Author Archive | lactationmatters

Joint Statement for CSW64: Invest in breastfeeding for gender equality and sustainable development

As skilled lactation providers, we know that national and global policies affecting health care, workplace support, and access to breastfeeding and chestfeeding support impacts our individual clients’ ability to reach their infant feeding goals. We additionally know that reaching those individual goals impacts that one family, but also the health of the community and even the climate. This is why ILCA is committed to international advocacy that ensures that promotion and protection of breastfeeding is recognized as a key issue for ensuring gender equality and sustainable development.

ILCA and the World Alliance for Breastfeeding Action have partnered to create the following statement to be delivered to the Commission on the Status of Women (CSW64) with the goal of highlighting the promotion and protection of breastfeeding and skilled lactation care on the world stage. Although the event itself has been scaled back in light of the current concerns regarding coronavirus disease (COVID-19), we hope to elevate the statement at upcoming meetings of the General Assembly. We also welcome you to share the statement widely within your community and with your national leadership.

Statement:

“Breastfeeding is the biological norm but it is not yet the social norm. When a mother chooses to breastfeed, every one of us has the responsibility to protect and support her. By doing so we’ve started a partnership with her. Breastfeeding partnerships matter, a lot! Not just at home with a partner and family but also at work and socially…..when everyone involved learns and positively accepts the challenge to shift breastfeeding to become the social norm.Leah Hughes, Girls Globe 

This year, the global community will mark the twenty-fifth anniversary of the Fourth World Conference on Women and adoption of the Beijing Declaration and Platform for Action (1995). The highlight includes a review of current challenges that affect the implementation of the Platform for Action and the achievement of gender equality and the empowerment of women and its contribution towards the full realization of the 2030 Agenda for Sustainable Development. The protection, promotion and support of breastfeeding is embedded in the 1995 Beijing Declaration and Platform for Action1, International Labour Organisation (ILO) maternity protection Convention C1832 and CEDAW3. Breastfeeding is one of the most effective and cost-effective ways to save and improve the lives of children everywhere, yielding lifelong health benefits for infants and their mothers. Therefore, breastfeeding is also a key intervention to achieve all the 17 Sustainable Development Goals.

Women’s reproductive health and rights must be prioritised as a key component of the Sustainable Development Goals. Lactation and breastfeeding are part of the reproductive continuum and require access to consistent information and skilled support. Breastfeeding protects the health of women by reducing the risk of breast and ovarian cancer, diabetes, and heart disease. Increased breastfeeding rates could prevent 20,000 maternal deaths each year from breast cancer alone and prevent over 820,000 child deaths each year.  Breastfeeding rates are stagnant or declining in many parts of the world. The cost of not breastfeeding on the global scale is about $302 billion annually. Although some progress has been made in supporting breastfeeding it is far from being the social norm.

When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. The Warm Chain places the mother-baby dyad at the core and follows the first 1,000 days timeline. With consistent messages and proper referral systems throughout the warm chain, the mother-baby dyad will benefit from ongoing support and skilled assistance. 

Women’s economic empowerment is inextricably linked to their empowerment as mothers and primary infant caregivers. According to the ILO, 830 million women workers do not have adequate maternity protection. When fathers/partners support breastfeeding and are involved in caring for the baby, breastfeeding improves, the parental relationship is better. Supporting parents at work is a prerequisite for optimal breastfeeding, distributing care work and transforming social norms. Parent-friendly policies, which enable women to remain and progress in paid employment and encourage men to take their fair share of care work, are crucial to achieving gender equality at work and at home. 

Balancing work and family life, including breastfeeding, is increasingly necessary for all. This will ensure a productive and healthy workforce thus leading to a better society.  Effective partnerships between governments, employers, trade unions and civil society organisations will increase access to gender equitable social protection. Gender equitable social protection includes legislation, positive social norms and supportive work policies which are the basis of the Empowering Parents Campaign.

In light of the Political declaration on the occasion of the twenty-fifth anniversary of the Fourth World Conference on Women, the International Lactation Consultant Association and the World Alliance for Breastfeeding Action therefore call upon governments, UN agencies, health systems, workplaces, communities and civil society organisations to

  • Implement gender-equitable social protection that will enable breastfeeding and greater gender equality.
  • Enact and monitor national legislation and policies that uphold the rights of women and their children in diverse contexts.
  • Enact paid parental leave and workplace breastfeeding policies for women in the formal and informal economy.
  • Create a warm chain of support for breastfeeding across healthcare, workplace and community from pregnancy until the child’s second birthday. 
  • Invest in interventions such as support for breastfeeding as a means to improve the health and survival of women and children.

Together we can help create a better world for women and men, girls and boys by supporting breastfeeding to become the social norm. This will benefit all of society.

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Celebrating IBCLC Day!

Lactation education. Home lactation support. Helping breastfeeding and chestfeeding families in clinics and hospitals. Human milk research. Emergency and disaster support for displaced families with infants. These are just a few of the ways that you as International Board Certified Lactation Consultants® (IBCLCs®) are contributing to world health outcomes by sharing your expertise.

On 4 March, 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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Ten Strategies for Supporting LGBTQIA Families

How well does your clinical setting or private practice serve LGBTQIA patients and clients? Is there more you could be doing? In ILCA’s recently released webinar, Care of the Same Sex Family, Diane DiTomasso, PhD, RN, shares strategies for effectively supporting LGBTQIA families.

Here are ten highlights for providing culturally appropriate care from her webinar. Answer the following questions to see how your practice measures up—and where you can improve.

Have you checked your implicit biases?

The first step, according to DiTomasso, is scrutinizing your own attitudes—especially subtle ones, which often come from early learning. “Take a minute and think about the earliest messages you ever received about people in this population and the source of those messages,” she advises. “Who taught you what and how to feel about people in the LGBTQIA community?”

If parents or other influences communicated negative attitudes, your early programming may still be influencing your behavior in ways you don’t realize—even if your beliefs as an adult don’t align with those messages. “Consider your verbal and nonverbal communications, and the intentional or unintentional signals you may be sending based on those messages you received,” DiTomasso says.

Are you fluent in LGBTQIA concepts and terms?

Knowing the right words to use reflects a commitment to respectful care. Some basic terms to know: Sexual orientation refers to how a person characterizes their sexual and emotional attraction to others. Gender identity is the internal sense of being male, female, both, or neither. When a person’s gender identity conforms to the gender they were assigned at birth, they are cisgender. Gender fluid means gender identity is not fixed—a gender fluid person may identify as male or female at different times. Someone who is transgender has a gender identity that does not correspond with the gender they were assigned at birth. Those who were assigned male sex at birth but who identify as female may refer to themselves as transgender women, trans women, or male-to-female persons. People who were assigned female at birth but identify as male may refer to themselves as transgender men, trans men, or male-to-female persons.

Another note on language: Pronouns are extremely important. “When we address people by the pronouns they use, that is central in … building rapport,” DiTomasso says. “Match the person’s language. Use the pronouns they use and use the names they use. This is so important.”

For a more comprehensive list of terms, the United States’ National LGBTQ Educational offers an updated and comprehensive list of terms here.

What messages do your workspace and paperwork convey?

These elements send powerful signals. Avoid clinic or practice names and signs that seem welcoming to only one gender. Include literature relevant to LGBTQIA people in your waiting areas, and establish gender-neutral bathrooms, DiTomasso suggests. Revise your forms and documents to reflect the diversity of sexual orientations, gender identities, and family structures. For example, instead of asking for “male or female” on a form, ask, “What is your gender identity?” Then offer these options: male, female, neither, both, transgender, other. “All of these things could be done in an afternoon,” DiTomasso says. “It doesn’t take a lot of time to go online and find a gender-neutral bathroom sign and tape it up, or to revise your forms and documents.”

However, “[Signs and forms] are meaningless if the care received and the treatment don’t match them,” DiTomasso cautions. “What matters is the way you are treated by the people—it’s so much more powerful than any of these other things.”

Are you open and trustworthy?

Do you encourage your clients to share sensitive information, by being a good listener? LGBTQIA clients may be reluctant to disclose personal information for fear of discrimination and compromised quality of care. “The consequences of nondisclosure can include development of mistrust, missed opportunities for health education, and ill-informed clients and health care workers,” DiTomasso says. How do you help someone feel safe to share information? “Open the door for disclosure. Recognize how difficult it is to come out, over and over,” she urges. “Ask open-ended questions with attention to tone of voice and body language. Encourage conversations. If you don’t know what to say, simply say, ‘Tell me about it.’ Let people talk. The key is using clear, nonjudgmental communication.”

Do you make assumptions during client contacts?

Assuming heterosexuality and assuming gender identity are “common and widely accepted,” according to DiTomasso, but this can lead to unintentional blunders—for example, asking a married female client about her husband, when in fact, she is married to a woman. “It takes a lot of emotional energy to correct someone,” DiTomasso says. “It’s like when someone calls you by the wrong first name. It becomes all you can think about in the interaction. You are embarrassed, because you don’t want to embarrass them.” If such a mistake happens? “Simply apologize and move on,” she suggests. Don’t allow embarrassment to cause you to overcompensate, making your client even more uncomfortable. “And then work on trying not to make assumptions, because that avoids the whole problem to begin with!”

The best way to avoid assumptions? Use inclusive rather than exclusive language. Examples of inclusive questions: Do you have a partner or significant other? How do you refer to your partner? Can you tell me about your family?

Are you aware of unique clinical concerns?

Certain issues like anxiety, depression, and substance use are higher among LGBTQIA populations. Other issues are as well, such as intimate partner violence and sexual abuse. Excellence in care means being aware of these statistics.

Does your workplace address invisibility?

Making sure LGBTQIA people are part of your community is another important step. “[We need to] recruit, support, and retrain ‘out’ LGBTQ-identified people to work in health care facilities,” DiTomasso says. You can also establish a visible LGBTQIA presence through posters, photos, other materials in your setting. “They make a difference,” she says.

Do you support research efforts?

More studies are needed to examine the impact of prejudice and discrimination on the wellbeing of LGBTQIA people and their families and to focus on the unique health needs and concerns of people in LGBTQIA groups.

Are you an ally?

“You may not be a member of this group, but you sure can be an ally,” DiTomasso says. What does that over-used word actually mean? “It means you stand up for and support the rights of minority people,” she says. “You respond to anti-LGBTQIA behavior, and you let people know you do not tolerate homophobia or transphobia. This sends a strong message.”

Want to learn more?

ILCA members, take advantage of your free webinars! Access the entire webinar here. Not a member yet? Learn more about how you can access this and other continuing education at ILCA here.

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Promote Skilled Lactation Support: Add an IBCLC Day 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 2020 on 4 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 any of the following options – “Proud to be an IBCLC” or “Proud to be an IBCLC” alongside hashtags celebrating the World Health Organization’s designation of the Year of the Nurse and the Midwife.

Happy IBCLC Day 2020

Happy IBCLC Day 2020 – #yearofthenurse

Happy IBCLC Day 2020 – #yearofthenurseandmidwife

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” 
  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” 
  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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ILCA Seeks Bylaws Changes in 2020

The ILCA Board of Directors is pleased to ask ILCA voting members (those who are currently certified as an IBCLC®) to vote on the 2020 bylaws changes.

The ILCA Board of Directors supports the proposed changes.

Voting ILCA members are encouraged to make an informed decision after thoughtful consideration of the issues, before they visit the voting site.

Vote carefully: Once your vote is cast, it cannot be changed, repeated or cancelled.

What is the balloting process?

ILCA’s balloting process allows bylaws elements to be voted on by section (instead of all-or-none).  We utilize a balloting platform to ensure one-member-one-vote.

If a dues-paid, IBCLC® ILCA member does not receive an email on 20 February 2020 containing a link to the ballot, please contact the ILCA Office at info@ilca.org (or) 1+  919-861-5577 (or) 888-452-2478.  Our ILCA staff is eager to make sure you get a ballot, so your vote can be counted.

Where can I view the proposed changes?

This document shows the 2015 ILCA bylaws, edited with “tracked changes,” to show the proposed 2020 ILCA bylaws. It lets you compare the old version with the new. The document also summarizes all the changes and the Board’s rationale for each, section-by-section. 

Can I discuss this with my colleagues before I vote?

Please do!  This blog and other social media venues encourage dialogue about ILCA’s governance! Use the comments section below to ask questions or make comments.

Ballot Vote No. 1: Why does the ILCA Board support giving voting powers to all dues-paying members in Bylaw 3.4 Voting Rights?

ILCA members have power to vote to (1) elect Directors, (2) ratify bylaws changes, and (3) make motions at the Annual General Meeting.

Since 1985, ILCA has invited open membership to anyone who supports our mission [ILCA Mission: To advance the International Board Certified Lactation Consultant (IBCLC®) profession worldwide through leadership, advocacy, professional development, and research]. From 1985-2007, any dues-paying ILCA member could vote. In 2007 voting rights were restricted to IBCLC®-only members, to demonstrate strong ILCA advocacy for the IBCLC® credential.

Undeniably, demographics of ILCA membership and the pathways of entry into our profession as a whole show significant race, income, and geographic-based barriers. ILCA’s Strategic Plan seeks to increase diversity by creating meaningful, accessible entry into the profession, and our professional association.

Right now, those who are seeking IBCLC® certification and knowledge do not have a professional “home.” The burden falls to the individual to cobble together education and training that will be acceptable to meet pathway requirements of the International Board of Lactation Consultant Examiners® (IBLCE®). ILCA values all members.

Further, extending voting powers to all dues-paying members allows those that have retired to continue to be advocates for the profession. We believe it is essential to honor retirees’ institutional knowledge and their dedication to ILCA and the profession, while continuing to move our mission forward. ILCA’s role has always been:

  • Serve current IBCLCs®
  • Engage and help others who believe in our work
  • Promote the value, growth, and awareness of our profession throughout all stages of your career

Inclusion will propel this profession into growth and sustainability. To address the challenges of current members, and generations of IBCLCs® to come, there must be an invited and equitable voice by those in our association. Inclusion assumes full acceptance; in a membership organization, that includes voting rights.

The ILCA Board supports this amendment to giving voting rights to all dues-paying members as means to build membership, increase diversity, and enhance equity.

Ballot Vote No. 2: Why does the ILCA Board support changes to Directors’ qualifications in Bylaw 5.2 Qualifications?

In previous years, there have been questions about when a Director meets the two (2) year ILCA membership mark. To alleviate confusion about membership validity, the revised bylaws require each Director be an ILCA member in good standing who has completed two (2) years of ILCA membership immediately prior to the date that nominations are called and be an IBCLC®.

The ILCA Board supports this amendment because it provides greater specificity for the two (2) year ILCA membership requirement.

Ballot Vote No. 3: Why does the ILCA Board support shortening the period for identifying Director positions to be filled by election in Bylaw 6.3 Directors?

New Directors start in July each year and the balloting period begins the following March. If the Director positions to be filled by election had to be identified by the Board six (6) months prior to the balloting period, the identification would need to take place by October and there often is not enough time for the Board to determine what is needed.

The ILCA Board supports this amendment to three (3) months prior to the balloting period because the change in timing allows new Directors to become acclimated each year before new positions need to be identified.

Ballot Vote No. 4: Why does the ILCA Board support removing chair of the Nominations Committee from the outgoing President’s responsibilities in Bylaw 6.7 Appointment of President?

The ILCA President serves for a two-year term and at the end of their term, the outgoing President serves as chair of the Nominations Committee for an additional two (2) years. This task and time frame extend beyond the responsibilities of the President. This function is covered in the ILCA Policies and Procedures as an operational task, not a governing task.

The Board supports changes that appropriately utilize the President’s time and contributions.

Ballot Vote No. 5: Why does the ILCA Board support the outgoing President serving as an ex-officio Board member for one year in proposed Bylaw 6.8 Immediate Past President?

Ex-officio Board members are valued for their knowledge, expertise, and experience. The immediate past President’s connections to the wider community can enhance the ILCA Board’s work.

The Board supports this amendment to the outgoing President’s duties to aid with the transition of knowledge and support.

Ballot Vote No. 6: Why does the ILCA Board support all these other little edits in Bylaws 6.5 Nominations Committee and 10.2 Voting Privileges?

Any bylaw amendment, no matter how small and non-controversial, requires member vote to ratify.  There are several such changes that we have “saved up” over the years, awaiting the next bylaws vote, which is now, in 2020.

The ILCA Board supports changes that will correct typographical errors and provide consistency of language.

I have a question, and a few comments!

Excellent!  Please contact ILCA directly or use the comments section below to tell us what you think or to seek more information before you vote (if you are a current ILCA voting member).

Thank you for your membership, and for helping to build a better ILCA!

Sincerely,

Mudiwah A. Kadeshe, President           

Tova Ovits, Secretary

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Ten Things IBCLCs Need to Know About the Gut Microbiome

New understanding of how human milk affects the gut microbiome is helping to explain exactly how the benefits of human milk are achieved.

We hear a lot these days about the gut microbiome—and with good reason. Evidence suggests that the bacteria in our gut influence virtually every aspect of our functioning, from our stress and anxiety responses, to our metabolism and appetite, to the robustness of our immune system, to even our experience of gender and mating. And when our gut microbiome is out of balance, research suggests negative consequences can result: depression and anxiety, obesity, irritable bowel syndrome, Alzheimer’s Disease, and asthma have all been linked to microbiome disruption.

What does the gut biome have to do with breastfeeding? A lot, as it turns out. A webinar hosted by ILCA, Jarold “Tom” Johnston, DNP, CNM, IBCLC, explores that connection. Here, based on Johnston’s talk, are the 10 things lactation consultants need to know about the maternal-infant gut microbiome.

1. The microbiomes of baby and birthing parent are inextricably linked.

When a person gives birth, they pass their microbiome to their baby—first through exposure to their normal flora in the birth canal and then through their milk during breast- or chestfeeding.

2. Communication is a two-way street.

The milk ejection reflex is a muscular contraction that pushes milk out to the baby. But did you know that once the milk ejection reflex slows, muscles relax and pull baby’s saliva back in? Lactocytes respond to saliva exposure by producing particular macrophages. If the baby has been exposed to an infection, at the next feeding, he will get leukocytes and antibodies to fight that specific infection.

3. Colostrum is not really food.

You read that correctly! Babies get very few calories at the breast during the first 48 hours, because the calories in colostrum are not intended for digestion. They come from immune cells, designed to populate the immune system. Rather than thinking of colostrum as calories, think of it as an immune system transfer.

4. Breastmilk sugars are more than food.  

Human Milk Oligosaccharides (HMOs) play a key role in developing the infant’s gut microbiome. Human milk contains more than 100 types of HMOs. (In contrast, cows’ milk contains only two.) Each HMO has a specific benefit for the infant’s gut microbiome. Some are prebiotics, acting to increase good bacteria in the gut. Others block the attachment of invading viruses and bacteria like RSV and e.coli by providing harmless “decoy” attachment sites. Another type coats the baby’s gastrointestinal tract, preventing pathogens from sticking.  But none of them are digested by baby as carbohydrates until the baby is more than four months old.

5. A breasted baby’s gut microbiome is optimized for nutrition delivery.

The breastfed infant’s gut contains a specialized group of bacteria known as the phosphotransferase system. This system transports lactose and makes it available for use. Breastfed babies have higher levels of phosphotransferase then formula-fed babies. This means breastfed babies can access the maximum amount of energy available in their breastmilk. This ensures a constant source of carbohydrate for the developing, glucose-dependent brain.

Breastfed babies have higher numbers of gut bacteria that produce Vitamin A, B Vitamins, Vitamin K-2, and more. When they drink breastmilk, it feeds the bacteria colonies in their gut that make these micronutrients. Are you ever asked whether breastmilk contains enough iron, Vitamin K, or other nutrients? That question is misleading! Babies actually do not “get” these important micronutrients from the breastmilk they drink; what they get from breastmilk are the ingredients to feed a microbiome that can synthesize these micronutrients.

6. There are “bonus” calories in breastmilk.

Epithelial cells in human milk (formerly thought to be dead) are actually alive, active, and functional. They form clusters (called mammospheres) in the baby’s gut and continue to make more milk! This means that for every calorie of breastmilk a baby takes in, he gets bonus calories as the epithelial cells continue to generate milk inside his gut.

7. Exclusively breastfed babies have “less mature” gut microbiomes, and that is a good thing.

At birth, babies have very different proportions of specific bacteria in their gut microbiome compared to their birthing parent’s. Over the first 12 months of life, the baby’s microbiome shifts to strongly resemble the birthing parent’s. However, this shift is accelerated by the introduction of formula or the feeding of solid foods. As soon as the baby ingests anything other than human milk, the gut microbiome changes rapidly, and it does not go back. This may explain why formula fed infants experience more auto-immune and infectious illness.

8. Birth interventions affect the microbiome.

Cesarean section birth reduces microorganism exposure. While infants born via vaginal birth show 135 of their mother’s 187 bacteria strains after birth, infants born via surgical delivery show only 55. Antibiotics given to Group Beta-Strep-positive parents during birth also have an effect, since they wipe out good flora in the birth canal. Exactly how these interventions affect long-term health is not yet clear, but continuing to think carefully about birth interventions is key.

9. What about special situations?

Many of the mechanisms of microbiome transfer rely on birth and direct feeding. What about parents who exclusively pump, rely on donor milk, or induce lactation for an adopted baby? Exclusive pumping and the use of donor milk both impact the microbiome to some extent. Pasteurization of donor milk inactivates some of the living organisms in human milk, and exclusive pumping does not allow for the two-way communication discussed earlier where baby’s saliva is taken into the breast and informs lactocytes of the baby’s specific infection exposure. However, as you address parents’ concerns, what the science tells us now is that receiving human milk is more important than how it is the baby receives the milk.

10. Microbiome science is only a baby itself.

According to Johnston, it is important to remember that our understanding of the gut microbiome is just getting started. There is a long way to go, and much more to learn. However, for those of us who work with lactating families, the exciting news is: Understanding how the unique components of human milk interact with the infant’s gut organisms is helping us begin to understand how those benefits occur—they operate through the microbiome.

Want to learn more? ILCA members, access the entire webinar here. Not a member yet? Learn more about how you can access this and other continuing education at ILCA here.

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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.

Not a member yet?

Get the clinical skills you need. ILCA members can earn up to 18 continuing education credits through membership. Learn more 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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