Archive | JHL article

JHL Research: Impact of Maternity Leave On Breastfeeding Outcomes

Journal of Human Lactation

Editor’s Note: Leigh Anne O’Connor, a U.S. based IBCLC in private practice who often works with mothers planning to return to work, recently interviewed Kelsey R. Mirkovic, one of the authors of the recently published study on the impact of maternity leave on breastfeeding outcomes. Read on to learn more about the outcomes, study design, and more:

Recently the Journal of Human Lactation published the study Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions by Kelsey R. Mirkovic, Cria G. Perrine, Kelley S. Scanlon, and Laurence M. Grummer-Strawn.

The study showed that employment can be a barrier to breastfeeding outcomes. This reiterates the importance of public health policy and its role in supporting employed breastfeeding parents.

I interviewed Kelsey R. Mirkovic, PhD to learn more about this study.

Here is what she had to say:

What were the key findings of your research?

We found that even among mothers who planned to breastfeed for more than three months, that those who returned to full-time work any time before three months were less likely to meet that intention.

Were there any big surprises for you and your team? 

Early return to full-time work has been frequently cited as a barrier to breastfeeding and we were not surprised to find that even among mothers who planned to breastfeed for at least three months that those who did return to full time work did not continue breastfeeding.

What compelled you to do this study?

Others have published studies that show mothers who take shorter maternity leaves and return to work full-time stop breastfeeding earlier; however, some people think that mothers who plan to breastfeed for a shorter duration will return to work earlier. Because so many mothers participate in the work force, most with a full-time schedule, we wanted to determine if earlier return to full-time work was a barrier to breastfeeding even among women who planned to breastfeed for at least three months. 

Was there any intervention for any of the parents with an IBCLC?

In this study we did not consider mothers experiences with an IBCLC.

What definition is used for breastfeeding? Partial or exclusive? Was the definition a consideration?

In this study we focused on any breastfeeding as an outcome. We considered looking at exclusive breastfeeding as an outcome; however, in another paper published using the same group of women, it was shown that even among mothers who planned to exclusively breastfeed, many infants were supplemented with formula within the first month. Because this happened so early, we thought that other barriers to breastfeeding were likely contributing to the early supplementation, such as hospital practices or lack of peer or professional support.

What are your hopes with this study? What outcomes on a national public health policy do you see occurring?

It is important for public health policy to support women who choose the healthiest option for feeding their infants and we hope this study will contribute to the growing evidence that returning to work earlier may reduce a mother’s ability to meet her own intentions for infant feeding.

Do you see this study as a tool to change policy?

At CDC, we are dedicated to conducting research that will inform public health policy and we believe this study will contribute to the growing evidence that longer maternity leaves and/or part-time return schedules may increase breastfeeding rates and have important health benefits for mothers and infants.

If you could do the same study again, what would you change about the methods used in this study?

The Infant Feeding Practices Study II (IFPS II) was a very valuable and comprehensive study that followed expectant mothers from the 3rd trimester of pregnancy through the first year of their child’s life. This study asked mothers a number of questions about infant feeding and infant care practices. Because this study was not primarily focused on maternal employment, only a few questions were asked about the new mothers’ work. It would be very interesting to know how much maternity leave each mother had available and why she returned to work when she did; and if she would have taken a longer maternity leave if she could have received pay during her leave. It would also be very interesting to know if the mothers who did not meet their three-month breastfeeding intention perceived work as a major barrier to breastfeeding as long as they had planned.

Did you find that the parents who planned to breastfeed for a shorter duration did, in fact, return to work sooner?

In this study, we only included mothers who planned to breastfeed for at least three months and most of the mothers in our study planned to breastfeed for at least nine months. In fact, more than 40% planned to breastfeed for at least twelve months. Despite the long breastfeeding duration many mothers planned, mothers who returned to work before three months were less likely to breastfeed for at least three months, especially mothers who returned to work full-time before six weeks.

What would you like to add that was not included in the final printed research?

This study focused on a breastfeeding duration of at least three months. However, the American Academy of Pediatrics recommends continued breastfeeding for the first twelve months or longer and it is important to support and encourage mothers to breastfeed as recommended.

LAO headshot summer 2014Leigh Anne O’Connor, IBCLC, RLC

Leigh Anne O’Connor is a Private Practice Lactation Consultant, La Leche League Leader and mother of three. She lives and practices in New York City. She writes at www.mamamilkandme.com. You can learn more about her work at www.leighanneoconnor.com

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Kelsey R. Mirkovic, PhD

Dr. Kelsey Mirkovic works as an epidemiologist for CDC in the Division of Nutrition, Physical Activity, and Obesity, where she focuses her work on infant feeding.  Her current research activities have focused on how topics related to maternal employment influences breastfeeding behaviors and how we may support more working mothers successfully breastfeed.

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New JHL Paper Calls for Standardization of Data on Human Milk Banking

By Monica Buchanan, Media and Public Relations Manager, Connecticut Children’s Medical Center

Photo by Mistel de Varona

Photo by Mistel de Varona

Most healthcare professionals know the health benefits of human milk for infants admitted to the NICU are well documented.  Human milk not only provides essential nutrients, but also helps build immunities in this fragile population.

Unfortunately, most mothers of NICU babies may be unable to provide some or all of the milk their infant needs.  However, the use of donor human milk (DHM) in the NICU setting provides an opportunity for very low birth weight infants (<1500 grams) to receive the valuable benefits of human milk.

While donor human milk undergoes extensive screening and testing to ensure its safety, a first-of-its-kind study by the Connecticut Human Milk Research Center at Connecticut Children’s Medical Center, published in the Journal of Human Lactation (JHL), has found a serious lack of standardized data among donor milk banks across North America.  Human Milk Banking Association of North America-affiliated milk banks do not collect consistent data regarding milk donors and milk bank operations.  The authors of the study conclude that “this lack of standardization and transparency may deter implementation of donor milk programs in the neonatal intensive care unit setting and hinder benchmarking, research and quality improvement initiatives.”

Dr. Elizabeth Brownell, Director of the Connecticut Human Milk Research Center, and her colleagues also found a consistent lack of data available to hospitals who offer a donor milk program.  There is no consistent definition, collection, or management of data among milk banks and a clear lack of transparency.  Again, this is not an issue of the milk’s safety, but rather one of failing to obtain critical information about how milk is categorized and distributed across the United States.

This becomes problematic when you consider that many hospitals offering a donor milk program don’t buy milk from the same milk bank, which could mean milk from Bank A may not be defined in the same way as milk from Bank B.  Of note, the study finds the definition of preterm milk varied between milk banks.

In 2010, the Food and Drug Administration recognized the need to develop a centralized registry to collect and disseminate standardized data.  This registry still does not exist.  Dr. Brownell suggests HMBANA- affiliate milk banks work with leadership and/or academic researchers to develop this registry as soon as possible.  Accountability by the FDA could help expedite this process.

Because donor milk use in NICU’s across the country is expanding rapidly, this study highlights the increasing importance of monitoring its infrastructure and reporting outcomes.  It also suggests standardizing data collection among all milk banks, storing it in a central repository, and distributing that information to stakeholders and hospitals.

The full article may be accessed by JHL subscribers HERE.

Buchanan, Monica (1)Monica Buchanan is the Media and Public Relations manager at Connecticut Children’s Medical Center. She joined the corporate communication department in August 2013. Monica transitioned into the PR world after spending nearly 10 years in local news. She was most recently an investigative reporter with WVIT- NBC CT in West Hartford, CT. There she covered major political stories involving corruption at Hartford city hall, covered Superstorm Sandy and the October snowstorm that devastated the Northeast. Monica began her news career as a general assignment reporter for WCTV in Tallahassee, FL in 2004 and has lived in Valdosta, GA and Sarasota, FL as well. She graduated summa cum laude from the University of Florida with a degree in broadcast journalism and is a wife and mom to son Brandon.

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How IBCLCs Can Make an Impact Through Social Media

Written by Robin Kaplan, M.Ed., IBCLC

With 93% of adults born after 1982 (the Millennial Generation) communicating online and nearly 3 out of 4 using social networking websites, such as Facebook and Twitter, breastfeeding promotion and support has been taken to an entirely new level. In the Journal of Human Lactation article, Establishing an Online and Social Media Presence for Your IBCLC Practice, authors Amber D. McCann and Jeanette E. McCulloch, present findings that encourage all of us in the breastfeeding community to step into the minds of these Millennial mothers and engage with them about breastfeeding in their preferred medium.

Why does breastfeeding promotion and support need a social media presence?

While health care providers continue to be the first choice for most people with health concerns, 80% of US Internet users have sought health advice online.  Plus, 44% of US women spend more time online after a new baby is born.  We live in an amazing time where we can find answers online in an instant when we used to have to wait until our doctor’s office opened the next morning.  The scary side of this is that there is so much misinformation online about breastfeeding and how easy it is for mothers to access this incorrect advice. Even formula companies have breastfeeding advice sections on their websites… this is NOT where new mothers should be receiving their evidence-based breastfeeding information and support….right next to a Enfamil advertisement!

Also, with breastfeeding being such a HOT TOPIC in the news, mothers are often bombarded with this negative press.  It goes viral in an instant!  The Time Magazine article, ‘Are You Mom Enough‘ and Mayor Bloomberg’s initiative to ban the formula bags in all New York City hospitals flooded the Internet and social media networks in record time.  Negative comments about breastfeeding were abundant!  While Best for Babes and Kellymom are doing all they can to turn this bad breastfeeding press into something positive, they need our help to further provide breastfeeding education and support online.

So where are these Millennial mothers and what are they doing online?

The four most dominant social media platforms are Facebook, Twitter, blogs, and Pinterest. What these platforms have in common is that they ALL promote engagement among Internet users.  This is not like reading a book for information, which is a one-sided conversation.  Using social media allows you the ability to comment, ask questions, and agree/disagree with the author and other commenters.  It’s a conversation.  When a mother posts a question on a Facebook page, she is actively seeking advice from her peers or an ‘expert.’  When a mom reads a blog article, she is looking to make connections with the author to help make sense of her world and often seek advice on a particular topic.  Twitter is all about conversation and engagement and Pinterest is now a hub for articles and driving more traffic to websites than Facebook.  We may not live in a village anymore, but the Internet is revitalizing the village mentality.  It’s all about the need for support and belonging.

How can an IBCLC use social media effectively, without feeling like it is a waste of his/her time?

  • Creating a social media plan can be extremely helpful or you might find yourself being led down the time-sucking social media rabbit hole.  As McCann and McCulloch suggest, create a plan that is appropriate for the size of your business or organization.
  • Decide who your target audience is and the purpose of your engagement.
  • Choose a social media platform or two that you feel is manageable and decide how much time you plan to dedicate to it a week.
  • Spend some time just watching and listening.  You will figure out pretty easily what your audience is looking for.
  • Keep in mind that social media is all about sharing information. While you don’t want to give away everything you know, the more information you benevolently share online, the more appreciative your audience will be and encouraged to return to your platform in the future.  You may have the chance to influence the greater masses with your positive messages about breastfeeding!

What about ethical concerns and client/patient confidentiality?

McCann and McCulloch stress the importance of upholding our Code of Professional Conduct, Scope of Practice, and Standards of Practice.  The authors state that while these documents ‘do not contain a specific social media policy, IBCLCs may want to review the American Medical Association’s Policy on Professionalism in the Use of Social Media’.

As an avid blogger and social media user, I have a phrase that I use very regularly when I receive a comment or question that takes information from general breastfeeding advice to specific for one mom and baby and it goes something like this…. “It definitely sounds like you have some very important questions that would be best answered in a private conversation with an IBCLC.  If you would like to discuss this further, please contact me at …..”   This lets the mother know that I would love to help her, but this is not the appropriate place to discuss private, personal information and I want to protect her privacy.

So, even if you feel like you are not Internet savvy and social media gives you hives, all you have to do is start off slowly.  Lurk a little on these social media platforms and just listen to what mothers are saying and asking for.  Check out the Lactation Matters article, Great Breastfeeding Blogs to Read, and start sharing these articles on a social media platform.  Begin a conversation on a Business Facebook page and see where it takes you.  My guess is that you quickly see your calling to offer breastfeeding-supportive and evidence-based guidance to our Millennial mothers.  And you never know… you might just have a ton of fun, as well!

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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From JHL: How US Mothers Store and Handle Their Expressed Breast Milk

Written by Robin Kaplan, M.Ed., IBCLC

Image via Mistel de Varona

Breast milk storage guidelines can be incredibly complicated for mothers to decipher. With each pump company and breastfeeding website having its own storage and handling recommendations, how’s a mother to know which one to follow? Plus, throw in whether the baby is full-term, pre-term, healthy, or in the NICU, and we have quite a confusing situation.

In the most recent online publication in the Journal of Human Lactation, How US Mothers Store and Handle Their Expressed Breast Milk, Judith Labiner-Wolfe and Sara B. Fein analyze the data they collected from over 2,000 pumping mothers in the United States. Their findings will probably not shock any lactation consultants, yet the authors bring up very valid conclusions for how we can educate the breastfeeding and pumping mothers that many of us work with.

Here are some of the significant results of the study:

  • 95% of mothers either never stored their milk at room temperature or did so for less than 4hrs. Recommendations range from 1-10 hours.
  • Roughly 50% of mothers never refrigerated their milk for less than 1 day and no more than 4% left it in the fridge for more than 5 days. Recommendations range from 1-8 days.
  • 10% of mothers heated their breast milk in a microwave, a practice that can cause uneven heating, as well as destroy some of the nutrient and anti-infective factors in breast milk. The professional consensus is to never microwave breast milk.
  • 17% of mothers with babies under 6.5 months old reported that they occasionally only used water to rinse the bottle nipples, which the authors stated could cause the baby to ingest harmful bacteria. Recommendations range from rinsing in warm, soapy to sterilizing daily.

What are our professional guidelines?

There are also some discrepancies as to how long pumped milk stays fresh and viable, even in our own professional guidelines. While these recommendations are similar to one another, there is still enough variability to cause confusion for even the most educated lactation consultant. Here are the recommendations, for a healthy infant, according to the newest edition of the Core Curriculum for Lactation Consultant Practice (2012):

Room Temperature 77 º: < 6 hrs.
Refrigerator: < 8 days
Insulated cooler with ice pack: < 24 hrs.
Completely thawed in the refrigerator: < 24 hrs.
Freezer compartment in 1-door refrigerator: 2 weeks
Freezer door in 2-door refrigerator: < 6 months
Deep freezer: < 12 months

The Academy of Breastfeeding Medicine Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants states:

Room temperature 16-29ºC (60-85ºF): 3-4 hrs. optimal; 6-8 hrs. acceptable under very clean conditions
Refrigerator ≤4ºC (39ºF): 72 hrs. optimal; 5-8 days under very clean conditions
Freezer < -17ºC (0ºF): 6 months optimal, 12 months acceptable
Reusing stored human milk – There is little information regarding the issue of refreezing thawed human milk or the duration of time that human milk can be used once a baby has begun drinking from the bottle or cup.

Both resources recommend washing human milk storage containers in hot soapy water and
rinsing or washing in the dish washer. Sterilization is not necessary.

How do these findings impact our practices when we work with breastfeeding and pumping mothers?

When we are discussing safe storage guidelines for breast milk, it is important to review our professional recommendations, as well as include warming, safe handling, and pump/bottle cleaning recommendations to protect the integrity of the breast milk, as well as the health of the child.

Recommendations should be accompanied by rationale, so that the mother understands WHY her breast milk is less compromised following these standards.

Where do we go from here?

This study’s findings highlight the need for a more systematic, researched-based recommendation for the viability of breast milk and what constitutes safe handling and storage. With so many variables (temperature of the storage space, type of storage equipment, handling, feeding, and cleaning procedures, etc.) there are just too many options, which I, myself, find incredibly confusing. While there are many factors that go into keeping breast milk viable for consumption, there has to be some way that we can create guidelines that are easier for new parents, and lactation consultants alike, to navigate and follow.

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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JHL’s Newest Podcast: Challenges and Successes: The Baby Friendly Initiative in Norway

The Journal of Human Lactation’s (JHL) newest podcast is now available on their website.  Based upon “Challenges and Successes: The Baby Friendly Initiative in Norway” from the latest issue of JHL, this podcast is an interview by Editor-in-Chief, Anne Merewood, of one of the paper’s authors, Mette Ness Hansen. Hansen is a registered nurse and IBCLC at The Norwegian Resource Centre for Breastfeeding at the Oslo University Hospital and has been involved with the Baby Friendly Hospital Initiative since the early eighties.

Click HERE for the latest podcast.

We asked Hansen to share a bit about how the tide turned in regards to being Baby Friendly in Norway and here is what she had to say:

 When we first began to implement the BFHI back in 1993, we were lucky to be supported by the Norwegian health authorities.

At that time, our maternity ward routines were not particulary Baby-Friendly: 24 hour rooming-in was rare, supplementing with formula and / or sugar water from day one was quite common and breastfeeding knowledge among staff was generally poor.

The general idea was that the best care for the mother after birth, was if she could sleep the whole night after beeing provided with pain killers and sleping pills, while the staff were looking after the baby, giving supplement and pacifiers.

For the staff who were used to taking care of the baby, it was hard to accept that the mother was capable of both feeding and nursing the baby herself. Losing ”control” of the newborn was like loosing their professional identity. Soon we realized that it was necessary to introduce a guiding principle: Caring for the mother, enabling her to care for the baby.

Changing routines is always a challenge and when implementing the BFHI. The most important task was to train the clinical staff members in breastfeeding skills to make them understand the usefulness of the Ten Steps. Today more than 90 % of all babies in Norway are born in a designated Baby-Friendly unit.

The Initiative has been expanded to the NICU’s and since 2005 the Initiative has been adapted to the Community Health Services. Today almost 50% of all mothers with newborn babies are linked to a Maternal and Child Health Center which are designated as, or are in the process of becomming Baby-Friendly.

We have no Baby-Friendly assessment and designation for educational establishments. Most education programs for midwifery and health visitors schools offer education on breastfeeding. The Norwegian Resource Centre for Breastfeeding in co-operation with the College of Health care studies have a program where we educate specialised breastfeeding counsellors on a national level.

Since Febryary 2012, we have been pilot testing an electronic reassessment tool based on WHO’s monitoring tool for BFHI. In October this year, we plan to carry out this reassessment in all Baby-Friendly hospitals and birthing units, and at the same time we are asking for Infant Feeding Records to register the use of supplements.

BFHI is an effective tool in increasing breastfeeding rates and interaction between mother and child. The training of staff is crucial; the more you know about breastfeeding, the more you understand the importance of implementing the Ten Steps.

For subscribers to the journal, you can read the full paper HERE.

Mette Ness Hansen, RN, RM, IBCLC, has been working several years in delivery- and maternity wards. She is now employed in The Norwegian Resource Centre for Breastfeeding, Oslo University Hospital. She has been involved in breastfeeding promotion support since the eighties including initiation and assessment of the WHO/UNICEF “Baby-Friendly Hospital Initiative” (BFHI) and the expansion of BFHI to the neonatal units in Norway. She is a BFHI coordinator, and is also working as a community midwife.

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What Do Undergraduates Think about Breastfeeding?

Written by Robin Kaplan, M.Ed., IBCLC

Photo by j.o.h.n. walker via Flickr

It is well known that in the United States, breastfeeding rates are somewhat discouraging. With only 35% of babies exclusively breastfeeding at 3 months and 44.3% receiving any breast milk at all at 6 months, as a nation we are not meeting the standards set forth by the American Academy of Pediatrics nor the World Health Organization. As we continue to look at ways in which we can increase our breastfeeding rates, one suggestion has been to examine the breastfeeding education taught to nonpregnant youth.

An article in the upcoming issue of the Journal of Human Lactation explores this issue. Kavanaugh, et al. surveyed 248 nonpregnant undergraduate youth at a large research university in Tennessee to determine their breastfeeding knowledge, attitudes, prior exposure, and breastfeeding intent (For subscribers to The Journal of Human Lactation, you can read the full text of the paper here).

The most significant findings from the study were:

  • Over 90% of the participants agreed that breastfeeding should be started soon after birth and that breast milk and formula were not the same. However, only about 50% of the participants knew that breastfeeding can reduce a mother’s risk of cancer and that formula-fed infants are ill more often than breastfed babies.
  • While a majority of the participants believed that breastfeeding was cheaper and healthier than formula, an astounding number felt that breastfeeding in public was embarrassing and unacceptable (71% female, 47.7% male) as well as inconvenient and painful (47.8 female, 33.8% male).
  • Those who had been breastfed as infants scored significantly higher on breastfeeding knowledge and positive attitude towards breastfeeding than those who were unsure or had not been breastfed.
  • The majority of the participants (80%) intended to breastfeed/support a partner to breastfeed in the future.

So where do we go from here? How do we change the attitudes of children, adolescents, and young nonpregnant adults about breastfeeding?

  • This research study is limited in its generalization due to the sample of the participants, therefore we need more wide spread, longitudinal studies of adolescents and young adults’ breastfeeding knowledge and attitudes.
  • We need better support and legislation to protect breastfeeding in public. If breastfeeding in public becomes the norm, as it is in MANY other countries, it should decrease the perception that it is embarrassing, unacceptable, and inconvenient. It’s time we start seeing more of this:

    Photo via blondebutbright.blogspot.com

    and less of this:

    Photo by Kate Gulbranson (@hygeiakate)

  • Additional curriculum, like the one pioneered in NY State, that promotes breastfeeding as the norm, in human development and nutrition classes for children, adolescents and college students. The bulk of the content could focus on the benefits of breastfeeding (for both mother and baby), the hazards of formula, and the superior nutritional components of breast milk.
  • A recommendation, per the authors (which I personally think is brilliant), it also to educate our youth about appropriate infant development and behavior. The authors concluded that if our youth understood how often an infant/toddler needed to breastfeed and that covering with a blanket was not always feasible (especially with an older infant who wants to see the world around him/her), that they might stop viewing a breastfeeding mother as being immodest when breastfeeding in public. Also, since an infant typically breastfeeds every few hours, it is irrational to expect this mother to stay at home for every feeding.

What recommendations would you add to this list? How does your community make breastfeeding the norm?

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of the International Lactation Consultant Association’s (ILCA) blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show, which launches on July 2, 2012, and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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Journal of Human Lactation Launches New Podcast Feature!

Written by Karen Wambach

In the first of a new regular feature, The Journal of Human Lactation and Sage Publications has just launched its FIRST PODCAST entitled “On the TRAIL of cancer fighting cells in human milk: The latest research” . These podcasts will feature the author of a JHL paper in a 10-15 minute interview and will be available from the JHL website. The goal is to have at least 1 podcast per JHL issue.

In the current podcast, Editor-in-Chief Anne Merewood PhD, MPH, IBCLC, interviews Italian researchers Riccardo Davanzo MD PhD, and Giorgio Zauli MD PhD, about their paper “Human Colostrum and Breast Milk Contain High Levels of TNF-Related Apoptosis-Inducing Ligand (TRAIL)”, published online in the Journal of Human Lactation. The researchers, in a first-time effort to measure TRAIL in human milk, took samples of colostrum and mature breast milk from new mothers. Researchers then obtained samples of blood from healthy women, and various ready-to-feed infant formulas. The colostrum, mature breast milk, blood and formula were then all tested to measure their level of TRAIL. The researchers found that colostrum and breast milk contained 400- and 100-fold, respectively, higher levels of TRAIL than blood. No TRAIL was detected in the formula.

In the podcast, the authors discuss the implications of their findings with regard to the cancer prevention properties of human milk, and areas of ongoing and future research. High levels of TRAIL protein in breast milk might contribute to anticancer activity.

For subscribers to the journal, read the full study here: “Human Colostrum and Breast Milk Contain High Levels of TNF-related Apoptosis-Inducing Ligand (TRAIL)” by Riccardo Davanzo, MD, PhD; Giorgio Zauli, MD, PhD;Lorenzo Monasta, MSc, DSc; Liza Vecchi Brumatti, MSc; Maria Valentina Abate, MD;Giovanna Ventura, MD; Erika Rimondi, MSc, PhD; Paola Secchiero, MSc, PhD; and Sergio Demarini, MD. Journal of Human Lactation

Karen Wambach is the Director of Research and Special Projects for ILCA. Karen received her nursing degrees from the University of Minnesota in 1982 (BSN), and her MS (1989) and PhD in Nursing (1993) from the University of Arizona. A nurse educator, researcher, and IBCLC, Karen is Associate Professor at the University of Kansas. She has been active in ILCA at the local, regional, and international levels as a presenter, regional conference planner, and member and chair of the ILCA Research Committee. She is a member of the Missouri and Kansas Breastfeeding Coalitions and involved in evaluation of the Kansas Breastfeeding Coalition’s Business Case for Breastfeeding project. A recipient of NIH funding for a randomized clinical trial; her program of research has evolved over the years and now focuses on promotion and support of breastfeeding in vulnerable populations including adolescent mothers and ethnic minorities.

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High Levels of TRAIL Protein in Breast Milk Might Contribute to Anticancer Activity

Press Release from the Journal of Human Lactation

Los Angeles, CA (April 23, 2012)  The benefits of breast milk are well known, but why breastfeeding protects against various forms of cancer remains a mystery. A new study in the Journal of Human Lactation (published by SAGE) found high levels of cancer-fighting TNF-related apoptosis inducing ligand (TRAIL) in human milk, which might be one source of breast milk’s anticancer activity.

Researchers took samples of colostrum, the first milk available to newborns, and of mature breast milk from new mothers. Researchers then obtained samples of blood from healthy women, and various ready-to-feed infant formulas. The colostrum, mature breast milk, blood and formula were then all tested to measure their level of TRAIL. The researchers found that colostrum and breast milk contained 400- and 100-fold, respectively, higher levels of TRAIL than blood. No TRAIL was detected in the formula.

“The important role of breastfeeding in the prevention of cer­tain childhood cancers, such as lymphoblastic leukemia, Hodgkin’s disease, and neuroblastoma, has been previously demonstrated,” wrote the authors. “However, endogenous soluble TRAIL represents a strong candidate to explain the overall biological effect of breastfeeding against cancer.”

Mothers chosen to participate in the study were eligible because they exhibited no signs of eclampsia, infection, or fever, and delivered healthy newborns at term.

The authors wrote, “To our knowledge, this is the first time that TRAIL has been measured in colostrum and human breast milk. This study has revealed much higher TRAIL concentrations in colos­trum and breast milk compared to the levels of circulating serum TRAIL.”

The article entitled “Human Colostrum and Breast Milk Contain High Levels of TNF-related Apoptosis-Inducing Ligand (TRAIL)” by Riccardo Davanzo, MD, PhD; Giorgio Zauli, MD, PhD; Lorenzo Monasta, MSc, DSc; Liza Vecchi Brumatti, MSc; Maria Valentina Abate, MD; Giovanna Ventura, MD; Erika Rimondi, MSc, PhD; Paola Secchiero, MSc, PhD; and Sergio Demarini, MD from the Journal of Human Lactation is available free for a limited time at: http://jhl.sagepub.com/content/early/2012/02/21/0890334412441071.full.pdf+html

Media may contact the author of the study at riccardo.davanzo@gmail.com

Riccardo Davanzo, M.D., Ph.D., is currently a consultant in neonatology at the Istituto Burlo Garofolo,  Trieste, Italy. His main areas of scientific interest are low-tech intervention in neonatal care (essential newborn care, kangaroo care), neonatal weight loss in the term healthy newborn, breastfeeding (medications for the nursing mother, breastfeeding in the NICU, training of health workers on breastfeeding).

Between 1987 and 1991, Dr. Davanzo took part in an international health cooperation programme in Maputo, Mozambique. He contributed to the preparation of documents for the World Health Organization: Essential Newborn Care (1996), Kangaroo Mother Care. A Practical Guideline (2003), Acceptable Medical Reasons for Use of Breast-milk Substitutes (2009).

Dr. Davanzo is a member of the International Society for Research in Human Milk and Lactation (ISRHML) and coordinator of the Italian Network of Trainers of Health Workers on Breastfeeding (RIFAM).

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Round Table Discussion: Predictors of Breastfeeding (Part Two)

Today, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.  Each
author’s title and JHL research article can be found on the first article of this series: Round Table Discussion: Predictors of Breastfeeding Duration (Part One)

As breastfeeding advocates, what recommendations can you make for us to help increase breastfeeding duration in our communities?

Lucía Colodro Conde:  Influences from factors related to breastfeeding duration should not be considered immutable. Researchers and practitioners should consider the social environment in which influential factors take place, as this may modulate its impact. Family structure, social support, norms about natural or artificial infant feeding,
working conditions, health promotion interventions, or hospital practices, among others, could moderate this interaction. Interventions should be adapted to the mother’s conditions as a whole, taking into account their personal and social characteristics and their social context. Interventions should start before childbirth and support and guidance should be readily available to those women who aim to breastfeed, taking into account their individuality and the characteristics of the communities.

Pippa Craig:

  • Culturally appropriate and practical information at earlier stage of pregnancy.
  • Engage senior Aboriginal women to support younger women during pregnancy.
  • The importance of involving peer support by members of the Aboriginal community, as well as professional support for this cultural group.
  • Engage younger community mothers who have successfully breastfed to act as role models.

Pat Benton and Beth H. Olson: Even mothers who are intent on breastfeeding and
get support in the hospital, from family, or from programs like the BFI, indicate they do not find the environment outside their home to be supportive of breastfeeding-they even find it to be disapproving. Local breastfeeding coalitions where community partners (i.e., physicians, nurses, Lactation Consultants, business owners, etc.) come together to support breastfeeding have been successful in changing the community atmosphere regarding breastfeeding. Also, mothers find support groups/moms clubs, where they can go and share their experiences and receive support that breastfeeding is the natural way to feed
their babies, a great support system.

After completing your research, what additional factors would you like to see studied as predictors of breastfeeding duration?

Lucía Colodro Conde:  At the moment, we have two lines of research about some factors that, according to preliminary studies, are related to breastfeeding duration and can help to understand and predict it. First, we want to focus on which part of this health behavior is due to differences in genetic configuration and differences in environmental factors among individuals. And second, we aim to analyze the relationships between
psychosocial and personality factors, and the establishment and duration of breastfeeding. We highly support the need of a multidisciplinary approach to this complex behavior.

Pippa Craig:  Further explore psychological factors predicting breastfeeding duration. Introduce and evaluate more culturally acceptable pre-, peri and post-natal services for Aboriginal women.

Pat Benton and Beth H. Olson: We would like to see more work done with populations with low breastfeeding rates, to better understand their particular barriers
such that we might develop targeted support programs. We would also like to see more cost-effectiveness work done on breastfeeding and breastfeeding support that might help us impact public policy and private organizations so they improve breastfeeding support. Research suggests factors that impact breastfeeding in the first day(s) greatly diminish breastfeeding duration; we need to better understand how to provide support in the hospital and in the first days a mother is home with her new baby-including home visiting/follow up care for new mothers.

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Round Table Discussion: Predictors of Breastfeeding (Part One)

Over the past few years, the Journal of Human Lactation has highlighted several research articles that measured factors that directly impact breastfeeding duration.  As health care professionals and lactation consultants, the outcomes of these research projects should inform the way we practice as well as help us to target areas where we can support mothers to increase breastfeeding duration in our communities and countries.

Four authors from around the world have generously offered to share their research and offer recommendations to us based on their findings:

Lucía Colodro Conde, BA, MSc.
Psychologist, Master on Clinical and Health Psychology. Seneca Foundation Research Scholarship. Department of Human Anatomy & Psychobiology. (University of Murcia) Spain.
August 2011: Relationship Between Level of Education and Breastfeeding Duration Depends on Social Context: Breastfeeding Trends Over a 40-Year Period in Spain

Dr. Pippa Craig, Ph.D
Academic Coordinator, Inter-Professional Learning
TheHealth ‘Hubs and Spokes’ Project
ANU COLLEGE OF MEDICINE, BIOLOGY AND ENVIRONMENT
Australian National University
August, 2011: Initiation and Duration of Breastfeeding in an Aboriginal Community in South Western Sydney

Pat Benton, MS, RD, CLE
Program Manager
Michigan Breastfeeding Initiative
Michigan State University Extension

Beth H. Olson, Ph.D.
Associate Professor; Extension Specialist
Associate Department Chair
Director of Graduate Studies
Food Science; Human Nutrition
Michigan State University
February, 2009: Characteristics Associated With Longer Breastfeeding Duration: An Analysis of a Peer Counseling Support Program

What were the largest factors predicting breastfeeding duration in your study?

Lucía Colodro Conde:  In our study we focused specifically on the mother’s level of education, which has been reported to be related to breastfeeding practices. We analyzed the relationship between this variable and the breastfeeding trends in a region of Spain during a 40 year period, along the second half of the 20th century.  We found that the direction and/or magnitude of the association were not constant across time and level of education, suggesting that other factors may moderate this relationship depending of the social context (i.e., family structure, social support, or working conditions).

Pippa Craig: This study has confirmed that more educated mothers of Australian Aboriginal infants in an outer urban environment, and those intending to breastfeed, were more likely to breastfeed. Intention to breastfeed was the strongest predictor.

Pat Benton and Beth H. Olson: Among low-income mothers we found formula
introduction by day one predicted shorter breastfeeding duration. Many mothers in our studies that identify themselves as breastfeeders still supplement with formula or cereal earlier than recommended. Lack of social support leads to shorter breastfeeding duration; new mothers have no role models for breastfeeding, and rely heavily on support from family who discourage them from breastfeeding. We also found that many working women don’t consider combining breastfeeding and employment-they see these two roles as mutually exclusive. They don’t initiate breastfeeding or wean prior to going back to school or work.

What were the most significant findings in your study?

Lucía Colodro Conde:  Our main finding was that the association between maternal education and breastfeeding is not consistent over time.  Today, a higher level of studies
appears to predict a longer duration of breastfeeding; this has not always been the case.  Among women with fewer school years, breastfeeding duration reduced very early in the period studied and remained at low levels for the rest of the duration. Meanwhile, among women with secondary education or higher, the duration of breastfeeding also reduced
markedly until the 1970s, but then it began to increase steadily until the late 1990s. These trends could change again following societal evolution.

Pippa Craig: Low initiation rates and a rapid decrease in breastfeeding rates. This suggests either a lack of commitment or lack of support to assist new mothers with any
early difficulties with breastfeeding. There was a tendency for mothers to receive antenatal care late in their pregnancy, and there was a lack of adequate and culturally appropriate antenatal/postnatal support services in the area.

Pat Benton and Beth H. Olson: A peer counselor (a breastfeeding mother from the community, trained to provide support and referrals and making home visits) from The Breastfeeding Initiative program of MSU- Extension and WIC, significantly increased breastfeeding rates among low income mothers. This duration is longer even compared to mothers referred to the program but not enrolled (due to overcapacity), showing even among women motivated to find support-those with peer counselors breastfed longer. We found that low income mothers may receive infant feeding advice from several sources (Extension, physicians, nurses, home visiting programs, WIC) and find it conflicting. This contributes to factors, such as early introduction of formula, which may impact breastfeeding duration.

In Part Two, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.

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