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Parental Proximity: A Vital Aspect of Our Message

By Marianne Vanderveen-Kolkena, IBCLC 

In the year 1994, our third daughter was born. It was a beautiful home birth and we all felt blessed to be safely together. After a few days, however, I fell seriously ill with an old-fashioned disease: puerperal fever. It brought me to the hospital and I entered a world I had never been in before: the delivery ward. My stay awakened an awareness in me that has grown ever since: mothers should be central in the care of their infants, and healthcare providers ought to refrain from interfering with the essential process of secure attachment.

Skin to SkinStarted in 1994, my work as a volunteer breastfeeding counselor evolved to the private practice I have now as an International Board Certified Lactation Consultant in Assen, in the north of the Netherlands. As an ardent reader, my notion of “breastfeeding” has broadened immensely over the years. Breastfeeding is a dyadic, relation-building process of which a baby latching properly and taking in enough breastmilk is only a small part. This notion made me decide to take up a couple of translation projects besides my consultations. Many parents are desperate for good information, information that helps them to make choices that match their family values. Many parents intuitively know that being close to their infants is something they will all benefit from. Western societal habits, however, often hardly allow for that much needed proximity of primary attachment figures. Talking with parents, seeing how they are moved when I address the issue of how much their baby needs them and how much they have to offer, is very inspiring. My Dutch translation of Sleeping With Your Baby, written by James J. McKenna, led to beautiful responses from parents in the Netherlands: “Wonderful, to have this book now! I always knew it was a good thing to sleep together!” Mid April, the Dutch translation of Jill and Nils Bergman’s book Hold Your Prem will be published.

We all need a place where we can feel safe, so that we can develop physical and psychological stability in life. We do not only need that as a baby, but also as parents, in order to take care of our babies. I feel privileged to be able to professionally contribute in different ways to that sense of security!

SONY DSCMarianne Vanderveen-Kolkena started her breastfeeding work in 1994 with the Dutch breastfeeding association VBN. She became an IBCLC in 2008 and runs her private practice in Assen, the north of the Netherlands, Borstvoedingscentrum Panta Rhei. She still works with the VBN as editor for the brochure committee and gives presentations in different settings. She contributed to the Dutch national guideline on dealing with excessively crying babies, making a warm plea for responsive parenting, and was one of the two final editors of the Dutch National breastfeeding guideline. Marianne is a coworker of the biggest Dutch breastfeeding website,, advisor of ‘Het OuderSchap’, a Dutch organisation for parents (to be) and and an ILCA member.  All her practice and advocacy work focuses on the normalcy of breastfeeding, the importance of the mother-child relationship, the value of parental proximity in the early years and on language use that supports these aspects. She is preparing to study Anthropology at the University.


Applauding Maryland’s Ban the Bags Initiative

The Maryland Breastfeeding Coalition has recently initiated a movement to “Ban the Bags” in Maryland. They sent the following letter and video outlining their efforts to to the CEOs of all birthing hospitals across the state, requesting the removal of all commercial infant formula discharge bags. We applaud their efforts and look forward to hearing how their actions support mothers and babies in Maryland. We hope that their letter and the influence it has can serve as a model for other states and countries to make the same changes in their communities.

banthebagsThe Maryland Breastfeeding Coalition lauds and strongly supports the recent release of the Maryland Hospital Breastfeeding Policy Recommendations by the Maryland Department of Health and Mental Hygiene (DHMH). As part of these recommendations, in an effort to protect and improve maternal and infant health in our state, we write today to urge your hospital to join with all hospitals in Maryland in discontinuing the distribution of commercial infant formula discharge bags. The initiative to ban the practice of marketing formula by health care institutions and professionals in all birthing hospitals is supported by DHMH’s recommendations, as well as other public health authorities, including the American Academy of Pediatrics, the Centers for Disease Control, and the 2011 Surgeon General’sReport.

Banning the bag is feasible!  Your hospital can join those hospitals that have committed to protecting breastfeeding and refuse to act as marketing agents of formula companies.  Several Maryland hospitals have already banned the formula company discharge bags without significant hardship or obstacles. In the process, they have been able to simultaneously increase their marketability.

  • Through working with their purchasing and marketing departments, some like Upper Chesapeake Medical Center and Shady Grove Adventist Hospital have designed and distributed their own discharge “gifts” which advertise their respective hospitals.
  • Johns Hopkins Hospital stopped giving out formula samples over three years ago as part of a hospital-wide effort to stymie the marketing of pharmaceuticals within its facilities.  The hospital administration has chosen not to give out a replacement bag.
  • Other hospitals such as Memorial Hospital at Easton discontinued distribution at the behest of Risk Management upon investigating their liability in the event of a formula recall or a baby getting sick from expired or contaminated formula.

While these hospitals and others no longer hand out formula bags upon discharge, banning the bag never prevents a mother from obtaining free formula samples if she so requests.   She can simply be directed to call the toll-free number on the back of every formula container to receive free bags, coupons, or samples. Your hospital aims to promote the health of infants and mothers, but when providing the bag and/or formula samples, the ongoing promotion of infant formula sends the inaccurate message that these products are medically approved, endorsed, and necessary.

The Maryland Breastfeeding Coalition has prepared a brief power point presentation to highlight the research regarding the effects of formula discharge bags and discuss further how hospitals can approach banning the bags. We encourage you to view and share it with your staff.


For more information, you can browse, and Public Citizen .  You can also visit the website of the Massachusetts Breastfeeding Coalition which has successfully led all 49 of Massachusetts’s birthing hospitals to ban the bag.  Our own Maryland Breastfeeding Coalition website will soon contain links to the You Tube video for staff and other resources. Help us make Maryland the next state to successfully put the health of our youngest citizens first by banning the formula discharge bags from all birthing hospitals. Please contact us if the Maryland Breastfeeding Coalition can be of further assistance to you, or if you have any questions.

Please share this information with other relevant departments within your hospital. We very much appreciate your time with this matter.

What is your community doing to eliminate the marketing of formula in your hospitals?


How Breastfeeding Saves Lives…and How You Can Help

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Annie Urban on her blog, PhD in Parenting. We appreciate her permission to repost it here.

830,000 newborn deaths could be prevented if babies were breastfed within the first hour.

1.4 million child deaths could be prevented if optimal breastfeeding practices were followed (exclusive breastfeeding for the first 6 months and continued breastfeeding until at least 2 years).

Vilma, 20, breastfeeds her youngest child, Alderico (10 months), in their one room home in an urban slum in Paranaque City, Metro Manila, The Philippines on 18 January 2013. Vilma had raised her first 3 children on formula and had to cut down on food for her family to afford it. Both John Ashley, 4, and Justin, 3, are malnourished and stunted, and after losing one of her children, she now breastfeeds her youngest, Alderico. Image Credit: Suzanne Lee / Save the Children (Used With Permission).

Overcoming Barriers to Breastfeeding Will Save Children’s Lives

Source: Save the Children, Superfood for Babies — How Overcoming Barriers to Breastfeeding Will Save Children’s Lives (2013).A new research report released by Save the Children today underscores the importance of breastfeeding in saving babies’ lives.

In developing countries, malnutrition is still a significant problem — it was the cause of one third of the 7 million child deaths in 2010. According to the Save the Children report, breastfeeding is “the closest thing there is to a ‘silver bullet’ in the fight against malnutrition and newborn deaths.” Although child mortality rates are decreasing overall, a greater proportion of deaths now occur during the first month.

The Save the Children report points out that breastfeeding could prevent a higher proportion of child deaths than any other intervention, including mosquito nets, vitamins, vaccines, clean delivery, water and sanitation, and more.  

Yet breastfeeding rates globally have remained stagnantly below 40% for the last 20 years. While progress has been made in some countries, there are other areas (especially in east Asia and the Pacific) where the rates are starting to fall with potentially disastrous consequences for babies’ lives.

Why aren’t more babies breastfed globally?

The report by Save the Children identifies four main barries to breastfeeding globally (which align well with the types of barriers and challenges I’ve spoken about on this blog over the years). They are:

  1. Community and Cultural Pressures: Bad advice, denying newborn colustrum or giving other foods or liquids before starting breastfeeding, pressure from other family members (many women are not free to make their own decisions about how to feed their child).
  2. Health Worker Shortage: One third of infants are born without a skilled birth attendant present, making it difficult to ensure mothers have good breastfeeding support in the first hours after birth.
  3. Lack of Maternity Legislation: Mothers often need to return to work  shortly after giving birth, cannot take their children with them, and do not have breastfeeding / pumping friendly workplaces.
  4. Big Formula: The marketing activities of formula companies continue to violate the WHO Code of Marketing of Breastmilk Substitutes, resulting in unnecessary and improper use of formula.  Legislation doesn’t exist or isn’t enforced, leaving mothers and babies vulnerable to predatory marketing practices.

What Needs to Change?

To help overcome these barriers and ensure that more mothers are able to breastfeed their babies, Save the Children is asking world leaders, international institutions and multinational companies to implement the following four recommendations:

  1. Fund projects that will help overcome harmful practices and tackle breastfeeding taboos by focusing on changing the power and gender dynamics so that young women are empowered to make their own decisions about how to feed their babies.
  2. Ensure sufficient resources and infrastructure are in place to allow a skilled health worker to be present  at every birth.
  3. Governments should introduce nationwide breastfeeding-friendly policies and legislation focused on maternity leave, financial protection for mothers on maternity leave, and employer support of breastfeeding women in the workplace.
  4. Improving breast-milk substitute industry (primarily the infant formula industry) practices through a combination of changes within the industry and better national regulation of marketing practices.

Image credit: Caroline Trutmann / Save the Children (Used With Permission).

The First Hour

What struck me the post reading the report were the figures on the estimated deaths that could be prevented through breastfeeding within an hour of birth. I’ve long known that it is a best practice, but looking at the significance of that seemingly little factor compared with all other interventions, amazed me.

Here is what the research said (from page 4 of the Save the Children report) :

Save the Children estimates that 830,000 infant deaths in developing countries could be prevented if every baby were given breast milk, and only breast milk, in the first hour. Using two studies from Ghana and Nepal, we calculated the effect that increasing the current rate of early initiation to 100% would have if all other factors remained the same. Infants who are not breastfed within an hour are 86.5% more likely to die during the neonatal period – the first 28 days of life – than those who are breastfed.

The study in Ghana found that 16% of neonatal deaths could be prevented if all infants were breastfed within 24 hours of birth, and 22% if breastfeeding started within the first hour of life. The study in Nepal found that an infant given breast milk within an hour of birth is up to three times more likely to survive than one breastfed a day later. Infants who are not breastfed until they are two days old are more than four times more likely to die.

My son wasn’t breastfed within the first hour. I don’t remember exactly when I first nursed him, but it certainly wasn’t immediately and once I did, he didn’t latch. He was born at 7:30am and I didn’t get to see a lactation consultant until sometime the next afternoon (i.e. around 32 hours later) despite the fact that he wasn’t latching on at all. If I could change one thing about hospital practices here in Canada, it would be to ensure that all moms who are planning to breastfeed are encouraged to nurse in that first hour and that they are referred to a lactation consultant immediately if things are not working. I shouldn’t have had to wait that long to get professional help. I shouldn’t have had nurses with insufficient training in lactation pushing formula on my child before I’d had a chance to see a lactation consultant. I shouldn’t have had to see the pediatrician (who only did her rounds once per day) before getting a referral to the lactation consultant.

Globally, if I could change one thing it would be to ensure that all mothers have access to a skilled birth attendant who is trained in breastfeeding best practices, whether they are delivering their baby at home, at a birth centre, or at a hospital.

As I’ve said before, moms don’t need more pressure to breastfeed. But they do to be empowered and supported in their feeding choices. At the moment, that still isn’t happening. In some cases, that means moms cannot meet their own breastfeeding goals. In other cases, especially in the developing world, it is still an issue of life or death.

What Can You Do To Help?

If you want to help save babies lives and ensure mothers are empowered in their feeding choices, you can:

  • Sign the petition calling on Nestlé and Danone to change the way they market infant formulato comply with the WHO Code of Marketing of Breastmilk Substitutes.
  • Donate to Save the Children’s No Child Born to Die campaign to help tackle malnutrition and overcome the global shortage of health workers.
  • Write to your local hospital, member of provincial parliament, and health minister, asking them to ensure that all mothers who are planning to breastfeed are encouraged to breastfeed within the first hour of birth and that they have immediate access to lactation consultants if they are having any difficulty.
  • Read the Save the Children report to educate yourself and so that you can educate others about the issue of breastfeeding globally. Some of the statistics on breastfeeding in countries around the world are staggering and fascinating.
  • Encourage companies you work for or buy from to sign on to the C.A.R.E-WHO Alliancecoordinated by Best for Babes, demonstrating their committment to caring about moms and babies and complying with the WHO Code.
  • Blog, Tweet, Facebook or otherwise share the Save the Children report or this blog post.

What do you think needs to change to increase breastfeeding rates globally?


URGENT ACTION NEEDED in the United States

By Marsha Walker, RN, IBCLC, USLCA Director of Public Policy

USLCAMany mothers need breastfeeding help, but cannot access the level of care that they need.

Even though the Affordable Care Act requires breastfeeding support, it does not specify the provider that best fulfills this mandate. Many insurers will not credential IBCLCs nor maintain IBCLC networks because IBCLCs are not licensed. Breastfeeding care becomes more fragmented and deferred to providers who may not have the training or expertise to handle complex lactation situations. This means that many breastfeeding women are without the care they need, when they need it the most.

Your voice is needed.

The Department of Health and Human Services (HHS) is creating rules for insurance companies in the individual and small group markets under the new health care law. As part of this effort, they will take comments from the public about what services insurance companies must cover. Use this opportunity to tell HHS that mothers should have access to IBCLCs, that insurers should cover the services of the IBCLC, and that all breastfeeding mothers deserve access to IBCLCs, not just those who can afford it.

We’ve made a lot of progress – but there’s still more to be done. Send in your comments at HERE. Comments are due by 5:00 PM Eastern time on December 26, 2012. The entire proposed rule can be found HERE.

The US Lactation Consultant Association is working hard to assure that IBCLC services are available to all women. Thank you for all you do to ensure women have access to quality, affordable health care. Your letter needs to be brief as the portal allows only 2000 characters. You can cut and paste the following sample letter into the comment portal HERE.

Please state that insurance companies must cover the services of the International Board Certified Lactation Consultant (IBCLC) in the maternal and newborn section of the Essential Health Benefits (EHB). IBCLCs are allied health professionals certified through a rigorous credentialing process who possess the requisite skills to manage common and complex lactation management issues. Too many breastfeeding mothers lack access to the level of care that they need, resulting in fragmented care deferred to providers who may not have the training or expertise to handle complex lactation situations. See for a guide to lactation qualifications. This drives up the cost of and increases the number of health claims due to increased infant illnesses and conditions preventable by successful breastfeeding. Services of IBCLCs result lower health care costs to insurers. The U.S. Surgeon General included in the 2011 Call to Action to Support Breastfeeding, the specific recommendation to provide reimbursement for IBCLCs independent of their having other professional certification or licensure. The Centers for Disease Control and Prevention use the IBCLC as a metric in its determination of the adequacy of breastfeeding support in its annual Breastfeeding Report Card. 

State required benefits should include IBCLC services to improve the quality and value of the coverage that is available for EHB. Please include coverage of IBCLC services under Sec. 147.150 Coverage of essential health benefits. Beginning in 2014, all non grandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, and Basic Health Programs (if applicable) will be required to cover essential health benefits. I strongly encourage Secretary Sebelius to expressly declare in the text of the final rule that health plans specifically state that coverage will be available for IBCLC services.

Thank you for helping USLCA with their advocacy efforts to bring increased access to lactation care for mothers, babies, and their families.


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