As information is rapidly unfolding about the new mRNA COVID vaccines and lactating families, we sat down with Dr. Lori Feldman-Winter to help our community get the information they need to support those with questions right now.
Dr. Lori Feldman-Winter is a fellow in the Academy of Breastfeeding Medicine (ABM) and helped to bring their recent statement to fruition. She is also on faculty at the Department of Pediatrics, Cooper Medical School, Rowan University and Children’s Regional Hospital at Cooper, Cooper University Health Care, Camden, New Jersey, US. In these interviews, she is speaking from her expertise as a health care provider and not on behalf of ABM or any of her other professional affiliations.
Can you explain to us how the new vaccine works? How are the mRNA COVID vaccines different from other vaccines, such as the flu vaccine?
What sort of questions should a family consider asking their care provider when assessing the risks and benefits of receiving the COVID vaccine while breastfeeding or chestfeeding?
With countries in the process of authorizing distribution of the first COVID-19 vaccines, lactation consultants may have questions about accessing the immunization as well as available safety information for breastfeeding and chestfeeding clients.
In this rapidly changing environment, ILCA is continuing to gather and disseminate international and regional updates about lactation-related COVID information here. Please consider sharing with us information or guidelines from your region that may be helpful to your colleagues and those you serve.
Watch here and on our social media for rapid updates as they become available.
Can IBCLCs and other lactation care providers be included in early priority groups to receive the vaccine?
While the World Health Organization (WHO) has provided guidance on vaccine access and allocation, decisions about how to prioritize who receives vaccines as they become available are being made at the local level. These plans are being made by countries, states or territories, depending on the region.
WHO guidelines prioritize health care workers for early access to the vaccine. However, their scenario-based recommendations vary based on factors including the local virus spread, the available vaccine in each community, and the healthcare worker’s risk of contracting the virus based on setting.
Understanding the role of IBCLCs in the health care system
If your local vaccine distribution plan follows the WHO framework, it is likely to prioritize your access based on local conditions and how the setting in which you practice impacts your risk of contracting COVID-19. You may also have the opportunity to play a leadership role in decisions at your facility or in your region. Here is some information you may find helpful as you navigate the question of how your role within the healthcare system relates to your priority status.
The independent international certification body conferring the IBCLC credential – the International Board of Lactation Consultant Examiners (IBLCE) – includes this in their definition of an IBCLC:
What is an IBCLC? International Board Certified Lactation Consultants function and contribute as members of the maternal-child health team. (Find it here)
The United States Centers for Disease Control and Prevention includes this definition of healthcare personnel in its resources on the coronavirus:
Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). (Find it here)
The World Health Organization, in a document on the National Health Workforce Accounts, offers this definition:
“The health workforce (HWF) includes all types of health, social, and support workers.” (p. 8) (find it here)
And in another document on health workers, offers this definition:
“This report defines health workers to be all people engaged in actions whose primary intent is to enhance health.” (find it here)
What can we tell clients about the safety of COVID-19 vaccines during pregnancy and lactation?
First, it is important to remind families that much of the information we need to make decisions is still forthcoming.
You may also provide them with guidance on what we know so far:
Overall safety considerations for pregnancy and for lactation may be different and should be considered separately.
Just as distribution of the vaccine happens locally, safety approval also is guided by local regulatory processes, typically at the national level.
These safety approval processes include a review of the outcomes of clinical trials. However, phase three clinical trials, which test vaccines for efficacy and safety, have not yet been conducted on people who are pregnant or lactating.
While additional data are on the way, in the short term, guidelines from different countries are likely to be conflicting as each region weighs the balance of limited evidence with a vaccine for a novel virus against their knowledge of the protective benefits of lactation.
We know that further information is critical for healthcare workers and essential workers who are also lactating. (See this op ed for context in the US setting.) ILCA will share more information as it becomes available.
Do you have information about how decisions about vaccine allocation is occurring or vaccine recommendations for those breastfeeding or chestfeeding in your community? Let us know in the comments or email us at media@ilca.org. We will continue to update ilca.org/COVID-19 with new information as it becomes available.
Looking for ways to promote the IBCLC® profession? ILCA has blog posts, infographics, and videos that you can share to help others learn about how IBCLCs transform world health.
Here are seven ways you can share materials on social media. Each share makes a difference! Together we can educate our communities about who IBCLCs are, what your care looks like, why skilled lactation care is important and where and how to access that care.
Over at Lactation Matters, find articles to share about common questions families may have about lactation. Each article ends by directing consumers to the Find A Lactation Consultant directory, where they can find skilled providers for support. Find the tips to share on social media below.
4. Educate about facilities that have received the IBCLC Care Award
The IBCLC Care Award recognizes maternity and community-based facilities worldwide that hire currently certified International Board Certified Lactation Consultant® (IBCLC®) certificants.
When we advocate for breastfeeding and chestfeeding friendly policies, we remove key barriers that our clients experience every day when trying to reach their lactation goals.
After receiving expert, skilled support from IBCLCs around early infant feeding questions and concerns, many parents return with questions as the time for starting solid foods approaches. An increasing number of questions over the past decade have been about Baby-Led Weaning – is it safe? When can it begin? What are trusted resources for learning more? How should parents balance offering table foods and continuing to nurse/provide human milk?
Meghan McMillin holds a Master’s Degree in Human Nutrition and is both a Registered Dietitian Nutritionist (RDN) and Board Certified Specialist in Pediatric Nutrition (CSP), as well as an International Board Certified Lactation Consultant (IBCLC). Meghan’s private practice focuses on prenatal, postpartum and infant care, and the introduction of solids, food allergies, and Baby-Led Weaning are among her specialties. Her webinar for ILCA, “Baby Led Weaning and the Role of the IBCLC” combines her expertise as a dietitian and her IBCLC experience to uniquely frame the research, practice, and guidelines around Baby-Led Weaning that IBCLCs need to know.
McMillan feels strongly that “IBCLCs need to be educated on the basics of Baby-Led Weaning. There are plenty of non-experts out there providing information, in social media groups, blogs, and peer-to-peer supports. We need to be the experts, making sure babies are fed safely.”
Here she shares a few key insights about about Baby-Led Weaning.
“Baby-Led Weaning” might be a confusing term for some
McMillin explains that in some English-speaking countries, including the United States, “weaning” refers to the end of breastfeeding or chestfeeding, and “baby-led” weaning to the act of letting a baby guide when to stop. However, in the United Kingdom, where the first book on Baby-Led Weaning was published, “weaning” refers to the introduction of solid or table foods – the beginning of complementary feeding, not the end of human milk feeding. And “baby-led” refers to the act of allowing the baby to feed themselves, “eating finger foods from the first bite.”
Baby-Led Weaning isn’t just about what babies eat, but howbabies eat
McMillin defines the basic principles of Baby-Led Weaning as starting to offer solid foods at six months of age (as recommended by the World Health Organization); offering healthy foods; sharing meals together as a family; and finally, allowing babies to feed themselves (instead of being given pureed food on a spoon by an adult). She points out that as IBCLCs, we teach families to allow babies to lead feeding from birth. We teach feeding cues, encourage parents to feed on cue and discourage them from timing or scheduling feeds. The self-feeding, responsive mindset of Baby-Led Weaning is a natural extension of that approach. In fact, McMillin shares research showing that in a randomized trial, parents taught to use Baby-Led Weaning chestfed or breastfed for longer durations than those who were not.
Many parents have questions about how to use Baby-Led Weaning safely
Baby-Led Weaning emphasizes allowing infants to self-feed by giving them large, “grabbable” pieces of food versus spoon-fed purees. This often leads to questions and concerns about the potential for a baby to choke if they break off a piece of food that is too large for them to handle. McMillin explains that research shows “babies that followed the Baby-Led Weaning approach did not choke more often than those that followed the traditional approach.” She highlights that “any feeding method can result in choking when the proper precautions are not taken, and educating parents on this can help reduce the risk.”
Are you ready to provide the families you serve with the information they need? McMillin notes that many health care providers are unfamiliar with Baby-Led Weaning, and that many health governing bodies offer little guidance or official positions for providers to turn to. As IBCLCs, we are trusted infant feeding professionals and can offer parents education on understanding a baby’s readiness for solids, information on safety and choking precautions, counsel them on continuing to maintain nursing and milk supply, and have referrals and resources for issues outside our scope of practice. In “Baby Led Weaning and the Role of the IBCLC,” McMillan covers all those topics and more, including how to counsel parents about what to expect when beginning Baby-Led Weaning, ideas for combining conventional feeding with Baby-Led approaches, food preparation ideas, and the ideal first foods for infants being fed human milk.
Ready to learn more? ILCA members can access this webinar for free right here! Not a member yet? Learn more about accessing ILCA continuing education here.
Patients and providers frequently turn to IBCLCs with questions and concerns about chest/breast and nipple pain, plugged ducts, mastitis, and engorgement. Whether it is a patient newly postpartum who is so engorged the baby cannot latch, one who is experiencing recurrent plugged ducts, or one who is exhausted having sought out treatment after treatment for chronic pain, we all could use more tools in our toolbox to support patients and help resolve their issues.
Katrina B. Mitchell, MD is a board-certified general surgeon, fellowship-trained breast surgical oncologist, and International Board Certified Lactation Consultant (IBCLC) whose practice includes the care and surgery of women with breast cancer and benign breast disease, and also treats complications of lactation. Her webinar for ILCA, “Physical Therapy Techniques in Lactation” draws on both her own intimate knowledge of breast anatomy and physiology as well as the knowledge of the skilled physical therapists she works with. Below, she shares insights and techniques that can help IBCLCs help their patients.
The breast is a dense and complex organ
Mitchell emphasizes that the lactating breast is “an extremely complex organ”: highly vascular, drained by a complex lymphatic network, and highly innervated. Multiple branches of the intracostal and supraclavical nerves are present throughout the breast, and many extend all the way from the border of the breast to the nipple/areolar complex. Mitchell explains that for this reason, “Any kind of deep breast pain is going to radiate to the nipple, and any kind of nipple pain is going to radiate back deeper in the breast.” Similarly, lymphatic congestion anywhere in the breast can contribute to and interact with breast pain, engorgement, plugged ducts, and mastitis. When patients experience breast congestion, it is important to have multiple techniques available to relieve the pressure and improve drainage.
Deep massage = tissue damage
When a patient has plugged or congested areas of the breast, many of us were taught at some point in our training that firm massage starting behind the plugged area and pushing towards the nipple would help “push” a plug out. “I tell patients – because I’m the person seeing the consequences of aggressive massage – basically, if you’re massaging this gland, it’s like massaging a thyroid gland or some other gland,” Mitchell explains. “It’s just going to traumatize it.” She emphasizes that milk ducts are tiny – attempting to force milk through is very unlikely to work, and can cause significant issues. Excessive massage for a plugged duct or mastitis can cause a “lactational phlegmon” in that part of the breast, a complex mass of tissue that can’t be drained and can be challenging to manage.
Physical therapy techniques can be very effective for pain relief and breast drainage
For alternatives to these potentially harmful methods, Mitchell encourages more awareness of physical therapy techniques for management. She explains that breast surgeons generally work closely with physical therapists who are trained in lymphatic drainage and treating edema often associated with breast surgeries. She and the PTs she works with have found that many of the techniques can be very effective for treating issues with lactation as well. In particular, instead of deep massage, she encourages a lymphatic massage approach – with a light touch, “like petting a cat” – done with awareness of lymphatic drainage techniques of the breast. Understanding a few key techniques, and simple steps parents can be taught for self-care, can enable IBCLCs to put these principles into practice when caring for patients.
Want to learn more? In her webinar, “Physical Therapy Techniques in Lactation,” she shares photos of cases, high quality medical illustrations, and her understanding of the complex and fascinating anatomy of the breast. You will also learn the principles behind approaches like kinesiology taping, neural mobilization, and therapeutic ultrasound – techniques practiced primarily by physical therapists, but important for IBCLCs to understand for collaboration and referral.
Ready to learn more? ILCA members can access this webinar for free right here! Not a member yet? Learn more about accessing ILCA continuing education here.
At this year’s All General Meeting, International Lactation Consultant Association® (ILCA®) members shared questions with the board and staff.
We were able to address most of your questions during the meeting, but were not able to get to all of them due to time constraints. Following the meeting, we reached out to board and staff with the remaining questions. Their answers are shared below. Other questions? Please leave them in the comments!
Missed the AGM? ILCA members can watch it here.
ILCA Member:
How can we, as IBCLCs, continue to grow our numbers internationally in this COVID financially challenged world?
ILCA Board and/or staff:
We received a number of questions about how ILCA will grow our membership globally during COVID, while ensuring that the needs of members in each region are both heard and met. Thank you to those who posed this question.
To best meet the needs of members, ILCA needs to understand what those needs are. ILCA is always working to find the best ways to hear those needs, from listening tours to enhancing the partners program. Watch in the upcoming year for additional strategies to hear your voice in each region and please be sure to participate, because without your voice, we can’t know what your community needs.
COVID is placing strains on resources everywhere, and ILCA is no exception. It is also requiring rapid responses, such as our quick pivot to a virtual conference this year. Please join us in thanking our incredible conference team for making this possible.
ILCA Member:
Where can I get more continuing education for L CERPs?
ILCA Board and/or staff:
Here at ILCA! We are currently offering more than 25 L CERPs as a part of your membership. If you have any questions about accessing your member benefits, please be sure to reach out to our incredible membership team at membership@ilca.org.
ILCA Member:
We received a number of questions and comments about how ILCA is working to promote the IBCLC profession globally and how that affects issues that are more local, such as licensure or payment models.
Questions included:
What is being done to protect the prestige of the IBCLC, in a political environment that does not want to pay for the training?
What is ILCA doing to help non-RN IBCLCs in the USA become eligible to bill Medicaid for services rendered?
I am finding it more necessary for licensure of lactation consultants. It is a matter of safety and establishing our profession.
How does ILCA plan to champion IBCLCs and skilled lactation care in countries such as Pakistan that currently are a bit of a blind spot in the space for lactation support?
What actions can we take as a board to get more hospitals to hire IBCLCs pathway 3(non- RN)?
ILCA Board and/or staff:
ILCA is working hard to promote the profession at the global level, which we believe will create the environment needed for local and regional organizations to advocate for those needs that vary depending on the community, such as training opportunities, integration into the health care system, licensure, or insurance reimbursement.
We believe that our global-level advocacy work – which includes working alongside the World Health Organization and UNICEF in calling for universal access to lactation support – will make it possible for regional and local organizations to create meaningful (and context-specific) change for IBCLCs.
ILCA Member:
How does increasing minority consultants fit into the strategic plan of 2020 & 2021?
ILCA Board and/or staff:
The events of the past six months have shone a much-needed light on the need to focus on increased access to the profession for people in non-dominant cultures around the globe.
But even though the light on the issues may be brighter, the need for this essential work is not new. ILCA has been laying groundwork for this work for some time, starting with the Lactation Summits, which brought together IBCLCs and aspiring IBCLCs from around the globe to clearly identify the barriers experienced to the profession.
As Mudiwah and Sabeen highlighted at the AGM, ILCA is committed to a series of action steps that follow directly from our focus area of equity. We welcome our members both to get involved, and also to continue to hold us accountable to this critical commitment.
ILCA Member:
Have you taken into consideration introducing Spanish translation of all the Annual Meeting Conferences?
ILCA Board and/or staff:
ILCA recognizes that to be a truly international organization, the option to participate in a number of events – from conference and the AGM to our committees to educational opportunities – in multiple languages must be available.
We have taken the first step by close captioning (CC) our educational offerings, which makes it possible for those who require CC to participate. It also makes future translations much easier to execute. Putting into place the steps needed for a truly multi-lingual organization will be incremental, but we look forward to and are committed to the process.
ILCA Member:
In the future, are there plans for a reduced or discounted ILCA membership for retired IBCLCs?
ILCA Board and/or staff:
This already exists! We welcome you to join as a retired IBCLC at a reduced rate. Learn more at ilca.org.
ILCA Member:
We also received a number of questions about the conference, including:
What are the plans for the conference 2021?
Any chance to have an ILCA Conference in Europe?
Wow. 1300 attendees is more than ANY ILCA conference in history! I have to believe that 54 countries = most diverse worldwide representation as well. No doubt the greatly-reduced cost to attend online helps. I wonder if returning to a four-day in-person conference in 2021 will meet the educational needs of this many members. Is it to be a hybrid conference, with some/all online options?
ILCA Board and/or staff:
We are excited, too, about the ways that a virtual conference made diverse participation possible.
In the past, the location of the ILCA conference has rotated, with one conference every three years in a country outside the US. Prior to the pandemic, ILCA was already exploring new models of hosting conferences that would allow for a more regional approach. Of course, COVID has made this sort of planning more challenging.
We plan to incorporate more virtual aspects to future conferences for a hybrid, more accessible event. The 2021 conference is currently planned as a hybrid event in Houston, Texas, US.
ILCA Member:
Is it possible to set a cultural equity development group?
ILCA Board and/or staff:
ILCA shares your commitment to being inclusive of different cultures, as is reflected in the diversity of our board. ILCA currently engages in this work through the equity committee. We would love to see you join! Contact education@ilca.org for more information.
ILCA Member:
Does ILCA plan on implementing a scholarship fund for expenses?
ILCA Board and/or staff:
ILCA offers equity pricing for members which adjusts the fee structure based on the economic status of the member’s country. Learn more at ilca.org.
ILCA Member:
When will the IBCLC Care Award recipients be announced? Thank you.
If so, how often are they held? I assume the board is meeting virtually. How can members attend?
ILCA Board and/or staff:
First and foremost, ILCA is deeply committed to transparency in all of our actions. The change that has happened globally from in-person to online meetings has led to a number of opportunities for members to be involved in unprecedented ways with the organization. Board meetings in the United States are bound by certain rules and regulations that are in the process now of catching up to this new, virtual world. We are working now on ensuring the new rules, our bylaws, and our commitment to transparency in meetings are all in alignment.
ILCA Member:
Where are the bylaws on the website? I can’t seem to find them.
In previous years, I was able to find the minutes or a summary of the board meetings on the website. I can’t seem to find them now.
ILCA Board and/or staff:
The Bylaws and Board Meeting minutes are in the process now of being populated on the “ILCA Connect” portion of the website. We look forward to sharing those with you soon.
ILCA Member:
A question for JHL – why are there not more IBCLCs as authors?
Journal articles are rigorous and challenging for those who are not familiar with them. Yet, if ILCA and JHL valued the IBCLC credential and other breastfeeding certifications, could a requirement be added that one of the authors must have some sort of lactation certification?
ILCA Board and/or staff:
While access to the Journal of Human Lactation (JHL) is a member benefit, the JHL intentionally maintains editorial independence, with the goal of ensuring that its content is held to the highest possible scientific standard and free from outside influence. We encourage you to direct your questions about JHL editorial decisions to the JHL editor and staff.
Questions for the International Board of Lactation Consultant Examiners® (IBLCE®) and LEAARC.
Our profession is supported by three independent but interrelated pillars: ILCA, your professional association; IBLCE, which sets the standards for the profession and oversees the exam; and LEAARC, which sets standards for education. (Learn more about these three pillars here).
We received a number of important questions that fall outside of our scope. These include questions like:
I am IBCLC valid 2001 thru 2021 this year with retired membership. Am I required to sit the exam next year?
How can you help us in starting a LC course in my institute?
What do I do about becoming a retired Ibclc?
Please let me know how I can become an IBCLC.
ILCA deeply values the role of all three pillars, and maintains close conversations with them to ensure that your voice is heard at IBLCE and LEAARC. We have passed along your questions to them.
Have other questions? Please post them in the comments!
Congratulations to the 2020 IBCLC Care Award recipients! In the midst of these unusual times, we thank you for your consistent dedication to promoting, supporting, and protecting breastfeeding by hiring IBCLCs and implementing projects and training that support high-quality lactation care.
What are the IBCLC Care Awards?
Hospital-Based Facilities and Community-Based Health Agencies that staff current International Board Certified Lactation Consultant® (IBCLC®) certificants, have planned and developed 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
People with disabilities are experienced at adapting to a world that is largely designed without considering their unique needs. Breastfeeding and chestfeeding parents are no different. As new parents, those with disabilities capably develop strategies to meet their breastfeeding goals.
As lactation providers, it is our obligation to familiarize ourselves with the unique needs of parents with disabilities. However, many of us did not receive training in providing this support, as there is very little research examining the strategies and techniques that best serve lactating parents with physical disabilities.
Tiahna Warkentin, an MD candidate (2020) at the University of Toronto, wants to change that fact. At the 2019 ILCA annual conference, Warkentin presented the results of a study she and her colleagues undertook to examine the breastfeeding experiences of parents with physical disabilities. Warkentin’s study (a summary of which was recently published in the American Journal of Obstetrics and Gynecology) offers fresh insight.
Based on her research, here are the important take-aways and action steps you can use to better support a client with a physical disability.
Tailor your help. The experiences of people with physical disabilities vary widely. A disability can be visible or invisible, short- or long-term, intermittent or ongoing. Common issues include pain, weakness, and problems with mobility or flexibility. Because of this diversity, the first key is understanding your specific client as completely as possible. Think through the client’s strengths and challenges and determine how they might affect breastfeeding. Listen carefully, think creatively, and be willing to experiment, reevaluate, and try something new.
Realize it is a demanding combination. A physical disability can make the regular exhaustion of new parenthood and chestfeeding or breastfeeding extreme. One mother in Warkentin’s study, who needed to feed her baby with an SNS and then pump at each feeding, eloquently described the exhaustion she experienced while repeating this routine throughout the day. “I’m sure many of us can appreciate how demanding of a process this is and how much an additional burden [a physical disability] can add,” Warkentin says. Acknowledging the enormity of the task undertaken by a client with a physical disability can help you provide empathetic and appropriate care and advice.
Common challenges can be harder. Of course, parents with physical disabilities are not exempt from “regular” lactation hurdles, but a physical disability can make these issues more challenging. For example, unlatching, repositioning, and re-attaching baby repeatedly to get a better latch may cause exhaustion or a worsening of chronic pain. “[There can often be] an additional physical burden related to latching on top of the physical challenges related to experiencing a physical disability,” Warkentin says. When your client experiences a common breastfeeding problem, understanding and anticipating these layered challenges can help you offer better support.
Positioning: Experiment and modify. Many study participants found they needed to modify traditional positions before they were successful. For example, one parent whose disability involved right-sided weakness found she needed to use her left hand to support her right hand when using a cross-cradle hold. Once she made that modification, the position worked. Another found that the football hold worked wonderfully on one side but not at all on the other, due to her specific disability, so she added it to her toolbox, but only for one side. This is where you can help—by understanding your client’s specific strengths and challenges, and helping them experiment with a wide variety of positions, you can help them find the ones that are most effective. [An important note on positioning: All of those in the study who tried breastfeeding lying down found it useful and many commented that it helped tremendously for relaxation, rest, and easy latching. It is definitely worth helping your client explore reclining positions that may work for them.]
Look critically at tools and accessories. Similarly, traditional breastfeeding aids such as pillows may need extra thought. All of the study participants said they used pillows to help position baby, but some found commercial breastfeeding pillows unhelpful. Participants whose disability involved short stature, for example, found that commercial pillows lifted their baby too far up. They found a thinner bed pillow or a blanket was a better choice. “This is a very good example of how breastfeeding accessories may not be designed for this population and may require modification depending on the mother’s unique needs,” says Warkentin.
Consider an extra set of hands. Especially at first, many of the participants in Warkentin’s study found having another person physically assist them with breastfeeding was very helpful. Partners and support personnel were the most common helpers, and assistance usually involved physically positioning the baby. Some parents needed this help long-term, while others were able to transition to breastfeeding independently once their babies got older. Suggesting that your client utilize help from another person in the beginning, with the goal of reevaluating and setting new goals as time goes on, is a good strategy.
Breastfeeding in a wheelchair. When a client uses a wheelchair, it’s important to help them figure out how the wheelchair fits into their breastfeeding strategy—and this may change over time. “Experiences with breastfeeding in a wheelchair were highly individualized,” Warkentin says. Challenges included moving from bed to wheelchair during the night to breastfeed and positioning the baby within the space limits of the wheelchair as the baby grew. “Overall, women reported challenges nursing in a wheelchair that developed over time,” Warkentin explains. “As a provider, it may be important to follow up with clients who attempt breastfeeding in a wheelchair, to be able to identify these barriers and challenges early and make recommendations and offer support.”
Ongoing support is key. In fact, this last piece of advice applies to any time a client has a physical disability: Make sure your helping relationship lasts over time. Checking back in, reevaluating to make sure previous strategies are still working, and being alert for when a new challenge may crop up are important for all clients, but take on even more significance for clients with physical disabilities. “It’s so important for us to realize that healthcare providers have an important role to play in supporting these women in meeting their goals and doing what we can to listen and respond to the unique needs and experiences of these women,” Warkentin says.
Note: While the research was conducted and written up well before the current COVID-19 pandemic, we want to acknowledge that the pandemic and restrictions in much of the world present special challenges for individuals with disabilities. Some may be at higher risk for health complications from contracting COVID-19, and need to be especially cautious about isolation. The need to minimize or eliminate outside contacts can affect the availability of the physical, hands-on support many parents find helpful. It may also affect their ability to seek in-person lactation support. We encourage all lactation supporters to be especially proactive and creative in their support for individuals with disabilities who are breastfeeding or chestfeeding during this time.
Ready to learn more? ILCA members can access this webinar for free right here! Not a member yet? Learn more about accessing ILCA continuing education here.
At the time of the webinar, Warkentin’s article was not yet published. It is now available here:
Breastfeeding and chestfeeding parents who are part of the workforce face unique challenges. If you are one of them, you have made an excellent choice for yourself and your baby! Below, experienced International Board Certified Lactation Consultant® (IBCLCs®) provide their best advice for combining lactation and employment.
For many of us, how and where we work, and how safe we feel at work, are changing rapidly in the midst of the COVID-19 pandemic. Much of the advice below applies regardless of when and how you are returning to work, and we have also included tips that are more specific to this point in time.
Be Mentally Prepared. Lactation and employment can absolutely be combined, and parents the world over do it successfully every day. However, it’s important to prepare yourself for the reality that working while breastfeeding is a demanding role. “Congratulations on your decision to provide your milk to your baby while you go back to work!” says Betsy Hoffmeister, IBCLC. “Working and breastfeeding/chestfeeding parents really have two jobs, which can be particularly exhausting.” Give yourself credit for how hard you are working. Reduce other stresses in any way you can. Do not be afraid to ask for help, and be willing to let other priorities go for a time.
Know Your Rights. Depending on where you live, laws may safeguard and facilitate your choice to pump at work. “Some countries provide protections for working parents,” Tori LaChapelle Sproat, IBCLC, points out. “That is worth looking up.” In the United States, for example, an employer with more than 50 employees legally must provide a private, non-bathroom space with a refrigerator and a sink for pumping parents. Lactating parents in the Philippines are entitled by law to a minimum of 40 minutes to pump or nurse per eight-hour work period, and employers are mandated to provide an appropriate lactation station. Other countries, like Greece, have laws against requiring nursing parents to work overnight until their baby is 12 months old.
Inform Your Employer. When you know you will be pumping at work, the time to get everyone on the same page is before your baby arrives. “Talking to your employer prenatally is essential,” advises Tori LaChapelle Sproat, IBCLC. “I’ve found in working with parents in a variety of fields, from military to office to restaurants, that having this conversation while pregnant helps a lot.” What should you plan to discuss? Present a proposed pumping schedule and plan to talk about how it will fit into the demands of your particular job. “The strategies that work for one type of job might not be the ones that work in another industry,” notes Cathy Carothers, IBCLC. If you live in the United States, the Office on Women’s Health website offers tips on how to make it work in your particular job setting. As you return to work at a time of heightened risk and concern, it is especially important to discuss this with your employer. Certain work settings (for example, health care workers who must stay in layers of personal protective equipment throughout their shift) make it more challenging to pump, and you may want this taken into consideration as your supervisor(s) decide how to assign you.
Stay Safe. As the world deals with the COVID-19 pandemic, you may have concerns about how this may affect expressing milk for your baby. Fortunately, research so far shows that COVID-19 is not transmitted via human milk – although antibodies are, which likely provide babies with protection. When pumping at work, as always use good hygiene practices by washing your hands, handling pump parts carefully, and cleaning parts thoroughly.
Make the Case. Another good move during your meeting with your employer: Present the “good business” case for breastfeeding. Let your boss know that your choice to provide your milk for your baby will also benefit them! “The Business Case for Breastfeeding is an absolutely brilliant website you can share with your employer explaining how much money they will save by supporting you in pumping for your baby,” Hoffmeister says.
Gather Knowledge. What is the best pump for your situation? How many times during a workday should you express your milk? How much milk should you leave each day for your baby? Parents who pump will need to answer these questions, and more. Learning as much as you can before your baby comes is key. Two great ways: Attending a local and/or online parent-to-parent support group meeting prenatally, and scheduling a prenatal IBCLC consult. “Find a lactation consultant and talk about pumping logistics for while you are at work, hands-on pumping, when to start collecting milk after having your baby, and be sure you are properly fitted for a pump,” LaChapelle Sproat offers.
Be Flexible. Many people who did not expect to be working from home are now doing so for an indefinite period of time. If you are working from home, and your baby is also home with you, you may not be sure how you want to manage feeding and pumping. Does it make sense to pump if your baby is just in the next room? Sometimes it might – if there are times you can’t be interrupted, it may be easier to pump beforehand and leave a bottle for whenever your baby needs it. At more flexible times, it may be easier to skip all the steps of pumping plus cleaning parts and bottles and just nurse your baby. Keep in mind that babies who no longer receive a bottle can lose interest in it. If you would like to keep your baby used to bottles – especially if you anticipate work-from-home ending at some point soon – it’s a good idea to give a few bottles a week.
Know Your Magic Number. Paying attention to how many times you breastfeed or pump during your parental leave (if you have one) gives you a good baseline when choosing how many times to pump at work. If you drop below your “Magic Number,” you may have difficulties keeping your milk supply going strong. “Keep an eye on how many milk removals (breastfeeds plus pumps) you do in a day,” says Nancy Morbacher, IBCLC. “Keeping that ‘Magic Number’ steady after you go back to work should prevent a dip in milk production.”
Educate Your Caregiver. Lastly, make sure the person who will care for your baby while you are working understands the nuances of feeding a breastfed baby. They will need to know proper handling techniques for human milk and be familiar with how to give your baby a bottle in an appropriate way. “Paced bottle feeding” is a good technique to know. “Avoid over-feeding when using a bottle, so that the parent can keep up with the baby’s needs when separated,” advises Laura Spitzfaden, IBCLC.
An International Board Certified Lactation Consultant® (IBCLC®) is a healthcare professional who specializes in the clinical management of breastfeeding.
A lack of access to culturally matched skilled lactation providers is one of the barriers that Black families face while working towards their breastfeeding and chestfeeding goals. In a recent address to more than 1500 participants around the globe, ILCA’s immediate past president, Mudiwah Kadeshe, shared the impacts of inequities in breastfeeding and a model for creating change.
Watch her presentation here:
Here is a transcript of her presentation:
Breastfeeding is a public health imperative. You cannot separate it from health equity.
As France [Begin, Senior Advisor, Early Childhood Nutrition at UNICEF] shared with us earlier, we know the cost of not breastfeeding is enormous.
And yet, we also know that while most mothers around the globe start breastfeeding, those who are economically or socially vulnerable are most likely to struggle with breastfeeding.
In high resource countries, low income families and those with less education are less likely to breastfeed than their high income counterparts.
And even where breastfeeding is more prevalent, in low- and middle-income countries, still less than 40 percent of infants under six months are exclusively breastfed.
Inequities in breastfeeding occur not just around income and education, but around other identities, including race, religion, sexual orientation, gender identity, and ability.
Inequities in lactation result because of the systems that perpetuate barriers to access in health care, including skilled breastfeeding care.
In both my global work with ILCA and locally with the Washington DC Breastfeeding Coalition, I have seen that addressing these barriers is possible. But it will take all of us.
How can we deliver skilled breastfeeding support both locally and around the globe? I know that International Board Certified Lactation Consultants, or IBCLCs, play an essential role, because the clinical skills these providers bring are particularly helpful in special circumstances, like small or sick newborns.
IBCLCs are just one of the many kinds of providers that can and do work together to ensure support for those critical first 1,000 days of life. I want to share with you one model of bringing together different providers of skilled breastfeeding care for addressing barriers – my work as a part of the DC Breastfeeding Coalition.
Our model has three essential components: knowledge, partnerships, and funding.
Equity starts with knowledge of the community’s needs. Washington DC is truly a tale of two cities. On either side of the river, you see very different communities, each with very different breastfeeding outcomes.
Working closely with the community, The DC Breastfeeding Coalition saw that one reason for those disparities was a lack of access to skilled breastfeeding support. Together, we established the East of the River Lactation Support Center to break down that barrier.
At our Center, we wrap care around the mother, from before birth until weaning. We ensure that the mother and child receive consistent care from trained, integrated, and collaborative teams of skilled breastfeeding care providers.
Breastfeeding education begins during pregnancy, provided by a community based peer educator. Peer educators continue to provide care at the hospital and after birth, and are full members of the health care team. As peers from the community, they are skilled at teaching breastfeeding, and they are experts in the culture of the families they serve.
Lactation care continues in the clinic. Routine questions are answered by a peer educator or Certified Lactation Counselor, who supports the normal course of breastfeeding.
More complex issues are referred to an IBCLC or a breastfeeding medicine specialist. Throughout care, this team works together.
Partnerships are critical to our success. Our peer educators go where the breastfeeding mothers are, including into the local public schools, providing support to breastfeeding students in the classroom.
Our team also provides care to one of the most marginalized populations, the deaf community, through our breastfeeding support for the students and employees of Gallaudet University.
We work with employers, conferring awards to those who create a supportive environment for their breastfeeding employees.
We facilitate a Lactation Certification Preparation Course for individuals from underrepresented groups to prepare them for the IBCLC exam.
Funding programs that generate positive results is critical. The Coalition is supported through grant funding. What you value is what you measure! The DC Breastfeeding Coalition developed a custom database to collect demographic data and breastfeeding rates.
We are in the early phases of data analysis, and know first hand that these efforts are most needed in the communities with the fewest available resources.
And, we are also looking towards ways that, over time, our program can become self-sustaining. But we know it will take time to get there.
In the meantime, models of skilled breastfeeding support, like the DC Breastfeeding Coalition’s efforts at East of the River, need sufficient and sustained financial support if they are to continue.
We know that breastfeeding prevents malnutrition, ensures food security, even in times of crisis, and plays a role in breaking the cycle of poverty. And, we know that skilled breastfeeding support – in all its forms – plays a critical role in improving breastfeeding outcomes.
Together, we can ensure that all families have access to the breastfeeding support they need to achieve the equitable health they deserve.
To view the entire webinar or to hear this presentation in Arabic, French, Russian, or Spanish, click here.
Mudiwah A. Kadeshe has more than 25 years of experience in women’s health nursing. Informed by her own birth experiences, she entered the profession wanting to support women in their birthing choices and became a certified childbirth educator and an International Board Certified Lactation Consultant to increase her ability to reach families. Mudiwah established and directed a lactation resource center at a tertiary
care medical system hospital that facilitated more than 3000 deliveries per year. She currently is a community based lactation consultant in one of the most poverty stricken wards in Washington, D.C. and oversees the peer counselor services through the Children’s National East of the River Lactation Support Center. She is currently the Vice President, Program Manager, and lead facilitator for grant-based projects for D.C. Breastfeeding Coalition.
