Archive | World Breastfeeding Week 2013

World Breastfeeding Week 2013: The Health Care System Circle of Support in Papua New Guinea

By Amber McCann, IBCLC

On this blog during World Breastfeeding Week, we have been highlighting the work of breastfeeding supporters in each of the 5 Circles of Support mentioned in this year’s theme. We have been honored to have interviews with support happening in the workplace, in the community, in the government, and with families in crisis. The final circle of support is the health care system.

I have been so honored to serve as the co-editor, along with Decalie Brown, of this blog for the past year. It was exciting to attend this year’s ILCA Conference in Melbourne, Australia and I came away so encouraged and excited about where our field is headed. After the conference, I was able to travel to a remote area in the highlands of Papua New Guinea to spend some time with my best friend, a family practice doctor at a mission hospital in Kudjip.

As an IBCLC who has worked in both private practice and in a private medical office, my experience with breastfeeding support within a hospital was practically zero. I have spent the past 10 days shadowing my friend as she and the nurses on the maternity ward provided compassionate care to the women who come to birth at their hospital.

IMG_3272I was quite sure when I arrived that I wouldn’t have anything to teach or any way to provide support in this culture. Papua New Guinea has one of the highest maternal and infant mortality rates in the world and yet, I mistakenly assumed that breastfeeding was so a “way of life” that my help wouldn’t be needed. Culturally, breastfeeding is the assumed method of infant feeding. Formula is hard to acquire and formula marketing is outlawed. Women have been breastfeeding for generations and breastfeeding in public is the norm.

But, I came to realize that, even with so many of the things that I imagined would make breastfeeding “easier” in the United States where I live, women will always be in need of trained, evidence-based lactation care.¬†

Fortunately, for women being cared for in the Kudjp hospital and several others Papua New Guinea hospitals, there is a wonderful organization called Susu Mamas. They provide nurses and mentoring mothers who share prenatal education as well as postnatal support in breastfeeding and infant care. They come daily to the hospitals and work with new mothers to establish breastfeeding, trouble shoot challenges, and provide education to hospital staff. In addition to the hospital care they give, in some locations, they also provide family planning and HIV testing. They also established a national breastfeeding hotline in 2008.

IMG_3451While thankful for the support being provided to the women I encountered, I had to get in on the action! I was surprised one afternoon to hear Dr. Jim Radcliffe, a surgeon who has served at this hospital for over 25 years, call down the hall “Amber, you’re needed in the ER for a lactation consult!” I hurried over to find a young mother of a 7 month old who reported that she had no milk and that her baby had failed to gain weight in some time. After taking as full of a history as my understanding of their culture and my terrible Pidgin (with the help of an interpreter) allowed, I examined her breasts. She reported that she had never made any milk and had been feeding the baby bananas and pineapple since he was two months of age. I was heartbroken to examine her breasts and realize that she had insufficient glandular tissue. I quickly asked if she knew of anyone else who would be willing to breastfeed her baby (as feeding another’s child is common in PNG) and referred the baby to the doctor on call in the pediatrics ward. This mama listened intently to my counseling and offered up her dry breast to her fussy baby. Even with no milk, the baby quieted and relaxed into his mother’s arm with her breast for comfort. I praised her for the way her mothering was meeting the needs of her baby and while finding appropriate nutrition for her young child would be challenging, I’m thankful for the smile she gifted us with.

IMG_3460I also realized that many breastfeeding challenges like sore nipples, engorgement, and thrush were universal! One mother came to the hospital and required a C-section (my first surgical observation!). We followed her closely in the days after and she struggled a bit with pain. Many of the women in Papua New Guinea have very long, pliable breasts (likely from not wearing a bra regularly). They simply lay the babies in their lap and their breasts reach easily to their child…no football (or rugby!) hold here! Ronda was mimicking the positioning she had seen all her life but her breasts were much shorter, leading to a very shallow latch. We changed her position and provided some pillow support as she learned and a huge smile appeared on her face.

I am heading home soon and will carry these experiences from my time at the hospital in Kudjip into my practice in the US. I am grateful to have had the experience of observing and participating in the important work of providing breastfeeding support in a hospital setting. I am honored by the warm welcome I received from the nurses and hospital staff and also from the mothers who I encountered. Breastfeeding support literally saves lives, especially in a place like Papua New Guinea and I’m so glad to be a part.

* And on a funny note, in Pidgin (a language spoken by many in PNG), “susu” is the term used for breasts, breastfeeding…anything having to do with milk. I heard the term “kalabus belong susu” being used to describe a bra. The translation? Prison of the breast! Take that, Victoria’s Secret! ūüôā

Amber McCann, IBCLC

Amber McCann, IBCLC is a  board certified lactation consultant with the Breastfeeding Center of Pittsburgh. 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 as the co-editor of Lactation Matters, the International Lactation Consultant Association’s official blog, she has written for a number of other breastfeeding support blogs including for Hygeia, The Leaky Boob, and Best for Babes and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms.

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World Breastfeeding Week 2013: The Response to Crisis and Emergency Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of lactation professionals in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Ali Maclaine, UK

photo 2Ali Maclaine is currently the Senior Humanitarian Nutrition Advisor for Save the Children based in London. Save the Children works in 120 countries worldwide and in many of the emergency affected countries, they are undertaking breastfeeding support through their Infant and Young Child Feeding in Emergencies (IYCF-E) program. The level of support varies from messaging, group education sessions, or peer support to one-on-one counseling. As well as providing support themselves, Save the Children often works with partners and undertakes trainings so that others can also learn about the life-saving importance of breastfeeding, especially in emergencies. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Response to Crisis and Emergency”. Can you describe for us a bit about the work you are currently doing in the field of lactation to support breastfeeding mothers in crisis? How did you become involved in this work? When emergencies happen, what might a day of support look like?

Following the completion of my Masters in Public Health Nutrition, I was a Consultant on a report called ‚ÄėCracking the Code‚Äô that looked at violations of the International Code of Marketing of Breastmilk Substitutes worldwide. This work increased my interest in breastfeeding. My first field placement with Save the Children was following the 2006 conflict in Lebanon. I saw how an influx of donations of breastmilk substitutes were undermining breastfeeding. I also saw the effects of common myths and misconceptions on breastfeeding and the lack of skilled breastfeeding support. During that crisis and in all the others I have worked in subsequently (Philippines, Indonesia, Haiti, East Africa, Syria, etc), the thing that I see is that breastfeeding mothers and their support circle often do not know how robust breastfeeding is. They instead seek formula to ease the burden of the breastfeeding. Many kind hearted people give formula as they want to help babies in emergencies but are not aware of the risks of artificial feeding during an emergency. Breastfeeding saves lives.

However, I have also seen many mothers who have sought breastfeeding support during emergencies and have not been able to find it ‚Äď either the health workers have disappeared, are too busy, or they are not trained about the emergency aspects of breastfeeding. They often repeat the normal breastfeeding messages which do not have the impact or relevance during an emergency. For example, families are often encouraged to exclusively breastfeeding for 6 months when, in reality, they simply need to get through the next 24 hours while caring for their family in a shelter.

Where we have the funding to have dedicated IYCF-E activities, we are able to provide key messages to mothers and into the wider community. We also provide mother-baby caravans/areas where mothers can go to breastfeed, meet other mothers and access skilled breastfeeding support, as well as be a part of educational sessions. There is also support for relactation and wet nursing.

The World Breastfeeding Week organizers stated “This circle of support represents the need for support if a woman finds herself in an unexpected and/or serious situation, with little control. Situations that require special planning and support could include natural disasters, refugee camps, divorce proceedings, critical illness of mother or baby, or living in an area of high HIV/AIDS prevalence with no support for breastfeeding.” Can you expand a bit on what some of the unique challenges are that breastfeeding women and babies who are in crisis face?

Breastfeeding women and babies have a number of challenges during emergencies:

  • There are often a huge number of additional myths and misconceptions that undermine breastfeeding during conflicts. Common emergency related myths/misconceptions are: Stress drying up breastmilk, lack of food or change of food negatively affecting breastfeeding, tension or even grief being passed on to the baby.
  • Many of the countries that we are currently working in are Muslim and populations are commonly displaced. Muslim mothers often will not breastfeed in public or even in tents, which they may share with other men. Hence, there needs to be dedicated private breastfeeding spaces.
  • Often there are huge donations and untargeted distributions of breastmilk substitutes (often labeled in the wrong language or near/past use-by-date) which are given to caregivers, and even to breastfeeding mothers. We have found that if a mother is given these, she is much more likely to use it and that it can then lead to breastfeeding difficulties and undermines breastfeeding. Often, these donations are only given for a short time, meaning that as her breastmilk supply has been affected, the mother has to then find formula and the money to continue to feed her child.
  • People often think that when the volume of breastmilk is diminishing, it can‚Äôt be increased. They mistakenly believe that there is no hope for increasing the supply that might have been impacted by the crisis.
  • There is often a lack of skilled support for breastfeeding mothers in emergencies. The health workers may have also been affected by the emergency, may be taking care of their own families, and there may be a lack of health workers who have been trained on breastfeeding before the emergency.
  • There is a lack of funding for programs to support breastfeeding in emergencies. Donors pay lip-service about the importance of breastfeeding but don‚Äôt give the money.
  • Communities often do not prioritize breastfeeding support during emergencies as a NEED. This is an issue we are increasingly looking at as “accountability to beneficiaries” is a key issue and we must prioritize our emergency responses based on what the community says it needs. Whilst this works in terms of shelter and water, I think that this methodology is flawed for identifying the need for breastfeeding support. The community leaders are rarely women and culturally, it would be difficult in some circumstances for women to tell their community leaders/outsiders about the need for breastfeeding support.

The challenges and need for support for women in crisis is ongoing. But there is hope! What are some of the most recent initiatives that have made breastfeeding for women in crisis easier? What are your hopes for the future?

Save the Children is creating an IYCF-E Toolkit, which it is hoping to get input in from other NGOs including those from the IFE Core Group which should ensure that we can provide breastfeeding support in a quality way quickly in emergencies. We also have partners who have undertaken work on the psycho-social support needs of breastfeeding mothers in emergencies that all agencies are trying to learn from.

My hope for the future is that health and nutrition workers in emergency prone countries are taught about breastfeeding in emergencies during their training so that they are equipped to support mothers during the additional stress of an emergency. Also, ¬†that during an emergency, breastfeeding support is regarded as part of our key work ‚Äď that every person that works in the field in an emergency response is aware of the need and how to support breastfeeding mothers. I hope that we are systematically able to provide the quality support that breastfeeding mothers need in that context.

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World Breastfeeding Week 2013: The Family and Social Network Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Katya Lokshina, Russia

katyaKatya is a former linguist turned IBCLC serving in Moscow, Russia. She is the mother of three children and was proud to be the first Russian La Leche League leader. She was one of the group of 12 first-ever Russian speakers in 2011 to pass the IBCLC exam in the former Soviet countries. She now leads a popular mother-to-mother support group and works as a private lactation consultant. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Family and Social Network”. Can you describe for us a bit about the work you are doing in the field of lactation to support breastfeeding families? How did you become involved in this work? What does a typical day of supporting breastfeeding families look like?

I am the mother of three children and providing breastfeeding support is both my day AND night job! I must balance my private life with that of being a breastfeeding professional. On a typical day, I get a few calls from mothers. While my children are at school, I do home visits. Sometimes driving to a mother’s home can take up to 1.5 hours due to the heavy traffic in Moscow. Russian women rarely get professional breastfeeding support at the hospital but things are slowly changing.

Being not only an IBCLC but also a La Leche League leader, I encourage expectant mothers to visit a breastfeeding support group. Watching other mothers and babies and talking with them can go a long way towards building a foundation for a successful breastfeeding relationship.

I believe that EVERY mother can be a huge promoter of breastfeeding! At the hospital, at family gatherings, at the playground, in the doctor’s office, and in many public places like shopping malls, cafes, on an airplane – simply by breastfeeding our babies and kindly answering questions and comments from others (those from teenagers and kids are most important!), we are doing a great job of supporting breastfeeding.

The World Breastfeeding Week organizers stated “Husbands, partners, fathers, family, and friends compose the mother’s immediate and continuous support network. Social support includes community support – at the market place, within a religious context, at a neighborhood park, etc. Support during pregnancy reduces stress. Support during labour and birth empowers the mother. Societal support increases the mother’s confidence in her ability to breastfeed beyond the early weeks and months.”¬†Can you expand a bit on what some of the unique challenges breastfeeding women and their babies face in your community? What is the reaction to breastfeeding women who feed in public? How is your group providing support?

As a La Leche League leader, I am able to observe the mothering styles from many different countries. Russians are less afraid of feeding in public than their American counterparts. Still, there is much to do in this field. Many Russian mothers are not willing to bring their babies into a public place at all. We are afraid of “infections” and, especially in the first weeks, of the “evil eye”. We’d rather ask for a home visit from a doctor or lactation consultant than come to an office or support group. BUT, it is gradually changing! I can see a difference after 8 years of working in the field.¬†

The challenges and need for support for breastfeeding support is universal. What has encouraged you in the last year when working with breastfeeding families? What are your hopes for the future?

My encouragement is my environment. With every year, I find more and more breastfeeding mothers offering their help to La Leche League. I have become acquainted with many highly-skilled professionals and I’ve met wonderful pediatricians, surgeons, general practitioners, and midwives, all of whom are well informed about supporting breastfeeding families. It is a pleasure to cooperate with them. This makes me very optimistic about the future of Russian babies!

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World Breastfeeding Week 2013: The Government and Legislation Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Susanna Scurry, Australia

photo sueWe were able to interview Susanna while at the 2013 ILCA Conference in Melbourne, Australia. Susanna is a midwife, and lactation consultant since 2005 and also a Baby Friendly Hospital Initiative (BFHI) assessor and educator. She was also on the board of Australian Lactation Consultant Association (ALCA) and Lactation Consultants of Australia and New Zealand (LCANZ). She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Government and Legislation”.¬†Can you describe for us a bit what work you are currently doing or hoping to do in the field of lactation and the government? How did you become involved in this work? What would a typical day of working at the government level, supporting breastfeeding look like?

I am a big fan of¬†Marilyn Waring, a New Zealand economist who states “An economic model that does not value clean air, clean rivers, forests, unpaid work by women, and breastfeeding is unsustainable.” I¬†am all for¬†an economic system that promotes,¬†protects, and supports normal birthing, breastfeeding, and sustained home visits to parents . I support anything that is making a community better for today‚Äôs parents, as they say , “it takes a village to raise a child”!¬†What I value for future generations, including¬†for¬†my 6 lovely grandchildren, is for a sustainable future.

My focus is on women’s health. For many years, I have been advocating for a human milk bank in our neonatal unit and family centered care in our NICU facility as well as a public IVF clinic in Newcastle along with community birthing, and palliative and aged care. I talk about the public health implication of not using breastmilk and also my support of BFHI. I truly believe it is “from the cradle to the grave”. If we had skin to skin contact throughout life, we would have a much kinder world.

The World Breastfeeding Week organizers stated “Women who plan to breastfeed or who are already breastfeeding benefit from the support of international documents, protections for optimal infant feeding, plus active and well funded national commissions. Legislation that combats aggressive marketing of breastmilk substitutes and enacts paid maternity leave also benefits breastfeeding women.”¬†Can you expand a bit on what some of the unique challenges are that women in your community face that could be improved through legislation?

I appeared before the Productivity Commission to argue the case for paid parental leave. I am proud of the four month paid parental leave granted but I think twelve months would be better and will continue to argue for this. I have also lobbied for many years for the implementation of the WHO Code in Australia. The Marketing in Australia of Infant Formula (MAIF) agreement is a toothless tiger and I would like to see it gone. Australia had a Parliamentary Inquiry into breastfeeding in 2007 and all of its recommendations should be implemented.

What are some of the current initiatives, laws, and policies that support breastfeeding women in your community? What are your hopes for the future?

We need to expand BFHI into the community, pediatric offices, child care centers, etc. We also need to reclaim breastfeeding in our culture. Australia needs, at a federal level, to have a paid breastfeeding coordinator as recommended by the World Health Organization and breastfeeding representation at an International level as well. I will continue to work towards these goals.

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World Breastfeeding Week 2013: The Workplace and Employment Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Vergie Hughes, USA

IMG_3126We were able to interview Vergie while at the 2013 ILCA Conference in Melbourne, Australia. Vergie has a long history of working in maternal child health and for the past 27 years, she has been an IBCLC. In addition to her work described here, she is the program director for Lactation Education Resources where she provides education for lactation consultants (and lactation consultants-to-be) all over the world. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Workplace and Employment”. Can you describe for us the work you are doing in the field of lactation to support working mothers? How did you become involved in this work? What does a typical day of supporting working mothers look like?

I have been the lactation consultant working on a contract with America Online (AOL) for more than 10 years now. I have worked in many areas of lactation over the years, but this is one of the most fun. I teach prenatal breastfeeding classes, have phone and email contact with the mothers [who are employed by AOL] over the months of pregnancy and during the time they are establishing lactation. Some even call me from the hospital, since we have an established relationship. Then, we keep in contact regarding any questions that come up and as they plan to return to work. The continuity of support with these mothers is so rewarding and often lacking in other work venues.

AOL is wonderful in that it provides 3 months of maternity leave and a pumping room with a hospital grade breast pump in each facility. Those things really make it easier for mothers to maintain breastfeeding when they do return to work.

The World Breastfeeding Week organizers stated “Employed women face challenges and need support at working and breastfeeding. The opportunities for mother support are as varied as the work women do, but usually involve facilitating mother-baby contact or expression and storage of breast milk.” Can you expand a bit on what some of the unique challenges are that women who work away from their babies face?

I do think that the women that I work with at AOL have an ideal situation since they are in an office environment with good support. It is not so easy for women who work in an outdoor environment, a busy retail environment, or in a setting with an unsupportive supervisor or co-workers. A lactation consultant can be the key person to help this mom problem solve her pumping situation and suggest strategies for persevering in a hostile workplace.

The challenges and need for support for women who are working outside of the home have been present for many years. But there is hope! What are some of the most recent initiatives, laws, and policies that have made breastfeeding for women in the workplace easier over the years? What are your hopes for the future?

I do think that support for breastfeeding has improved over the past few years. In the United States, the new Affordable Care Act regulations have made breast pumps more available to mothers, which is good. However, the quality of these pumps and the quick availability is often lacking.

The regulations regarding workplace accommodation¬†of lactating mothers has been supportive of women who request time and a place for breast pumping. Hopefully, a supervisor would provide these¬†accommodations for the breastfeeding mother because it is the “right thing to do”. But, if not, then the mother has the support of the regulations to push for the time and facilities that she needs.

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