How Can You Improve Outcomes By Supporting A Family’s Breastfeeding Self-Efficacy?

Self-efficacy—most of us have heard the term. Similar to self-confidence, self-efficacy is the feeling you have when you see yourself as capable of accomplishing a goal, and you are pretty certain that you can succeed.

You probably know intuitively that your client’s self-efficacy about breast- or chestfeeding is an important component of their success. But there’s numerical evidence to show that it may be even more important than we thought.

A 2017 study in the Journal of Human Lactation suggests that a person’s confidence in their breastfeeding success can have a marked impact on their actual success—and that the right interventions can significantly increase that all-important sense of self-assurance.

In the first investigation of its kind on this topic, Interventions to Improve Breastfeeding Self-Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis looked at the data from 11 previously published studies. Each had measured Breastfeeding Self-Efficacy (BSE), a numerical score indicating confidence, before and after breastfeeding interventions. Studies had then compared changes in BSE to breastfeeding rates at particular points postpartum.

Researchers grouped the data from the 11 studies’ control groups and intervention groups to compare results.

Overall, intervention groups had Breastfeeding Self-Efficacy scores 4.86 points higher than control groups.

But that’s not all. Researchers found that for every 1-point increase in the mean BSE score between groups, the odds of exclusive breastfeeding went up by 10 percent.

“We wanted to ask, ‘Is BSE a theory that means something for breastfeeding outcomes?” says Meredith (Merilee) Brockway, PhD, RN, IBCLC, a post-doctoral researcher at the University of Manitoba and the study’s lead author. “And the answer is yes. If we can improve a person’s BSE, we will see significantly improved breastfeeding rates.”

What is BSE?

About 20 years ago, researchers in human lactation created the term “Breastfeeding Self-Efficacy,” or BSE, to describe an individual’s degree of confidence in their ability to successfully nurse their child. A scale (the Breastfeeding Self-Efficacy Scale) was created to measure it, and was later refined to the Breastfeeding Self-Efficacy Scale Short Form, or BSES-SF. The concept has been used in many studies. However, until Brockway’s study, no one had measured whether BSE could be changed—or whether changing it enhanced breastfeeding success.

What Shapes BSE?

Some people enter their lactation journey full of confidence, some full of doubt. Most are somewhere in the middle. What creates the difference? Factors fall into four domains.

  • Previous accomplishments. Has this person breast- or chestfed before? What was that experience like?
  • Vicarious experience. Who else’s lactation journey have they seen? How did it go?
  • Verbal persuasion. Messages about the likelihood of success from important others in the person’s social sphere, like friends, family, and physicians, are key.
  • Physiological/affective status. How is the person feeling, physically and mentally? A traumatic birth, fatigue, depression, or anxiety can all effect BSE.

What Does this Mean for You?

Since BSE is an important predictor of success, how can lactation support professionals apply this concept in their work with families? Brockway has several suggestions.

Keep BSE on your radar. Remember that confidence in one’s ability, not just actual factors affecting ability, determines success.

Assess your client’s BSE. Ask questions in each of the four domains,” Brockway suggests. “What are their previous experiences? Vicarious experiences? What messages are they receiving from important others? What are they experiencing, mentally and physically, that might be impacting their confidence? If you notice red flags in a category, recognize that this client may have lower confidence in their ability to succeed, and that’s where you can augment your work for this family.”

Maintain continuity of care. Some studies the meta-analysis intervened in the hospital, others in the community, and others in both locations—with overwhelming evidence that interventions need to extend over both settings. When interventions only took place in the hospital, BSE scores only increased an average of 0.16 points. When they took place in the community after discharge, scores went up 0.84 points. But when an intervention spanned both settings, BSE jumped 5.37 points. “If you just end the work in the hospital, it is not fine,” Brockway says. “The person goes home and is on their own, and what are they to do? There has to be a transition where they keep contact. It’s very important.”

Understand How BSE Creates Success. From previous work on the concept of self-efficacy in general, we get a glimpse into why a person with higher BSE is more likely to meet their breast- or chestfeeding goals. It turns out that self-efficacy is what allows us to navigate obstacles that come up on the path to our goal. And since almost no one’s lactation journey is obstacle-free, that ability is critical to sustained success.

“When you build up someone’s BSE, you empower them,” Brockway concludes. “When you increase their self-efficacy, you launch them—you give them the eventual ability to operate successfully long-term on their own. So when that person hits an obstacle—sore nipples, a growth spurt, a sleep regression—they don’t think, ‘I’m failing at this.’ They think, ‘Okay, this is good. I can get through this, and I’m still doing well.”

Want to learn more?

ILCA members, did you know that you can earn CERPs by studying select journal articles? Learn how to get continuing education credit from this article here.

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IBCLC Care Awards: Applications Now Open

Let potential clients know that your Hospital-Based Facility or Community-Based Agency recognizes the role of the International Board Certified Lactation Consultant® (IBCLC®) in protecting, promoting and supporting breastfeeding by applying for the IBCLC Care Award.

The IBCLC Care Awards are promoted to new families and the general public which means your facility can enjoy the benefits of positive public relations in your community, including:

  • Enhanced attractiveness to potential patients
  • Competitive edge in recruiting lactation consultants, nurses, midwives, mother support counselors and other medical staff
  • General good will in the community by providing excellent care in helping new families reach their breastfeeding goals

Visit the IBCLC Care Directory to see which Hospital-Based Facilities are already benefiting from the IBCLC Care Award program!

Hospital-Based Facilities and Community-Based Health Agencies that staff currently certified IBCLCs can apply online to become a recognized IBCLC Care Award facility. Learn more about the qualifications and complete the online application here.

Applications will be accepted online starting 13 January 2020 through 14 February 2020. Please contact us at admin@ilca.org if you have any questions.

The award was created by International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®). Learn more and apply here.

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Top 10 JHL Posts of 2019

On topics ranging from addressing disparities to trends in research on human milk exchange, our community tapped into the top-accessed resources of Journal of Human Lactation (JHL) nearly 180,000 times last year.

As we wrap up 2019, we compiled this list of the year’s top ten most accessed JHL articles. Planning on using research to guide your practice? Your ILCA membership ensures a full year’s access to the next year’s content, along with online, on-demand searchable access to the full database of JHL research to find the evidence you need. Not a member or time for you to renew? Click here to join or renew your membership now.

#10 Critical Review of Theory Use in Breastfeeding Interventions

Yeon K. Bai, Soyoung Lee, Kaitlin Overgaard

#9 A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support

Corrine S. Casal, Ann Lei, Sera L. Young, Emily L. Tuthill

#8 Does Truthful Advertising Ever Pass “The Smell Test” in a Peer-Reviewed Journal?

Elizabeth C. Brooks

#7 Reflexivity in Qualitative Research

Joan E. Dodgson

#6 Current Trends in Research on Human Milk Exchange for Infant Feeding

Aunchalee E. L. Palmquist, Maryanne T. Perrin, Diana Cassar-Uhl, Karleen D. Gribble, Angela B. Bond, Tanya Cassidy

#5 Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis

Ellen M. Chetwynd, Heather M. Wasser, Charles Poole

#4 An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse

Kathleen A. Marinelli, Helen L. Ball, James J. McKenna, Peter S. Blair

#3 Feasibility and Acceptability of Metformin to Augment Low Milk Supply: A Pilot Randomized Controlled Trial

Laurie Nommsen-Rivers, Amy Thompson, Sarah Riddle, Laura Ward, Erin Wagner, Eileen King

#2 Breastfeeding in the Community: Sharing Stories on Implementations That Work

Sheree Holmes Keitt, Harumi Reis-Reilly, Nikia Fuller-Sankofa, Margaret Carr

#1 Breastfeeding in the Community: Addressing Disparities Through Policy, Systems, and Environmental Changes Interventions

Harumi Reis-Reilly, Nikia Fuller-Sankofa, Calondra Tibbs

Editors Note: As originally posted, some authors were listed in the incorrect order. This post was edited on 16 January 2020 to list the authors in order as published in the Journal of Human Lactation.

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Fighting Cross-Marketing of “Follow-up” Milks

Families often do not know the difference between infant formula and toddler milks. According to UNICEF and the World Health Organization (WHO), advertising and promotion of toddler or follow-up milks is a way to circumvent the protections provided by the International Code of Marketing of Breast-milk Substitutes (International Code).

These toddler or follow-up milks are often labelled nearly identically to infant formula intended for infants birth – six months, but are in some countries not subject to the same marketing restrictions.

According to the World Health Organization: “Products that function as breastmilk substitutes should not be promoted. A breastmilk substitute should be understood to include any milks . . . that are specifically marketed for feeding infants and young children up to the age of 36 months (including follow-up formula and growing-up milks).” 

These are just two of the reasons why ILCA volunteer Maryse Arendt attended the Codex meeting in Dusseldorf, Germany, where follow-up formulas, cross-promotion, and the International Code were being discussed.

Following the six day meeting, Maryse reported that important progress was made following significant discussions, negotiations, and compromises. As ILCA’s representative to Codex, she worked alongside the handful of other lactation-supportive NGO and breastfeeding-friendly country representatives. 

Codex Alimentarius is a set of internationally recognized standards and guidelines for food, food production, and food safety. Since 1963, Codex has existed to protect the health of consumers and ensure fair practices in international food trade.

Progress at Codex often happens in small steps and over multiple years of effort and negotiation. Previously, the Codex standard defined follow-on milks as not being breastmilk substitutes. This is significant as it allowed formula companies to label follow-on milks in similar packaging (often in stages, such stage 1, 2, and 3) and then market the toddler drinks without the protections of the International Code.

The new Codex draft under discussion now names the product a “drink for young children” or a “drink for young children with added nutrients,” without requiring it to be exempted from the International Code. This is important because countries that are already or want to define the product as a breastmilk substitute can do so, without threat of violations of World Trade Organization agreements. The text has still to undergo different Codex steps before being final in 2022.

Up next: a discussion to include a reference to the International Code and WHA resolutions in the preamble, which was deferred to next year. The United States was the biggest opponent to strengthening references to the Code in Codex.

Thank you to Maryse for your significant efforts. 

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Call for Papers: State of the Science August 2020 Issue

Guest post by Journal of Human Lactation Editor in Chief, Joan Dodgson, PhD, MPH, RN, FAAN

The aim of state of the science literature reviews that Journal of Human Lactation (JHL) features in our August issue is to provide an up-to-date picture of what is well established in a particular aspect of lactation and to suggest possible areas that need further research. These reviews are critical analyses of the body of research about a specific narrowly defined topic, written by researchers who have the breadth and depth of knowledge along with the research skills to distill a body of work for the rest of us. It is important that the authors’ analysis within state of the science articles addresses a number of very important questions:

  • Why is this an important area within lactation?
  • What assumptions are being made in the existing literature?
  • How rigorous are the study designs within this body of literature?
  • Who is and who is not being studied (and why)?
  • What do we know, what are we fairly certain about, and what do we not know about this topic?
  • Where or what are the disparities?
  • What are next steps in moving this knowledgebase forward? 

We consider state of the science analysis a type of research because it requires much more depth of analysis than a synthesis of existing literature. Therefore, all components of a research paper (i.e., background, study aim, methods [design, sample, data collection, data analysis] results, discussion and limitations) are required in the state of the science papers.

  • First, a brief Background about the topic of study that includes the significance of this topic is needed. 
  • A clearly written Study Aim that describes the area to be critically analyzed is essential or the reader will be unable to determine if the authors have adequately addressed the issue. 
  • The methods section begins with the Design section statement, in which a design statement is required. A number of ways to conduct an analytical review of the literature (i.e., the design) exist, any of which would be appropriate for a state of the science paper. We have previously published state of the science papers that used the methods of systematic reviews, meta-analyses, scoping reviews, integrated and qualitative synthesis; however, other methodologies also could be used. 
  • In this type of research, the articles reviewed are the Sample, which need to be described using inclusion and exclusion criteria. This section also provides a description of how the literature review was done, including the databases searched, search strategy and search terms. To do an adequate review a minimum of 4 databases need be searched. In addition to the health science databases, many topics relevant to lactation also require a search of humanities (JSTOR) and social science (PsycINFO, social science abstracts & others) literature. It might be helpful to readers if a table of the search strategy was included. Additionally, a PRISMA diagram is required.
  • The Data Collection section must include how data from each article was abstracted (e.g., using matrices), when and by whom. This section also needs to include which variables were extracted with clear definitions, keeping in mind that breastfeeding variables frequently are ill defined or defined differently by various authors.
  • The Data Analysis section clearly describes to the reader how variables were analyzed (e.g., descriptive statistics, etc.) and compared. 
  • It is likely that most of the Results will be presented in the form of tables and/or figures. 
  • It is in the Discussion section that the authors will need to distill the meanings within their findings, discuss the gaps in the existing body of literature and identify areas for future research. 
  • A Limitation section is required
  • Conclusions need to be generalized statements 

State of the science articles are the most up-to-date evaluations about the topic analyzed, as textbooks are always out of date, making state of the science articles invaluable resources for researchers, educators and clinicians. It is of great importance that experts in the field publish state of the science papers, which is why we are posting this call for papers. We ask that, if you feel this is something you could do, you consider submitting one for upcoming state of the 2020 science issue (manuscripts due 20 January 20).

Find JHL Author Directions here.

For examples of state of the science articles, see our August 2019 issue.

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Understanding ILCA’s Advocacy Strategy

At ILCA, all of our advocacy work is defined by our overarching goal: sustainable policy change so that more children survive and thrive through breastfeeding/chestfeeding and so that skilled lactation care is valued globally.

The advocacy strategy was shared with our community by advocacy advisor Michele Griswold at the recent All General Meeting at the ILCA conference in Atlanta, Georgia:

Read on for a summary of key elements of ILCA’s advocacy strategy:

Our overarching goals

At ILCA, all of our advocacy work is defined by our overarching goal: sustainable policy change so that more children survive and thrive through breastfeeding/chestfeeding and skilled lactation care is valued globally.

Of course, ILCA’s advocacy strategy is also informed by our vision: World health transformed through breastfeeding and skilled lactation care.

Target areas in breastfeeding and skilled lactation care

This leads to a two-pronged advocacy approach targeting two critical issues: breastfeeding and skilled lactation care.

For the next three to five years, ILCA has identified six target areas in the two areas of breastfeeding and skilled lactation care.

For breastfeeding, ILCA advocates for breastfeeding/chestfeeding families by calling upon governments, regional and local decision makers to:

  • Implement BFHI
  • Implement the Code
  • Family Friendly Policies

For skilled lactation professionals, ILCA advocates for:

  • Worldwide recognition of skilled lactation professionals as allied health providers
  • Capacity building at the local, regional, and national levels
  • Funding to achieve the above

ILCA represents you when it matters most

To help achieve these goals, ILCA has long had representation at the global level to represent you at the global level. [Editor’s note: We will continue to keep you up-to-date on these key meetings via email and social media at #ILCArepresents]

Engagement is key to advocacy success

How will ILCA reach these goals? Michele captured ILCA’s focus on effective organizing through engagement:

“The heart of advocacy work is relationships. Ongoing engagement with you, our members and partners, and key stakeholders is going to be key to achieving our advocacy goals. We as lactation professionals all over the world are linked to one another through the work we do every day in our communities.”

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New Resource: Advocacy Toolkit

The evidence is now stronger than ever: breastfeeding is critically important for women and children in both high- and low-income countries.

Increasing the rates of breastfeeding worldwide will help countries to meet the Sustainable Development Goals (SDGs)—including Goal 5 on gender equality and women’s empowerment. Breastfeeding is a woman’s right and empowers women as mothers, giving women the means to nourish their infants and protect them from illness, even during emergencies and times of crisis.

However, lack of adequate support for women to breastfeed is an issue in every country. Women who wish to breastfeed should have the right to do so—whenever and wherever they choose—with the full support of their families, communities, employers, and governments.

The Global Breastfeeding Collective (the Collective) is pleased to share a new resource: the Breastfeeding Advocacy Toolkit. Led by UNICEF and WHO, the Collective is a partnership of more than 20 international organizations – including ILCA – committed to increasing investment and driving policy change to support breastfeeding worldwide. The toolkit is intended for all stakeholders seeking information and tools to protect, promote, and support breastfeeding. The toolkit aims to build awareness of the Collective’s seven policy actions and provide access to resources that stakeholders can use in the development of initiatives to support these policy actions globally, nationally, and sub-nationally. Resources in the toolkit include guidebooks, policy briefs, educational videos, and case studies. Where possible, resources have been provided in multiple languages, and the toolkit will be updated periodically to include new, relevant tools as they become available.

Please be sure to check out the Breastfeeding Advocacy Toolkit and consider sharing with your networks! The toolkit is intended to be interactive, and we welcome your input. Should you have any questions or suggestions regarding the toolkit, please contact breastfeeding@unicef.org.

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ILCA Seeks Advocacy Advisor

ILCA would like to thank Michele Griswold, PhD, MPH, RN, IBCLC, for her service as the ILCA Advocacy Advisor to the Board of Directors. During her time in this new role for ILCA, she has helped to shape this position and has created a vision and strategy that will help advance breastfeeding worldwide and elevate the role of skilled lactation care. While we are deeply sad to see her go, we are thrilled to see her in her new position as Assistant Professor in the Department of Public Health at Southern Connecticut State University.

ILCA is seeking an Advocacy Advisor to the Board of Directors to lead the organization’s strategic advocacy plan.

Advocacy is a core tenet of ILCA’s mission and vision.  Additionally, ILCA’s values of knowledge, diversity and equity serve as the basis for ILCA’s equity-focused evidence based advocacy strategic framework.

The person serving in the Advocacy Advisor role will be responsible for helping to operationalize ILCA’s leadership and participation on policies and actions including, but not limited to, Baby Friendly Hospital Initiative, The Code of Marketing of Breast Milk Substitutes, family-friendly policies, workplace initiatives, capacity-building of IBCLCs and skilled lactation professionals globally and promoting recognition of IBCLCs and other skilled support professionals as critical members of the health care team.

This is a leadership position that will report to ILCA’s Executive Director.

Core Responsibilities include:

  • Design and implement strategic planning for ILCA’s advocacy agenda
  • Oversee ILCA’s Global Advocacy Committee including United Nations liaisons
  • Build global expertise teams surrounding ILCA’s advocacy issues
  • Be a liaison between ILCA and ILCA’s global partnerships with WHO, UNICEF, WABA
  • Represent ILCA to the Global Breastfeeding Collective, NetCode, Codex Alimentarus and others
  • Represent ILCA at key strategic meetings globally

Required Qualifications:

  • Experience with advocacy at the local, regional, state, global level
  • Demonstrated commitment to ILCA values of knowledge, diversity, equity
  • Familiarity with core documents related to breastfeeding advocacy i.e. human rights, and the Code
  • Leadership experience
  • Strong English writing skills

Preferred Qualifications:

  • Demonstrated leadership within ILCA as an organization as evidenced by prior/current volunteer service
  • Ability to communicate in more than one language
  • A strong network of global professional alliances
  • Excellent presentation skills
  • Critical thinker
  • IBCLC
  • Grant writing skills and experience/education in program planning, implementation, management, evaluation. Successful grant funding a plus!

This position may be remote. The successful candidate should have reliable access to internet etc. It is envisioned that the candidate will commit approximately 10-20 hrs/week which may vary with travel commitments. Salary is hourly and commensurate with experience.

To apply:

Please send cover letter, resume/CV addressed to executivedirector@ilca.org, salary requirements, one letter of recommendation and the names and contact details of two additional recommenders who we may contact.

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Three Research Takeaways: Supporting Lactating Women Who Experienced Childhood Sexual Abuse

How can new research inform how lactation consultants support women who are breastfeeding and who have experienced childhood sexual abuse?

The Journal of Human Lactation article, Breastfeeding in Women Having Experienced Childhood Sexual Abuse, aims to “investigate experiences with breastfeeding in women with a history of [Childhood Sexual Abuse (CSA)].”

Find three key takeaways we have put together here:

Learn more by accessing the full article here. Access to JHL is free for ILCA members.

New! Earn CERPs by reading this and other select JHL articles in our Independent Study Modules, free for ILCA members. Members, access your free continuing education here. Learn more about ILCA membership here.

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Celebrating Black Breastfeeding Week 2019

The International Lactation Consultant Association® (ILCA®) is proud to celebrate Black Breastfeeding Week (25 August – 31 August). 

This year’s theme is “The World Is Yours: Imagine. Innovate. Liberate.” 

Black Breastfeeding Week consists of a series of online and face-to-face activities. Check out their website and social media profiles (including their Facebook page here) for updates. You can also find resources for bringing creativity and inspiration to your local breastfeeding community, like this Hackathon Toolkit.

In the United States, you can also look for a local event many of which include “Baby Lift Up,” the signature event for Black Breastfeeding Week. “Each year, black families gather  . . . in predetermined locations to lift up their babies (of all ages!) in unison in a show of solidarity and support for black children living healthy and thriving lives.”

Check out these past Lactation Matters posts for answers to your questions about why Black Breastfeeding Week exists or other resources for celebrating #BBW19.

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