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Open Letter: Barriers To The IBCLC Profession

The following is an open letter sent to International Lactation Consultant Association® (ILCA®) president Elizabeth Brooks. Lactation Matters is sharing this letter with the goal of sparking conversation before, during, and after the Lactation Summit (hosted by Lactation Education, Accreditation and Approval Review Committee (LEAARC), ILCA, and International Board of Lactation Consultant Examiners®(IBLCE®). We welcome your open and honest dialogue about barriers to the International Board Certified Lactation Consultant® (IBCLC®) profession in the comments and in your own community.

In her IBCLC Day address, Elizabeth Brooks, ILCA president, acknowledged the inequities to entering the profession. I thanked Elizabeth informally, and after a long discussion with her, decided to write this open letter for public consideration.

On IBCLC day, I opened my Facebook feed to find a sea of messages posted by Facebook friends thanking the IBCLCs who had inspired them or helped them on their path through the difficulties of breastfeeding. While I have also been inspired by many IBCLCs, instead of joining in the congratulations and well wishing, I felt a wave of regret for those people who do not have equal access to the field and who, despite their talents and experience, may never become IBCLCs.

In Europe, where I live, the number of practicing IBCLCs is very low. The new IBLCE exam prerequisites have made access to the profession very difficult (especially for non-health care professionals). Even those private practice IBCLCs and health care professionals who have the qualification have difficulty actually practicing with it.

Europe has an aging population. A review of health care education in the UK shows a distinct lack of maternal and infant health courses, and I think this is common across Europe. Because of a predicted decline in births, most resources are directed towards mental health nursing and aged care. Despite access to free or subsidized health care for a large number of Europeans, that health care does not include lactation support. Even when lactation support is identified as needed, the IBCLC credential is not recognized as the standard for delivering that care.

Here in Europe and in other parts of the world we need help promoting a qualification that is difficult to promote. The IBCLC qualification is known as the ‘gold standard,’ but unlike gold (which has a predictable mass), the prerequisites have changed consistently throughout its 30 years of existence. When people ask me to explain exactly what an IBCLC is and what an IBCLC has studied I begin with a “well, it depends . . ..”

We (breastfeeding advocates, providers and supporters) need a clear idea of what the profession is and what we want it to be. Currently the qualification is used predominantly as an add-on to existing health care professions. Non-health care professionals are following a precarious path through ‘patched together’ education; 14 health-science subjects from different faculties and institutions, 90 hours of lactation specific education from independent sources and a various assortment of practical hours with varying degrees of supervision.

Unlike other professions with a clearly outlined study path, navigating the IBCLC exam prerequisites requires skills and experience unrelated to those necessary for success at completing the required courses and practical hours – the system currently privileges those with prior tertiary education, familiarity with education institutions, independent study skills and, for those of us in Europe, internet access, and the economic means to affront unsubsidized private education.

Each country in Europe has an existing health care education system which is not organized along the same lines as the courses outlined in the Health Sciences Education Guide. The difficulties in finding courses that satisfy the specified requirements are forcing many of us to spend our ‘lactation education dollars’ in the US rather than within our own education systems, due to bureaucratic difficulties such as course names, length and content. This is an unfortunate loss of resources as our own education systems are often subsidized or free but don’t necessarily offer individual courses with the same division of content.

My hope is that IBLCE will recognize the resources that we do have instead of requiring a standard list of courses, which we do not have. Such a recognition could then help us open dialogue with our own institutions. We could ask for permission to access to the pre-existing courses that we require by emphasizing the need to train professionals within existing institutions, in turn promoting recognition of the qualification in our own countries. This could be a tangible way to demonstrate to our governments, education systems and health care systems the need for lactation education and professionally trained providers. In the interim, we also need help in simplifying access to the exam and assistance in sourcing universally available online courses that are accepted by IBLCE.

In opening opportunities for new IBCLC candidates, we should also focus on creating opportunities for those less advantaged and those from marginalized communities in order to increase diversity within the profession. Currently, the practical hours component of the prerequisites privileges health care professionals already in practice and those who can afford, and are eligible to, volunteer with mother-to-mother support counseling organizations.

This constitutes a barrier to those who do not have a health care degree, and those who are not mothers (including men), those who do not parent in a certain way, or who cannot afford to volunteer. Other analogous professions, including counseling, nursing, and midwifery, do not have these kinds of restrictions and as a result have a wider diversity of practitioners. We should be turning our gaze to the entry points of both the education and practical requirements and consider how to remove barriers to entry in order to create a system that truly welcomes candidates of all ages, genders, race, abilities, and sexual orientations.

The African American community is pioneering work in this area, creating systems that build on WIC peer-counsellor programs enabling IBCLC candidates to build on their existing experience under the guidance of qualified mentors. In Europe we do not have programs such as WIC (nor easy access to mentors nor academic programs) and there are growing numbers of independent peer counsellors, volunteer and professional, doulas, breastfeeding counsellors and lactation educators who are unable to use their experience towards the IBCLC exam.

These individuals could be encouraged to participate in a structured and supervised support network that could enrich and enlarge the small but significant pool of candidates who acquire experience via volunteer mother support organizations such as La Leche League International (LLLI). The mother support organizations recognised by IBLCE are not accessible to all, nor provide support to all. LLL has recently widened their application requirements to include men who have breastfed, a change in policy from two years ago when they refused the application of Trevor MacDonald. This is a positive step towards inclusion by the association which has a history of difficult relations with working mothers, single mothers and women in same-sex relations – factors that limit this organization (the world’s largest mother support organization) as an equitable entry point to the profession. I hope that other entry points for non-health care professionals will be recognized or created.

Lastly, there are many people with skills and experience from within underserved communities that could be serving communities worldwide, including indigenous, marginalized ethnicities, rapidly increasing migrant populations, the diversely abled and the LGBTIQ population. Our access to the exam is limited for the same reasons that our communities are underserved. Nearly three-quarters of the world’s IBCLCs reside in America (or serve in the American military) and even there many communities are unrepresented in the profession and underserved.

In lieu of statistics, we can look at the way the profession is described, the images used in breastfeeding literature, and the gendered language used by IBLCE and throughout the breastfeeding field generally. I think it is safe to say that the lactation profession is practiced predominantly by white, English speaking, middle-class, heterosexual, partnered, cisgender women. I know there are a few exceptions to that and I take my hat off to sole earners or primary breadwinners, people of color, LGBTIQ people, men, and those with linguistic challenges who have managed to enter and gain employment within the profession.

These were the thoughts that cast the cloud over the IBCLC for me, a cloud that lifted upon reading Elizabeth Brooks’ address, opening a much needed dialogue on barriers to the profession. The discussion that followed with her and others was, in the end, a cause for celebration of IBCLC day. I am currently an IBCLC exam candidate and believe strongly in creating a profession that is as equitable as it is professional. I am much looking forward to continuing this discussion at the Lactation Summit in Phoenix in July, where I will be an eager participant.

profile 02.14 edited II croppedAlice Farrow is an Australian who has lived most of her adult life in Italy where she is currently a single parent of two bilingual and bicultural children. A member of the LGBTIQ community and mother of a diversely abled breastfeeder (a daughter born with a cleft lip and palate), she writes on issues of inclusion and special needs in breastfeeding  support through her two websites www.languageofinclusion.com and www.cleftlipandpalatebreastfeeding.com.

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Q & A with Sherry Payne, MSN, RN, CNE, IBCLC: An Innovator In Lactation Equity

Screen Shot 2014-04-16 at 12.54.48 PMSherry Payne, MSN, RN, CNE, IBCLC, is the Executive Director of Uzazi Village, a nonprofit organization devoted to decreasing pregnancy related health disparities in the urban core of Kansas City. She is also the facilitator of the upcoming 2014 Lactation Summit: Addressing Inequities within the Lactation Consultant Profession. Ms. Payne speaks frequently around the country to professional audiences on topics related to lactation and birth disparities (including the upcoming 2014 ILCA Conference). One of the many barriers that aspiring IBCLCs of color face is acquiring clinical hours. The Uzazi Village Lactation Consultant Mentorship Program is an innovative solution, connecting aspiring International Board Certified Lactation Consultants® (IBCLC®) from the Kansas City community to the Uzazi Village Breastfeeding Clinic, which provides free services to area families.

Ms. Payne was recently interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.

Marie Hemming: Why did you start the Lactation Consultant Mentorship Program?

Sherry Payne: I started this program with the idea that we needed more IBCLCs of Color. I am currently the only IBCLC of Color practicing in my city (though I am the third African-American IBCLC to be certified in my community). This has become a top priority for Uzazi Village – making accessible pathways for lactation educators and peer counselors to become board certified professionals, and then linking those professionals to families in our community who need those services. We already had our free Breastfeeding Clinic up and running two days a week and four volunteer IBCLCs to run it. It was not too difficult to add the mentorship program to it. Three of our IBCLCs qualify to be mentors and there were always plenty of women at our door inquiring about how to become a Lactation Consultant. The research tells us that recruiting and diversifying the ranks of IBCLCs should be a part of the strategy for overcoming disparities in lactation in the African-American community. That’s what we are attempting to do.

MH: Tell us about the Breastfeeding Clinic and how it serves families in Kansas City.

SP: Clients are referred from community-based prenatal clinics and local hospitals that serve low income breastfeeding women who otherwise would not be able to access the lactation support they need. I talk to the local lactation consultants, nurse midwives, pediatricians, doulas and other care providers about our clinic. We receive referrals from Women, Infants, and Children (WIC) and home visiting programs such as Healthy Start and Nurse Family Partnership. We have three to five moms in clinic and home visits each day and we spend an average of two hours with each client on everything from sore nipples, to milk supply issues, to relactation and weaning. We also offer two breastfeeding support groups: La Leche League on Troost, and the Chocolate Milk Café. Our support groups and breastfeeding classes also draw local women into the clinic.

MH: How does the Mentorship Program work?

SP: The interns need to accumulate 300 or 500 hours and we ask that they work at the Breastfeeding Clinic a minimum of one day per week every other week. If they come to every clinic it will take them four to six months or it may take them as long as 10 months to get their hours if they come less often. They are also encouraged to take the WHO/UNICEF Breastfeeding course which is offered every quarter. The interns pay a fee for the program on a sliding scale depending on income.

The program is just starting out, however, we have our first intern beginning in May 2014, with two other candidates seeking placement. We are currently working on getting hospital placement for our interns to do part of their hours. We are also in talks with a local community college to package all the required courses to create a one-stop shopping curriculum for our interns. We hope to be able to simplify things by having classes and clinical experiences all in one program.

MH: What are some of the other barriers that aspiring IBCLCs of Color experience? How is Uzazi Village helping to break down those barriers?

SP: Barriers for aspiring IBCLCs include accessing the educational components, finding mentors, and completing the hours. Women of Color will of course be much less likely to find mentors that look like them, and normative culture mentors may be uncomfortable bringing a Woman of Color into their practice. (I am actually experiencing the same difficulty in my midwifery training.) Many aspiring IBCLCs of Color are found in the ranks of WIC Peer Counselors, but there is no clear cut pathway to move them into the ranks of IBCLCs. It is the presence of these types of barriers that compelled me to create a program at Uzazi Village. International Board of Lactation Consultant Examiners® (IBLCE®) requirements often presuppose educational attainment that peer counselors may not possess, leaving them stranded at the bottom of the professional and economic rungs.

MH: You were invited to Washington DC by the United States Breastfeeding Committee to discuss continuity of care with advocates from around the country. If you could change one thing about our healthcare system to improve breastfeeding outcomes, what would it be?

SP: The Affordable Care Act makes provision for reimbursement for lactation professionals. I would like to see reimbursement for ALL levels of breastfeeding support professionals – direct compensation for the work we do, particularly WIC Peer Counselors. We need our WIC Peer Counselors in our communities. Lactation consultants are most often isolated in hospitals and accessing them is difficult, if not impossible, following hospital discharge. Private practice IBCLCs are cost prohibitive to access among the women we regularly see. Peer counselors have had the greatest impact on increasing breastfeeding rates in our community – they do most of the front-line work and yet they receive the least amount of recognition and pay. I would like to see Peer Counselors and Certified Lactation Counselors compensated by insurance companies for the valuable service and support they offer. This does not take anything away from the board certified professional, but enhances and refines his or her role. We need all levels of expertise.

MH: Of all of the things that you have done, are there one or two things that stand out as being most effective in helping the moms that come to Uzazi Village?

SP: The Chocolate Milk Café, which is a mother-to-mother support group for African-American women, has been groundbreaking. It is designed to meet the needs of our urban moms and has been one of our most successful programs. At Chocolate Milk Café, mothers can attend with their babies and have a safe environment in which to discuss their breastfeeding issues. We are starting to replicate this model around the country.

MH: You are breaking new ground with your work at Uzazi Village, is there someone who has influenced you or mentored you in your own career as a lactation consultant & natural birth educator?

SP: Lots of people have invested in my success over the years, but my primary mentor in lactation has been Charlene Burnett, BSN, RN, IBCLC. She mentored me when I was an L & D nurse, but I worked at a different hospital. She received special permission from her hospital to mentor me 500 hours in a year. I could not have done this without her. She is one of my LC volunteers and she is the Director of Lactation Services at Uzazi Village. We have named a scholarship after her: the Charlene L. M. Burnett IBCLC Scholarship, set aside for a candidate of color in the greater metropolitan area of Kansas, Missouri who has met all requirements to sit for the IBLCE exam. It is our small way of thanking her for all that she has invested in Uzazi Village.

MH: What advice would you give to others hoping to increase access to lactation services for women of Color?

SP: Be creative, assess your community assets and find a way to connect what you have to what women need. When I’m considering a project large or small, I always call to mind the words of the late tennis great, Arthur Ashe: “Start where you are, use what you have, do what you can.” Finally, if you are not a woman of color yourself, join your efforts to someone who is. Allies are important to the cause, but they must take their lead from someone who is a member of a community of color. At Uzazi Village, we counsel many allies around the state and around the country to place women of color in central roles when doing outreaches to communities of color. On our website, you’ll find the success stories (Uzazi Champions) of those we have worked with to improve lactation rates in other communities of color.

Marie Hemming, IBCLC is the mom of three breastfed children (now 20, 16 & 15 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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IBCLC Day 2014: Honoring the Ways IBCLCs Help Families

IBCLCs, get ready to give thanks – and accept gratitude.IBLCDaySocialMedia-Final-A

Every day, I hear from people who are grateful for the IBCLCs in their community. Families who were able to reach their breastfeeding goals. Health care providers who see the vital role the IBCLC plays on a baby’s team. Community leaders who value how breastfeeding improves their citizens’ health and well being.

This year, IBCLC Day is designed to deepen the connections we have to families, health care providers, and our community by taking a moment to share that gratitude.

ILCA has created a series of images – designed to be shared on social media – that invite the community to share their reflections on the impact of IBCLCs. (Check out a sample one at the top of this post!) We also hope that families and others will take this opportunity to thank the IBCLCs in their lives by sharing these reflections on social media.

On March 5th – IBCLC Day 2014 – please watch on the blog, Facebook page, and in your e-mail for ways that you can encourage sharing.

Want to take action today? On the ILCA website, you’ll find a flyer all about how your community can participate. Please print and post wherever families, health care providers, or anyone who cares about breastfeeding might see it – like your local baby store, community center, or health care center.

Know an organization who would like to help us celebrate IBCLC day with a blog post to encourage sharing? Contact us at LactationMatters {at} gmail {dot} com.

We know that in the past, IBCLC Day has focused on local events. While we don’t have some of the materials as in year’s past (like cake art) others will still be available (like thank you certificates and e-cards). We hope that you’ll continue to organize those in your community! You can also purchase IBCLC merch at the ILCA store here as thank you gifts! We encourage you to take this opportunity to come together and share your gratitude for your local breastfeeding community.

You can also take March 5th as an opportunity to share gratitude for your IBCLC colleagues. Stop by the ILCA Facebook page and share a “thank you” with your mentor, your practice partner, or an IBCLC that you collaborated with sometime this year. Or send an e-card (you’ll find those and everything else you need for IBCLC Day here). The more gratitude, the better!

In the words of the U.S. poet and author Maya Angelou: “When we give cheerfully and accept gratefully, everyone is blessed.”

Photo credit for image: courtesy of the Indiana Black Breastfeeding Coalition. Anne Schollenberger Photography.

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Transitions At Lactation Matters

by Amber McCann, IBCLC

This week marks an exciting transition at Lactation Matters. After almost two years, I will be stepping down as the editor of ILCA’s blog. As you may have heard, Jeanette McCulloch, IBCLC, will be taking on the role of ILCA’s media coordinator. Jeanette and I have worked closely together for a number of years to help educate and inspire our lactation colleagues to embrace using online communications with the families they serve. I am confident that Jeanette will confidently take ILCA forward as they seek to effectively communicate why IBCLCs are essential to new families. I talked with Jeanette about her passion for this work and her vision for the organization’s online presence.

McCulloch Speakers Headshot Cropped

Amber: Tell us a little about how you became to be an IBCLC and what led you to use your skills in communications and PR in our field?

Jeanette: I became an IBCLC like so many of us – after lots of breastfeeding challenges of my own. My experience of transitioning to parenting gives me lots of empathy for what many new mothers face. I had a satisfying but demanding PR job and a much-cherished high needs baby, born after years of fertility treatment. She would later be diagnosed as tongue-tied (by a speech pathologist when she was three) but all I knew is that in order to gain weight, she needed to nurse (and be held) round-the-clock. After one day of day care, I knew this wasn’t going to work for either of us.

I left my beloved job and found more flexible work where I could often bring my daughter along. I truly found my tribe as I supported a community of doulas. While there, I saw – daily – the powerful interplay between birth, breastfeeding, postpartum support, and perinatal mood disorders. I saw how much mothers need a community of support, especially when our mothers, sisters, and aunts are so far-flung. I helped to build a lactation program that coordinated care between doulas and IBCLCs and offered a warmline, a clinic, and home visits.

What I missed, though, was using my PR skills. In my previous role, I did what is known as “public interest” PR. I missed the craft of using communications to shape public policy. In my work at BirthSwell, I am so grateful to be able to bring the two together – using communications to help spread accurate, empowering information about birth and breastfeeding.

Amber: What are your hopes as you take on this new position?

Jeanette: I am so excited to be in this new role. I think there is a huge potential for ILCA to connect in a new way to its members and the broader breastfeeding community. The good news is that ILCA has a strong community base – all thanks to the efforts of the past social media team. Bloggers Robin Kaplan and Decalie Brown launched a powerful tool in Lactation Matters, with Amber McCann really building and sustaining an audience there. Maryanne Perrin’s work on social media has resulted in a strong community on Facebook and Twitter, with a combined audience of more than 12,000 followers. And we shouldn’t forget the work of Doraine Bailey, who edited our e-Globe for a number of years and kept members informed of all of the wonderful work of ILCA.

The next level for ILCA is to begin to really engage with that base – to get into conversations that deepen relationships and opportunities. But building relationships is time and resource intensive. That’s why I’m excited to be building a team of volunteers that will be engaging with the ILCA audience on a daily basis.

Amber: What do you see as the biggest challenge for ILCA in regards to communications and how do you envision tackling it?

Jeanette: Social media is a powerful tool for listening to *and* engaging with our community. When organizations first start to truly hear the “buzz” out there, there’s usually some good news – and a few tough truths. With every group I work with, I think the hardest moments have been when we’ve had to take that look in the mirror and learn what’s being said out there. And see it as opportunity.

I’m starting this work at a time of change for the IBCLCs; where the growth of competing service providers is colliding with a scarcity of available funding; where undeveloped regions of the world are desperately working to establish breastfeeding as a cultural norm; and where the move toward cultural, racial, and economic diversity in our profession is being actively pursued. There’s also the real challenge of helping families and others sort through the different kinds of breastfeeding helpers, without being divisive and while recognizing the need for care in underserved communities.

I know there’s no way I can do this alone – which is why I am so excited to be pulling together a team. A team that will be building relationships and tapping into the resources of the larger community. My goal is to work with the team to make sure ILCA is bringing the voice of its membership to the conversations about breastfeeding support today.

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Dr. Miriam Labbok – Global Breastfeeding Leader & APHA Lifetime Achievement Award Winner!

By Maryanne Perrin, MBA

labbokThere is no doubt that it will take a global village to improve breastfeeding rates and ensure that every child gets the optimal nutrition and immunity to start life. Our global village needs fearless leaders to advance the breastfeeding cause, and Dr. Miriam Labbok is one such visionary, which is why we were delighted to see the announcement last week that she had received the American Public Health Association’s Lifetime Achievement Award.  ILCA is proud to claim Dr. Labbok as a fellow IBCLC, and even more proud of the decades of impact she has had on breastfeeding outcomes. In case you aren’t familiar with Dr. Labbok’s work (which is hard to imagine!) here is a brief summary of her many contributions:

  • Dr. 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.
  • From 2001 to 2005 she served as UNICEF’s Senior Advisor, Infant and Young Child Feeding and Care.
  • From 1996 to 2001 she served as Chief, Nutrition and Maternal Health Division for the Agency of International Development (USAID).
  • From 1992 to 1996 she served as the Director of the World Health Organization’s Collaborating Center on Breastfeeding.
  • A Pubmed search of “Labbok + breastfeeding” generates over 75 published papers on topics ranging from infant feeding practices in international communities, to the impact of the Ten Steps in maternity hospitals, to IBCLCs experience with health insurance coverage of breastfeeding support services.

Dr. Labbok’s lifetime of work has had an immeasurable impact on improving global health. Congratulations on the much deserved APHA Lifetime Achievement Award!

MaryannePerrin3-2Maryanne Perrin loves all things related to food: growing it, cooking it, eating it, and now studying about it at the molecular and cellular level.  She has a BS in Industrial Engineering from Purdue University and an MBA from the University of North Carolina, Chapel Hill, and enjoyed a variety of career paths (information technology, management consulting, stay-at-home-mom, entrepreneur) before returning to school to obtain a PhD in Nutrition Science. She was quickly captivated by the amazing story of human milk and is focusing her research on understanding the nutritive and immunoprotective value of donor milk beyond one year postpartum.  When she’s not studying or helping ILCA with social media, she likes playing in the woods with her husband, three kids, and the family dog.  

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A Response from the International Chiropractic Pediatric Association

Lactation Matters received the following response from Dr. Joel Alcantara, the Research Director of the International Chiropractic Pediatric Association in response to remarks from Dr. Howard Chilton in the September issue of ILCA’s e-Globe. In the issue, Dr. Chilton, one of the plenary speakers at this year’s ILCA Conference in Melbourne, Australia, responded to questions about the use of chiropractic care for colicky infants. He said,

“I find too often when I am asked to manage the colicky and unsettled baby that they have already been seen by a chiropractor and have had some form of cranial or spinal treatment. This type of management is unproven, has no basis in science and is potentially dangerous, both of itself and from the delay in the application of sound medical and nursing procedures for this complaint. The movement of chiropractors into the management of paediatric, and especially neonatal conditions, is very
troubling.

The parents of young children are highly vulnerable when their children are perceived to be unwell and, combined with their reasonable wish to avoid medications, are easily mislead by the anecdotal claims of such pseudoscience. As I heard someone remark recently: “the collective noun for ‘anecdote’ is not ‘evidence’.” I wish I’d thought of it!

However when one is marketing what is in effect the placebo effect one is certainly motivated to be sympathetic and kind and to give extra attention and time to the concerns of the parent. It is this benefit that derives from the chiropractor in this field, and perhaps it is in this area that conventional medicine can improve.”

Lactation Matters always welcomes discourse such as this as we seek to develop evidence based practice and we thank the International Chiropractic Pediatric Association for reaching out to us to publish their comments.

By Joel Alcantara, Research Director of the International Chiropractic Pediatric Association

ICPA Logo (1)We thank the ILCA for the opportunity to respond to comments made by Howard Chilton, MBBS, MRCP(UK), DCH on the subject of chiropractic care for infants with colic. In this era of evidence-informed medicine, Dr Chilton is obviously ill informed on chiropractic for colicky infants and colic medications. A recent systematic review of the literature on chiropractic and infantile colic by Alcantara and colleagues1 found 26 published articles in peer-reviewed journals consisting of three clinical trials, two survey studies, six case reports, two case series, and four cohort studies. Overall, the published literature supports chiropractic for colicky infants. In terms of comparative effectiveness research, it should interest Dr Chilton that a clinical trial has compared chiropractic versus Dimethicone, a very popular medication prescribed for infants with colic. The study demonstrated that chiropractic care was more effective in relieving infantile colic.2 This is not surprising to those familiar with the scientific literature on drug prescriptions for colic that finds “little scientific evidence to support the use of Simethicone, Dicyclomine hydrochloride, Cimetropium bromide, lactase, additional fiber or behavioral interventions.”3

Chiropractic is a vitalistic, holistic and patient-centered approach to patient care. Chiropractic is a caring profession where mutual trust, understanding and acceptance is of paramount importance in our approach with patients, adult or children. As chiropractors, we acknowledge and embrace the non-specific effects of the clinical encounter – what Dr Chilton refers to as the placebo effect. With all due respect, perhaps Dr Chilton should not be so arrogant and judgmental and embrace the placebo effect since colic medications such as dimethicone or semithicone have been demonstrated to be no better than placebo.4,5  Even more pressing, safety concerns have been raised with a number of these colic medications.6,7

A systematic review of the scientific literature on adverse events associated with pediatric spinal manipulation found only 10 documented adverse events attributed to pediatric chiropractic in a span of over 100 years of chiropractic practice.8 Our own practice-based research network studies point to the safety of pediatric chiropractic with prevalence of adverse events at less than 1% and risk estimates placed at <1000 adverse events per 1 million children followed under chiropractic care for 1 year.9,10 Dr Chilton should be more concerned about the practice of “off-label” prescribing for infants and children in his profession. The first study to examine the extent of this practice of prescribing medication for children without the safety, efficacy, and quality assurance that is required of medications was performed in the UK. The study found that 70% of children received either an unlicensed or off-label drug prescription, with approximately one-third of drug prescriptions being unlicensed or off-label.10,11 Subsequent studies have confirmed the popularity of this practice in pediatric medicine with documented adverse events that is unmatched in frequency and severity by chiropractic or other alternative forms of pediatric care.

The practice paradigm of the 21st century is integrative care that is embraced by lactation professionals, chiropractors, nurses, and other healthcare professionals. It is characterized by mutual respect and shared managementthat emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions), drawing upon the best of both conventional and alternative therapies.13 Antiquated attitudes expressed by Dr Chilton have no place in the care of infants and children in the 21st century.

References

  1. Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore (NY). 2011;7(3):168-74.
  2. Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther. 1999;22(8):517-22.
  3. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012 Feb;48(2):128-37
  4. Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics 1994; 94(1): 29-34
  5. Danielson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone). Acta Paediatr Scan 1985;74(3):446-50.
  6. Crotteau CA, Wright ST, Eglash A. Clinical inquiries. What is the best treatment for infants with colic? J Fam Pract 2006;55(7):634-6.
  7. Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop WJ, Neven AK. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;316(7144):1563-9.
  8. Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83
  9. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY). 2009;5(5):290-5.
  10. Alcantara J, Ohm J, Kunz D. A practice-based prospective study on the incidence and prevalence of adverse events associated with pediatric chiropractic spinal manipulative therapy. J Ped Matern & Fam Health – Chiropr [Submitted for Publication]
  11. Choonara I, Sharon C. Unlicensed and off-label drug use in children. Implications for safety. Drug Safety 2002; 25 (1):1-5
  12. Turner S, Gill  A, Nunn T,et al. Use of ‘off-label’ and unlicensed drugs in paediatric intensive care unit. Lancet 1996;347:549-50
  13. Bell IR, Caspi O, Schwartz GE, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002;162: 133-40.

alcantara_joelDr. Joel Alcantara, I.C.P.A. Research Director, spearheads the profession’s largest and most successful Practiced Based Research Network (PBRN) and continuously oversees numerous projects relevant to evidenced based family chiropractic care. He is instrumental in involving members of the International Chiropractic Pediatric Association in publishing the research so necessary in the profession. His commitment to publishing is establishing recognition and validity to the necessity, safety and effectiveness of chiropractic care for pregnant women and children.

Dr. Alcantara was born in the Philippines and grew up in Calgary, Alberta. Prior to attending Chiropractic College, he was trained in Chemistry-Biochemistry and Cellular, Molecular and Microbial Biology at the University of Calgary. Upon graduating from Palmer College of Chiropractic West in 1995, he was given a full-time faculty appointment at his alma mater in the Research Department. In the two years prior to his position with the I.C.P.A. , he held the rank of Assistant Professor at Life Chiropractic College West. During his tenure at both chiropractic colleges, he has taught an array of subjects from Chiropractic Pediatrics, Physical Diagnosis, Research Methods, Public Health and various chiropractic clinical courses. He has published widely in scientific journals and in the popular chiropractic media and has co-authored several chapters in various chiropractic textbooks. Dr. Alcantara is completing his Master of Public Health degree at San Jose State University with a specialty in Community Health Education.

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Insights into Working with Breastfeeding Mothers Who Have Experienced Trauma

By Dianne Cassidy, IBCLC

Photo by 55Laney69 via Flickr Creative Commons

Photo by 55Laney69 via Flickr Creative Commons

When I first began working with new mothers, it was with a local community program.  The more women I met, the more I saw a link between breastfeeding and trauma.  Most of the women that I assisted had a limited support system available to them, and limited education.  In many instances, we were the only ones who offered the support they needed to initiate breastfeeding.  As a bond was built during pregnancy, sometimes a new mother would open up and talk about her personal history, things that she may have endured during childhood, or in the not-so-distant past.

I have heard some terrible stories.  Many of these stories come with a happy ending of sorts – the fairy tale where the woman finds her strength and confidence and realizes that she is capable.  Some are not as favorable, and can haunt you for years.  I became more and more interested in how abuse can impact a woman’s decision to breastfeed.  I decided to make this the topic of a research project while completing my Bachelor’s degree a couple of years ago. While important, coming face to face with the emotional scars of many of these women was very challenging.

While doing my research, the literature review unearthed some interesting information about abuse and breastfeeding, particularly child sexual abuse (CSA) and how it may impact breastfeeding initiation.  When working with the community programs, one of the focuses of breastfeeding support was teen age mothers.  We have a high rate of teenage pregnancy here (enough that there is an entire high school dedicated to teen mothers) and teen mothers have been known to have a low breastfeeding rate. Childhood sexual abuse prevalence among adolescent mothers is close to 50%. Adolescents who have been abused as children are more likely to become sexually active at a younger age than those not abused.  Adolescent survivors of CSA were 3x likely to become pregnant than those who were not abused.  Studies reflect that breastfeeding is not readily initiated among adolescent mothers.  This is not to say that these mothers will not initiate breastfeeding at all, but those who do initiate are more likely to wean earlier than adolescent mothers who are not victims of CSA.

One of the most wonderful things about breastfeeding is the close, intimate connection between mother and baby.  For a survivor of CSA, this may be an unfamiliar, unwelcome sensation.  Intimacy disturbance and dissociation are consequences that are likely to influence feeding decisions of adolescent mothers.  CSA victims and survivors may struggle with trust issues, building relationships and emotions.  Abusers are often someone that the victim is familiar with – family friend or relative for example, leading to feelings of betrayal and vulnerability.

Trust is a tricky thing.  It’s important that a woman has a good relationship with her provider, a trustworthy relationship.  Without this, information is skewed.  Communication is key.  It may be difficult for a survivor to confide her concerns regarding her feeding choice to someone if a relationship of trust has not been established. When preparing for labor, a provider can gain the trust of their patient if they listen carefully and validate her feelings, exploring what concerns she may have in regards to breastfeeding.  When working with expectant women, or in particular adolescent mothers, education is an important part of breastfeeding initiation.  Educate expectant mothers about their feeding choices in a non judgmental manner.  Mothers with CSA history are likely to have come from a family environment that is chaotic, deprived and emotionally dysfunctional.

As a lactation consultant, it can be difficult to explore options other than breastfeeding with a new mother.  We know that breastfeeding is the optimal choice, and mothers know this to be true as well.  Sometimes, exploring other alternatives is necessary.  The role of the provider is to offer the patient evidence-based information so that the patient can make the appropriate decision.  Once the information has been disclosed, it is the role of the provider to offer support, no matter what that decision is and how the provider feels about that decision.

Every new mother and baby deserves the opportunity to enjoy a breastfeeding relationship, free of distress, no matter what the history may be.  I feel honored that I have been able to assist with offering this to survivors, encouraging mothers and babies to get the best start in their life together.

References:

Bowman KG (2007). When breastfeeding may be a threat to adolescent mothers. Issues in Mental Health Nursing, 28(1), 88-89.

Brooks, EB (2012). Legal and Ethical Issues for the IBCLC. Jones and Bartlett.

photo-2Dianne Cassidy is a lactation consultant in Rochester, New York. She became interested in the field of lactation consulting after breastfeeding her own children.  After spending thousands of hours working with new mothers and babies, she was able to sit for the board exam, which qualified her as an International Board Certified Lactation Consultant (IBCLC). In 2010, she completed her Advanced Lactation certification and BS in Maternal Child Health/Lactation.  She is dedicated to serving mothers and babies, and has the unique ability to identify with the needs and concerns of new mothers. She also has experience working with older babies and mothers returning to work and wishing to continue their breastfeeding relationship. She has worked extensively with women who have survived trauma, babies struggling with tongue tie, birth trauma, milk supply issues, attachment, identifying latch problems, returning to work and breastfeeding multiples.

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Embracing the ILCA Sisterhood

By Indira Lopez-Bassols, BA with hons, MPP, IBCLC

My first encounter with the International Lactation Consultant Association® (ILCA) was in the form of an email when I had just become an IBCLC. It was invitation to a trial membership, which of course I accepted. Although I did look around the articles online and found the information sheets invaluable, I thought naively that it looked like an interesting AMERICAN organization but too far across the Atlantic sea to be valuable to me in Great Britain.

A set of coincidences allowed me to embrace ILCA and become an avid fan! My inlaws celebrated their Jubilee anniversary in Tampa, Florida in July 2012. I had received the information about the 2012 ILCA Conference which looked amazing but again seemed quite unreachable. But then it clicked to me that I was going to be in Tampa just a few days before the conference in Orlando!

My first moves were to see if I could fit the days into our itinerary, enroll as a member of ILCA to get a great deal for the conference, and apply to Lactation Consultants Great Britain (LCGB) for some funding. All three tasks were completed quickly and successfully and I was off to Orlando for the conference. It was mind blowing! Luck was on my side as the oral skills sessions were full as I had signed so late so I attended the Spanish sessions, which I thought were incredibly well presented.

In the first session I actually sat next to Roberta Graham de Escobedo, without realizing the role she played on the ILCA Board of Directors. She was so welcoming and warm, no wonder she is in charge of ILCA memberships!

I remember thinking after the morning session, “This has already been so worth it! Thank be to God for all these coincidences!” The following day were the plenaries and I just could not believe how so many people together could share the same interest and passion as me!

I said hello to people I had met in the past and enjoyed all the networking from the International delegate gathering and meeting the Hispanic community. Being Mexican, married to a Peruvian/Italian/American citizen, having lived all over the world because my father was a Diplomat, and now residing in the UK, you can imagine how I feel like a true citizen of the world.

I came out of the conference feeling exhilarated, refreshed and uplifted. There are around 26,000 IBCLCs working around the world today, and only 423 of those are in the UK. The National Health Service has yet to recognize us so although there is a lot of work to be done nationally, it sometimes feel we are riding solo into the battle. I was really impressed as the group of IBCLCs in Orlando felt like a more cohesive united group with a true international presence from different fronts.

I swore that, if in the future, I had money to attend breastfeeding conferences, my priority would be on those produced by ILCA. The following year after I attended, I revisited the ILCA website to stay connected and read voraciously every Journal of Human Lactation I received through my subscription.

Jill Dye, Director of LCGB and Indira

Jill Dye, Director of LCGB and Indira

There are coincidences in life and we use them to craft our destiny. My next set of coincidences came in the form of another email I received, a reminder about the ILCA conference scholarships. I had no idea ILCA offered any type of scholarship. I still thought the 2013 conference in Melbourne, Australia was way too far away and expensive, so I didn’t imagine I could attend, even in my wildest dreams. But, I took a risk and emailed Glenna Thurston, who was in charge of ILCA Membership Development, to ask her about the application form and process as I might apply in the future to another ILCA Conference in the US which is closer and more accessible economically to London. Glenna kindly explained the process but did encourage me to apply to Melbourne anyway. I did so and was awarded a scholarship! I again applied to LCGB for a bit extra funding and I was able to cover airfare and the remainder of the conference fee. To make my trip possible, a friend of a friend that lived in Melbourne kindly opened his home for that week.

Two consecutive years, I was able to attend the ILCA Conference and I felt like I was in heaven. I enjoyed tremendously the whole experience. Before the conference started, I went on the guided tour to the Sanctuary where we saw Australian native species and learned about some of their mammal’s breastfeeding experiences. One of the IBCLCs shared that kangaroos make pink milk but none of the zoologists onsite could confirm that for us.

I enjoyed most of the sessions that I attended and found Linda Smith to be a wonderful presenter with a great sense of humor. Influenced by her, I will definitely be adding more humor to my teaching and presentations in the future. Nils Bergman’s presentation was also fantastic and particularly useful to have science affirm what we have known for millennia about attachment and separation.

This year, I, like many others, volunteered to help out at the Conference. I was a bit nervous the first time I stood in front of everybody to introduce the speaker but soon it became second nature. I had a strong gut feeling that, although I am, like we say in Spanish still a bit “fresh like a lettuce”, the day will come that I will be a presenter.

The pinnacle of the Melbourne Conference for me was a session I attended as part of the Oral Skills rotating session on supporting mothers with voluptuous breasts, presented Gini Baker and Decalie Brown. Gini asked for two volunteers to pretend they had voluptuous breasts and were having breastfeeding problems.It was slightly embarrassing but on the funny side as she made us feel all so comfortable. She reminded us gently that we were all on the same boat: the sisterhood. That was a highlight, an “aha” moment for me. It is truly a wonderful sisterhood, as we all speak the same language, we are all passionate about what we do, we are fanatics about supporting breastfeeding families, and most important of all: united we are stronger!

Joining ILCA is much more than getting a membership. It is also about being a part of the sisterhood of wise, passionate, bright women that are changing the world one breastfeeding baby and mother at a time.

If after reading this article you have been gently persuaded to become an ILCA member, please mention me through the Each One Reach One Campaign. The purpose of this campaign is to increase membership by spreading the word. Who knows? Your support may help me to attend a third ILCA Conference in the future.

Indira Lopez-Bassols, B.A. with Hons, M.P.P. and IBCLC, works in private practice in London and at Kings College Hospital Tongue Tie Clinic.   In addition, she leads the La Leche League Wimbledon group.  In combination with her doula work and her passion for teaching, she also offers breastfeeding study for doulas.  In her scare free time, she enjoys writing about birth and breastfeeding and has published in several related magazines.  She was awarded the 2013 ILCA scholarship to attend the organization’s annual conference in Melbourne, Australia.  For more information, visit: www.indirayoga.com

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Introducing Marcy Cottle, ILCA’s New Assistant Executive Director

Marcy

ILCA is proud to welcome Marcy Cottle as our new Assistant Executive Director. We look forward to her work with us to further the IBCLC profession and support breastfeeding families all over the world. We’ve asked her to introduce herself to us on Lactation Matters.

Greetings! I am excited to be part of ILCA as the new Assistant Executive Director. This is a welcome addition to my personal and professional journey – allow me to introduce myself!

The majority of my career has been spent developing people and processes, simply put. I have worked with some great leaders in the training and development arena, including the late Dr. Paul Hersey. It was through my association with Doc and his company that I learned the power and responsibility of influence.

My most recent positions include working for the Muscular Dystrophy Association as a Regional Coordinator. I was responsible for training internal teams, establishing key donor relationships, and delivering MDA family services. Over a year ago, I re-established a consulting company that specializes in providing resources for the nonprofit, organizational development, and business development arenas.

My family and I live in Wake Forest, NC. I came to North Carolina 19 years ago, via the Chicagoland area and fell in love with both NC and my husband! We have been married for 14 years this year and have a wonderful little girl, Brynn, who turns 4 in March. My husband works for the United States Post Office and Brynn started Montessori preschool this year. Hobbies of mine include cooking (she-crab soup a specialty), reading (Christy – my favorite) and exercising ( finished my first half marathon in December – truth be told, that is neither my favorite distance nor number).

Working for ILCA allows me to continue a portion of my professional experience in the nonprofit arena. I am excited to be associated with such a great organization that is active in improving health across the globe. I look forward to working with ILCA for years to come!

Lastly, I will leave you with a favorite quote…

“The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind.” William James

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New Book Describes the Importance of Caring for Newborn Families

By Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA

A little over 20 years ago, I started writing for a little indie magazine called, The Doula. I was thrilled to have the opportunity. As a new mother myself, I loved that magazine. Each article was well written and spoke so beautifully to my experience. It was during that time, that I first encountered the work of Salle Webber, a postpartum doula in Santa Cruz, California. She had written about the needs of postpartum women. I quoted that article for 20 years. I was fortunate that when she decided to write a book, she got in touch with me. I was privileged to serve as doula to her first book, and I am pleased to present an excerpt from it. As International Board Certified Lactation Consultants (IBCLC) as well as breastfeeding volunteers and supporters, being in tune with the needs of women in these moments is essential. In this season of Thanksgiving, I hope it nurtures you as it has nurtured me. Enjoy!

Cover photo credit: Maggie Muir

Excerpt from The Gentle Art of Newborn Family Care by Salle Webber:

Birth is a deeply spiritual event, mysterious and miraculous. At the same time, birth is profoundly physical, with pain, blood, risk, and no guaranteed outcome. A new mother and her infant are a holy couple, inspiring reverence in all who come near. Yet they are delicate, depleted by the exertions they have undergone, and touched forever by the nature of their birth experience. They require careful attention to their physical bodies, bacteria testing, as well as sensitivity toward their ever-changing emotions and needs.

A father has a somewhat different path. He has a more intellectual idea of the child, not experiencing the intimacy of sharing his body. Not only is he now a father of a helpless infant, but his wife or partner has become someone else. The new dad may feel overwhelmed with responsibility. He may feel that his own needs are pushed into the background, and his best friend has a new love–the baby.

Author Salle Webber

Parents need care as they make this huge transition. The life change that a seven-pound infant can generate is surprising. In the first few days postpartum, mother and baby will mostly be snuggled in bed together. The mother should be encouraged to get up only when she feels like it, and provided with food and drink. One wonderful female doctor recommends, especially after surgical birth, two weeks in the bed, two weeks on the bed, and two weeks near the bed.

Try to create an environment that is restful to eye and soul, that will allow the new mom to dwell on the beauty of her child without material distraction. It is also helpful to see that the things she needs, such as her water, a snack, phone, magazine or book, are in easy reach. These simple acts will make a big difference.

Sharon is a rock in her community, one who others come to for advice and support. When she delivered her third child, it was a difficult birth. She lost a significant amount of blood, and was physically and emotionally exhausted. As her doula, I found her in bed looking quite disheveled and uncomfortable, her older children appearing lost without the attention of the capable and devoted mother they were used to. I herded the kids into the kitchen, fixed them breakfast, and went back to Sharon. She was instantly relieved to have a bit of the pressure taken off, and said she wanted nothing more than to sleep. I bundled her newborn girl onto my chest, threw a load of laundry into the washer, and moved the energetic youngsters into the other end of the house. I engaged the older children in drawing, then in the game of sorting laundry. They played outside for a while as their mom slept deeply. About the time the baby began to stir, Sharon awoke, feeling that tingling in her breasts. After a session of nursing, I brought her a tray of warm and nourishing food. I held the infant while she ate and checked in with her other children. Friends came by to invite the older ones to the park to play. Once the house was quiet, Sharon took a leisurely shower, during which time I changed her sheets and tidied up her bedroom. She returned from her shower and uttered a cry of joy to see her bed so welcoming! Little things mean a lot at times like this. She crawled right in.

It took two weeks for Sharon to begin feeling well, and she spent her time close to her bed. I worked to ease her burden by tending the other children’s needs, keeping the laundry moving, and holding her baby. I encouraged her to take care of herself, to enjoy long showers and good food and drink, and to allow members of her community to assist her family by bringing meals, entertaining the children, helping with shopping, and stopping by for an hour to do whatever needed to be done. Many women are so used to taking care of everyone else, they hardly remember how to honor their own needs. It was a reminder for Sharon that we all need each other, and she surrendered gracefully to the demands of her own body.

The art of being a doula lies in a compassionate and nurturing heart, a willingness to serve others, love of family life and babies, and a healthy respect for the work of the home. This is holy work. We are laying the foundation of this family’s life with this precious new addition. We can help to bring harmony, calm, humor, and rest. I encourage every postpartum care provider to consider what it is she wants to model. I believe the experiences of infancy are vitally important in the development of the deeply held mental structures with which we respond to life. As we demonstrate relaxed and contented behavior, we impart these feelings to the child as well. How better to serve the future of humanity?


Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. She has authored or edited 22 books and more than 320 articles on family violence, postpartum depression, breastfeeding, and women’s health. Dr. Kendall-Tackett is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is a Fellow of the American Psychological Association, and is president-elect of the APA Division of Trauma Psychology. You can view her website at www.KathleenKendall-Tackett.com.

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