Archive | Breastfeeding Around the Globe

Current Global Recommendations Regarding Breastfeeding with Ebola Virus for Mothers and Infants

By Kathleen Marinelli, MD, IBCLC, FABM
ILCA Board of Directors Director of Professional Development

Screenshot 2014-11-07 20.10.02As the global community comes to grips with the Ebola epidemic, most of the press and information available pertains to surveillance, recommendations for quarantine, containing the geographic spread, determining risk of exposure, protection of health care workers, and support and treatment of those diagnosed with the deadly virus. Of particular concern to those in the maternal-child health, nutrition, and lactation fields is the effect of potential exposure and proven infection with the Ebola virus on pregnant and lactating women and their infants.

Compounding the difficulty with finding this information is the simple fact that we don’t really know the answers at the level of evidence-based medicine. This is our first experience with an Ebola epidemic of this proportion. Decisions are being made to direct clinical practice by authorities like the Centers for Disease Control and Prevention (CDC) and UNICEF and the World Health Organization (WHO) based on our knowledge of how other viruses act, anecdotal stories from the field, and an occasional clinical report. While we all want the answers yesterday, authorities are doing their best to guide practice to save lives, while not panicking health authorities into making decisions that will cause more harm than good.

The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with likely or confirmed Ebola infection (1), as has the Emergency Nutrition Network (ENN) in collaboration with UNICEF/WHO/CDC/ENN, which has significantly more detail. (2)

Important points are:

  1. Pregnant women have a much higher mortality rate with Ebola than non-pregnant women. At this time, there have not been any reported cases of a pregnant woman infected with Ebola virus surviving.
  2. Data from the field are spotty. WHO, CDC, ENN and other agencies are trying to aid in improving data capture so that we can better understand the history of Ebola in different types of patients and thus make informed determinations such as related to breastfeeding.
  3. Ebola virus has been found in human milk (1 sample). (3) In earlier outbreaks, no infants born to infected women and/or who were breastfed have survived. Presence does not equal infectivity, but at this point we do not know in the case of Ebola.
  4. Virus remains in some bodily fluids, like semen and human milk, after the blood has cleared. For lactating mothers who recover from Ebola, and are able to maintain or resume lactation (another issue to be considered and dealt with due to the illness severity), it is not known when it is safe to resume breastfeeding. Recommendations are to have the milk tested every 2-3 days in a laboratory that tests blood. For many women this is not feasible related to where they live. The recommendation then being made is to refrain from breastfeeding for 8 weeks, although not based on any evidence.
  5. For detailed instructions on feeding, please refer to reference 2. Essentially, when safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infant, which includes breastfeeding.
  6. If mother must stop breastfeeding, the mother must be helped to express her breastmilk to alleviate pain and prevent inflammation. The expressed milk must be treated as an infected bodily fluid and discarded as such. There are some suggestions to heat treat (pasteurize) the expressed milk for the baby, but equipment and thermometers to make sure the milk is heated to the proper temperature for the correct amount of time to destroy virus and preserve nutrients and immune factors are not readily available. Most mothers become rapidly so sick that expressing milk becomes very difficult.
  7. In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease when deciding to breastfed or feed a substitute.(2)
  8. Wet nursing is very common in West Africa. However do not allow wet-nursing to avoid any possibility of infection of the infant by the wet nurse, or of the wet nurse by the infant.
  9. If both mom and child have confirmed Ebola, if mom is able, breastfeeding should continue. If mom becomes too ill, a safe alternative should be used.
  10. Orphans should be fed with a safe alternative.

ILCA recommends following the guidance for feeding of infants and young children given in these documents and continuing checking for updates to the CDC (1) and the ENN (2) papers as more information becomes available.

References

  1. http://www.cdc.gov/vhf/ebola/hcp/recommendations-breastfeeding-infant-feeding-ebola.html (accessed 11/5/2014)
  2. http://www.ennonline.net/infantfeedinginthecontextofebola2014 (accessed 11/5/2014)
  3. http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full.pdf (accessed 11/5/2014)

Kathleen Marinelli has been a neonatologist for over 25 years, an IBCLC since 2000 and is a Fellow of the Academy of Breastfeeding Medicine (FABM). Although unable to practice clinical neonatology for over a decade due to a significant water-skiing accident, she has continued her life-long commitment to improving breastfeeding, the use of human milk, and the use of donor milk, everywhere but especially in the NICU through all of her volunteer roles, research, teaching both here in the US and abroad, and publishing papers, monographs and chapters.

She is an Associate Professor of Pediatrics at the University of CT Medical School, and a member of the Human Milk Research Center at CT Children’s Medical Center, in Hartford, CT. She graduated from Cornell University & Cornell University School of Medicine; and was a pediatric intern, resident, nephrology and neonatology fellow at Children’s National Medical Center, George Washington University, Washington DC.  Additionally, she is founding Medical Director of the New England Mother’s Milk Bank and is currently co-Medical Director of the Mothers’ Milk Bank of the Western Great Lakes.  She is a founding and current member of the Connecticut Breastfeeding Coalition, has been on the Board of the Academy of Breastfeeding Medicine for many years, and chairs its Protocol Committee.  She has served as Chair of the United States Breastfeeding Committee, and was chosen to Chair the new US Baby-Friendly Hospital NICU Initiative. 

7

Clinicians in the Trenches: Francisca Orchard from Santiago, Chile

Screenshot 2014-10-20 10.41.26

By Francisca Orchard, CNM, IBCLC

I became a certified midwife 20 years ago, assisting women in labor since my early adult days. I came into this field with an eye toward low intervention birth and respect for mothers, with special emphasis on the humanization of birth. This was probably because, during my internships in hospitals, I saw very little respect for women and a lot of poor treatment of them.

In the 1990s, I worked in a neonatal intensive care unit where the promotion of breastfeeding in preterm infants was a priority. Later, I also received doula training in the U.S. and earned a diploma in infant massage in London.

In 2011, I achieved my goal of becoming an International Board Certified Lactation Consultant® (IBCLC®). The road was not easy for me. The year I took the exam was the first time in Chile the exam was given at the same time as in the rest of the world.

Since then, I have been working in breastfeeding promotion, and consulting in support of perinatal health professionals. I began a prenatal education program for pregnant women and their families that promotes breastfeeding and respectful delivery to reduce the number of caesarean section deliveries in Chile, and to increase our prevalence of exclusive breastfeeding to 6 months of life.

In Chile, we have 43% of mothers still breastfeeding at 6 months, but there is a huge disparity in breastfeeding rates related to women’s income.  We have an urgent need to follow mothers during the first days after maternity hospital discharge, where most abandon exclusive breastfeeding. We also struggle with  health professionals who, due to their lack of knowledge about breastfeeding, are perhaps our biggest barrier to breastfeeding duration. Most pediatricians encourage the use of artificial supplements instead of working with mothers and babies early to help them continue breastfeeding.

Currently, I am a member of the Chilean Committee on Breastfeeding and the Lactation Committee of the Chilean Society of Pediatrics. Some months ago, I collaborated with a multidisciplinary team of psychologists and photographers on a project called “Breastfeeding Mothers.” We created a space where women of different ethnicities and Chilean places were professionally photographed in different breastfeeding situations.  It is a beautiful work with more than 50 photographs. We are awaiting funding to publish it for breastfeeding promotion in Chile.

In my daily work, I consult with women and babies with breastfeeding difficulties and write articles of interest to our community.As of this writing, I am one of only 2 IBCLCs in Chile. During World Breastfeeding Week, I traveled to different cities in Chile to participate in breastfeeding promotion activities. Additionally, I work on an advisory team of the ministry of health. We are working toward implementing the Baby Friendly Hospital Initiative in Chile during 2015. The Chilean government is also discussing the approval of human milk banks.

It is an exciting time in Chile with so much going on to support and promote breastfeeding. I am thankful for the International Lactation Consultant Association’s® resources that help me inform my community about the competencies and value of IBCLCs, and to increase our numbers throughout Latin America.

chiliPhoto via the author

2

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.

steamboat6
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

Traveling as a Pumping Mother

7497500748_5f37df32aa_bBy Nicole Goodman

One of the biggest challenges working mothers face is traveling away from their babies while they’re still breastfeeding. Pumping while on the road – or in the air – can be inconvenient, uncomfortable, and downright unpleasant, but many mothers find that is it worth it so they can continue breastfeeding.

Here are some hints to help you prepare for trips away from your little one. Working mothers going on a business trip or those that stay at home getting away for a weekend can benefit from planning ahead.

Supplies Checklist

Pumping while traveling requires some additional supplies that you may not need when you’re at home:

  • Batttery pack & fresh batteries – Make sure your battery pack works BEFORE leaving and load your pack with fresh batteries.
  • Extra batteries – Depending on length of your trip, it’s always a good idea to carry an extra set of batteries. Remember to keep batteries with your carry-on luggage to avoid any problems with checked luggage.
  • Convertor/adapter – If you are traveling internationally, make sure to pack the appropriate power convertor/adapter plug so that the pump will work at your final destination.
  • Milk storage bags/containers – If you plan to bring milk home after the trip, make sure to pack plenty of storage bags. I like the Medical-Grade, Pre-Sterilized Plastic Storage Bags. Freeze them flat so you can stack them up on the return trip.
  • Ice or cold packs – Especially for long or multi-segment flights, ice or cold packs will help keep milk frozen on the return trip. Some thawing may occur, so put the milk into the freezer as soon as possible. Use the milk pumped on a trip as soon as possible after you return.
  • Cleaning supplies – I LOVE the microwave disinfecting bags. You might not always have access to a place to scrub pump parts while traveling, but most hotel rooms and offices have a microwave. Throw everything into these bags, pop into microwave for 3 minutes, and everything is sterile for their next use.
  • Power cord, tubing, membranes, breast shields & pump parts – A breast pump won’t do you any good if you don’t have all of the essential parts with you! Pack a few extra pump membranes, just in case.
  • Hand sanitizer – It’s always a good idea to pack a little (3 oz or less) bottle of hand sanitizer in your carry-on.

Pack Smart

If you can fit a pump into your small rollerboard suitcase, great! Otherwise, you’ll need to check your suitcase and keep your computer bag/purse and pump as carry-on items.

Do NOT check a breast pump in a suitcase or as a stand alone item. Travel delays happen all the time; luggage gets damaged or lost. The last thing you need is to end up at your destination without your pump!

Be Security Savvy

In the United States, pumping mothers are permitted to travel with breast pumps and breast milk, regardless of whether or not they are traveling with their children. If a security agent says otherwise, ask to speak to a supervisor.

To make the security process as smooth as possible, you should alert the security officers so they know you are traveling with a pump:

  • Pull the pump out of your carry-on bag and place it in a separate bin before it goes through the x-ray machine. Tell the agent that the item is a breast pump.
  • If returning from a trip and carrying breastmilk, place the milk in a separate bin and alert the agents that the liquid is breastmilk. Breastmilk is NOT subject to the three-ounce limitation.
  • If a security agent asks to test the milk, ask to speak to a supervisor. They may want to swab the outside of the milk bags or containers, but they cannot make you open your milk and test it.

A mother may be asked to go through additional screening. I’ve had my pump searched and swabbed and I’ve also been subjected to a pat down. Be prepared for either scenario.

Pumping en Route

Sometimes it’s necessary to pump before you reach your final destination. Because I fly in and out of a small airport, I always have to make at least one connection, which can make for a long travel day. Most major airports have family bathrooms with electrical outlets and they are a great place to pump. On longer or international flights, you may need to pump in your seat or in the airplane bathroom. Ask the flight attendants if they can suggest a pumping location.

Well Worth the Effort!

Pumping while traveling presents some unique challenges, but it’s ultimately worth the extra effort. With a little planning, preparation and patience, you can maintain your milk production while you’re away from your little one and they will be ready to welcome you home at your breast.

You can find the TSA official guidelines for traveling with breastmilk HERE.

Nicole_GoodmanNicole Goodman is a full-time working mother who successfully nursed both of her daughters through their first 12 months. She had to go on many business trips while she was still nursing and has lots of funny stories about her experiences pumping & (sometimes) dumping. You can learn more on Nicole’s blog, Work in Sweats Mama.

68

Journey to Uganda: an IBCLC’s Perspective

By Pat Young, APN, IBCLC

I’ve just returned from a trip to Uganda in East Africa. While there, I visited several hospitals – rural and city, public and private.

First, let me say that the poverty is mind boggling. I have a new theory that every health worker in a developed country needs to go on a medical mission to a third world country!

DSCN0698Second, the level of care in a good, private hospital was similar to what someone would have received here in the United States in the 1960s. Americans would now consider such care substandard, but the people are trying so hard to improve, even without the resources of a developed country. In the capital city of Kampala, the public hospital is very aware of the Baby Friendly Hospital Initiative (BFHI) and using skin-to-skin care for mothers and babies.

Most deliveries (city and rural) are unmedicated. C-sections in the rural hospital are “knocked out” and mothers miss the first few hours of their babies’ lives. In the rural hospitals, mothers must be accompanied by her family to feed her as there are no cafeterias. She comes to the hospital in labor with her mat on her head so that she will have a clean place to lay on the floor after her delivery.

Of the hospitals surveyed by BFHI, most are meeting 80% of the Ten Step goals. Most health care providers had never heard of La Leche League International (there are currently no groups meeting in Uganda) or mother-to-mother peer support. I can see that breastfeeding support needs to go two ways in Uganda – from the bottom up and the top down – to improve care.

IMG_0995Almost every mother breastfeeds. How long she does so is becoming the crux of the problem. Formula advertising is rare, except in the grocery stores where it is featured by location and on displays. In the villages, there is simply no safe way to use formula, although some try it. I saw several of these babies in the ward of the hospital that dealt with malnutrition. I also saw one infant who tried mightily to breastfeed but transferred very little milk as his was tongue-tied.

One thing that really impressed me was the use of skin-to-skin care with preemies. Mothers are taught skin-to-skin care (a la Nils Bergman) and as soon as the infant shows adequate sucking skills, they are sent home. The babies are seen weekly until they reach 2.5kg and then monthly until they are 2 years of age.

I had the opportunity to spend time with a wonderful woman in the capital city who is working on the hours necessary to qualify for the IBLCE exam. I don’t believe that there are any other Ugandans aspiring currently towards IBCLC certification. She needs any help we can give her.

How can we help breastfeeding support in these countries?

  1. Go on a medical mission and have the opportunity to experience it yourself.
  2. Sponsor aspiring IBCLCs (like WALC, the Wisconsin chapter of USLCA, has done) and help these health care providers get the materials and education that they need to reach their IBCLC goal. Health care providers in third world countries often have access to computers. ILCA offers a number of educational opportunities like CERPS on Demand and webinars. There are also impressive conferences like GOLD Lactation and iLactation which are completely online. Consider sponsoring someone to “attend” one of these opportunities. For example, you could sponsor someone from Uganda to attend the GOLD Conference for $49. Be creative and think of other ways to share of your knowledge and expertise.
  3. I am looking for any pediatric stethoscopes you might have lying around. There is a need in the pediatrics ward in one of the rural hospitals I visited and likely in others as well. I have a Peace Corp volunteer who is willing to distribute the donations. If you are able to help, please email me at patyoungz@verizon.net.

Have you participated in breastfeeding support in a country other than your own?

We’d love to hear about it at Lactation Matters. Please leave us a comment.

Pat Young has 5 grown children, 15 almost grown grandchildren and 5 great grandsons. She got involved with La Leche League in 1966 with the birth of her 4th baby and became a leader a year later. She took the first IBLCE exam in 1985 and worked as a hospital lactation consultant from 1986 to 1991. She received her MSN and became a Pediatric Nurse Practitioner in 1994. She continues to lead La Leche League meetings and work part-time as an APN as well as helping mothers as an IBCLC.

3

A Closer Look at Cultural Issues Surrounding Breastfeeding

By Emma Pickett, IBCLC

As lactation consultants, we’ve been reading about breastmilk for a long time. It makes a nice contrast from the science of oligosaccharides to learn about the importance of goat meat soup to a lactating mother in Somalia or about the huge variety of cultures worldwide that emphasizes the importance of a mother avoiding ‘cold’ foods postpartum to seek spiritual balance. When it comes to reading about different cultural practices surrounding breastfeeding, there’s a lot that is simply fascinating.

Photo by mrcharley via Flickr Creative Commons

There’s a fabulous article by a breastfeeding mum named Ruth Kamnitzer which I would encourage you to read. In it, she talks about her experiences as a Canadian mother moving to Mongolia. She describes how feeding in public becomes a very different experience when complete strangers bend down to kiss your baby’s cheek – while he is feeding! Then, as he pops off in surprise, the giver of the kiss gets a face full of milk and everybody laughs. Try and picture that scene taking place in your local mall!

We enjoy reading about the fact that Japanese kindergarten admission forms might ask matter-of-factly whether a child has weaned from the breast. Or, that in Korea, an IBCLC declaring a baby to be beautiful would be going against the cultural practice of not commenting that a baby is healthy, fat or beautiful for fear of making the mischievous Gods jealous.

But once we’ve satisfied that natural boob and baby-obsessed curiosity, how do we balance our desire for evidence-based practice with some of the cultural messages that may seem harder to support?

Cultural practices fit into only 3 categories: beneficial, harmless or harmful.

Many Muslim families wish to practice the sunnah of ‘tahneek’. A softened date is sometimes rubbed on the baby’s palate before the first feed so the baby will enter ‘a sweet world’. Traditionally, if a date cannot be found, anything sweet will do. An IBCLC might guide a family towards a clean finger dipped in glucose water rather than the boiled hard candy from uncle’s pocket.

Other beliefs are more of a struggle. One study of 120 cultures showed that 50 withheld the infant from the breast for 48 hours or more due to the belief that colostrum was “dirty”, “old”, or “not real milk”. In central Karnataka in India, 35% of infants were still not breastfeeding at 48 hours, yet at 1 month 94% were. A mother who may be reluctant to give colostrum feeds in a western hospital may be passionately committed to exclusive breastfeeding later on.

Some of us can be a little smug when it comes to looking at cultural practices from around the world. We may feel uncomfortable when we hear of the lives of women in Kenya who are strongly instructed to avoid breastfeeding after quarrels to prevent “bad blood” entering the milk and affecting baby. This may mean breastfeeding is paused or a mother’s rights are infringed by family members or neighbors , yet she doesn’t speak up for fear of conflict. Several cultures – traditional groups in Papua New Guinea and the Gogo tribe of Tanzania among them – emphasize the need for the woman to be celibate during breastfeeding. A mother may be torn between her desire to breastfeed – in an environment when food after weaning may not be plentiful – and her desire to satisfy her husband. A husband who is often not expected to also remain celibate.

Those descriptions may be hard to hear but I have no doubt there are women pitying the cultural constraints put upon many woman living in Western industrialized cultures. These poor mothers are still often expected to be separated from their healthy babies after birth. Their baby may sleep in a separate area of a large building (“the hospital nursery”) because culture says “that’s best”. These poor mothers feel obliged to feed according to the clock and feel like failures if their babies feed more frequently. The babies in this culture are often weaned prematurely because the breast is over-sexualized and it’s deemed inappropriate for older children to feed at the breast. Many of us live in a culture that values privacy, scientific “measurement”, control, infant independence. It’s hard to imagine a set of cultural norms more incompatible with breastfeeding.

Is any of this really any less harmful in the long-term than avoiding colostrum feeding?

As an IBCLC, how do you educate yourself about the cultural issues within your community?

With a background of teaching in inner-city London, Emma Pickett, IBCLC came to breastfeeding support after she had her first child in 2004. She trained as a breastfeeding counselor with the UK-based charity the Association of Breastfeeding Mothers (ABM). Now sitting on their central committee, Emma continues to volunteer on the National Breastfeeding Helpline and the ABM’s own helpline as well as running three support groups in North London. Emma qualified as an IBCLC in 2011 and has a private practice alongside her voluntary work. Her work focuses on how breastfeeding impacts on a woman’s sexuality and relationships but also crucially how the sexualization of Western society affects the initiation and continuation of breastfeeding. She is keen to encourage open dialogue in an area which even breastfeeding supporters sometimes shy away from. You can her discuss Breastfeeding and Sexuality on a recent episode of The Boob Group

11

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

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World Breastfeeding Week: Breastfeeding in Ireland

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

By Geraldine Cahill, IBCLC

The promotion of breastfeeding has been a key government health policy in Ireland since the 1990’s and yet the prevalence of breastfeeding is still incredibly low. The Growing up in Ireland Longitudinal Study has shown that Ireland has the lowest breastfeeding rate in Europe. Less then 50% of babies are still breastfeeding when they leave the hospital and less than 15% are still breastfeeding by six months. As happens in the rest of the Western world, levels of breastfeeding were likely to increase with educational levels. Some of the reasons given for not breastfeeding at all, were inconvenience and fatigue or simply having a preference for feeding formula (48%). Ireland has a long way to go to meet the goal of breastfeeding being the normal way to feed a baby.

How do I as an IBCLC in Private Practice view the state of Breastfeeding in Ireland?

There are currently 197 IBCLCs in Ireland. Most of them are working in the hospital systems as midwives and some are employed as nurse specialists in breastfeeding. Additionally, a number work as public health nurses who visit the mothers in their homes after birth (but these nurses also have other responsibilities within the community and don’t just deal with mothers and newborns). The lactation consultants who work in private practice tend to have come from parent-to-parent support groups such as Cuidiú (Irish word for “caring support”) and La Leche League.

Cuidiú, a parent-to-parent support organization which provides education  and support for all parents (from birth to the teen years), is inundated with requests from women all over the country for training to become Breastfeeding Counselors – and with help from government grants are doing so. La Leche League of Ireland is also reporting the same surge of interest in training, with attendance at their groups on the rise. There are support groups in the major centers of Dublin and Cork every day of the week and many IBCLC’s in Ireland are involved with this work.

Social marketing has had a huge impact in Ireland. We have big urban centers but also many rural mothers. These mothers have set up groups to support themselves and some of these groups have asked IBCLCs to join them.  They have asked because they know this format is mostly about peer support but they want the information on their boards to be correct so that “we don’t give incorrect information or overstep our boundaries”.

One of those mothers, Aideen Ni Cheilleher, has singlehanded done as much work as the rest of us put together over the last year in the area of connecting people together to support one another. She found herself with a year off work, with a newborn, a toddler and a 7 year old, while living in Kerry in a very rural area. In order to get support for herself in her tandem nursing, she set up a facebook group called Extended Breastfeeding in Ireland.  The group grew quickly, with 100 members within 24 hours of being started.  She now has 750 members! These mothers are very committed to breastfeeding and using breastfeeding as a parenting tool but felt isolated and alone in this journey. Now, there is a buzz and a sense of possibility about the future that hasn’t been around in a long time.

The statistics in Ireland have, for so long, concentrated on the lack of breastfeeding that in
some ways, the success of those who continue to feed has not been recognized. I asked those who have met or are meeting their breastfeeding goals, “What do you feel about the State of Breastfeeding in Ireland?” Among the usual complaints about the lack of support and good education in the hospital setting, there were lots of positives, such as the fact that there are so many parent-to-parent groups and that they have better access to support because they can find it online. They also commented that they realize THEY are the community now and feel encouraged to run events and make the changes themselves.

For me, what I hold onto is changing things one family at a time, being there for
mothers when they need support, providing information and letting them get on with the job of changing society as only this younger generation are capable of doing.

Geraldine Cahill has been an IBCLC since 2007 and works in Private Practice. She provides home visits for Mums in the early postpartum period and also provides consults at Touchstone Medical Practice. In addition, she runs Breastfeeding Classes for mothers alongside and complemetary to her work as a Childbirth Educator. Geraldine is also the current President of Cuidiú (a parent to parent support group) and represents them on the Irish National Breastfeeding Strategy and Implementation Committee.   She is also on the Education and Membership Committees of ILCA working with other IBCLC’s to enhance the educational needs of her profession.

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Care for a Virtual Cuppa? Australia’s first Online Breastfeeding Café launched.

Written by Maddy Knight

The Australian Breastfeeding Association (ABA) has welcomed the newest addition to its stable of services for breastfeeding families, the Online Breastfeeding Café(OBC).

With so many blogs on the web about breastfeeding (ILCA’s Lactation Matters recently referred to BlogHer’s study where over 98% of respondents said they trusted the information they received on blogs), the Online Breastfeeding Café has been developed by the ABA as an online community where users can share, discover and chat with guaranteed reliable, up to date information.

The OBC also has families in mind. This means the inclusion of  an additional men’s parenting section and private, log-in only forum for Dads.

The new site was launched on behalf of NSW Minister for Health, the Hon. Jillian Skinner by State Member Roza Sage at Glenmore Park Child and Family (NSW real estate Australia) precinct on Tuesday 26 June. Also present at the launch were Cr Greg Davies, Mayor of Penrith and Todd Carney representing Federal Member the Hon. David Bradbury.

The Online Breastfeeding Café was three years in development and was designed with Generation Y parents in mind, knowing that for today’s families both mums and dads want to share in the breastfeeding and parenting journey.

“The OBC can help make sure mother’s and fathers both have a place to go to ask and share about their experiences. It really helps them to parent from the same page” says Nicole Bridges, Australian Breastfeeding Association Assistant Branch President.

“These days dads aren’t passive breastfeeding supporters, they want to know what’s going on and how they can help and support mum in any way they can. If she’s happy then the whole family is happy.”

The Online Breastfeeding Café features many of the Australian Breastfeeding Association’s reliable resources and information, but packaged in a new, vibrant and easy to use website that compliments its existing website.

The concept of the breastfeeding café as a physical venue first took off in the UK a couple of years ago. The OBC is the first attempt to take the concept of a comfortable, relaxed place to share and chat about breastfeeding and turn it into an online community.

A café theme runs through the website, with areas such as The Breastfeeding Couch, full of great tips, latest articles and breastfeeding videos; a dad’s-own section of the website aptly titled Dad’s Espresso Bar; great stories and inspiration in A Cuppa and a Read, as well as a long list of popular tools such as finding your local breastfeeding-friendly café.

More features of the Online Breastfeeding Café:

  • Most asked breastfeeding questions, and tips on making breastfeeding easier.
  • How to find your local breastfeeding class or breastfeeding-friendly café or lactation products.
  • Information on breastfeeding and returning to work.
  • The latest breastfeeding articles from the ABA and other trusted sources.
  • Great forums to get involved in, including a general/mum’s forum and completely private Dad’s forum.
  • In “Dad’s Espresso Bar”, a new father can find some practical ways to develop his own special unique bond with his baby even though mum does the breastfeeding. He can also chat with other dads in a private forum about some of the unique concerns of fathers.

The Online Breastfeeding Café also has forums that are fully mobile (containing every post) so you can take it with you and have a virtual cuppa and chat with other parents, all while you enjoy your latte at your local breastfeeding-friendly café.

We would love new mothers (and dads) to know all about this great new online community.

Log in today at www.onlinebreastfeedingcafe.com.au or contact the community manager@onlinebreastfeedingcafe.com.au for more information.

Maddy Knight is Project Director of the Online Breastfeeding Café. She is an experienced journalist, media advisor, publicist and graphic designer and has worked extensively with non-profit organisations including the Australian Breastfeeding Association. The Online Breastfeeding Café was her brainchild for which she developed the website plan and layout, edited and wrote much of the content and even designed the logo and slogan. She spends her spare time singing and writing her blog Bondi Sourdough 101. She lives in Bondi Beach with her husband and cat, Luna.

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The Best and Worst Places in the Industrialized World for Breastfeeding Support

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 Canadian RN and IBCLC Fleur Bickford on her blog Nurtured Child and she has graciously allowed us to republish it here.  You will have the opportunity to hear Fleur speak at this year’s ILCA Conference on the topic “Social Media as a Means to Protect, Promote and Support Breastfeeding”.

Written by Fleur Bickford

Photo via Save the Children

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme.

This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the best and worst places in the world to be a mother and the Infant and Toddler Early Feeding Score in this companion blog post.

The Breastfeeding Policy Scorecard for Developed Countries is new this year, and it provides an interesting look at support for breastfeeding in the industrialized world. Rankings are based on maternity leave laws, right to daily nursing breaks, percentage of hospitals that are baby friendly, state of policy support for the International Code of Marketing of Breastmilk Substitutes and breastfeeding practices. Of the 36 countries listed, Norway ranks first with a score of 9.2 and the USA ranks last with a score of 4.2. Canada ranks 31st with a score of 5.4.

From the report, we see that Norway is doing a wonderful job of supporting breastfeeding
mothers:

“Norway tops the Breastfeeding Policy Scorecard ranking. Norwegian mothers enjoy one of the most generous parental leave policies in the developed world. After giving birth, mothers can take up to 36 weeks off work with 100 percent of their pay, or they may opt for 46 weeks with 80 percent pay (or less if the leave period is shared with the father). In addition, Norwegian law provides for up to 12 months of additional child care leave,  whichcan be taken by both fathers and mothers. When they return to work, mothers have the right to nursing breaks as they need them. Nearly 80 percent of hospitals have been certified as “baby-friendly” and many provisions of the International Code of Marketing of Breast-milk Substitutes have been enacted into law. Breastfeeding practices in Norway reflect this supportive environment: 99 percent of babies there are breastfed initially and 70 percent are breastfed exclusively at 3 months.”

Compare this to the USA:

“The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country – and one of just a handful of countries worldwide – where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as “baby-friendly” and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months.”

The differences between Norway and the United States is staggering (and Canada isn’t doing much better than the United States). For all the talk about “Breast is best”, North America is doing a very poor job of providing parents with the support they need to actually give their babies the “best”. Most mothers want to breastfeed. Breastfeeding initiation rates are high, but breastfeeding drops off rapidly in the early weeks after birth. This happens not because mothers don’t want to breastfeed anymore, but because they haven’t received the support they need to continue. Breastfeeding is natural, but it is also something that requires community support. Conditions during birth and the first 72hrs after birth are critical for establishing breastfeeding (hence the importance of hospitals being Baby Friendly) and it is important that mothers have sufficient time off of work to establish their breastfeeding relationship which encourages a longer duration of breastfeeding.

Although not specifically about breastfeeding, below are some other key points about the United States from the report that should really be cause for alarm:

In the United States, mothers face a 1 in 2,100 risk of maternal death – the highest of any industrialized nation. In fact, only three developed countries – Albania, Moldova and the Russian Federation – perform worse than the United States on this indicator. A woman in the U.S. is more than 7 times as likely as a woman in Ireland or Italy to die from a pregnancy- related cause and her risk of maternal death is 15 times that of a woman in Greece.

The U.S. under-5 mortality rate is 8 per 1,000 births. This is on par with rates in Bosnia and Herzegovina, Montenegro, Slovakia and Qatar. Forty countries performed better than the U.S. on this indicator. This means that a child in the U.S. is four times as likely as a child in Iceland to die before his or her 5th birthday.

The United States has the least generous maternity leave policy of any wealthy nation. It is the only developed country – and one of only a handful of countries in the world – that does not guarantee working mothers paid leave.

The United States is also lagging behind with regard to preschool enrollment and the political status of women. Performance in both areas places it among the bottom 10 in the developed world.”

An interesting (and again alarming!) point about Canada from the Save the Children Canada website:

“Norway’s under 5 mortality rate is half that of Canada (3 deaths per 1000 live births vs 6 deaths per 1000 live births).”

The risks of not breastfeeding are well documented, and there is plenty of research on the best ways to encourage breastfeeding duration and exclusivity. The statistics from this report for the countries at the top of the Breastfeeding Policy Scorecard show that interventions such as requiring hospitals to be Baby Friendly, providing adequate paid maternity leave and supporting the International Code of Marketing of Breastmilk Substitutes DO work. This report should be a wake-up call for the countries at the bottom of the scorecard!

Below is the full list of where the 36 countries placed on the Breastfeeding Policy Scorecard. For the full details, and to see the score for each country, please refer to section 1:43 of the full report:

  1. Norway
  2. Slovenia
  3. Sweden
  4. Luxembourg
  5. Austria
  6. Lithuania
  7. Latvia
  8. Czech Republic
  9. Netherlands
  10. Germany
  11. Estonia
  12. Poland
  13. Portugal
  14. France
  15. Belgium
  16. Ireland
  17. Italy
  18. Switzerland
  19. New Zealand
  20. Cyprus
  21. Denmark
  22. Greece
  23. Slovak Republic
  24. Spain
  25. United Kingdom
  26. Finland
  27. Israel
  28. Japan
  29. Hungary
  30. Liechtenstein
  31. Canada
  32. Iceland
  33. Monaco
  34. Australia
  35. Malta
  36. United States
Fleur Bickford is a mother of two, an RN, IBCLC and retired LLLL. She worked in obstetrics as an RN for several years before taking time off to raise her family. During that time she gained experience in labour and delivery, post partum care and pediatrics. As a Leader for La Leche League Canada, she served as a member of both the Professional Liaison Department and the Social Media Advisory Committee. Currently, Fleur works in private practice in Ottawa, Ontario as owner and operator of Nurtured Child, and she is President of Ottawa Valley Lactation Consultants. Fleur maintains a blog, and is very active on both Twitter (@NurturedChild) and Facebook (NurturedChild).
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