Ramadan and Breastfeeding

 

by Nor Kamariah Mohamad Alwi, BE, MIT, IBCLC

Ramadan is the most holy month of the year for Muslims. During the month, those who follow Ramadan abstain from eating, drinking, and sexual activities between sunrise and sunset. Additionally, they practice being extra patient, kind, and generous throughout the four weeks. These observances can have an impact on breastfeeding so it is important that International Board Certified Lactation Consultants® (IBCLCs®) understand how to best provide guidance to families.

Muslims scholars, or “ulama,” have been discussing breastfeeding while fasting for decades. Many rulings or “fatwas” have been issued to address this issue, enabling women to make wise decisions for themselves. Muslim women are encouraged to refer to the rulings of their respective local scholars to determine the options most suitable for their situations.

While fasting during Ramadan is not obligatory for all breastfeeding women, here is some guidance that I have found useful in my practice with clients in Malaysia who choose to fast during this time:

  • STAYING HYDRATED: Daily water intake is very important to keep the body sufficiently hydrated. It is recommended to drink bit by bit throughout the permitted time, from sunset to early sunrise. Drinking too much just before fasting will just fill up the bladder and gets urinated out soon after, resulting in the mother feeling thirstier for the rest of the day.
  • EATING WISELY: Eating well-balanced food, including proteins and complex carbohydrates, during “suhoor” – the meal right before the start of a fasting day – is very essential. This will provide the energy that mothers need for the rest of the day, until the breaking of the fast.
  • BREAKING THE FAST: As the fasting day ends, mothers should break her fast as early as possible, by eating natural high-energy foods, to quickly regain energy. A common option among the muslim community (which is also culturally recommended) are black dates. Mothers can opt for creative preparations such as blending the dates with milk.
  • HANDS-ON BREASTFEEDING: For mothers who are breastfeeding directly throughout the day, some will notice that their baby became a bit fussier at the end of the fasting day, as the mother’s body is impacted by the fast. Additionally, the milk ejection reflex can slow down due to the stress of the fast. When breastfeeding at this point, breast compressions while feeding will help drain out milk from the back of the breast. Mom will notice improved milk transfer, which can satisfy the baby faster.
  • EXPRESSING MILK: Expressing milk (for mothers who have to be separated from their baby) can be a varied experience. Some mothers find no change at all in terms of the quantity of expressed milk, especially in the first half of the day. However, some may find that the yield of milk collected at the end of the day is lower compared to earlier in the day. When this occurs, the mother needs to stay calm and understand how milk supply is produced. When milk is expressed from the breast regularly, a new milk supply will be produced. However, when the amount of body liquid reduces as part of the effects of fasting, the quantity of breast milk can be a bit lower than the usual, and mothers will find that their milk at this point usually looks thicker.

At any point in time during a fasting day that a mom feels too lethargic, it is important for her to carefully consider her condition, as well as her baby’s condition, before deciding to continue the fast. Consult with the local scholars and doctors, on how to deal with such situations.

Are there any religious and/or cultural implications that you find useful in your practice?

 

Nor Kamariah Mohamad Alwi resides in Bandar Baru Bangi, Selangor, Malaysia. She created the online breastfeeding support forum susuibu.com in 2004 and is a co-founder and President of Malaysian Breastfeeding Peer Counselors. She is on the Local Governance Task Force Coordinator for World Alliance for Breastfeeding Action (WABA). Kamariah is working with IBCLCs to establish a Malaysian Lactation Consultant Association. She is currently a private practice lactation consultant. (Read more about Kamariah in her ILCA Board of Directors nominee profile.) 

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Win a FREE #ILCA18 Virtual Conference Registration!

Join Us for the #ILCA18 Virtual Conference:

LEARNING: INNOVATIVE EDUCATION on the topics you need. 12 Continuing Education Units will be available for the Virtual Conference.

CONNECTION: BUILD RELATIONSHIPS with the entire #ILCA18 community by joining our Online CONNECT Community, exclusively for conference participants. Chat with both face-to-face and virtual contributors, get your questions answered by speakers, and find and share resources on the topics discussed at the conference.

BUILD THE SESSIONS YOU NEED: In addition to the scheduled sessions, #ILCA18 virtual attendees get FREE additional continuing education. Choose the content YOU need most by selecting an additional credit from our on-demand learning in the Knowledge Center.

LIVE OR ON YOUR TIME: Participate LIVE 20 – 21 July or watch on YOUR time – 60 full days of ACCESS to your content.

EASY TO USE + HELP WHEN YOU NEED IT: We are here to help! You will receive a direct link to our EASY-TO-USE conference platform with dedicated and patient tech support. During the live sessions, our professional tech support is staffed by skilled moderators. We love bringing your online questions to the floor of #ILCA18!

 

Equity Access Pricing:

ILCA is committed to ensuring the lactation community has access to #ILCA18, even in low-resource countries. Live streaming pricing is based on the same equity pricing model as our annual membership dues:

Category A: Standard/Clinical Members – $165, Students/Breastfeeding Supporters – $89, Retired – $66

Category B: Standard/Clinical Members – $32, Students/Breastfeeding Supporters – $19, Retired – $13

Category C: Standard/Clinical Members – $8, Students/Breastfeeding Supporters – $5, Retired – $4

Category D: Standard/Clinical Members – $4, Students/Breastfeeding Supporters – $2, Retired – $2

Non-Member Pricing: $241

To find which category your country is in, click here.

 

FREE registration for the #ILCA18 Virtual Conference winner announced!

Thank you to all those who left comments on Lactation Matters and in this ILCA Facebook post letting us know from whom you are most looking forward to learning during the #ILCA18 Virtual Conference!

Congratulations to our contest winner, Gina Tseka! Gina will have the opportunity to learn from her top picks, James McKenna and Tom Hale, as well as participate in the rest of our #ILCA18 Virtual Conference lineup.

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Announcing the 2018 IBCLC Care Award Recipients

 

The IBCLC Care Awards have been announced! Congratulations to the Community-Based Care Award and Hospital-Based Facility recipients!

What are the IBCLC Care Awards?

Hospital-Based Facilities and Community-Based Health Agencies that staff currently certified International Board Certified Lactation Consultant (IBCLC) certificants, host dedicated lactation support programs, and have completed specific projects promoting breastfeeding, can apply online to become a recognized IBCLC Care Award facility and be included in the IBCLC Care Directory.

The IBCLC Care Awards are promoted to new families and the general public which means Care Award facilities can enjoy the benefits of positive public relations in your community, including:

  • Enhanced attractiveness to potential patients
  • Competitive edge in recruiting lactation consultants, nurses, midwives, mother support counselors and other medical staff
  • General good will in the community by providing excellent care in helping new families reach their breastfeeding goals

Who are this year’s recipients?

To see a full list of the Care Award Recipients, click here.

The award was created by International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®). Learn more and apply here.

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Take the World Breastfeeding Week Pledge

Please join us in celebrating World Breastfeeding Week (WBW) 2018, coordinated by the World Alliance for Breastfeeding Action (WABA), 1-7 August 2018!

The theme this year is Breastfeeding: Foundation of Life. Breastfeeding helps to prevent malnutrition in all its forms, ensures food security for infants and young children, and thus, helps to bring people and nations out of the hunger and poverty cycle. It is because of these life-supporting and life-altering qualities that we refer to it as a foundation of life.

Even though it is still months away, we encourage everyone to start planning how you can participate in WBW this year. Tailor your event to best meet your local needs and interests: host a lecture, show a movie, plan a support group, have a picnic, organize a panel, write your legislators, or develop a unique event for your community. Once you plan your event, be sure to sign the WBW 2018 Event Pledge Form. This pledge will track your commitment to celebrate by hosting a WBW event.

For every pledge that is received, the WBW 2018 logo will appear on a world map on their website, with celebrants names and the locations of events. See what others are doing the world over to mark the occasion by viewing the events so far. Do not forget to hashtag your event with #WBW2018!

Need inspiration or resources? Here are some other ways you can get ready for WBW!

Visit the WBW 2018 website for general information and downloadable promotional materials, including the WBW 2018 Action Folder. The action folder information on the theme, and includes useful facts and figures, infographics, case studies, and suggested ways to take action.

Share your commitment to breastfeeding advocacy and education. The links between breastfeeding and nutrition, food security, and poverty reduction may be obvious to breastfeeding advocates, but there is still work to be done to make these connections clear to others. We know what needs to be done to support and enable mothers to breastfeed optimally, but we need to be more proactive and engage more people to make this a reality.

Look for information and action steps throughout WBW at Lactation Matters, where you’ll find articles, images, action steps, and more to help with your successful WBW 2018 observance.

For the most up-to-date information about WBW 2018 and to download promotional materials, please visit the World Breastfeeding Week website by clicking here.

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International Kangaroo Care Day: An Interview with Dr. Nils Bergman

 

In just two months, Dr. Nils Bergman, one of the world’s experts on the impact of skin-to-skin contact between an infant and their new family, will present at TOGETHER: Changing YOUR Community and the World, ILCA’s annual conference, in Portland, Oregon, United States, which will be held 18 – 21 July. Attendees at both our in-person and virtual conferences will be able to hear his presentation Skin-to-Skin Contact: Current Research and Mediating Mechanisms.

Dr. Bergman, who has shared his expertise on six continents, worked with Midwife Agneta Jurisoo in Zimbabwe to develop and implement Kangaroo Mother Care (KMC) for premature infants right from birth. This resulted in a five-fold improvement in survival of very low birth weight babies. He introduced KMC to South Africa in 1995, and after 5 years, KMC became official policy for care of premature infants in the hospitals of the Western Cape province. Dr Bergman continues to live and work in Cape Town as a Consulting Public Health Physician. He is also an Honorary Research Associate at the Karolinska Institute, Stockholm, Sweden.

In celebration of International Kangaroo Care Awareness Day, celebrated this year on 15 May, we’ve reached out to find out more about what drew Dr. Bergman to this work, why skin-to-skin contact is critical for infants, and what we can look forward to in his presentation.

 

Lactation Matters (LM): How did you come to be interested in early skin-to-skin contact between infants and their parents?

Nils Bergman (NB): Way back in 1988, I began working in a remote mission hospital in a low income country, with no incubators or realistic means to transfer small babies for care. We had learnt of Kangaroo Mother Method before we came. Since we had no incubators to stabilise babies, we started skin-to-skin contact immediately after birth. We saw a startling difference, instead of taking 6 days to stabilise, it took 6 hours. And we lowered mortality by 40%. The small babies had clear personas, rather than seemingly amorphous immature protoplasm.

 

(LM): Why is this such a critical issue for those who support new families to understand?

(NB): Perhaps it was an accidental discovery, but what we have to understand is that skin-to-skin contact is NORMAL, normal biology and part of reproductive fitness. Worse: separating mothers from babies is actually harmful. Toxic stress is defined as the ‘absence of buffering protection of adult support’, and this applies to premature babies more, not less. And it is very much a ‘family’ thing, the family fabric may also be adversely affected.

 

(LM): What new research or new techniques are you MOST excited to share with us in July?

(NB) Bill & Melinda Gates Foundation have funded a multicentre study, being conducted by WHO in Ghana, India, Malawi, Nigeria and Tanzania. We will randomise 4200 babies weighing between 1000g and 1800g to normal care in warmers and compare them to the same normal care in “Immediate KMC”.

Want to learn more? Join us for #ILCA18!

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Warm Chain of Support for Breastfeeding

World Alliance for Breastfeeding Action (WABA), an ILCA Global Collaborator, has introduced a new initiative and vision for quality, consistent pre- and post-natal care: Warm Chain of Support for Breastfeeding. The Warm Chain strives to coordinate efforts at all levels to provide a continuum of care, from pregnancy through a child’s second birthday. There are usually many people providing care and support along the way to new families or families-to-be. The Warm Chain seeks to intentionally connect these “links” with consistent messaging and proper referral systems so that parents and children can benefit from ongoing support and skilled assistance.

International Board Certified Lactation Consultants® (IBCLC®s) play a multidisciplinary role that straddles generalized support for breastfeeding and allied healthcare. This improves maternal and infant survival, health, and well-being rates over the antenatal, birth, and postnatal periods.

As an IBCLC, there are many ways in which the care you provide can serve to further strengthen the links along the Warm Chain. Empowering parents to achieve their breastfeeding goals; providing accurate lactation information and training; and facilitating the establishment of programs, research, and policies in support of breastfeeding and lactation support are ways you can—and probably already DO—encourage connectivity between all actors along the continuum of care.

 

Find more suggestions on ways IBCLCs can support the Warm Chain HERE.

Take advantage of new Warm Chain of Support for Breastfeeding seed grants for projects “that focus on either starting a project or strengthening an existing effort to create an enabling environment for mother to continue breastfeed.” Seed grants are available up to $3000.00 (USD) per project. Find out more HERE.

Complete the Warm Chain survey to highlight both the links and the gaps between those links in the current model of care. Access the survey HERE.

1

2018 ILCA Elections: Board of Directors

The ILCA Board of Directors has presented a ballot for ILCA voting members to select their next Director.

All ILCA members who are certified as an International Board Certified Lactation Consultant® (IBCLC®) and are in good standing should have received an email from ILCA on 23 April 2018 containing a link to the ballot (subject line: Your 2018 ILCA Board of Directors Ballot). If you did not receive an email and you should have, please contact the ILCA Office at admin@ilca.org (or) 1+ 919-861-5577 (or) 888-452-2478. Our ILCA staff is eager to make sure you get a ballot so your vote can be counted. To ensure a timely and secure election, all voting will take place through an online survey.

Prior to casting a vote, all voting ILCA members are encouraged to thoughtfully consider all information provided below. This will enable you to make an informed decision. Vote carefully: Once your vote is cast, it cannot be changed, repeated, or cancelled.

The balloting commences 23 April 2018 and concludes 07 May 2018, at which time all electronic votes will be tallied by the ILCA staff.

Board of Director Elections

On behalf of the Board of Directors, we are pleased to present the 2018 ballot for election of one Director. The Nominations Task force used an objective scoring system to conduct a fair and impartial assessment of each application. After thorough review and analysis, the following candidates were approved by the ILCA Board of Directors. This year, we will be electing one new director.

A Director must be elected by a majority of ILCA voting members. (Note: ILCA Bylaw 3.4 confers voting privileges to those dues-paying ILCA members who are also IBCLC certificants.)

To run for the position of ILCA Director, ideally, candidates would:

  1. Have prior experience within ILCA; or experience in other national or international breastfeeding/professional advocacy groups, preferably in a board/director post or demonstrated leadership in other positions;
  2. Have verbal, written, organizational, teamwork, and delegation skills;
  3. Be sensitive to the challenges of ensuring equitable access to positions of leadership within ILCA for historically underrepresented groups; and
  4. Be sensitive to the challenges of ensuring equitable access to breastfeeding and skilled lactation care in areas where breastfeeding practices are unequal.

Please take time to review the profiles of each nominee, by clicking on their names, prior to casting your vote. You will vote for one.

Stephanie George, Bachelor of Arts (Honors), Aboriginal Midwife, IBCLC, Postpartum Depression Support Person, Crisis Trauma Responder; Jarvis, Ontario, Canada

Meena Sobsamai, Bachelor of Science in Nutrition and Dietetics, Registered Nurse Midwife, Graduate Diploma in Childbirth Education, IBCLC; Bangkok, Thailand

The ILCA Board extends a special thanks to the Nominations Task Force for their efforts on behalf of the entire membership.

Questions? Comments? Share them here! We want to hear from you.

 

5

#ILCA18 Virtual Conference Registration Now OPEN!

Join the International Lactation Consultant Association® (ILCA®) for our #ILCA18 Virtual Conference!

LEARNING: INNOVATIVE EDUCATION on the topics you need. 12 Continuing Education Units will be available for the Virtual Conference.

CONNECTION: BUILD RELATIONSHIPS with the entire #ILCA18 community by joining our Online CONNECT Community, exclusively for conference participants. Chat with both face-to-face and virtual contributors, get your questions answered by speakers, and find and share resources on the topics discussed at the conference.

BUILD THE SESSIONS YOU NEED: In addition to the scheduled sessions, #ILCA18 virtual attendees get FREE additional continuing education. Choose the content YOU need most by selecting an additional credit from our on-demand learning in the Knowledge Center.

LIVE OR ON YOUR TIME: Participate LIVE 20 – 21 July or watch on YOUR time – 60 full days of ACCESS to your content.

EASY TO USE + HELP WHEN YOU NEED IT: We are here to help! You will receive a direct link to our EASY-TO-USE conference platform with dedicated and patient tech support. During the live sessions, our professional tech support is staffed by skilled moderators. We love bringing your online questions to the floor of #ILCA18!

 

For more information about the #ILCA18 online conference, a full schedule of events, and registration information, visit the virtual conference webpage!

0

2018 Baby-Friendly Hospital Initiative (BFHI) Revised Implementation Guidance

The document commonly known as the “Ten Steps” has recently been updated. ILCA has been actively advocating on behalf of the lactation community throughout the revision process. Below is a open letter to the community with an update on the revisions. ILCA would like to extend significant gratitude to the volunteers who have devoted many, many hours to this effort.

Dear Colleagues,

After months of thoughtful and productive discussion with our five global breastfeeding promotion organizations, on April 11, 2018, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) released the final version of the Implementation Guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018. The final document is highly responsive to the recommendations made by our organizations, and we congratulate the WHO and UNICEF on a successful launch.

We strongly agree with the WHO and UNICEF that “breastfeeding is a vital component of realizing every child’s right to the highest attainable standard of health, while respecting every mother’s right to make an informed decision about how to feed her baby, based on complete, evidence-based information, free from commercial interests, and the necessary support to enable her to carry out her decision.”

We also concur that “the first few hours and days of a newborn’s life are a critical window for establishing lactation and providing mothers with the support they need to breastfeed successfully” and that the “core purpose of the Baby-Friendly Hospital Initiative (BFHI) is to ensure that mothers and newborns receive timely and appropriate care before and during their stay in a facility providing maternity and newborn services, to enable the establishment of optimal feeding of newborns, which promotes their health and development.”

We applaud the full application of the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly Resolutions (the International Code), comprehensive, evidence-based infant feeding policies and ongoing internal monitoring of adherence to relevant clinical practices being incorporated into Step One.

We stand united with the WHO and UNICEF on the goal of scaling up to universal BFHI coverage and ensuring its sustainability over time.

BACKGROUND

Motivated by deep concerns about the uneven and relatively low global adoption of the BFHI, the WHO and UNICEF undertook the important tasks of evaluating the strengths and weaknesses of the initiative and charting a course to revitalize both the overall initiative and the global standards. It was an enormous undertaking.

An initial draft of their new proposed approach was released for public comment on October 11, 2017.  Our five organizations came together and, at the invitation of the WHO and UNICEF, shared our collective expertise and worked with them to recommend changes in some areas that were not fully addressed in the proposal and further develop the guidance.

We would like to thank the WHO and UNICEF for their openness and willingness to engage in discussions and undertake the extra effort required to incorporate our recommendations.  During the 6-month period of meetings, all parties worked together with the mutual goal of strengthening the guidance to empower countries to scale up to universal adoption.

HIGHLIGHTS OF KEY HIGH-LEVEL RECOMMENDATIONS

  • Governments should become involved in the national implementation of the BFHI and should undertake efforts to integrate international standards into national systems.
  • Professional organizations responsible for pre-service education should incorporate the evidence and practices embodied in the Ten Steps to Successful Breastfeeding (the Ten Steps) into their curricula.
  • Efforts should be undertaken to draw public attention to the importance of breastfeeding, the risks of formulas and the practices that will help to protect, promote and support breastfeeding.
  • Efforts should be undertaken to protect breastfeeding, families and staff from commercial marketing and unethical pressures.
  • BFHI should be integrated into other interventions, existing international and/or national programs, and coordinated with efforts to support breastfeeding in communities and the workplace.
  • For those countries that currently have a well-functioning designation program able to reach the majority of facilities providing maternity and newborn services nationwide, this new guidance should not be viewed as a reason to discontinue a successful program.

HIGHLIGHTS OF KEY COMPONENTS OF THE GUIDANCE

  • Stresses the importance of exclusive breastfeeding for six months to provide the nurturing, nutrients and energy needed for physical and neurological growth and development.
  • Includes a clear set of global criteria, with the option to tailor for applicability to national standards.
  • Retains the Ten Steps in their original order and subject matter. Includes wording changes that are more generalized and designed to allow for the future incorporation of new and/or updated evidence. Explains the intent of each of the steps and offers clear guidance for their implementation.
  • Acknowledges the contribution of each of the ten steps to improving the support for breastfeeding, and stresses the need for all ten steps to be implemented as a package in order to attain an optimal impact on breastfeeding practices.
  • Provides updated guidance for the safe implementation of practices and monitoring of patients. Reminds health care providers of the importance of individualized attention and care.
  • Describes the importance of mother-friendly birth practices and the impact of birth practices on breastfeeding. Stresses the importance of healthcare professionals being knowledgeable about those practices and their responsibility for educating mothers. Refers them to other WHO guidelines for more details on the specific practices.
  • Stresses the importance of breastfeeding and/or breast milk feeding for all infants cared for in a facility by including some guidelines, indicators and standards for providing breastfeeding support for preterm infants in addition to the guidelines, indicators and standards that have been traditionally included for healthy term infants.
  • Sets a mandate for the evidence and practices embodied in the Ten Steps to be included in health care pre-service curricula while retaining the need to continue with in-service education until this is accomplished and several classes have graduated and entered into practice.
  • Explains the responsibility of healthcare facilities and professionals for implementing the International Code and places it prominently in Step 1, setting the stage for the International Code to be embodied in all aspects of patient care.
  • Stresses the importance of and proposes systems for monitoring and sustaining the practices.
  • Provides clearly defined indicators that are easy to assess and will allow for comparisons between countries. Retains all indicators at the 80% level.
  • Acknowledges the importance of public recognition, such as accreditation, as a key driver for change. Points to the need for external evaluation or assessment as one of the key principles of quality improvement and acknowledges the process of becoming Baby-friendly as transformative, with impacts pertaining to the entire environment around infant feeding.  This included the care being more patient centered; staff attitudes and skill levels about infant feeding improving dramatically; the use of infant formula and newborn nurseries being significantly reduced. States that the quality of care for breastfeeding clearly improved in facilities designated as “baby-friendly”.
  • Offers robust guidance for additional quality improvement options for countries where the traditional accreditation options are beyond reach.
  • Reinforces the role of facilities providing maternity and newborn services of identifying appropriate community resources for continued and consistent breastfeeding support that is culturally and socially sensitive to the needs of families. Reminds facilities they have a responsibility to engage with the surrounding community to enhance such resources.

 

Call to Action:

Given the responsiveness of this document to the concerns raised around the initial 2017 draft, we now call upon all those working with families on infant and young child feeding to band together, support its goals, and work within your countries to implement it in the most effective manner.

Next Steps:

We are working to ensure that a provision is included in a resolution for the upcoming World Health Assembly (WHA) to request the Director General of WHO to work in collaboration with UNICEF to develop tools for training, monitoring, and advocacy on the Baby-Friendly Hospital Initiative to assist Member States with implementation. We will continue to monitor the progress of the resolution, the development of tools, and implementation of the BFHI guidance.

Thank you.

 

Sincerely,

Trish MacEnroe
Coordinator
Baby-Friendly Hospital Initiative Network of Industrialized Nations, Central and Eastern European Nations and Independent States (BFHI Network)

Elisabeth Sterken
Co-chair IBFAN Global Council
International Baby Food Action Network (IBFAN)

Michele Griswold
President
International Lactation Consultant Association (ILCA)

Ann Calandro
Chair
La Leche League International (LLLI)

Felicity Savage
Chairperson
World Alliance for Breastfeeding Action (WABA)

 

Additional translations of this blog post are available in Spanish, Italian, French, and Japanese.

3

Iniciativa Hospital Amigo De Los Niños Y Las Niñas 2018 (IHAN) Guia Revisada De Implementacion

Estimados colegas,

Tras meses de profundo y productivo debate entre nuestras cinco organizaciones mundiales de promoción de la lactancia materna, el 11 de abril de 2018, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF) publicaron la versión final de la Guía de Implementación: Proteger, promover y apoyar la lactancia materna en instituciones que brindan servicios de maternidad y neonatología: la Iniciativa Hospital Amigo de los Niños y las Niñas 2018 revisada. El documento final responde en gran medida a las recomendaciones formuladas por nuestras organizaciones y felicitamos a la OMS y al UNICEF por el éxito de su lanzamiento.

Estamos completamente de acuerdo con la OMS y UNICEF en que “La lactancia materna es un componente vital para hacer realidad el derecho de todos los niños y niñas a gozar del más alto nivel posible de salud, al tiempo que se respeta el derecho de todas las madres a tomar una decisión informada sobre cómo alimentar a su bebé, basada en información completa y basada en la evidencia, libre de intereses comerciales, y el apoyo necesario para que pueda llevar a cabo su decisión”.

También estamos de acuerdo en que “las primeras horas y días en la vida de un recién nacido son una ventana crítica para establecer la lactancia y proporcionar a las madres el apoyo que necesitan para amamantar con éxito” y que “el propósito central de la Iniciativa Hospital Amigo de los niños y las niñas (IHAN) es asegurar que las madres y los recién nacidos reciban atención oportuna y apropiada antes y durante su estancia en una institución que proporciona servicios de maternidad y neonatología, que permita el establecimiento de una alimentación óptima para los recién nacidos, lo que promueve su salud y desarrollo.”

Aplaudimos la plena aplicación del Código Internacional de Comercialización de Sucedáneos de Leche Materna y Resoluciones relacionadas de la Asamblea Mundial de la Salud (el Código Internacional), la incorporación en el Primer Paso de políticas integrales de alimentación infantil basadas en la evidencia y la monitorización continuada de la observancia de las prácticas clínicas relevantes.

Nos alineamos con OMS y UNICEF en su objetivo de ampliar a universal la cobertura de la IHAN para las instituciones de salud materno infantil y garantizar su sostenibilidad en el tiempo.

ANTECEDENTES

Motivados por la profunda preocupación ante la adopción desigual y relativamente baja de la IHAN en todo el mundo, la OMS y el UNICEF emprendieron la importante tarea de evaluar las fortalezas y debilidades de la IHAN y trazar un rumbo para revitalizar tanto la iniciativa como los estándares globales. Una tarea ingente.

l 11 de octubre de 2017 se abrió un periodo de comentario público sobre el primer borrador con propuestas de un nuevo enfoque. Nuestras cinco organizaciones se reunieron y atendiendo a la invitación de la OMS y el UNICEF, compartieron experiencia y trabajaron conjuntamente para aportar a un mayor desarrollo de la guía y recomendar cambios en determinadas áreas no abordadas plenamente por la propuesta.

Deseamos agradecer a la OMS y al UNICEF su apertura y disposición para el debate y haber realizado el necesario esfuerzo adicional para incorporar nuestras recomendaciones. Durante el período de seis meses en que se celebraron las reuniones, todas las partes trabajaron conjuntamente con el objetivo común de fortalecer la guía para empoderar a los países hasta alcanzar la adopción universal.

RECOMENDACIONES PRINCIPALES: ASPECTOS DESTACADOS.

  • Los gobiernos deben involucrarse en la aplicación nacional de la IHAN y realizar esfuerzos para integrar los Criterios Globales en los sistemas nacionales de salud.
  • Las organizaciones profesionales responsables de la educación pre-grado deben incorporar en sus planes de estudio las evidencias y prácticas concernientes a los Diez Pasos para una feliz Lactancia Materna (los Diez Pasos).
  • Se deben realizar esfuerzos para atraer a la atención pública la importancia de la lactancia materna, los riesgos de las fórmulas y las prácticas que ayudaran a proteger, promover y apoyar la lactancia materna.
  • Se deben realizar esfuerzos para proteger a la lactancia materna, las familias y los trabajadores de las presión y las prácticas no éticas de la industria.
  • La IHAN debe ser integrada en otras intervenciones y programas internacionales y/o nacionales ya existentes, y coordinarla con otros esfuerzos de apoyo a la lactancia materna en las comunidades y lugares de trabajo.
  • En aquellos países que actualmente cuentan con un programa de acreditación que funciona correctamente y capaz de llegar a la mayoría de los centros que prestan servicios de maternidad y neonatología del país, esta nueva guía no debe ser considerada una razón para interrumpir un programa con éxito.

GUIA DE IMPLEMENTACION: ASPECTOS DESTACADOS DE LAS PRINCIPALES RECOMENDACIONES

  • Destaca la importancia de la lactancia materna exclusiva durante 6 meses para proporcionar la nutrición y la energía necesarios para el crecimiento y el desarrollo físico y neurológico.
  • Incluye un conjunto claro de criterios globales, con la opción de adaptar la aplicabilidad a las normas nacionales.
  • Mantiene los Diez Pasos en su orden y tema original. Incluye cambios de redacción más generalizados y diseñados para permitir la incorporación futura de pruebas nuevas y/o actualizadas. Explica la intención de cada uno de los pasos y ofrece una guía clara para su implementación.
  • Reconoce la contribución de cada uno de los Diez Pasos a la mejora del apoyo a la lactancia materna, y subraya la necesidad de que para lograr un impacto óptimo en las prácticas de lactancia materna, los Diez Pasos se implementen como un todo.
  • Proporciona una guía actualizada para la implementación segura de las prácticas y el seguimiento de los pacientes. Recuerda a los proveedores de salud la importancia de la atención y el cuidado individualizados.
  • Describe la importancia de las prácticas de parto amigables con la madre y el impacto de las mismas sobre la lactancia materna. Destaca la importancia de que los profesionales de la salud conozcan estas prácticas y su responsabilidad en la educación de las madres. Les remite a otras guías de la OMS para más detalles sobre las prácticas específicas.
  • Destaca la importancia de la lactancia materna y/o la leche materna para todos los lactantes atendidos en una institución, mediante la inclusión de directrices, indicadores y normas para la prestación de apoyo a la lactancia materna de los lactantes prematuros, además de las directrices, indicadores y normas que tradicionalmente se han incluido para los lactantes a término sanos.
  • Establece un mandato para que la evidencia y las prácticas incorporadas en los Diez Pasos sean incluidas en los planes de estudio de pre-grado de las profesiones sanitarias, manteniendo la necesidad de continuar con la educación post grado hasta que esto se logre y varias generaciones se hayan graduado y estén trabajando.
  • Explica la responsabilidad de las instituciones de salud y de los profesionales de la salud en la implementación del Código Internacional y lo coloca en un lugar pre eminente en el Paso 1, sentando las bases para que el Código Internacional se incorpore en todos los aspectos de la atención al paciente.
  • Propone sistemas para monitorizar y asegurar la sostenibilidad de las prácticas y destaca la importancia de las mismas.
  • Proporciona indicadores claramente definidos fáciles de evaluar y permitirán comparaciones entre países. Mantiene todos los indicadores al nivel del 80%.
  • Reconoce la importancia de medidas de reconocimiento público, como la acreditación, como motor clave del cambio. Señala la necesidad de una evaluación o valoración externa como uno de los principios clave de la mejora de la calidad y reconoce que el proceso de convertirse en “IHAN” es transformador, con repercusiones en todo el entorno de la alimentación infantil. Esto incluye que la atención se centra más en el paciente; que las actitudes y los niveles de destreza del personal con respecto a la alimentación infantil mejoran drásticamente; y que se reduzca significativamente el uso de fórmulas para lactantes y de las “nido” para recién nacidos. Afirma que la calidad de la atención de la lactancia materna mejora significativamente en las instituciones IHAN.
  • Ofrece una guía sólida para opciones adicionales de mejora de la calidad para países donde las opciones tradicionales de acreditación están fuera de alcance.
  • Refuerza el papel de las instalaciones que proporcionan servicios de maternidad y neonatología en la identificación de recursos comunitarios apropiados para un apoyo continuo y consistente a la lactancia materna que sea cultural y socialmente sensible a las necesidades de las familias. Recuerda a los establecimientos que tienen la responsabilidad de involucrarse con la comunidad para mejorar dichos recursos.

Llamada a la acción:

Dada la receptividad de este documento a las preocupaciones planteadas en torno al borrador inicial de 2017, hacemos ahora un llamamiento a todos los involucrados en la alimentación de lactantes y niños y niñas pequeños, que trabajan con las familias, para que se unidos, apoyen sus objetivos y trabajen dentro de sus países para implementarlo de la manera más eficaz posible.

Siguientes Pasos:

Estamos trabajando para asegurar que se incluya una disposición en una resolución de la próxima Asamblea Mundial de la Salud, que solicite al Director General de la OMS que trabaje en colaboración con UNICEF para desarrollar herramientas para la capacitación, el monitoreo y la promoción de la Iniciativa de Hospitales Amigos de los Niños que ayuden a los Estados Miembros con la implementación. Continuaremos monitorizando el progreso de la resolución, el desarrollo de herramientas y la implementación de la guía IHAN.

Gracias.

Sinceramente,

Trish MacEnroe
Coordinadora
Red IHAN de las Naciones Industrializadas, las Naciones de Europa Central y Oriental y los Estados Independientes (BFHI network)

Elisabeth Sterken
Copresidenta del Consejo Mundial de IBFAN
Red Internacional de Acción para la Alimentación Infantil (IBFAN)

Michele Griswold
Presidenta
Asociación Internacional de Consultores en Lactancia (ILCA)

Ann Calandro
Presidenta
Liga Internacional de la Leche (LLLI)

Felicity Savage
Presidenta
Alianza Mundial para la Acción pro Lactancia Materna (WABA)

Las traducciones adicionales de esta comunicación están disponibles en inglés, italiano, francés, y japonés.

 

 

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