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USDA Child Nutrition Program and Breastfed Toddlers in Day-Care

By Laura Spitzfaden, LLLL, IBCLC

Under the USDA Child Nutrition Program guidelines, infants and children 1 year of age and older, who are in licensed day-care programs, must be offered fluid cow’s milk (or approved alternative milk) in order for their day-care providers to be reimbursed for their meals. This is in conflict with what is best for employed mothers of breastfed toddlers and their day-care providers, who have limited breastfeeding friendly options under these guidelines.

iStock_000016831831SmallMany employed mothers, knowing that their breastmilk provides excellent nutrition, antibodies, and a sense of security for their older babies, continue to breastfeed when they are with their babies, even if they no longer express milk while they are at work. A breastfed baby, who is 1 year of age or older and eating nutrient dense solids, needs approximately 15 ounces of breastmilk each day to meet child nutrition standards. If a mother and baby breastfeed at least 3–4 times daily, the baby will receive age-appropriate amounts of milk and will not need a milk-substitute when separated from the their mother.

In order to support the breastfeeding relationship, a day-care provider may choose not to be reimbursed for the meals the breastfed child consumes that do not include milk, however this option is economically punitive to the provider and may affect how much they charge for their services. In order to take the burden off the day-care provider, the mother may send food from home for the child to consume at day-care but this creates extra work and expense for the mother. Alternatively, the mother’s own expressed breastmilk may be served at meals. This satisfies the milk requirement under the USDA Child Nutrition Program, but continued breastmilk expression may be unnecessarily burdensome for the mother of an older baby who doesn’t need this extra milk.

Expressing breastmilk takes a great deal of dedication and time; pump-weaning can be a welcome relief for the employed breastfeeding mother of an older baby. No longer does she have to cart her pump to and from work or have to scramble to accommodate for the occasional misplaced or broken pump part. Break times become actual breaks and lunches can be enjoyed without the hassle of setting up a pump, expressing and storing milk, and cleaning pump parts.

If a breastfeeding mother allows cow’s milk or other alternative milks to be offered at her child’s meals, she may risk their breastfeeding relationship. One mother who had pump- weaned but whose toddler continued to breastfeed when they were together writes, “when I got to that point with [my daughter], she just stopped getting milk at daycare. She is getting enough mama milk straight from the source when we are together. She just drinks water at daycare. We didn’t originally do it that way—we gave her cow’s milk for a couple of days—then she drastically reduced nursing, so I took her off of cow’s milk. She went back to nursing like normal.”

The Healthy, Hunger-Free Kids Act of 2010 states “In the case of children who cannot consume fluid milk due to medical or other special dietary needs, other than a disability, the caregiver may serve non-dairy beverages in lieu of fluid milk….If a non-dairy milk substitute is served that does not meet the nutritional standards outlined in Title 7 CFR 210.10(m)(3), then the meal is not reimbursable.” According to Kelley Knapp, MS RD from the California Department of Education Nutrition Services Division, there is another option in USDA’s Child Nutrition Programs. The child’s physician can fill out a form, “…stating that the child cannot receive milk due to a disability.” In this case, the toddler may be offered a physician-determined alternative (e.g. water or juice) with meals and the meal may still be reimbursable.

These options do not address the unique needs of the breastfed toddler who does not have a disability or a medical condition, but just doesn’t need additional milk in their diet. It doesn’t address the concern that offering non-human milk to a breastfed toddler can reduce the amount of breastmilk that is consumed and replace it with an inferior substitute that is linked to allergy and obesity.

Employed mothers should not have to continue to express milk for their children past the age when it is needed and they should not have to jump through hoops for their children to continue to enjoy a health promoting breastfeeding relationship. Day-care providers should not have to take an economic hit in order to support their breastfeeding clients. It is imperative that this gap in the USDA food program be closed, so that we may continue to support breastfeeding mothers, their babies, and their care providers, whether their breastfeeding relationships are measured in terms of months or years.

References:

Child & Adult Care Food Program Reimbursable Meals and Snacks

Long-Term Breastfeeding: Nourishment or Nurturance? Kathleen M. Buckley, PhD, RN, IBCLC, J Hum Lact November 2001 17: 304-312

Breastfeeding Past Infancy Fact Sheet

Feeding Infants: A Guide for Use in the Child Nutrition Programs, Chapter 3

USDA FCS INSTRUCTION 783-7 Food and Nutrition Service REV. 1 Milk Requirement Child Nutrition Programs

The Healthy, Hunger-Free Kids Act of 2010, Public Law 111-296, Section 221.17(g); USDA Policy Memo CACFP 21-2011-REVISED; USDA Policy Memo CACFP 04-2010 Fluid Milk and Fluid Milk Substitutions (Revised)

Child Nutrition Programs PHYSICIAN STATEMENT FOR FOOD SUBSTITUTION

LauraLaura Spitzfaden is a private practice IBCLC in Charlotte, Michigan. She has been a La Leche League Leader since 1998 and an associate area professional liaison (AAPL) for La Leche League since 2012. She has three children whom she breastfed for a total of 10 years. Laura has a passion for helping moms to reach their own breastfeeding goals and has created an informational breastfeeding website dedicated to providing moms with accessible breastfeeding help and resources so they may solve some of their own breastfeeding difficulties. She has written many articles on breastfeeding topics including, bed-sharing, milk-sharing, tongue and lip-tie, birth practices and milk-supply and provides these articles freely, to support breastfeeding moms and their babies.

Laura has a special interest in early childhood development and has worked in preschools and her own child-care business, creating hands-on, science based curriculums for toddlers, preschoolers and young 5’s. She has also presented multiple science workshops for young children and for adults who work with young children and has worked in a children’s science museum in exhibit development. Additionally, Laura has a love of dance and has studied tap, jazz, lyrical, modern and ballet and performs each year with The Community Dance Project.

© 2013 Laura Spitzfaden, LLLL, IBCLC

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Reflections from a Former Chris Mulford ILCA-WABA Fellow

The International Lactation Consultant Association® (ILCA®) and the World Alliance for Breastfeeding Action (WABA) are pleased to once again jointly sponsor the exciting opportunity for a Fellowship to travel and work with WABA on outreach and advocacy projects at their headquartersin Penang, Malaysia. ILCA has designated this annual Fellowship, the 6th to be awarded, as the Chris Mulford WABA ILCA Fellowship. Chris had been an ILCA member and helped to guide the birth and growth ofthe profession with a gentle spirit and wise leadership. Chris first joined WABA in 1996 at the first WABA Global Forum in Bangkok and became a long term volunteer for WABA. She worked mainly on Women and Work and Gender issues, bringing many achievements in supporting working women to breastfeed globally. She also paved the way for the first WABA‐ILCA Fellowship, in 2007, by being an exemplar of a Fellow. At Lactation Matters, we are proud to highlight this post, by Denise Fisher, a recent fellow, about her experiences in Malaysia with WABA.

For more information about applying to become a Fellow, please see this document. The deadline for applications is October 22, 2013.

By Denise Fisher AM, MMP, BN, IBCLC

In 2010, I was honored to be selected the Fellow to work with the World Alliance for Breastfeeding Action (WABA) staff on several projects to support breastfeeding worldwide.

WABA’s home office is in Penang. Penang has been called the Jewel of the Orient, and is a beautiful island off the coast of Malaysia. Malaysia is a bustling melting pot of races and religions where Malays, Indians, Chinese, and other ethnic groups live together harmoniously. Because of this multiculturalism, this tropical paradise has also made Malaysia a gastronomical paradise, and even the Malays from Kuala Lumpur will tell you that Penang is the place for the best food.

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I was incredibly excited to be given the opportunity for this fellowship to not only continue my passion for promoting breastfeeding, but to do it in such a fascinating country.

Now, while I was working on a purely volunteer basis, I was aware that ILCA® and WABA had invested financially in my travel and accommodation, and my family and work colleagues back home were also putting in big-time for me in my absence; so while the temptation was to spend many hours on the beach, I was keen to be able to help WABA as much as possible. I was given several projects to complete. They select projects that are in line with your interests and skills, so needless to say mine were either internet-related or education-related.

The biggest project was the establishment of the Breastfeeding Gateway. We worked as a small team to establish it in time to be launched for WABA’s 20th birthday celebrations. The goal of this Gateway is to provide you with all the quality information about a topic in one easy collection.  For example, you may be asked at work to develop a policy on an HIV-positive mother breastfeeding. You only need click on the HIV heading in the Gateway to open a page with links to all the quality information sites relevant to HIV on the internet, saving you hours of searching. This is perfect for students too – so easy. I loved helping to create this resource – it was such fun to work together on it.

Another project I had was to go to one of the local hospitals and film a mother doing skin-to-skin care and have baby self-attach. As a midwife, the opportunity to visit the maternity unit was one not to be missed, and then we had the most delightful mother, with a very obliging newborn who did exactly what he was supposed to (phew!).

Presenting a full-day workshop for the medical and nursing staff at the local university was pretty nerve-wracking, but on the day it all went smoothly and everyone was happy. Doing a workshop for the mother support group that had been established by a previous WABA/ILCA Fellow was much less stressful and I got to cuddle babies!

IMG_6511It wasn’t all work though. The WABA staff welcomed me into their lives and social events, and were all very friendly. I still keep in contact with some of them. I’ve been told I have to come back when the durian are fruiting (!). A young intern from America was working there at the same time I was, so both being visitors to the island, we spent our leisure time exploring – most memorable was the bicycle tour through Georgetown (the capital of Penang). You think traffic is bad where you live – wait until you’ve ridden a bike through the streets of an Asian city! This was a history and food tour – we went to lots of the historical sites (Georgetown is a UNESCO World Heritage Site) and our guides (two lovely young men) told us about living and working in Penang now, and what it was like for their parents and grandparents. And then there was the food – they took us to each of the places that was famous for each of the dishes Penang is famous for – lucky we did lots of riding to work it off. Another tour I did with my son was a guided taxi ride around the island. It truly is a tropical paradise.

Since my time in Penang, I’ve become one of a select group who get to meet up at the ILCA conference and talk about the good old days – the former WABA/ILCA Fellows! And even better, this year ILCA decided to honor us with a special Fellow’s pin. Based on my wonderful experience which was so personally and professionally rewarding I’d encourage everyone to consider applying for this yearly fellowship. You won’t regret it.

IMG_6093Denise is a registered nurse, midwife practitioner, and lactation consultant who has worked in education for many years. In recognition of her services to health professional education, specifically in the mother and baby area, Denise was inducted as a Member of Australia last year. Recognizing that the internet was the way of the future, Denise and her team created Health e-Learning in 2000, followed by the very popular GOLD conferences, to provide breastfeeding education for lactation consultants and other health professionals. She is now the Director of Step2 Education, a company that delivers Baby Friendly education to hospitals worldwide. Denise is married to Steve and mother to 3 beautiful young adults – James, Nicholas and Laura, and lives outside a little country town in Queensland, Australia.

0

New Families Need Community Support: Beyond Talk into Action

By Jane I. Honikman

I was pregnant, single and alone.  I gave birth in a foreign country, and never saw my baby.  I had no emotional support. 

I was married, and was finally pregnant.  I gave birth, away from my extended family, but with a supportive husband.  We had no emotional support. 

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Photo by familymwr via Flickr Creative Commons

It is these contrasting, yet similar experiences which have motivated me to become passionate about improving the outcomes for babies and their parents.

After the birth of our second child, my friends and I co-founded Postpartum Education for Parents (PEP).  It was conceived from our own needs as struggling young parents, removed from our families, and inundated with professional advice.  What we lacked was a supportive environment where we could share our highs and lows each week, and not be judged or criticized when we admitted to being overwhelmed, scared, or inadequate.  It was about making friends, learning about community resources, and gaining confidence as new parents.

We launched the first ever warmline, staffed entirely by trained parent volunteers, 24 hours per day, 7 days per week.  It has been available since July 1, 1977.  I took the first shift that day and received the first call.  I was an ordinary mother actively listening to the needs of another ordinary parent.  We offered free emotional support to other new families.  PEP became our local community’s way to help ease the adjustment of developing families.

We know that communities are human systems where we live, work, learn, pray, and play together.  We tend to gather together based on our cultural values and with a common purpose. It is during pregnancy that the first shift in emotional needs occurs. The arrival of the newborn does interrupt a new parent’s existing community, as well as a good night’s sleep.  Social connections, our networks, exist within each community, yet how do expectant and new families find or create them?  In general, our networks help us find employment, friendship, and provide emotional support and comfort.  We may relish these natural human interactions, take them for granted, or in some cases, ignore them.  Then, the new baby arrives.   The need for community support takes on a different meaning. 

I want to emphasize the importance of community based social support.  Researchers have found that we are healthier and happier when surrounded by supportive peers, family, and friends.   It is with a social support network that we feel a sense of belonging and more secure.  As new parents increase their self-worth by not being isolated and struggling alone, the baby will feel this as well.

Connections between people are also called social capital.  We invest in material goods (physical capital), and value education (human capital).   It is critical that our social networks for new families are consciously created.  Academic scholars have shown that our psychological well-being benefits by having a network of supportive relationships.  Even if a new family has relatives living nearby when a baby arrives, making friends with others experiencing the same life event is vital.

All new parents will experience a wide range of physical and emotional challenges.  The transition from being single, becoming a couple, and then a family cannot happen without many changes.  PEP refers to these as “special circumstances”.   This list consists of every possible “less than easy or wonderful” situation.  For example, had I given birth after PEP was established I would have called the Warmline for emotional support after our son was born.  I would been connected with a volunteer who had had difficulty breastfeeding, who had also supplemented with formula.  I would have been encouraged to join a new parent discussion group where I would have shared how inadequate I felt as a mother.  My peers would also be new parents and eventually I would have felt secure enough to share that I’d placed my first baby for adoption.

My personal journey through parenthood would have been smoother had I had professional support as well as good friends.  Unfortunately, my depression went undiagnosed far too long.  It is ironic that although I had become involved with world leaders in the field of maternal mental health, it took decades to overcome my own denial.

There are many therapists, doctors, and educators who want to work with expectant and new families.  Their role as professionals in pregnancy and postpartum social support networks is to serve as advisors to trained peer volunteers.  A paid childbirth or lactation assistant is not the same as someone who has “been there” and offers empathetic comfort. A support group that is led by a professional is important to deal with stress and illness but it does not substitute for peer to peer support.  In all circumstances, however, they are definitely essential parts of community support.  When a PEP volunteer hears from a Warmline caller about a situation beyond the listeners’ capacity, the caller is referred to his or her own doctor, other professionals, and/or organizations listed in the PEP Community Resource Guide.

Families need and deserve supportive communities to bond with their peers as well as reach out to professional services.  Over the decades, studies consistently show that for good health and emotional well-being we need each other. We know that social interactions are needed for optimum physical and mental health.  The baby and the parents will build lasting friendships, strong personal relationships, and social ties in a community that offers this opportunity.

How supportive is your community for new parents?  Don’t wait for someone else to initiate what might work.  Start asking your friends, peers, family members and work colleagues if they’d like to explore the possibility of a social support network in your community.  You can replicate PEP in your community. It won’t look exactly like PEP. That is impossible since each community is unique. It all starts with a few friends who understand the importance of building a social support network.  Your efforts will be rewarded by meeting the needs of your own new families.

As Margaret Mead wisely said “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever does.”

MINOLTA DIGITAL CAMERAJane Honikman, M.S., is a Postpartum Parent Support  Consultant from Santa Barbara, California. In 1977, she co-founded Postpartum Education for Parents (PEP). She founded Postpartum Support International (PSI) in 1987. She lectures internationally on the role of social support and the emotional health of families. Her book, Community Support for New Families: A Guide to Organizing a Postpartum Parent Support Network in Your  Community, is available from Praeclarus Press

2

Racial Inequities in Breastfeeding: My Commitment to be a Mentor

By Betsy Hoffmeister, IBCLC

Recently, some of my colleagues in private practice were discussing the topic of IBCLC® mentoring. I’ve only been an IBCLC for four years, but I receive many phone calls per year from women looking for a mentor.  Some of my colleagues mentioned the uneasy sensation that they are training their own competition.  I want to add a different perspective.

iStock_000016195932SmallIn June, the two-day Inequity in Breastfeeding Support Summit in Seattle was the site of passionate discussion about barriers to breastfeeding support, for and by women of color. Women of color in the US have a lower rate of initiation and duration of breastfeeding, and women and their babies suffer higher rates of morbidity and mortality that could be mitigated by breastfeeding. There are also few IBCLCs and other breastfeeding support people who are women of color.

In the Greater Puget Sound Area, there are very few (possibly zero!) private practice lactation consultants who are also black, Latina, Asian, or Native American. I know of one Seattle-area Native American woman who just sat the exam and I can’t wait to hear her results! There are a few IBCLCs who are women of color who work for WIC or for hospitals. Why is that? There are many, many, MANY obstacles.  One obstacle cited was the barriers to entry – the bar keeps getting raised and it’s terribly expensive. Here in Washington State, for a variety of reasons, we have few to no La Leche League (LLL) Leaders who are also women of color. Since Leadership used to be the traditional route to becoming an IBCLC, lack of Leaders who are women of color is also a challenge. LLL of WA has been actively working to address this.

Conversely, what we learned from the women of color in attendance at the Summit, is that while the breastfeeding rates, especially in the African American community are very low, there are no visible black breastfeeding role models (calling Michelle Obama, we want your photos!!) Very often, women of color would feel more comfortable working with a breastfeeding helper who had similar life experiences. IBCLCs are typically compassionate, wise, lovely women – and yet, at least here in WA State, we have not walked in the shoes of the African American experience. I have come to understand and honor the desire of women to want to work with someone who not only has experience and training, is compassionate, wise and lovely, but also shares life experience and understanding. Incidentally, that’s why the following video is so important. I’m thrilled that when I first saw it, it had less than 10,000 hits and now it has more than 300,000!

[youtube=http://www.youtube.com/watch?v=SZ3QO-7h4YA&w=853&h=480]

One agenda item strongly suggested at the close of the Summit was for IBCLCs to seek out and mentor women of color as IBCLCs. And, if at all possible, NOT charge for it if the woman in training is low income. I don’t depend on my IBCLC income to run my household. I can afford to take on a free mentee. I don’t feel like I’d be training my competition. Right now, my clientele are mainly white, Asian, and Southeast Asian. I see the occasional Latina and very, very rarely an African American mother. If I could mentor an IBCLC-in-training who was also a woman of color, I feel like I’d be training valuable colleagues who could support women in my community who desperately need the services but are not seeking me specifically. I publicly committed at the Summit and here commit again: when I achieve my 5-year status and go through the process of becoming a mentor, I commit to actively seeking out a woman of color in my community who wishes to become a breastfeeding counselor and mentoring her through the process of becoming an IBCLC. I know I will learn much in the process and become a better helper to all mothers as a result.

sixBetsy Hoffmeister, MPA, IBCLC, has been a LLL Leader since 2002 and a private practice IBCLC since 2009. She lives in Seattle with her husband, who makes chocolate from beans, (but sadly, without sugar), her son who just became a Bar Mitzvah and her 8 year old daughter. In her spare time, Betsy reads, gardens, and is experimenting with knit and crochet breast patterns. She only recently got turned onto anti-racism and equity in breastfeeding support and is excited and passionate about helping the movement. Contact her atbetsy@betsysbabyservices.com.

4

New Mothers Are Finding Breastfeeding Help and Making Friends Online

By Lara Audelo, CLEC

I can’t recall ever seeing women breastfeed their babies when I was growing up. To be honest, there weren’t many babies around me at all when I was a child. I was the youngest in my family, and my sister is four and a half years older. I always knew that if I had children, I wanted to breastfeed, but I never really gave much thought to all it would entail before I was pregnant.

Once I learned I was pregnant with my older son in May 2006, I began to research everything from natural childbirth to breastfeeding. I rarely make a decision without doing research and weighing my options. For me, birth and breastfeeding were no different. Based on what I had read, I decided to write a birth plan, take childbirth classes, and hire a doula to assist me in giving birth. Looking back, I realize that my birth choices were almost completely motivated by my desire to successfully breastfeed.

Intro_Lara with OwenWhen it was time for my son to make his arrival, everything went as planned: no epidural, short pushing stage, and only a first-degree tear. I really was lucky considering my hospital that had a 98% epidural rate. But we did have an unforeseen hiccough as soon as my son was born: he was taken to the NICU for two days because he had difficulty breathing immediately after birth, and was diagnosed with a pneumothorax. Thankfully, he recovered quickly and we both went home at the 48-hour mark. He was about 27 hours old when I first put him to my breast, and he took to it like a champ.

Shortly after my son was born, our little family of three re-located from the East Coast to the West Coast. I found myself in a new place with no friends, a husband who was gone on deployment, a four month-old baby, and still many, many questions as a new mother. When my son was about six months old, I turned to the Internet for breastfeeding support. Looking back, it was a watershed moment for me. I had no idea that so much of my time would include helping breastfeeding mothers through the Internet, and using technology to help mothers feel confident, the way my sister helped me as I sat in the NICU with my new baby. But that is exactly what happened. I turned to the La Leche League International mother-to-mother forums. Before I knew it, I was asking for–and offering–advice to other breastfeeding mothers. Then something unexpected happened: I was making friends in a way that I never had before—online.

My second son was born in the summer of 2009. My early breastfeeding experience with him was very different. His birth was wonderful as well. He was placed directly on my chest, and latched on and began breastfeeding within about ten minutes after birth. I quickly realized that breastfeeding counseling and education was a professional avenue I wanted to pursue. The fact that it all happened online was serendipitous. I had two young children and a husband who was deployed often. I went online and began connecting with other breastfeeding mothers, to offer support, encouragement, and advice.

The Advantages of Online Support

The Internet offers support in a unique way. You can take what you want and leave the rest. You can find mothers online at 2 a.m. when another late-night feeding that has left you feeling ragged. It’s a global community; your midnight is someone else’s 10 a.m. You might find like-minded women who share many of the same values, who live in a different town, state, or country−but your similarities are enough that you form friendships and keep coming back for more support.

Even if you don’t have access to local support groups at hospitals, or there are no breastfeeding mothers who meet regularly in your area, you don’t have to be alone. You can find your tribe online. The collective group of online mothers offering nursing support is very giving. Someone will hop in on a moment’s notice to help. Access is instant, and in our increasingly technologically driven world, this is appealing to many mothers. Sometimes the support becomes real and tangible: a card for Christmas, a birthday present, a sympathy gift for a lost relative, etc. Either way, the friendships are genuine and the support is invaluable. Online support helped me to continue breastfeeding, and on some days my friend from the forum saved my sanity!

Mothers have been using the Internet to help one another since the 1990s, but those born after 1982, which we refer to as the Millen­nial Generation, grew up alongside the Internet, and they use technol­ogy in almost every aspect of their lives. Time spent online increases after our babies are born by as much as 44% (McCann & McCulloch, 2012). A recent study, Feeding on the Web: Online Social Support in the Breastfeeding Context, by Jennifer Gray, examines how and why women are plugging into the virtual world for breastfeeding support.

More and more women are turning to the Web for health-related support, making it a fruitful option to study breastfeeding communication … An interesting arena to study breastfeeding support communication is the Internet as it offers a record of such support requested and received, and is a place more and more women are seeking breastfeeding support and information (Gray, 2013).

With every breastfeeding-related article published, blog post shared, question answered on a Facebook Timeline, or tweet sent through the “Twitterverse,” this information is stored and can be accessed at will when needed by mothers. The best part is that once you connect with mothers online, they will show you exactly where to go to get what you need. Then that mother will share it, and so on and so on. In less than two decades, women have built an amazing virtual infrastructure of support with the hope that no mother in need of help will fall through the cracks.

One aspect of virtual support is that mothers came to the Internet for answers, and they often stayed because of friends. Friendships began online with the first groups of women who communicated through email and LISTSERVs, and they became more real with the passage of time as technology now allows women to share not only stories, but pictures and videos of themselves and their families, thus enhancing the “real-life” aspect of virtual friendships. It should come as no surprise that women in the early days of motherhood spend more time online than ever before.

They may participate in hyperpersonal communica­tion online, building relationships and finding sup­port that they could not receive face to face, particu­larly those who are isolated in the early period after a birth, feeding an infant at home every two to three hours (Gray, 2013).

Ask any new mother who is at home with a week-old baby how different her life is now, and she probably wouldn’t even be able to articulate the incredible change. It is an awkward time. We need support and help more than ever, but we are often alone and afraid because we have no idea what we are doing. No mother should ever feel alone, or like she doesn’t have anyone to talk to who can help answer her questions. Technology has given us a way to end the isolation and increase support: anywhere, anytime.

Lara AudeloLara Audelo is the mother of two young boys, and a passionate breastfeeding educator and advocate. She believes increased education for all is the key to helping mothers achieve their individual breastfeeding goals, and is crucial for individuals who are responsible for providing much-needed support to nursing mothers. She received her Certified Lactation Education Counselor (CLEC) credential from University of California San Diego (UCSD) in 2010. This article is excerpted from her new book, The Virtual Breastfeeding Culture (2013, Praeclarus Press. Used with permission). Lara can be reached at mamapeardesigns@gmail.com.

 

4

Black Mothers’ Breastfeeding Association: Narrowing the Disparity Gap

By Anjanette Davenport Hatter, BMBFA President

On May 24, 2013, Black Mothers’ Breastfeeding Association (BMBFA) held our 4th National Seminar, Innovations in Breastfeeding Support in Detroit, MI, USA. The Seminar consisted of a plenary address, keynote speaker and lecture sessions from some of the most notable experts in the field of lactation. Topics were directed toward maternal-child healthcare professionals on innovative solutions that address the cultural road blocks in breastfeeding support.

seminar presenter bmbfa founding directorThe Seminar began with Beth Eggleston MS, RD of Michigan Department of Community Health offering the plenary address where current breastfeeding rates in Michigan were shared and a lively discussion was held about why disparities exist. The information provided about Baby-Friendly Hospitals was particularly interesting as it not only described the 10 steps to achieving Baby-Friendly designation but also explored realistic strategies to eliminate barriers presented by hospital administration as well as mothers of newborns. Allison Benjamin RN, IBCLC of Harlem Hospital (retired), described her instrumental role in assisting Harlem Hospital in becoming the first Hospital in New York City to receive the distinguished Baby-Friendly designation. While breastfeeding provisions are still a work in progress, Leila Abolfazli, J.D., of Washington, DC, shared that the Affordable Care Act offers insurance coverage to breastfeeding mothers for services such as breastfeeding support, supplies and counseling. Interestingly enough, breast milk is being viewed as preventive healthcare according to Leila. BMBFA’s Founding Director, Kiddada Green, M.A.T., of Detroit, MI, shared strategies necessary to organize and sustain a breastfeeding support group using a model that has proven successful as it has expanded its reach throughout the Detroit area. Other strategies for sustaining community based breastfeeding support suggested by Sade Moonsammy-Gray, B.A. and Kathleen Logan, RN, CPNG, IBCLC of Community of Hope Family Healing and Birthing Center, Washington, D.C. included education, self-efficacy and empowerment of breastfeeding mothers while utilizing evidence based interventions. Dr. Paula Schreck of St. John Mother Nurture Project in Detroit, MI, offered valuable insight into community based breastfeeding support as she compared and contrasted the Mother Nurture Project with traditional hospital-based programs. Dr. Schreck facilitated the first Physician led outpatient breastfeeding clinic in Michigan. I can’t wait to begin planning next year’s seminar. I’m sure it will be yet another stellar opportunity to provide education and resources to breastfeeding professionals.

community partner st. john mother nurture projectI’m excited to report that BMBFA has made significant progress in our efforts to support breastfeeding mothers and healthcare professionals in our community. We have increased our breastfeeding clubs from once monthly to four times per month with various times and locations throughout the city of Detroit. This expansion has enabled us to reach a far greater target population and minimized barriers to our mothers receiving necessary support. How awesome is that!

breastfeeding club mtgAnother area of significant progress is our breastfeeding peer counselor program. We recently graduated 11 women who have completed a rigorous curriculum assisted by Health Connect One, which has enabled them to provide breastfeeding counseling to women in the Detroit area with hopes of increasing breastfeeding initiation and duration rates. Surely this will help our mothers by overcoming obstacles that may otherwise lead to breastfeeding cessation.

bmbfa bf peer counselorsWe have formed amazing relationships in the community with those who share our enthusiasm and passion in which reciprocal support is provided to breastfeeding mothers and public health professionals. These relationships include Neighborhood Service Organization Harper Gratiot Service Center, Wayne CHAP (Children Healthcare Access Program), WIN (Women Inspired Neighborhood) Network, Detroit Black Community Food Security Network, Focus Hope and First Beat. Our relationship with the St. John Mother Nurture Project has flourished as we forge our efforts to diversify Lactation Consultants (IBCLC) in the state of Michigan. The Michigan Department of Community Health awarded BMBFA a $117,000 grant to supplement our work to eliminate breastfeeding disparities.

bmbfa board.founding directorBMBFA has also received a $400,000 grant from the W.K. Kellogg Foundation. The funds will be used to strengthen organizational capacity by building management systems, expanding existing programs and developing new programs, leading to sustainable growth to improve the quality of life for vulnerable, poverty stricken children, while causing social change for the greater good.
BMBFA’s community approach to breastfeeding support has been deemed innovative due to its explicit focus on narrowing the disparity gap that exists in breastfeeding rates.  In Michigan, only 50.9 percent of black children ever receive breast milk as compared to 68.5 percent of white children. Strengthening BMBFA’s infrastructure will lead to long-term increases in breastfeeding rates and work to create a monumental social impact that restores the emotional, psychological and physical health of the Detroit community.

We are looking forward to following our passion and doing incredible work in our community as we continue to answer the US Surgeon General’s Call to Action to Support Breastfeeding. Please visit our website at bmbfa.org to learn more about our breastfeeding programs and services. Also follow us on Facebook and Twitter!

Anjanette Davenport HatterAnjanette Davenport Hatter is the President of the Board of Director’s for Black Mothers’ Breastfeeding Association. Mrs. Davenport Hatter has dedicated her time to eliminate breastfeeding disparities for African American families. She understands how breast-milk decreases the risk factors for developing chronic diseases and has worked extensively with organizations such as Gift of Life MOTTEP, National Kidney Foundation, Children’s Hospital of Michigan and as a member of Alpha Kappa Alpha Sorority Inc. Her tireless efforts in working to improve health outcomes in her community has led to her nominations for the WEGO Health Activist  Award and the National Advisory Council on Maternal, Infant and Fetal Nutrition-Breastfeeding  Promotion. Mrs. Davenport Hatter holds Master’s Degree in Social Work from Wayne State University. She is a dedicated wife, mother and social worker.

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Contaminants in Breastmilk? IBFAN Responds.

By Joy Heads, OAM, IBCLC, FILCA, 

7643953482_b74b48b183The reality of the presence of environmental chemicals has been on the world’s radar since the release of Rachel Carson’s book Silent Spring in 1962.

Today it is accepted that every human body contains many man-made chemicals that can cause harm. Human milk has a high proportion of fat and therefore fat soluble contaminants, including dioxins, can be very easily measured.

Expressed breastmilk used to be included in the Australian Basket Market Survey, now called Australian Total Diet Study (ATDS), because it was easy to collect from consenting women in postnatal wards.

Over the last few decades, scare tactics have emerged, warning women about the perceived danger of breastfeeding.  I clearly remember one front page headline in a Sydney Sunday paper in the mid 70’s screaming: DDT’s in breastmilk: mothers poisoning their babies.

The press coverage of Florence William’s 2012 book: “Breasts: A Natural and Unnatural History”, which covers her investigations into the issue, did little to allay these fears.

It is therefore heartening that the International Baby Food Action Network (IBFAN) has just released “IBFAN Statement on Infant and Young Child Feeding and Chemical Residues” (2013), which presents objective and independent information for parents, carers and health professionals.

The main author of the paper is well respected Dr Adriano Cattaneo, Consultant Epidemiologist and Co-ordinator of the Unit for Health Services Research and International Health, Institute of Child Health “IRCCS Burlo Garofolo”, Trieste, Italy, a WHO Collaborating Centre for Maternal and Child Health. Dr Cattaneo was an Expert Reviewer on the 2012 NHMRC Infant Feeding Guidelines.

This evidence-based, well referenced statement goes beyond the issue of possible residues in human milk to include that of contaminants in infant formula including in the unnecessary, but cleverly marketed, follow-on formulas, baby foods, feeding bottles and teats.

The paper also emphasises the potential harm of chemical exposure during pregnancy at a time when tissues and organs are growing rapidly. It reinforces the fact that there is now far greater understanding of the beneficial effects of breastfeeding and its role in developing immune protection and mitigating the harmful effects of chemical exposure in the womb.

Conversely, formula feeding does not afford any protection to babies at all. The ecological footprint and consequence of increasing rates of formula feeding is also addressed.

The document lists 10 Key Points and Key IBFAN Messages, which includes the statement that “pregnant and breastfeeding mothers have the right to receive full and unbiased information”.

IBFAN endorses international health regulations to protect, promote and support breastfeeding – because the benefits outweigh any possible harm -“except in the case of industrial disasters and of exceedingly high residues after industrial disasters”.

Contained within the paper is a Call for Action, urging decision-makers and industry across the globe to implement the Stockholm Convention on Persistent Organic Pollutants (POPs).

The Appendix is an excellent reference and carries an analysis of 13 chemical residues or families of chemical residues. IBFAN have considered only substances “for which there is ample literature and that are a target for important policies and regulations worldwide.”

This paper provides strong evidence that the continuing fight for a healthy global environment, with minimum toxins, is a challenging one considering industry redistribution and weak environmental regulations.

This post was originally published on Crikey, a news service from Australia. We thank them for allowing us to republish it here. 

Joy HeadsJoy Heads, OAM, IBCLC, FILCA,  is a midwife and has been an International Board Certified Lactation Consultant since 1986. In 2009, she was awarded the designation of Fellow of the International Lactation Consultants Association (ILCA™). She is currently on the Board of Directors of ILCA, and co-wrote the chapter on “Breast Pathology” for the ILCA’s Core Curriculum for Lactation Consultants (Editors: Mannel B, Martens P J, Walker M. (3nd ed) Jones & Bartlett. MA. USA. 2013). In 2006 she was awarded the Order of Australian Medal for service to nursing and midwifery as a specialist lactation consultant and to health professional and parent education. Joy was the Clinical Nurse Consultant (Lactation) at the Royal Hospital for Women, Sydney for many years until she retired from paid work in late 2010.

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A Look Inside A Work in Progress

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By Christine Staricka

How do new ideas spread in the lactation community? How often are there really any NEW ideas? How big does an idea have to be to make a real difference? These are questions I am asking myself as I write and create a new lactation education toolkit based on my middle-of-the-night revelation that we need a better way to motivate and empower mothers.

The idea sprang from working through two very routine cases with patients in the hospital…not an unusual situation but I was frustrated that I couldn’t find the words to teach these mothers effectively. This led to lengthy conversations with my lactation colleagues, then some sleepless nights and, finally, a light bulb moment.

But this is about what happens AFTER the light bulb moment, after you start frantically typing and rifling through piles of research articles and textbooks, the days where you move through all you other activities, waiting for the free moment when you will have time to express your blossoming ideas and capture them, and the glazed-over look of your family member who have long since tired of hearing about your new breastfeeding project.

What does one do with a new idea? My first obstacle was deciding on a format to express the idea. In this case, an article seemed as if it would not do justice to the concept, so a blog post or an entry to a journal seemed like the wrong place to start. The concept lends itself well to a toolkit and a toolkit with a broad audience requires excellent and accurate reference. Proper credit must be given to those whose ideas came before and which form the basis of the founding principles of the new concept. Research articles much be located and cited. Well-accepted textbooks must be consulted and cited. Online searches for similar concepts must be performed diligently. As the research and writing proceed, new thoughts on the direction of this concept are constantly forming and being reshaped.

Considering the direction of the project has revealed several things to me: the lactation community is global, diverse, and highly intelligent. Providing lactation support is an endeavor which requires not only the accumulation of knowledge, but the critical thinking skills and resourcefulness to make judgement calls and navigate tricky situations, both with parents and in healthcare settings. It takes a very unique set of skills to be an effective lactation support provider. Lactation care providers also must be effective educators, sensitive and valuable counselors, and excellent communicators.

The lactation community has learned to embrace all new methods of communication. LactNet has existed as a way of connecting far-flung individuals involved in lactation support for most of the time the internet has been widely available. All of the newer methods of communication have been rapidly assimilated into the culture of our community. This blog is an excellent example of a modern and efficient tool for mass communication used to all of its advantage by our professional organization.

So, with the ease of communication which has been established by the lactation community, the only issue remaining for someone with a new idea is to reflect on how new the idea really is and how to measure its effectiveness. Just as the writer of an essay considers and reconsiders the thesis statement many times during the writing, this idea must be truly probed for its originality. If it is not unique enough, its scope of influence will be small.

But that thought has brought me back to the basic principle of lactation support: if an idea or a tool helps even one mother and baby experience breastfeeding, it is successful. If a lactation care providers helps one mother and baby breastfeed better even one time, the provider has completed his or her objective. If an idea, a tool, or a provider can influence even one mother and her baby, it is meaningful for this world.

photoChristine Staricka is a hospital-based IBCLC. She became a Certified Lactation Educator through UCSD while facilitating local breastfeeding support groups. She studied independently while accumulating supervised clinical hours and passed the exam in 2009 to become an IBCLC. She holds a BS in Business Management from University of Phoenix. Christine is the co-owner of Bakersfield Breastfeeds, which provides lactation education to professionals and expectant parents. She has contributed to USLCA’s eNews as well as this blog. She enjoys tweeting breastfeeding information as @IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of who have been or are still breastfeeding. She is partial to alternative rock and grunge music, especially Pearl Jam, and attends as many concerts as financially able with her husband of 18 years.

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Myth Busting the Milk Banks: The Top Four Misunderstandings about Milk Banks

Recently we started a conversation within the IBCLC community about milk banking.  This post is dedicated to clearing up some common milk banking misunderstandings. IBCLCs and others who support breastfeeding families can be important advocates and the issues surrounding milk banks are very relevant to your practice. A study in Brazil showed that the top reason mothers donated milk was that it was recommended by a health care professional so this is certainly an area where IBCLCs can have an impact regarding improving access to the gold standard of infant nutrition – human milk.

By Frances Jones, RN, MSN, IBCLC 

Does milk keep its healthful properties when pasteurized?

pumped milkThere has been quite a bit of discussion about the impact of pasteurization on human milk’s “miracle” properties. Milk banks provide milk to the most fragile infants and cannot risk even the every-day types of viruses that mom’s own baby could tolerate. The Holder Pasteurization method, used by HMBANA milk banks, impacts some of the biological activity of the milk, but many of the compounds unique to human milk are retained either completely or partially.  Studies show that Human Milk Oligosaccharides (HMOs) that contribute to gut development and pathogen binding are retained, and partial amounts of antibodies and antimicrobial proteins also remain.  Researchers are studying other pasteurization techniques, such as ultrasonication, high-temperature short-time, and microwaving, that would allow even more of the beneficial elements to be preserved while continuing to ensure the product is free of pathogens.

Related to this issue, we are often asked about whether or not “raw” milk is better for babies. Yes –milk directly from the breast of the baby’s own mother is absolutely the best choice! Policies and practices in the United States and beyond must continue to focus on supporting and protecting women to breastfeed their own children. Every HMBANA bank supports breastfeeding as a central operating principle. Pasteurized donor human milk is the alternative after mother’s own milk.

What does it cost to process human milk and how is this cost passed on to the consumer?

Some donors confuse the milk processing charges of non-profit HMBANA milk banks with the profit-motive of for-profit pharmaceutical companies. HMBANA banks operate on very tight budgets, relying on grants and charitable donations to provide their service to families whose infants’ lives may depend on the milk. The milk processing fee charged to the family (and, in some cases, covered by their medical insurance) only partially covers a milk bank’s operating costs.  Clearly, the fee for pasteurized donor milk in North America is a barrier to access for some and HMBANA leaders are working behind the scenes to shape health reform laws so all insurance companies cover this medical expense.  In Brazil, where the milk banks are part of the government health services, pasteurized donor milk is dispensed via prescription at no charge to the recipient. Access to human milk is an important public health initiative and future policies and programs should reflect this.

Can families who don’t have babies in the NICU access milk from HMBANA milk banks?

Photo by bgreenlee via Flickr Creative Commons

Photo by bgreenlee via Flickr Creative Commons

While critically ill infants are the first priority for milk banks, when adequate donations are available, HMBANA banks provide for infants whose mothers are ill or deceased, toddlers with medical conditions, and even adults.  Donor milk is dispensed via physician’s prescription.  Last year, demand shot past supply, and as word continues to spread about the benefits of donor milk, HMBANA banks routinely experience low or empty freezers.  The more regular donors HMBANA has, the better equipped they will be to meet the needs of all who could benefit from donor milk.

How can IBCLCs support families in donating to HMBANA milk banks?

Currently, there are 13 HMBANA milk banks serving all of North America and more are opening each year. The first thing you can do as someone who supports breastfeeding families is to identify which HMBANA milk bank serves your community. If you need help, please don’t hesitate to contact HMBANA directly. If you are fortunate enough to have a bank close to you, please direct families to contact them for information about donating. For out of town donors, nearly all HMBANA banks will provide coolers and pay the shipping costs to have milk sent overnight to the bank for processing. In an upcoming blog post, we’ll discuss the requirements for donation and interview a current donor to a HMBANA milk bank about her experience. 

IMG_3767Frances Jones is the Coordinator of the Lactation Services and Milk Bank at British Columbia Women’s Hospital in Vancouver, British Columbia, Canada. Frances has worked with breastfeeding families for over thirty years and has been running the milk bank since 2000. She is the author of the HMBANA’s Best Practice for Expressing Storing and Handling Human Milk in Hospitals Homes and Child Care Settings and has spoken at many conferences on breastfeeding and milk banking topics. Most importantly, she is the mother of five sons and grandmother of one granddaughter – all breastfed. 

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Getting Human Milk to Human Babies: The Role that HMBANA Milk Banks Play

One of the wonderful things about the internet is having access to so much information. Need a recipe, driving instructions, or a referral for an electrician? It’s a click or two away.  The downside is that information isn’t always complete or accurate, and misinformation can spread.  The amount of media attention on the sharing of human milk has exploded in recent years leading to a certain amount of confusion.  We caught up with Frances Jones, Executive Director of BC Women’s Mothers’ Milk Bank in Vancouver, Canada and president-elect of the Human Milk Banking Association of North America (HMBANA) and have developed this “Milk Banking 101” blog in order to clear up some confusion about non-profit milk banks and open a conversation within the IBCLC community so that IBCLCs are positioned to support the choice that best meets the needs of breastfeeding families and their babies. We hope you’ll join in this conversation!

By Frances Jones RN, MSN, IBCLC

Photo used with permission from Indiana Mothers' Milk Bank

Photo used with permission from Indiana Mothers’ Milk Bank

Background on Milk Banking

The first milk banks came into existence in the early 20th century as food technology evolved allowing for successful storage of human milk. Even in those early banks, donors and their milk were carefully screened. Fast forward to the 80’s and a post-AIDS era of caution. Those of us who believe in the power of human milk formed the Human Milk Banking Association of North America (HMBANA) to ensure safe standards for all donor milk banks in North America. The HMBANA guidelines, developed with the assistance of the Food and Drug Administration (FDA), the Center for Disease Control (CDC) and the American Academy of Pediatrics (AAP), have been used globally in the development of nearly all milk banking standards and are reviewed annually to ensure safety.

Milk that is subject to storage and transportation is not the same product as milk that is consumed straight from a mother’s breast (which is why Louis Pasteur is considered a founder of disease-prevention-science for figuring out how to reduce the pathogens in milk and wine through a technique that still carries his name today). HMBANA’s safety steps include screening donors through interviews and blood tests (for HIV, HTLV, syphilis, hepatitis B and C), pasteurizing the milk, testing for pathogen growth, tracking milk and implementing mock recalls.  Milk banks put huge effort into ensuring donor human milk is safe for the most vulnerable of infants.

Photo used with permission from Indiana Mothers' Milk Bank

Photo used with permission from Indiana Mothers’ Milk Bank

What is the Difference Between “Milk Banking” and “Milk Sharing”?

Milk banking involves donating human milk to an intermediary (similar to a blood bank) who ensures the safety of the product and distributes it to those in greatest need.  Milk sharing involves sharing human milk with sisters, neighbors, and friends, and is a practice that has been going on for centuries as mothers have helped each other.  Today, the Internet has changed the way we communicate, enabling a rise in milk sharing outside of our closest circles. This capacity for expanded milk sharing may increase the risk associated with the transmission of disease and contaminants (e.g. drugs and alcohol). Several health authorities including the FDA, AAP, Health Canada as well as the French government have expressed concern over Internet milk sharing.

When supply is scarce, as it has been in recent years with a growing demand for donor milk,  HMBANA banks are limited to serving the most vulnerable and critical babies in our communities. In 2010, the CDC reported over 325,000 low-birth weight (LBW) births in the United States, of which over 55,000 were very low birth weight (VLBW) babies, weighing less than 1.5kg.  In 2011, HMBANA banks collected a little over 2 million ounces of donor milk, which averages only 7 ounces per LBW/VLBW baby. We simply need more milk to be able to meet the needs of these vulnerable infants. We recognize that many non-NICU infants (and even some adults!) would benefit from donor milk and that the cost of pasteurized donor milk in North America is a barrier to access for some (which is one of the factors contributing to the rise in milk sharing). This is why HMBANA supports many families through charity care and our leaders are working behind the scenes to try to shape laws so donor milk is covered by more insurance companies.  In Brazil, where the milk banks are part of the government health services (in contrast to the practices in North America), pasteurized donor milk is dispensed via prescription at no charge to the recipient. Access to human milk is an important public health initiative and future policies and programs should reflect this.  In the meantime, the more milk that HMBANA banks collect, the more families can be served.

What is the Difference Between Non-Profit Milk Banks and For-Profit Pharmaceutical Companies?

HMBANA defines a milk bank as  ”a service established for the purpose of recruiting and collecting milk from donors, and processing, screening, storing, and distributing donated milk to meet the specific needs of individuals for whom human milk is prescribed by health care providers who are licensed to prescribe.” There are also “milk depots” which are locations that collect and store milk and then transport it to a “milk bank” for processing and distribution.  These terms are used loosely and some sites that are actually depots label themselves as milk banks.

Increasingly, our non-profit milk banks have faced competition for donors from for-profit pharmaceutical companies that solicit donor milk and turn it into high-end products.  HMBANA milk banks are non-profit and keep processing costs associated with safety protocols as low as possible.  For-profit companies sell their products at a profit while relying on donor mothers to provide the raw human milk for processing. HMBANA banks count on additional funds through grants and in-kind donation to continue operating. Private companies must achieve profit from their products to satisfy investors.  Many IBCLCs and others who support breastfeeding mothers are confused because some of the for-profit collection sites have names that seem to indicate that they are association with non-profit banks (e.g. Milk for Wishes Milk Bank, Helping Hands Milk Bank). Ambiguity can sometimes mislead and confuse donors. Every donor should understand who is receiving their milk and what will be done with it (read this great blog post by a mom who felt misled regarding the generous donation of her milk).

IMG_3767Frances Jones is the Coordinator of the Lactation Services and Milk Bank at British Columbia Women’s Hospital in Vancouver, British Columbia, Canada. Frances has worked with breastfeeding families for over thirty years and has been running the milk bank since 2000. She is the author of the HMBANA’s Best Practice for Expressing Storing and Handling Human Milk in Hospitals Homes and Child Care Settings and has spoken at many conferences on breastfeeding and milk banking topics. Most importantly, she is the mother of five sons and grandmother of one granddaughter – all breastfed. 

In our next blog we’ll tackle some misunderstandings about milk-banking.  If you have questions you’d like answered, please leave a comment and we’ll do our best to find answers.  We’d love to hear about the resources you feel would help you to provide mothers with good information regarding their options when they have extra milk or are seeking milk for their infants. We look forward to continuing this conversation.

* A special THANK YOU to Indiana Mothers’ Milk Bank for permission to use their photos. For more of their photos, check out their Instagram profile.

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