Author Archive | lactationmatters

Tell Us About Your Amazing Colleagues!

Lactation Matters has just launched a feature called “Clinicians in the Trenches”.  It is our hope that with this, we can both highlight those who are doing outstanding work in our field and also encourage each other, give us new ideas, and cheer each other on!

Here is our first entry, focusing on Colette Acker and The Breastfeeding Resource Center.    But, we need YOU to tell us about your colleagues.

Who is bringing to light a new idea with their practice?
Who is paving the way with techniques that we could all benefit from?
Who has a really great story to tell about what lactation practice has meant in her/his life?

Please contact Robin Kaplan and Amber McCann with your suggestions at lactationmatters@gmail.com.  Please use the subject ‘Clinician in the Trenches.’ Include a brief paragraph with the name of the clinician you are recommending, her/his contact information, and a short explanation of why she/he should be highlighted in Lactation Matters.

Look for new stories about these amazing clinicians every 2 weeks on the blog!

Amber McCann, IBCLC, Lactation Matters Volunteer
Robin Kaplan, M.Ed., IBCLC, Lactation Matters Co-Editor

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A BFHI Update – ‘Call to Action for Breastfeeding Support from the Surgeon General ‘

How do you see the Call to Action impacting Baby Friendly in the United States? (Maybe even internationally?)

The United States now has a strong, evidence based national policy on infant and young child feeding that specifically calls for expanding implementation of the Baby-Friendly Hospital Initiative (BFHI). This is an extremely important turn of events and status change.  BFHI is also specifically mentioned in the White House Obesity Report, and possibly even more importantly, in The Joint Commission’s recent Speak Out campaign. Internationally, Baby Friendly USA (BFUSA) has always been a strong collaborator with other nations’ BFHI Authorities and I would expect this collaboration to increase.

What changes are you hoping to see?

The Director of Health of my state met with our state Lactation Consultant chapter in early August, and within two weeks convened a high-level meeting of organizations to begin discussions on moving BFHI ahead. That’s amazing progress! Several states have conducted in-depth surveys of maternity facilities (in addition to encouraging hospitals to respond to the Center for Disease Control’s mPINC surveys), developed interim goals and local incentive programs, held Hospital Summits, and more.  Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey of maternity care practices and policies that is conducted by the CDC every 2 years beginning in 2007. The survey is mailed to all facilities with registered maternity beds in the United States and Territories.  I expect the Call to Action will resonate with and inspire the entire public health professional community, at every level.

Why is this Call to Action coming at a critical time?

I’m tempted to say “It’s about TIME!” The momentum for breastfeeding has escalated in the past ten years in the US, partly due to the collaborative work of the US Breastfeeding Committee. The economic conditions are encouraging everyone (individuals and companies) to re-think spending patterns; health decision-making is becoming more transparent; and virtually everyone is calling for better health outcomes. Over 40,000 IBCLCs around the world are working with other health care providers to provide the up-close one-to-one clinical support for mothers and babies. Without this rich network of support, mothers would face far more avoidable problems.

How will the Call to Action impact not only hospital-based lactation consultants, but lactation consultants in private practice, as well?

There’s something in the Call to Action for everyone. As an lactation consultant in private practice myself, I was thrilled to see a call for appropriate reimbursement for my services as an LC, regardless of other credentials or licenses. I’m currently in graduate school and was very excited to see a call for more research on breastfeeding. The Call to Action’s recognition of lactation consultants as important players on the health care team was extremely gratifying.

Linda J. Smith, BSE, FACCE, IBCLC, FILCA
Bright Future Lactation Resource Centre Ltd.
6540 Cedarview Ct., Dayton OH 45459-1214
Phone (937) 438-9458   Fax (937)-438-3229
www.BFLRC.com

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United States Lactation Consultant Association’s Response to the Call to Action for Breastfeeding

The Surgeon General’s Call to Action for Breastfeeding offers opportunities for US-based IBCLCs in virtually every one of its twenty action steps. From #1, give mothers the support they need to breastfeed their babies to #20 improve national leadership on the promotion and support of breastfeeding. IBCLCs play key roles and the United States Lactation Consultant Association (USLCA) is actively involved to promote, equip, and empower members. USLCA is working hard to ensure that IBCLCs are represented in discussions with both policymakers and caregivers in a variety of venues. The Call to Action strengthens the voice of the lactation professional and gives IBCLCs the credibility and clout to do what they do best for mothers, for babies, and the health of the nation.

USLCA is responding to the Surgeon General’s Call to Action by networking and relationship-building with organizations such as the Academy of Breastfeeding Medicine, AWHONN, the American Academy of Pediatrics, United States Breastfeeding Committee, National WIC, and Texas WIC Association. In every discussion, language is emphatically clarified so that a breastfeeding support person translates directly into IBCLC, as per the Surgeon General’s specific and strategic recommendation.

USLCA recognizes the responsibility for IBCLCs to provide the best care possible as they work with employers to develop breastfeeding-friendly workplaces, with hospitals as they move along on the Baby-Friendly journey, with educational institutions creating curricula to incorporate lactation care into health care education, with public health entities as they expand services for maternal and infant care, and for individual families as they seek to achieve their breastfeeding goals. To that end, USLCA publishes its peer-reviewed Clinical Lactation and presents cutting-edge educational programs each month via webinar technology.

USLCA encourages its members to be politically engaged at community, state, and national levels, participating in state Breastfeeding Coalitions and advocating for IBCLCs in a wide cross-section of settings. As Milk for Thought traveled the nation in the Big Pink Bus, USLCA members participated in community rallies at every stop. USLCA President, Laurie Beck, MSN, RN, IBCLC, participated in the documentary chronicling the tour and promoting breastfeeding.

The Surgeon General’s Call to Action is a wonderful tool to advocate for communities that support breastfeeding at every juncture with the goal of health care that begins with breastfeeding. IBCLCs are key figures in the Call to Action and USLCA is responding to the call by providing education, support, and advocacy for IBCLCs.

Laurie Beck, RN, MSN, IBCLC, RLC
President of USLCA on behalf of the USLCA Board of Directors

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Clinicians in the Trenches – Colette Acker

Please welcome Colette Acker, our first clinician to be highlighted in our monthly series, Clinicians in the Trenches.  In this new series, Lactation Matters will take you into lives and businesses of fellow colleagues around the world, allowing them to share their knowledge, expertise, and wisdom.

Colette M Acker, IBCLC lives in Glenside, Pennsylvania with her husband, Rodney.  They have three children who are now in the teen/young adult age range.  Nursing her own children led to her passion for assisting other mothers.  She became a volunteer breastfeeding counselor in 1995, an IBCLC in 1998, and co-founded the Breastfeeding Resource Center (BRC) 5 years later.  Although Colette loves working with new moms and babies, the multi-tasking life of the director of nonprofit calls for much more and never leaves her bored!  Outside of lactation, Colette’s favorite stress release is running and has developed a new addiction to Zumba classes.

1. What is the Breastfeeding Resource Center (BRC)?

The BRC is a nonprofit organization committed to providing expert clinical and educational breastfeeding services.  We offer a variety of lactation services from the prenatal period through weaning. We provide problem-solving consultations, back-to-work planning, and weight checks, along with other consultations designed to meet a mother’s individualized needs. Weekly support group meetings and low cost parent classes complement our outreach efforts. The BRC is an asset to the medical community by providing supervised clinical opportunities, as well as being a resource of evidence-based information. All services are offered on a sliding scale of payment to ensure access for all families.

2. Why did you decide to start a non-profit?

Two colleagues and I were on our way to our ILCA affiliate meeting and were dreaming.  We fantasized about a place where women could go if they were having difficulty with breastfeeding, planning to return to work, needing assistance in choosing the right products, or just needing some support and reassurance.  We also imagined it being a valuable resource for healthcare professionals serving breastfeeding families.  We were currently working in the private practice arena and we knew many moms couldn’t afford the service.  We felt strongly that this center should be accessible to all families, regardless of income.

3. What are your biggest challenges running a non-profit?

The biggest challenge is finding funding to allow the BRC to provide LC visits on a sliding scale of payment. Thirty three percent of our budget needs to be obtained through fundraisers, donations, and grant funding. All of these take a lot of time and effort by many people. The employees of the BRC wear many hats. Janice McPhelin, our Director of Development, is an IBCLC who works with moms on a daily basis and needs to jump into grant writing whenever a free moment arises. This hat-switching life can be very crazy, yet it also makes the job more interesting!

4. What resources have been most helpful to sustain your non-profit?

The greatest part about running a nonprofit center is that you are not alone. We have 16 members on our Board of Directors. We’ve found volunteers with expertise from all walks of life such as accounting, law, grant writing, physicians, RNs, and event planners. Developing a strong board with experience in the areas where the BRC needs the most help is vital. Also, creating a strong community among our clients has led to a large volunteer base. It is amazingly touching to see our clients so appreciative of our work that they volunteer time to keep it going strong!

5. What advice would you give to an LC who wanted to open a non-profit center similar to yours?

Prepare for a wild ride!  I’d suggest learning everything you can about running a nonprofit.  There are many opportunities available in most communities and on the web such as www.Nonprofitwebinars.com. Plan on working long hours with little pay until funding becomes accessible. Discover your weaknesses and find board members and volunteers to fill that gap. Collect emails and join social networks for the most efficient and inexpensive way to spread the word. Become a strong member of your community by participating in health fairs, the chambers of commerce, as well as partnering with other nonprofits that target a similar audience.

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Summary of the Surgeon General’s Call to Action to Support Breastfeeding

On January 20, 2011, Surgeon General Regina M. Benjamin issued a “The Surgeon General’s Call to Action to Support Breastfeeding,” outlining steps that can be taken to remove many of the challenges faced by women who want to breastfeed their babies. The Surgeon General identified 20 evidence-based actions that are needed, including establishing worksite policies and programs that are supportive to employees who are breastfeeding, implementing maternity care practices in hospitals and birthing facilities that do not sabotage breastfeeding, reducing marketing of infant formula products, and ensuring access to services provided by International Board Certified Lactation Consultants (IBCLCs). The Call to Action asks six segments of society to step forward and take responsibility for removing breastfeeding barriers within each of their respective spheres of influence.The twenty action steps within the six categories have numerous suggested implementation strategies.

Mothers and their Families: recognizes the need for mothers to be informed by their health care providers of the importance of breastfeeding, and that health care providers support mothers in their efforts to breastfeed.
Communities: asks for community-based support for breastfeeding mothers from public health programs, including the provision of peer counseling support, and around the clock breastfeeding support from community organizations. Manufacturers of infant formula should be held accountable for marketing their products within the guidelines of the International Code of Marketing of Breastmilk Substitutes and health care providers should not serve as advertisers of infant formula.
Health Care: requests that hospitals accelerate their efforts to achieve the Baby-Friendly designation, ensure access to skilled, professional lactation care services following hospital discharge, provide training in lactation care in undergraduate and graduate educational programs for health professionals, encourage insurers to reimburse for services provided by IBCLCs, and increase availability of banked donor milk.
Employment: calls for paid maternity leave, the establishment of lactation support programs by employers, and the adoption of child care standards that support breastfeeding mothers.
Research and Surveillance: identifies the need for new research regarding the most effective ways to increase breastfeeding rates among populations with low rates, conduct analyses of the cost effectiveness of breastfeeding, and provide a better evidence base for making clinical decisions in challenging situations.
Public Health Infrastructure: urges the creation of a federal interagency work group on breastfeeding, and increasing the capacity of the United States Breastfeeding Committee and affiliated state coalitions.

The Call to Action represents a significant tool for use in validation of the importance of both breastfeeding and the role that the IBCLC plays in assuring that all mothers and infants receive the level of lactation care and services that they need. The document can be used in numerous ways to improve access to evidence-based care in the hospital, to provide post discharge lactation care in the community, and in settings where mothers experience the most difficult challenges to breastfeeding, such as the workplace. The Call to Action functions as a guide or roadmap for those wishing to make changes, as it places the responsibility for breastfeeding improvement on all the segments of society that interact with mothers or who have an influence on how lactation support is provided. It provides suggestions on how best to reduce barriers, and challenges health care providers, institutions, organizations, agencies, the Government, employers, and insurers to all do their part to see that mothers and infants receive the support to which they are entitled.

Action 11 specifically recommends, “Ensure access to services provided by International Board Certified Lactation Consultants.” It goes on to ask that IBCLCs be designated as “covered providers” and that reimbursement should be provided independent of licensure. Adherence to these recommendations will go a long way in reducing disparities and providing access to care that can be financially out of reach for mothers when insurers refuse reimbursement for lactation care and services provided by IBCLCs. Use this document to your advantage, whether you work in a hospital, clinic, agency, or private practice. There is so much room for improvement that we should make sure that we have all of the tools at our disposal in our work to help mother and babies breastfeed. To obtain copies of the Call to Action see:

http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf

Summary http://www.surgeongeneral.gov/topics/breastfeeding/executivesummary.pdf

MarshaWalker, RN, IBCLC

Marsha Walker has worked with breastfeeding mothers since 1976, first as a volunteer counselor with Nursing Mothers Counsel in California and eventually as the Director of the Breastfeeding Support Program at Harvard Pilgrim Health, a large HMO in Massachusetts. Much of her time is currently spent advocating for breastfeeding on the state and federal levels. She is the executive director of the National Alliance for Breastfeeding Advocacy (NABA) which is the organization that monitors the Code in the US. Marsha also sits on the Board of Directors Baby Friendly USA, Massachusetts Breastfeeding Coalition, and Best for Babes. She represent USLCA to the US Department of Agriculture’s Breastfeeding Promotion Consortium and represent NABA to the US Breastfeeding Committee.

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Ethical Issues in Breastfeeding Support

Born in Brooklyn, New York, Dr. Gartner received his undergraduate education at Columbia University and his medical degree from Johns Hopkins University. Returning to New York after internship in Pediatrics at Hopkins, he continued his training in Pediatrics at the Albert Einstein College of Medicine, specializing in neonatology and pediatric liver disease. The great majority of his basic laboratory and clinical research has been in the area of neonatal jaundice, with particular reference to its relationship to breastfeeding. He continued his combined work in bilirubin metabolism and breastfeeding in Chicago and has now published more than 200 papers on this subject and on other aspects of breastfeeding.

Dr. Gartner was Founding Chair of the Executive Committee of the Section on Breastfeeding of the American Academy of Pediatrics from 1998 to 2006. He is also a Past- President of the Academy of Breastfeeding Medicine, of which he is a founder, and a Past-President of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, which he also helped found. He lectures regularly on breastfeeding issues. He is currently Chair of the ABM Ethics Committee.

At the 2011 ILCA Conference in San Diego, CA, Dr. Gartner presented this plenary session titled, “Ethical Issues in Breastfeeding Support.”

Lawrence M. Gartner, M.D., FAAP
Professor Emeritus
Departments of Pediatrics and OB/GYN
The University of Chicago

Ethics is the discipline dealing with what is good and bad or what is right and wrong.  Every health practitioner must adhere to the highest standards of ethical behavior and assure that their practice provides the best possible care for their patients.   As breastfeeding practitioners, we take responsibility for our patients, both the mother and the child, and we must give them every reason to trust our knowledge and our judgment.

To fulfill these ethical standards the practitioner must know the proven scientific facts and accepted practices in the field.  These must always be presented to the patient honestly and completely.  At the same time we must recognize that the mother makes the final decision, based on the information that has been presented to her.  It is never acceptable to use coercion.

Other ethical concerns are to assure confidentiality of all information obtained in the course of caring for the patient. Records must be secure at all times.  Discussion of patients with colleagues or students should be discrete and private, protecting the identity of the patient.  The patient’s privacy must be honored during examinations.  Students may be present at the interview or examination  only with the specific consent of the patient.  One must be aware of cultural differences and  avoid bias in making decisions.  All procedures must be performed only after obtaining fully informed written consent.

Among the most difficult and challenging ethical issues is that of avoiding conflict of interest.   Financial interest in a product that one recommends or provides is a conflict of interest and may result in a recommendation that is not necessarily in the best interest of the patient.  In the practice of breastfeeding an seo consultant, the renting or selling of breastfeeding pumps and supplies is particularly troubling.

In the world of breastfeeding, commercialism or the marketing and sale of products for profit, independent of health care practitioners, has become a major force and often brings a great deal of marketing pressure on breastfeeding mothers and their families.  Most prominent among these are the infant formula companies and their efforts to promote sale of their breastmilk substitutes through practices that are considered unethical or highly questionable.  As practitioners we must make every effort to distance ourselves from their marketing ploys.  Thus, we should not distribute their “educational” materials or hang their posters in our offices.  We also must avoid the subtle temptations of a free lunch or a gift from them as these have been shown to bias our prescribing practices.

We must also have ethical awareness with regard to the hospitals, clinics and other institutions in which we may work or be employed.  These may have conflicts of interest or policies that are not in the best interest of the breastfeeding dyad.  They may provide discharge gift bags possibly because they are being given a grant from the company.  Employees and those who use these facilities can influence the administration to change these unethical practices into ethical ones that improve the environment for breastfeeding.

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Is Pumping Out of Hand? Why Hand Expression in the First 3 Postpartum Days is Important

Stanford trained, Jane Morton, became a partner at the Palo Alto Medical Foundation, where she practiced general pediatrics and was repeatedly recognized by her colleagues as
one of the top pediatricians in the Bay Area.  She was invited to join the Stanford neonatology faculty to develop their Breastfeeding Medicine Program. She designed a nationally recognized educational program, published her original research and traveled extensively and internationally as an invited speaker.  At the 2011 ILCA Conference in San Diego, CA, Jane presented this plenary session titled, “Is Pumping Out of Hand?”

Jane Morton, MD
Cl Professor of Pediatrics
Stanford Pediatrics
www.burgesspediatrics.com
drjane@burgesspediatrics.com

A low milk supply is the most common reason for mothers to stop breastfeeding. (1.)  We have learned that what we do (or do not do) in the first 3 days after delivery can have a major impact on future milk production potential.  In our research, we found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery. (2.)  Mothers who used hand expression more than 5 times a day in the first 3 days yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression and hand expression with electric pumping and does not require more time.  Of the 67 study participants, several volunteered to demonstrate hand expression and hands-on pumping on the Stanford website.  (3.)

For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch on and nurse effectively.  About 50% of mothers will have some difficulty getting their babies to latch on well in the first day. (4.) While providing a mother with a pump may be the easiest solution from the nursing standpoint, a recent study suggests it is more effective to teach her to hand express milk after breastfeeding. (5.) At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%). (p=0.02)

A smaller study suggests more milk can be removed with manual expression than with a new, double rental-grade pump in the first 48 hrs post partum. (6.) Given the feasibility and safety of spoon feeding, (7.) perhaps the routine practice in the first several days for infants at risk for suboptimal intake and/or mothers at risk for suboptimal milk production should be to encourage hand expression and spoon feeding after breastfeeding. This provides more milk for the baby and more stimulation to the breasts than breastfeeding alone. There seems to be no cost or risk and only potential benefit in this approach.

  1. Ruowei Li, Fein SB, Chen J,
    Grummer-Strawn L. Pediatrics 2008; 122(2):S69-S76.
  2. Morton J, J
    Perinatol. 2009 Nov;29(11):757-64. Epub 2009 Jul 2
  3. http://newborns.stanford.edu/Breastfeeding/  See: Hand
    Expressing Milk — video
    and Maximizing via Katy TX
    Milk Production — video
    . Complete video, Making Enough Milk, the Key to Successful Breastfeeding, can be
    previewed and purchased at www.breastmilksolutions.com
    . Soon available in Spanish
  4. Dewey KG.
    Risk Factors for Suboptimal Breastfeeding Behavior, Delayed Onset of Lactation
    and Excess Neonatal Weight Loss. Pediatrics 2003;112:607-619
  5. Flaherman VJ, Archives of Disease in
    Childhood 2011
  6. Ohyama M. Pediatr Int. 2010
    Feb;52(1):39-43
  7. Kumar A. J Perinatology 2010;
    30:209-217
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Round Table Discussion: Predictors of Breastfeeding (Part Two)

Today, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.  Each
author’s title and JHL research article can be found on the first article of this series: Round Table Discussion: Predictors of Breastfeeding Duration (Part One)

As breastfeeding advocates, what recommendations can you make for us to help increase breastfeeding duration in our communities?

Lucía Colodro Conde:  Influences from factors related to breastfeeding duration should not be considered immutable. Researchers and practitioners should consider the social environment in which influential factors take place, as this may modulate its impact. Family structure, social support, norms about natural or artificial infant feeding,
working conditions, health promotion interventions, or hospital practices, among others, could moderate this interaction. Interventions should be adapted to the mother’s conditions as a whole, taking into account their personal and social characteristics and their social context. Interventions should start before childbirth and support and guidance should be readily available to those women who aim to breastfeed, taking into account their individuality and the characteristics of the communities.

Pippa Craig:

  • Culturally appropriate and practical information at earlier stage of pregnancy.
  • Engage senior Aboriginal women to support younger women during pregnancy.
  • The importance of involving peer support by members of the Aboriginal community, as well as professional support for this cultural group.
  • Engage younger community mothers who have successfully breastfed to act as role models.

Pat Benton and Beth H. Olson: Even mothers who are intent on breastfeeding and
get support in the hospital, from family, or from programs like the BFI, indicate they do not find the environment outside their home to be supportive of breastfeeding-they even find it to be disapproving. Local breastfeeding coalitions where community partners (i.e., physicians, nurses, Lactation Consultants, business owners, etc.) come together to support breastfeeding have been successful in changing the community atmosphere regarding breastfeeding. Also, mothers find support groups/moms clubs, where they can go and share their experiences and receive support that breastfeeding is the natural way to feed
their babies, a great support system.

After completing your research, what additional factors would you like to see studied as predictors of breastfeeding duration?

Lucía Colodro Conde:  At the moment, we have two lines of research about some factors that, according to preliminary studies, are related to breastfeeding duration and can help to understand and predict it. First, we want to focus on which part of this health behavior is due to differences in genetic configuration and differences in environmental factors among individuals. And second, we aim to analyze the relationships between
psychosocial and personality factors, and the establishment and duration of breastfeeding. We highly support the need of a multidisciplinary approach to this complex behavior.

Pippa Craig:  Further explore psychological factors predicting breastfeeding duration. Introduce and evaluate more culturally acceptable pre-, peri and post-natal services for Aboriginal women.

Pat Benton and Beth H. Olson: We would like to see more work done with populations with low breastfeeding rates, to better understand their particular barriers
such that we might develop targeted support programs. We would also like to see more cost-effectiveness work done on breastfeeding and breastfeeding support that might help us impact public policy and private organizations so they improve breastfeeding support. Research suggests factors that impact breastfeeding in the first day(s) greatly diminish breastfeeding duration; we need to better understand how to provide support in the hospital and in the first days a mother is home with her new baby-including home visiting/follow up care for new mothers.

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Round Table Discussion: Predictors of Breastfeeding (Part One)

Over the past few years, the Journal of Human Lactation has highlighted several research articles that measured factors that directly impact breastfeeding duration.  As health care professionals and lactation consultants, the outcomes of these research projects should inform the way we practice as well as help us to target areas where we can support mothers to increase breastfeeding duration in our communities and countries.

Four authors from around the world have generously offered to share their research and offer recommendations to us based on their findings:

Lucía Colodro Conde, BA, MSc.
Psychologist, Master on Clinical and Health Psychology. Seneca Foundation Research Scholarship. Department of Human Anatomy & Psychobiology. (University of Murcia) Spain.
August 2011: Relationship Between Level of Education and Breastfeeding Duration Depends on Social Context: Breastfeeding Trends Over a 40-Year Period in Spain

Dr. Pippa Craig, Ph.D
Academic Coordinator, Inter-Professional Learning
TheHealth ‘Hubs and Spokes’ Project
ANU COLLEGE OF MEDICINE, BIOLOGY AND ENVIRONMENT
Australian National University
August, 2011: Initiation and Duration of Breastfeeding in an Aboriginal Community in South Western Sydney

Pat Benton, MS, RD, CLE
Program Manager
Michigan Breastfeeding Initiative
Michigan State University Extension

Beth H. Olson, Ph.D.
Associate Professor; Extension Specialist
Associate Department Chair
Director of Graduate Studies
Food Science; Human Nutrition
Michigan State University
February, 2009: Characteristics Associated With Longer Breastfeeding Duration: An Analysis of a Peer Counseling Support Program

What were the largest factors predicting breastfeeding duration in your study?

Lucía Colodro Conde:  In our study we focused specifically on the mother’s level of education, which has been reported to be related to breastfeeding practices. We analyzed the relationship between this variable and the breastfeeding trends in a region of Spain during a 40 year period, along the second half of the 20th century.  We found that the direction and/or magnitude of the association were not constant across time and level of education, suggesting that other factors may moderate this relationship depending of the social context (i.e., family structure, social support, or working conditions).

Pippa Craig: This study has confirmed that more educated mothers of Australian Aboriginal infants in an outer urban environment, and those intending to breastfeed, were more likely to breastfeed. Intention to breastfeed was the strongest predictor.

Pat Benton and Beth H. Olson: Among low-income mothers we found formula
introduction by day one predicted shorter breastfeeding duration. Many mothers in our studies that identify themselves as breastfeeders still supplement with formula or cereal earlier than recommended. Lack of social support leads to shorter breastfeeding duration; new mothers have no role models for breastfeeding, and rely heavily on support from family who discourage them from breastfeeding. We also found that many working women don’t consider combining breastfeeding and employment-they see these two roles as mutually exclusive. They don’t initiate breastfeeding or wean prior to going back to school or work.

What were the most significant findings in your study?

Lucía Colodro Conde:  Our main finding was that the association between maternal education and breastfeeding is not consistent over time.  Today, a higher level of studies
appears to predict a longer duration of breastfeeding; this has not always been the case.  Among women with fewer school years, breastfeeding duration reduced very early in the period studied and remained at low levels for the rest of the duration. Meanwhile, among women with secondary education or higher, the duration of breastfeeding also reduced
markedly until the 1970s, but then it began to increase steadily until the late 1990s. These trends could change again following societal evolution.

Pippa Craig: Low initiation rates and a rapid decrease in breastfeeding rates. This suggests either a lack of commitment or lack of support to assist new mothers with any
early difficulties with breastfeeding. There was a tendency for mothers to receive antenatal care late in their pregnancy, and there was a lack of adequate and culturally appropriate antenatal/postnatal support services in the area.

Pat Benton and Beth H. Olson: A peer counselor (a breastfeeding mother from the community, trained to provide support and referrals and making home visits) from The Breastfeeding Initiative program of MSU- Extension and WIC, significantly increased breastfeeding rates among low income mothers. This duration is longer even compared to mothers referred to the program but not enrolled (due to overcapacity), showing even among women motivated to find support-those with peer counselors breastfed longer. We found that low income mothers may receive infant feeding advice from several sources (Extension, physicians, nurses, home visiting programs, WIC) and find it conflicting. This contributes to factors, such as early introduction of formula, which may impact breastfeeding duration.

In Part Two, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.

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Working and Breastfeeding: Can we do both?

With the known benefits of breastfeeding for the infant, mother, and employer, it is discouraging that most mothers who initiate breastfeeding quit before their infants’ first birthday. Among children born in 2008, only 44% were breastfed at 6 months and 24% at 12 months, even though 75% were breastfed after birth. Work-related issues can be a major reason why women fail to start breastfeeding after the birth of their child, or stop breastfeeding before the child has received the full benefits.  With more than 50% of mothers of infants participating in the work force, we need to find ways to balance employment and breastfeeding.

Our recent study found that women who were working full-time (≥35hrs/week) were less likely to initiate breastfeeding or to continue breastfeeding beyond 6 months, compared to women who were not working. The breastfeeding experience of women who worked part time was similar to that of women who were not working. We also found that mothers in professional occupations (architecture, engineering, legal, health care practitioner, etc) were more likely to initiate breastfeeding when compared to women in administrative occupations or other occupations (namely farming, fishing, and forestry; construction and extraction; installation, maintenance, and repair; production; transportation and material moving; and military-specific occupations), even after taking into account several factors known to be associated with breastfeeding, including the amount of maternity leave time taken.

The findings from our study, and others, suggest that part-time work offers an effective strategy for successfully combining breastfeeding and employment. There has been some success with corporate lactation support programs in helping working women breastfeed longer.  However, pumping alone at work may be inadequate to maintain milk flow because direct breastfeeding stimulates the breasts more effectively than do the best electric or manual pumps. Among women who breastfed and worked, women who directly breastfed their infant during the workday persisted in breastfeeding longer than other breastfeeding women who returned to work.

We recommend that employers, in addition to providing comprehensive, high-quality lactation support programs, explore strategies that allow lactating mothers have direct access to their babies. Such strategies, as promoted in the Surgeon General’s Call to Action to Support Breastfeeding, include having the mother keep the baby with her while she works, allowing the mother to go to the baby to breastfeed during the workday, telecommuting, offering flexible work schedules, maintaining part-time work schedules, and using on-site or nearby child care centers.  Because no single strategy will fit all employment settings, creativity is needed, especially for mothers who are not working in professional occupations. A woman’s decision to breastfeed, though personal, requires action from multiple players, if she is to succeed. Let’s act NOW!

Chinelo Ogbuanu, MD, MPH, PhD

Senior Maternal and Child Health Epidemiologist

Maternal and Child Health Program

Georgia Department of Public Health

chogbuanu@dhr.state.ga.us

 More information about our work is available in:

“Balancing Work and Family: Effect of Employment Characteristics on Breastfeeding”

J Hum Lact, August 2011; vol. 27, 3: pp. 225-238.

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