Archive | Clinical Practice

New Strategies For Relieving Engorgement: Tips and Tools From Maya Bolman, BA, BSN, IBCLC

By Christine Staricka, BS, IBCLC, CCE, ILCA Medialert Team

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When Maya Bolman was a young girl in Russia, her godmother was known to all the women in her village as the one who could help with breastfeeding. People said her hands were “like magic.”

A young Bolman paid attention. She is now a well-respected clinical lactation care provider in the U.S. who uses her hands to help nursing mothers relieve the breast fullness that can interfere with their breastfeeding. In July, she brought her skills, clinical knowledge, and time-tested wisdom to the International Lactation Consultant Association® (ILCA®) 2014 Conference, and attendees returned home with a skill they could use immediately to help their own clients and patients.

Bolman observes that, since the breast has no fascia or muscle to aid in movement of fluids other than breast milk, congestion of the breasts is common during early lactation. As a new mother’s body sheds fluids from pregnancy and those given intravenously during hospital labor and childbirth, milk production begins in earnest. The breasts can become uncomfortably full or even swell to the point that milk ceases to flow. In addition, the skin covering the breast can become so taut and the areolae so swollen that the baby cannot latch. The simplest solution is a combination of gentle massage and manual milk expression, which softens the breasts and eases infant latch.

Evidence supporting the effectiveness of hand expression continues to mount. In locations lacking electricity for breast pumps, hand expression allows mothers to sufficiently maintain milk for premature and sick infants who are unable to feed directly at the breast. Teaching all new mothers to hand express ensures compliance with Step Five of the Ten Steps to Successful Breastfeeding, part of the Baby-Friendly Hospital Initiative.

“There is no right way to do hand expression, only the way that is gentle and that works,” Bolman explains. She has created a free video which she encourages to be shared with mothers (with appropriate credit to Bolman). Her work with Breast Feeding Medicine of Northeast Ohio confirms that even mothers who have already attempted these techniques on their own can still benefit from in-office treatment. The video provides an excellent introduction for new mothers and clinicians to hone their hand expression technique.

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In her clinic, Bolman and her colleague, Dr Ann Witt, MD, FABM, IBCLC, teach mothers to use these techniques when they come in for hands-on treatment of engorgement and plugged ducts. She finds that mothers of the youngest babies typically ask for help with engorgement, while plugged ducts seem to peak around 10 weeks postpartum. During the session, Bolman shared videos of herself and her colleagues providing gentle, sweeping massage of the breasts. In a motion toward the axilla, they use the sides of their hands and a generous amount of olive oil mixed with a few drops of an essential oil. Mothers are encouraged to lie back at an angle similar to the position used for prone breastfeeding. If their babies are present and hungry, they feed on the opposite breast during treatment as desired.

Results of these treatment sessions are overwhelmingly positive. They produce relief of overall pain, resolution of plugged ducts immediately in at least half the cases, decreased levels of nipple pain and tenderness, reduced periareolar edema, and easier latching/feeding. This type of customized “touch care” of breastfeeding mothers is derived from the wisdom of the ages. It is also very appropriate and relevant for today’s mothers who frequently have little experience with physical touch to their breasts other than during intimacy.

Bolman firmly believes that mothers are empowered when they are taught techniques for hand expression and massage to relieve engorgement on their own. She insists that we cannot teach it enough times to the mothers in our care, regardless of the age of their babies.

“They really want to learn these techniques for self-care,” Bolman stated, “because they are not necessarily instinctive.” She firmly believes that lactation care providers should guide mothers’ hands through the process of hand expression by placing a hand over the mother’s hand rather than directly on mother’s breast. She observes that we can often find solutions to common challenges by looking to other cultures. Bolman’s background and personal experience of blending her native and adoptive cultures has provided the lactation field with a priceless treasure in her techniques.

For more information, please see Recapturing the Art of Therapeutic Breast Massage during Breastfeeding by Bolman, Saju, Oganesyan, Kondrashova, & Witt in the Journal of Human Lactation HERE.


Maya Bolman, BA, BSN, IBCLC, was born and raised in Minsk, Belarus. Certified as  IBCLC in 2001. She has worked in both inpatient and outpatient settings and, since 2009, also worked as lactation consultant in a large pediatric practice and breastfeeding medicine practice. Bolman traveled to Russia in 2009, 2010 and 2012 to work with breastfeeding consultants and as the IBLCE Country Coordinator for Russia, Belarus, Ukraine and Latvia, helped to prepare 14 IBCLC candidates to pass certification exam and became the first IBCLCs in their countries. 


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


Informative Brochure for Radiology Personnel from the Breastfeeding Resource Center

Lactation Matters is proud to highlight this fantastic resource produced by the Breastfeeding Resource Center (BRC), a brochure intended to educate radiology personnel about breastfeeding. We hope that it will be helpful for those with questions about the compatibility of breastfeeding and contrast agents. We thank them for encouraging all of our readers to widely share this resource.

By Colette Acker, Executive Director of Breastfeeding Resource Center

“I had to switch to formula for two days because of my MRI. I couldn’t pump enough beforehand.”

“The doctor said I had to stop breastfeeding for a week because I needed the MRI and he said he wasn’t sure what that would do to the baby.”

These are common phrases we all have heard as IBCLCs. It’s even more frustrating when we hear about it after the fact.

By Helmut Januschka via Wikimedia Commons

By Helmut Januschka via Wikimedia Commons

The Breastfeeding Resource Center (BRC) provides assistance to fourth year medical students from Drexel University in Philadelphia, PA and they can use us as a resource for projects. Mariya Gusman, a Drexel student, came to the BRC to pick my brain for ideas for her project. Her passion lay in Radiology, but a visit to our center validated the important link between breastfeeding and Radiology.  You can only imagine my excitement when we started talking. Together with the BRC’s Education Committee, we planned to create a brochure for local Radiology Departments.  I pointed Mariya to resources to find evidence based information on contrast agents and their impact on breastfeeding. Interestingly, she came back to me with one question, “What’s the big deal about pumping and dumping for a few days?” Even she, a doctor and breastfeeding advocate, didn’t understand the difficulty.  So we decided to add a portion addressing the concerns surrounding pumping and dumping.

The BRC then gathered 15 volunteers to begin the search for contact information on as many Radiology Departments and Imaging Centers as we could find. A cover letter was developed and mailed along with two brochures to 85 researched addresses. We also emailed the brochure to our local ILCA affiliate members and offered to mail nicely printed copies to them. Many were excited to help spread the word.

Since the mailing, many of the recipients have contacted us. They have thanked us for our work and requested more brochures. We hope this project can end the senseless need for pumping and dumping!

We are proud to offer this resource to all of our readers. You can access it by clicking on Radiology brochure.

ColetteColette Acker is the Executive Director of the Breastfeeding Resource Center (BRC) in Abington, PA. In 1998, Colette became an IBCLC. She began providing home visits, but many mothers couldn’t afford to pay. In 2003, Colette and a colleague founded the BRC which provides visits on a sliding scale of payment. The first year they worked with almost 300 families. Last year, they worked with close to 1,000! New programs were developed over the years such as free support group meetings, observation days for pediatric residents, and a pump program for low income mothers. Colette loves both working with mothers and doing the daily tasks of the executive director.


Providing Support for Mothers Who Wish to Relactate

By Tom Johnston, CNM, IBCLC

Editor’s Note: This was first published on Tom Johnston’s Facebook Page which seeks to provide breastfeeding information to mothers. He has graciously allowed us to republish it here.

Photo by miriamwilcox via Flick Creative Commons

The vast majority of women who wean prematurely do so out of fears of inadequate milk supply. New mothers are in an incredibly vulnerable state and tend to blame every hiccup, every cry, and every fussy baby on herself and her milk supply. This often leaves new mothers feeling that they are failures because they were unable to breastfeed their babies and guilty because they are giving their baby formula which is known to increase the risk of countless childhood diseases. Fortunately, the perception of inadequate milk supply is often more of a misperception rather than a physiologic fact. That means that most women who wish to breastfeed after weaning can relactate and resume breastfeeding with the proper support and coaching.

Most women who have prematurely weaned and wish to relactate are good candidates for success. There is a small pool of mothers who find breastfeeding nearly impossible due to physical factors. Those with developmental abnormalities affecting the glandular tissue of the breast, endocrine disorders (disorders of the thyroid or pituitary gland), mothers of premature infants, and mothers who have never nursed may find relactation difficult. Most women however are healthy, have healthy term infants, and are likely to succeed, particularly if they have successfully nursed in past. There is even evidence suggesting that breast development during the first pregnancy and breastfeeding attempt is enhanced following the birth of a second child, even if the mother did not successfully breastfeed her first child.

Keys to Successful Relactation

Realistic Goals: Relactation can be time consuming and stressful and it may take several weeks to reach exclusive breastfeeding. While many women can successfully re-establish exclusive breastfeeding, there will be women who are unable, for myriad reasons, to exclusively breastfeed. I encourage women to set realistic goals on how long it will take to achieve success and what success will mean to her but to never give up. After all, a mother who is partially nursing while supplementing is still breastfeeding her child, whereas the mother who quits entirely is not breastfeeding at all. Success in relactation however, must be determined by the goals set by mothers, not lactation professionals.

Support: Lack of support leads to lack of confidence; lack of confidence leads to infrequent suckling; infrequent suckling leads to breastfeeding failure. All three are associated with less successful relactation. Breastfeeding mothers who suffer with feelings of inadequacy due to milk supply problems must be supported by their family and social groups if they hope to successfully relactate. Breastfeeding cannot be one of the many chores a woman must do each day; it must be the priority of the entire family. Mothers who find themselves trying to work pumping, the use of an at the breast supplementer, and breastfeeding into their already full schedule will often find themselves unable to overcome the challenges of relactation.

Breast/Nipple Stimulation: There are several techniques for breast and nipple stimulation, perhaps the most successful is direct infant suckling. However, the mother can augment that with hand expression, breast massage, warm compresses prior to stimulation, and mechanical pumping. Some studies have shown that combinations of these techniques enhance success.

Milk Removal: Since the breasts synthesize milk based on the degree of emptiness, breast drainage must be a part of nipple stimulation. The mother may find that a period of trial and error is needed to determine the best strategy for breast emptying (infant suckling, hand or pump expression, etc…).

Galactogogues: Galactogogues are medications or herbal supplements that increase milk production/synthesis. The two most common medications used to augment milk synthesisare Metaclopramide (Reglan) and Domperidone. Both are anti-nausea medicines which increase prolactin production. Unfortuantely, scientific evidence demonstrating the effectiveness of galactogogues is weak. Both Reglan and Domperidone have been shown to increase prolactin levels and milk production. However, the studies demonstrating this lack credibility in the scientific community. As such, it is important that women who take these medication understand that while they may be helpful, they are by no means a magic bullet that will increase milk synthesis. The evidence in support of Mother’s Milk Tea, Fenugreek and Milk Thistle (all common herbal galactogues) is even more questionable. Given the subjective way that milk production is measured, it is possible that many galactogogues work through the placebo effect rather than by actually increasing activity at the molecular level. That said, the point is moot; the goal of relactation is to empower a mother to breastfeed her child and the exact physiology behind her success is not as important as her success. I therefore support safe and responsible galactogogue use under the supervision of a competent IBCLC.

Oxytocin: Oxytocin is the hormone that causes the Milk Ejection Reflex (MER), also known as the “let down” effect. It surges in response to nipple stimulation, and during pleasurable experiences (skin to skin contact, infant snuggling, and affectionate attention from a loved one). It is therefore, no surprise that stress, anxiety, fear, and pain all decrease oxytocin release. Oxytocin is also released due to conditioning responses, meaning that release is enhanced when mothers do things that remind them of breastfeeding. For example if you always sit in the same chair to breastfeed, the act of sitting in that chair will increase your likely hood of having an oxytocin surge. I often suggest that pump dependent mothers cover their breasts and pump with the baby’s blanket. Not only does this hide the pump and keep mothers from stressing over the actual movement of milk, but it also triggers a conditioned response to breastfeed due to the smell of the baby on the blanket. The important thing about oxytocin is to relax and enjoy the time spent breastfeeding, and as much as possible, the time spent pumping, hand expressing, massaging the breasts. A synthetic oxytocin is available in some areas through compounding pharmacies and can enhance the let down response.

Yes, you can relactate but you and your loved ones have to commit to it. The key physical factors needed for relactation are breast/nipple stimulation and milk removal. I can’t stress enough that in order to enhance the success of nipple stimulation and milk removal the mother must be confident in her abilities, comfortable and relaxed while nursing, and must have realistic goals. The mother must be supported and able to prioritize relactation. I strongly recommend that any mother having difficulty with milk production see a lactation consultant immediately to avoid weaning however, weaning does not have to be permanent. If you have stopped nursing and want to relactate, you can.

In the words of Winston Churchill “Never, Never, Never, Never, Never, Give Up!” You can do it!

Thorley, V. (2012) Induced Lactation and Relactation. In Mannel R., Marten, P.J. and Walker, M. Core Curriculum for Lactation Consultant Practice 3rd Ed. Jones and Bartlett Publishers. Burlington MA.
Academy of Breastfeeding Medicine Protocol Committee. (2011). ABM Clinical protocol no. 9: Use of galactogogues in initiating or augmenting the rate of maternal milk secretion (first revision January 2011). Breastfeeding Medicine, 6, 41-49.
Agarwall, S., & Jain, A. (2010). Early successful relactation in a case of prolonged lactation failure. Indian J of Pediatrics, 77(2), 214.

Jarold (Tom) Johnston, father of eight breastfed children, has spent his career advocating for the rights of fathers in the perinatal arena and has spoken on a variety of topics at conferences around the world. He is uniquely placed as a father, midwife, and lactation consultant, and brings that one of a kind perspective to his writing. He is a budding author with many ideas on integrating fathers into the birthing and breastfeeding process.


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


How Often Does Breastfeeding Just Not Work? (from Dr. Alison Stuebe and the Academy of Breastfeeding Medicine Blog)

Occasionally on Lactation Matters, we find a blog post that is so incredibly important that we want to do everything in our power to make sure all ILCA members can read it.  This is just such a post from Dr. Alison Stuebe. Dr. Stuebe is a maternal-fetal medicine physician, breastfeeding research, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is also a member of the board of the Academy of Breastfeeding Medicine. So often, as we study lactation, we talk about the “HOW”…this post asks “WHY”.  Thank you, Dr. Stuebe for allowing us to republish your blog post here on Lactation Matters. It was originally published on the Academy of Breastfeeding Medicine blog.

How Often Does Breastfeeding Just Not Work?

By Dr. Alison Stuebe, MD, MSc

Jessica Isles posted a great question today on my blog, “When Lactation Doesn’t Work:

I was wondering if any comparative studies have been done on the statistics of lactation failure in various cultures both developed and less developed. Please post if you are aware of any – or any statistics on how many women’s milk never comes in (in the US), with a healthy full term new born, in an environment supportive of breastfeeding. We need to help mothers who struggle with this.”

That’s a great question – and a difficult one to answer. Marianne Neifert estimates that “as many as 5% of women may have primary insufficient lactation because of anatomic breast variations or medical illness that make them unable to produce a full milk supply despite heroic efforts.”   [Neifert MR (2001). “Prevention of breastfeeding tragedies.” Pediatr Clin North Am 48(2): 273-97.]

We are working on a research project to try to estimate the proportion of women in the Infant Feeding Practices Survey II who experienced unplanned, undesired weaning due to physiologic problems with breastfeeding. One challenge is what to call this condition. I’ve written a draft of the paper using the term “failed lactation,” but I don’t like it.  I have problems using the word “failed” to describe mothers who have gone to heroic lengths to sustain breastfeeding. We’ve also tossed around “lactation dysfunction” or “unwanted weaning,” but those don’t quite cut it either. I want a phrase that health care providers will take seriously and moms will perceive as a lifeboat in a storm, not as insult added to injury. My personal favorite is “Lactastrophe,” but I suspect that would not make its way into the medical lexicon. What do you think we should call it when lactation doesn’t work?

We’re also finding that it’s quite difficult to tease out the issue of “a supportive environment” vs biological problems with lactation. It’s a bit like trying to tease out how much of the type 2 diabetes epidemic is caused by “biology” vs “the environment.”  Over the past two decades, the proportion of our population that is obese has sky-rocketed, in the setting of decreasing physical activity, ballooning portion sizes, neighborhoods without sidewalks, and worsening economic inequality and job insecurity. Some people who live in this country have developed diabetes, and some have not.  It’s likely that some individuals have a biological predisposition that makes them vulnerable, whereas others do not. Regardless of the precipitating factor, however, these patients need help to control their blood sugars.

Similarly, for lactation, there are some mothers who are blessed with ample milk supplies and with babies who are born with a championship suck-swallow pattern, and they would be likely to breastfeed successfully in just about any environment. And there are other dyads for whom one piece of bad advice or a nasty encounter with a stranger while breastfeeding in public is enough to throw lactation completely off track.  Furthermore, it’s likely that women who have been socialized to mistrust their bodies are more vulnerable to interpreting early feeding challenges as evidence that their bodies can’t sustain breastfeeding– and they are thus more likely to wean and attribute their decision to a physiological problem.

From a health and wellbeing perspective, however, I’m not sure that it matters whether we “count” both “biological” and “perceived” insufficient lactation together. The total burden of this problem is enormous, and mothers are suffering, whether they lack glandular tissue and or they lack self-efficacy and support.  We need mothers for whom lactation doesn’t work to know that they are not alone.  And we need to demand research to develop the tools that will identify the underlying problems and allow us to implement the appropriate treatment.

We also need to step back from assertions that every mother can breastfeed, if she just tries hard enough. As Neifert has written, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’ The fact is that lactation, like all physiologic functions, sometimes fails because of various medical causes.”

Lactation is part of normal human physiology, and like all other human physiology, it can fail. It’s time to stop bickering about whether this mom tried as hard as that mom to breastfeed. We have too much work to do.

Please take the opportunity to visit the Academy of Breastfeeding Medicine’s blog and leave your comments.


Increasing breastfeeding duration: One Sling at a Time!

Written by Jennie Bever Babendure, PhD, IBCLC

Author Jennie Bever Babendure with her little one

By now, most of us in the lactation field have heard of Kangaroo Mother Care (KMC). Maybe you’ve even been lucky enough to hear Nils Bergman speak passionately about the work he’s done using KMC, and its benefits for premature infant thermal regulation and brain development. Most importantly for those of us in the lactation world, the skin-to skin contact (SSC) used in KMC is associated with increased breastfeeding duration. Despite all the attention SSC and KMC have received, no one has yet looked at the impact on breastfeeding of mother/infant body contact beyond the first hours after birth in term infants.

A recent article in Acta Paediatrica by Continisio, Continisio, Filosa and Tagliamonte, set out to remedy this by designing an intervention to increase mother/infant body contact in the first month of life. 100 Italian mothers were given information on breastfeeding as well as a cloth baby carrier. They were shown how to put their (clothed) infants into the carrier and asked to wear the baby in the carrier as often as possible, and for at least 1 hour per day during the baby’s first month. Control mothers were given information on breastfeeding only.

What they found surprised even me, a sling-wearing, card-carrying member of the babywearing fan club.

Photo by hugabub via Flickr Creative Commons

Mothers in the intervention group were 1.8 times more likely to still be breastfeeding at 2 months and 2.9 times more likely to still be breastfeeding at 5 months and breastfed their babies significantly more often (times per day/ night) at 1 and 2 months. Mothers in the intervention were also more likely to be exclusively breastfeeding at 2 and 5 months. In addition, the majority of the mothers who used the baby carrier felt it was useful for breastfeeding as well as bonding, understanding of baby needs, and getting things done.


For me, these results are staggering. The intervention is simple, requires minimal skill to administer, and mothers and babies are not only getting the health advantages of longer and more exclusive breastfeeding, they’re also getting more bonding time and getting things done! It is for this last reason, I would imagine, that women the world over have chosen to carry their babies in cloth carriers for thousands of years. They, like many mothers who use cloth carriers these days, likely could have told us that babywearing makes breastfeeding easier. Thanks to this study, we now know that it also helps mothers breastfeed longer and more exclusively.

This study provides solid evidence that increased mother/baby contact through the use of a baby carrier can increase breastfeeding duration and exclusivity. Although this study was done with only one type of carrier, I would guess that most carriers that allow mothers to wear their new babies close to their chests (as in KMC) would be of similar benefit.

One of my favorite resources for all things babywearing is They have reviews, forums, and information on buying, making, and using baby carriers of all kinds. Be sure to check out the resources on their homepage on safe positioning. Like any type of baby gear, baby carriers must be used properly, and it’s important to check to make sure that any baby carrier you use has not been recalled.

I’m not sure I would have made it through the first few months without a baby carrier. In fact as I finish this post, my son is snuggled against my chest in a carrier while we sway back and forth to Neil Diamond.

Have you or the mothers you work with used a baby carrier? Have you found it to make breastfeeding easier?

Pisacane A, Continisio P, Continisio GI, Filosa C, Tagliamonte V. Use of baby carriers to increase breastfeeding duration among term-infants: the effects of an educational intervention in Italy. Acta Paediatrica 2012:epub ahead of print.

Jennie Bever Babendure, PhD, IBCLC: I am mom 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


Playing Sherlock

Written by Diana Cassar-Uhl

When we begin our encounter with a mother, whether it’s before she’s discharged from the hospital, on a home visit during the first week, or after she’s struggled to find comfort and confidence in breastfeeding, our assessment of her situation starts with her report:

“My nipples are so painful.”

“My baby’s weight gain isn’t good enough and I don’t want to use formula.”

“There are shooting pains running through my breast. Is it serious?”

“Can I text you a picture of my baby’s last poop? I don’t know if it’s normal.”

We get as much of a history as the situation permits, and the diagnostician inside of us gets to work. We assess the foundational things – positioning, latch, breastfeeding management. Are feeds on demand or on a schedule? Is there a pacifier in the picture? Are mother and baby comfortable? Sometimes, these answers are enough to get the dyad on their way to breastfeeding success for the weeks, months, or years they hoped to accomplish.

Benedict Cumberbatch during filming of Sherlock.
Photo by bellaphon via Flickr Creative Commons

Other times, our detective skills are necessary. The preliminary suggestions brought little or no relief, and it’s up to us to help the mother solve the whodunnit mystery that spurred her to seek our help in the first place. Like any good detective, we have our eyes open for clues (if the “Blues Clues” theme music is playing in your head, that’s a good sign you’ve been a mother or a grandmother in the United States sometime in the last 15 years or so). When we assess mother and baby as a dyad, many clues are revealed. Why does this work? There is no breastfeeding without both a baby and a mother. The dyad is interdependent, a single entity. Baby needs mother, but mother also needs baby. It follows, then, that when something is amiss in one part of the system, we’ll get to the bottom of the problem faster if we look at the whole mother-baby system. Baby’s tongue is firmly attached to the bottom of their mouth? Aha! No wonder this mother’s nipples are destroyed! Breasts are spraying like Old Faithful at every feeding? Gotcha! The cause of those green, mucousy bowel movements!

Often, after I’ve taken out my magnifying glass and started dusting for fingerprints, I realize my culprit was sitting at the dining room table, holding the candlesticks, all along … baby with sluggish weight gain AND mother with repeated plugged milk ducts? Why didn’t I ask first about breastfeeding management before I started wondering about whether the baby had problems absorbing nutrients? Why was I so quick to send the mother researching about lecithin instead of looking at the more obvious causes of her plugs?

Assessing both the mother and the baby will help us get to the root causes of breastfeeding problems much more quickly, and often more completely, than evaluating each separately might permit. When we keep in mind that we are facilitating the establishment, maintenance, and growth of a holistic, two-part system, solving the breastfeeding whodunnits becomes … elementary, my dear.

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


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