Is Pumping Out of Hand? Why Hand Expression in the First 3 Postpartum Days is Important

Stanford trained, Jane Morton, became a partner at the Palo Alto Medical Foundation, where she practiced general pediatrics and was repeatedly recognized by her colleagues as
one of the top pediatricians in the Bay Area.  She was invited to join the Stanford neonatology faculty to develop their Breastfeeding Medicine Program. She designed a nationally recognized educational program, published her original research and traveled extensively and internationally as an invited speaker.  At the 2011 ILCA Conference in San Diego, CA, Jane presented this plenary session titled, “Is Pumping Out of Hand?”

Jane Morton, MD
Cl Professor of Pediatrics
Stanford Pediatrics
www.burgesspediatrics.com
drjane@burgesspediatrics.com

A low milk supply is the most common reason for mothers to stop breastfeeding. (1.)  We have learned that what we do (or do not do) in the first 3 days after delivery can have a major impact on future milk production potential.  In our research, we found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery. (2.)  Mothers who used hand expression more than 5 times a day in the first 3 days yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression and hand expression with electric pumping and does not require more time.  Of the 67 study participants, several volunteered to demonstrate hand expression and hands-on pumping on the Stanford website.  (3.)

For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch on and nurse effectively.  About 50% of mothers will have some difficulty getting their babies to latch on well in the first day. (4.) While providing a mother with a pump may be the easiest solution from the nursing standpoint, a recent study suggests it is more effective to teach her to hand express milk after breastfeeding. (5.) At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%). (p=0.02)

A smaller study suggests more milk can be removed with manual expression than with a new, double rental-grade pump in the first 48 hrs post partum. (6.) Given the feasibility and safety of spoon feeding, (7.) perhaps the routine practice in the first several days for infants at risk for suboptimal intake and/or mothers at risk for suboptimal milk production should be to encourage hand expression and spoon feeding after breastfeeding. This provides more milk for the baby and more stimulation to the breasts than breastfeeding alone. There seems to be no cost or risk and only potential benefit in this approach.

  1. Ruowei Li, Fein SB, Chen J,
    Grummer-Strawn L. Pediatrics 2008; 122(2):S69-S76.
  2. Morton J, J
    Perinatol. 2009 Nov;29(11):757-64. Epub 2009 Jul 2
  3. http://newborns.stanford.edu/Breastfeeding/  See: Hand
    Expressing Milk — video
    and Maximizing via Katy TX
    Milk Production — video
    . Complete video, Making Enough Milk, the Key to Successful Breastfeeding, can be
    previewed and purchased at www.breastmilksolutions.com
    . Soon available in Spanish
  4. Dewey KG.
    Risk Factors for Suboptimal Breastfeeding Behavior, Delayed Onset of Lactation
    and Excess Neonatal Weight Loss. Pediatrics 2003;112:607-619
  5. Flaherman VJ, Archives of Disease in
    Childhood 2011
  6. Ohyama M. Pediatr Int. 2010
    Feb;52(1):39-43
  7. Kumar A. J Perinatology 2010;
    30:209-217
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Round Table Discussion: Predictors of Breastfeeding (Part Two)

Today, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.  Each
author’s title and JHL research article can be found on the first article of this series: Round Table Discussion: Predictors of Breastfeeding Duration (Part One)

As breastfeeding advocates, what recommendations can you make for us to help increase breastfeeding duration in our communities?

Lucía Colodro Conde:  Influences from factors related to breastfeeding duration should not be considered immutable. Researchers and practitioners should consider the social environment in which influential factors take place, as this may modulate its impact. Family structure, social support, norms about natural or artificial infant feeding,
working conditions, health promotion interventions, or hospital practices, among others, could moderate this interaction. Interventions should be adapted to the mother’s conditions as a whole, taking into account their personal and social characteristics and their social context. Interventions should start before childbirth and support and guidance should be readily available to those women who aim to breastfeed, taking into account their individuality and the characteristics of the communities.

Pippa Craig:

  • Culturally appropriate and practical information at earlier stage of pregnancy.
  • Engage senior Aboriginal women to support younger women during pregnancy.
  • The importance of involving peer support by members of the Aboriginal community, as well as professional support for this cultural group.
  • Engage younger community mothers who have successfully breastfed to act as role models.

Pat Benton and Beth H. Olson: Even mothers who are intent on breastfeeding and
get support in the hospital, from family, or from programs like the BFI, indicate they do not find the environment outside their home to be supportive of breastfeeding-they even find it to be disapproving. Local breastfeeding coalitions where community partners (i.e., physicians, nurses, Lactation Consultants, business owners, etc.) come together to support breastfeeding have been successful in changing the community atmosphere regarding breastfeeding. Also, mothers find support groups/moms clubs, where they can go and share their experiences and receive support that breastfeeding is the natural way to feed
their babies, a great support system.

After completing your research, what additional factors would you like to see studied as predictors of breastfeeding duration?

Lucía Colodro Conde:  At the moment, we have two lines of research about some factors that, according to preliminary studies, are related to breastfeeding duration and can help to understand and predict it. First, we want to focus on which part of this health behavior is due to differences in genetic configuration and differences in environmental factors among individuals. And second, we aim to analyze the relationships between
psychosocial and personality factors, and the establishment and duration of breastfeeding. We highly support the need of a multidisciplinary approach to this complex behavior.

Pippa Craig:  Further explore psychological factors predicting breastfeeding duration. Introduce and evaluate more culturally acceptable pre-, peri and post-natal services for Aboriginal women.

Pat Benton and Beth H. Olson: We would like to see more work done with populations with low breastfeeding rates, to better understand their particular barriers
such that we might develop targeted support programs. We would also like to see more cost-effectiveness work done on breastfeeding and breastfeeding support that might help us impact public policy and private organizations so they improve breastfeeding support. Research suggests factors that impact breastfeeding in the first day(s) greatly diminish breastfeeding duration; we need to better understand how to provide support in the hospital and in the first days a mother is home with her new baby-including home visiting/follow up care for new mothers.

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Round Table Discussion: Predictors of Breastfeeding (Part One)

Over the past few years, the Journal of Human Lactation has highlighted several research articles that measured factors that directly impact breastfeeding duration.  As health care professionals and lactation consultants, the outcomes of these research projects should inform the way we practice as well as help us to target areas where we can support mothers to increase breastfeeding duration in our communities and countries.

Four authors from around the world have generously offered to share their research and offer recommendations to us based on their findings:

Lucía Colodro Conde, BA, MSc.
Psychologist, Master on Clinical and Health Psychology. Seneca Foundation Research Scholarship. Department of Human Anatomy & Psychobiology. (University of Murcia) Spain.
August 2011: Relationship Between Level of Education and Breastfeeding Duration Depends on Social Context: Breastfeeding Trends Over a 40-Year Period in Spain

Dr. Pippa Craig, Ph.D
Academic Coordinator, Inter-Professional Learning
TheHealth ‘Hubs and Spokes’ Project
ANU COLLEGE OF MEDICINE, BIOLOGY AND ENVIRONMENT
Australian National University
August, 2011: Initiation and Duration of Breastfeeding in an Aboriginal Community in South Western Sydney

Pat Benton, MS, RD, CLE
Program Manager
Michigan Breastfeeding Initiative
Michigan State University Extension

Beth H. Olson, Ph.D.
Associate Professor; Extension Specialist
Associate Department Chair
Director of Graduate Studies
Food Science; Human Nutrition
Michigan State University
February, 2009: Characteristics Associated With Longer Breastfeeding Duration: An Analysis of a Peer Counseling Support Program

What were the largest factors predicting breastfeeding duration in your study?

Lucía Colodro Conde:  In our study we focused specifically on the mother’s level of education, which has been reported to be related to breastfeeding practices. We analyzed the relationship between this variable and the breastfeeding trends in a region of Spain during a 40 year period, along the second half of the 20th century.  We found that the direction and/or magnitude of the association were not constant across time and level of education, suggesting that other factors may moderate this relationship depending of the social context (i.e., family structure, social support, or working conditions).

Pippa Craig: This study has confirmed that more educated mothers of Australian Aboriginal infants in an outer urban environment, and those intending to breastfeed, were more likely to breastfeed. Intention to breastfeed was the strongest predictor.

Pat Benton and Beth H. Olson: Among low-income mothers we found formula
introduction by day one predicted shorter breastfeeding duration. Many mothers in our studies that identify themselves as breastfeeders still supplement with formula or cereal earlier than recommended. Lack of social support leads to shorter breastfeeding duration; new mothers have no role models for breastfeeding, and rely heavily on support from family who discourage them from breastfeeding. We also found that many working women don’t consider combining breastfeeding and employment-they see these two roles as mutually exclusive. They don’t initiate breastfeeding or wean prior to going back to school or work.

What were the most significant findings in your study?

Lucía Colodro Conde:  Our main finding was that the association between maternal education and breastfeeding is not consistent over time.  Today, a higher level of studies
appears to predict a longer duration of breastfeeding; this has not always been the case.  Among women with fewer school years, breastfeeding duration reduced very early in the period studied and remained at low levels for the rest of the duration. Meanwhile, among women with secondary education or higher, the duration of breastfeeding also reduced
markedly until the 1970s, but then it began to increase steadily until the late 1990s. These trends could change again following societal evolution.

Pippa Craig: Low initiation rates and a rapid decrease in breastfeeding rates. This suggests either a lack of commitment or lack of support to assist new mothers with any
early difficulties with breastfeeding. There was a tendency for mothers to receive antenatal care late in their pregnancy, and there was a lack of adequate and culturally appropriate antenatal/postnatal support services in the area.

Pat Benton and Beth H. Olson: A peer counselor (a breastfeeding mother from the community, trained to provide support and referrals and making home visits) from The Breastfeeding Initiative program of MSU- Extension and WIC, significantly increased breastfeeding rates among low income mothers. This duration is longer even compared to mothers referred to the program but not enrolled (due to overcapacity), showing even among women motivated to find support-those with peer counselors breastfed longer. We found that low income mothers may receive infant feeding advice from several sources (Extension, physicians, nurses, home visiting programs, WIC) and find it conflicting. This contributes to factors, such as early introduction of formula, which may impact breastfeeding duration.

In Part Two, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.

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Working and Breastfeeding: Can we do both?

With the known benefits of breastfeeding for the infant, mother, and employer, it is discouraging that most mothers who initiate breastfeeding quit before their infants’ first birthday. Among children born in 2008, only 44% were breastfed at 6 months and 24% at 12 months, even though 75% were breastfed after birth. Work-related issues can be a major reason why women fail to start breastfeeding after the birth of their child, or stop breastfeeding before the child has received the full benefits.  With more than 50% of mothers of infants participating in the work force, we need to find ways to balance employment and breastfeeding.

Our recent study found that women who were working full-time (≥35hrs/week) were less likely to initiate breastfeeding or to continue breastfeeding beyond 6 months, compared to women who were not working. The breastfeeding experience of women who worked part time was similar to that of women who were not working. We also found that mothers in professional occupations (architecture, engineering, legal, health care practitioner, etc) were more likely to initiate breastfeeding when compared to women in administrative occupations or other occupations (namely farming, fishing, and forestry; construction and extraction; installation, maintenance, and repair; production; transportation and material moving; and military-specific occupations), even after taking into account several factors known to be associated with breastfeeding, including the amount of maternity leave time taken.

The findings from our study, and others, suggest that part-time work offers an effective strategy for successfully combining breastfeeding and employment. There has been some success with corporate lactation support programs in helping working women breastfeed longer.  However, pumping alone at work may be inadequate to maintain milk flow because direct breastfeeding stimulates the breasts more effectively than do the best electric or manual pumps. Among women who breastfed and worked, women who directly breastfed their infant during the workday persisted in breastfeeding longer than other breastfeeding women who returned to work.

We recommend that employers, in addition to providing comprehensive, high-quality lactation support programs, explore strategies that allow lactating mothers have direct access to their babies. Such strategies, as promoted in the Surgeon General’s Call to Action to Support Breastfeeding, include having the mother keep the baby with her while she works, allowing the mother to go to the baby to breastfeed during the workday, telecommuting, offering flexible work schedules, maintaining part-time work schedules, and using on-site or nearby child care centers.  Because no single strategy will fit all employment settings, creativity is needed, especially for mothers who are not working in professional occupations. A woman’s decision to breastfeed, though personal, requires action from multiple players, if she is to succeed. Let’s act NOW!

Chinelo Ogbuanu, MD, MPH, PhD

Senior Maternal and Child Health Epidemiologist

Maternal and Child Health Program

Georgia Department of Public Health

chogbuanu@dhr.state.ga.us

 More information about our work is available in:

“Balancing Work and Family: Effect of Employment Characteristics on Breastfeeding”

J Hum Lact, August 2011; vol. 27, 3: pp. 225-238.

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Informed Consent: What is My Responsibility as a Lactation Consultant? – Reader Response

Doreen says:

August 1, 2011 at 10:35 pm (Edit)

I feel so alone in my profession and this will be a blessing! I have a question that I need help with. My manager at work, in a large hospital, told me that the nurses and physicians had a problem with “informed consent” when it came to breastfeeding. ie: we have mothers who state that they want to breast and bottle feed. I discuss the importance of getting a good milk supply started before introducing a bottle, always asking why. Most mothers state it is because they are going back to work, then I discuss this finding out when they go back, making a breastfeeding plan. The problem is that the nurses want to give bottles without informing the patients about possible consequences as they get their milk supply going for NON medical reasons ie: get sleep at night, second night feeding frenzie, etc. I feel it is my ethical responsibility as a RN and IBCLC to give “informed consent” (ie: information) because most mothers do not understand the consequences of bottles of formula in the first few days and I have made it clear that the nurses have that responsibility also. They do not like this. Any suggestions would be helpful as I have called a meeting of the managers next week. Thanks, Doreen 

Doreen, you raise an important issue for IBCLCs everywhere! 

To be clear:  the issue isn’t whether you “should” provide information and support to a breastfeeding mother, so she can make an informed decision about matters affecting her/her baby’s health.  Rather, the issue is “how” to effectively assist the mother, as her allied health care provider, in a work setting where other caregivers are offering conflicting or erroneous advice.   

ILCA’s recently-published monograph “Risks of Not Breastfeeding” concludes that “[e]xclusive breastfeeding is the normative standard for infant feeding.  Not breastfeeding increases infant and maternal acute and chronic illnesses….  The research demonstrates that there is a dose response to breastfeeding and human milk exposure for mothers and infants.  Healthcare professionals must be aware of the research and find ways to share this information with families so they can make responsible informed feeding decisions for their children.” (Spatz, D., & Lessen, R. (2011). Risks of not breastfeeding. (Monograph).  Morrisville, NC: International Lactation Consultant Association, p. 8)(emphasis added).   Your meeting with your managers is your opportunity to suggest that evidence-based practice is not being followed if non-medically-indicated use of formula is tolerated (and even promoted) by caregivers whose patients are breastfeeding mothers and babies.

You are the ideal healthcare professional to teach families (and colleagues) about human lactation. 

The IBLCE Scope of Practice, “encompassing the activities for which IBCLCs are educated and in which they are authorized to engage” (from the preamble; full IBLCE SOP at http://www.iblce.org/upload/downloads/ScopeOfPractice.pdf) anticipates that as allied health care providers we will advocate for the baby, the mother and the breastfeeding relationship.  It describes IBCLCs as having “specialized knowledge and clinical expertise in breastfeeding and human lactation.”  It describes the IBCLC duty to offer evidence-based information to help mothers meet their breastfeeding goals, and the duty to educate families and healthcare professionals about breastfeeding and human lactation.  Your ethical responsibility to inform, advocate, and educate is bolstered by the IBLCE Code of Ethics requiring, at tenet 11, that the IBCLC “provide sufficient information to enable clients to make informed decisions”  (http://www.iblce.org/upload/downloads/CodeOfEthics.pdf).

All health institutions and health care providers should support and assist breastfeeding families.  In the United States, advocating for breastfeeding as a public health imperative has received significant boosts from highly esteemed entities.  The U.S. Surgeon General’s Call to Action to Support Breastfeeding asks all health care providers, their institutions, employers, families and communities-at-large to support breastfeeding mothers.  (http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf).  This powerful document comes from the US federal government, but its call to action by the community at large is universal, and the concepts are applicable worldwide. 

The Centers for Disease Control recently issued their report concluding that US hospitals have a fairly dismal record when it comes to breastfeeding supportive practices. http://www.cdc.gov/vitalsigns/Breastfeeding/index.html.  And yet, the Joint Commission, which accredits hospitals in the US, now looks at exclusive breastmilk feeding as part of the Perinatal Care core measure set.  Because breastfeeding is the biologic norm, any (unexplained) deviation from it is seen as a deviation from best practices.  The United States Breastfeeding Committee has a toolkit to assist in the explanation and implementation of these core measures (http://www.usbreastfeeding.org/Portals/0/Publications/Implementing-TJC-Measure-EBMF-2010-USBC.pdf).

IBCLCs are specialists in a field that crosses several disciplines.  Our colleagues are not subject- matter-immersed in breastfeeding, as we are.  Use the meeting with your managers as your “toe in the door” to educate them: breastfeeding is the biologic norm and a public health imperative; hospitals can and should do a better job to support their breastfeeding patients, and this is a significant core measure that Joint Commission inspectors will be evaluating. And it is what the family wants and needs, to boot. 

Liz Brooks JD IBCLC FILCA

Liz Brooks is a lawyer, private practice lactation consultant and international speaker on legal and ethical matters affecting IBCLCs.

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Curious to hear your thoughts!

 

 

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Thank You!

The editorial staff of Lactation Matters and ILCA would like to take a moment to thank you.  Our first week in the blogosphere has been tremendous, full of excitement and new challenges.  We are sincerely grateful for the outpouring of support that we have received with the launch of this blog.  In one week we had over 2,000 visits and a number of wonderful commenters encouraging us along.  This blog has been created for all of you, to create an ongoing source of community and support for our fellow LC’s.

At times it can be hard to remember how small the world really is, and how connected we are.  While the facilities that we practice at may be different, we are all working towards the same mission.  Our goal with Lactation Matters is create a safe and informative place that LC’s can gather and never feel alone in their profession again.

Quite an ambitious goal that we’ve set for ourselves, to ensure that this blog stays current and meeting your needs we want to encourage you to submit questions, comments, suggestions, and thoughts to lactationmatters@gmail.com.  This blog is your blog and we want to make sure that Lactation Consultants and healthcare professionals working with breastfeeding mothers around the world are having their voices heard.  Stand as one, be united, and let us know what is happening in your own community.

We look forward to what the future holds for our ‘baby’ blog and watching how all of you connect and interact with us.

Again, thank you for subscribing, reading, and sharing. Stay tuned for some exciting posts next week and a poll coming your way this Friday!

Robin Kaplan, M.Ed., IBCLC, Lactation Matters Editor

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

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Round Table Discussion: Baby Friendly Health Initiative

Protecting, Promoting and Supporting Breastfeeding

What is the Baby Friendly Health Initiative (BFHI)?

Baby Friendly Health Initiative is a World Health Organization (WHO) and UNICEF a worldwide program launched in 1991 following the Innocenti Declaration of 1990 that aims at creating a health care environment that supports mothers and babies to have the best start in life. This may have evolved in your country to suit your specific needs and some examples are; the BFI (Baby Friendly Initiative), BFHI (Baby Friendly Health Initiative) or Baby and Mother Friendly Hospital Initiative. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.

Creating a health care environment where Breastfeeding is the norm, Practices known to promote the health and well-being of all babies and their mothers are followed.

The Ten Steps to Successful Breastfeeding is the minimum global standard by which hospital facilities are assessed and accredited. A ‘Baby Friendly’ facility is one where a mothers’ informed choice of infant feeding is supported, respected and encouraged. Community Health has seven steps.

Baby Friendly Accreditation is a quality improvement measure which demonstrates that a facility offers the highest standard of care to all mothers and babies. Attaining accreditation reflects the commitment of the facilities staff.

To achieve this standard, midwives and other carers obtain an increased knowledge of infant feeding, greater skills and commitment to facilitate breastfeeding. This engenders an environment that encourages best practice, improving the health of new generations.(bfhi.org.au). See additional links below for more information.

Participants:

Angela Smith, RN CM IBCLC FILCA  Nurse Unit Manager

Royal Prince Alfred Hospital Sydney Australia BFHI Accredited 2011

 

Cathy Holland RN, BS, IBCLC, FACCE, LCCE

Over my 46 years as a registered nurse, Women’s Health, focusing on lactation and birth using both traditional and energy medicine to facilitate success is my passion.

 

Trish MacEnroe Executive Director

Baby-Friendly USA, Inc.

tmacenroe@babyfriendlyusa.org

Cindy Turner-Maffei, MA, IBCLC National Coordinator

Baby-Friendly USA, Inc.

 
1. Why should a hospital work toward BFHI certification?

Angela Smith (AS): All hospitals want to provide the best possible care they can and we know that the BFHI accreditation is the Gold Standard in not only Breastfeeding Care but in excellent Postnatal care generally.

Cathy Holland (CH): BFHI accreditation indicates the facility is making efforts to show the community they value infant nutrition, over free products from companies who are more interested in $$$$$$ than mother-baby health.

Trisha & Cindy (TC): The Baby-Friendly Designation is the globally recognized symbol of world-class maternity care practices that lead to optimal infant feeding outcomes.  In this process birth facilities

  • deliver patient-centered care
  • improve health outcomes and patient satisfaction
  • increase community recognition of excellence
  • enhance a professional environment of competence, including leadership and team skills
  • demonstrate a commitment to quality improvement
  • meet corporate compliance requirements

In the US this may also

  • improve m-PINC scores
  • meet Joint Commission maternity care standards for exclusive breast milk feeding
  • lead the way to achieving Healthy People 2020 goals for breastfeeding

2. Why should expectant parents choose a BFHI facility?

AS: Expectant parents like the rest of the population these days will search the internet looking for the hospital that provides the best service. By being BFHI accredited the new parents are reassured that the hospital they have chosen has gone “the extra mile” and will provide them with First class care.

CH: Securing the best possible care should be a concern. Often the choice of facility is “where they have insurance coverage.” A BFHI facility has made an effort, greater than that which is required of them. Having this designation could nudge the insurance payers to notice the BFHI facility. Health and $$$$$ savings are the expected outcomes.

TC: Baby-Friendly birth facilities have taken special steps to create the best possible environment for bonding with and feeding your baby.  The Initiative celebrates hospitals and birth centers that have put in place policies and practices to enable parents to make informed choices about how they feed and care for their babies.   Birthing facilities voluntarily seek out this designation as a demonstration of their commitment to new families.

3.  What does BFHI mean for us (me/my baby/my family)?

AS: The idea of BFHI means quality for each group. For staff it means they know they are working in a hospital that is not frightened of accreditation but is proud of its achievements.  For new parents and families it gives them peace of mind that the facility they have chosen is committed to breastfeeding and giving quality care.

CH: The BFHI means the health facility in my neighborhood is prepared to offer the best possible start for families. Creating health in every way is a great philosophy for a facility.

TC: In a Baby-Friendly birth facility you will have the opportunity to hold your baby skin to skin immediately following birth, you will be able to have your baby stay with you in your room during your entire hospital stay and you will have the confidence in knowing that you are being cared for by highly trained staff who can help you learn to respond to your baby’s specific needs. Staff will also help you to identify supportive resources in your community to help you with infant feeding after you go home.

4. What is some recent research or statistics relating to BFHI?

AS: ‘Baby Friendly’ accredited hospitals in Australia is 77 which is 23% of all Australian hospitals providing maternity services (based on approximate number of facilities being 330).

TC: US STATISTICS

114 designated hospitals http://babyfriendlyusa.org/eng/03.html

4.5% of births take place in Baby-Friendly Hospitals http://www.cdc.gov/breastfeeding/pdf/2011BreastfeedingReportCard.pdf

RESEARCH

The Ten Steps to Successful Breastfeeding have been demonstrated to increase both initiation and duration of breastfeeding

DiGirolamo AM, LM.Grummer-Strawn and SB Fein. 2008.  Effect of Maternity-Care Practices on Breastfeeding Pediatrics122;S43-S49

Merten, S, et al. 2005. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics 116; e702-e708.

Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681.

DiGirolamo AM, LM Grummer-Strawn, S Fein. 2001. Maternity care practices: implications for breastfeeding. Birth 28:94-100.

Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA 285:413

For more information check out these sites:

http://www.bfhi.org.au/

http://www.unicef.org.uk/babyfriendly/

http://www.babyfriendlyusa.org/eng/index.html

http://www.waba.org.my/

http://www.babyfriendly.org.nz

http://www.who.int

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The Breastfeeding Team

Fathers influence mothers’ breastfeeding decisions and experiences! Fathers’ perceptions of their roles as members of the breastfeeding family are probably important components of that influence. Previous studies asking men directly about their breastfeeding-related roles have predominantly focused on the “dark side” of the father’s experience – particularly their limited ability to nurture and bond with their babies. Our study more fully explored fathers’ experiences by interviewing twenty-one involved fathers of breastfeeding babies about fathering a breastfed baby and about their role in the breastfeeding family.

Fathers identified their unique roles as team members ensuring that their babies received the benefits of breastfeeding. When asked “What is it like to be the father of a breastfeeding baby?” fathers generally focused on the pleasure of knowing that their baby was obtaining the benefits of breastfeeding and their role in supporting the breastfeeding mother. They frequently used the term “we”, suggesting their roles as integral members of the breastfeeding team and characterized themselves as the supporting cast member to the mother’s starring role. One father summed up his role as “…a support person…almost like a checking line as opposed to scoring line. She’s doing the big good stuff and I’m just supporting her to get that done.”

A primary fathering role was supporting breastfeeding by learning about breastfeeding both with the mother and independently. Some fathers became the mother’s memory when she could not take in all the advice she was being given and others used their knowledge of breastfeeding resources to encourage mothers seek out professional breastfeeding support when needed. As well, many fathers supported breastfeeding by sharing housework and childcare and some provided assistance “in the breastfeeding moment” by facilitating mothers’ comfort during breastfeeding or assisting with the use of breastfeeding equipment.  Perhaps most importantly, fathers supported the breastfeeding mother by valuing her and by trusting, respecting, and supporting her personal choices.

Fathers insisted that being the father of a breastfeeding baby was not unique in general, but they often identified their own special ways of nurturing and fostering positive father-infant relationships as they “waited their turn” to bond with their babies through feeding. Some fathers chose to be involved while the mother was breastfeeding so that they could bond while the infant “is still in the feeding zone.” Others developed rituals for spending time with baby or found their own masculine way of nurturing, such as holding their infant with their strong arms and talking to the infant in their deeper voice. These supportive and nurturing behaviors were not seen as compensating for the “dark side” of breastfeeding, but as important contributions in their own right.

Many fathers want to be involved in the lives of their breastfeeding children. Health care providers should be encouraged to acknowledge fathers as members of the breastfeeding team and engage fathers in learning about breastfeeding and the many possible forms of breastfeeding support. Each father should be encouraged to communicate with his partner about her goals and desires for breastfeeding and regularly negotiate the type and amount of involvement both parents want the father to have. We suggest that fathers should be presented with the range of possible supportive behaviors and empowered to explore and determine their own unique roles as an integral part of the feeding process in which, although they may be the “supporting actor” and the mother the “star”, both roles are essential and worthy of acclaim.

Lynn Rempel, RN, PhD

Associate Professor, Chair,

Department of Nursing

Brock University

lrempel@brocku.ca

Rempel LA, Rempel, JK. The Breastfeeding Team: The Role of Seo Services Involved Fathers in the Breastfeeding Family J Hum Lact. 2011:27;115-121.

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Patient Access

A great deal has changed in patient care over the last decade or so.  The number of patients coming in with articles from various websites and claiming uncommon diseases discovered through symptom checker on WebMD has increased.  As we all know information and knowledge are power and that is something that many patients hunger for when feeling so helpless in regard to their own care.  However, greater access to information does not mean an increase in quality, and thus many of us are faced with combating an inevitable cycle of misinformation passed from social media, Wikipedia, and “medical” websites lacking references.  Many of the mothers we meet with are well-informed patients, and want to have access to credible information to help guide them through the adventures of breastfeeding.  With that very notion at mind ILCA and SAGE Publications are pleased to announce the roll-out of our Patient Access offering for the Journal of Human Lactation. This feature allows individuals the availability to request free access to research for personal use via an article’s login/challenge page. SAGE will monitor and track all requests and supply individuals with PDFs of their chosen articles.

The Patient Access feature allows patients, their family members and anyone interested in learning more about a specific disease or its treatment to access your journal’s most important new research articles. Although research articles should never replace a patient’s consultation with a primary or specialist physician, SAGE and ILCA believe that access to this information can educate and empower our readers to learn more about diseases and conditions.

We hope that this new feature will give lactation consultants another tool in their kit when working with families.

You can view our request interface and learn more at http://jhl.sagepub.com/site/includefiles/patient_inform.xhtml

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