Author Archive | lactationmatters

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.

8

Informed Consent: What is My Responsibility as a Lactation Consultant? – Reader Response

Doreen says:

August 1, 2011 at 10:35 pm (Edit)

I feel so alone in my profession and this will be a blessing! I have a question that I need help with. My manager at work, in a large hospital, told me that the nurses and physicians had a problem with “informed consent” when it came to breastfeeding. ie: we have mothers who state that they want to breast and bottle feed. I discuss the importance of getting a good milk supply started before introducing a bottle, always asking why. Most mothers state it is because they are going back to work, then I discuss this finding out when they go back, making a breastfeeding plan. The problem is that the nurses want to give bottles without informing the patients about possible consequences as they get their milk supply going for NON medical reasons ie: get sleep at night, second night feeding frenzie, etc. I feel it is my ethical responsibility as a RN and IBCLC to give “informed consent” (ie: information) because most mothers do not understand the consequences of bottles of formula in the first few days and I have made it clear that the nurses have that responsibility also. They do not like this. Any suggestions would be helpful as I have called a meeting of the managers next week. Thanks, Doreen 

Doreen, you raise an important issue for IBCLCs everywhere! 

To be clear:  the issue isn’t whether you “should” provide information and support to a breastfeeding mother, so she can make an informed decision about matters affecting her/her baby’s health.  Rather, the issue is “how” to effectively assist the mother, as her allied health care provider, in a work setting where other caregivers are offering conflicting or erroneous advice.   

ILCA’s recently-published monograph “Risks of Not Breastfeeding” concludes that “[e]xclusive breastfeeding is the normative standard for infant feeding.  Not breastfeeding increases infant and maternal acute and chronic illnesses….  The research demonstrates that there is a dose response to breastfeeding and human milk exposure for mothers and infants.  Healthcare professionals must be aware of the research and find ways to share this information with families so they can make responsible informed feeding decisions for their children.” (Spatz, D., & Lessen, R. (2011). Risks of not breastfeeding. (Monograph).  Morrisville, NC: International Lactation Consultant Association, p. 8)(emphasis added).   Your meeting with your managers is your opportunity to suggest that evidence-based practice is not being followed if non-medically-indicated use of formula is tolerated (and even promoted) by caregivers whose patients are breastfeeding mothers and babies.

You are the ideal healthcare professional to teach families (and colleagues) about human lactation. 

The IBLCE Scope of Practice, “encompassing the activities for which IBCLCs are educated and in which they are authorized to engage” (from the preamble; full IBLCE SOP at http://www.iblce.org/upload/downloads/ScopeOfPractice.pdf) anticipates that as allied health care providers we will advocate for the baby, the mother and the breastfeeding relationship.  It describes IBCLCs as having “specialized knowledge and clinical expertise in breastfeeding and human lactation.”  It describes the IBCLC duty to offer evidence-based information to help mothers meet their breastfeeding goals, and the duty to educate families and healthcare professionals about breastfeeding and human lactation.  Your ethical responsibility to inform, advocate, and educate is bolstered by the IBLCE Code of Ethics requiring, at tenet 11, that the IBCLC “provide sufficient information to enable clients to make informed decisions”  (http://www.iblce.org/upload/downloads/CodeOfEthics.pdf).

All health institutions and health care providers should support and assist breastfeeding families.  In the United States, advocating for breastfeeding as a public health imperative has received significant boosts from highly esteemed entities.  The U.S. Surgeon General’s Call to Action to Support Breastfeeding asks all health care providers, their institutions, employers, families and communities-at-large to support breastfeeding mothers.  (http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf).  This powerful document comes from the US federal government, but its call to action by the community at large is universal, and the concepts are applicable worldwide. 

The Centers for Disease Control recently issued their report concluding that US hospitals have a fairly dismal record when it comes to breastfeeding supportive practices. http://www.cdc.gov/vitalsigns/Breastfeeding/index.html.  And yet, the Joint Commission, which accredits hospitals in the US, now looks at exclusive breastmilk feeding as part of the Perinatal Care core measure set.  Because breastfeeding is the biologic norm, any (unexplained) deviation from it is seen as a deviation from best practices.  The United States Breastfeeding Committee has a toolkit to assist in the explanation and implementation of these core measures (http://www.usbreastfeeding.org/Portals/0/Publications/Implementing-TJC-Measure-EBMF-2010-USBC.pdf).

IBCLCs are specialists in a field that crosses several disciplines.  Our colleagues are not subject- matter-immersed in breastfeeding, as we are.  Use the meeting with your managers as your “toe in the door” to educate them: breastfeeding is the biologic norm and a public health imperative; hospitals can and should do a better job to support their breastfeeding patients, and this is a significant core measure that Joint Commission inspectors will be evaluating. And it is what the family wants and needs, to boot. 

Liz Brooks JD IBCLC FILCA

Liz Brooks is a lawyer, private practice lactation consultant and international speaker on legal and ethical matters affecting IBCLCs.

5

Curious to hear your thoughts!

 

 

0

Thank You!

The editorial staff of Lactation Matters and ILCA would like to take a moment to thank you.  Our first week in the blogosphere has been tremendous, full of excitement and new challenges.  We are sincerely grateful for the outpouring of support that we have received with the launch of this blog.  In one week we had over 2,000 visits and a number of wonderful commenters encouraging us along.  This blog has been created for all of you, to create an ongoing source of community and support for our fellow LC’s.

At times it can be hard to remember how small the world really is, and how connected we are.  While the facilities that we practice at may be different, we are all working towards the same mission.  Our goal with Lactation Matters is create a safe and informative place that LC’s can gather and never feel alone in their profession again.

Quite an ambitious goal that we’ve set for ourselves, to ensure that this blog stays current and meeting your needs we want to encourage you to submit questions, comments, suggestions, and thoughts to lactationmatters@gmail.com.  This blog is your blog and we want to make sure that Lactation Consultants and healthcare professionals working with breastfeeding mothers around the world are having their voices heard.  Stand as one, be united, and let us know what is happening in your own community.

We look forward to what the future holds for our ‘baby’ blog and watching how all of you connect and interact with us.

Again, thank you for subscribing, reading, and sharing. Stay tuned for some exciting posts next week and a poll coming your way this Friday!

Robin Kaplan, M.Ed., IBCLC, Lactation Matters Editor

Decalie Brown, RN, CM, CFHN, IBCLC, ILCA Director of Marketing

0

Round Table Discussion: Baby Friendly Health Initiative

Protecting, Promoting and Supporting Breastfeeding

What is the Baby Friendly Health Initiative (BFHI)?

Baby Friendly Health Initiative is a World Health Organization (WHO) and UNICEF a worldwide program launched in 1991 following the Innocenti Declaration of 1990 that aims at creating a health care environment that supports mothers and babies to have the best start in life. This may have evolved in your country to suit your specific needs and some examples are; the BFI (Baby Friendly Initiative), BFHI (Baby Friendly Health Initiative) or Baby and Mother Friendly Hospital Initiative. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.

Creating a health care environment where Breastfeeding is the norm, Practices known to promote the health and well-being of all babies and their mothers are followed.

The Ten Steps to Successful Breastfeeding is the minimum global standard by which hospital facilities are assessed and accredited. A ‘Baby Friendly’ facility is one where a mothers’ informed choice of infant feeding is supported, respected and encouraged. Community Health has seven steps.

Baby Friendly Accreditation is a quality improvement measure which demonstrates that a facility offers the highest standard of care to all mothers and babies. Attaining accreditation reflects the commitment of the facilities staff.

To achieve this standard, midwives and other carers obtain an increased knowledge of infant feeding, greater skills and commitment to facilitate breastfeeding. This engenders an environment that encourages best practice, improving the health of new generations.(bfhi.org.au). See additional links below for more information.

Participants:

Angela Smith, RN CM IBCLC FILCA  Nurse Unit Manager

Royal Prince Alfred Hospital Sydney Australia BFHI Accredited 2011

 

Cathy Holland RN, BS, IBCLC, FACCE, LCCE

Over my 46 years as a registered nurse, Women’s Health, focusing on lactation and birth using both traditional and energy medicine to facilitate success is my passion.

 

Trish MacEnroe Executive Director

Baby-Friendly USA, Inc.

tmacenroe@babyfriendlyusa.org

Cindy Turner-Maffei, MA, IBCLC National Coordinator

Baby-Friendly USA, Inc.

 
1. Why should a hospital work toward BFHI certification?

Angela Smith (AS): All hospitals want to provide the best possible care they can and we know that the BFHI accreditation is the Gold Standard in not only Breastfeeding Care but in excellent Postnatal care generally.

Cathy Holland (CH): BFHI accreditation indicates the facility is making efforts to show the community they value infant nutrition, over free products from companies who are more interested in $$$$$$ than mother-baby health.

Trisha & Cindy (TC): The Baby-Friendly Designation is the globally recognized symbol of world-class maternity care practices that lead to optimal infant feeding outcomes.  In this process birth facilities

  • deliver patient-centered care
  • improve health outcomes and patient satisfaction
  • increase community recognition of excellence
  • enhance a professional environment of competence, including leadership and team skills
  • demonstrate a commitment to quality improvement
  • meet corporate compliance requirements

In the US this may also

  • improve m-PINC scores
  • meet Joint Commission maternity care standards for exclusive breast milk feeding
  • lead the way to achieving Healthy People 2020 goals for breastfeeding

2. Why should expectant parents choose a BFHI facility?

AS: Expectant parents like the rest of the population these days will search the internet looking for the hospital that provides the best service. By being BFHI accredited the new parents are reassured that the hospital they have chosen has gone “the extra mile” and will provide them with First class care.

CH: Securing the best possible care should be a concern. Often the choice of facility is “where they have insurance coverage.” A BFHI facility has made an effort, greater than that which is required of them. Having this designation could nudge the insurance payers to notice the BFHI facility. Health and $$$$$ savings are the expected outcomes.

TC: Baby-Friendly birth facilities have taken special steps to create the best possible environment for bonding with and feeding your baby.  The Initiative celebrates hospitals and birth centers that have put in place policies and practices to enable parents to make informed choices about how they feed and care for their babies.   Birthing facilities voluntarily seek out this designation as a demonstration of their commitment to new families.

3.  What does BFHI mean for us (me/my baby/my family)?

AS: The idea of BFHI means quality for each group. For staff it means they know they are working in a hospital that is not frightened of accreditation but is proud of its achievements.  For new parents and families it gives them peace of mind that the facility they have chosen is committed to breastfeeding and giving quality care.

CH: The BFHI means the health facility in my neighborhood is prepared to offer the best possible start for families. Creating health in every way is a great philosophy for a facility.

TC: In a Baby-Friendly birth facility you will have the opportunity to hold your baby skin to skin immediately following birth, you will be able to have your baby stay with you in your room during your entire hospital stay and you will have the confidence in knowing that you are being cared for by highly trained staff who can help you learn to respond to your baby’s specific needs. Staff will also help you to identify supportive resources in your community to help you with infant feeding after you go home.

4. What is some recent research or statistics relating to BFHI?

AS: ‘Baby Friendly’ accredited hospitals in Australia is 77 which is 23% of all Australian hospitals providing maternity services (based on approximate number of facilities being 330).

TC: US STATISTICS

114 designated hospitals http://babyfriendlyusa.org/eng/03.html

4.5% of births take place in Baby-Friendly Hospitals http://www.cdc.gov/breastfeeding/pdf/2011BreastfeedingReportCard.pdf

RESEARCH

The Ten Steps to Successful Breastfeeding have been demonstrated to increase both initiation and duration of breastfeeding

DiGirolamo AM, LM.Grummer-Strawn and SB Fein. 2008.  Effect of Maternity-Care Practices on Breastfeeding Pediatrics122;S43-S49

Merten, S, et al. 2005. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics 116; e702-e708.

Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681.

DiGirolamo AM, LM Grummer-Strawn, S Fein. 2001. Maternity care practices: implications for breastfeeding. Birth 28:94-100.

Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA 285:413

For more information check out these sites:

http://www.bfhi.org.au/

http://www.unicef.org.uk/babyfriendly/

http://www.babyfriendlyusa.org/eng/index.html

http://www.waba.org.my/

http://www.babyfriendly.org.nz

http://www.who.int

1

The Breastfeeding Team

Fathers influence mothers’ breastfeeding decisions and experiences! Fathers’ perceptions of their roles as members of the breastfeeding family are probably important components of that influence. Previous studies asking men directly about their breastfeeding-related roles have predominantly focused on the “dark side” of the father’s experience – particularly their limited ability to nurture and bond with their babies. Our study more fully explored fathers’ experiences by interviewing twenty-one involved fathers of breastfeeding babies about fathering a breastfed baby and about their role in the breastfeeding family.

Fathers identified their unique roles as team members ensuring that their babies received the benefits of breastfeeding. When asked “What is it like to be the father of a breastfeeding baby?” fathers generally focused on the pleasure of knowing that their baby was obtaining the benefits of breastfeeding and their role in supporting the breastfeeding mother. They frequently used the term “we”, suggesting their roles as integral members of the breastfeeding team and characterized themselves as the supporting cast member to the mother’s starring role. One father summed up his role as “…a support person…almost like a checking line as opposed to scoring line. She’s doing the big good stuff and I’m just supporting her to get that done.”

A primary fathering role was supporting breastfeeding by learning about breastfeeding both with the mother and independently. Some fathers became the mother’s memory when she could not take in all the advice she was being given and others used their knowledge of breastfeeding resources to encourage mothers seek out professional breastfeeding support when needed. As well, many fathers supported breastfeeding by sharing housework and childcare and some provided assistance “in the breastfeeding moment” by facilitating mothers’ comfort during breastfeeding or assisting with the use of breastfeeding equipment.  Perhaps most importantly, fathers supported the breastfeeding mother by valuing her and by trusting, respecting, and supporting her personal choices.

Fathers insisted that being the father of a breastfeeding baby was not unique in general, but they often identified their own special ways of nurturing and fostering positive father-infant relationships as they “waited their turn” to bond with their babies through feeding. Some fathers chose to be involved while the mother was breastfeeding so that they could bond while the infant “is still in the feeding zone.” Others developed rituals for spending time with baby or found their own masculine way of nurturing, such as holding their infant with their strong arms and talking to the infant in their deeper voice. These supportive and nurturing behaviors were not seen as compensating for the “dark side” of breastfeeding, but as important contributions in their own right.

Many fathers want to be involved in the lives of their breastfeeding children. Health care providers should be encouraged to acknowledge fathers as members of the breastfeeding team and engage fathers in learning about breastfeeding and the many possible forms of breastfeeding support. Each father should be encouraged to communicate with his partner about her goals and desires for breastfeeding and regularly negotiate the type and amount of involvement both parents want the father to have. We suggest that fathers should be presented with the range of possible supportive behaviors and empowered to explore and determine their own unique roles as an integral part of the feeding process in which, although they may be the “supporting actor” and the mother the “star”, both roles are essential and worthy of acclaim.

Lynn Rempel, RN, PhD

Associate Professor, Chair,

Department of Nursing

Brock University

lrempel@brocku.ca

Rempel LA, Rempel, JK. The Breastfeeding Team: The Role of Seo Services Involved Fathers in the Breastfeeding Family J Hum Lact. 2011:27;115-121.

2

Patient Access

A great deal has changed in patient care over the last decade or so.  The number of patients coming in with articles from various websites and claiming uncommon diseases discovered through symptom checker on WebMD has increased.  As we all know information and knowledge are power and that is something that many patients hunger for when feeling so helpless in regard to their own care.  However, greater access to information does not mean an increase in quality, and thus many of us are faced with combating an inevitable cycle of misinformation passed from social media, Wikipedia, and “medical” websites lacking references.  Many of the mothers we meet with are well-informed patients, and want to have access to credible information to help guide them through the adventures of breastfeeding.  With that very notion at mind ILCA and SAGE Publications are pleased to announce the roll-out of our Patient Access offering for the Journal of Human Lactation. This feature allows individuals the availability to request free access to research for personal use via an article’s login/challenge page. SAGE will monitor and track all requests and supply individuals with PDFs of their chosen articles.

The Patient Access feature allows patients, their family members and anyone interested in learning more about a specific disease or its treatment to access your journal’s most important new research articles. Although research articles should never replace a patient’s consultation with a primary or specialist physician, SAGE and ILCA believe that access to this information can educate and empower our readers to learn more about diseases and conditions.

We hope that this new feature will give lactation consultants another tool in their kit when working with families.

You can view our request interface and learn more at http://jhl.sagepub.com/site/includefiles/patient_inform.xhtml

0

A Message from Incoming JHL Editor, Anne Merewood

In England, you learn to talk, and shortly thereafter, to answer the question, “What will you be when you grow up?” For better or worse, kids soon set a goal, be it fireman, footballer, or pharmacologist. My brother planned to be a horse, one of the few aims he didn’t achieve. The UK education system plays into this – from around age 14 students begin to specialize. I studied English Literature at Cambridge University. I didn’t major in English Literature, I read English Literature for my BA, and nothing else.

 After graduating, I entered a field related, arguably, to Literature – journalism; specifically, BBC TV news. I learned editing, news writing and film-making, and met Paul McCartney and Phil Collins. I then married (not Paul or Phil, but Gerassimakis) and moved to Greece for a year before my husband took a research post at Harvard in 1987. For over 10 years, I freelanced as a writer, but after my three boys were born, I wanted a change, a career with meaning, and a five figure income. For the usual reasons – personal obstacles met with inadequate answers – lactation attracted me. I became an IBCLC in 1999, gained my MPH in 2006, and my PhD from Cambridge in 2010. During this time I moved away from the purely clinical into teaching and my grown up passion – research.

My vision for JHL emerges from this mottled background in science and journalism. I believe excellent research and accessibility can be – indeed, must be – compatible. Research is fun – exciting – an endless creative torrent of new information pouring from the pages to readers thirsting for knowledge. Writers and editors must make this knowledge accessible for practicing clinicians and personal enlightenment. At JHL, I will strive to increase clarity and readability of research, reduce restrictive jargon, and battle against – yes – the distancing drone of the passive voice. The first rule of good writing is to make the reader read it. Why are so many academic journals hard to read and, frankly, so boring?

Before the purists run screaming for the archives, I don’t advocate sacrificing quality for over-simplification. Specific terminology is critical and beautiful, nothing beats clarity of meaning in excellent writing. Indeed some of our breastfeeding terminology could use a dose of epidemiologic precision. As more than one epidemiologist has asked me, what do you mean by a breastfeeding rate?

With all this in mind, changes I hope to bring to JHL will include some revamping of  writers’ guidelines. We will print longer, structured abstracts, and shorter articles. We will feature student research, expert round tables, and regular themed issues, the first of which will focus on the Baby-Friendly Hospital Initiative, in August 2012. Editorially speaking, Donna Chapman, RD, PhD, will remain as Associate Editor; Supriya Mehta, MHS, PhD, (Associate Professor of Epidemiology at the University of Chicago School of Public Health) will join us as Methods Editor. We will create an International Advisory Board to involve proactive non-US researchers, and subject area Assistant Editors to reach more expert reviewers in the ever growing field of lactation research.

A field, it seems, that failed thus far to nourish my English family. When I announced my new position, my brother shook his sadly depleted mane and said, “the Journal of What?” I proceed undaunted, despite my healthily humbling British roots. Touring SAGE Publications back in June, I was delighted to discover so many strange people like myself – ex newspaper editors polishing scientific tables; ex lab technicians crunching data and deadlines. I had found what I grew up to be. I hope my platform of readable research will serve ILCA members well for many years to come.

 Anne Merewood PhD, MPH, IBCLC

Incoming JHL Editor

6

Happy Birthday!

When I meet someone for the first time and they ask what my profession is, I usually receive a raised eyebrow when I tell him/her that I am a lactation consultant.  This raised eyebrow is typically followed by either, “What type of consultant?” or “Wow, I could have used you when I had my kids (followed by a 5 minute soliloquy of her breastfeeding challenges),” or “Well, why would someone need a lactation consultant?  Isn’t breastfeeding easy?”  As lactation consultants, we are often working on our own or with other health professionals who don’t truly appreciate all we do for mothers and their families.  We don’t just help mothers breastfeed….we nurture a mother’s self-confidence as she enters the full-time profession of motherhood.

To be a successful lactation consultant does not mean that we make a ton of money (wouldn’t that be nice???)  Instead it means that we provide gentle, emotional (and breastfeeding!) support  to those families who need it the most.  But where do we receive our support?  Sure, we attend professional development seminars and workshops.  We might network with colleagues.  We might volunteer at our local county breastfeeding coalition.  All in all, we could use more support, just like our moms.

In answer to our need for support, we would like to introduce ILCA’s newest support system: Lactation Matters, the official blog of the International Lactation Consultant Association.  In this blog, you will hear from authors about their latest research, in 600 words or less!  You will learn tips from colleagues who are setting up outpatient clinics, non-profit organizations, and private practices.  You will be exposed to international news about breastfeeding from around the world.  All of our articles will be focused on supporting lactation consultants and breastfeeding professionals with pertinent research, tools and tricks of the trade, and global movements in breastfeeding promotion.  It serves as the perfect complement to ILCA’s monthly member newsletter, e-Globe.  Lactation Matters will help us take one more step to meeting ILCA’s vision and mission: Our vision is a worldwide network of lactation professionals. Our mission is to advance the profession of lactation consulting worldwide through leadership, advocacy, professional development, and research.

We look forward to sharing our knowledge and experiences with you.  We hope that it will nurture your education and self-confidence as a health-care professional and lactation consultant.  We also hope it will inspire you to share your knowledge and experiences with us as well!   If you find an article that you feel your colleagues would benefit from, please link to it from your Facebook page or Twitter account and add comments to the bottom of the blog to keep the conversation going.  If you are interested in submitting an article to Lactation Matters, please contact us at lactationmatters@gmail.com.

Robin Kaplan, M.Ed., IBCLC, Lactation Matters Editor, Owner San Diego Breastfeeding Center

Decalie Brown, RN, CM, CFHN, IBCLC, ILCA Director of Marketing

10

Powered by WordPress. Designed by WooThemes

Translate »