Do Interruptions Interfere with Early Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

In the Jan/Feb 2012 edition of the American Journal of Maternal Child Nursing, Barbara Morrison and Susan Ludington-Ho published a study looking at Interruptions to Breastfeeding Dyads in an LDRP Unit(1).   They observed the doors to the rooms of 30 breastfeeding mother-infant dyads in a community hospital birthing center from 8AM to 8PM on post-delivery day 1, and found that mothers were interrupted an average of 53 times in that 12 hour period.  The average duration of interruptions (18.5+/- 34.5min) was longer than the average duration of time alone (15.4+/-17.3 min), and half of the episodes of time alone lasted 10 minutes or less.

As mothers in the study reported that they spent an average of 25.68 minutes (+/-16.7) at each breastfeeding session, these interruptions were likely to impact early breastfeeding when frequent breast stimulation is critical.  In fact, breastfeeding frequency was moderately negatively correlated with the number of interruptions.  Additionally, the authors found that a mother’s satisfaction with her breastfeeding experiences was significantly correlated with her perception of amount of time alone with her infant, and when mothers felt interruptions interfered with breastfeeding; they found the interruptions more annoying.

Although I was astonished at the number of interruptions this study found in a 12 hour period (consistent with an earlier study in a university hospital(2)), I was not surprised that frequent interruptions impact breastfeeding. Given attitudes in the United States about breastfeeding in public, mothers may feel self-conscious about baring their breasts to visitors, nurses, and other hospital staff members while learning to breastfeed. Ideal amounts of skin-to-skin contact and relaxation may be difficult to accomplish when mothers feel they need to keep one eye on the door and a cover-up at the ready.  Even when this isn’t the case, a mother who finds herself continually interrupted to place her lunch order, talk to visitors, answer the phone, have her vitals checked, and talk to physicians may delay or shorten breastfeeding sessions.

Not surprisingly, the majority of the women in the study only met the minimum recommended number of breastfeeding sessions (4 times in 12 hours), and several mothers fed their babies only 2 or 3 times for less than 15 minutes in that time frame.  As infrequent and inadequate breastfeeding sessions can rapidly progress to infant weight loss and supplementation, this finding is particularly relevant to the cause of increasing breastfeeding duration and exclusivity. Coupled with this, frequent interruptions may prevent mothers from getting the rest they need to recover from childbirth and have the energy for frequent nighttime feedings.

Undoubtedly, many interruptions are necessary and unavoidable; however Morrison and Ludington-Hoe have a number of suggestions to minimize the impact on breastfeeding.  These include:

  • Discuss the importance of alone time, Kangaroo care, frequent breastfeeding and limited visitors during prenatal visits, classes and tours.
  • Cluster care, plan care activities with mothers to enable quiet times, use door signs to signal time alone, and institute “quiet” times when no visitors or staff enter rooms.
  • Minimize rounds and discontinue 24/7 visiting hours.

In our efforts to translate high breastfeeding initiation rates into longer breastfeeding duration, we must continue to remove barriers to establishing a successful breastfeeding relationship.  As we think about how to best accomplish this task, minimizing the frequency of interruptions to mothers and baby may be a simple step in the right direction.

1. Morrison BP, RN, FNP, CNM; Ludington-Hoe, Susan PhD, RN, CNM, FAAN. Interruptions to Breastfeeding Dyads in an LRDP Unit. American journal of Maternal Child Nursing 2012;37(1):36-41.

2. Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2006;35(6):709-716.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants.  I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating!  As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

Lactation Matters Editor’s Note: Just to add, Jennie has a brand new addition to the family.  Welcome Noah Lev, born on Oct 28, 2011, who is breastfeeding beautifully!  Congratulations !

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New Possibilities in 2012! A message from our President

Beginning a new year can be a rejuvenating time to set new goals and explore new opportunities.  For the International Lactation Consultant Association, the opportunities have never been greater!  I hope each of you will resolve TODAY to get involved in your professional association.  You’ll find, as countless others have, that giving your time and your talents will come back to you in the most incredible ways as you seek to make a difference.

Earlier this week I sent my ILCA President letter to inform you about the status of ILCA as we begin this new year.   Click here to read about ILCA’s strong foundation of sound financial health and highest membership numbers ever (over 6,000!), and details about the many exciting new initiatives.

Coming in 2012:

  • The 2012 ILCA Conference in Orlando…with live simultaneous translations in Spanish for the first time ever, a new ILCA “lounge” for networking with colleagues, and family activities to make this a wonderful vacation while you learn.  Be sure to check out the YouTube™ video at http://www.youtube.com/watch?v=yzEeqvRsCRw&feature=youtu.be and pass it along to your colleagues on your Facebook™ and Twitter™ sites and be an early bird registering and have an opportunity to win a fabulous i pad 2, check the details.   http://www.ilca.org/files/events/ilca_conference/2012_Conference/Registration_Brochure.pdf
  • New changes to the Journal of Human Lactation under the new editorial leadership of Anne Merewood.
  • CERPS on Demand© with a full slate of webinars in many languages!
  • Baby-Friendly Initiative Committee to explore strategies for promoting and implementing BFHI worldwide.
  • European Task Force to address member needs across Europe.
  • Continued expansion of our robust translation program.
  • Collaborative projects with IBLCE, including a NEW consumer website, IBCLC promotional brochure, and hospital outreach initiatives.
  • Position papers and clinical protocols.
  • NEW edition to the Core Curriculum for Lactation Consultant Practice.
  • Expansion of our global relationships worldwide.
  • And more!

I love to sign my communications, “ILCA is YOU,” and I believe that phrase perfectly captures how important each of you are to ILCA’s success.  There has never been a better time to get involved, so join us in 2012 as we work together to meet the needs of the lactation community worldwide.

Cathy Carothers, BLA, IBCLC, FILCA ILCA President 2010-2012

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Clinicians in the Trenches – Rose deVigne-Jackiewicz

I first met Rose deVigne-Jackiewicz in 2008, when I began my supervised clinical hours (through UCSD’s Lactation Consultant Program) at her outpatient lactation clinic at Kaiser Permanente in San Diego, CA.  Within minutes I knew that this woman was special!  Her kindness and support she offered me, as well as the plethora of ‘soon-to-be lactation consultants’ that spent time in her clinic, was unmatched.  Within months she transitioned me from a passive spectator to an active participant in helping mothers learn to breastfeed their babies.  I will forever be grateful for the education and clinical style that I learned, and continue to learn, from Rose.

How did you decide to become a lactation consultant?

When I was working in Labor and Delivery, I learned about the lactation consultant training program at UCLA. My supervisor asked if I would like to take the program (she was offering to pay for the program). I had one baby and breastfed very successfully, but realized how much I really didn’t know.  I would help new mothers start breastfeeding after delivery, but thought there was nothing to it, just put the baby to breast and they would nurse.

So I trained at the UCLA program in 1984. I was pregnant with my 2nd baby at the time. When I finished the program, I admit, I felt a little cocky: I am now a lactation consultant (thought I know everything), had already breastfed a baby, and was ready to breastfed my 2nd baby when she was born. What could go wrong?!

The first mother I worked with after my training was a young 19 year old who was having problems getting her baby to latch. I worked with her for 3 hours that day. Went home, patting myself on the back, thinking, wow, I did a great job working with that mother. When I came back to work the next day, I found out in report, the mother decided to switch to bottle feeding. I admit, my first thought was, “How could she, after everything I did for her yesterday”. Well, that mother taught me a very valuable lesson…first, 3 hours is WAY too long to work with mother and baby at a single time, second, TALK to the mother, find out how she is feeling about the feedings, and what does SHE want to do. I had just charged in and followed my own agenda. Wish I could go back and apologize to that mother!!!

Can you describe a typical day in your outpatient clinic?

A typical day in my outpatient clinic, hmmmm. Well, first of all, it is usually fully booked!

I start the day by reviewing the schedule and gathering the information about mothers and babies coming in that day. The babies range from a few days old to years old, depending on the issues.  The majority of the babies are newborn to 6 weeks old.  I receive calls from other pediatrician’s, obstetrician, and primary care offices with mothers and/or babies that need to be seen. So in spite of the schedule being full, I often will add on throughout the day. I will often need to contact the pediatrician or obstetrician due to special issues going on with mother or baby (such as excessive weight loss, jaundice, mastitis, etc).  Throughout the clinic day, there are frequent knocks on the door, mothers wanting to ask a question, walk in – wanting to be seen, and also mothers just wanting to show me their baby or grown child and saying ‘Thank You’ for helping them be successful at nursing their babies. I have learned to multi-task throughout the day, seeing 1-3 mothers and babies at one time, answering the phone, answering the door, etc.

What is your favorite aspect of your job?

Having a new mother come in to the clinic in tears, wondering what she is “doing wrong”, and having her walk out all smiles.  The saying on my cup says, The Greatest Joy is Nursing One’s Own Infant, The Second Greatest is Helping Another Woman to Nurse Hers.

I have the best job.  Not only do I help mothers learn to feed their baby, but I help them become a better mother and we end up with a happy, healthy mother and baby!

Being a resource for other nurses and physicians is another very rewarding aspect of my job. I get many calls per day from other health professional asking for information related to “their” patients.

You are a mentor many soon-to-be LCs.  How has this enriched your practice?

Oh, my goodness, I love working with and mentoring soon-to-be LCs. When I finished my training at UCLA, I got my clinical training, “on the job”.  I look back to those early days and wished I had someone beside me, guiding me. Being able to help educate someone else to do what I do is really an honor. But, it also helps me in the clinic, having an extra set of hands in the clinic help me help MORE mothers and babies.

Do you have any advice for other lactation consultants who plan to mentor a new LC?

Don’t look at it as “something else you have to do”. You are seeing the mothers and babies anyway. It really does not take that much more time (overall). Once your ‘lactation-consultant-in-training’  is “oriented”, you will find you can get MORE done and see more mothers and babies. Remember when you were new in the field….. give back! You will really enjoy it. Also, I want to be able to pass on that passion to those following in my footsteps. I will not be here forever…. I want those taking over for me to have the same experience, knowledge and passion as I do.  Call me if you need help!!

Rose deVigne-Jackiewicz, RN, MPH, IBCLC, has been a lactation consultant since 1984.  In 2000, she started one of the largest outpatient lactation clinics at Kaiser Permanente in San Diego, CA.  Rose has mentored several hundred soon-to-be lactation consultants through the UCSD Lactation Consultant Program.  She also has given many lectures around the country, including ILCA in 2011.

Robin Kaplan, M.Ed., IBCLC, Co-Editor of Lactation Matters, Owner of San Diego Breastfeeding Center

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Video Vignettes – Family Support for Breastfeeding

All rights reserved by LittlePao

Breastfeeding is an intimate relationship, rather than a skill to be learned.  While mother and baby are getting to know each other and forming their intimate bond – lactation consultants can guide family members to also play a supportive role in breastfeeding success.

Family members express their love and support in many ways – some expressions of love are supportive of breastfeeding and some less so.   Grandma that encourages the mother to get some rest and send the infant to the nursery is doing so out of love without realizing the potential negative impact the separation may cause on the breastfeeding relationship.  Or, brother that mentions his own practice of initiating solids early to improve sleep may inadvertently cause a diminished milk supply before baby is ready to wean.

Lactation consultants can encourage new mothers (and their families if possible) to agree on feeding goals.  What is the breastfeeding goal for mother and baby?  6 months?  One year?  IBCLCs can also educate the family during the hospital stay about the normal behaviors of infants, the expected frequency of feeding, the sleep patters of newborns and the cues infants send when they are hungry.  Working the education into the conversation as mother and LC visit during the hospital stay will support the breastfeeding dyad.

As always with this monthly blog entry, we have identified several YouTube videos available to assist the LC or the breastfeeding mother in defining family support.

Baby Gooroo offers this great, short visual about fathers and their important role in supporting the breastfeeding dyad- How Can Dad Help? 

WomenseNews has a great video called “A Father’s Side of Breastfeeding.”  This video is targeted for African-American mothers and fathers to address the statistic of lower incidence of breastfeeding in the African-American population.  Appropriate for all audiences – excellent points, personable presenters and accurate information.  

Please send additional videos you are using to encourage family support of breastfeeding to lactationmatters@gmail.com.  We would love to feature them on our blog!

Wendy Wright, MBA, IBCLC Co-Owner Lactation Navigation – Workplace Lactation Consultants, LLC

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Preparing for the New Year

As Lactation Matters enters 2012, we would like to revisit our mission and assess if we are meeting your professional needs.  As we launched this blog in August 2011, our goals were to:

  • Nurture your education and self-confidence as a health-care professional and lactation consultant
  • Provide insight into current lactation research
  • Share stories about the different facets of our profession and how lactation consultants are practicing around the world
  • Report global breastfeeding movements and events
  • Share tricks of the trade

Are we meeting these goals for you?

In which areas would you like to see more articles? Which experts would you like to learn from?

Are you interested in sharing YOUR story?

Please take a few minutes to answer our poll so that we may increasingly meet your professional needs in the upcoming year.

Also, we have a one question survey we would love if you would answer. Please click below on the ‘Take Our Survey’ button:

Take Our Survey!

As always, if you find an article that you feel your colleagues would benefit from, please link to it from your Facebook page or Twitter account and add comments to the bottom of the blog to keep the conversation going.  If you are interested in submitting an article to Lactation Matters, please contact us at lactationmatters@gmail.com.

Best wishes during this holiday season!

Warmly,

Robin Kaplan, M.Ed., IBCLC, Lactation Matters Editor, Owner San Diego Breastfeeding Center

Decalie Brown, RN, CM, CFHN, IBCLC, ILCA Director of Marketing

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Happy Holidays!

From those of us at Lactation Matters, we wish you well during this holiday season.  May you find joy and happiness spending time with family and loved ones.  May you find a few quiet moments to spend by yourself, relaxing and decompressing from an often-abundant workload.  May you find the time to reflect on all of the good you do for mothers and babies, throughout the world, as you provide them with the necessary support to continue breastfeeding.

We look forward to continuing to share your stories, provide you with professional support, and nurture your self-confidence as a health-care professional in the field of lactation.

Happy holidays and we will see you in 2012!

Robin Kaplan, M.Ed., IBCLC, Lactation Matters Editor, Owner San Diego Breastfeeding Center

Decalie Brown, RN, CM, CFHN, IBCLC, ILCA Director of Marketing

Keep sending your stories in to LactationMatters@gmail.com and hopefully meet in beautiful Orlando this July at the 2012 ILCA conference. http://youtu.be/yzEeqvRsCRw

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Becoming a FILCA: Part Two

In Becoming a FILCA: Part Two, Joy Heads shares her story.  Don’t miss Kathy Parkes reflecting on her designation as FILCA in Becoming a FILCA: Part One.

Joy Heads RM; CM, MHPEd, IBCLC, FILCA ILCA

BOD Global Outreach 2011-2014

Joy Heads describes being a FILCA as, “It’s important to be a Fellow of ILCA, as  ‘Fellowship’ is defined by the Encarta World English Dictionary (1999) as ‘a member of a learned or scientific society’. Professional organizations created the Fellowship as a formal way of recognizing a colleague’s contribution to their chosen profession. ILCA, as a relatively new professional organization, achieved this developmental goal in 2007, when it established the Fellow of ILCA. This designation would suitably recognize significant professional achievements of the leaders and mentors in the field of lactation consultancy.

Many IBCLCs contribute to their profession, not only by being a member but also by working on the various committees ILCA and its affiliates have. This may be, for example, on an Affiliate Board or part of ILCA’s Conference committee. Mentoring, lecturing, being an ILCA liaison or slogging it out at the coalface are all ways of promoting the profession of IBCLCs and their professional body, ILCA.

I wanted to be a Fellow of ILCA, because being a Fellow of ILCA recognizes proven commitment to ILCA which I am proud to have as my professional organization. The fact that it is self-nominated and self-funded appealed to me. I felt that I would be making an extra contribution to ILCA and in addition, if successful, I would be able to enthusiastically promote ILCA as THE experts in Human Lactation.

Within Australia, as in other countries we ‘compete’ – if that is the right word – with midwives. It is often difficult to present the Lactation Consultant as having an extended role in the mother/baby relationship. You have to remind everyone that midwifery care only covers the postpartum period of about six weeks. (International Confederation of Midwives 2005) where as the IBCLC can care for women for as long as they are breastfeeding – which in many cases is well beyond the second year of life.

Being accepted as a Fellow of your professional association is an amazing honor. You have to meet independently-set criteria that you know is objective. It was a real challenge to fill in the application form. I have been an IBCLC and an ILCA member since 1986 so digging back into my files/my life to document it was very empowering and proved to me that I had made the right choices along the way.

Breastfeeding became my passion when feeding my twins. Involvement in the Australian Breastfeeding Association and the Australia Multiple Birth Association followed. Once back at work and starting university for the first time the choices of teaching topics, electives and assignments revolved around my expertise… breastfeeding. It didn’t take me long to figure out that the lecturers didn’t compare notes – so I could use a breastfeeding angle in every assignment.

My first job as a nurse educator was to teach the “Bottle Feeding Demonstration” to the student midwives….. …that soon was replaced.  Over time, my professional life serendipitously fell into place to enable me to meet the established criteria and achieve my FILCA designation in 2008. Along with my Order of Australia Medal and my Masters being a FILCA is one of the highlights of my professional life.

All eligible ILCA members are encouraged to submit their application to permit this wonderful recognition as a Fellow of ILCA (FILCA).   Any questions, contact the ILCA office info@ilca.org.

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Becoming a FILCA: Part One

Become a Fellow of ILCA! Applications for this year are closing soon!

The deadline for applications for the 2012 Fellow of the International Lactation Consultant Association (FILCA) are about to close on December31, 2011.  This is a self-nominated, self-funded designation recognizing ILCA members who have achieved a high level of commitment to ILCA and to professionalism in the field of lactation consulting.

The application information for 2012 can be found on the FILCA webpage of ILCA’s website.  A “Fellow” of ILCA (FILCA) has achieved a high level of professionalism, demonstrated by meeting independently-set criteria, and will be permitted to attain this universal form of recognition. There is an application form, a fee to pay and once the Fellow of ILCA (FILCA) designation is achieved, membership is maintained by paying a small annual fee.

All eligible ILCA members are encouraged to submit their application to permit this wonderful recognition as a Fellow of ILCA (FILCA).  Any questions, contact the ILCA office info@ilca.org.

We have asked two of our Fellows of ILCA to give us some idea on what FILCA means to them.

Kathy Parkes, BSPsy, RN, IBCLC, RLC, FILCA

ILCA Treasurer, 2011-2014

Firstly, FILCA is an official recognition of your hard work. Have you spent years volunteering in your area affiliate group? Then moved on to work even harder and longer in your state affiliate? Have you mentored other up-and-coming lactation consultants, even though you know you have to put in many extra hours? Have you slaved away at the computer to write a book on lactation? You deserve recognition for all that time, dedication, love, effort, and work you put into your volunteer hours.

Secondly, being a FILCA is networking. You will be in a classification with other top-notch lactation consultants. Those with whom you can discuss situations and case studies, as well as practice guidelines, protocols, and situations about which you might be unsure.

Third, you are being a mentor. You are paving the way for new IBCLCs who will follow after you, in your footsteps, looking to you to share that knowledge with them. You are someone else’s mentor, the one they go to when they need to know how to solve a lactation problem, a hospital policy situation, or a private practice challenge.

And fourth, but certainly not last, being a FILCA is FUN. You can impress your favorite doctor with the new credential. You can meet other FILCAs and find out what they do that is totally outside of the realm of lactation. You get to eat lunch together at the annual ILCA conference.

So join us. Become a FILCA!

In Part Two, find out what being a FILCA means to Joy Heads.

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Nursing is Normal – A Video from the Central District Breastfeeding Coalition

Thank you so much to Betsy Ayers, a lactation consultant at Meridian St. Luke’s hospital in Boise, Idaho, for sending this video to Lactation Matters.  What a beautiful testiment to normalizing breastfeeding, especially in public!

If you have a video or story that you would like to share with our readers, please email us at Lactationmatters@gmail.com

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IBCLCs Around the World – Natalya Razakhatskaya

I was born in Belarus in 1978. While in school, I wanted to be a doctor just like my granny. Later, I entered the linguistic university and became an interpreter. After graduation, I started to work in a French IT company as a translator, but that job didn’t make me happy. I was eager to be useful to people, so when I got pregnant I decided to change my job. As a breastfeeding mother, I had many questions about breastfeeding and care of my first baby. I didn’t receive helpful assistance from my pediatrician. Luckily, I met the first Belarusian lactation consultant at that time, who explained the simplicity of breastfeeding.  Soon, I decided to become a breastfeeding counselor in order to help other mothers feel happy.

The am-am.info website was started in March 2008 as a personal blog, which my husband kindly gave to me as a present on Women’s Day. Gradually the blog was filled with articles about breastfeeding and natural parenting. At the same time, I began to meet with other breastfeeding mothers almost every week and the blog became a good place for communication. The blog became a unique community which, in addition to the forum, included a list of sites for women, Frequently Asked Questions (FAQ), and a photo-gallery and online consultations on various women’s topics. I made educational video clips about breastfeeding, and how to carry your baby in-arms and in a sling. After a few years of work on the blog, I managed to write and publish a book about breastfeeding, called “Breastfeeding: A Guide for Nursing Mothers”.

On average, about 5,000 people visit the am-am.info website every day. The most popular articles are about normal infant weight gain, infant stooling, low milk supply, and how to transition the baby from artificial feedings to full breastfeeding. Each day, I reply to about 10 e-mails, and about the same number of comments to articles, forum posts and telephone calls.  Also, the website supports live chat and Skype. Occasionally, I organize free educational webinars. I continue to meet with forum members in person at family centers around Minsk and organize local breastfeeding support events.

To encourage breastfeeding in public, we have created a special project: www.go.am-am.info. At this website, you can download stickers of the international breastfeeding symbol and distribute them to cafes and other public places which are friendly to breastfeeding mothers.

The project is funded from personal sources. I’ve received voluntary donations from other breastfeeding support group leaders and breastfeeding mothers from the forum who help answer questions of other visitors. I am really amazed to read feedback from many countries and know that my project can help breastfeeding mothers all over the world.

The purpose of the am-am.info project is to provide an informative resource about breastfeeding and natural parenting and to facilitate communication with other parents. I want to open a test center on this website, first for parents who are interested in breastfeeding, and then an educational platform for other breastfeeding specialists.

Natalya Razakhatskaya, IBCLC

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