Author Archive | lactationmatters

Clinicians in the Trenches: Diana Jordan, IBCLC

Written by: Amber McCann, IBCLC, Owner of Nourish Breastfeeding Support

Lactation Matters is always looking for innovative and excellent IBCLCs to profile on our blog.  Today, we are profiling Diana Jordan, an IBCLC working with the Breastfeeding Center of Pittsburgh.   She was nominated by her fellow practitioner, Ellen Rubin.  

Ellen says, “I learned that her secrets to great lactation care were not only an exquisite skill in assessing the mother-child pair but also a special ability to communicate with women who were feeling very vulnerable as they dealt with breastfeeding issues.  Mothers leave consults with Diana armed with new breastfeeding knowledge and also feeling valued and empowered.”

We are so honored to share this profile of Diana with you.

I began my career in lactation as a breastfeeding mother to my 2 daughters in the mid 1980’s. The help and support I received from La Leche League prompted me to become a group leader in 1987 and eventually held several area leadership positions for the organization. In 1990, the WIC program was in the beginning stages of developing a breastfeeding program. A friend, already an IBCLC, suggested I apply for one of the “breastfeeding doula” positions. I began working for the WIC Breastfeeding Program in 1991 where I did in-home consulting with mothers and babies under the supervision of an IBCLC. The program gradually took a turn towards hiring lactation consultants instead of peer counselors, so in 1996, I sat for the exam and became an IBCLC. I continued to work for WIC until 2008, when I took a position at The Breastfeeding Center of Pittsburgh.

In my current position, I do in-office consulting.  Mothers schedule a consult and are seen by both an IBCLC and a physician, who is usually an IBCLC. After taking a thorough history, I observe a feeding with mother and baby,  answer questions and address problems with latching, positioning, or any other part of the breastfeeding experience. I present my opinion of and solution for any problems to the physician who then does a physical exam of both mother and baby. I am available for any follow up consults or phone calls as needed by mother.  On an average day I can see as many as 5 mother/baby dyads.  I then chart in an Electronic Medical Records system and letters are sent to both mother’s and infant’s PCP.

The challenges I have working in this setting are the volume of mothers I may see in one day.  It can be difficult to provide each mother with the amount of time she may need to meet not only the physical challenges she may be having but the emotional challenges. I try very hard not to just “fix” the problem but give mother the confidence she may need to successfully meet her goals, but I am limited in the time available to do this.

I feel very lucky to be working with Dr. Nancy Brent, IBCLC, the Medical Director.  She provides the medical view that I haven’t had in my previous positions. She and I are able to work together to provide  mothers with a complete consultation.  Breastfeeding challenges or problems are addressed, prescriptions are written as needed, and tests or cultures are taken if necessary. It is a unique opportunity to meet the patients needs completely.

I would encourage all those working in the field of lactation to take advantage of all the opportunities we have available for continued education and networking. It is easy, in any profession, to get too comfortable in one’s knowledge base. The one thing I have found in my 16 yrs as an IBCLC is that there is always something to learn. Every mother and every baby have their own individual needs, problems, and solutions. With each consult comes an opportunity to learn and grow as a Lactation Consultant. I look forward to each lactation consult as I would a puzzle. You have to work with the pieces given to you and become a team player with mom, baby, and family to put the puzzle together.

I feel so fortunate to have traveled this road of  an IBCLC. I never thought, when I struggled with nursing my first born, that my journey in life would lead me here. I am thankful to LLL for the support and help that was given to me with my early challenges, and give them credit for not only my becoming an IBCLC but for the support and respect given to me in my journey of mothering.

1

Do Children See Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

With the recent push to Bring Breastfeeding back to Sesame Street, and deletion of breastfeeding images by Facebook, this month’s article seems particularly timely. In countries where the act of breastfeeding is often done behind closed doors and breastfeeding imagery is controversial—what do children say about how babies are fed?

In the Dec 2011 issue of BIRTH, Angell, Alexander and Hunt explore this issue looking at infant feeding awareness in primary school children1.  In this small pilot study in southern England, 56 children ages 5/6, 7/8 and 10/11 were read a story about a hungry newborn baby, and asked to finish it with drawings and text about how the baby would be fed, then invited to talk about their work with a researcher.

36% of the children depicted breastfeeding, with 13% of 5/6 and 7/8 year-olds and 83% of the 10/11 year-olds referring to breastfeeding in their drawings or text.  The younger children tended to be confident and articulate in their descriptions of breastfeeding, while the 10/11 year olds were more hesitant. The 10/11 year-olds were more likely to illustrate mothers in awkward poses in their drawings, and to use euphemisms and gestures to describe breastfeeding.   They were also more likely to indicate they had learned about breastfeeding in school, while the younger children demonstrated detail from personal experience.

Formula was depicted by 55% of children evenly distributed across age groups, many of whom also described breastfeeding or solid foods. Although the researchers identified little difference between the responses of boys and girls, the impact of school-based teaching was evident in the responses of the 10/11 year-olds as children from urban schools seem to have more detailed working knowledge of breastfeeding gained from school curricula than did rural school children.

This study is consistent with others that demonstrate a greater awareness of bottle feeding among both children and adults.  The authors point out that while bottle feeding imagery is everywhere, most children and adults in the UK have never seen a friend or family member breastfeed.  I would venture to guess that the same is true in the US.   Despite the fact that my 5 year old son has been proudly pointing out nipples on mother animals in his picture books since he was old enough to talk, and has a good working knowledge of the mechanics of a breast pump, I was a bit surprised to learn that I am the only person he has ever seen breastfeed.

Importantly for the authors and for breastfeeding advocates, these findings demonstrate a real opportunity.   In spite of the awkwardness of the 10/11 year olds in discussing breastfeeding, the school-specific differences in breastfeeding knowledge suggests that they are receptive to learning about infant feeding.   Angell, Alexander and Hunt conclude that in the UK, an evidence-based standardized infant feeding curriculum in primary school may be a promising first step to breaking down culturally entrenched barriers and increasing the success of later breastfeeding promotion efforts.  Should the US and other countries follow suit, this type of education could have wide-reaching influence both on attitudes towards breastfeeding and on public health for generations to come.

1. Angell C, Alexander J, Hunt JA. How Are Babies Fed? A Pilot Study Exploring Primary School Children’s Perceptions of Infant Feeding. Birth 2011;38(4):346-353.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

7

Breastfeeding During a Disaster – Typhoon Washi

Written by Crystal Karges, DTR, CLEC

There is nothing more significant or essential during the occurrence of natural disasters or catastrophes than maintaining breastfeeding between a mother and her nursing baby.  The number of emergency situations occurring world-wide that have affected mothers and infants has increased over the last several years. This can prove to be both challenging and difficult as families who have survived such unpredictable incidences are often displaced from their homes and have suffered the loss of family and property.  Additionally, the incredible stress and anxiety resulting from experiencing such a trauma can undoubtedly be enough to sever a mother’s desire to continue breastfeeding. Perhaps the most susceptible victims in the repercussions of such calamities are infants, thus increasing the need to breastfeed during emergency situations.

Recently, residents of Cagayan de Oro City in the Philippines suffered the disastrous effects from Typhoon Washi, leaving countless families without homes or shelter and claiming many lives.   Amidst this tragic situation, mothers have regained hope by continuing to provide nourishment for their babies by sustaining breastfeeding.  One mother in particular, who survived the flashflood along with her husband and six-month old, shared of her decision in continuing to breastfeed her baby during this chaotic event: “I don’t feel shy or embarrassed breastfeeding in the evacuation center.”

Efforts from organizations such as UNICEF, have worked to promote breastfeeding during emergency situations, such as the devastating Typhoon Washi, by establishing breastfeeding areas within evacuation sites and conducting counseling for mothers to encourage continued breastfeeding or to assist with re-lactation.  Promoting such practices, along with the recommendations from ILCA (International Lactation Consultant Association), is critically important in ensuring that infants affected by these disasters will have adequate nutrition, as well as immunological protection.  IBCLCs, International Board Certified Lactation Consultants, can play a crucial role in humanitarian relief efforts to areas that have suffered natural disasters by implementing these necessary recommendations.

Though disastrous situations cannot be predicted, knowing the essentials on infant feeding in emergencies feeding can be life-saving.  Continue reading here for more information on ILCA’s Position of Infant Feeding in Emergencies.

What has been your experience in counseling the nursing mother during an emergency situation?

Crystal Karges, DTR, CLEC

0

Clinicians in the Trenches – Fleur Bickford

Written by Amber McCann, IBCLC, Owner of Nourish Breastfeeding Support

Fleur Bickford is an IBCLC in private practice who lives in Ottawa in Ontario, Canada with her husband and two children, ages 6 and 8. Lactation Matters is glad to profile Fleur and find out a bit more about how she has used social media to promote her business and connect with breastfeeding mothers.

I have always had a passion for helping others and I always knew that I would work in health care. After completing a Bachelor of Science in Life Sciences, I went on to become a Registered Nurse. It was during my maternity rotation at school that I discovered how much I loved working with new families. I got a job as a graduate nurse on the obstetrical unit of our local hospital and gained experience in labour and delivery, post partum care and pediatrics. After becoming a mother myself, and experiencing breastfeeding challenges with our second child, I discovered both La Leche League and a passion for helping other families with breastfeeding. I became a La Leche League Leader in 2007 and in 2009, I wrote and passed the exam to become an International Board Certified Lactation Consultant (IBCLC).

I chose to start my own private practice as an IBCLC after passing the exam as it gives me the flexibility to work around my children’s schedules. I see clients mainly in their own homes although in urgent situations, they sometimes come to me. In between consults, I can usually be found answering e-mails, making follow up calls, writing articles for both my own blog and the Best for Babes blog (ed. note: Read Fleur’s fantastic post “The Latest on Latching” with Best for Babes), and updating my Twitter and Facebook profiles. We are very lucky in Ottawa to have a large and very active group of IBCLCs and I enjoy volunteering some of my time as president of Ottawa Valley Lactation Consultants.

When I started my business, it seemed natural to use the Internet as a means to market it. After our first child was born, I frequently turned to online forums for information and support. I started to realize then how powerful the internet and social media could be. No matter what time it was, there was always someone online to chat with when I had questions and concerns.

Recent stats show that 95% of adults age 18-33 are online, with 80-89% of them using social networking sites. I created business profiles on both Twitter and Facebook, and I also started a blog. My goal was to use the blog as a means to market myself by providing up-to-date information about breastfeeding, and Twitter and Facebook seemed like good ways to promote my blog. As I started using Facebook and Twitter, I quickly discovered that along with the ability to market my business, there are many other benefits to social media. I have found that Twitter in particular is a wonderful medium for networking with others in the lactation community. I have made wonderful connections that I likely wouldn’t have made otherwise. I started a weekly chat on Twitter for breastfeeding professionals and volunteers using the hashtag #LCchat, and every Wednesday we share information, inspire and motivate one another, and connect with others around the world who are also working to support breastfeeding mothers.

Along with the marketing and networking, social media is a powerful way to reach both parents and other health care providers with accurate information, and to promote both breastfeeding and our profession. I also learn a great deal from the interactions I have with parents online. I am able to keep in touch with what parents are experiencing and worried about, and the interactions I have with parents allow me to refine my approaches to teaching and promotion so that I am better able to empower families to reach their breastfeeding goals.

You can see for yourself how Fleur is using social media on Facebook, Twitter and on her blog, Nurtured Child.

1

Supporting Breastfeeding with New Technologies

A few months ago a story out of Australia caught my attention.  A research study conducted at Queensland University of Technology showed that new mothers who received cell-phone based text-messaging support (also referred to as SMS, which stands for Short Message Service) were four times less likely to stop breastfeeding than those who did not.  This collision of technology with nature’s perfect infant nutrition piqued my interest and I wanted to learn more (self disclosure – I’m a bit of a technophile).  While details of the study have not yet been published, I was able to talk with an IBCLC who uses SMS, as well as hear the perspectives of several nursing mothers.  This post is intended to share this story and also generate a conversation about what other practitioners have experienced using text-messaging to support breastfeeding moms.  Please join in the discussion!

An IBCLC’s Perspective

Robin Kaplan, IBCLC and founder of San Diego Breastfeeding Center, LLC, offers mothers the option to communicate with her via SMS after she conducts an initial in-home consultation.  She estimates that about 25% of her follow-up communication is through text-messaging, with some clients using it for 100% of their contacts.  The nature of Robin’s texts are primarily responding to questions from new mothers (moms can include a photo with the question to help in diagnosing some problems), as well as checking in with mothers to see how they are doing.  One of the benefits of text messaging is that it isn’t interruptive, like a phone call may be, and it can be managed from a time perspective (versus not knowing how long a phone call might last).  This seems to be important for new mothers, as Robin gets more responses from texting than she does from phone calls.  Texting is also conducive to the round-the-clock hours that nursing mothers keep.  “They can leave me information any time they want,” says Robin.  From a business perspective, she sees texting as time and cost-effective.  “It makes a lot of sense!”

Mothers’ Perspectives

“When you have a sleeping baby, or you’re just too tired to get into a long conversation, texting is so convenient,” said texting mother, Tracy.  “Robin was able to get straight to the point and offer quick responses to my questions, which were very helpful… Though some might think it’s impersonal, texting is still a conversation and a readily available one at that, I really appreciated the instant gratification.”

Adoptive mother, Danielle, said text-messaging support was a huge help in establishing her breastfeeding practice.  “The reason texting worked for me is that my consultant, Robin, was always quick to reply…  This [breastfeeding an adopted infant] is a new frontier and being able to text when your baby is asleep in your arms is so helpful…  For me, texting as opposed to verbalizing sometimes kept me a bit calmer. I always know I can call if I need to. The ability to have both options, however, was great.”

According to Erin, “Because newborns require so much attention around the clock, texting was the easiest form of communicating with Robin.  It allowed me to send her a quick message, an update or ask a question without regard to the hour or any of the long winded social niceties that a telephone conversation would require. By the same token, Robin was able to check in on my progress, offer much needed practical advice and soothe my worries with most welcome words of support.”

On the Bleeding Edge

How does text-messaging fit into healthcare privacy laws that might impact lactation consulting care?  This will vary country by country, and many governments are still trying to figure this out.  Robin said she is moving towards printing and then deleting text messaging conversations and adding them to patient records.  She deletes photos immediately.  Having a password lock on your phone is another measure of security.  It’s always important to get a mother’s consent before you begin sending text messages.

What has your experience been with adding text-messaging support to your lactation practice?  We’d love to hear your stories!

By Maryanne Perrin MBA, graduate student in Nutrition Science, and ILCA volunteer

11

Breastfeeding and the Working Mother

Written by Diana Cassar-Uhl, IBCLC and La Leche League Leader

We know what the studies say:  mothers who have to separate from their infants to return to the workplace are statistically less successful  (Johnson & Esposito, 2007) at meeting the goal recommended by child health promotion organizations around the globe:  exclusive breastfeeding until around the middle of the baby’s first year, thereafter supplemented with nutritionally sound, complimentary foods while breastfeeding continues through the child’s second year or beyond (World Health Organization, 2002).

This is not a significant issue for IBCLCs outside the United States, in nations where paid maternity leave is normal and expected after a mother has a baby; however, IBCLCs in the U. S. will likely find themselves in the position to counsel and assist mothers who wish to maintain a breastfeeding relationship with their infants after a return to work or school.  Reminding a mother that many mothers before her have been successful in continuing to breastfeed after regular separations from their babies and providing practical suggestions can be valuable.

Direct breastfeeding is best for mother and baby.

This is always my first tenet of support when I’m helping a mother who has to separate from her baby.  Is there any way for the mother to spend more time in her baby’s presence?

  • Can maternity leave be extended, or can the mother return to work on a gradual/partial basis (for example, half days; or back 2 days the first week, 3 days the 2nd week, and so on)?
  • Can the baby be brought to work with his mother?  There are workplaces that have experimented with this option and found it to be a win-win alternative.  The Parenting in the Workplace Institute offers some details.
  • Is the daycare on-site or close enough to mother’s workplace that she can breastfeed her baby during her lunch or other breaks?  Keep in mind that Federal legislation, as part of the Patient Protection and Affordable Care Act supports break time for nursing mothers.
  • Can the baby be brought to visit his mother one or more times during her workday?  Even one breastfeeding session during the separation can make a difference in how much milk continues to be produced long-term.

But I have to travel for my job!

While Transportation Security Administration rules permit a mother to travel with her pumped breastmilk when she is not traveling with her child, a more lactation-friendly alternative is to bring baby along and breastfeed whenever possible – often, this is more frequently than when mother is at her home office.  It has been reported that Julie Andrews, while on location to film The Sound of Music, had her toddler on site with a caregiver.  This was a sensible solution in 1964 and can still work today!

Even if I give my job 75% and my baby 75%, that still adds up to 150% and I’m exhausted!

As an IBCLC, I support a mother in her efforts to breastfeed her baby; this can include practical tips for a new family.

  • If there is a support person at home (baby’s father, mother’s partner, other family member), is he or she in agreement that breastfeeding is the best course of action for mother and baby?  This person and others close to the mother will have a tremendous impact on the choices she makes.
  • Remind the family that when mother is not at work, her #1 priority is to care for the baby; this means everyone must pitch in to care for the mother and the household.
  • Safely sharing sleep with her baby as detailed here can ensure a mother gets some rest (though likely not as much as she desires or needs unless she can modify her work situation or her baby gets older) and meet the nutritional and attachment needs of her baby.

Some breastfeeding is better than no breastfeeding.

If a mother can’t employ the tips shared above and struggles to express enough milk to meet her baby’s needs, remind her that she can still pump what is feasible for her – every drop her baby gets is a precious gift.  She can also continue to enjoy the breastfeeding relationship when she is with her baby, even if he has been partially weaned to commercially-prepared baby milk.

Finding her tribe.

When a breastfeeding mother returns to work, she may feel stuck between two worlds; her heart is with her baby but her mind is on her job.  The other breastfeeding mothers she knows stay home with their babies and the mothers at her workplace weren’t successful at combining employment outside the home with breastfeeding.  If enough of your clientele combines working and breastfeeding, perhaps you can host a monthly discussion group (in the evening, baby required for admission!) where mothers can share their strategies in your presence (and you can moderate comments to ensure everyone leaves with sound information).  If your breastfeeding and employed population is smaller, see if one or two mothers who have been particularly successful at the balancing act might be willing to serve as a resource to other mothers embarking on the journey.

Turn your frustration into advocacy!

If you’ve seen too many overwhelmed mothers give up breastfeeding because the “otherhood” complicates new motherhood, take action.  In her Call to Action to Support Breastfeeding, U. S. Surgeon General Regina Benjamin encourages us to “work toward establishing paid maternity leave for all employed mothers” (United States Department of Health and Human Services, 2011).  A letter to your elected officials at every level will keep this issue on the table.  Breastfeeding protects the health of babies and their mothers; we are called to protect breastfeeding in any way we can.

Johnston, M. L. & Esposito, N. (2007).  Barriers and facilitators for breastfeeding among working women in the United States.  Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36: 9–20.  doi: 10.1111/j.1552-6909.2006.00109.x

United States Department of Health and Human Services, Office of the Surgeon General. (2011). The Surgeon General’s Call to Action to Support Breastfeeding.  Washington, D. C.

World Health Organization. (2002). Global strategy on infant and young child feeding. 

Diana Cassar-Uhl, IBCLC and La Leche League Leader, enjoys writing to share breastfeeding information with mothers and those who support them.  In addition to her frequent contributions to La Leche League International’s publication Breastfeeding Today, Diana blogs about normalizing breastfeeding in American culture at http://DianaIBCLC.com and has been a guest blogger at Best for Babes and The Leaky Boob.  Diana can be found lecturing at breastfeeding education events around the United States.  She is pursuing a Master of Public Health, and upon graduation hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition.  Mother to three breastfed children, Diana has served as a clarinetist on active military (Army) duty in the West Point Band since 1995.

If you want to link to Diana’s Breastfeeding Today article on breastfeeding and working, (mothers are the target audience) it’s here.

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IBCLCs Volunteering at HIAM-Health in Timor Leste (East Timor )

Article by Sue Williamson IBCLC, Anne Scollon IBCLC, and  Maree Twomy,Dietician

Sue, Maree & Anne relaxing with their much needed ILCA Fans

This is the first-hand recollection of volunteering overseas in East Timor as shared by three Australians, two IBCLCs and a Dietician, after their month long experience at HIAM-Health. This facility provides a place for mothers and babies to come for a week after being in Dili Hospital, to learn about health and nutrition.  Timor Leste (East Timor) has a population of  1 million, with unfortunately an infant mortality rate  as high as 111 per 1000 births in some districts. Over 50% of children under 5 years are malnourished and hungry (MoH 2008) HIAM Health is an abbreviation of the East Timorese words Hamutuk Ita Ajuda Malu “Together we help each other”.

 “Almost home”…an email shared from Sue, Anne, and Maree.   Bon Dia Colleagues, Friends, and Family,

Our time at HIAM health Dili has been an amazing cultural, emotional, and educational experience for Anne, Maree and myself. The Timorese have endured incredible hardships and yet are simple, happy people, interested in learning, especially those in our class room.

Leaders breastfeeding their children

We have had 20 days of teaching breastfeeding and nutrition, also laughter, singing, and exercises.  Our endorphins are high. We sleep well. The 3 of us have bonded well and our skills complimented each others’ personalities. We could have never picked a better team.    We have taught women and men from 3 different communities; Aileu , Ermera district, and Atauro Island. They are valued leaders in their communities – non medical. They have shared with us their culture and stories and we will never forget.

Also the HIAM health workers were in our sessions most of the time.  They have heard the information 3 times over, so hopefully they can continue to teach the mothers in the centre. There are nurses amongst them plus those who are studying nutrition, a great benefit to the centre. They have been very impressive.  Jill (director at HIAM Health) has chosen well and they have great respect for her and Rosaria.  We had about 15 to 20 people at each session.   The Mothers and babies/ toddlers in residence, about 10 to 15 at a time, plus some siblings, usually stay for 21 days depending on the conditions. We have children with Tuberculous, heart disease with a weak suck etc.  All with malnutrition, they are put on a “plump-up” corn meal program. It takes about 2 months to make a difference in their body structure. There are 10 breastfeeding mothers in the center at the moment and we will be teaching and encouraging them over the next couple of days and spending time with the little one with a weak suck.

Around maternal health, the mothers eat very little in pregnancy so they can have small babies for easier labour.  Many still give birth at home and some still don’t give colostrum.  Instead they give sugar water. The mother and baby stay beside the fire in a smoky room for a number of days, postpartum. They usually breastfeed for beyond 2 years of age, and all sleep with their babies. Mothers believe when they are pregnant with their next child, that they should wean the first so he / she won’t be infected by the milk. With inverted nipples and delayed milk supply they stop breastfeeding. If their milk is not flowing well by day 2 they give up.

The two directors, Jill Hillary (Aussie) and Rosaria Martins da Cruz (Timorese) are amazing.  Jill works as the advisor and Rosaria as the up-front person.  Both had a vision for this place, meaning ‘together we can help each other’. You can read all about them on the HIAM Health web site.

There is a miracle tree here, called the MORINGA tree, and it is very high in protein, vitamins, and minerals.  Maree has been encouraging everyone to eat it 3 times a day for health and wellbeing. What a blessing as it grows all over Timor.   It’s like breast milk… free and readily available.

We visited Dr Dan Murphy’s clinic at Bairo Pite. So many medical problems and then a ward full of stunted young children,  oh so much to take in!  During our 2 hour round with him, we checked 5 new babies born overnight and witnessed a mother with Tuberculosis, who has been ill for many years, take her last breath! He sees 300 patients a day in his clinic!

Our rest and recreation at Atauro Island over night seemed like a ‘full week’ of rest. We stayed in an Eco hut and enjoyed meeting people who were bringing various skills to help Timor get back on their feet. It warmed our hearts to hear their stories. The clear sea water refreshed us to no end. We enjoyed being at the celebration for Tour de Timor, the extremely tough annual bike ride.  We even shook hands with the President, Prime Minister and his Aussie wife, Kirsty. Oh my, what a day! We also were invited to the US Embassy to have cocktails with Judith Fergin the Ambassador.  Always so much excitement going on here in Dili, we will never be the same. I think that will be enough for now, see you when we get home.”

Blessing Sue, Anne and Maree

Read about the History of Timor Leste (East Timor)

Sue:  aussiesjw@gmail.com

Anne:   scollona@optusnet.com.au

For more information about Sue, Anne, and Maree’s trip to East Timor, please see their article in the February E-Globe.

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Breastfeeding and Hypertension

Written by Crystal Karges, DTR, CLEC

Undoubtedly, the field of lactation continues to be an exciting subject of study, particularly as newfound evidence from developing research studies are confirming and fortifying the importance and benefits of breastfeeding. Knowledge of the latest research findings can be invaluable to the clinician who has the opportunity to encourage and educate the breastfeeding mother, particularly as they are able to assist in overcoming obstacles to breastfeeding that could make a difference in women’s health.

A recent study published in the American Journal of Epidemiology demonstrated that mothers who breastfed for a minimum of six months were less prone to developing hypertension over a 14 year period compared to those who bottle fed. These findings are contiguous with previous studies which have established that women who breastfeed have lower risks of diabetes, heart disease, and high cholesterol later in life.

In this latest study, researchers examined the relationship between breastfeeding and later risk of developing hypertension among approximately 56,000 American women who took part in this long-running study. All women participating in this research had at least one baby.

While findings included substantiation that an estimated 8,900 women from this study were ultimately diagnosed with high blood pressure over more than 20 years, data revealed that the probability women would develop hypertension were 22 percent higher in the incidence of not breastfeeding compared with women who exclusively breastfed for six months.

More specifically, this particular study concluded that never or abridged lactation was correlated with an increased risk of incident maternal hypertension, contrasted with the endorsed 6 months of exclusive or 12 months of total lactation per child. Researchers had also estimated that up to twelve percent of high blood pressure cases among women with children could be associated with “suboptimal” breastfeeding, including mothers who gave their babies formula or breastfed for less than three months. These findings are of utmost significance to the lactation consultant, who may make the difference in a mother’s long-term health by removing barriers that may prevent her from successfully breastfeeding.

To be directed to the original research study, please continue reading here.

Research findings such as these continue to give substantial support to the role of the lactation consultant in a mother and baby’s well being, particularly as the LC has the ability to empower a mother to create optimal health for herself.

What research findings do you find beneficial in sharing with your own clients?

Sources:
http://www.telegraph.co.uk/health/healthnews/8949323/Mothers-who-breastfeed-for-at-least-six-months-have-lower-blood-pressure.html
http://aje.oxfordjournals.org/content/174/10/1147.short

Crystal Karges, DTR, CLEC

4

Do Interruptions Interfere with Early Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

In the Jan/Feb 2012 edition of the American Journal of Maternal Child Nursing, Barbara Morrison and Susan Ludington-Ho published a study looking at Interruptions to Breastfeeding Dyads in an LDRP Unit(1).   They observed the doors to the rooms of 30 breastfeeding mother-infant dyads in a community hospital birthing center from 8AM to 8PM on post-delivery day 1, and found that mothers were interrupted an average of 53 times in that 12 hour period.  The average duration of interruptions (18.5+/- 34.5min) was longer than the average duration of time alone (15.4+/-17.3 min), and half of the episodes of time alone lasted 10 minutes or less.

As mothers in the study reported that they spent an average of 25.68 minutes (+/-16.7) at each breastfeeding session, these interruptions were likely to impact early breastfeeding when frequent breast stimulation is critical.  In fact, breastfeeding frequency was moderately negatively correlated with the number of interruptions.  Additionally, the authors found that a mother’s satisfaction with her breastfeeding experiences was significantly correlated with her perception of amount of time alone with her infant, and when mothers felt interruptions interfered with breastfeeding; they found the interruptions more annoying.

Although I was astonished at the number of interruptions this study found in a 12 hour period (consistent with an earlier study in a university hospital(2)), I was not surprised that frequent interruptions impact breastfeeding. Given attitudes in the United States about breastfeeding in public, mothers may feel self-conscious about baring their breasts to visitors, nurses, and other hospital staff members while learning to breastfeed. Ideal amounts of skin-to-skin contact and relaxation may be difficult to accomplish when mothers feel they need to keep one eye on the door and a cover-up at the ready.  Even when this isn’t the case, a mother who finds herself continually interrupted to place her lunch order, talk to visitors, answer the phone, have her vitals checked, and talk to physicians may delay or shorten breastfeeding sessions.

Not surprisingly, the majority of the women in the study only met the minimum recommended number of breastfeeding sessions (4 times in 12 hours), and several mothers fed their babies only 2 or 3 times for less than 15 minutes in that time frame.  As infrequent and inadequate breastfeeding sessions can rapidly progress to infant weight loss and supplementation, this finding is particularly relevant to the cause of increasing breastfeeding duration and exclusivity. Coupled with this, frequent interruptions may prevent mothers from getting the rest they need to recover from childbirth and have the energy for frequent nighttime feedings.

Undoubtedly, many interruptions are necessary and unavoidable; however Morrison and Ludington-Hoe have a number of suggestions to minimize the impact on breastfeeding.  These include:

  • Discuss the importance of alone time, Kangaroo care, frequent breastfeeding and limited visitors during prenatal visits, classes and tours.
  • Cluster care, plan care activities with mothers to enable quiet times, use door signs to signal time alone, and institute “quiet” times when no visitors or staff enter rooms.
  • Minimize rounds and discontinue 24/7 visiting hours.

In our efforts to translate high breastfeeding initiation rates into longer breastfeeding duration, we must continue to remove barriers to establishing a successful breastfeeding relationship.  As we think about how to best accomplish this task, minimizing the frequency of interruptions to mothers and baby may be a simple step in the right direction.

1. Morrison BP, RN, FNP, CNM; Ludington-Hoe, Susan PhD, RN, CNM, FAAN. Interruptions to Breastfeeding Dyads in an LRDP Unit. American journal of Maternal Child Nursing 2012;37(1):36-41.

2. Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2006;35(6):709-716.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants.  I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating!  As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

Lactation Matters Editor’s Note: Just to add, Jennie has a brand new addition to the family.  Welcome Noah Lev, born on Oct 28, 2011, who is breastfeeding beautifully!  Congratulations !

13

New Possibilities in 2012! A message from our President

Beginning a new year can be a rejuvenating time to set new goals and explore new opportunities.  For the International Lactation Consultant Association, the opportunities have never been greater!  I hope each of you will resolve TODAY to get involved in your professional association.  You’ll find, as countless others have, that giving your time and your talents will come back to you in the most incredible ways as you seek to make a difference.

Earlier this week I sent my ILCA President letter to inform you about the status of ILCA as we begin this new year.   Click here to read about ILCA’s strong foundation of sound financial health and highest membership numbers ever (over 6,000!), and details about the many exciting new initiatives.

Coming in 2012:

  • The 2012 ILCA Conference in Orlando…with live simultaneous translations in Spanish for the first time ever, a new ILCA “lounge” for networking with colleagues, and family activities to make this a wonderful vacation while you learn.  Be sure to check out the YouTube™ video at http://www.youtube.com/watch?v=yzEeqvRsCRw&feature=youtu.be and pass it along to your colleagues on your Facebook™ and Twitter™ sites and be an early bird registering and have an opportunity to win a fabulous i pad 2, check the details.   http://www.ilca.org/files/events/ilca_conference/2012_Conference/Registration_Brochure.pdf
  • New changes to the Journal of Human Lactation under the new editorial leadership of Anne Merewood.
  • CERPS on Demand© with a full slate of webinars in many languages!
  • Baby-Friendly Initiative Committee to explore strategies for promoting and implementing BFHI worldwide.
  • European Task Force to address member needs across Europe.
  • Continued expansion of our robust translation program.
  • Collaborative projects with IBLCE, including a NEW consumer website, IBCLC promotional brochure, and hospital outreach initiatives.
  • Position papers and clinical protocols.
  • NEW edition to the Core Curriculum for Lactation Consultant Practice.
  • Expansion of our global relationships worldwide.
  • And more!

I love to sign my communications, “ILCA is YOU,” and I believe that phrase perfectly captures how important each of you are to ILCA’s success.  There has never been a better time to get involved, so join us in 2012 as we work together to meet the needs of the lactation community worldwide.

Cathy Carothers, BLA, IBCLC, FILCA ILCA President 2010-2012

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