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IBCLCs Play a Critical Role in the US Best Fed Beginnings Program

By Debi Ferrarello, MSN, MS, IBCLC

The National Initiative for Children’s Healthcare Quality (NICHQ) launched it’s CDC-supported Best Fed Beginnings program with the ambitious goal of preparing 90 US hospitals for Baby-Friendly designation by September, 2014. The 90 hospitals were selected from 235 applicants and represent 29 states with dubious distinction of having the lowest breastfeeding rates and the highest rates of supplementation during the hospital stay. The 90 hospitals were further divided into three geographical cohorts of 30
hospitals each.

IBCLCs gathering at the recent NICHQ Region B conference in Baltimore.

Each hospital has a “core team” that includes a senior administrator, at least one physician, a nurse leader, a bedside nurse, a data manager, a team leader, a senior lactation consultant, and a mother who does not work for the hospital and has given recently given birth at the hospital. This model addresses administrative “buy-in” issues by requiring senior administrator participation. In fact, the senior administrators have their own track tailored especially for their needs. Since creating a community that supports breastfeeding is a goal of Baby-Friendly, involving a mother from the community makes so much sense!

Recently, hospital core teams from “Region B” gathered in Baltimore, MD for a two day learning session (and Baltimore’s famous crabcakes on our own!). National public health leaders such as CDC’s Laurence Grummer-Strawn and Charles Homer, MD, MPH, president of NICHQ and on faculty at Harvard University, kicked off the event and energized the crowd. Over the course of two days, participants learned more about why breastfeeding is so important, how hospital practices make a difference, and what teams can do to transform the culture. We heard specifics about Baby-Friendly designation directly from Trish Mac Enroe and Liz Westwater of Baby Friendly USA. ILCA members Lori Feldman-Winter, MD, MPH, IBCLC and Anne Merewood, PhD, IBCLC provided specific strategies for success. Pediatrician Sahira Long, MD, gave insights into providing culturally appropriate care. We learned Continuous Quality Improvement (CQI) techniques that are essential to measure our baseline, develop strategies for change and chart our progress as we strive to support breastfeeding from the prenatal period, throughout childbirth and the hospital stay, and into the postpartum period. Finally, we heard from hospitals in our region who have already become Baby-Friendly as they shared trials and triumphs that we could all relate to.

Each participating hospital made a “story board” or video about their hospital, their goals, their successes, and challenges. Pennsylvania Hospital Core Team members enjoyed seeing what others have done and were proud to share our history of “rooming-in” dating back to 1765! Debi Ferrarello, Susan Meyers, Brittany Stofko, Kelly Wade, Pam Powers, and Karen Anastasia in front of their hospital story board.

So what do IBCLCs need to know about this initiative? IBCLCs need to know that after years of pushing that boulder up the mountain alone, there is suddenly an army of folks pushing right along with us…And we need to welcome the newcomers to the task. We need to be prepared to graciously play support roles as leaders who may never before have considered breastfeeding suddenly “discover” it. Many of the hospital team leaders are IBCLCs, meaning that we need to quickly become experts in CQI tools that were never part of The Exam and develop the essential skills to effectively lead an interdisciplinary team through a complex and multi-layered transformation. This is challenging work, but then again, IBCLCs have always be up for a challenge!

Best Fed Beginnings brings opportunities for IBCLCs. In order to become Baby-Friendly, hospitals need to make sure that all of their nurses have at least 20 hours of breastfeeding education, including five hours of competency-based demonstration. IBCLCs can teach classes and conduct skills labs for the competency education. While hospitals are not required to employ IBCLCs for Baby-Friendly designation, many do hire IBCLCs to care for their patients, as well as to provide education for other staff members. And finally, as hospitals invest resources into breastfeeding support, the visibility of those with expertise in lactation care rises. IBCLCs become far more valuable in the eyes of the hospital and the community. This is all good for IBCLCs, and ultimately for mothers and babies!

Debi Ferrarello, MSN, MS, IBCLC is honored to lead the NICHQ Core Team for the nation’s first hospital—Pennsylvania Hospital in Philadelphia.  Over the years she has worked in private practice, co-founded the nonprofit communty-based Breastfeeding Resource Center with Colette Acker, IBCLC, and led hospital-based lactation programs.  She conducts breastfeeding-related research, writes and speaks about breastfeeding, and is passionate about breastfeeding as public health.  She currently serves on the board of the United States Lactation Consultant Association. 


Reducing the Breastfeeding Disparities Among African American Women: A Commentary from ROSE, Inc.

Reaching Our Sisters Everywhere, Inc. (ROSE) seeks to enhance, encourage, support, and promote breastfeeding throughout the USA, by working to reduce the breastfeeding disparities among African American women. We also seek to strengthen the health of their families through, mentoring, breastfeeding support groups, social support, outreach, education, health policies and social marketing. ROSE works with national groups to strengthen local groups that serve African Americans who breastfeed.

It is our understanding that a storm is brewing in the lactation community among International Board Certified Lactation Consultants (IBCLC) and the several other lactation certifying organizations to gain the title of grand matron of the breastfeeding world. The African American community needs all the breastfeeding management assistance we can get in order to overcome the breastfeeding disparities in our community. ROSE is grateful for the work that you all do. We understand that breastfeeding promotion is not enough. To be successful, mothers may need hours of skilled help that is provided when needed. We are of the position that there is a need for several levels of lactation managers. There is a need for the novice, the beginner, the intermediate and the expert lactation specialist. We are of the position that EVERY informed person can help a mother to breastfeed. We are in NEED of every advocate who wishes to be involved with lactation management, to be applauded and welcomed to the table of breastfeeding protection. Everyone does not NEED a cardiologist. Everyone does not need a specialist. However, when a specialist is needed, it is wonderful to be able to refer to the IBCLC.

Becoming and maintaining the designation as an IBCLC is a complicated and expensive process. Many of us, concerned with addressing the disparities of breastfeeding in the African American community do not have the luxury of the time that it takes nor the necessary funds to be involved in this complicated process. This is what we have been told by African American health care providers and community organizers as we travel. That some sort of designation is important for the provider of direct lactation services in the hospital, is an underlying theme. We are of the firm belief that EVERY person, that has contact with and cares for mothers and babies in the hospital, should be trained to assist mothers in the hospital with skin to skin, latch and pumping when necessary. Our goal is to have every African American woman who has successfully breastfed a baby help another African American woman breastfeed her baby. Most of these women will never be an IBCLC.

Reaching Our Sisters Everywhere, Inc. recently coordinated a Breastfeeding Summit which involved African American healthcare providers, community advocates, organizations, and government representatives from throughout the United States. We came together to ponder, discuss and debate the breastfeeding disparities in the African American community. We also celebrated. We celebrated the many accomplishments of the breastfeeding advocates that were gathered. This was an African American “Dream Team” of breastfeeding experts. There were 49 persons who assisted with the planning and execution of the summit. Three were African American IBCLC’s. Ten were African American CLC’s. All were experts at what they brought to the table to assist African American women breastfeed their babies.

Discussions during the Summit included: reforming healthcare through breastfeeding, exemplary lactation projects, consulting with doctors on effective initiatives, samples of breastfeeding support programs, saving our babies, reclaiming our breastfeeding experience, a continuum of care from the hospital to the neighborhood which featured primary care, hospital, community and public health and bridging the gap on breastfeeding disparities. These were the concerns of the experts on the planning committee. They were confirmed to be significant issues in our community by those in attendance. The raging debate about what certifying body should reign supreme in lactation management cannot distract us as we seek to save our babies. We could, however use your help with special situations when the occasion arises. ROSE will continue to be about the business of increasing initiation rates and duration rates of breastfeeding in the African American community.

You may contact ROSE, Inc. by sending email to or visiting their website at

Kimarie Bugg MSN, MPH, is President and CEO of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Kim has been a bedside breastfeeding counselor in a large metropolitan hospital, managed perinatal and breastfeeding projects and programs at the state level, and has served as a technical advisor to Best Start, as well as for the US Baby Friendly Hospital Initiative. Kim was a founding member and officer of Georgia breastfeeding task force (coalition) and SEILCA. Kim was trained at Wellstart International and has traveled throughout the United States and several foreign countries training healthcare professionals to manage lactation. Kim previously worked for Emory University, school of medicine, department of pediatrics as a nurse practitioner. She also provides the training for Georgia’s WIC Breastfeeding Peer Counselors, a proud position held since 2005. Kim is married to Dr. George Bugg Jr, a neonatologist and they have five breastfed children.

Mary Nicholson Jackson, CLC, works in a large urban hospital as a breastfeeding consultant and is the co-president of the Georgia State Breastfeeding coalition. Mary is Vice President of ROSE She is on numerous committees and task forces that address breastfeeding and lactation management in the community. She previously worked with Healthy Mother, Healthy Babies of Georgia. Mary is married and the mother of three adult children. She has three grandchildren.

Betty Neal, R.N., MSN, is a founding member of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Betty has worked in women’s health for over 30 years. She completed certification as a Women’s Health Nurse Practitioner from Emory University. She recently retired from the State of Georgia Department of Human Resources, DeKalb County Board of Health as a public health nurse and program administration where she managed, developed and implemented numerous statewide and local public health programs. Her past experiences include instruction in a baccalaureate nursing program and mother-baby nursing in a large urban hospital. She has an passion for mothers and babies and believes we must support and ”nurture our mothers who will nurture our babies”.

Andrea Serano, a ROSE Inc. staff member, is from North Hollywood CA., and attended Mount St. Mary’s College with a major in Healthcare Policy and minor in Business Administration. During her course of studies, she participated in the Washington Semester Program- Transforming Communities at American University. She has interned at the U.S. Department of Health and Humans Service in the Office on Women’s Health and at Great Beginnings for Black Babies. Andrea has participated in breastfeeding awareness movements through the use of social media and hopes to one day establish a young women’s development center in the country of Belize.


What a Difference a {National Breastfeeding} Month Makes!

Written by Jennie Bever Babendure, PhD, IBCLC

ILCA Marketing Committee

Although my oldest son is the reason I got into lactation, my youngest has borne the brunt of my lactivist enthusiasm by virtue of being born after I became an IBCLC. For the first week, his every latch was overanalyzed and photographed, and my researcher self will admit to saving an ounce of breastmilk for future study everyday for the first 2 months after he was born. Along those same lines, we celebrated his 9 month birthday by attending ILCA’s 2012 Conference, the unofficial preparty for World Breastfeeding Week, and in the United States, National Breastfeeding Month. There, we met up with friends and lactation rockstars (some of whom are one in the same!) and I not only increased my breastfeeding knowledge, but also began to see the potential of social media in breastfeeding advocacy and support.

For those of us in the US, August 1 not only marked the first day of World Breastfeeding Week and Month, but also the day that many of the breastfeeding provisions of the Affordable Care Act went into effect—Hooray!! Starting that week, my Facebook and Twitter feeds were all a flutter with breastfeeding twitter parties, and excitement about the Great Nurse In on the US Whitehouse Lawn! For me, the highlight of the week was being part of The Big Latch On in San Diego. Arriving just in time for the Official Latch On, Noah and I mingled with the crowd and basked in the glow of happy mothers, sweet babies and supportive partners, and were lucky enough to have our picture taken. We were having so much fun that my family had to drag us out of that event to go to the beach.

Our celebration continued the following week when we got the chance to visit lactation rockstar (and former editor of Lactation Matters), Robin Kaplan at her breastfeeding support group. For those of you who don’t know, in addition to helping mothers and babies in person, Robin has a wonderful blog and has recently started an online radio show, aptly named The Boob Group. Robin chatted with me and helped mothers while Noah made a game of stealing toys from unsuspecting members of the support group who were not yet mobile….

That week my newsfeeds were humming with news stories, blogs and tweets about Mayor Bloomburg’s push to make New York City hospitals Baby Friendly. Although much of what went out from the news media was misinformation, it was heartening to see so many mothers and bloggers speak up, (even this one on to talk about the importance of the Baby Friendly Hospital Initiative and what it really means for hospitals, mothers and babies.

Meanwhile there were wonderful blog posts all over the internet in honor of World Breastfeeding Month. Some of my favorites were from people and organizations that celebrate breastfeeding all year long, such as this post from Best for Babes, 100 words (by Lactation Matters editor Amber McCann) and this one from Diana Cassar-Uhl. Mainstream parenting site The Bump even got on board, proclaiming Aug 15 Public Display of Breastfeeding Day, and asking mothers to tweet about where they were nursing their babies.

For the rest of the month Noah and I celebrated by breastfeeding anywhere and everywhere!

At the beginning of our celebration of World Breastfeeding Month, my little Noah was still toothless and the media outlets were reporting that reality TV personality, Snooki, pregnant with her first child, was hesitant to try breastfeeding. Now Noah’s sporting 2 sharp little incisors and Snooki is nursing! I can’t help but think–What a difference a month makes!

How did you Celebrate World Breastfeeding Month?

Send us your stories and photos!

Jennie Bever Babendure, PhD, IBCLC: I am mother to 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. For more research news and commentary, check out my blog at


Hats Off to Kentucky Educational Television for An Awesome Breastfeeding Panel Discussion!

Kentucky Educational Television (KET) is Kentucky’s educational television network with a mission of “educating, inspiring, informing, and connecting its citizens through the power of public media.” With Kentucky’s breastfeeding rates ranked 48th among states in the US according to the 2012 CDC Breastfeeding Report Card (59.4% ever-breastfed; 9.6% exclusively breastfed at 6 months), there is lots of opportunity to educate, inspire, and inform on this important topic. Check out the following trailer for the segment on YouTube.


KET took up the call for this year’s National Breastfeeding Awareness Month by airing a 28-minute segment on all things breastfeeding: benefits, barriers, laws, workplace considerations, hospital initiatives, cultural challenges, and more. The panel of breastfeeding gurus included Doraine Bailey, MA, IBCLC of the Lexington-Fayette County Health Department (and ILCA’s eGlobe editor), Jan Johnson, RD, IBCLC of the Pike County Health Department, and Cerise Bouchard, President of the Lactation Improvement Network of KY.

You can view the 28 minute segment HERE.

Kudos to KET for covering this important topic!  


Interview with Trish MacEnroe of Baby Friendly USA

Lactation Matters recently caught up with Trish MacEnroe, Executive Director of Breastfeeding USA.  While the Baby Friendly Hospital Initiative is well established in many areas of the world, the number of facilities pursuing the designation has soared recently in the US.  Trish gives us a glimpse into the current trends.

1.      Can you give us a brief history of the Baby Friendly Hospital Initiative in the US?

The Baby-Friendly Hospital Initiative (BFHI) is an international recognition and quality improvement program that evaluates hospital practices to ensure the successful implementation of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) Ten Steps to Successful Breastfeeding and International Code of Marketing of Breast Milk Substitutes. In addition, the Baby-Friendly assessment serves as an external verification of the CDC’s mPINC survey and is a key strategy to sell my settlement for meeting Healthy People 2020 Goals for breastfeeding. At its core, this designation process involves significant quality improvement and organizational change that replaces long-standing practices with new evidence-based practices that have been proven to lead to better outcomes.

The Baby Friendly Hospital Initiative was launched globally in 1991.  In 1992, the US Department of Health and Human Services funded an Expert Work Group to consider how to implement the BFHI in the United States. In 1994, with support from the U.S. Committee for UNICEF, Wellstart International Screen Sharing developed the evaluation tools to implement the BFHI assessment process. At the request of the U.S. Committee for UNICEF, in January 1997, the Healthy Children Project, Inc. accepted responsibility for creating the organization to serve as the designating body for the BFHI in the United States. Since August 1997, Baby Friendly USA, Inc, a non-profit 501(c)(3) organization, is the US national authority for this global breastfeeding initiative.

Currently, 145 hospitals and birthing centers in 34 states are designated as Baby-Friendly Facilities in the United States. 23 hospitals were added in 2011 and 22 more have already received the designation in 2012. Another 675 are working towards designation. The Baby Friendly Hospital Initiative is growing rapidly in this country as more and more birthing facilities commit to becoming Baby Friendly.

 2.      How has the Surgeon General’s Call to Action impacted the practice?

The US Surgeon General acknowledged the benefits of the Baby-Friendly Hospital Designation in her Call to Action to Support Breast Feeding. Baby-Friendly USA, Inc. (BFUSA) is committed to advancing effective strategies that assist hospitals, breastfeeding coalitions, public health entities and funders to work collaboratively in implementing Action 7 of the Call to Action and improve outcomes.

Since the Surgeon General’s Call to Action, the number of local departments of health, breastfeeding coalitions and other community organizations (auto glass replacement houston shops) assisting hospitals in working to become Baby-Friendly designated has risen dramatically. While there is no direct evidence that it is specifically attributable, since the Call to Action was released 512 hospitals have officially begun work on the BFHI in the US.  My opinion is that the surge in hospital interest is the result of a combination of factors: a call to action from the highest levels of the US government, as well as some new funding opportunities to help hospitals change practices.

3. There has been news lately of the Latch On NYC  initiative to “lock up” formula in the hospital?  What is Baby Friendly USA’s stance on such practices?

Mayor Bloomberg and the NYC Department of Health and Mental Hygiene are to be commended for being proactive on a very important consumer protection issue.

Human milk fed through the mother’s own breast is the normal way for a human infant to be nourished.  Breastfeeding is the biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant.  Naturally, things that occur outside the norm have side effects, including health consequences.  The “Latch-On NYC” campaign, which is voluntary for the facilities, asks that mothers be educated about the benefits of breastfeeding, which naturally includes the possible consequences of formula.  Some mothers will weigh the benefits and risks and compare them to other factors in their lives and decide that formula feeding is the best option for their circumstances.  When that occurs, their wishes should be respected.  This is very much in keeping with the tenants of the Baby-Friendly Hospital Initiative.

Another very important point that has been lost in the media frenzy around the Latch-On NYC campaign is that hospitals have standard policies that either limit access to (which is what Latch-On NYC calls for) or “lock up”  most of the products they use.  This is done for patient safety reasons as well as inventory control.  What we really should be asking is why is this not standard operating procedure for infant formula in all facilities throughout the US, and why has the suggestion of it stirred up such a controversy? It just makes good sense.

4.  What is your hope for BFUSA as we move forward in the US?

I can’t wait for the day that the last hospital in the US receives the Baby-Friendly designation.  My hope is that we effectively fulfill our vision of creating an American culture than values the enduring benefits of breastfeeding and human milk for mothers, babies, and society.

Trish MacEnroe is Executive Director of Baby-Friendly USA, treasurer of the NYS Breastfeeding Coalition, and former chair of the WIC Association of NYS. At Baby-Friendly USA, Trish has reorganized the Baby-Friendly designation process and created
tools to assist facilities pursuing designation. Previously, Trish worked for the WIC program, most recently as Director of the NYS WIC Training Center, and oversaw development of training programs for all aspects of WIC including the development of their Breastfeeding Peer Counselor website and curriculum. Trish received her Bachelor of Science degree in Food Science and Nutrition from the University of Rhode Island.


Just When You Didn’t Plan Anything for World Breastfeeding Week…..

World Breastfeeding Week brought about wonderful opportunities to engage with our communities about the incredible impact of breastfeeding.  This is one IBCLCs account of her thought process as she navigated doing a live, on-air television interview.

By Denise Altman, RN, IBCLC, LCCE

One day last week, after seeing my patients, I checked my messages and listened to one from a reporter wanting to ask me some questions about World Breastfeeding Week (WBW). My knee jerk reaction was either to not return the call-I had been at the beach for a week and was woefully behind-or hand her off to another IBCLC practicing in a pediatric office. However, I just don’t have it in me to pass up a marketing opportunity, so I called her back.

She sounded young, and was calling about WBW in general but she also wanted to know what exactly I do. She didn’t know much about the Affordable Healthcare Act but knew that there were parts that addressed breastfeeding . She wanted help with a story angle and maybe a live interview.

Story angle? Role of the lactation consultant? Oh yeah, this is worth pursuing.

I spent about ten minutes just talking, and hit her with enough stuff to get her excited. I
then added the suggestion of also having mama and baby on camera. Sold! She wanted a
live remote tomorrow morning at 7:30am. She had to confirm with her producer and I had to figure out how to mange this new activity on a full schedule, so we decided to touch base by phone at the end of the day.

After hanging up, I started thinking….who do I want?

I need a working mama who looks professional but not too “businessey”. Nice round happy baby who is easy going. Both available at short notice. Mama is willing to be primed and focused but can articulate well without script.

Wait a minute! I have a speech therapist in my patient population (this is why I always ask what people do for a living)! I remembered how she communicates, that she works with kids and understands the science as well as the parent perspective. Score!

Next, I have to decide on my two key points (one for each hand). This is my focus for every interview question so I stay on track.

Breastfeeding is Normal.
IBCLC are the Experts.

In between the mental gyrations, I have to do a home visit to see a mama, and of course, line up my on camera mama and consider back up. I emailed the reporter resources from the ILCA website such as What is an IBCLC?, How IBCLCs Make a Difference, and 10 More Reasons to Breastfeed. There is a ton of support materials already created and the added benefit is that the reporter knows then where to go for future stories or additional info. I also suggested live remote from chiropractor’s office where I do classes-it’s a thank you to the doc, plus the space is soothing and quiet, rather than a busy, cold newsroom. I sent a short list of common myths (along with truth statements) and recommended this as the focus of the interview.

Finally, I rearranged my patient schedule for the next morning. Then, I sent a “heads up”
on my personal social media outlets. I think I have done as much as I can, but there must
be something more.

Can I make this opportunity go further?

Once I called the reporter again about the final details, and then suggested that she
continue coverage for the full week. Then I pitched three additional story ideas with
contact info:

  1. A local NICU (the first or only in the state?) that has started using donor milk that has previously had an unheard of necrotizing enterocolitis rate.
  2. Healthy Carolina’s Lactation Program, which is helping to institute corporate lactation wellness program within our local university.
  3. Local Big Latch On event which could highlight lots of nursing mamas and babes in one handy spot.

After then phone call, I then gave various organizational contacts a heads up that TV reporter may call. Not only could they get positive exposure for breastfeeding support, but
is a great way to build or strengthen community relationships.

The night before, I didn’t sleep very well. I hate doing stuff on TV because my double chin always shows, and I tend to talk fast when I get excited about a topic. I decided to channel Leigh Anne O’Connor, who many private practice IBCLCs would vote “Most Likely To Get Her Own TV Show”! She is an IBCLC in New York who often appears in TV and radio spots. She always appears very calm and focused (maybe its her acting background).

In the morning, the reporter tells me that the producer has given not one, but two segments due to all of the good information she presented! I dressed carefully, trying to look both professional and approachable, wearing a pressed blouse with my business logo on it. When the mama arrived, we quickly discussed the focus for her-normal, working mother, benefits from professional standpoint as well as family focus. She nailed all of it, and the baby was so cute reaching for the mic, that I was hard pressed not to laugh through the whole thing. In my head, I repeated “Normal and IBCLC”.


As she was packing up, the young reporter told me she is one of 12 kids, all breastfed.
When she called home the previous night and shared what she was covering and why, her
mama told her she was proud of her for doing this kind of story.

The world is round.

Because of a call that I didn’t want to return, and a TV appearance I didn’t want to do,
breastfeeding support had a good day in South Carolina.

Denise Altman is a private practice LC in Columbia, South Carolina, USA, and author of two textbooks for healthcare professionals; “History and Assessment: Its All in the Details” and “Mentoring Our Future“. A frequent conference speaker, she enjoys sharing topics and stories “from the trenches”. Her professional picture has been photo shopped to remove her double chin. You can reach Denise at


The 10th Step and Beyond: Mother Support for Breastfeeding

By Virginia Thorley, OAM, PhD, IBCLC, FILCA

Mother support for breastfeeding has been my passion for more years that I care to admit, starting when Marian Tompson, La Leche League’s first president, provided me with the confidence and encouragement to reverse iatrogenic lactation failure and successfully breastfeed my first daughter. At the time, I was living in remote north-west Queensland and Marian was in Chicago, the other side of the world. There was no email or Skype, international calls were prohibitively expensive, and we did not have easy telephone access. So contact was by letter, supported by printed material – a newspaper reprint, “Mother’s milk saves baby”, and the LLL book, The Womanly Art of Breastfeeding, which arrived in the nick of time.

After writing and speaking on mother support groups over the years, the logical next step was a book of information on old and new ways of providing this support, drawing on experience from round the world. Finding the right co-editor was important, and friends in WABA recommended Melissa Vickers. What an inspired recommendation! Melissa was the ideal collaborator, with professionalism and heart, and we thought alike in so many ways. It has been a joy to work with her. We also had a small support team who acted as a sounding board – Rebecca Magalhaes (USA), Sarah Amin (Malaysia) and Paulina Smith (Mexico).

The resultant book, The 10th Step and Beyond: Mother Support for Breastfeeding,
describes a range of ways to support mothers to continue breastfeeding after they leave
the maternity hospital. While mother support for breastfeeding is the 10th Step of the Ten
Steps for Successful Breastfeeding, which hospitals must fulfill in order to be accredited
as Baby Friendly, the chapter authors of this book go beyond this to look at mother support in a wider context.

Melissa and I have brought together experienced people from five continents to describe
what is being done to support mothers to breastfeed in different situations and cultures.

Some chapters describe traditional mother-to-mother groups such a La Leche League,
the Australian Breastfeeding Association and the Scandinavian and Malaysian groups.
Others describe innovative approaches to mother support through the use of new
technology such as text messaging (MumBubConnect), a peer counsellor program in a
Neonatal Intensive Care Unit, groups for mothers of multiples, and the Baby Café drop-
in centres. Other authors describe how peer counselling programs have been developed
in a variety of settings, for example in Bangladesh, India, Paraguay and South Africa,
occasionally with male breastfeeding peer counsellors as part of the team. Steps to
encourage exclusive breastfeeding for the recommended six months, and breastfeeding
with complementary foods thereafter, are described by some of the authors. Finally, the
authors discuss why good programs fail and what is needed for sustainability.

Mother support is not only about providing a mother-to-mother breastfeeding support
group or a peer counsellor program, but it is something the whole community can be
involved in. This book provides ideas to get you and your workplace or community
started. The intended audience is hospitals, departments of health, non-government
organizations, BFHI committees at hospital, state and national level round the world,
and individual health workers and policy makers whose work involves the breastfeeding
mother and her baby.

The editors have donated their royalties to support the work of the World
Alliance for Breastfeeding Action (WABA).

“The 10th Step and Beyond is about supporting the mothers. Virginia Thorley and Melissa Clark Vickers have brought together a truly remarkable mix of 26 people, a team that reflects both the global character of the issue, as well as its multidimensional nature.”
-Professor Anwar Fazal, Chairperson Emeritus, WABA

How has mother-to-mother support impacted your breastfeeding relationship?

*** Watch this space on Thursday for a follow-up piece by Dr. Thorley’s co-editor, Melissa Vickers on the power of making connections. ***

Dr. Virginia Thorley has been involved in the breastfeeding field since qualifying as a breastfeeding counselor in 1966 with both La Leche League and the Australian Breastfeeding Association (then the Nursing Mothers’ Association). She certified as an IBCLC in 1985 and remains certified. She was inducted as a Fellow of the International Lactation Consultant Association (FILCA) in 2008. She is on the Board of Directors of the Lactation Consultants of Australia & New Zealand (LCANZ). A cultural historian of the history of medicine, she holds two research high degrees in History (MA and PhD) and has many publications


World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).


Education, Social Media & Motherhood

Written by Deirdre McLary for her blog, Breastfeeding Arts

I was recently discussing the upcoming ILCA conference and the business of breastfeeding, both locally and nationally with a friend and dear colleague. Part of our discussion was on the business of education and helping mothers grow their confidence and wisdom before baby arrives. The models for education can be both face to face; through class time and instruction, or online via email and social media. Knowledge is power, as the expression goes. How do we, as breastfeeding educators, grow that knowledge base for expectant mothers, and how can we expand our reach so that your transition to new motherhood is a smooth one?

As both an IBCLC and a childbirth educator & doula, I know all too well how few families seek out empowering childbirth & breastfeeding education.

But are enough women turning to seeking prenatal education? I don’t think so. What I do know, and see repeatedly, is that those women who do not seek good prenatal education have a greater likelihood of feeling overwhelmed and isolated. I know this because they call me desperate for help and support.

A solid network of education, support and resources should be cultivated prior to baby’s arrival. This will help the mother navigate those first weeks of baby blues and postpartum healing. Not all mothers, mind you, have a difficult transition. One of the many benefits to consider is not just the knowledge base a mother will take into birthing and breastfeeding, but also the relationship she has now established! Wise Woman to New Mother! She has her tribe, someone she can now turn to postpartum to seek answers and support. As my colleague says, “a friend in her pocket”!

Social media and online support can be a wonderful conduit for support and wisdom. Sixteen years ago, when I was pregnant with my first, I researched something on the “then pretty new” internet. I brought it to the attention of my OB, who I subsequently left for the care of a midwife. You know why? He scoffed and said, “Are you going to trust some quack you find off the internet?” and immediately dismissed my researching things outside his care. (That quack was Ina May Gaskin). Well, I did trust what I had read. Those were my instincts kicking in and my ability to trust myself.

I encourage all pregnant mothers to seek out advice online from reputable IBCLC businesses and online communities! (Editor’s Note: Check out Australia’s new Virtual Breastfeeding Cafe) There are many wonderful resources with excellent professionals happy to help you find your way. As a La Leche League leader, the concept of “mother to mother” support is still, in my opinion, one of the best conduits of postpartum sisterhood out there! And now that “mother to mother” care can be found online, on many a Facebook page, blog, Twitter or Listserv. It’s not always easy getting out of the house as a new mother. While I never want online communication to replace face-to-face connection, there are a wealth of relationships available there.

It all comes back to education and support! Whether it’s private or group prenatal classes (each has its advantages), a private lactation consult in the comfort of your home, an online consult via email or even a Twitter chat (for example, #bfcafe) — all are great ways to stay connected to a professional who only wants the best for you — normal, healthy birthing which leads to normal, healthy breastfeeding!

How have you, as an IBCLC or breastfeeding professional, helped mothers to receive prenatal education and support?

Deirdre McLary is the founder of BREASTFEEDING ARTS and has provided expert IBCLC Lactation Support, Doula Care and Childbirth Education since 1997 in the Hudson Valley, NY area. Deirdre is deeply committed to raising childbirth, breastfeeding and parenting awareness throughout her area by providing compassionate, holistic & open-minded options for anyone who seeks them. She is a board certified lactation consultant (IBCLC), a labor support and post partum doula, La Leche League leader, childbirth educator, and new parent mentor. She has also held leadership positions in The Metropolitan Doula Group, La Leche League, River Doulas and The International Cesarean Awareness Network.


Social Media Highlight: Nevada Breastfeeds Facebook Page

At Lactation Matters, we love having the opportunity to hear from YOU about innovative ideas to reach and support breastfeeding mothers.  We were recently encouraged to check out the Nevada Breastfeeds Facebook page.  We had the privilege of interviewing Sarah Ortega, founder of the page that is currently supporting almost 2,500 “friends”, about why she thinks online support is essential to today’s mothers. Sarah and her family are long-time residents of the Reno, Nevada area and she has four breastfed children.  Her experience with Robin Hollen, IBCLC of Starfish Lactation after the birth of her youngest child, who was born with a severe cleft palate, put her on her current path towards becoming an IBCLC.

1.  How did the Nevada Breastfeeds FB get started?

I started the Nevada Breastfeeds Facebook page after many talks with Robin Hollen, the IBCLC with whom I work. We decided that it was in our community’s best interest to have a page for breastfeeding women to find information, support and encouragement. I created Nevada Breastfeeds as a “friends” page, meaning I would have to send and/or receive friend requests. The main reason for approaching it this way was so that women could send a personal message to me if they didn’t want their question publicized. (Editor’s note:  Facebook recently added a “private messaging” feature to business pages.) When I first started, I had a small group of women that I knew from other breastfeeding projects, so I sent them friend requests and the page grew from there. It was a slow start, but I dedicate a lot of time and effort to make sure I “friend” people that would benefit from this page.

Used with permission from Amen Photography

2.  How is it moderated? Do you personally answer questions or do the mothers on the page respond to each other?

I monitor the page almost 24/7…just ask my husband. 🙂 I am a Certified Lactation Educator (CLE) and am training to be an IBCLC.  There are several different options that women have to get their questions or concerns addressed. Friends of the page can post directly to the wall. If they want a direct answer from me, they can send me a personal message.  I try my hardest to answer all questions within 24 hours. Depending on the question, I will comment or ask for additional detail, then repost so everyone can see the question. This seems to be the most effective way to get people to comment. If I determine that the person posting needs more one-on-one help, I will remove the question from the wall and send a personal message to address the issue or concern. I am very careful to not go outside of my scope, which can be very limited as a CLE and I always refer to ILCA’s Find A Lactation Consultant page or help them find an IBCLC when I feel they need more professional help.

Used with permission from Amen Photography

3.  Why do you feel this is an essential opportunity for mothers?

You must be a part of the conversation to have any impact on people. I work very hard to establish relationships on Facebook. I believe that women are hearing information from many different people (friends, family, doctors, strangers etc..). For me to come along and offer advice doesn’t set me apart from all of the others. It is about building relationships. If someone has had a question or concern, I try to follow-up with them to make sure they received what they needed. If they need additional follow-up with a professional, I refer. If they just need some more support, I am there for them. This page is very close to my heart and I want people to know that they are cared about.

Used with permission from Amen Photography

4.  Any great success stories?

One friend of the page wasn’t planning to breastfeed because she had tried with her first two children and was not successful. We had many conversations during her pregnancy and she decided that she would start out with a goal of breastfeeding for 6 weeks.  She had a little bit of a rough start and she sent me many messages because she thought things were going terrible. With the information she would give me, I could tell she was doing GREAT! Her baby was gaining really well and she wasn’t in pain, so I just kept encouraging and reassuring her. Her goal quickly changed to 4 months, then 6 and so on. She is now in the process of weaning him at 14 months. I am so proud of her and she is proud of herself! In my heart and mind, this is what my page is all about.

In addition, here is a message that I received this past week from a women who is a friend of the page and attended a few support groups…

I just wanted to say thank you for all your support and help with breast feeding! My son is soon to be five months old and is healthier than ever. In his first few months of life, he had respiratory, sinus and weight gain issues but I am pleased to say those have all subsided. He is a chunky, happy, healthy baby and I truly believe it is because of breastfeeding! You gave us a gift for a lifetime and I couldn’t have lasted this long exclusively breastfeeding without your support. Your FB page gave me hope when I was in tears and the posts from other moms gave me confidence that I could do it. When I had a question, no matter how personal or minimal, it was answered! So again I thank you!

We thank Sarah for her commitment to supporting breastfeeding mothers and encourage all ILCA members to check out Nevada Breastfeeds on Facebook.

*Special thanks goes to Amen Photography for allowing us to share these photographs which will be used in the 2013 Nevada Breastfeeds Calendar.  Look for a future post about this great project!


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