Archive | Reader Response

URGENT ACTION NEEDED in the United States

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

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

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

Your voice is needed.

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

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

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

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

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

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

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We need your INTERNATIONAL perspective!

Written by Amber McCann, IBCLC

In my few short weeks as the new co-editor of Lactation Matters, I have skidded right smack dab into a wall…the wall of realization that my perspective on our profession is overwhelmingly American.  Of course, this is understandable as I was born in a small farming community right smack dab in Middle America.  But, I desire to have a global perspective…to understand just how different life can be for mothers on the other side of the world.  And how similar.

Photo by Tareq Salahuddin via Flickr

So, we need YOU!  This blog is for all of us, IBCLCs from the United States and from Australia and from Japan and from South Africa and from Ireland…and everywhere in between.

We need your STORIES.

We need your PERSPECTIVE.

We need your LEADS to innovative people who are making a difference.

If you know of someone or something that needs profiled here, please comment with how we might get in touch with you.  If there is breaking news in your country, let us know.  If you know of research being conducted or published in your part of the world, reach out so that we can include it here.

I am proud to be an INTERNATIONAL Board Certified Lactation Consultant.  Help us make this blog international as well.

Amber McCann, IBCLC

Amber McCann, IBCLC is a  board certified lactation consultant in private practice with Nourish Breastfeeding Support, just outside if Washington, DC and the co-editor of this blog.  She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same.  In addition to her work here, she has written for a number of other breastfeeding support blogs including The Leaky Boob and Best for Babes and served on the Communications Team for GOLD Conference . When she’s not furiously composing tweets (follow her at@iamambermccann) or updating her Facebook page, she’s probably snuggling with one of her three children or watching terrible reality TV. 

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Implications of Obesity in Breastfeeding Women – A Follow-Up

Lactation Matters would like to thank all of our readers who left comments about the Implications of Obesity in Breastfeeding Women article.  Your comments clearly raised some very important issues about how we, as lactation consultants, should use research articles to guide our practices.  Fortuitously one of our guest bloggers, Jennie Bever Babendure, has significant research experience with cellular and animal models of obesity.  She has graciously offered her insight into understanding this research article and its relevance to our practice.  Again, we thank you for your thoughtful comments about this research study and the conversation it helped to create.

 

Response by Jennie Bever Babendure, PhD, IBCLC (email: jennie.bever@gmail.com)

“In light of the advice given to speak with mothers about the impact of a high fat diet on lactation, it’s important to point out that feeding rats high fat chow (which is also higher calorie) is a way researchers induce obesity in rats. This was done 6 weeks before the rats got pregnant, so they were already obese before pregnancy and lactation.

As a result, this study cannot separate the effects of a high fat diet during pregnancy and lactation from the effects of preexisting maternal obesity.  Had the 2 sets of rats consumed the same amount of calories on low or high fat diet, we might be able to draw conclusions about dietary fat’s impact on lactation in rats. However, the rats fed a high fat diet consumed more calories and were obese before they even became pregnant. As such, this study does not provide sufficient evidence to recommend that human mothers consume low fat diets when pregnant or lactating to improve lactation outcomes.

As this study was written for the research community, I don’t think the authors made a point to clarify that they were using high fat feeding primarily to study the impact of obesity, not necessarily dietary fat content, on lactation.  In the interest of evidence-based practice, I felt it was important to make this distinction.  This study doesn’t demonstrate that consuming a diet with a higher percentage of fat during pregnancy and lactation leads to lactation problems in humans, but rather suggests that preexisting diet-induced obesity leads to delayed onset of full lactation, and changes in the mammary gland in rats.”

 

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Informed Consent: What is My Responsibility as a Lactation Consultant? – Reader Response

Doreen says:

August 1, 2011 at 10:35 pm (Edit)

I feel so alone in my profession and this will be a blessing! I have a question that I need help with. My manager at work, in a large hospital, told me that the nurses and physicians had a problem with “informed consent” when it came to breastfeeding. ie: we have mothers who state that they want to breast and bottle feed. I discuss the importance of getting a good milk supply started before introducing a bottle, always asking why. Most mothers state it is because they are going back to work, then I discuss this finding out when they go back, making a breastfeeding plan. The problem is that the nurses want to give bottles without informing the patients about possible consequences as they get their milk supply going for NON medical reasons ie: get sleep at night, second night feeding frenzie, etc. I feel it is my ethical responsibility as a RN and IBCLC to give “informed consent” (ie: information) because most mothers do not understand the consequences of bottles of formula in the first few days and I have made it clear that the nurses have that responsibility also. They do not like this. Any suggestions would be helpful as I have called a meeting of the managers next week. Thanks, Doreen 

Doreen, you raise an important issue for IBCLCs everywhere! 

To be clear:  the issue isn’t whether you “should” provide information and support to a breastfeeding mother, so she can make an informed decision about matters affecting her/her baby’s health.  Rather, the issue is “how” to effectively assist the mother, as her allied health care provider, in a work setting where other caregivers are offering conflicting or erroneous advice.   

ILCA’s recently-published monograph “Risks of Not Breastfeeding” concludes that “[e]xclusive breastfeeding is the normative standard for infant feeding.  Not breastfeeding increases infant and maternal acute and chronic illnesses….  The research demonstrates that there is a dose response to breastfeeding and human milk exposure for mothers and infants.  Healthcare professionals must be aware of the research and find ways to share this information with families so they can make responsible informed feeding decisions for their children.” (Spatz, D., & Lessen, R. (2011). Risks of not breastfeeding. (Monograph).  Morrisville, NC: International Lactation Consultant Association, p. 8)(emphasis added).   Your meeting with your managers is your opportunity to suggest that evidence-based practice is not being followed if non-medically-indicated use of formula is tolerated (and even promoted) by caregivers whose patients are breastfeeding mothers and babies.

You are the ideal healthcare professional to teach families (and colleagues) about human lactation. 

The IBLCE Scope of Practice, “encompassing the activities for which IBCLCs are educated and in which they are authorized to engage” (from the preamble; full IBLCE SOP at http://www.iblce.org/upload/downloads/ScopeOfPractice.pdf) anticipates that as allied health care providers we will advocate for the baby, the mother and the breastfeeding relationship.  It describes IBCLCs as having “specialized knowledge and clinical expertise in breastfeeding and human lactation.”  It describes the IBCLC duty to offer evidence-based information to help mothers meet their breastfeeding goals, and the duty to educate families and healthcare professionals about breastfeeding and human lactation.  Your ethical responsibility to inform, advocate, and educate is bolstered by the IBLCE Code of Ethics requiring, at tenet 11, that the IBCLC “provide sufficient information to enable clients to make informed decisions”  (http://www.iblce.org/upload/downloads/CodeOfEthics.pdf).

All health institutions and health care providers should support and assist breastfeeding families.  In the United States, advocating for breastfeeding as a public health imperative has received significant boosts from highly esteemed entities.  The U.S. Surgeon General’s Call to Action to Support Breastfeeding asks all health care providers, their institutions, employers, families and communities-at-large to support breastfeeding mothers.  (http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf).  This powerful document comes from the US federal government, but its call to action by the community at large is universal, and the concepts are applicable worldwide. 

The Centers for Disease Control recently issued their report concluding that US hospitals have a fairly dismal record when it comes to breastfeeding supportive practices. http://www.cdc.gov/vitalsigns/Breastfeeding/index.html.  And yet, the Joint Commission, which accredits hospitals in the US, now looks at exclusive breastmilk feeding as part of the Perinatal Care core measure set.  Because breastfeeding is the biologic norm, any (unexplained) deviation from it is seen as a deviation from best practices.  The United States Breastfeeding Committee has a toolkit to assist in the explanation and implementation of these core measures (http://www.usbreastfeeding.org/Portals/0/Publications/Implementing-TJC-Measure-EBMF-2010-USBC.pdf).

IBCLCs are specialists in a field that crosses several disciplines.  Our colleagues are not subject- matter-immersed in breastfeeding, as we are.  Use the meeting with your managers as your “toe in the door” to educate them: breastfeeding is the biologic norm and a public health imperative; hospitals can and should do a better job to support their breastfeeding patients, and this is a significant core measure that Joint Commission inspectors will be evaluating. And it is what the family wants and needs, to boot. 

Liz Brooks JD IBCLC FILCA

Liz Brooks is a lawyer, private practice lactation consultant and international speaker on legal and ethical matters affecting IBCLCs.

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