeed, a higher percentage of women will bedshare. As recent studies have repeatedly found, bedsharing increases breastfeeding duration. This is particularly true for exclusive breastfeeding.

Bedsharing is a particular concern when we are talking about breastfeeding in the African American community. Of all ethnic groups studied, bedsharing is most common in African Americans. It is unrealistic to think that we are going to simultaneously increase breastfeeding rates while decreasing bedsharing rates in this community. The likely scenario is that breastfeeding would falter. It’s interesting that another recent CDC report, Public Health Approaches to Reducing U.S. Infant Mortality, talks quite a bit about safe-sleep messaging, with barely a mention of breastfeeding in decreasing infant mortality. A more constructive approach might be to talk about being safe while bedsharing. But as long as the message is simply “never bedshare,” there is likely to be little progress, and it could potentially become a barrier to breastfeeding.


Don’t miss the Interview with Sherry Payne on Fighting Breastfeeding Disparities with Support.


Reason to Hope

Even with these barriers, and others I haven’t listed, Baby-Friendly Hospitals are having a positive effect. When hospitals have Baby-Friendly policies in place, racial disparities in breastfeeding rates seem to disappear. For example, a study of 32 U.S. Baby-Friendly hospitals revealed breastfeeding initiation rates of 83.8% compared to the national average of 69.5%. In-hospital exclusive breastfeeding rates were 78.4% compared with a national rate of 46.3%. Rates were similar even for hospitals with high proportions of black or low-income patients (Merewood, Mehta, Chamberlain, Phillipp, & Bauchner, 2005). This is a very hopeful sign, especially as more hospitals in the U.S. go Baby-Friendly.


Click here to watch the Teach Me to Breastfeed Rap!


In summary, we have made significant strides in reducing the high rates of infant mortality, particularly among African Americans. I am encouraged by the large interest in this topic and the number of different groups working towards this goal. Keep up the good work. I think we are reaching critical mass.

And thanks for impacting your community—one mother at a time. Wishing you a happy and healthy 2014.

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA

Editor-in-Chief, Clinical Lactation

Reference

Merewood, A., Mehta, S. D., Chamberlain, L. B., Phillipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in U.S. Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116(3), 628-634.

Reprinted with permission from Clinical Lactation, Vol. 5-1

About the Author

kendall-tackett 2014-small

Dr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, Fellow of the American Psychological Association in Health and Trauma Psychology, President of the APA Division of Trauma Psychology, and Editor-in-Chief-elect of Psychological Trauma. She is a Clinical Associate Professor of Pediatrics at the Texas Tech University School of Medicine in Amarillo, Texas and Research Associate at the Crimes against Children Research Center at the University of New Hampshire. Her most recent books include The Science of Mother-Infant Sleep (with Wendy Middlemiss) and Psychology of Trauma 101 (with Lesia Ruglass). Her websites are KathleenKendall-Tackett.com and UppityScienceChick.com.

Posted in Black Breastfeeding Week | Tagged | 1 Comment