How would it change your practice if you learned that just about everything you think you know about the lingual frenulum is wrong?  

New research to be presented at the International Lactation Consultant Association’s Annual Conference in Texas in July suggests exactly that, with serious implications for lactation professionals’ work.

As a Pediatric ENT Consultant at Starship Children’s Hospital in New Zealand, Nikki Mills, BHB, MBChB, FRACS, Dip Paeds, IBCLC, sees a lot of baby’s tongues. And, she is often asked to perform frenotomies.

Over time, Mills began to have more questions than answers about the procedure.

Why did some of her patients seem to get great benefit from the procedure, breastfeeding more successfully afterward, while others saw no benefit at all?

“As a surgeon who was being asked to divide frenulums in babies, I really wanted to know what it was that I was cutting,” Mills says. “I wanted to understand exactly what tissues I was dealing with and what they did.

“I believed that understanding should be the basis for deciding when a frenulum should be cut—and when it should not,” Mills continues. “For me, it was a fundamental question.”  

But when she went looking for research to answer her questions, Mills came up empty handed.

“No one had ever looked at the anatomy and function of the lingual frenulum in detail,” she says.

She decided it was high time someone did.

So she scaled back her clinical practice and spent the next four years researching.

As part of her investigation, she dissected fresh neonatal cadavers to better understand the anatomy and function of the lingual frenulum.

What she discovered was out of sync with everything she had been taught.

“What I found was very different from what has been the popular understanding of the lingual frenulum,” she says. “It’s challenging because when I present my research, it makes everyone who thinks they understood the lingual frenulum rethink and reframe what they thought.

“We have started to think of any lingual frenulum as a tongue tie,” Mills continues. “We’ve created a situation where normal anatomy is called an anomaly.”

At the ILCA conference, she will explain her published research in detail, as well as its implications for evaluating and treating breastfeeding problems.

In addition, she will present research she has recently published on the effect of positioning on babies who are having difficulty with swallowing and breathing during breastfeeding.

Mills placed breastfeeding parents and their infants inside MRI machines, capturing dynamic MRI images of what happens during sucking and swallowing.

Because most previous research has been done with bottle-feeding infants, these MRI studies represent a leap forward in understanding what happens during breastfeeding.

“We wanted to understand and define the impact of different breastfeeding positions on tongue position and dynamic airway collapse with the tissues above the voice box, and also with milk flow,” she explains. “What happens when the baby is positioned in different ways?

“When a baby is having trouble breathing, breastfeeding is often the first thing to go,” she continues. “Parents are told they must bottle feed. I wanted to know, what can be done to modify positioning to create a greater possibility of supporting safe breastfeeding in at least some of those babies?”

Mills will present these findings, along with tips for how IBCLCs can apply them when working with babies with Laryngomalacia and other challenges.

From her unique perspective as a clinician and a researcher, Mills will discuss:

• How the field of lactation support is getting it wrong when it comes to the lingual frenulum.
• Why assessing lingual frenulum in isolation is a costly mistake.
• How her new data inform decisions about when frenotomy is indicated and when it is not.
• The results of her dynamic MRI studies of babies feeding at the breast, the first of their kind, and implications for using positioning to help babies with sucking and swallowing difficulties.

This year’s conference will be hybrid, offering both online and in-person options in Houston, Texas, US. To learn more about the #ILCA21 conference, offered both virtually and in person, visit here.

The perspective of each IBCLC is unique. Your viewpoint is shaped by whether you practice in the community, in a health-care facility, or as a researcher. In your region of the world, you may hold a different vantage point based on the cultural needs and practices of the families that you serve. And yet there are common threads we all hold as providers and for the breastfeeding mothers and chestfeeding parents we serve. 

The ILCA board is where we weave together all of these perspectives to inform the best possible support for you, the lactation profession, and the global breastfeeding community.

Board nominations are now open. We welcome you to take a moment to consider who in your community can best represent your unique needs while holding the vision for our diverse global profession. Our goal is to ensure a board that can truly capture all the threads that make up the lactation consultant field.

Candidates must self-nominate. Required qualifications include:

• Membership in good standing for two years (immediately prior to the date nominations are called)
• IBCLC in good standing
• Strong interest in the growth and development of ILCA
• Demonstrated leadership

Learn about all of the qualifications and time commitment here in the job description and complete the application here.

Questions about your membership status or the application process? Contact our helpful support staff at info@ilca.org.

The deadline for applications has been extended to 7 June 2021, 23:59 New York EDT; 8 June 2021 5:59 Geneva CEST / 13:59 Sydney AEST.

Our nominations task force, led by Past President Mudiwah Kadeshe, MSN, RN, LNC, IBCLC, looks forward to learning more about you.

What do you do when your job is to help breastfeeding families in your local area—but your local area comprises three states, two countries, and two languages?

If you’re Elsa Quintana, you become an expert in collaboration—in envisioning it, in building it, and in funding it.

Quintana, BA, IBCLC, BCJ, works at the intersection of three locales—far west Texas (United States), extreme southern New Mexico (United States), and Ciudad Juarez, Chihuahua (Mexico). 

She navigates three state governments, two national governments, and two languages in her job of facilitating lactation care for families across multiple borders.

At this year’s International Lactation Consultant Association’s conference, Quintana will share tips and strategies for harnessing the power of collaboration, no matter your setting.

“We are unique in that we have two countries and three states that are all about five minutes from each other,” Quintana says. “But we have all found a way to pull together and it truly works. At the conference, I want to share our story because I believe it has lessons that can be used in many other places. I’m hoping to inspire people to see what’s possible where they are.”

Quintana served for many years as the State Coordinator for the WIC Breastfeeding Peer Counselor Program in New Mexico, where she and her program have received awards and recognition locally, nationally, and internationally for their efforts to increase breastfeeding rates in the state.

She currently contracts with the New Mexico Department of Health to teach a bilingual 100-hour certification course for community health workers.

Working within the Binational Breastfeeding Coalition (BBC), Quintana worked on a three-year grant project called Breastfeeding on the Border.

The project brought together WIC peer counselors, community health workers, and professionals across borders to better serve lactating families.

Breastfeeding on the Border successfully established community lactation support groups, which connected resources and built networks within communities. The result is sustainable, community-driven supports that are culturally informed and not susceptible to rises and falls in government funding.

In addition, Quintana helped create a unique presentation series called “Look Who’s Talking.” These talks brought renown speakers such as Kathleen Kendall Tackett and Laurel Wilson to share information with BBC, whose membership includes lactation professionals, nurses, social workers, pediatricians, therapists, dentists, and others. The speakers presented to packed rooms, while even more attendees watched online.

The Look Who’s Talking presentations and other education efforts under the project shared one simple goal: to get a variety of professionals who serve childbearing families all on the same page about lactation basics.

“That way, the same message is being delivered in many settings across the communities,” Quintana notes.

Bringing together diverse professionals from different states and different countries around the same goal may sound like a huge task, but Quintana says it comes down to perseverance and believing in your mission.

“Every time I talk to other lactation professionals, they ask, ‘How in the world do you guys do it?’” Quintana says. “They are especially surprised that we have been able to fund some of our initiatives, like the high-level speakers we’ve brought in.

“The keys are developing good contacts, networking, and looking for shared goals,” she continues. “Maybe you’re looking for ways to provide lactation support, and another organization in your community is talking about adolescent pregnancy. How can you share resources? You are always looking to partner and invite.

“It can be done, and you can do it,” she encourages. “When you have a passion to help families, you don’t see bridges and interstate lines and borders. You just see a parent who needs help.”  

From her unique perspective, Quintana will share tips on:

• Networking and finding shared goals
• Finding your setting’s unique opportunities
• Understanding your audience’s needs
• Collaborating to find funding
• Navigating bureaucracy
• Not getting discouraged

This year’s conference will be hybrid, offering both online and in-person options in Houston, Texas, US. To learn more about the #ILCA21 conference, offered both virtually and in person, visit ilca.org/conference.

The Journal of Human Lactation (JHL) is soliciting manuscripts for their February 2022 special issue on a wide variety of topics pertaining to laws and policies related to infant and young child feeding. 

Submissions can include original research, literature reviews, case studies, and insights into practice and policy. Examples of topics include, but are not limited to, the following:

• The International Code of Marketing of Breast-milk Substitutes: Describe how it is applied in 2021; which countries follow it; which countries have laws that are actually enforceable and how that is done with outcomes; how they are actually enforced when this does happen (in your own country and/or compared to other countries); describe companies/organizations that operate on the “edges” of the International Code (i.e. breast pump companies that are not code compliant; non-profit foundations that were founded by executives from and funded by profits from Code non-compliant companies that fund Infant and Young Child Feeding-related research).
• Paid parental leave: Describe the laws in your country and how changes in policy/law have influenced infant and young child feeding standards over time; describe how changes in policy/law have influenced breastfeeding initiation and exclusivity rates.
• Workplace lactation support: Implementation of work environment policy for working lactating mothers; employers’ responsibility to make lactation room(s) available for employees or any similar policies and how has that affected Infant and Young Child Feeding; consider state, provincial and/or federal laws concerning workplace lactation support that do not include means of enforcement or where they do not even exist and the ramifications.
• Government regulations: Lack of, or conversely presence of policy intended to increase access to the care of an International Board Certified Lactation Consultant^® (IBCLC^®) care; consider how governmental guidance specific to one country or region that may be implemented in other parts of the world can actually cause harm.
• Breastfeeding in public: Consider whether laws are needed based on current policies and laws; write about the existing laws; on-going issues with complaints about public indecency.
• Education policy: Discuss whether funding (and where it might come from) should be provided to assist persons working with childbearing/childrearing families in communities with low rates of breastfeeding (i.e., exclusive to 6 months; duration to one year or more) to become IBCLCs; examples of model programs; how to create model programs.
• Funding regulations or policies for health care practices: The influence of insurance regulations/policies/national health care practices influence infant and young child feeding practices in your location.
• Licensure of IBCLCs: Obstacles that have arisen in states/provinces where human milk feeding advocates have introduced legislation to license IBCLCs; places obstacles to licensure have been overcome; how this was accomplished. 
• Drug regulations: In the US there are regulations concerning the use of Domperidone; how this affects practice; other issues globally pertaining to drug regulations and lactation.

The submission deadline is 1 October 2021.

For more information, please visit the JHL journal homepage here.

Please send email inquiries about specific ideas for manuscripts for this special issue to the Editor in Chief at jhleditorinchief@gmail.com.

If an IBCLC^® you knew helped a client with a history of breast cancer induce lactation for an adopted infant, wouldn’t you want to hear the story?

How about if a friend had been involved in a study measuring COVID-19 antibodies in human milk during the newborn phase? Definitely a great story to hear!

Case studies—stories—of others’ successes and challenges have so much to teach.

Now, you can access the full text of five new case studies here free of charge in a collection recently released by the Journal of Human Lactation. The case studies will remain open access through 15 June.

Topics include:

Maternal Transfer of Cetirizine Into Human Milk. A study in which levels of the drug found in the common allergy medication Zyrtec were measured in human milk, filling a previous gap in data.

Severe Lactational Mastitis With Complicated Wound Infection Caused by Streptococcus pyogenes. Management of a severe case of mastitis at two weeks postpartum has a positive outcome, with the pair nursing successfully into toddlerhood.

Induction of Lactation After Adoption in a Muslim Mother With History of Breast Cancer: A Case Study. Details the protocols used to successfully induce lactation and discusses the benefits to both parent and baby.

Induced Lactation in a Mother Through Surrogacy With Complete Androgen Insensitivity Syndrome (CAIS). A mother through surrogacy, with XY karyotype and CAIS, is able to partially breastfeed, supporting the concept of helping more nontraditional parents with lactation.

Early Identification of IgA Anti-SARSCoV-2 in Milk of Mother With COVID-19 Infection. Do mothers with Covid-19 infection produce milk that has antibodies that could protect their nursling? This case study suggests the answer is yes.

Each case study in the collection gives detailed information about the issue, history, management, and outcome.

Want to read more great content from the Journal of Human Lactation? ILCA members can access the full Journal of Human Lactation for free! Join online today.

Let potential clients know that your Hospital-Based Facility or Community-Based Agency recognizes the role of the International Board Certified Lactation Consultant^® (IBCLC^®) in protecting, promoting and supporting breastfeeding by applying for the IBCLC Care Award.

The IBCLC Care Awards are promoted to new families and the general public which means your facility 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

Visit the IBCLC Care Directory to see which Hospital-Based Facilities are already benefiting from the IBCLC Care Award program!

Hospital-Based Facilities and Community-Based Health Agencies that staff currently certified IBCLCs can apply online to become a recognized IBCLC Care Award facility. Learn more about the qualifications and complete the online application here.

Applications will be accepted online starting January 2021 through 5 March 2021. Please contact us at admin@ilca.org if you have any questions.

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

It would be difficult to think of a year when being an International Board Certified Lactation Consultant^® (IBCLC^®) has been so challenging—or so important.

In 2021, birthing and lactating families all over the world have faced unprecedented hurdles as they’ve brought their babies into the world amid the COVID-19 pandemic. They have needed the help of IBCLCs like never before, to navigate obstacles none of us could have imagined.

At the same time, IBCLCs have had to dive deeper into their own creativity to find ways to connect with and support families, amid lockdowns, quarantines, and social distancing. And you have risen to the challenge, innovating, persevering, and caring like never before.

On 3 March 2021, we welcome your community to celebrate YOU by thanking IBCLCs.

We hope you will also take this opportunity to celebrate the IBCLCs that have made a difference in your life, through mentorship, community, or support.

Show your IBCLC pride! Starting now, use our IBCLC Day frame on your Facebook image to help build recognition for your profession.

Find the IBCLC Day frame here.

Find IBCLC Day images for you and your community to share here.

We have also welcomed code-compliant organizations that would like to provide special offers to IBCLCs for #happyIBCLCday to do so on our event page. Feel free to check out what they have shared with you here. We also hope that you will share with us what you are doing in your local community to celebrate!

#happyIBCLCday

Early in the COVID-19 pandemic, a troubling trend emerged—as hospitals struggled to understand the new risk, birthing parents and their infants were routinely being separated. Parents were told not to breastfeed or chestfeed, or counseled to only feed expressed milk.

Babies were spending the first days of their lives unable to be in contact with their lactating parent.

Nearly a year later, that situation in many places still stands. Despite scientific evidence that infants kept together with their mother or other lactating parent are at no greater risk for SARS-CoV-2 infection than those cared for separately, routine separation is still happening.

Why is this the case? In her new webinar, available to ILCA members here, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, draws on her dual training in anthropology and epidemiology to answer this critical question. 

UNDERSTANDING THE BACKDROP

To understand why separating birthing parents and their infants was an automatic response from many guiding bodies and institutions, one has to understand an invisible historical backdrop, according to Tomori.

Healthcare policy does not take shape in a vacuum, nor is it ever simply the result of a neutral examination of hard scientific data. “It really is drawn from how we approach the evidence, and these things are social,” she says.

In this case, much of the world approached the evidence about COVID-19 and parent-baby separation from a single perspective: they assumed that separating parents and infants is a neutral, default act with no potential for harm.

Why? As Tomori explained, that attitude is the result of decades of industrial capitalism and colonialism that led to a medicalization of birth and parenting and to the view of parents and babies as completely separate. 

Shored up by cultural beliefs about independence, by the mid-20^th Century this added up to a loss of the previous understanding of birthing parents and their infants as a dyad—they were no longer seen as an interconnected unit that needed to stay together.

By the late 20^th Century, parent-infant interdependence and breastfeeding had been “rediscovered,” but in a very medicalized version. And importantly, medical training in much of the world is still rooted in the previous paradigm.

It is this view of separation as the default, according to Tomori, that has led to damaging separation policies and practices during the pandemic. Keeping parents and babies together is seen only as a threat—in this case, as a potential source of SARS-CoV-2infection.

Tomori acknowledges that it can be hard to grasp how such large, unseen forces are at work when one of your clients is told they cannot keep their baby with them, or is urged to express milk instead of nursing. But she argues that it’s important to understand the assumptions behind the policies in order to evaluate what is truly happening.

HIDDEN HARMS

When policies are made based on the belief that separation is benign and that proximity only represents a threat, the threat of very real, cumulative harm due to separation is ignored.

Keeping babies and their birthing parents together is the evolutionary and biological norm because human infants are comparatively immature and vulnerable. Unlike many other primates, they are unable to cling to their parent and unable to maintain their temperature. Proximity to their parent—and breastfeeding in particular—are unique adaptations that allow the parent to co-regulate the baby’s system. Separation prevents this.  “Evidence for this is vast,” Tomori notes.

One other harm from separation is totally overlooked as well. Since breastfeeding is often seen only as nutrition, providers miss the fact that “breastfeeding is a major adaptation for protection from infectious disease,” Tomori says. “This is repeatedly overlooked … and that’s a really major oversight during a pandemic, when you’re looking at an emerging infectious disease.”

Another major oversight? Providers who advocate separation assume it will lessen the infant’s exposure—but in fact, the opposite may be true. Infants require extensive care, and if their parent is not able to do it, healthcare staff or another caregiver will need to do it instead. Each new contact the baby has can increase exposure. The baby may end up with more exposure and less immune protection from breastfeeding.

INEQUITIES EXACERBATE HARMS

The harms of separation are extensive and cumulative, according to Tomori—and they are also uneven. They do not affect all parents and babies equally.  

Why? Because far from being a “great equalizer,” as some suggested early on, COVID-19 has instead revealed and worsened preexisting inequities between groups.

Who are the parent-baby pairs most likely to be harmed by separation? Those whose essential worker status forces them to attend jobs, those who are least able to follow recommendations to avoid exposure, those with underlying conditions due to historical inequities, those with less access to culturally competent, skilled birth and lactation support, and those for whom power dynamics make it more difficult to challenge medical advice.

“Separation has a disproportionate effect on the most vulnerable mothers and infants,” Tomori says.

What are your setting’s policies and practices around separation during COVID-19? For tips on how you can take action to support parent-infant togetherness, check out the first blog in this series here.

Ready to learn even more? ILCA members can access Tomori’s webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic.

In the early days of the COVID-19 pandemic, one issue quickly rose to the surface for birthing families and their providers. Considering the new risks, could parents and their infants safely remain together?

It was a scary time for birthing parents and those who support them, as stories of painful separation abounded from areas around the globe.

Nearly a year later, data has shown that babies who stay with their parent are at no greater risk for COVID-19 infection than those who are separated. However, separation of birthing parents and their babies remains common practice in many settings. The implications are significant, and dire—particularly for the success of breastfeeding or chestfeeding. As a lactation professional, what can you do to help ensure contact for your clients and their babies? 

In her new webinar, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, discusses the latest developments, as well as what you can do to help. (Find the free webinar here; CERP-eligible for ILCA members here).

THE CURRENT CLIMATE

Months into the pandemic, researchers have gathered a lot of data. Unknowns remain, but there is growing agreement on significant points. First, infants and children are “underrepresented in reported and confirmed cases,” according to Tomori, suggesting they contract COVID-19 less frequently than older individuals. 

Second, they are likely to have a milder clinical course if they do get sick. Exceptions exist, and there is the potential for severe cases, including the risk of Multisystem Inflammatory Syndrome, a rare but serious condition. However, “We have very good data now, from many months and thousands of papers,” Tomori says, “to support the fact that overall, we are definitely seeing lower severity among infants and children.” 

Additionally, data has shown that separating infants from their parents in the hospital doesn’t reduce the likelihood of COVID-19 infection.

So with better data, is all well now? Not quite, according to Tomori.

Following nearly a year of mixed messages and policy reversals, birthing parents are still routinely being separated from their infants, and there is insufficient support for parent-baby contact and for breastfeeding in many areas.

Guidance varies across settings, and some settings are still recommending no breastfeeding or the feeding of expressed milk only.

Separation policies remain common, although they have taken different forms in different areas. In both the United States and the United Kingdom, anecdotal reports of hospitals routinely separating birthing parents and infants are still common, according to Tomori—even when the official policy supports keeping parents and babies together.

WHAT CAN YOU DO?

In the face of confusing and changing policies and practices, how can you advocate for the parents and babies in your care and help ensure they remain together? Tomori has several suggestions.  

Reference high quality resources. As you work to keep up with emerging evidence, stick with proven sources. “Rely on experts who have thought about the issues carefully and thoroughly and are capable of integrating multiple sources of evidence,” she says. “When in doubt, go back to the WHO.” Whatever you do, don’t reference the day’s headlines. “Don’t follow whatever news release you may see—that may not be linked to any research at all, or to poor quality research,” she cautions. You can find up-to-resources at the ILCA website here.

Navigate the guidance. Carefully examine the policies and practices in your own setting. Compare to the WHO guidance, and look for differences and discrepancies. “Think through what the [practice or policy] actually does,” Tomori says. “Map out potential exposures. Map out the trade-offs.”

Challenge problems. If a policy or practice in your setting is out of line with best recommendations, speak up.

Keep parents’ and infants’ rights at the center. Look for opportunities to advocate for these rights in your setting.

Collaborate and communicate. “Don’t go it alone,” Tomori says. Look for others to work alongside you who share your commitment to parents and babies.

Evaluate for inequities. Importantly, any time you are evaluating guidance, policy, or practices, do so with an eye toward inequities. Look for places where your setting’s policies impact different families differently, and question the invisible beliefs and values behind the advice. “Ask, ‘What are the built-in assumptions that are not obvious?’” Tomori advises. “This should be a primary consideration. It will tell you a great deal about what is really happening.”

HOW DID WE GET HERE?

Early in the pandemic, the World Health Organization (WHO) issued guidance urging health care providers to keep birthing parents and their infants together, according to Tomori.

Unlike many country-level and professional bodies, WHO integrates knowledge of past pandemics with a focus on maternal-child health as well as expertise in feeding infants in emergencies and infectious disease control. The result was quick early guidance that centered the rights of the birthing parent, regardless of COVID-19 status.

WHO also stressed labor support, skin-to-skin care, and direct breastfeeding, with the parent wearing a mask and practicing hand hygiene.

However, things got much more complicated after that. National and professional bodies began to weigh in with conflicting recommendations.

Statements by various experts and advising bodies around the world recommended separating parents and babies, and even in areas where official guidance recommended keeping dyads together, individual institutions frequently opted for separate care. 

Then in February 2020, the Centers for Disease Control (CDC) in the United States advised healthcare providers to consider separating mothers and babies. The CDC’s statement advocated shared decision making, with risks and benefits discussed between families and providers—but this did not routinely occur, according to Tomori. Instead, birthing parents were frequently separated from their newborns with no discussion of their options or of the risks of separation.

The CDC’s stance affected practices around the world, as many countries followed its advice. 

With the support of lactation professionals and other parent-baby advocates, including ILCA, in April 2020, the CDC issued new guidance that re-emphasized the benefits of contact and the importance of breastfeeding.

In August 2020, revised CDC  recommendations further re-centered contact, saying the risk of infection from parent to baby was low.

These final recommendations still stand, and in November 2020, new resources issued for the public by the CDC additionally acknowledged that breastmilk is not a likely cause of COVID-19 infection.

A BIGGER PICTURE

Larger questions remain: Why were policies and practices of separating parents and newborns so quick to emerge? And why have they been so hard to dispel? An anthropologist by training, Tomori has very clear answers for these questions—and the answers have big implications for caring for families. To learn more, read the upcoming blog “Anthropology Meets Public Policy: Understanding Parent-Baby Separation in the Pandemic.”

 ILCA members can access Tomori’s CERP-eligible webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic. Non-members can access for free (not CERP eligible) here.