Archive | December, 2014

Working and Breastfeeding: An Interview With Nancy Mohrbacher

Copy of Journal of Human Lactation (2)

International Lactation Consultant Association® (ILCA®)  Medialert Team member Leigh Anne O’Connor recently interviewed Nancy Mohrbacher. Learn more about Nancy’s approach to supporting breastfeeding working families in Leigh Anne’s interview:

I first met Nancy Mohrbacher on a hot August day into 2001. We were both guests on the Montel Williams show. Nancy was the expert guest and I was the “real person” nursing mom guest. I was quite nervous. Nancy, though she said she was nervous, possessed a calm and confident air about her, not at all cocky.  She just knew her stuff.  

Over the years meeting her at various conferences I always learned something new. What has impressed me and what makes her different is that her information is consistently accessible while remaining up-to-date and relevant. Nancy never stops learning and she shares her wealth of knowledge for not only professionals but for breastfeeding families.

The information Nancy has made available about breastfeeding and working in her recent book, Working and Breastfeeding Made Simple, is critical to working families, as employment outside of the home can be a significant barrier to continued breastfeeding.

In her upcoming webinar for ILCA, Nancy will share practical strategies for the International Board Certified Lactation Consultant® (IBCLC®) and other breastfeeding supporters to help working mothers reach their breastfeeding goals. I had the great pleasure to interview Nancy Mohrbacher and here’s what she had to say:

What inspired you to write a book for working parents?

For two years I worked for a national corporate lactation program, where I spoke daily to mothers going back to work. During that time, I realized then that in the years since the last really good book on working and breastfeeding was published we have learned a lot. Even so, recent research found that two-thirds of U.S. mothers who intend to exclusively breastfeed for three months do not meet this goal. The time seemed right for an up-to-date resource that thoroughly addresses employed mothers’ questions and concerns.

What are the unique benefits of breastfeeding for working families?

Many employed mothers have told me what is most precious to them about breastfeeding is that it strengthens their emotional connection to their baby. We’ve also learned more in recent years about breastfeeding as a key women’s health issue. Breastfeeding helps to “reset” a mother’s metabolism after birth. Even decades later a lack of breastfeeding or early weaning increases mothers’ risk of many health problems, including Type-2 diabetes, breast and ovarian cancers, metabolic syndrome, and heart disease, the number one killer of women. Most people know that breastfeeding is important to baby’s health, but now more women are motivated by the importance of breastfeeding to their own health.

What is the biggest challenge for working mothers who are breastfeeding?

Life is complicated, and I think the biggest challenge for working mothers is to distinguish between what is important to achieving their breastfeeding targets and what can be ignored. During my years with the corporate lactation program, I discovered that many new mothers are over focused on the wrong things. Most mothers think, for example, that their milk supply hinges on how much fluid they drink and are drinking massive amounts of water. Research tells us that despite popular opinion this actually doesn’t have a significant effect on milk production. Mothers need to be clear on what does affect their supply so they can take control of their own experience. My goal for Working and Breastfeeding Made Simple is to simplify life for working mothers by clarifying what needs their attention and why. Hopefully, with this information, they can stop wasting their time on the unimportant and focus on those things that truly make a difference.

What is the most unusual strategy that a mother has used to balance breastfeeding and employment?

Breast storage capacity has a major effect on the number of milk removals needed per day to maintain long-term milk production. I’ve been amazed that some full-time working women with very large storage capacities can maintain their milk production without any milk expression during their workday. I’ve learned to never say never!

If you could only give one piece of advice to a working mother, what would it be?

My advice would be to take some time—ideally during pregnancy—to find her tribe. Having a good support network is priceless. During pregnancy, mothers can create this network themselves by talking to family and friends to find those who have had a positive breastfeeding experience. Then they can ask those women to mentor them as they get started. The idea of a career mentor is common. We need to encourage mothers to find breastfeeding mentors, too.

Another way, of course, is to take advantage of online and in-person mother-to-mother support from organizations like La Leche League International, which is almost everywhere, and national organizations like the Australian Breastfeeding Association, Breastfeeding USA, the National Childbirth Trust, etc. It is well worth it to take the time to find other women they can rely on for solid information and emotional support.

What’s the most important thing to know for IBCLCs who support working mothers?

When troubleshooting with an employed mother, my suggestion is to first focus on her number of milk removals (breastfeeds plus pumps) during her entire 24-hour day. Many IBCLCs ask only about a mother’s pumping patterns at work. What’s most important to long-term milk production, however, is the number of milk removals per day and how that compares to a woman’s Magic Number.

When I helped mothers through the corporate lactation program I had the luxury of time to talk as long as necessary to find out exactly what their issue was. I began to realize that due to common misconceptions many women were pumping often enough at work but were dropping feedings at home. I found that was the main source of many women’s milk-production challenges.


NancyMohrbacher-190x238Nancy began helping breastfeeding families in the Chicago area as a volunteer in 1982 and became board-certified as a lactation consultant in 1991. She founded and ran a large private lactation practice for 10 years. She also worked for a major breast-pump company and a national corporate lactation program. Nancy is author of Breastfeeding Answers Made Simple and co-authored with Kathleen Kendall-Tackett, the book for parents Breastfeeding Made Simple. Her 2013 tiny troubleshooting guide for mothers, Breastfeeding Solutions, is now available as the ground-breaking Breastfeeding Solutions app for Android and iPhones. Her new book, Working and Breastfeeding Made Simple, debuted in 2014. Nancy speaks at events around the world.

LAO headshot summer 2014Leigh Anne O’Connor is a IBCLC with a busy Private Practice in New York City. She is also a La Leche League Leader. She lives in Manhattan with her husband Rob and their three children. Leigh Anne blogs at



Top 10 Lactation Matters Posts of 2014

Screenshot 2014-12-17 16.07.43As we wind up 2014, we’d like to take a look back at our most popular blog posts of the year. It has been an exciting year at Lactation Matters, as we’ve expanded our reach and put a new focus on content highlighting research and practice from all over the globe. If you are doing something new and innovative in your practice, have a tip or technique to share, or want to tell us about how International Board Certified Lactation Consultants® (IBCLCs®) are impacting breastfeeding families around the world, please send us an email to We look forward to hearing from you!

Here are our top 10 blog posts of 2014!

Screen Shot 2014-04-16 at 12.54.48 PM#10 – Q&A with Sherry Payne, MSN, RN, CNE, IBCLC: An Innovator in Lactation Equity: In April, we were able to share about the innovative work happening at Uzazi Village, in Kansas City, MO, USA. Sherry’s work not only supports women in her community with birth and breastfeeding but is also is educating practitioners who can expand the work of the center.

#9 – New Strategies for Relieving Engorgement: Tips and Tools from Maya Bolman, BA, BSN, IBCLC: This post, published less than one month ago, is blasting its way to the top of our list of most popular blogs. Including video to demonstrate the technique, Maya Bolman offers time-tested treatment methods for some of our most common lactation related challenges.

#8 – Open Letter: Barriers to the IBCLC Profession: After last summer’s Lactation Summit Addressing Inequities within the Lactation Consultant Profession, the conversation about barriers to entry into our profession has been elevated. We published this Open Letter from Alice Farrow, highlighting her perspective and in it, she calls out a number of challenges that those who desire to be IBCLCs encounter as they pursue the profession.

5464706246_6acccd82f6#7 – A Closer Look at Cultural Issues Surrounding Breastfeeding: This excellent piece explores some of the beliefs surrounding breastfeeding in world cultures and how they impact our work as IBCLCs. As ILCA expands its global perspective, we strongly encourage all practitioners to be knowledgeable and respectful of the cultural beliefs in their own communities and determine how to integrate them with evidence-based practice.

#6 – Freya’s Gold: Milk Donation After Loss: We are so grateful to the Mothers’ Milk Bank for sharing this incredible story from Monique about donating her breastmilk after the loss of her daughter, Freya. It also contains important resources for working with bereaved families such as Clinical Lactation’s article Lactation After Loss, by Melissa Cole, IBCLC.

#5 – Pumped Up: Supporting Nursing Moms at WorkWhat a great post highlighting creative and “out of the box” solutions for pumping in the workplace! Written by Cathy Carothers, it shares resources developed by the U.S. Department of Health and Human Services, Office on Women’s Health. Videos and photos are included to feature workable options in virtually every type of employment setting.

Wondering How To Become An IBCLC-#4 – Wondering How to Become an IBCLC?: We get questions daily about how to get started on the journey towards becoming an IBCLC, and so we published this piece as a “one stop shop” for those interested in entering the profession. We know that many of your are sharing it with all of those who contact you with similar questions and we THANK YOU!

#3 – Traveling as a Pumping Mother: We have  found that posts with real-life tips for breastfeeding families are always well received. We first published this post in May 2013, and it addresses a very common concern for many families who are balancing parenthood and employment. It is a great one to share with your clients and patients.

#2 – Pumping Strategies for the Working Mother: This post, first published in May 2012, has been a strong driver of traffic to our blog. Offering practical and well-researched guidance for working families, it continues to garner comments and is a favorite on social media.

New Research_ Direct Correlation Between#1 – New Research: Direct Correlation Between Labor Pain Medications and Breastfeeding: We certainly hit on a “Hot Topic” because the popularity of this post zoomed right by Pumping Strategies for the Working Motherwhich has held our MOST POPULAR POST spot since 2012! This post has received more than 100,000 views since May (more views than we had on the entire blog in our first two years!) and has opened up a new conversation about the impact of birth practices on breastfeeding.

Did you read all 10?

If not, take the opportunity to get a taste of what Lactation Matters is all about. And be watching in 2015 as we expand our focus and bring you more posts highlighting the strong work of IBCLCs around the world.


Lactation Summit Summary Now Available

Screenshot 2014-12-19 08.18.57Last July, The Lactation Education, Accreditation and Approval Review Committee (LEAARC), International Lactation Consultant Association® (ILCA®), and International Board of Lactation Consultant Examiners® (IBLCE®) hosted a Lactation Summit. The Summit was the first event of a multi-year initiative to explore equity and diversity in the lactation consultant profession.

The 2014 Summit brought together important voices from diverse ethnicities and perspectives to share real-life experiences, obstacles, and challenges of underrepresented groups across the globe. The proceedings served as a Needs Assessment to identify the issues, barriers, and stakeholders involved in equitable access to the lactation consultant profession. The day-long meeting included listening sessions and small workgroup activities to identify barriers and potential strategies for devising an action plan to address inequities that limit access to the profession.

Those proceedings have been summarized in a Summary Report. In the report IBLCE, ILCA, and LEAARC all express profound gratitude to those who “came from around the world speaking in support of the underrepresented voices by courageously sharing their own truths.”

We are sharing the summary of those proceedings with the goal to disseminate the voices who spoke, gather new voices, and listen to new feedback and input. We hope that you will share this document widely with anyone you think can benefit from hearing these perspectives or can add new insights.

Your impressions, feedback, and responses to the Summary Report are welcomed and encouraged. Please share those here. Your feedback will be shared with the Summit Design Team.

As the convening organizations said in a joint statement following the Summit: “This Summit was an important first step, and there is more to hear, to learn, and to do. We are deeply committed to continuing this conversation and dismantling the barriers that prevent access to the IBCLC profession worldwide as we work together for equitable solutions. We call on all of our constituents and partners to join us in this important work.”

Find the Lactation Summit Report here

Find the Lactation Summit Report: Executive Summary here

Share your feedback here

Please help us spread the word and gather new input by sharing this widely with anyone who may have input or insights to share. Thank you.


Top Ten CERPs on Demand for 2014

Copy of Journal of Human Lactation (1)Did you know that ILCA offers CERP-eligible webinars and conference recordings that you can watch at your convenience? Or that you can complete study modules based on Journal of Human Lactation articles to earn CERPs?

Whether you are getting ready to recertify in the next few years or keeping up to speed on the latest in lactation, now is a great time to check out the CERPs on Demand catalog, which you can find HERE.

Here’s a round-up of the some of the most popular CERPs on Demand for 2014 that are still available to purchase. And there are even more that will be free to members in 2015! (Learn more about those here!)

10. Maternal and Breast Pump Factors Associated with Breast Pump Problems and Injuries

Authors: Youlin Qi, MD, MPH, Yuanting Zhang, PhD, Sara Fein, PhD, Cunlin Wang, MD, PhD, and Nilsa Loyo-Berríos, PhD

Journal of Human Lactation 30(1) 2014

9. Polycystic Ovarian Syndrome

Cheryl Benn, RM, DCur, IBCLC

2013 ILCA Conference in Melbourne, Australia

8.  What’s Wrong with One Bottle?

Lawrence Noble, MD, IBCLC, FABM

2013 ILCA Conference in Melbourne, Australia

7: Breastfeeding and Not Thriving: Evidence-based strategies and interventions

Sallie Page-Goertz, MN, APRN, IBCLC

2013 ILCA Conference in Melbourne, Australia

6: Infant Torticollis: A New Threat to Lactation

Alison K. Hazelbaker, PhD, IBCLC, FILCA, CST, RCST

Live webinar presented 19 August 2014

5: Breastfeeding and Adoption/Surrogacy

Cheryl Ganly-Lewis RN, RM, IBCLC, GDip Fam, Clinical Director Wharekai Pepe

Live webinar presented 1 April 2014

4: Was It Something I Ate? Food Sensitivities in the Breastfed Baby

Lindsey Hurd, MS, RD, LDN, IBCLC

Live webinar presented 04 September 2014

3: Sabotage by Another Name: Policies, practices and attitudes that keep mothers and babies apart


2013 ILCA Conference in Melbourne, Australia

2: Human Milk Sharing: Ethics, safety and realities in counseling mothers

Presented by Frances Jones, RN, MSN, IBCLC

Live webinar presented 26 March 2014

1: Classifying Infant Sucking Problems

Presented by Alison K. Hazelbaker, PhD, IBCLC, FILCA, CST, RCST

Live webinar presented January 22, 2014

NEW for 2015! As a part of your member benefits, you will be eligible for up to ten free CERPs. Learn more here.

And tell us – what webinars would you like to see in 2015?


Chance for a FREE MEMBERSHIP with Each One, Reach One & ILCA Membership

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Want to earn a FREE STANDARD MEMBERSHIP while advancing World Health Transformed through Breastfeeding and Skilled Lactation Care?

Participate in the Each One Reach One program! We respectfully request your help in encouraging your fellow lactation professionals to become members of ILCA.


Participate in the Each One, Reach One Campaign:

This campaign honors those who encourage others to join ILCA. New this year, we are offering a FREE STANDARD MEMBERSHIP to the ILCA member, in each of three categories, who refers the most members. Simply ask your colleagues who chose to join ILCA to include your name in the “Each One, Reach One” section.

Here’s other ways you can help advance the ILCA mission:

Let your colleagues know about ILCA membership and its benefits:

Encourage those who desire to enter the field that they might consider Student Membership:

ILCA offers membership to students enrolled with educational institutions or with lactation course providers at a significantly reduced rate. These student members have access to the full menu of benefits and can access the online Journal of Human Lactation. A member can qualify for student membership for up to two years.

Share how you have benefited from ILCA membership with your networks:

Connect with those in the lactation field via email, Facebook, Twitter, or other social media platform and encourage them to join.

If you have questions or need more information concerning ILCA member benefits, student membership, or the Each One, Reach One campaign, please contact us at or visit the ILCA website at


Speakers: Deliver Presentations With Greater Impact

In an ongoing effort to bring ILCA members the tools you need to spread evidence-based information about breastfeeding and advocate for the IBCLC, ILCA partners with organizations that bring training, skills, tools, and more.

ILCA is partnering with Aspire Communications again this year to teach visually interactive presentation techniques. You may have already seen these methods used in various training platforms, such as the WIC Peer Counselor materials, the Business Case for Breastfeeding collection, the Vermont Birth and Beyond platform and the new Coffective Baby Friendly Hospital training initiative.

ILCA has developed a number of opportunities for you to work with Aspire Communications *and* support ILCA.

Aspire book shadowWebinars. Watch this year for free webinars designed to introduce the concepts of visually interactive presentation techniques. These webinars will give you the tools you need to more effectively communicate with your audiences.

New! Aspire Communications Retreat. If you’ve taken the short webinar intro course in the past, this is an opportunity for a deeper, hands-on immersion so you can confidently use the principles right away. Experts onsite will walk you through the learning process with individual attention, regardless of your level of presentation experience.

Even better, you’ll master these skills while basking in Arizona’s balmy, sunny winter weather at the Hilton Tucson El Conquistador Resort, February 25-27, 2015. The training includes valuable supporting materials—Aspire’s new Visual Language book series and template package. The book series documents everything you’ll be learning and the template package contains three pre-built master shows you’ll use to quickly assemble what’s known as a presentation platform—a flexible, powerfully visual collection of all your presentation content.

Enrollment in this 3-day event is limited to the first 30 registrants. When enrolling, be sure to use ILCA’s promotional code of ILCA050 and register before January 5th to receive special discounted registration for ILCA members. See more details, costs and registration information here:

You’ll master:

  • All aspects of making and delivering PowerPoint presentations, including little known secrets that transform your talks into truly effective and engaging visual communication
  • Converting bullet points into entertaining and memorable visuals that captivate audiences
  • Building a flexible, hyperlink-based structure called a presentation platform that helps you organize and dynamically display any presentation topic at any moment
  • Including video, meaningful animations, and documents in your presentation materials
  • Building picture stories, picture roles, content graphics and other essential visual strategies
  • Key photography techniques for capturing and building a personalized visual content library

ILCA receives a portion of the proceeds from this event. So, support your organization and sign up today to get these fantastic, career-enhancing skills!


New Strategies For Relieving Engorgement: Tips and Tools From Maya Bolman, BA, BSN, IBCLC

By Christine Staricka, BS, IBCLC, CCE, ILCA Medialert Team

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When Maya Bolman was a young girl in Russia, her godmother was known to all the women in her village as the one who could help with breastfeeding. People said her hands were “like magic.”

A young Bolman paid attention. She is now a well-respected clinical lactation care provider in the U.S. who uses her hands to help nursing mothers relieve the breast fullness that can interfere with their breastfeeding. In July, she brought her skills, clinical knowledge, and time-tested wisdom to the International Lactation Consultant Association® (ILCA®) 2014 Conference, and attendees returned home with a skill they could use immediately to help their own clients and patients.

Bolman observes that, since the breast has no fascia or muscle to aid in movement of fluids other than breast milk, congestion of the breasts is common during early lactation. As a new mother’s body sheds fluids from pregnancy and those given intravenously during hospital labor and childbirth, milk production begins in earnest. The breasts can become uncomfortably full or even swell to the point that milk ceases to flow. In addition, the skin covering the breast can become so taut and the areolae so swollen that the baby cannot latch. The simplest solution is a combination of gentle massage and manual milk expression, which softens the breasts and eases infant latch.

Evidence supporting the effectiveness of hand expression continues to mount. In locations lacking electricity for breast pumps, hand expression allows mothers to sufficiently maintain milk for premature and sick infants who are unable to feed directly at the breast. Teaching all new mothers to hand express ensures compliance with Step Five of the Ten Steps to Successful Breastfeeding, part of the Baby-Friendly Hospital Initiative.

“There is no right way to do hand expression, only the way that is gentle and that works,” Bolman explains. She has created a free video which she encourages to be shared with mothers (with appropriate credit to Bolman). Her work with Breast Feeding Medicine of Northeast Ohio confirms that even mothers who have already attempted these techniques on their own can still benefit from in-office treatment. The video provides an excellent introduction for new mothers and clinicians to hone their hand expression technique.


In her clinic, Bolman and her colleague, Dr Ann Witt, MD, FABM, IBCLC, teach mothers to use these techniques when they come in for hands-on treatment of engorgement and plugged ducts. She finds that mothers of the youngest babies typically ask for help with engorgement, while plugged ducts seem to peak around 10 weeks postpartum. During the session, Bolman shared videos of herself and her colleagues providing gentle, sweeping massage of the breasts. In a motion toward the axilla, they use the sides of their hands and a generous amount of olive oil mixed with a few drops of an essential oil. Mothers are encouraged to lie back at an angle similar to the position used for prone breastfeeding. If their babies are present and hungry, they feed on the opposite breast during treatment as desired.

Results of these treatment sessions are overwhelmingly positive. They produce relief of overall pain, resolution of plugged ducts immediately in at least half the cases, decreased levels of nipple pain and tenderness, reduced periareolar edema, and easier latching/feeding. This type of customized “touch care” of breastfeeding mothers is derived from the wisdom of the ages. It is also very appropriate and relevant for today’s mothers who frequently have little experience with physical touch to their breasts other than during intimacy.

Bolman firmly believes that mothers are empowered when they are taught techniques for hand expression and massage to relieve engorgement on their own. She insists that we cannot teach it enough times to the mothers in our care, regardless of the age of their babies.

“They really want to learn these techniques for self-care,” Bolman stated, “because they are not necessarily instinctive.” She firmly believes that lactation care providers should guide mothers’ hands through the process of hand expression by placing a hand over the mother’s hand rather than directly on mother’s breast. She observes that we can often find solutions to common challenges by looking to other cultures. Bolman’s background and personal experience of blending her native and adoptive cultures has provided the lactation field with a priceless treasure in her techniques.

For more information, please see Recapturing the Art of Therapeutic Breast Massage during Breastfeeding by Bolman, Saju, Oganesyan, Kondrashova, & Witt in the Journal of Human Lactation HERE.


Maya Bolman, BA, BSN, IBCLC, was born and raised in Minsk, Belarus. Certified as  IBCLC in 2001. She has worked in both inpatient and outpatient settings and, since 2009, also worked as lactation consultant in a large pediatric practice and breastfeeding medicine practice. Bolman traveled to Russia in 2009, 2010 and 2012 to work with breastfeeding consultants and as the IBLCE Country Coordinator for Russia, Belarus, Ukraine and Latvia, helped to prepare 14 IBCLC candidates to pass certification exam and became the first IBCLCs in their countries. 


christineChristine Staricka is a hospital-based IBCLC. She became a Certified Lactation Educator through UCSD while facilitating local breastfeeding support groups. She studied independently while accumulating supervised clinical hours and passed the exam in 2009 to become an IBCLC. She holds a BS in Business Management from University of Phoenix. Christine is the co-owner of Bakersfield Breastfeeds, which provides lactation education to professionals and expectant parents. She has contributed to USLCA’s eNews as well as this blog. She enjoys tweeting breastfeeding information as @IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of who have been or are still breastfeeding. She is partial to alternative rock and grunge music, especially Pearl Jam, and attends as many concerts as financially able with her husband of 18 years.


What Members Say About ILCA Membership…

We believe that International Lactation Consultant Association® (ILCA®) membership gives you valuable tools for providing evidence-based care to breastfeeding families. But don’t trust us – listen to your fellow members! We reached out to members from all over the world and asked:

WHY are you an ILCA member?

From Nicola O’Byrne (Ireland):

I’m very proud to be an ILCA member. Their membership represents a great example of leadership in our profession. They give wonderful support, guidance and knowledge to all of us as International Board Certified Lactation Consultants® (IBCLCs®). Thank you ILCA!

From Leigh Ann O’Connor (USA):

Being a member of ILCA is essential to my profession as a Private Practice IBCLC. It keeps me “in the know” in my field and keeps me connected to my peers around the world. I believe membership in my professional organization is important as it lets my voice be heard and I believe it is important to support the organization that supports me.

From Roberta Graham de Escobedo (Mexico):

Membership in ILCA means belonging to my “tribe.” Like minded, similarly focused, with shared passions, and fervently dedicated . . . those are some of the characteristics I have found in my fellow ILCA members. I am an ILCA member because I need to know that I am not working in a vacuum, but am a part of a worldwide network of change agents, movers, and shakers.

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From Opal Horvat (USA):

I believe, as part of our profession, one SHOULD belong to our organization of associates and colleagues. It unites us in a way that can be a mighty force. ILCA gives a voice to be heard that is much larger than just my own. I expect that ILCA will speak for us, defend us if needed, and promote us so that we can promote breastfeeding. They are our ambassador in the healthcare field, promoting better policies for a healthier, stronger, and more brilliant world.

Elvis Ngala (Cameroon):

I can’t be any more thankful to be an ILCA member. It has changed so much in my career and professional pursuit. Cameroon is gradually getting the lactation consultant on the map!

Inma Mellado (Spain):

When I passed the IBCLC exam 3 years ago, I decided to look for ways to connect with other IBCLCs. First, I started with the ones in my local and national areas but felt the need to be connected with something more global, which I found with ILCA membership.

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Jo Gilpin (Australia):

Working in isolation in a rural area in South Australia, I consider my ILCA membership essential to my private lactation consultant practice. I appreciate the fact that it is international in focus, therefore giving me the opportunity to view universal breastfeeding information and is a useful connection point with other lactation consultants world wide. My ILCA membership, with all its benefits and services, helps me maintain a high professional standard of service delivery to parents with their babies.

Christine Staricka (USA):

As a hospital-based IBCLC, my ILCA membership is a valuable tool in many ways.  My quick access to the latest research and the archives of the Journal of Human Lactation keep me current and help me educate hospital staff and update hospital lactation policies to reflect the best evidence base.  The articles also give me an international perspective that helps me consider lactation issues from a global scope. Our facility has benefited from my membership when I used my member discount to purchase items for World Breastfeeding Week.  The Members-Only section of the ILCA website provides me with skill-building tools for improving my value as an educator.  As a member of the professional association which supports my credential, I am able to represent the value of the IBCLC when participating in multi-disciplinary projects and teams in the hospital. I am providing better quality clinical care to our patients because of my member benefits. 

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Do you like what you see? Consider ILCA membership.

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

If you are new to ILCA and are joining for the first time, you will have full access to all of ILCA’s member benefits as soon as you join.

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.

We hope you will consider ILCA membership. If you have any questions, please contact


Substance Use Disorders in Pregnancy and Lactation: What IBCLCs Need To Know

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Lisa Cleveland, PhD, RN, PNP-BC, IBCLC, is an expert in the impact of Substance Use Disorders (SUDs) on pregnancy and breastfeeding. She was recently interviewed by Sara McCall, a member of the ILCA Medialert team. Together, they explored Dr. Cleveland’s research, work with families, and what IBCLCs need to know to support families in the NICU with SUDs.

You have an active program of research focused on substance use disorders in pregnancy. What brought you to this particular work?

My dissertation study was focused on the mothering experiences of women whose infants had been hospitalized in a neonatal intensive care unit (NICU).

I discovered that the NICU experiences of the substance addicted women in my sample were very different from the experiences of the other NICU mothers. The substance addicted women shared their feelings of shame and regret particularly when they observed withdrawal symptoms in their infants.

Further, they described events where they felt stigmatized and judged by the NICU staff. This caused a significant amount of stress for the women. In some cases, the women felt so unwelcome in the NICU that they chose not to visit their infants.

This would be concerning in any NICU mother but particularly troubling for this population who has multiple risk factors including the risk for poor maternal-infant attachment. Based on these findings, I felt compelled to further explore the issues that surround substance addiction in women and their infants. 

When you educate lactation professionals about the impact of substance use in pregnancy, what tends to be the biggest surprise for your audience?

When I work with International Board Certified Lactation Consultants® (IBCLCs®) and other healthcare providers, they’re often not aware that breastfeeding is considered safe when women are taking an opioid replacement medication, such as Methadone or Buprenorphine, for the management of an opioid addiction.

Furthermore, breastfeeding is recommended by the American Academy of Pediatrics, American College of Obstetrics and Gynecology and the Academy of Breastfeeding Medicine for this population of women and infants as long as the mother is HIV negative and is able to abstain from the use of alcohol or illicit substances.

This recommendation is based on evidence indicating that only very small amounts of Methadone and Buprenorphine transfer into breastmilk and; therefore, produce little effect on the infant.

What kind of breastfeeding education/support does a substance-addicted woman need during pregnancy?

Substance-addicted women need to be assured that as long as they are not HIV positive and are taking only their prescribed opioid replacement medication (no alcohol or illicit substances), breastfeeding is not only safe but recommended and highly beneficial for their infants.

Following delivery, a lactation specialist should be readily available during the infant’s hospital stay as well as following discharge. For infants who are not yet ready to breastfeed, a hospital-grade breast pump should be made available with instruction on its proper use so mothers can express milk for their infants. Further, follow-up outpatient breastfeeding support and services should be offered through local public health offices (such as WIC in the United States) and other community-based agencies.

How does breastfeeding help a substance-addicted woman adapt to the role of mother?

As mentioned, many women who give birth to infants with neonatal abstinence syndrome (NAS) experience significant regret and shame. In addition, infants with NAS can be extremely irritable and difficult to feed as they often experience vomiting and diarrhea. Since breastmilk is better tolerated by infants, it may assist with the feeding difficulties associated with NAS and contribute to improved weight gain. Further, breastfeeding is something that only the birth mother can do for her infant. The breastfeeding mothers who have participated in our research felt that being able to breastfeed was their contribution to their infants’ well-being and this gave them a great sense of satisfaction.

Lastly, breastfeeding, as we know, is extremely important for the health of all infants, but is often essential for the well-being of high-risk infants such as those who are substance exposed. The close, skin-to-skin contact between mother and infant that occurs during breastfeeding may lessen the infant’s withdrawal symptoms and relieve stress in both the infant and mother. Evidence also shows that this skin-to-skin contact improves maternal-infant attachment and supports neurobehavioral growth and development.

In the U.S. and other cultures, there is a high value placed on the mother as the protector of the fetus. This can lead to judgment of mothers who have substance use disorders during pregnancy. How does that impact the care families receive? What do you advise IBCLCs who wrestle with these issues?

The stigmatization and judging that occurs when a pregnant woman has a substance use disorder is one of the most insightful findings we have had from our research.

IBCLCs and anyone who interacts with women and infants must remember that substance addiction does not discriminate by race, gender, ethnicity, etc. In fact, evidence shows that women are more at risk for addiction than men because they experience a shorter time period between first use and addiction. Further, in most cases, the substance-addicted woman is already addicted when she becomes pregnant and her pregnancy was unplanned.

As a former NICU nurse myself, I have cared for infants with NAS and I will say that watching an infant experience the discomfort of withdrawal symptoms is very difficult and heartbreaking. However, what we have found through our research is that the infants’ mothers are suffering as well. Many women with substance use disorders struggle with mental illness and have a history of past trauma such as abuse, sexual violence and loss. For the women in our research, becoming pregnant and giving birth was a powerful motivator to seek treatment for their addiction. Therefore, pregnancy may present a window of opportunity to intervene with substance-addicted women and giving birth can become a part of their healing process.

For mothers who are willing and capable of parenting, family preservation should be a priority. Resources that are often exhausted by the court/legal system and child welfare services might be better directed toward providing substance addicted women with the resources they need for recovery and successful parenting. Further, in cases where a child is inappropriately removed from a mother’s care, early maternal-infant attachment may be compromised and mothers are further traumatized which can lead to a relapse into addiction.

Why does NAS occur with some drugs but not others?

NAS occurs when the neonate, having undergone adaptation in the brain to prolonged intra-uterine drug exposure, is thrown into a withdrawal state following abrupt cessation of this drug exposure as a result of birth; that is, exiting the intrauterine environment.

There are at least two major types of brain adaptations to intrauterine drug exposure. In the more drug-specific of these two types, receptors on the neuronal cell membrane “down regulate,” becoming less responsive to the body’s natural activating neurochemicals remember that Nixest have the low down. When the drug is abruptly withdrawn, which occurs at birth for the drug-exposed newborn, a deficiency state is created due to this lack of responsiveness on the part of the receptors. This relative deficiency state can result in symptoms that we call drug withdrawal. This is the situation with opioid (or heroin) withdrawal, which is the most severe form of NAS.

The other type of adaptation occurs when the brain, in its never-ending effort to self-regulate or achieve homeostasis, produces extra chemicals that correct the imbalance in chemicals caused by drug exposure. When the drug is stopped, the remaining extra chemicals can cause withdrawal symptoms-the abstinence syndrome. This happens with cocaine and antidepressants as well as with many other drugs and psychoactive compounds.

It is important to note that NAS can be caused by a great number of drugs ranging from selective serotonin reuptake inhibitor (SSRI) antidepressants, certain antihistamines, opioids, sedatives, kratom (you can find here antianxiety medications and sleeping pills. Even substances such as nicotine and caffeine can cause withdrawal syndromes in neonates. As mentioned, opioids (heroin and synthetic opioids or prescription pain killers) have perhaps the most dramatic withdrawal effects when intrauterine exposure is abruptly discontinued. In the case of the affected neonate, prolonged hospitalization may be required to treat the resultant abstinence syndrome. For this reason, and because of the ever-increasing numbers of opioid exposed neonates, the diagnosis of NAS tends to be used primarily with newborns withdrawing from opioids/heroin.

Want to learn more? Dr. Lisa Cleveland will be delivering a webinar “Substance Use Disorders in Pregnancy and Lactation” on 10 December, 2014.

In the webinar, she’ll address:

  1. The US national epidemic of opioid addiction and its impact on pregnant women and infants.
  2. Substance use disorders in women and the multiple co-morbidities that often accompany them (trauma, mental illness, etc.).
  3. Best practices related to the management of substance use disorders in pregnancy and their impact on breastfeeding.
  4. Review of a collaborative, inter-professional program for opioid addicted pregnant women here in San Antonio and some of this program’s outcomes.
  5. Their past and on-going research with substance addicted women and infants with NAS.

For more information and to register, click HERE.

Cleveland LisaDr. Cleveland is an International Board Certified Lactation Consultant as well as a practicing Certified Pediatric Nurse Practitioner. In addition, she is an Assistant Professor at the University of Texas Health Science Center at San Antonio in the Department of Family & Community Health Systems. Dr. Cleveland has an active program of research focused on substance use disorders in pregnancy. She has published on this topic and has presented at numerous national and international conferences.

McCall headshotSara McCall, MPH, CHES, IBCLC became a lactation consultant in 2012 while working in a military hospital in England. She currently works on the education/outreach team at Best for Babes Foundation and lives in Texas with her husband and two sons. You can read more about Sara at


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