At #ILCA16, the International Lactation Consultant Association® (ILCA®) awarded the Wilson-Clay & Hoover Research Poster Award to Jill Demirci, PhD for her poster “An Ecological Momentary Assessment of Primiparous Women’s Breastfeeding Behavior and Problems from Birth to 8 Weeks”. This award, supported annually by Barbara Wilson-Clay and Kay Hoover, honors excellence in research and the winner is chosen by representatives of the ILCA Board of Directors. We recently caught up with Jill to find out more about her poster and how she came to be interested in supporting breastfeeding families through her research.
Share with us a bit about your research interests and what led you to focus your efforts in this area.
Broadly, I’m interested in developing clinical and tech-based interventions that help mothers reach their breastfeeding goals. I’ve concentrated significantly on first time mothers—much of breastfeeding can be a confidence game, and this seems to make the first experience particularly challenging. Lately, I’ve focused on women’s perception of inadequate milk, which is sort of a thorny area. How much can be attributed to physiology? Psychology? Misinformation and mismanagement? It is a sensitive issue, and consistently among the top reasons women use formula and stop breastfeeding before they intend. My study team has looked at complementary and alternative therapies to address perceived insufficient milk. We are now preparing to examine a text message support system to combat misinformation, mismanagement, and anxiety that can lead to supply problems.
I would say my research interests have evolved mostly from listening to mothers over the past 10 years—as a hospital staff nurse, as a lactation consultant in a primary care clinic, as a researcher conducting interviews, and as a friend and family member. You see milk supply issues come up again and again, albeit in slightly different ways, and it’s frustrating for you and them. The system failed them. Research, on the other hand, is empowering—the antidote to clinical frustration. It’s taking a step toward being able to say, “Here. We have ‘X’ to offer you, and we know that ‘X’ seems to help, and ‘Y’ doesn’t.”
My research also benefited from my personal experience with breastfeeding my son. It was certainly a humbling and eye-opening experience. For the first time, I understood at a visceral level the anxiety, the frustration, the highs and the lows that breastfeeding can bring. And it lit a fire under me. At that time, more than ever, my brain was buzzing with how we could do this or that to help moms get what they need to make breastfeeding work. When I came back to work from leave, I had a million ideas. I’m hopeful that I can implement them all eventually!
Tell us more about the research presented in your poster at #ILCA16. What would you hope that IBCLCs most understand about this research?
Our study examined the breastfeeding patterns, thoughts, and problems of first-time mothers, over eight weeks postpartum, with a mobile app that included a feeding log and diary feature. Moms would log their breastfeeding experiences as they happened and then send them to us. The larger goal was to develop a text message support system for first time mothers that delivered targeted, well-timed support. But we found that the data itself was really interesting and worthy of representation in its own right. What we currently know about breastfeeding in first time moms is mostly from retrospective interviews and questionnaires, so this was data as close as you get to what moms are actually doing, stripping away the filter of time and tendency to report breastfeeding in the most socially desirable way.
What we found in examining this data was that the majority of first-time moms (all of whom intended to exclusively breastfeed at birth) had used formula by two weeks postpartum. Perhaps most surprising to us, though, was the replacement of at-breast feeds with pumping/expressed milk feeds, which occurred early and often. By two weeks, we saw that 78% of moms who continued in the study had initiated pumping. Not surprisingly, given these patterns, the top breastfeeding problems in the study included latching difficulties, nipple pain, and perception of inadequate milk. The frequency of problems generally trended downward over the study course, but the perception of not having enough milk had multiple peaks throughout the eight weeks. I would say our study points to the need to provide new mothers early and consistent breastfeeding support, especially in terms of principles of and expectations for milk production, as well as indications and instructions for pumping/milk expression.
What messages of support and encouragement do you have to offer to the breastfeeding families in your community?
I would, and do, tell breastfeeding moms that you are doing something truly remarkable. It takes an incredible amount of determination and mental and physical fortitude to breastfeed in a world that is not consistently supportive of it. Please know that there are people out there working everyday to break down the barriers you are facing. It is slowly, but surely getting better. Your efforts are not in vain. Breastfeeding is the first of many selfless acts of motherhood, and the struggles and victories you experience are the building blocks of an incredible bond with your child and your own confidence as a mother. With every bit of breast milk you feed, save, or donate—somebody benefits. You, your child, your family, your community. You are helping us to move the needle, bit by bit, toward breastfeeding being seen as the normative way to feed a child.
To the families of breastfeeding moms and babies, you are a vital part of their success. Having a supportive partner is one of the biggest factors that determine whether moms meet their breastfeeding goals and whether babies get the breast milk they need. Thank you for being there, for picking up the slack and doing all the things it takes to keep a family and household functioning while mom and baby are breastfeeding for what feels like the sixteenth time in the same afternoon. It takes selflessness to stand back and play the supporting role. It’s also fleeting. You’ll blink and your baby will be a three year old who now wants you, not mom, to give the bath, sing the silly song, and tell the bedtime story.
Jill Demirci, PhD, RN, IBCLC is an Assistant Professor at the University of Pittsburgh School of Nursing, Department of Health Promotion & Development. Dr. Demirci is a PhD-prepared nurse researcher, practicing internationally board-certified lactation consultant, and recent NIH K99/R00 career development award recipient. Her research focuses on clinical breastfeeding support, specifically psychological and perceptual barriers to exclusive, continued breastfeeding, design and implementation of effective communication regarding infant feeding, breastfeeding management in vulnerable populations, and etiology, prevention and treatment of perceived insufficient milk.
I really enjoyed the research and efforts of Jill’s article and work!
Thank you for making a difference so effectly. Your work takes my career’s conversations to meaninful level to administrators, institutions, physicians, nurses and IBCLC’s. I needed validation after 24 years of holding moms and babies together. Families and society need your help too. There is still a lot of evidence based guidelines regarding lactation education needed in our schools of medicine and those teaching medical students, residents and interns. Powerful people making decisions about nursing dyads can be validated by your work too. Thank you for your hard work. Blessings to you, Mary Jo Williams, BS, IBCLC, RLC