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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.


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.


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:


Introducing Marcy Cottle, ILCA’s New Assistant Executive Director


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


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


Establishing a Breastfeeding Clinic in Guadalajara, Mexico

By Barbara Oñate, IBCLC

Before I became an International Board Certified Lactation Consultant (IBCLC), I had the opportunity to visit a friend 24 hours postpartum in the most expensive hospital suite available in my hometown in Mexico. I was truly aghast to see she had such damaged and bleeding nipples. I asked her who was helping her at the hospital and she replied that the nurses told that her she needed to “wipe her nipples and withstand the pain”. You can imagine how desperate I was for my friend so I sat with her and helped as much as possible with what I knew from my own breastfeeding experiences. I went back to the United States amazed by how poorly women were served, even in the most expensive birthing facilities available.  That is when I decided to pursue becoming an IBCLC.

Five years ago, my family and I moved back to Mexico and I was ready to help. There was very little lactation support available in my community and few people were aware of how IBCLCs could impact breastfeeding for mothers and babies.  While studying to meet the requirements for certification,  I worked for free at a local hospital in Guadalajara. The use of formula for infants was “protocol” in my facility and a representative of a formula company regularly did “lactation rounds” in the hospital. I was diligent in my efforts to meet with mothers just after this representative had visited their room and support moms and babies while combating the poor information she had given. I would help the mother and baby latch-on after 10-20 hrs of separation with their babies, fully fed with bottles and formula. Before long, patients began coming to the hospital asking for my help. Not long after, the formula representative simply quit coming and I was left with the whole maternity floor to myself! This is how pediatricians and OB’s started to trust me, call me and even consult with me. I soon began my own private practice.  With the contact hours I was afforded at the hospital and in my practice, I applied for my IBCLC exam and in October 2009, I earn my certification.

As my practice grew, I began noticing that a large number of mothers were wanting to breastfeed but lacked support and the adequate tools. Our country of 120 million people is experiencing a significant lack of IBCLC care (ed. note: IBLCE notes that, as of April 2012, there are 19 IBCLCs in the entire country). I began to contacting those in the community with the power to effect change, asking them how we could provide more support to Mexico’s mothers and babies.  One said to me, “I see your passion about breastfeeding and I can see how important it is for babies and mother’s. I think we have to do something about it”. We recognized together that increasing breastfeeding rates could have a significant impact on Mexico!

We now have a lovely breastfeeding clinic in Guadalajara and we hope to open 14 more throughout Mexico. We are also launching an educational campaign on social media to educate moms and empower them in regards to their breastfeeding “powers” and rights. We are setting up a nationwide breastfeeding call center and we are negotiating with private insurers to provide breastfeeding benefits for all their clients.  We are starting to see wonderful momentum from mothers who are finding the kind of support they deserve. We are devoted to giving to our beautiful country smarter, healthier, and more attached babies, mothers and families.

I think all IBCLCs need to find the power in their passion. We are saving lives every day. We are the soldiers, fighting for infants’ lives and we need to stand tall in every corner of the world. I always tell my trainees, “If we do our jobs right today, we can save families from difficulties or problems they will never know thanks to breastfeeding”.


We need your INTERNATIONAL perspective!

Written by Amber McCann, IBCLC

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

Photo by Tareq Salahuddin via Flickr

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

We need your STORIES.

We need your PERSPECTIVE.

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

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

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

Amber McCann, IBCLC

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


Clinicians in the Trenches: Kathleen Stahl, RN, IBCLC

I would like to introduce you to Kathleen Stahl, an RN and IBCLC from the Annapolis/Baltimore area.  I first met Kathleen at a local educational meeting and have since had several conversations with her about her unique perspective on breastfeeding support.  As a NICU IBCLC in a hospital that primarily sees an underserved population and with a private practice in a particularly wealthy area, she sees a wide range of perspectives on breastfeeding support.

Can you describe a typical day in your current hospital job?

I work as a lactation consultant in the NICU of a large, Baltimore hospital.  Most of the babies that I see in the NICU are very premature and may not feed by mouth for several weeks or more so, in working with them, I support moms in pumping.  I touch base with any moms who are coming in for feedings but many aren’t able due to transportation issues. I will follow up with moms who are still admitted to the hospital, making sure everything is going well and that they have a breast pump for discharge home. I will also see anyone who is on bed rest prenatally that is high risk to talk about the value of breastfeeding.  I also do consults in the NICU during the day for the babies that are starting to go to breast.

In addition, I do follow up phone calls to track our breastfeeding in the NICU at 1 week, 2 weeks, 6 weeks, 3 months, and 6 months and provide outpatient support as we frequently have preemies going home that are not consistently feeding well at breast and will need to have supplemental expressed milk.  The outpatient consult also gives the mother the confidence and reassurance she needs to wean off of breast milk supplementation to exclusive breastfeeding.  I have found that in this particular NICU setting, private outpatient consultation has been more successful than breastfeeding support group once the babies are  discharged.  Mothers can schedule the time to come in when it works for them. While all the mothers have phones, many do not have cars or computers, so finding the best mode of communication for each mom is vital.

The majority of the time I spend educating mothers on the value of breastfeeding.  It is a very scary and stressful time for these mothers with babies in an intensive care unit.  They are afraid to touch and hold their babies and they are fearful of the monitors.  I spend alot of time just building relationships of trust with them so they feel comfortable talking with me about their breastfeeding concerns.  Since the parents watch the nurses with wide eyes as they measure everything that goes in and out of their babies, it is difficult to get the parents to have the confidence while breastfeeding when they cannot measure exactly how much is going in to the baby.

In the NICU, the challenge is mother and infant separation.  Ideally, I would like to see both parents be able to stay comfortably with their babies.  I feel that there is room for more parent education that would make them more comfortable to help in the care of their babies. The NICU is very intimidating with all of the wires that are attached to the babies and the monitor alarms going off.  It makes parents and family members/visitors very nervous. NICU is a very scary time for families.  It is important in my role to educate and try to help the parents be at ease with their baby.

How does your hospital work contrast with your role in private practitioner?

Many of the mothers who have premature babies where I work have not even considered breastfeeding. Many of the pregnancies are not planned. Formula feeding/bottlefeeding is the cultural norm. They are shell shocked to have just given birth to a baby that weighs a little over a pound.  They may not have even planned to breastfeed but just spoke with a neonatologist that told them that breast milk can help save their baby’s life.  Often times there is a cultural barrier…all they know is bottle feeding.  They are afraid of people seeing their breasts and most have had very little prenatal care or none at all.  Due to economic barriers, they come at most once a day and stay for about an hour or two and leave. Some are just stressed from the dire circumstances of their baby’s health and the stress can impede their milk supply.  I spend most of my time talking parents into breastfeeding and how wonderful it is not just for the baby but for them.  Many of these patients have economic stressors like one mother I supported who was back to work 2 weeks after giving birth at a local fast food chain.  Many mothers are single parents and many have poor family support.

Contrast that with the mothers I see in my private practice who want to breastfeed. They have already been educated about the value of breastfeeding not only for the baby but for themselves.  They know they will have a healthier baby and many do not want formula to ever touch their baby’s lips. Many of these parents were breastfed as infants and see formula feeding as a failure. These parents would gladly pump or stand on their heads to breastfeed. These parents are usually higher-income, higher-educated people who have taken the classes and had the prenatal care.  They are usually committed couples who do not have many economic stressors.  Most also don’t have the stressor of an extremely ill child.  These parents have invited me in to assist with their breastfeeding relationship of a healthy child.

These groups are as different as night and day.  Most mothers in the NICU will pump once they are informed of the benefits of human milk for their sick babies.  But they have many social and economic barriers that cause additional stressors to the mother and infant dyad.  Where as in my private practice, there are many fewer barriers to breastfeeding.  These mothers have plenty of support and they see breastfeeding as the cultural/desired norm.

What are the unique challenges of each of these kinds of work?

I wish I could do more for these mothers.  A single mother who has 5 children at home giving birth to a 28 weeker, and her car breaks down…I wish I could find a way to fix her car! Talk about stress and socio-economic factors!  Also, the father of the baby is not involved. How do I meet her needs? Need I say more?  My heart breaks for the disadvantaged families here.

The rewards of seeing healthy babies going out the door.  That is a huge reward!  The biggest reward is the great big smile on a mother’s face when she can tell that the baby is nursing well. Often times, NICU mothers have a hard time exclusive breastfeeding when they go home because they still have to supplement and because they don’t trust that the baby will get enough.  I do test weights so the parents can see what baby is getting.  I have had a mom of twins that is now exclusively breastfeeding because she was coming in for outpatient consults after her babies were in the NICU.  That has been a very rewarding experience for her and me.

I have to say that my private practice support group recharges my soul when I get discouraged working in the NICU.  Those mothers and babies in the NICU have so much working against them, separation, sick baby, having to pump, stress, stress stress.  Nurses that are used to measuring everything going in and going out that are unsure of breastfeeding and inadvertently say the wrong things…parents that stop pumping or don’t want to put baby to breast and I feel like I have failed them…like I have let them down. Then I go to my mother’s support group and look at the 2 year old that is still nursing whose mommy told me he was a failure to thrive 20 months before.  I am encouraged how we worked together and he is a beautiful happy breastfeeding boy!  Or the mom that says she is thinking of weaning and at the end of group says, “Nope, we’re not ready yet”.  I have moms of newborns that are having melt downs and another mother puts her arm around her and tells her not to give up.  I have hope for the next day.

Annapolis Breastfeeding Care,LLC, was formed in January of 2008 by Kathleen Stahl, recognizing the needs of women and infants with the desire to receive services in the privacy and comfort of their own home.  Kathleen provides private home consultations, breastfeeding classes, pump rentals, sales and breastfeeding accessories.  Kathleen has been a registered nurse since 1994 and an International Board Certified Lactation Consultant since 1999.

After years of working in Labor and Delivery, Kathleen decided to dedicate her nursing skills to helping mothers breastfeed.  Kathleen is a strong believer in the many benefits which breastfeeding provides for both mother and baby, and after almost 10 years of working in Lactation departments, helping mothers and listening to their struggles and concerns (and having had two kids of her own!), Kathleen realized that having to travel back and forth to the hospital with a newborn added unnecessary stress to new mothers.  So, in January of 2008 Kathleen started Annapolis Breastfeeding Care, LLC, which offers a wide array of lactation consulting services, geared towards bringing quality lactation services and products to the comfort of one’s home.


Implications of Obesity in Breastfeeding Women

Written by Crystal Karges, DTR, CLEC

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

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

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

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

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

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

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

Crystal Karges, DTR, CLEC


Breastfeeding and the Working Mother

Written by Diana Cassar-Uhl, IBCLC and La Leche League Leader

We know what the studies say:  mothers who have to separate from their infants to return to the workplace are statistically less successful  (Johnson & Esposito, 2007) at meeting the goal recommended by child health promotion organizations around the globe:  exclusive breastfeeding until around the middle of the baby’s first year, thereafter supplemented with nutritionally sound, complimentary foods while breastfeeding continues through the child’s second year or beyond (World Health Organization, 2002).

This is not a significant issue for IBCLCs outside the United States, in nations where paid maternity leave is normal and expected after a mother has a baby; however, IBCLCs in the U. S. will likely find themselves in the position to counsel and assist mothers who wish to maintain a breastfeeding relationship with their infants after a return to work or school.  Reminding a mother that many mothers before her have been successful in continuing to breastfeed after regular separations from their babies and providing practical suggestions can be valuable.

Direct breastfeeding is best for mother and baby.

This is always my first tenet of support when I’m helping a mother who has to separate from her baby.  Is there any way for the mother to spend more time in her baby’s presence?

  • Can maternity leave be extended, or can the mother return to work on a gradual/partial basis (for example, half days; or back 2 days the first week, 3 days the 2nd week, and so on)?
  • Can the baby be brought to work with his mother?  There are workplaces that have experimented with this option and found it to be a win-win alternative.  The Parenting in the Workplace Institute offers some details.
  • Is the daycare on-site or close enough to mother’s workplace that she can breastfeed her baby during her lunch or other breaks?  Keep in mind that Federal legislation, as part of the Patient Protection and Affordable Care Act supports break time for nursing mothers.
  • Can the baby be brought to visit his mother one or more times during her workday?  Even one breastfeeding session during the separation can make a difference in how much milk continues to be produced long-term.

But I have to travel for my job!

While Transportation Security Administration rules permit a mother to travel with her pumped breastmilk when she is not traveling with her child, a more lactation-friendly alternative is to bring baby along and breastfeed whenever possible – often, this is more frequently than when mother is at her home office.  It has been reported that Julie Andrews, while on location to film The Sound of Music, had her toddler on site with a caregiver.  This was a sensible solution in 1964 and can still work today!

Even if I give my job 75% and my baby 75%, that still adds up to 150% and I’m exhausted!

As an IBCLC, I support a mother in her efforts to breastfeed her baby; this can include practical tips for a new family.

  • If there is a support person at home (baby’s father, mother’s partner, other family member), is he or she in agreement that breastfeeding is the best course of action for mother and baby?  This person and others close to the mother will have a tremendous impact on the choices she makes.
  • Remind the family that when mother is not at work, her #1 priority is to care for the baby; this means everyone must pitch in to care for the mother and the household.
  • Safely sharing sleep with her baby as detailed here can ensure a mother gets some rest (though likely not as much as she desires or needs unless she can modify her work situation or her baby gets older) and meet the nutritional and attachment needs of her baby.

Some breastfeeding is better than no breastfeeding.

If a mother can’t employ the tips shared above and struggles to express enough milk to meet her baby’s needs, remind her that she can still pump what is feasible for her – every drop her baby gets is a precious gift.  She can also continue to enjoy the breastfeeding relationship when she is with her baby, even if he has been partially weaned to commercially-prepared baby milk.

Finding her tribe.

When a breastfeeding mother returns to work, she may feel stuck between two worlds; her heart is with her baby but her mind is on her job.  The other breastfeeding mothers she knows stay home with their babies and the mothers at her workplace weren’t successful at combining employment outside the home with breastfeeding.  If enough of your clientele combines working and breastfeeding, perhaps you can host a monthly discussion group (in the evening, baby required for admission!) where mothers can share their strategies in your presence (and you can moderate comments to ensure everyone leaves with sound information).  If your breastfeeding and employed population is smaller, see if one or two mothers who have been particularly successful at the balancing act might be willing to serve as a resource to other mothers embarking on the journey.

Turn your frustration into advocacy!

If you’ve seen too many overwhelmed mothers give up breastfeeding because the “otherhood” complicates new motherhood, take action.  In her Call to Action to Support Breastfeeding, U. S. Surgeon General Regina Benjamin encourages us to “work toward establishing paid maternity leave for all employed mothers” (United States Department of Health and Human Services, 2011).  A letter to your elected officials at every level will keep this issue on the table.  Breastfeeding protects the health of babies and their mothers; we are called to protect breastfeeding in any way we can.

Johnston, M. L. & Esposito, N. (2007).  Barriers and facilitators for breastfeeding among working women in the United States.  Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36: 9–20.  doi: 10.1111/j.1552-6909.2006.00109.x

United States Department of Health and Human Services, Office of the Surgeon General. (2011). The Surgeon General’s Call to Action to Support Breastfeeding.  Washington, D. C.

World Health Organization. (2002). Global strategy on infant and young child feeding. 

Diana Cassar-Uhl, IBCLC and La Leche League Leader, enjoys writing to share breastfeeding information with mothers and those who support them.  In addition to her frequent contributions to La Leche League International’s publication Breastfeeding Today, Diana blogs about normalizing breastfeeding in American culture at and has been a guest blogger at Best for Babes and The Leaky Boob.  Diana can be found lecturing at breastfeeding education events around the United States.  She is pursuing a Master of Public Health, and upon graduation hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition.  Mother to three breastfed children, Diana has served as a clarinetist on active military (Army) duty in the West Point Band since 1995.

If you want to link to Diana’s Breastfeeding Today article on breastfeeding and working, (mothers are the target audience) it’s here.



Irena Zakarija-Grković, MD, FRACGP, IBCLC, is a GP and passionate breastfeeding advocate from Melbourne, Australia who moved to Split, Croatia in 2004 with her husband and three children. Irena now works at the University of Split School of Medicine where she is involved in teaching and research. Irena is a founding member of the National Breastfeeding Committee, a BFHI educator, president of the Croatian Association of Lactation Consultants, 80-hour breastfeeding course provider, former IBLCE coordinator for Croatia and an active member of ILCA (volunteer member of Scholarship Committee and Multilingual Committee)and ABM. She also conducts breastfeeding classes for expectant parents, does some private practice as a lactation consultant and is the author of several chapters in Croatian on breastfeeding . Irena loves what she does and tries hard to infect others with her enthusiasm for breastfeeding.

Back in 2007, I was a fortunate recipient of an ILCA scholarship and so, thanks to the generosity of numerous friends of ILCA, I was able to attend my first ILCA Conference, held in San Diego, California.

It was an exhilarating experience and among the many interesting talks I attended, the one that stood out was the talk given by Nils Bergman, on the importance of skin-to-skin contact for brain growth. After the presentation I struck up a conversation with Nils and soon found out that Nils traveled to Europe regularly to visit family in Sweden. Immediately, the thought of Nils visiting Croatia came to mind but seemed too farfetched to mention at the time, so I left San Diego with some lovely memories and lots of useful information and resources.

Upon returning to Split, I realised that unless I tried to bring top experts to Croatia the likelihood of my colleagues hearing about the latest recommendations in the field of breastfeeding medicine was minimal, and hence I set about making plans on how to bring the exciting world of evidence-based breastfeeding medicine to Croatia. This wouldn’t have been possible without collaborating with neighbouring Slovenia, specifically the Slovenian Association of Lactation Consultants and UNICEF in Slovenia. Together we’ve brought several renowned speakers to our neck of the woods over the years and by doing so have raised the awareness of the importance of breastfeeding. This, in addition to organizing an annual 80-hour breastfeeding course for health professionals (5 years running) and getting the IBLCE exam translated into Croatian and offered in Split (since 2009), has brought the number of certified lactation consultants in Croatia from one in 2007 to 21 in 2011!

This year, for WBW, the Croatian Association of Lactation Consultants (CALC) was honoured to welcome Nils Bergman to Croatia. My dream had come true- thanks to Nils’s trust in me, his generosity of spirit, and to the support of my Croatian and Slovenian colleagues. Nils’s tour started off with a two-day visit to sunny Split where he was run off his feet meeting the media, giving talks to health professionals and demonstrating to mothers and staff at the University of Split Neonatal Unit how to practice kangaroo mother care.

The latter was the highlight of Nils’s visit because it brought home the importance of placing the baby in its proper environment, the beauty of which brought tears to the eyes of all present. For some mothers with babies in the Neonatal Unit, it was the first time they had held their children. The media were so impressed with what Nils had to say on the topic of caring for premature babies that he made the midday news and was featured on four other TV programs!

  Next, Nils spoke in Zagreb, the capital of Croatia, to a full house at the Hospital of the Holy Spirit and was then whisked off to Lasko, in Slovenia, where he was an eagerly awaited speaker at the Slovenian breastfeeding symposium.

Despite all the work involved in organising Nils’s visit, it was well worth the effort and has brought hope, joy and revelation to all those he met. Thanks Nils and good luck with all of your endeavours in promoting kangaroo mother care!


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