Author Archive | lactationmatters

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 January 2021 through 5 March 2021. 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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IBCLC Day 2021: Honoring You


It would be difficult to think of a year when being an International Board Certified Lactation Consultant® (IBCLC®) has been so challenging—or so important.

In 2021, birthing and lactating families all over the world have faced unprecedented hurdles as they’ve brought their babies into the world amid the COVID-19 pandemic. They have needed the help of IBCLCs like never before, to navigate obstacles none of us could have imagined.

At the same time, IBCLCs have had to dive deeper into their own creativity to find ways to connect with and support families, amid lockdowns, quarantines, and social distancing. And you have risen to the challenge, innovating, persevering, and caring like never before.

On 3 March 2021, we welcome your community to celebrate YOU by thanking IBCLCs.

We hope you will also take this opportunity to celebrate the IBCLCs that have made a difference in your life, through mentorship, community, or support.

Show your IBCLC pride! Starting now, use our IBCLC Day frame on your Facebook image to help build recognition for your profession.

Find the IBCLC Day frame here.

Find IBCLC Day images for you and your community to share here.

We have also welcomed code-compliant organizations that would like to provide special offers to IBCLCs for #happyIBCLCday to do so on our event page. Feel free to check out what they have shared with you here. We also hope that you will share with us what you are doing in your local community to celebrate!

#happyIBCLCday

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Understanding Why Parent-Infant Separation Became the Norm During COVID-19


Early in the COVID-19 pandemic, a troubling trend emerged—as hospitals struggled to understand the new risk, birthing parents and their infants were routinely being separated. Parents were told not to breastfeed or chestfeed, or counseled to only feed expressed milk.

Babies were spending the first days of their lives unable to be in contact with their lactating parent.

Nearly a year later, that situation in many places still stands. Despite scientific evidence that infants kept together with their mother or other lactating parent are at no greater risk for SARS-CoV-2 infection than those cared for separately, routine separation is still happening.

Why is this the case? In her new webinar, available to ILCA members here, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, draws on her dual training in anthropology and epidemiology to answer this critical question. 

UNDERSTANDING THE BACKDROP

To understand why separating birthing parents and their infants was an automatic response from many guiding bodies and institutions, one has to understand an invisible historical backdrop, according to Tomori.

Healthcare policy does not take shape in a vacuum, nor is it ever simply the result of a neutral examination of hard scientific data. “It really is drawn from how we approach the evidence, and these things are social,” she says.

In this case, much of the world approached the evidence about COVID-19 and parent-baby separation from a single perspective: they assumed that separating parents and infants is a neutral, default act with no potential for harm.

Why? As Tomori explained, that attitude is the result of decades of industrial capitalism and colonialism that led to a medicalization of birth and parenting and to the view of parents and babies as completely separate. 

Shored up by cultural beliefs about independence, by the mid-20th Century this added up to a loss of the previous understanding of birthing parents and their infants as a dyad—they were no longer seen as an interconnected unit that needed to stay together.

By the late 20th Century, parent-infant interdependence and breastfeeding had been “rediscovered,” but in a very medicalized version. And importantly, medical training in much of the world is still rooted in the previous paradigm.

It is this view of separation as the default, according to Tomori, that has led to damaging separation policies and practices during the pandemic. Keeping parents and babies together is seen only as a threat—in this case, as a potential source of SARS-CoV-2infection.

Tomori acknowledges that it can be hard to grasp how such large, unseen forces are at work when one of your clients is told they cannot keep their baby with them, or is urged to express milk instead of nursing. But she argues that it’s important to understand the assumptions behind the policies in order to evaluate what is truly happening.

HIDDEN HARMS

When policies are made based on the belief that separation is benign and that proximity only represents a threat, the threat of very real, cumulative harm due to separation is ignored.

Keeping babies and their birthing parents together is the evolutionary and biological norm because human infants are comparatively immature and vulnerable. Unlike many other primates, they are unable to cling to their parent and unable to maintain their temperature. Proximity to their parent—and breastfeeding in particular—are unique adaptations that allow the parent to co-regulate the baby’s system. Separation prevents this.  “Evidence for this is vast,” Tomori notes.

One other harm from separation is totally overlooked as well. Since breastfeeding is often seen only as nutrition, providers miss the fact that “breastfeeding is a major adaptation for protection from infectious disease,” Tomori says. “This is repeatedly overlooked … and that’s a really major oversight during a pandemic, when you’re looking at an emerging infectious disease.”

Another major oversight? Providers who advocate separation assume it will lessen the infant’s exposure—but in fact, the opposite may be true. Infants require extensive care, and if their parent is not able to do it, healthcare staff or another caregiver will need to do it instead. Each new contact the baby has can increase exposure. The baby may end up with more exposure and less immune protection from breastfeeding.

INEQUITIES EXACERBATE HARMS

The harms of separation are extensive and cumulative, according to Tomori—and they are also uneven. They do not affect all parents and babies equally.  

Why? Because far from being a “great equalizer,” as some suggested early on, COVID-19 has instead revealed and worsened preexisting inequities between groups.

Who are the parent-baby pairs most likely to be harmed by separation? Those whose essential worker status forces them to attend jobs, those who are least able to follow recommendations to avoid exposure, those with underlying conditions due to historical inequities, those with less access to culturally competent, skilled birth and lactation support, and those for whom power dynamics make it more difficult to challenge medical advice.

“Separation has a disproportionate effect on the most vulnerable mothers and infants,” Tomori says.

What are your setting’s policies and practices around separation during COVID-19? For tips on how you can take action to support parent-infant togetherness, check out the first blog in this series here.

Ready to learn even more? ILCA members can access Tomori’s webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic.

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Promote Skilled Lactation Support: Add an IBCLC Day 2021 Frame to Your Facebook Profile

Show your pride in transforming world health through skilled lactation care. Educate your community by changing your Facebook Profile Frame to celebrate IBCLC Day!

This day – celebrated in 2021 on 3 March – is an opportunity to honor how IBCLCs transform world health by providing skilled lactation care. (Find other ways to celebrate IBCLC Day here at the ILCA website.)

Choose from either of the following options:

Option 1 – “IBCLC Day 2021 v1”

Option 2 – “IBCLC Day 2021 v2”

How to Add a Profile Frame on Desktop 

  1. Navigate to your profile page by clicking your name on top blue bar. 
  2. Hover over your profile picture. 
  3. Click “Update”. 
  4. Click “Add Frame”. 
  5. In the search box, type “IBCLC Day 2021”. 
  6. Click on your preferred style. 
  7. Use the editing box on the right to adjust the size and placement of your profile picture. 
  8. On the bottom row, next to “Switch back to previous profile in”, click on the drop down menu. 
  9. Choose how long you would like to keep your frame. 
  10. Click “set”. 
  11. Click “Use as Profile Picture”. 
  12. You’re all done! If you want, make a post about your new profile frame to your followers. 

How to Add a Profile Frame on Mobile (iOS)

  1. Navigate to your profile by tapping the person icon on the bottom of the screen.
  2. Tap the photo icon on your profile picture. 
  3. On the menu that pops up at the bottom of the screen, tap “Add Frame”. 
  4. At the top of the screen, click on the search bar. 
  5. Search “IBCLC Day 2021”. 
  6. Choose your style by tapping on it. 
  7. Tap the button that says “Make Temporary” and choose “Custom” in the drop-down menu. 
  8. Choose how long you would like to keep your frame. 
  9. Tap “Set”. 
  10. Tap “Save” in the upper right hand corner of the screen. 
  11. You’re all done! If you want, make a post about your new profile frame to your followers. 
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Critical Contact: Helping Ensure Parents and Infants Stay Together During COVID-19


In the early days of the COVID-19 pandemic, one issue quickly rose to the surface for birthing families and their providers. Considering the new risks, could parents and their infants safely remain together?

It was a scary time for birthing parents and those who support them, as stories of painful separation abounded from areas around the globe.

Nearly a year later, data has shown that babies who stay with their parent are at no greater risk for COVID-19 infection than those who are separated. However, separation of birthing parents and their babies remains common practice in many settings. The implications are significant, and dire—particularly for the success of breastfeeding or chestfeeding. As a lactation professional, what can you do to help ensure contact for your clients and their babies? 

In her new webinar, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, discusses the latest developments, as well as what you can do to help. (Find the free webinar here; CERP-eligible for ILCA members here).

THE CURRENT CLIMATE

Months into the pandemic, researchers have gathered a lot of data. Unknowns remain, but there is growing agreement on significant points. First, infants and children are “underrepresented in reported and confirmed cases,” according to Tomori, suggesting they contract COVID-19 less frequently than older individuals. 

Second, they are likely to have a milder clinical course if they do get sick. Exceptions exist, and there is the potential for severe cases, including the risk of Multisystem Inflammatory Syndrome, a rare but serious condition. However, “We have very good data now, from many months and thousands of papers,” Tomori says, “to support the fact that overall, we are definitely seeing lower severity among infants and children.” 

Additionally, data has shown that separating infants from their parents in the hospital doesn’t reduce the likelihood of COVID-19 infection.

So with better data, is all well now? Not quite, according to Tomori.

Following nearly a year of mixed messages and policy reversals, birthing parents are still routinely being separated from their infants, and there is insufficient support for parent-baby contact and for breastfeeding in many areas.

Guidance varies across settings, and some settings are still recommending no breastfeeding or the feeding of expressed milk only.

Separation policies remain common, although they have taken different forms in different areas. In both the United States and the United Kingdom, anecdotal reports of hospitals routinely separating birthing parents and infants are still common, according to Tomori—even when the official policy supports keeping parents and babies together.

WHAT CAN YOU DO?

In the face of confusing and changing policies and practices, how can you advocate for the parents and babies in your care and help ensure they remain together? Tomori has several suggestions.  

Reference high quality resources. As you work to keep up with emerging evidence, stick with proven sources. “Rely on experts who have thought about the issues carefully and thoroughly and are capable of integrating multiple sources of evidence,” she says. “When in doubt, go back to the WHO.” Whatever you do, don’t reference the day’s headlines. “Don’t follow whatever news release you may see—that may not be linked to any research at all, or to poor quality research,” she cautions. You can find up-to-resources at the ILCA website here.

Navigate the guidance. Carefully examine the policies and practices in your own setting. Compare to the WHO guidance, and look for differences and discrepancies. “Think through what the [practice or policy] actually does,” Tomori says. “Map out potential exposures. Map out the trade-offs.”

Challenge problems. If a policy or practice in your setting is out of line with best recommendations, speak up.

Keep parents’ and infants’ rights at the center. Look for opportunities to advocate for these rights in your setting.

Collaborate and communicate. “Don’t go it alone,” Tomori says. Look for others to work alongside you who share your commitment to parents and babies.

Evaluate for inequities. Importantly, any time you are evaluating guidance, policy, or practices, do so with an eye toward inequities. Look for places where your setting’s policies impact different families differently, and question the invisible beliefs and values behind the advice. “Ask, ‘What are the built-in assumptions that are not obvious?’” Tomori advises. “This should be a primary consideration. It will tell you a great deal about what is really happening.”

HOW DID WE GET HERE?

Early in the pandemic, the World Health Organization (WHO) issued guidance urging health care providers to keep birthing parents and their infants together, according to Tomori.

Unlike many country-level and professional bodies, WHO integrates knowledge of past pandemics with a focus on maternal-child health as well as expertise in feeding infants in emergencies and infectious disease control. The result was quick early guidance that centered the rights of the birthing parent, regardless of COVID-19 status.

WHO also stressed labor support, skin-to-skin care, and direct breastfeeding, with the parent wearing a mask and practicing hand hygiene.

However, things got much more complicated after that. National and professional bodies began to weigh in with conflicting recommendations.

Statements by various experts and advising bodies around the world recommended separating parents and babies, and even in areas where official guidance recommended keeping dyads together, individual institutions frequently opted for separate care. 

Then in February 2020, the Centers for Disease Control (CDC) in the United States advised healthcare providers to consider separating mothers and babies. The CDC’s statement advocated shared decision making, with risks and benefits discussed between families and providers—but this did not routinely occur, according to Tomori. Instead, birthing parents were frequently separated from their newborns with no discussion of their options or of the risks of separation.

The CDC’s stance affected practices around the world, as many countries followed its advice. 

With the support of lactation professionals and other parent-baby advocates, including ILCA, in April 2020, the CDC issued new guidance that re-emphasized the benefits of contact and the importance of breastfeeding.

In August 2020, revised CDC  recommendations further re-centered contact, saying the risk of infection from parent to baby was low.

These final recommendations still stand, and in November 2020, new resources issued for the public by the CDC additionally acknowledged that breastmilk is not a likely cause of COVID-19 infection.

A BIGGER PICTURE

Larger questions remain: Why were policies and practices of separating parents and newborns so quick to emerge? And why have they been so hard to dispel? An anthropologist by training, Tomori has very clear answers for these questions—and the answers have big implications for caring for families. To learn more, read the upcoming blog “Anthropology Meets Public Policy: Understanding Parent-Baby Separation in the Pandemic.”

 ILCA members can access Tomori’s CERP-eligible webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic. Non-members can access for free (not CERP eligible) here.

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COVID Vaccine 101 for Skilled Lactation Providers


As information is rapidly unfolding about the new mRNA COVID vaccines and lactating families, we sat down with Dr. Lori Feldman-Winter to help our community get the information they need to support those with questions right now.

Dr. Lori Feldman-Winter is a fellow in the Academy of Breastfeeding Medicine (ABM) and helped to bring their recent statement to fruition. She is also on faculty at the Department of Pediatrics, Cooper Medical School, Rowan University and Children’s Regional Hospital at Cooper, Cooper University Health Care, Camden, New Jersey, US. In these interviews, she is speaking from her expertise as a health care provider and not on behalf of ABM or any of her other professional affiliations.

Can you explain to us how the new vaccine works? How are the mRNA COVID vaccines different from other vaccines, such as the flu vaccine?

There is “little biological plausibility that the vaccine will cause harm [to the] breastfeeding child,” according to the recent statement from the Academy of Breastfeeding Medicine. Can you explain why this is?

What sort of questions should a family consider asking their care provider when assessing the risks and benefits of receiving the COVID vaccine while breastfeeding or chestfeeding?

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What IBCLCs Need to Know About COVID Vaccines


With countries in the process of authorizing distribution of the first COVID-19 vaccines, lactation consultants may have questions about accessing the immunization as well as available safety information for breastfeeding and chestfeeding clients.

In this rapidly changing environment, ILCA is continuing to gather and disseminate international and regional updates about lactation-related COVID information here. Please consider sharing with us information or guidelines from your region that may be helpful to your colleagues and those you serve.

Watch here and on our social media for rapid updates as they become available. 

Can IBCLCs and other lactation care providers be included in early priority groups to receive the vaccine?

While the World Health Organization (WHO) has provided guidance on vaccine access and allocation, decisions about how to prioritize who receives vaccines as they become available are being made at the local level. These plans are being made by countries, states or territories, depending on the region.

WHO guidelines prioritize health care workers for early access to the vaccine. However, their scenario-based recommendations vary based on factors including the local virus spread, the available vaccine in each community, and the healthcare worker’s risk of contracting the virus based on setting.

Understanding the role of IBCLCs in the health care system

If your local vaccine distribution plan follows the WHO framework, it is likely to prioritize your access based on local conditions and how the setting in which you practice impacts your risk of contracting COVID-19. You may also have the opportunity to play a leadership role in decisions at your facility or in your region. Here is some information you may find helpful as you navigate the question of how your role within the healthcare system relates to your priority status.

The independent international certification body conferring the IBCLC credential – the International Board of Lactation Consultant Examiners (IBLCE) – includes this in their definition of an IBCLC:

What is an IBCLC? International Board Certified Lactation Consultants function and contribute as members of the maternal-child health team. (Find it here)

The United States Centers for Disease Control and Prevention includes this definition of healthcare personnel in its resources on the coronavirus:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). (Find it here)

The World Health Organization, in a document on the National Health Workforce Accounts, offers this definition

“The health workforce (HWF) includes all types of health, social, and support workers.”  (p. 8) (find it here)

And in another document on health workers, offers this definition:

“This report defines health workers to be all people engaged in actions whose primary intent is to enhance health.” (find it here)

What can we tell clients about the safety of COVID-19 vaccines during pregnancy and lactation?

First, it is important to remind families that much of the information we need to make decisions is still forthcoming. 

You may also provide them with guidance on what we know so far:

  • Overall safety considerations for pregnancy and for lactation may be different and should be considered separately.
  • Just as distribution of the vaccine happens locally, safety approval also is guided by local regulatory processes, typically at the national level. 
  • These safety approval processes include a review of the outcomes of clinical trials. However, phase three clinical trials, which test vaccines for efficacy and safety, have not yet been conducted on people who are pregnant or lactating. 
  • While additional data are on the way, in the short term, guidelines from different countries are likely to be conflicting as each region weighs the balance of limited evidence with a vaccine for a novel virus against their knowledge of the protective benefits of lactation.

We know that further information is critical for healthcare workers and essential workers who are also lactating. (See this op ed for context in the US setting.) ILCA will share more information as it becomes available.

Do you have information about how decisions about vaccine allocation is occurring or vaccine recommendations for those breastfeeding or chestfeeding in your community? Let us know in the comments or email us at media@ilca.org. We will continue to update ilca.org/COVID-19 with new information as it becomes available.

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Seven Ways to Promote the IBCLC Profession

Looking for ways to promote the IBCLC® profession? ILCA has blog posts, infographics, and videos that you can share to help others learn about how IBCLCs transform world health.

Here are seven ways you can share materials on social media. Each share makes a difference! Together we can educate our communities about who IBCLCs are, what your care looks like, why skilled lactation care is important and where and how to access that care.

1: Why to seek the care of an IBCLC

This blog post on five reasons to ask for help from an IBCLC can be used anytime you need to educate people on when to seek support.

2. How to find an IBCLC that provides telehealth visits

Let people know that virtual visits are available, and they can find providers at www.findalactationconsultant.org in this Facebook post and this Instagram post

While you are at it, add a virtual telehealth frame to your profile pic!

3. Share breastfeeding and chestfeeding tips

Over at Lactation Matters, find articles to share about common questions families may have about lactation. Each article ends by directing consumers to the Find A Lactation Consultant directory, where they can find skilled providers for support. Find the tips to share on social media below.

Combining Lactation and Employment Lactation Matters post.

Tip #1 on Facebook and Instagram.

Tip #2 on Facebook and Instagram.

Tip #3 on Facebook and Instagram.

Tip #4 on Facebook and Instagram.

Six Tips for Preparing to Breastfeed Lactation Matters post.

Tip #1 on Facebook and Instagram.

Tip #2 on Facebook and Instagram.

Tip #3 on Facebook and Instagram.

Tip #4 on Facebook and Instagram.

Tip #5 on Facebook and Instagram.

Tip #6 on Facebook and Instagram.

4. Educate about facilities that have received the IBCLC Care Award

The IBCLC Care Award recognizes maternity and community-based facilities worldwide that hire currently certified International Board Certified Lactation Consultant® (IBCLC®) certificants.

Direct families to the Care Award directory by sharing this on Facebook. You can also find graphics honoring specific facilities in this Facebook album, updated weekly.

5. Share why IBCLCs matter

Find posts like these on Facebook and Instagram that share the evidence about why your care matters.

Share on Facebook or Instagram.

Share on Facebook or Instagram.

Share on Facebook or Instagram.

6. Advocate for breastfeeding friendly policies

When we advocate for breastfeeding and chestfeeding friendly policies, we remove key barriers that our clients experience every day when trying to reach their lactation goals.

Share on Facebook.

Share on Facebook.

7. Let us know what you want to share

Have ideas for future blog posts, infographics, or videos you would like to see in 2021? Let us know in the comments.

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Teaching Baby-Led Weaning To Parents: A Guide For Lactation Consultants


After receiving expert, skilled support from IBCLCs around early infant feeding questions and concerns, many parents return with questions as the time for starting solid foods approaches. An increasing number of questions over the past decade have been about Baby-Led Weaning – is it safe? When can it begin? What are trusted resources for learning more? How should parents balance offering table foods and continuing to nurse/provide human milk?

Meghan McMillin holds a Master’s Degree in Human Nutrition and is both a Registered Dietitian Nutritionist (RDN) and Board Certified Specialist in Pediatric Nutrition (CSP), as well as an International Board Certified Lactation Consultant (IBCLC). Meghan’s private practice focuses on prenatal, postpartum and infant care, and the introduction of solids, food allergies, and Baby-Led Weaning are among her specialties. Her webinar for ILCA, “Baby Led Weaning and the Role of the IBCLC” combines her expertise as a dietitian and her IBCLC experience to uniquely frame the research, practice, and guidelines around Baby-Led Weaning that IBCLCs need to know. 

McMillan feels strongly that “IBCLCs need to be educated on the basics of Baby-Led Weaning. There are plenty of non-experts out there providing information, in social media groups, blogs, and peer-to-peer supports. We need to be the experts, making sure babies are fed safely.” 

Here she shares a few key insights about about Baby-Led Weaning. 

“Baby-Led Weaning” might be a confusing term for some

McMillin explains that in some English-speaking countries, including the United States, “weaning” refers to the end of breastfeeding or chestfeeding, and “baby-led” weaning to the act of letting a baby guide when to stop. However, in the United Kingdom, where the first book on Baby-Led Weaning was published, “weaning” refers to the introduction of solid or table foods – the beginning of complementary feeding, not the end of human milk feeding. And “baby-led” refers to the act of allowing the baby to feed themselves, “eating finger foods from the first bite.”

Baby-Led Weaning isn’t just about what babies eat, but how babies eat

McMillin defines the basic principles of Baby-Led Weaning as starting to offer solid foods at six months of age (as recommended by the World Health Organization); offering healthy foods; sharing meals together as a family; and finally, allowing babies to feed themselves (instead of being given pureed food on a spoon by an adult). She points out that as IBCLCs, we teach families to allow babies to lead feeding from birth. We teach feeding cues, encourage parents to feed on cue and discourage them from timing or scheduling feeds. The self-feeding, responsive mindset of Baby-Led Weaning is a natural extension of that approach. In fact, McMillin shares research showing that in a randomized trial, parents taught to use Baby-Led Weaning chestfed or breastfed for longer durations than those who were not. 

Many parents have questions about how to use Baby-Led Weaning safely

Baby-Led Weaning emphasizes allowing infants to self-feed by giving them large, “grabbable” pieces of food versus spoon-fed purees. This often leads to questions and concerns about the potential for a baby to choke if they break off a piece of food that is too large for them to handle. McMillin explains that research shows “babies that followed the Baby-Led Weaning approach did not choke more often than those that followed the traditional approach.” She highlights that “any feeding method can result in choking when the proper precautions are not taken, and educating parents on this can help reduce the risk.” 

Are you ready to provide the families you serve with the information they need? McMillin notes that many health care providers are unfamiliar with Baby-Led Weaning, and that many health governing bodies offer little guidance or official positions for providers to turn to. As IBCLCs, we are trusted infant feeding professionals and can offer parents education on understanding a baby’s readiness for solids, information on safety and choking precautions, counsel them on continuing to maintain nursing and milk supply, and have referrals and resources for issues outside our scope of practice. In “Baby Led Weaning and the Role of the IBCLC,” McMillan covers all those topics and more, including how to counsel parents about what to expect when beginning Baby-Led Weaning, ideas for combining conventional feeding with Baby-Led approaches, food preparation ideas, and the ideal first foods for infants being fed human milk. 

Ready to learn more? ILCA members can access this webinar for free right here! Not a member yet? Learn more about accessing ILCA continuing education here.

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Physical Therapy Techniques in Lactation


Patients and providers frequently turn to IBCLCs with questions and concerns about chest/breast and nipple pain, plugged ducts, mastitis, and engorgement. Whether it is a patient newly postpartum who is so engorged the baby cannot latch, one who is experiencing recurrent plugged ducts, or one who is exhausted having sought out treatment after treatment for chronic pain, we all could use more tools in our toolbox to support patients and help resolve their issues.

Katrina B. Mitchell, MD is a board-certified general surgeon, fellowship-trained breast surgical oncologist, and International Board Certified Lactation Consultant (IBCLC) whose practice includes the care and surgery of women with breast cancer and benign breast disease, and also treats complications of lactation. Her webinar for ILCA, “Physical Therapy Techniques in Lactation” draws on both her own intimate knowledge of breast anatomy and physiology as well as the knowledge of the skilled physical therapists she works with. Below, she shares insights and techniques that can help IBCLCs help their patients.

The breast is a dense and complex organ

Mitchell emphasizes that the lactating breast is “an extremely complex organ”: highly vascular, drained by a complex lymphatic network, and highly innervated. Multiple branches of the intracostal and supraclavical nerves are present throughout the breast, and many extend all the way from the border of the breast to the nipple/areolar complex. Mitchell explains that for this reason, “Any kind of deep breast pain is going to radiate to the nipple, and any kind of nipple pain is going to radiate back deeper in the breast.” Similarly, lymphatic congestion anywhere in the breast can contribute to and interact with breast pain, engorgement, plugged ducts, and mastitis. When patients experience breast congestion, it is important to have multiple techniques available to relieve the pressure and improve drainage.

Deep massage = tissue damage

When a patient has plugged or congested areas of the breast, many of us were taught at some point in our training that firm massage starting behind the plugged area and pushing towards the nipple would help “push” a plug out. “I tell patients – because I’m the person seeing the consequences of aggressive massage – basically, if you’re massaging this gland, it’s like massaging a thyroid gland or some other gland,” Mitchell explains. “It’s just going to traumatize it.” She emphasizes that milk ducts are tiny – attempting to force milk through is very unlikely to work, and can cause significant issues. Excessive massage for a plugged duct or mastitis can cause a “lactational phlegmon” in that part of the breast, a complex mass of tissue that can’t be drained and can be challenging to manage.

Physical therapy techniques can be very effective for pain relief and breast drainage

For alternatives to these potentially harmful methods, Mitchell encourages more awareness of physical therapy techniques for management. She explains that breast surgeons generally work closely with physical therapists who are trained in lymphatic drainage and treating edema often associated with breast surgeries. She and the PTs she works with have found that many of the techniques can be very effective for treating issues with lactation as well. In particular, instead of deep massage, she encourages a lymphatic massage approach – with a light touch, “like petting a cat” – done with awareness of lymphatic drainage techniques of the breast. Understanding a few key techniques, and simple steps parents can be taught for self-care, can enable IBCLCs to put these principles into practice when caring for patients.

Want to learn more? In her webinar, “Physical Therapy Techniques in Lactation,” she shares photos of cases, high quality medical illustrations, and her understanding of the complex and fascinating anatomy of the breast. You will also learn the principles behind approaches like kinesiology taping, neural mobilization, and therapeutic ultrasound – techniques practiced primarily by physical therapists, but important for IBCLCs to understand for collaboration and referral. 

Ready to learn more? ILCA members can access this webinar for free right here! Not a member yet? Learn more about accessing ILCA continuing education here.

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