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Late-Preterm Infants: A Population at Risk

Written by Crystal Karges, DTR, CLEC

During my pregnancy with my second child, the last thing I expected was to deliver prematurely; at 35 4/7 weeks’ gestation to be exact.  After the experience with the birth of my first child, who practically had to be coaxed from the womb at almost 41 weeks, I was not prepared for the challenges that came with having a late preterm baby.

Rushing to the hospital the night of my daughter’s birth, I remember praying earnestly for her precious life, unknowing of how her beginning moments would unfold.  She was born swiftly, weighing a whopping 7lbs of pure sweetness.  Unbeknownst by her size, however, the next couple days confirmed her vulnerability and immaturity as a late preterm, and much to my dismay, she struggled with hypoglycemia, hyperbilirubinemia, and poor feedings.

My greatest struggle lay in my inability to properly nourish her in those first critical days.  So eager was I to breastfeed, yet her feeding difficulties proved it much more complicated than I had ever imagined.  With the help of some fantastic lactation consultants and in my stubborn adamancy and determination, we formulated an effective plan to deliver my baby the vital nutrition she needed to combat the hypoglycemia and hyperbilirubinemia while assisting us in establishing breastfeeding-all so crucial in those first 72 hours.

“Late-preterm infants”, defined by birth at 34 0/7 through 36 6/7 weeks’ gestation, are a population at risk, particularly as they are less physiologically and metabolically mature than term infants.  As a result, late-preterm infants are at a higher risk than term infants of developing medical complications, resulting in higher rates of mortality and morbidity during the birth hospitalization. Though many late-preterm infants are frequently the size and weight of some term babies (as was the case with my own baby), there is the potential that they may be managed by caregivers and health professionals as though they are developmentally mature.  Herein lies the danger however, as studies have demonstrated the risks this special population faces, including higher rates of hospital readmission during the neonatal period (Engle, et al).

Perhaps one of the most challenging aspects of having a late-preterm, as I discovered with my own baby, are the unique obstacles that may be confronted with breastfeeding.  It is particularly crucial to educate mothers on how to evaluate feeding success and what signs to look for to detect dehydration and hyperbilirubinemia.  The American Academy of Pediatrics recommends that a formal evaluation of breastfeeding, including observation of position, latch, and milk transfer be undertaken and documented a least twice daily after birth along with a developed feeding plan that is understood by the family.  Helping mothers of the late-preterm infants understand the different needs her baby has, along with a targeted feeding plan of care, can help establish breastfeeding success in the short and long term.

I am deeply grateful to the Lactation Consultants who supported my desire to breastfeed while addressing the needs of my baby, who decided to enter the world a bit sooner than expected.  Through their gentle guidance, I was able to use a supplementary nursing system to feed her at breast to help promote and establish our breastfeeding relationship while ensuring she was receiving the nutrition she needed.  Fast forward five months, and we’re still going strong with exclusive breastfeeding.  I know the guidance and support I had in her early days of life were monumental in setting us up for success in the long run.

Lactation Consultants are a vital part of a comprehensive team that can address the unique needs of the late-preterm infant population.  What has been your experience in your practice working with late-preterm infants?  How have  you  helped a mother establish breastfeeding?

For more valuable resources on breastfeeding the late preterm baby, please refer to the following:

References:

“Late-Preterm” Infants: A Population at Risk.  William A. Engle, Kay M. Tomashek and Carol Wallman.  Pediatrics 2007; 120; 1390.  DOI: 10.1542/peds.2007-2952

The Relationship of Brain Development and Breastfeeding in the Late-Preterm Infant.  Sunny G. Hallowell and Diane L. Spatz.  Journal of Pediatric Nursing 2012; 27: 154-162.

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Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link?

Written by Jennie Bever Babendure, PhD, IBCLC

The ever increasing rates of labor induction and augmentation have caused many to begin to ask if the use of synthetic oxytocin to start or augment labor may impact mothers and babies after birth. In an Acta Paediatrica article published online ahead of print, Ibone Olza-Fernandez and her colleagues asked this question by looking at neonatal feeding reflexes in relation to oxytocin dosage during labor1. In this small pilot study, researchers documented the total dose of oxytocin given during labor to induce or augment contractions in 20 first time mothers. On day 2 of life, and at least 1 hour after breastfeeding, they placed babies skin to skin with their mothers in biological nurturing positions to elicit Primitive Neonatal Reflexes, including those involved in breastfeeding. When 3 observers blind to the oxytocin dose coded videotapes of these 20 minute sessions, they found a significant correlation between higher doses of synthetic oxytocin during labor and the absence of sucking behavior in infants. In fact, many of the newborns whose mothers received higher doses of oxytocin spent a large part of the 20 minutes skin to skin crying.

When the authors later followed up with the mothers about breastfeeding status at 3 months, they found another surprising correlation: mothers who were exclusively breastfeeding at 3 months had received a lower average dose of oxytocin during labor than mothers who were not breastfeeding exclusively.

Findings of this study are limited in that this was a very small pilot of only 20 women, and all received oxytocin either to augment or induce labor, thus the study lacks an important control group of mothers who did not receive oxytocin. As such, the authors are careful to point out that the results should be interpreted with caution. The relationship found between oxytocin dose and infant suck in this study is a correlation only, and provides no evidence that higher doses of oxytocin caused the depression in sucking behavior. (Click this link for a great discussion of why we can’t say a correlation indicates cause.)

In addition, all study mothers received epidural anesthesia, thus the depressed sucking behavior could be related to maternal dose of anesthesia (which was not recorded), precipitating increased need for labor augmentation. However, as studies in rodents have shown reduced food intake in response to oxytocin injection, and previous clinical research has demonstrated an association between intrapartum oxytocin administration and risk of artificial feeding independent of epidural anesthesia, the idea that synthetic oxytocin might have an impact on breastfeeding behavior is an intriguing hypothesis that deserves further study2-8.

I joke that the picture below shows me ‘under the influence’ of oxytocin. If you look closely, I look just the tiniest bit love-crazed. Could oxytocin, a hormone that can inspire such intense bonding actually have a negative effect at high doses? I’ll keep a close watch as further research unfolds!

For more research commentary, check out Jennie’s new blog: www.breastfeedingscience.com

1. Olza Fernández I, Marín Gabriel M, Malalana Martínez A, Fernández-Cañadas Morillo A, López Sánchez F, Costarelli V. Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica 2012.

2. Arletti R, Benelli A, Bertolini A. OXYTOCIN INHIBITS FOOD AND FLUID INTAKE IN RATS. Physiology & Behavior 1990;48(6):825-830.

3. Jordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: An International Journal of Obstetrics & Gynaecology 2009;116(12):1622-1632.

4. Benelli A, Bertolini A, Arletti R. OXYTOCIN-INDUCED INHIBITION OF FEEDING AND DRINKING – NO SEXUAL DIMORPHISM IN RATS. Neuropeptides 1991;20(1):57-62.

5. Olson BR, Drutarosky MD, Chow MS, Hruby VJ, Stricker EM, Verbalis JG. OXYTOCIN AND AN OXYTOCIN AGONIST ADMINISTERED CENTRALLY DECREASE FOOD-INTAKE IN RATS. Peptides 1991;12(1):113-118.

6. Ounsted MK, Boyd PA, Hendrick AM, Mutch LMM, Simons CD, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .2. NEURO-BEHAVIORAL STATUS OF INFANTS. Early Human Development 1978;2(3):241-253.

7. Ounsted MK, Hendrick AM, Mutch LMM, Calder AA, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .1. SOME PERINATAL AND POSTNATAL PROBLEMS. Early Human Development 1978;2(3):227-239.

8. Wiklund I, Norman M, Uvnas-Moberg K, Ransjo-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009;25(2):E31-E38.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 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.

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An Interview with Catherine Watson Genna

Written by Robin Kaplan, M.Ed., IBCLC, Owner of the San Diego Breastfeeding Center, and Co-editor of Lactation Matters

Over the past year, I have had the pleasure of listening to Catherine Watson Genna speak about the topic of an infant’s use of his/her hands while latching.  I constantly share this new information with the breastfeeding mothers I work with and I have seen it completely transform a nursing session from a ‘battle of wills’ to one where the baby latches with ease and grace.  Here’s hoping this information will do the same for you!

Robin:  How do breastfeeding infants typically use their hands while latching?

Catherine: Babies use their hands to help them locate the nipple and define a nice mouthful of breast. You may notice the baby often finds the nipple with his hands and then starts to suck his hands. At this point, many moms
pull the baby’s hands away and he gets upset, because he knew what he was doing. If you encourage mom to wait a few minutes, the baby will move his hand and latch onto the breast where his hand was a moment before.

Robin: How does this hand use help the baby latch?

Catherine: If the baby’s face is not close enough to the breast to find the nipple by feel with her lips and cheeks, she’ll bring her hands into the action. I’ve also seen babies whose faces were close to the breast, but were not in the exact right spot to latch well, move the breast around with their hands until they got just the right ‘mouthful’ lined up. Some babies even push or pull the breast into their mouths, or shape it like we sometimes teach moms to!

Robin:  What techniques should Lactation Consultants and parents use to help facilitate the baby’s hand use while latching?

Catherine: First off, I like to see what the baby will do if we place him or her skin to skin with mom and encourage mom to lean back so gravity supports baby against her body. Most babies find their way to the breast if they are calm enough. If mom has sore nipples, cuddling baby so her arms encircle and ‘hug’ the breast, and her chin and lips touch just below the nipple, lets her find the breast with her mouth and not her hands. Basically the Lactation Consultant should help the mom see how baby is working toward latching and let baby try unless they are getting frustrated or getting in their own way. Sometimes babies do get caught in a ‘reflex loop’ of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom’s breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again.

For more detailed information about this topic, please see Catherine Watson Genna’s article in Clinical Lactation, Facilitating Autonomous Infant Hand Use During Breastfeeding.

Catherine Watson Genna has been an IBCLC in private practice in NYC since 1992. She has a special interest in the anatomical, genetic and neurological influences on infant sucking skills, and writes and speaks on these topics. She serves as associate editor of Clinical Lactation. Catherine has performed research using ultrasound and cervical auscultation to study sucking and suck:swallow coordination in infants with ankyloglossia. Her clinical photographs have been published in both lay and scholarly venues. She is the author of Supporting Sucking Skills in Breastfeeding Infants (Jones and Bartlett Publishers, 2008 and 2012) and Selecting and Using Breastfeeding Tools (Hale Publishing, 2009).

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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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Implications of Obesity in Breastfeeding Women

Written by Crystal Karges, DTR, CLEC

With the growing concern of obesity in the United States, the implications for breastfeeding women are not completely understood. The frequency of obesity of adult women in the United States, particularly of those women who are considered to be within the reproductive age (20-39 years old), is increasing rapidly. A recent study has analyzed how a high fat diet may alter lactation outcomes, revealing possible complications for mothers who consume high-fat diets during pregnancy or who are overweight or obese.

Several studies have demonstrated the negative effects of obesity on various physiological pathways. Such outcomes resulting from excessive weight gain during pregnancy include increased risk of developing breast cancer, increased birth weights in offspring, augmented probability of developing obesity or metabolic syndrome in their lifetime, development of gestational diabetes, and the possibility of delayed lactogenesis (failure to lactate for more than 72 hours postpartum). This is particularly important for the breastfeeding mother, as delayed onset of lactogenesis has also been correlated with overall shorter duration of breastfeeding. While it has been determined that obesity is a contributing factor to the interference of normal lactation cycles in mothers, the mechanisms within mammary glands that trigger delay of lactogenesis are yet to be understood.

In this recent study by Hernandez et al, the possible mechanisms by which high fat diets effect lactation outcomes were explored on rodent models. These researchers discovered that the mammary glands of rats ingesting a high fat diet had a significant reduction in the number of intact alveolar units within the mammary glands, which are critical for lactogenesis to occur normally. Additionally, it was also concluded from this study that within the mammary gland itself, there was a decline in genes corresponding with the uptake of glucose and development of milk proteins (an essential step for the synthesis of lactose), along with the increase in genes linked with the inflammatory process (a response activated by obesity). Based on these results, authors were able to determine that the consumption of a high-fat diet inhibits the normal functional ability of mammary parenchymal tissue, hindering its capability of manufacturing and secreting milk.

This information would be relevant to discussing with patients/clients in the prenatal period, particularly in encouraging pregnant mothers to consume a relatively low-fat diet with the goal of optimizing initiation and long-term duration of breastfeeding.

How does this information affect your scope of practice as a Lactation Consultant?

To be directed to the original study, please continue reading here.

Citation: Hernandez LL, Grayson BE, Yadav E, Seeley RJ, Horseman ND (2012) High Fat Diet Alters Lactation Outcomes: Possible Involvement of Inflammatory and Serotonergic Pathways. PLoS ONE 7(3): e32598. doi:10.1371/journal.pone.0032598

Crystal Karges, DTR, CLEC

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Can a Change in Pediatric Office Policy Begin to Change the Culture of Infant Feeding?

Written by Jennie Bever Babendure, PhD, IBCLC

In the February issue of Breastfeeding Medicine, Ann M. Witt and her colleagues analyze the impact of integrating lactation consultants into a pediatric practice1.  Although providing referral to or in-office lactation services if requested is not a new idea, what makes this study unique is the systematic change made to schedule ALL breastfeeding newborns with a lactation consultant for their first pediatric office visit.

How did this work?  At the time of the study, the American Academy of Pediatrics (AAP) policy dictated that all healthy term breastfeeding infants be seen at the pediatric office within 3-5 days of hospital discharge2.  In 2009, the study practice changed their policy to routinely schedule these visits with an in-office IBCLC precepted by a physician.  IBCLC’s spent 45-60 minutes with the patient, then discussed the history and breastfeeding evaluation with an available physician who spent about 5 minutes in the room evaluating the patient and deciding on a treatment plan.   Follow up phone calls and in-person visits were scheduled, as well as a routine visit with the primary physician at 2 weeks of age.  More than 45% of patients had multiple visits with a practice IBCLC, and a limited survey indicated high maternal satisfaction with the new policy.  IBCLC’s were employed 4 hours a day 5 days a week in the practice to meet the need for these visits and follow up.  As the physician evaluated the patient at the 3-5 day visit, it was reimbursed as a general medical visit, which sufficiently covered IBCLC salaries.

How did this impact breastfeeding?  In 2007, all infants were seen in the office by 2 weeks of age unless jaundice or weight gain problems were identified in the hospital.  The practice employed an RN, IBCLC 3 days a week to provide phone support for breastfeeding problems as well as in-person consultations.   When researchers compared infant feeding method  in retrospective chart review between 2007 and 2009 patients, they found that non-formula feeding (breastfeeding) went up by 10-15% at all time points from 2-9 months, demonstrating a significant increase in breastfeeding intensity following the intervention.

When I first read this study, I was struck by the brilliant simplicity of this idea.  By integrating lactation consultants into the existing medical structure, mothers and babies got automatic breastfeeding help and follow-up, and physicians could follow AAP policy and monitor jaundice and weight gain as well have a large influence on the on-going health of their patients with minimal input of time or cost and no additional formal training.  As I continued to think about this study, I realized that this policy has a much broader impact.  By making this systematic change to their office policy, they have changed the culture of infant feeding in their practice.  Routinely scheduling the first office visit with an IBCLC sends a strong message to patients.  It says:  “Your physicians know you want to breastfeed, and feel breastfeeding is so important to your child’s health that we will do everything we can to help you through the challenges.”

I can’t help but imagine the impact if all pediatric practices were to adopt this model.  Would these actions speak louder than our words?  Would they whisper or shout: Breastfeeding is a public health issue3, we’re here to help you make it happen.

1.  Witt AM SS, Mason MJ, Flocke SA., Source1 Department of Family Medicine CWRU, Cleveland, Ohio. Integrating routine lactation consultant support into a pediatric practice. Breastfeeding Medicine 2012;7(1):38-42.

2.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115(2):496-506.

3.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2012;129(3):e827-e841.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 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.

2

Breastmilk Oligosaccharides and Their Effects on Necrotizing Enterocolitis

Written by Crystal Karges, DTR, CLEC

Just when the benefits of breastfeeding couldn’t seem to get any better, new research is revealing even more reasons for mothers to breastfeed.  Increased knowledge and understanding about the various properties and components of human breast milk, and the interaction with the newborn gut, make for profound evidence for its unsurpassed advantages.

A newly published study by Dr. Lars Bode, assistant professor in neonatal medicine and pediatric gastroenterology and nutrition at University of California San Diego (UCSD) School of Medicine’s Department of Pediatrics, has evaluated the effects of how a particular human milk oligosaccharide (HMO) can considerably decrease the risk of necrotizing enterocolitis.

One of the most recurrent and deadly intestinal disorders in premature infants is necrotizing enterocolitis (NEC), and it has been demonstrated that an estimated five percent of all premature infants born with a low birth weight acquire NEC.  While the mechanism behind NEC is not widely understood, the devastating effects are undeniably seen, with statics disclosing the fatality of this condition and the rigorous complications for survivors.

Amidst the difficulties associated with this complex condition, there are promising discoveries being made about the properties of breast milk that have been shown to counteract the outcomes correlated with NEC.  In his latest research findings, Dr. Bode and his colleagues discovered that out of the estimated 150 oligosaccharides unique to human milk alone, one oligosaccharide in particular (Disialyllacto-N-tetraose) is accountable for the advantageous effects of decreasing the risk of NEC in neonatal rats.  In contrast, infant formulas, which are supplemented with galactooligosaccharides (GOS), have a negligible influence on NEC in neonatal rats.

These findings not only elaborate on the numerous advantageous of human milk, but also illustrate how it functions in providing health benefits outside of nutrition and sustenance for the infant.  Sharing research such as this with clients and patients will continue to encourage and empower new mothers to breastfeed their infants.

For more information about Dr. Bode’s lab site, continue reading here.

About SPIN at UC San Diego

Premature infants who receive human breast milk have the best outcomes – medically, nutritionally, and developmentally. Within the Neonatology Division at UCSD’s Department of Pediatrics, the Supporting Premature Infant Nutrition (SPIN) program was developed to address the challenges of helping mothers produce sufficient breast milk for their premature infants, and to improve the manner in which neonatal intensive care units (NICUs) support optimal nutrition and growth in their most vulnerable population of patients.

Source: http://healthsciences.ucsd.edu/Pages/Home.aspx

Crystal Karges, DTR, CLEC

1

Supporting Breastfeeding with New Technologies

A few months ago a story out of Australia caught my attention.  A research study conducted at Queensland University of Technology showed that new mothers who received cell-phone based text-messaging support (also referred to as SMS, which stands for Short Message Service) were four times less likely to stop breastfeeding than those who did not.  This collision of technology with nature’s perfect infant nutrition piqued my interest and I wanted to learn more (self disclosure – I’m a bit of a technophile).  While details of the study have not yet been published, I was able to talk with an IBCLC who uses SMS, as well as hear the perspectives of several nursing mothers.  This post is intended to share this story and also generate a conversation about what other practitioners have experienced using text-messaging to support breastfeeding moms.  Please join in the discussion!

An IBCLC’s Perspective

Robin Kaplan, IBCLC and founder of San Diego Breastfeeding Center, LLC, offers mothers the option to communicate with her via SMS after she conducts an initial in-home consultation.  She estimates that about 25% of her follow-up communication is through text-messaging, with some clients using it for 100% of their contacts.  The nature of Robin’s texts are primarily responding to questions from new mothers (moms can include a photo with the question to help in diagnosing some problems), as well as checking in with mothers to see how they are doing.  One of the benefits of text messaging is that it isn’t interruptive, like a phone call may be, and it can be managed from a time perspective (versus not knowing how long a phone call might last).  This seems to be important for new mothers, as Robin gets more responses from texting than she does from phone calls.  Texting is also conducive to the round-the-clock hours that nursing mothers keep.  “They can leave me information any time they want,” says Robin.  From a business perspective, she sees texting as time and cost-effective.  “It makes a lot of sense!”

Mothers’ Perspectives

“When you have a sleeping baby, or you’re just too tired to get into a long conversation, texting is so convenient,” said texting mother, Tracy.  “Robin was able to get straight to the point and offer quick responses to my questions, which were very helpful… Though some might think it’s impersonal, texting is still a conversation and a readily available one at that, I really appreciated the instant gratification.”

Adoptive mother, Danielle, said text-messaging support was a huge help in establishing her breastfeeding practice.  “The reason texting worked for me is that my consultant, Robin, was always quick to reply…  This [breastfeeding an adopted infant] is a new frontier and being able to text when your baby is asleep in your arms is so helpful…  For me, texting as opposed to verbalizing sometimes kept me a bit calmer. I always know I can call if I need to. The ability to have both options, however, was great.”

According to Erin, “Because newborns require so much attention around the clock, texting was the easiest form of communicating with Robin.  It allowed me to send her a quick message, an update or ask a question without regard to the hour or any of the long winded social niceties that a telephone conversation would require. By the same token, Robin was able to check in on my progress, offer much needed practical advice and soothe my worries with most welcome words of support.”

On the Bleeding Edge

How does text-messaging fit into healthcare privacy laws that might impact lactation consulting care?  This will vary country by country, and many governments are still trying to figure this out.  Robin said she is moving towards printing and then deleting text messaging conversations and adding them to patient records.  She deletes photos immediately.  Having a password lock on your phone is another measure of security.  It’s always important to get a mother’s consent before you begin sending text messages.

What has your experience been with adding text-messaging support to your lactation practice?  We’d love to hear your stories!

By Maryanne Perrin MBA, graduate student in Nutrition Science, and ILCA volunteer

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Breastfeeding and Hypertension

Written by Crystal Karges, DTR, CLEC

Undoubtedly, the field of lactation continues to be an exciting subject of study, particularly as newfound evidence from developing research studies are confirming and fortifying the importance and benefits of breastfeeding. Knowledge of the latest research findings can be invaluable to the clinician who has the opportunity to encourage and educate the breastfeeding mother, particularly as they are able to assist in overcoming obstacles to breastfeeding that could make a difference in women’s health.

A recent study published in the American Journal of Epidemiology demonstrated that mothers who breastfed for a minimum of six months were less prone to developing hypertension over a 14 year period compared to those who bottle fed. These findings are contiguous with previous studies which have established that women who breastfeed have lower risks of diabetes, heart disease, and high cholesterol later in life.

In this latest study, researchers examined the relationship between breastfeeding and later risk of developing hypertension among approximately 56,000 American women who took part in this long-running study. All women participating in this research had at least one baby.

While findings included substantiation that an estimated 8,900 women from this study were ultimately diagnosed with high blood pressure over more than 20 years, data revealed that the probability women would develop hypertension were 22 percent higher in the incidence of not breastfeeding compared with women who exclusively breastfed for six months.

More specifically, this particular study concluded that never or abridged lactation was correlated with an increased risk of incident maternal hypertension, contrasted with the endorsed 6 months of exclusive or 12 months of total lactation per child. Researchers had also estimated that up to twelve percent of high blood pressure cases among women with children could be associated with “suboptimal” breastfeeding, including mothers who gave their babies formula or breastfed for less than three months. These findings are of utmost significance to the lactation consultant, who may make the difference in a mother’s long-term health by removing barriers that may prevent her from successfully breastfeeding.

To be directed to the original research study, please continue reading here.

Research findings such as these continue to give substantial support to the role of the lactation consultant in a mother and baby’s well being, particularly as the LC has the ability to empower a mother to create optimal health for herself.

What research findings do you find beneficial in sharing with your own clients?

Sources:
http://www.telegraph.co.uk/health/healthnews/8949323/Mothers-who-breastfeed-for-at-least-six-months-have-lower-blood-pressure.html
http://aje.oxfordjournals.org/content/174/10/1147.short

Crystal Karges, DTR, CLEC

4

Do Interruptions Interfere with Early Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

In the Jan/Feb 2012 edition of the American Journal of Maternal Child Nursing, Barbara Morrison and Susan Ludington-Ho published a study looking at Interruptions to Breastfeeding Dyads in an LDRP Unit(1).   They observed the doors to the rooms of 30 breastfeeding mother-infant dyads in a community hospital birthing center from 8AM to 8PM on post-delivery day 1, and found that mothers were interrupted an average of 53 times in that 12 hour period.  The average duration of interruptions (18.5+/- 34.5min) was longer than the average duration of time alone (15.4+/-17.3 min), and half of the episodes of time alone lasted 10 minutes or less.

As mothers in the study reported that they spent an average of 25.68 minutes (+/-16.7) at each breastfeeding session, these interruptions were likely to impact early breastfeeding when frequent breast stimulation is critical.  In fact, breastfeeding frequency was moderately negatively correlated with the number of interruptions.  Additionally, the authors found that a mother’s satisfaction with her breastfeeding experiences was significantly correlated with her perception of amount of time alone with her infant, and when mothers felt interruptions interfered with breastfeeding; they found the interruptions more annoying.

Although I was astonished at the number of interruptions this study found in a 12 hour period (consistent with an earlier study in a university hospital(2)), I was not surprised that frequent interruptions impact breastfeeding. Given attitudes in the United States about breastfeeding in public, mothers may feel self-conscious about baring their breasts to visitors, nurses, and other hospital staff members while learning to breastfeed. Ideal amounts of skin-to-skin contact and relaxation may be difficult to accomplish when mothers feel they need to keep one eye on the door and a cover-up at the ready.  Even when this isn’t the case, a mother who finds herself continually interrupted to place her lunch order, talk to visitors, answer the phone, have her vitals checked, and talk to physicians may delay or shorten breastfeeding sessions.

Not surprisingly, the majority of the women in the study only met the minimum recommended number of breastfeeding sessions (4 times in 12 hours), and several mothers fed their babies only 2 or 3 times for less than 15 minutes in that time frame.  As infrequent and inadequate breastfeeding sessions can rapidly progress to infant weight loss and supplementation, this finding is particularly relevant to the cause of increasing breastfeeding duration and exclusivity. Coupled with this, frequent interruptions may prevent mothers from getting the rest they need to recover from childbirth and have the energy for frequent nighttime feedings.

Undoubtedly, many interruptions are necessary and unavoidable; however Morrison and Ludington-Hoe have a number of suggestions to minimize the impact on breastfeeding.  These include:

  • Discuss the importance of alone time, Kangaroo care, frequent breastfeeding and limited visitors during prenatal visits, classes and tours.
  • Cluster care, plan care activities with mothers to enable quiet times, use door signs to signal time alone, and institute “quiet” times when no visitors or staff enter rooms.
  • Minimize rounds and discontinue 24/7 visiting hours.

In our efforts to translate high breastfeeding initiation rates into longer breastfeeding duration, we must continue to remove barriers to establishing a successful breastfeeding relationship.  As we think about how to best accomplish this task, minimizing the frequency of interruptions to mothers and baby may be a simple step in the right direction.

1. Morrison BP, RN, FNP, CNM; Ludington-Hoe, Susan PhD, RN, CNM, FAAN. Interruptions to Breastfeeding Dyads in an LRDP Unit. American journal of Maternal Child Nursing 2012;37(1):36-41.

2. Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2006;35(6):709-716.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 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.

Lactation Matters Editor’s Note: Just to add, Jennie has a brand new addition to the family.  Welcome Noah Lev, born on Oct 28, 2011, who is breastfeeding beautifully!  Congratulations !

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