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Ethical Leadership: Meeting obligations under the International Code

by ILCA Board Member Lisa Akers MS, RD, IBCLC, RLC

ILCALogo_full_text (2)Organizations of all types have shown important advancements in ethical practices over the past century, even as the challenge of providing ethical leadership while following evidence-based practice and performance standards remains unchanged. ILCA® is dedicated to promoting a climate that facilitates ethical decision-making and commitment to the profession. As such, ILCA supports the hierarchy of infant feeding as specified in the Global Strategy for Infant and Young Child Feeding (2003)[1]. Upholding the International Code of Marketing of Breast-milk Substitutes[2] and all relevant subsequent World Health Assembly resolutions (i.e. International Code) is one way in which ILCA reflects an ethical climate and positively effects decision-making. ILCA has long taken steps to ensure that it “does not invest in, nor accept funding, donations, advertising, or sponsorship from corporate entities that do not meet their obligations” under the International Code.

More recently ILCA took the seriousness of its obligations for upholding the International Code to a higher level by forming an independent panel of International Code experts in November 2013. The International Code Expert (ICE) Panel is recognized for their training and experience interpreting the International Code. The ICE Panel was first introduced through the Lactation Matter blog in June 2014 and continues to provide expert guidance to the ILCA Board behind the scenes. The ICE Panel has enabled ILCA to re-examine sponsorship relationships. Among its responsibilities, the ICE Panel has been charged with determining “whether potential commercial affiliates are meeting their obligations under the International Code.” All potential commercial affiliates are now subject to an examination process by which the ICE Panel determines if they are meeting their obligation specified by the International Code. When a commercial affiliate is determined to not be meeting their obligation, the ICE Panel provides feedback to the organization on meeting International Code standards.

While the ICE Panel recognizes that mothers choose to use feeding bottles or other devices to give their expressed milk to their babies, this is not the same as direct breastfeeding and is specifically addressed in the Global Strategy. When there are clinical or medical problems that temporarily or permanently prevent direct breastfeeding, alternative feeding devices are clinically appropriate and instruction in their use should be taught by healthcare professionals (International Code Article 4). ILCA supports one-to-one instruction from the IBCLC® and health professionals[3] as the appropriate action.[4] Under its obligations of the International Code, ILCA does not support the public promotion of bottles and teats to the general public.

ILCA’s mission “to advance the International Board Certified Lactation Consultant® (IBCLC) profession worldwide through leadership, advocacy, professional development, and research” would not be realized without fostering a positive ethical climate. ILCA continually strives to uphold the International Code while remaining cost effective and considerate of the external patrons during the decision-making process. ILCA asks that members also support their obligation to the International Code through their personal interactions with mothers and commercial relationships.

[1] “The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.” World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[2] World Health Organization. (1981). International code of marketing of breast-milk substitutes. WHO Chron, 35(4), 112-117.

[3] World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[4] Global Strategy, article 19.

Lisa-AkersLisa Akers is a Registered Dietitian Nutritionist (RDN) and an International Board Certified Lactation Consultant (IBCLC). She has been working in the field of public health and human lactation for over 14 years. Her current position as the State Breastfeeding Coordinator is to support and promote breastfeeding endeavors for the Commonwealth of Virginia, which includes the development of public policy and media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding Peer Counselor Program; and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. Lisa serves as the Director of Marketing on the ILCA Board of Directors. She also serves as the Chair of the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee.

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Gathering More Voices: The North and South America Panel at the 2014 Lactation Summit

7The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on North and South America. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., and Hispanics in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

North and South America – Canada, Mexico, South America

Many real-world stories were shared, noting similar barriers already described. Additional issues of transportation, costs, and language were noted. It should be noted that the South American representative to the Summit was unfortunately unable to attend; input from South America will be critical moving forward.

Canada
In the world’s second largest country, travel and transportation costs, as well as distance and access to appropriate resources were identified as significant barriers to accessing the profession.

  • Exam site assignments – do not always accommodate everyone. Some Canadians reported they had to take the take the exam in the United States, requiring passports and often significant travel expenses for airfare or mileage, hotel, meals, child care, and work replacement. Carpooling is often not possible as people are frequently assigned to take the exam at different sites in the U.S.
  • Language barriers – pose hardships for many aspiring lactation consultants. This is further complicated when office staff for IBLCE do not speak French, making it more challenging to register for the exam.
  • Racism – is a significant issue in Canada. For example, a painful history of killing First Nations children and outright abuse of aboriginals in Canada has resulted in continuing issues of discrimination and lack of access to appropriate health care among underrepresented groups. There is a great need for families to heal from intergenerational trauma.
  • Cultural practices – of First Nations peoples are not recognized or valued by those from the dominant culture in Canada.
  • Lack of IBCLC mentors – is a special concern within aboriginal communities. Because many aboriginals lack trust in the dominant culture, this is a significant need. Currently there is only one IBCLC in Canada from a First Nations tribe.
  • Cost and lack of jobs – are significant challenges to motivating people to become IBCLCs in Canada.

Mexico
Despite the large population of Mexico (over 20 million in Mexico City alone) there are relatively few IBCLCs (only 20). There are 67 native languages spoken in Mexico, and there are wide variances in beliefs and practices surrounding breastfeeding, with significant issues impacting the lactation profession.

  • The profession – is mostly unknown in the country. Lactation is not incorporated into medical training, and health providers are not knowledgeable about the profession.
  • Lactation knowledge – is lacking. Many health workers believe they are already lactation experts. Unified evidence-based standards are not shared between health providers, resulting in inadequate lactation care. There are few Spanish language lactation courses and continuing education programs available to educate health professionals and aspiring IBCLC candidates and help them maintain the credential.
  • Breastfeeding promotion – is challenging. Aggressive formula marketing practices have penetrated the indigenous communities in Mexico. Complementary feeding practices are not based on best practices in nutrition. While the Baby-Friendly Hospital Initiative (BFHI) is gaining momentum in the country, the public health department added 15 additional steps (for example, vaccinations) that make acquiring BFHI designation much more cumbersome and difficult to attain.
  • Time constraints and high turnover – add to issues of lack of motivation and knowledge about the profession.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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#ILCA15: Register NOW for our Clinical Skills Rotations

Blog Images (1)We are excited to once again offer our popular Clinical Skills Rotations. Participants will rotate between our skill stations in each two hour session. At each station, those attending will spend 25 minutes with an expert facilitator, who will provide a demonstration and support hands-on skill practice.

Clinical Skills Rotations are available for beginning practitioners (primary session) and for seasoned consultants (advanced sessions). You may register to attend on either Wednesday, Thursday, or Friday, depending upon the skill level you select. Expanding the offerings to three days doubles the number of participants who may take advantage of this popular offering!

Attendees are asked to register for only one Clinical Skill Rotation block  to allow sufficient room for others to participate. This is a popular feature of the ILCA conference so register early if you wish to participate!

Primary Clinical Skills Rotation (available Wednesday, 22 July 10:30am – 12:30pm and Thursday, 23 July 2:45pm – 4:45pm):

  • Breast Massage Influenced by Japanese Style. (Rika Dombrowski, RN, MS, MA, IBCLC)
  • Teaching Tools for Basic Breastfeeding Skills. (Sherry Payne, MSN, RN, CNE, IBCLC, CD)
  • Three Important Rules for the Beginner IBCLC. (Barbara Wilson-Clay, BSEd, IBCLC, FILCA)
  • Case Study Review: Reducing the mother’s anxiety to accept help. (Mireya Patricia Roman, LMHC, IBCLC)

 Advanced Clinical Skills Rotation (available Wednesday, 22 July 1:30pm – 3:30pm and Friday, 23 July 3:00pm – 5:00pm):

  • Being the IBCLC Detective: Where do the clues take us? (Carole Dobrich, RN, IBCLC, RLC)
  • Powers of Deduction: Tongue kinematics in normal infant suck. (Catherine Watson Genna, BS, IBCLC)
  • Handling the Pain: Use of therapeutic breast massage for the treatment of engorgement, plugged ducts and mastitis. (Maya Bolman, RN, BA, BSN, IBCLC)
  • Choosing Supplementation Methods and Devices. (Tanefer L Camara, IBCLC, MS-HCA)

Are you looking to increase your clinical skills? Join us!

RegisterNow

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Gathering More Voices: The Hispanic Panel at the 2014 Lactation Summit

6The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Hispanics in the U.S. Read our other posts on the assessments made by individuals representing the panel on African Americans in the U.S. and Native Americans in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

U.S. – Hispanic Panel

A multitude of barriers impact access to the lactation profession within Hispanic communities in the U.S. Although similarities were found with other groups, unique issues were noted among Hispanics in the United States.

  • Generalizations about Hispanic groups – are frequently made, clustering all groups that speak Spanish into one category of “Hispanic.” In fact, the word “Hispanic” is widely used to denote a single population group in national data, research methodologies, and general policies and programming. However, “Hispanics” are not a single group and are, instead, a diverse body of peoples from many different countries, traditions, and cultural practices. Even language variances are noted within Spanish-speaking cultures. One attendee noted, “Knowing one type of Hispanic means…knowing one type of Hispanic.”
  • Anti-immigrant/anti-Hispanic attitudes – are pervasive throughout the United States, and begin at an early age. Typical assumptions include the myth that people from Spanish-speaking countries (or for whom English is a second language) lack the education to attain the profession or cannot communicate in English and cannot perform well. These assumptions are hurtful and degrading, and result in a lack of the support that aspiring IBCLCs need to pursue the profession. Hispanic immigrants do not feel welcomed; the social, cultural and professional discomfort that many IBCLCs from the profession’s dominant culture feel about Hispanic immigrants erects barriers to their certification as IBCLCs, and to their advancement to positions of power and leadership within the IBCLC profession.
  • The immigrant experience – A fundamental lack of understanding of the immigrant experience is widespread throughout the dominant culture of the United States. The typical immigrant’s story is filled with human drama, with characteristics and qualities such as sacrifice, courage, loss, hope, tragedy, principle, fear, character, and sorrow. These qualities permeate and define every immigrant’s relationship to the U.S., its residents, and as a result, the IBCLC profession. To fail to understand this is to fail to understand immigrants.
  • Structural barriers – that keep mothers and babies from breastfeeding in traditional “Hispanic” cultural groups also keep people from becoming IBCLCs. Acculturation contributes to a significant decline in breastfeeding rates among people from Spanish-speaking countries.
  • Language barriers – are major issues in the United States among Spanish-speaking and English as a Second Language (ESL) communities. Often health providers do not know Spanish and rely on translation or interpretation services at health facilities, which are not always personal. These same language barriers make it difficult for Spanish-speaking people to access required coursework, appropriate clinical mentors, clinical hours, and continuing education.
  • Lack of knowledge – among those in the dominant culture about the educational opportunities in other countries. This lack of knowledge has led to assumptions that Spanish-speaking people are not well educated.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Great Lactation Consulting: Diana West, BA, IBCLC and Lisa Marasco, MA, IBCLC, FILCA

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

Marasco BlogImagine creating an informal survey, hoping to gather 100 responses to a question you have wondered about for a long time. Now, imagine receiving 87 responses in the first hour, and then receiving thousands of responses during the survey period. That is exactly what happened to Lisa Marasco, MA, IBCLC, FILCA and Diana West, BA, IBCLC when they decided to poll mothers on what they look for in an International Board Certified Lactation Consultant® (IBCLC®). To top it off, not only did mothers respond, but IBCLCs responded in droves to request their own survey to answer that question as well.

Marasco and West shared their results at the 2014 ILCA Conference in their presentation Mothers Speak Out: Top Traits of a Great Lactation Consultant. This presentation has now been made available as a study module through the International Lactation Consultant Association® (ILCA®)’s CERPs onDemand portal and is worth 1 L-CERP and 1 contact hour.

The presentation is a dynamic, exciting, and fascinating look at what mothers say they want from their IBCLC.  It’s difficult to imagine that any IBCLC would not be interested in knowing what mothers themselves say about how their needs can best be met, particularly in light of a related session at ILCA2014 that covered meeting the needs of today’s generation, Lactation Support for the Next Generation: Communicating Effectively  with Millennial Moms, Co-workers and Interns (presented by Dr. Jane Heinig, PhD, IBCLC).

IBCLCs also expressed their opinions on what makes a great IBCLC. In many ways, they were in line with what mothers expressed though what clinicians value and know to be important can seem less significant to mothers who are working hard to be successful at breastfeeding. Marasco acknowledges that modern mothers are accustomed to having services available to them 24 hours a day, 7 days a week, and not all IBCLCs are able to make themselves accessible around the clock.

In this interview, Marasco and West highlight some of their thoughts on the survey:

CS: I definitely got the sense that you were overwhelmed at the response to your online poll.  When did you start to realize that this was huge, and it was going to be really groundbreaking?

LM & DW: Within the first hour that it went live. We were communicating as the survey hit, and could not believe how fast the responses came back, and how passionate some were.

CS: How do you feel about the results your research revealed in relation to Dr. Jane Heinig’s work on communicating with millennial mothers? Specifically, that they are less interested in hierarchy and more interested in hearing multiple expert opinions, that they seek information in many ways (mostly digital)?

LM & DW: Our survey did not directly explore how mothers seek out information. Rather, we sought their feelings regarding their experiences, and in that context we heard their stories. While they may hunt for info, I think it is clear that their interaction with the people they contact is important and plays a big role in who they choose for their care, as well as their expectations about the outcome.

LM: In this vein, I personally had a lot of mixed feelings regarding the things mothers valued, available not only in various ways, but also on-demand.  As a mother, I understand these desires, but as an IBCLC, I realize that I cannot give them everything they want all of the time, especially at this stage of my life. There is a huge variation on where IBCLCs draw their practice boundaries; some people are on call 24/7, others are not.  It is difficult to be there for moms all of the time, and I have to think about how to balance their needs with mine.

DW: Absolutely. And then there’s the aspect of where IBCLCs expend their energies, which is driven by their beliefs about the needs and desires of their clients. Since this survey has shown that mothers tend to value counseling skills over technical expertise, our colleagues may now choose to spend more time enhancing their interpersonal counseling skills.

With regard to millennial mothers, our data definitely showed that mothers tend to fact-check recommendations online and put more stock in their peers’ experiences and opinions than those of professionals and authority figures, which is consistent with Heinig’s and my own research about millennial mothers.

CS: I felt completely motivated to ensure that my skills in supporting pumping are really excellent and current.  Which feedback from this research have you personally put to use and why?

LM: More than anything, it reinforced my drive to keep up with things like new technologies and techniques for pumping, and also the importance of slowing down, listening, and taking the time to formulate a plan with mom so that she will own it.

DW: Yes, it really validated the professional practice philosophies I carried over from my volunteer work as a La Leche League Leader to meet mothers where they are, emphasize counseling over information, and respect the mothers’ knowledge of and instincts about their own babies and bodies.

As we found in this survey, the bottom line is that we all want to feel good about what we are doing – mothers and lactation consultants alike. Even when breastfeeding doesn’t go as planned, a mother’s perception of her breastfeeding experience can be greatly improved when her lactation consultant invests time in validating her feelings, respecting her search for the most accurate information, and empowering her decisions. Lisa and I are very grateful for the rich understandings this survey is able to provide to our fellow IBCLCs.


This enlightening session presents the essential traits of a great lactation consultant from the perspective of breastfeeding mothers, and encourages IBCLCs to reevaluate their accepted model of care.

CERPs onDemand from ILCA conferences are a great way to catch conference presentations that you missed while earning CERPs. You can access CERPs onDemand at the times that work best for you!

ILCA Members receive a 50% discount on all CERPs onDemand.

CERPs on Demand Button

MarascoLisa Marasco, MA, IBCLC, FILCA has been working with breastfeeding mothers for over 20 years. She holds a master’s degree in Human Development with specialization in Lactation, co-authored The Breastfeeding Mother’s Guide to Making More Milk, and is a contributing author to the Core Curriculum for Lactation Consultants. In addition, she serves on the editorial review board of Clinical Lactation and is a new Cochrane Collaborative author. Currently, she is employed by WIC of Santa Barbara County while maintaining a small practice, Expressly Yours Lactation Services. She also serves on the Breastfeeding Coalition of Santa Barbara County.

Diana WestDiana West, BA, IBCLC is a lactation consultant in private practice. She is the author of several popular breastfeeding books, including The Womanly Art of BreastfeedingThe Breastfeeding Mother’s Guide to Making More Milk, and Sweet Sleep:  Nighttime and Naptime Strategies for the Breastfeeding Family . She is on the Editorial Review Board for the Journal of Clinical Lactation, a La Leche League Leader, and the Director of Media Relations for La Leche League International.

Christine2Christine Staricka, BS is a hospital-based IBCLC. Christine is the co-owner of California Advanced Lactation Institute, which provides lactation education to professionals and expectant parents. She has contributed to USLCA’s eNews as well as this blog. She enjoys tweeting breastfeeding information as @IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of who have been or are still breastfeeding.

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Gathering More Voices: The Native American Panel at the 2014 Lactation Summit

5The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Native Americans in the U.S. To read our post on the assessments made by individuals representing the panel on African Americans in the U.S., click here. To access information on each of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

U.S. – Native American Panel

Issues affecting Native American aspiring IBCLCs are similar to those of the African American community in some aspects. However, other unique barriers were also identified.

  • Rampant poor health outcomes – including high rates of diabetes and obesity, can impact breastfeeding success, and can also be decreased and/or prevented through breastfeeding if rates were higher.
  • Breastfeeding rates are low – the by-product of generations of abuse against Native peoples, including forced sterilizations and systematic removal of Native children from their homes. Alcohol became a coping mechanism for many Native communities. Lack of family structures and support as a result of institutional racism contributed to the decline in breastfeeding rates. Where once breastfeeding was an historical norm in the Native community, it has now become a lost art for many.
  • Lack of IBCLCs – in a community where breastfeeding is not the norm. In the U.S., it is believed that there are only about a dozen IBCLCs within the entire community of Native American tribes across the country. The lack of data breaking down ethnicity among IBCLCs was reported as a continuing concern in being able to identify accurate numbers of population groups within the profession, and being able to track progress in addressing inequities.
  • Hard to develop new IBCLCs – in a culture where there are so many vastly different Native reservations across the country and so few IBCLCs. In the Native culture, whites are often not trusted due to the painful history of injustice. This makes it hard to prepare new IBCLCs without adequate mentors to model the profession.
  • Myths about Native Americans – continue to abound, tokenism continues, and assumptions are often made that are incorrect.

Solutions for addressing the unique barriers of aspiring lactation consultants within the Native American community were suggested to include increasing breastfeeding rates, such as outreach with tribal leaders and elders, engaging culturally relevant extended family supports such as grandmothers and “aunties,” and incorporating more Native American IBCLCs as breastfeeding conference speakers to speak as knowledgeable experts about clinical topics rather than just “token” cultural sensitivity topics. This would help heighten visibility of the profession and the contributions of Native American professionals.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Gathering More Voices: The African American Panel at the 2014 Lactation Summit

4The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on African Americans in the U.S. To access information on each of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

U.S. – African American Panel

Racism in the United States permeates all aspects of American society. As Cynthia Good Mojab wrote, “Eliminating inequity in the field of breastfeeding requires that we understand that racism and all other systems of privilege/oppression exist at various levels: personally mediated, internalized, institutional, and systemic.” Racism is evident where white privilege affords opportunities that are disproportionately less available to people of color.

In the lactation profession, the original systems and processes set up to develop the IBCLC credential were based on values, understandings, and resources common among whites, the dominant racial group in the United States. Rethinking those systems and processes based on other values, understandings, and resources will be critical to begin an authentic process of dismantling barriers and welcoming people of color into the lactation profession. This goes beyond simply having diverse representation in the leadership of the lactation organizations, although this is a critical element. It also requires facilitating a process whereby people of color are actively engaged and taking the lead in addressing those barriers.

Many participants described overcoming intense struggles to attain and retain the IBCLC credential, and expressed that many African Americans are unable personally to fight the challenges that make it so difficult. Common barriers include:

  • Lack of diversity – on all of the lactation profession organization boards and within the profession itself. With no African Americans at the table when processes and structures are developed that affect people of color, assumptions continue to be made based on the dominant race: white. The lack of diversity within the profession often leaves African Americans feeling uncomfortable and not truly welcomed.
  • The application process – needs to be simplified. One person put it this way: “Trying to figure out how to get into the lactation profession was like going on a road trip across the country without a map or a GPS.” Suggestions were made to create an interactive smart-logic website to allow applicants to chart their best course and track their progress toward designation based on their background/prior learning and experience in a simple format.
  • Educational and clinical prerequisites – are elusive to those who cannot afford postsecondary education or return to college to acquire the required courses. Suggestions were made to develop high-quality, affordable educational modules that do not require college enrollment. It was further suggested that verifiable work and life experiences could count toward educational requirements.
  • Recertification process – is confusing to maintain, CERPs are difficult to track, and the cost is often out of reach to many in the African American community. Suggestions were made to regularly update current IBCLCs with information about their status obtaining and maintaining certification requirements with an online tracker system similar to the one instituted by the American Board of Pediatrics when it transitioned to a complicated Maintenance of Certification process.
  • Significant cost barriers – for all aspects of obtaining and maintaining the IBCLC credential and participating in the life of the profession. Some must sacrifice multiple paychecks to afford coursework and pay for exam fees. Because many African Americans are underpaid and must work more than one job to make ends meet, this poses significant financial hardships. Suggestions included providing scholarships for lactation courses, high level advocacy by the lactation organizations for employer reimbursement of exam fees, and improved marketing of the importance of the IBCLC credential so aspiring African American IBCLCs will value it enough to make it a priority.
  • Clinical pathways – have become so structured that they are now obstacles to anyone outside the medical field. One person said, “Women have been breastfeeding since the beginning of time. When did something so natural become so clinical?” The highly structured approach makes assumptions that devalue the role of community and social support that has been a vital part of the African American community for generations.
  • Accessing clinical hours – is difficult for African Americans who do not hold professional credentials. The medical field is dominated by those of privilege (for example, over 83% of nurses in the U.S. are non-Hispanic whites), adding layers of inequity to African Americans wanting to become IBCLCs. Many hospitals are unwilling to hire aspiring IBCLCs seeking clinical hours, and many African Americans do not have the professional credentials to be hired in the health care field. Opportunities for volunteer positions are scarce. Other potential sources of clinical experience (for example, the WIC program) are often not sufficiently funded to hire peer counselors who simply need to work long enough to obtain clinical hours. Many WIC agencies hire Caucasian peer counselors, even in predominantly African American communities, so there are inherent inequities within WIC, as well.
  • Recognized lay breastfeeding support organizations – have been touted as one way aspiring IBCLCs can gain their needed clinical hours, working as volunteers or paid staff. Historically, many lay breastfeeding support organizations have not been racially inclusive or diverse; thus many African Americans do not feel comfortable seeking support through currently recognized organizations. Additionally, the process of a lay breastfeeding support organization becoming certified by IBLCE is based on a structure that does not value the role of experience and peer learning. This adds layers of inequity through processes that are not attainable to African Americans participating in newly developed lay support organizations geared toward the needs of underrepresented minorities.
  • Clinical mentors – are scarce among the African American community. Finding relational mentors is pivotal for African Americans to be able to relate culturally to those in their community. In addition to identifying African American mentors, it was recommended that lactation conferences, including ILCA, make a concerted effort to have non-dominant lactation consultants speak on clinical topics, not just topics related to diversity and cultural issues.
  • IBCLC exam – features photos that primarily depict Caucasian mothers and babies. Summit attendees were reminded that many clinical conditions manifest differently depending on the degree of pigmentation of breasts. The exam needs to reflect cultural sensitivity and the diversity of families served.
  • Inherent racism – continues to exist throughout American society. The ramifications are seen throughout the African American community, impacting their ability to become IBCLCs. Some Caucasian families do not want to be cared for by an African American breastfeeding counselor, making it difficult for an African American to obtain the needed clinical hours or to practice in the field after becoming an IBCLC. Some white lactation consultants make assumptions that African Americans will not be able to pass the IBCLC exam, and therefore do not provide the needed mentorship support.
  • Lack of jobs – remains a significant barrier. Some African American IBCLCs reported that navigating the changing requirements was difficult enough, and some colleagues made assumptions that they would not be able to achieve them. Yet once they overcame these obstacles and achieved the IBCLC certification, they then faced new hurdles to employment. The doors to employment are often disproportionately closed to African Americans. Many hospitals continue to require additional professional credentials such as R.N. While this is a common concern of other ethnicities, it adds another layer of difficulty for African Americans who are underrepresented within the nursing profession, as well. Achieving employment thus means they must face the additional obstacles of penetrating yet another system of inequity within the nursing profession before they can practice as an IBCLC. Many WIC agencies do not have funding or internal structures to allow former peer counselors who have attained the IBCLC credential to do the work they are educated and qualified to do. Those who are able to get limited employment within WIC find that they must continue to work as peer counselors within the peer counselor scope of practice and at peer counselor pay even though they now have the IBCLC credential.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Breastfeeding Interventions: Miriam Labbok, MD, MPH, FACPM, FABM, IBCLC

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

Screenshot 2015-01-22 09.55.20One of the amazing things about attending a live conference with lactation professionals is hearing the history of our profession from the people who have made it happen.  Dr. Miriam Labbok, MD, MPH, FACPM, FABM, IBCLC has significantly advanced the field of lactation over her career, and her presentation at the 2014 ILCA Conference, Breastfeeding Interventions: What We Know and Do Not Know, reflects her deep knowledge of our field.

This presentation has now been made available as a study module through the International Lactation Consultant Association® (ILCA®)’s CERPs on Demand portal and is worth 1 L-CERP and 1 contact hour.

Dr. Labbok’s presentation is an excellent primer on how to critically read research and includes plenty of examples to drive home the concepts.  She shares that her personal interest and pathway into research came from learning that, “clinical medicine turned out to be less about patient support and more about rote prescription of medicines, and [I] turned to public health to allow me to think outside the box.”

In the presentation, she also shares insights into why certain questions about breastfeeding have been studied and from where the motivation and funding arise for these studies.  She discusses the classic question for lactation professionals reading research, “What is the definition of breastfeeding?”  She leads the audience through a consideration of the challenges of ethics in research, provides a helpful how-to on setting up a study, ponders the problems with data mining, and ends with an inspiring call to action for new research.

In a written interview after the conference, Dr. Labbok shared her thoughts on the most pressing needs for research:

CS: Hearing historical perspectives on issues around breastfeeding (such as the history discussed in this presentation surrounding the definition of breastfeeding) is so influential for newer IBCLCs [International Board Certified Lactation Consultants®] like me; in fact, it is a huge motivator to invest in attending conferences such as ILCA.  How can the next generation hold on to these stories in a meaningful way?

ML: Honestly, this is a question that might better be answered by someone in the next generation! I would suggest that the next generation be encouraged to keep an open mind to what came before. Today, much of this is available on the web, IF you know what to look for. Actively asking for history is also good; trying not to take things at surface value, but asking “How did that come about? How was that decision reached?”  Again, I think you would have a better answer to this than I.

CS: Did you ever face a choice between spending your professional time and energy on clinical work vs. focusing more on research? How did you choose?

ML: My own decision to do research on breastfeeding was actually quite circuitous. My interest began before I even finished medical school and public health school, as Dr. Cicely Williams was my adviser.  At the time, unfortunately, I thought of her as being old and out of touch (she was in her 70s, and I, in my 20s), just as many of my students today find me.

As time has passed, I have realized that her approach, which was always to ask for dialogue and to liberally share anecdotes, still serves me today when I try to illustrate a point or challenge folks to try original thinking.  I found that clinical medicine turned out to be less about patient support and more about rote prescription of medicines, and I turned to public health to allow me to think outside the box.  In public health, the entire population is your patient!

CS: What research would you love to see in the next 5 years?  What research do you think would be most useful for helping today’s mothers?

ML: At least 5 areas of research are needed immediately to support today’s new mothers:

  • Safe, long-acting contraception for use during breastfeeding that does not have any negative impact on breastfeeding.
  • Value of breastfeeding in economic terms including the costs of alternatives, excess DALYs, and hospital/medical costs. These could be used to help sway policy towards paid maternity leave.
  • Cost to the environment of formula feeding, including the carbon footprint of the dairy industry, wasted plastics, excess pharmaceutical use, trucking, etc.
  • Differential impact on women’s and children’s health of expressed milk feeding vs direct breastfeeding.
  • Identification and reduction of remaining barriers to breastfeeding success, including continuity of care, prenatal prophylactic education, etc.

As a leader in policy research, Dr. Labbok’s presentation is highly enlightening and inspiring. It will certainly be viewed as a seminal conversation between the newest and the most experienced IBCLCs — a way to forge strong connections between what has been done and what is to come in the future.

CERPs on Demand from ILCA conferences are a great way to catch conference presentations that you missed while earning CERPs. You can access CERPs on Demand at the times that work best for you!

ILCA Members receive a 50% discount on all CERPs on Demand.

CERPs on Demand Button

Dr. Miriam Labbok, MD, MPH, FACPM, FABM, IBCLC, is currently a professor at the University of North Carolina Gillings School of Global Public Health. She also serves as the Director of the Carolina Global Breastfeeding Institute, which offers a comprehensive program of research, service to the greater community, and education related to breastfeeding and optimal reproductive health.

 

Christine2Christine Staricka, BS is a hospital-based IBCLC. Christine is the co-owner of California Advanced Lactation Institute, which provides lactation education to professionals and expectant parents. She has contributed to USLCA’s eNews as well as this blog. She enjoys tweeting breastfeeding information as @IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of who have been or are still breastfeeding.

 

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Lactation Support for Pediatric Trainees: Q & A with the Authors


Pediatric TraineesDrs. Avika Dixit, MBBS, MPH and Lori Feldman-Winter, MD, MPH recently published an article (with co-author Dr. Kinga A. Szucs, MD, IBCLC) in the
Journal of Human Lactation (JHL) titled, “Frustrated,” “Depressed,” and “Devastated” Pediatric Trainees: US Academic Medical Centers Fail to Provide Adequate Workplace Breastfeeding Support, a study of pediatricians who parent during their medical training and the substantial obstacles they face in achieving their own breastfeeding goals.  

Drs. Dixit and Feldman-Winter were interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.

MH: What led you to investigate the issue of breastfeeding support at United States academic medical centers?

LFW & AD: There is an increased focus on improving work and life balance during medical training. We have seen that more pediatric residents are having children during residency and wondered what their breastfeeding experiences have been, given the rigors of residency, and the presumption that they may have difficulty.

We wondered how trainees balance the needs of their baby, specifically breastfeeding, with the demands of their profession and how this experience affects their practice. This led us to explore this issue more.

MH: What was the most surprising finding from the research?

LFW & AD: We were surprised to see just how strong the emotions related to barriers and challenges of breastfeeding [were]. It was really disheartening to see how passionate and negative these emotions were, upon not meeting their breastfeeding goals, as well as the finding that many agreed that this affected their interactions with their own patients.

AD: There is an obvious disconnect between what the profession preaches as an optimal health behavior, exclusive breastfeeding, and what the training institutions do in terms of supporting this choice. The word cloud here was striking; the bigger the word the more often it appeared in the responses. Words like disappointed, sad, guilty and frustrated [were] prominent.Words for Pediatric Trainees

MH: Pediatricians are at the forefront of supporting the mother-baby dyad during breastfeeding. What changes do you think can be made to improve the ability of pediatricians to provide effective support?

LFW: Graduate medical education (GME) programs, especially in pediatrics, need to be more proactive in making sure their trainees who have children during training are supported to meet their breastfeeding goals. This could mean longer leaves, more options for flexible schedules upon return, more apparent places and facilities to express milk, or onsite child care to facilitate breastfeeding during the workday. Successful trainees will be the best spokespersons for their colleagues seeking ways to support breastfeeding mothers.

AD: I agree with Dr. Winter. Pediatric training programs can lead the way for other GME programs in developing support for breastfeeding trainees with changes such as longer parental leaves, flexible schedules upon returning, easily accessible and good quality facilities for breastfeeding mothers at the workplace, etc.

MH: Were you able to look at the correlation between the breastfeeding support provided for pediatric trainees and the Baby-Friendly hospital designation of the facility where they were trained?

LFW & AD: We did not look at this, as we did not have these data, but, at the time of the study, there were very few academic medical centers designated [as Baby-Friendly hospitals]. Over the past few years, the number of Baby-Friendly hospitals that train pediatric residents has increased dramatically, with multiple national initiatives helping hospitals achieve designation, so a follow up study looking at this factor would be interesting.

MH: Working and breastfeeding is a well-documented challenge, and yet, economic pressures and inadequate leave policies leave many families with wage-earning breastfeeding parents. Pediatric training programs can lead the way in resolving this conundrum, beginning with their own family leave policies. What role can healthcare practitioners play in resolving this critical issue affecting the health of our society?

LFW: It is vital for health care organizations as well as private practices to model optimal leave policies, including paid leave and flexible options for return to work. There should be national policies that incentivize these accommodations.

AD: There is increasing impetus nationally to revise parental leave policies. Healthcare practitioners can be advocates both at their workplace and by supporting changes in national leave policies. At the workplace, not only can they support patients and co-workers, but [they] can advocate for leave policies and improvement of facilities; while, at the national level, healthcare practitioners can write to their representatives about changing leave policies.

avikaDr. Avika Dixit, MBBS, MPH, is a third year pediatric resident at Indiana University School of Medicine. She is the AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) liaison to the Section on Breastfeeding (SOBr). 

 

 

feldman-winterLori Feldman-Winter, MD, MPH, is Division Head of Adolescent Medicine at The Children’s Regional Hospital at Cooper and Professor of Pediatrics at Cooper Medical School of Rowan University in Camden, NJ. Dr. Feldman-Winter is recognized nationally and internationally for her work related to breastfeeding education programs and nutrition policy. She is the chair of the Policy Committee for the AAP Section on Breastfeeding, member of the AAP Task Force on SIDS, AAP representative to the United States Breastfeeding Committee (USBC), and National Faculty Chair for the National Initiatives for Children’s Healthcare Quality (NICHQ) Best Fed Beginnings Project. Most recently, she is consultant to the Kellogg funded CHAMPS Project Communities and Hospitals Advancing Maternity Practices, and the NJHA Mother-Baby Hospital Initiative.

Marie ipad photoMarie Hemming, IBCLC is the mom of three breastfed children (now 21, 17, and 16 years of age). She developed and taught a 20-hour breastfeeding class at the Florida School of Traditional Midwifery. She is currently volunteering as an IBCLC and lay community counselor at Birthline of San Diego, serving families living in poverty.

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In Remembrance: Patricia Martens, IBCLC, PhD, FILCA, CM

Pat Martens oct 2007 high resThe International Lactation Consultant Association® (ILCA®), along with the lactation profession as a whole, grieves the recent passing of Patricia Martens. Pat has been instrumental in the advancement of our field and her contributions will be missed.

We reached out to Dr. Anne Merewood, the editor for the Journal of Human Lactation (JHL) to share some stories and memories of her relationship with Pat. She shared:

There are several stories that stick in my mind about Pat that go beyond the research and teaching at which she so excelled. Pat and her husband had a farm (as well as an airplane), and some of her animal stories were her funniest. She told one about a sheep that had fallen over, and could not get up. The sheep was lying in her barn and no matter what she and Gary did, it was lethargic and refused to move. They fed it and cared for it as it was lying there declining, and they were sure it wouldn’t make it. They asked a local farmer who obviously had more experience than they did, what to do. The man looked at them as if they were mad and said, “Just stand up the sheep.” Those who knew Pat can imagine her description of this activity. Sure enough, Pat and Gary lifted up the sheep, stood it on its four feet, and off it ran.

She also loved to tell a story about a cow that had bloat and gas problems on Christmas, and a local farmer (there were a lot of them about, apparently) told them to feed it a bottle of soapy water. So there was Pat on a freezing cold Canadian winter Christmas Day, pumping a bottle of soapy water into the cow. The cow did an enormous burp and all its problems vanished.

Pat had ways of telling these simple funny stories and laughing along with you that were quite unique. She permeated all her research talks with humor. One can just imagine, as she told it, all her statistics students sitting in their exams, furtively waving their arms about and putting their fingers to their noses to remember the action-packed mnemonics that helped everyone to recall the complex statistical concepts she was so good at teaching. She combined humor, common sense, and research acumen to prove that you can lead an outstanding academic center without being aloof or pretentious. It was Pat who persuaded me to apply for the position of JHL editor. While I received plenty of wise counseling from many people during that application process and in the position ever since, it was Pat who looked at me with a big smile and said, “But of course you should do it.” She was always at the end of the phone with pragmatic, down to earth, straightforward advice.

When Pat first told me about her cancer, we knew it was bad news. “Now if I had to choose, this would NOT be my choice of a cancer to get…hoping I’m a friendly outlier. It’s weird to be sitting here working, feeling pretty good and looking just like I always do (except slimmer), and knowing that it is a flip of the coin if I survive the next 9 months.  But my emotional/spiritual state of mind is just fine, so don’t worry about me.  I’m a do-er, not a worrier, and I approach this as a very interesting scientific research project on the qualitative experience of cancer.” Pat lived 22 months after this email. She also said, “I couldn’t ask for a better more loving environment of support at work, home, and around the world.”

Good people should live longer. It will be hard to manage without Pat.

Barbara Wilson-Clay also offered the following remembrance:

We lectured together at several conferences, and got to know one another over dinners. Pat was one of the most talented teachers I’ve ever observed. Her wit and humor brilliantly transformed subjects like interpreting statistics. I once saw her make a crowd of several hundred health care professionals act out the nursery rhyme “I’m a Little Tea Pot” to clarify a statistical concept. Pat was kind enough, on several occasions, to look at manuscripts I was working on to check whether my conclusions about the research were sound on the basis of the numbers cited. She contributed hugely to our profession, to mothers and babies, and I’m sure her students at the university were changed forever by her instruction. I’m heart sick to hear she has passed away. I would have loved to tell her how I valued her.

DSCN6526In 2013, at the ILCA Conference in Melbourne, Australia, it was announced that JHL would begin awarding the JHL Patricia Martens Annual Award for Excellence in Breastfeeding Research. As was only appropriate, the inaugural award was given to Pat herself for her incredible body of research in the lactation field. While accepting the award, Pat graciously said,

“Thank you to all of my ‘journey friends’. I call you ‘journey friends’ because you don’t come to success without the persons, the places, and the times being fortuitous in your lifetime. We want to make those persons, places, and times fortuitous for everyone so that we may allow success for everyone. This is not an individual award. It is an award because I have such a wonderful community around me of ILCA, La Leche League, and all of the people who are my ‘journey friends’.”

We are so grateful for Pat and what she gave to our field and those around here. We are honored to be her “journey friends”. You may read Pat’s obituary HERE.

How did Pat’s work impact your practice? Do you have memories to share or a reflection to offer? We would love to hear from those who were influenced by Pat, not only for her research and teaching, but also for the care she provided to breastfeeding families. Please comment below or on our Facebook Page. These comments would be treasured memories for all who cared for Pat.

 

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