IBCLCs Traveling the Globe: Conference in Uppsala, Sweden: Part 2

On September 14-16, 2011, 215 participants from 26 countries around the world took part in a 3 day Neo-BFHI program in Uppsala, Sweden. Ten Australians, from New South Wales, South Australia and Victoria were amongst the multidisciplinary group.

The purpose of the conference and workshop was to present and discuss evidence for adaption of the WHO/UNICEF 10 steps to Successful Breastfeeding for neonatal intensive and intermediate care and to discuss a draft document prepared by a working group from the Nordic countries and Quebec.

IBCLCs at the Uppsala Workshop

Day One of the conference was opened by Professor Paula Meier from the United States. She spoke of breastfeeding support for infants in neonatal units. Human milk banking was the norm in many units and Professor Meier stated ‘that by giving the at-risk premature infant artificial milk, it was putting them at further risk of complications’. The predominantly female lineup of speakers spoke on varying aspects of care with Renee Flacking, a health care worker and mother of a premature infant, discussing the U.K. and Swedish experience.

Randa Saadeh gave the WHO perspective on adaption of the ten steps, while Yvette Sheehy, from Sydney, discussed their Hospital in the Home: ‘The Discharge on Tubes – DOTS program’-infants discharged home on tube feeds with health care support.
The closing speaker for Day One, Birgitte L Ekeberg, spoke of ‘Moving towards family centered care , the first Family Centered Neonatal Intensive Care Unit in Norway’.

On days two and three, participants chose workshop groups to attend, and discussed the draft BFHI Initiative in Neonatal Units document and the Ten Steps, and came together in the afternoon of the final day to present the outcomes of their discussions. The final document, which is a Global document, will need to be representative of all participants and there was considerable debate on how this could be implemented worldwide. As bottle feeding and pumping is the norm in some parts of the Western world the impact of including this in developing countries was an issue.

Uppsala University hosted the meeting and welcomed participants with a welcome reception opened by Vice-Chancellor Anders Hallberg followed by the conference dinner which was held at the Norrlands Student Club. Participants were serenaded by the student choir during the dinner.

Kersten Hedberg Nyqvist

Kersten Hedberg Nyqvist, one of the conference organizers, was overwhelmed by the number of participants who wished to visit the Uppsala Family centered neonatal unit and after discussions with the unit managers decided the numbers were too many. With the interests of those within the unit in mind and the interest shown by conference participants she opted on a presentation that was to challenge the practice of many. Parents live in the neonatal units with the babies and infants from 32 weeks. They are given the opportunity to have Kangaroo Mother Care, 24 hours a day, while parents are taught to recognize the cues of the baby and breastfeed them when they are ready. Babies are discharged at 34 weeks partially breastfeeding, partially tube-feeding. Kersten stated ‘that there is no such thing as non-nutritive sucking’. She also said that the program has taken time to implement and one of the biggest problems is staff attitudes to change.

While walking to the bus to leave Uppsala for home, the chilly wind was blowing as winter was closing in. Thousands of bikes were chained up in this university town and I thought how lucky these babies are to be cared for in a society so socially aware.

Susanna Scurry
RN,RM, BFHI Educator & Assessor, LCANZ Board of Director, IBCLC

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IBCLCs Traveling the Globe: Uppsala, Sweden: Part 1

Baby-Friendly Neonatal Care Conference and Workshop Uppsala, Sweden, Sept 14-16, 2011

L to R is Yvette Sheehy, Anne Merewood, Annette Wright, Susanna Scurry

IBCLCs, hospital clinicians, researchers, and lactation professionals from around the world met at the Baby Friendly Neonatal Care Conference and Workshop in Uppsala, Sweden, for a groundbreaking meeting on a proposed expansion of the Ten Steps to Successful Breastfeeding to the Neonatal Intensive Care Unit. The conference was the brainchild of the Nordic expert group, in response to the document “Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care”, UNICEF/WHO 2009.

On a packed first day in the beautiful and historic Uppsala University, 220 attendees from 27 nations listened to internationally representative presentations on the importance of breastfeeding in intensive care, and about innovatory programs and guidelines that are making NICUs more Baby-Friendly. Many speakers and participants were leaders of the Baby-Friendly initiative in their home countries.

On days 2 and 3, attendees met in workshops to discuss each of the Ten Steps, and their potential adaptation to the NICU. Participants also made suggestions for monitoring progress and standards. In the final session, group leaders summarized suggestions for all attendees.

Uppsala was an appropriate location for this conference, with its hospital NICU standing out as one of the world’s most family centered units. The working group will take conference suggestions and use them to create a final document to present to the World Health Organization for approval in the future.

Abstracts from oral, poster, and workshop presentations will be published online by the Journal of Human Lactation (JHL) in early 2012. JHL aims to publish the recommendations in full when they are finalized.

The conference was not all hard work. The Conference Dinner at Norrlands Student Nation included student singing and other musical entertainment, and the meeting opened with Swedish-style sing-alongs to “We are Family, Baby-Friendly Centered Family” and – but, of course – Abba’s Mama Mia…..

Anne Merewood PhD MPH IBCLC
Director, The Breastfeeding Center, Boston Medical Center
Associate Professor of Pediatrics, Boston University School of Medicine
Division of General Pediatrics
Boston, MA 02118

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Get Ready for ILCA 2012!

Start planning today to come and celebrate the 27th ILCA Annual Conference in beautiful Orlando, Florida.

This 2012 ILCA Annual Conference will provide a rich learning environment for lactation professionals and others who assist mothers and babies with breastfeeding. It will offer current and aspiring lactation consultants information on cutting-edge lactation practices and research to equip you in giving optimal breastfeeding care and support to mothers and babies.

Registration opens December 2011
Check back at the ILCA 2012 conference page often as more information will be available soon.

ILCA Discounts Galore!

Orlando might be home to some of the nation’s greatest theme parks, but there’s a lot more the great City of Orlando has to offer!

See ILCA’s special page for specialty discount attraction tickets, shopping, dining and more information for you and your family vacation.

It’s back again ….Exam Review at ILCA!
Are you new to the lactation consultant profession and taking the IBLCE exam for the first time?
Are you recertifying next year?

The IBLCE exam will be offered at the JW Marriott immediately following the 2012 ILCA conference. The final day of the conference will present an opportunity for last-minute review of key information and clinical slides along with tips on test taking.

What a great opportunity to be able to have a hassle free exam preparation, no traffic delays or stressful situations , cruise down the lazy river and into your exam, cool and calm!

There are so many exciting places to visit…. Let us know what you’re planning, share your ideas.

Abstracts for the conference are now open, what an opportunity to get your message out there, share your exciting projects you’re working on …

Start planning your next summer with ILCA in Orlando today….

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ILCA Conference 2011 – Reflections

I absolutely love going to ILCA conferences!  While San Diego was quite a treat with its gorgeous weather and fabulous beaches, even the heat of San Antonio and Las Vegas couldn’t diminish the way an ILCA conference re-energizes and makes me feel so proud to be a part of this valuable profession.

Planning my trip to ILCA 2011 was not too challenging, since I live about 10 minutes from where the conference was hosted.  Yet, I still had to juggle clients and my son’s 6th birthday to make it to all of my favorite sessions.  It was so worth it!

The week before the conference, I started to create my ‘plan of attack.’  Which sessions would I attend Thursday through Sunday?  Would I finally learn how to deal with those flat heads and stiff necks?  Is pumping really out of hand?  Where would I meet my friends and colleagues that I met at previous conferences?  Would I have time to peruse the exhibition hall?

I started the conference by attending the Wednesday Clinical Rotations and the rumors from past conferences were all true: What an amazing experience!  It was like having a private session with my favorite experts in the field.  Alison Hazelbaker went through her entire Assessment Tool for Lingual Frenulum Function.  Marsha Walker was so lovely I could just listen to her speak for hours and hours.  The day just flew by!

Thursday through Sunday was a whirlwind, but so many of the things I learned and people I met have influenced my daily practice as a lactation consultant.  At the poster session I met Lenore Goldfarb, who since then has been helping me with a client who is inducing lactation with her adopted son.  I have now mentioned Jane Morton’s video on Hand Expression at least twice a week with new clients and prenatal breastfeeding students.  I have shown samples of the Danish Wool breast pads to several clients with Reynaud’s.  I finally met my fellow marketing committee members face to face for the first time.  I have stayed connected with colleagues I met during lunch and breaks over Facebook and email, which allows us to further our conversations and support one another.

The energy at an ILCA conference is colossal!  The amount of knowledge I obtain in those 4-5 days is immeasurable!  When I leave an ICLA conference I feel smarter, revitalized, invigorated, and supported.  And I can’t wait for the next conference to arrive.  Stay tuned for exciting information about ILCA2012 in Orlando, Florida.

Now it’s your turn to share:

What was your favorite part about ILCA2011?

Who was your favorite speaker? 

What feedback would you like to share?

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

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Tell Us About Your Amazing Colleagues!

Lactation Matters has just launched a feature called “Clinicians in the Trenches”.  It is our hope that with this, we can both highlight those who are doing outstanding work in our field and also encourage each other, give us new ideas, and cheer each other on!

Here is our first entry, focusing on Colette Acker and The Breastfeeding Resource Center.    But, we need YOU to tell us about your colleagues.

Who is bringing to light a new idea with their practice?
Who is paving the way with techniques that we could all benefit from?
Who has a really great story to tell about what lactation practice has meant in her/his life?

Please contact Robin Kaplan and Amber McCann with your suggestions at lactationmatters@gmail.com.  Please use the subject ‘Clinician in the Trenches.’ Include a brief paragraph with the name of the clinician you are recommending, her/his contact information, and a short explanation of why she/he should be highlighted in Lactation Matters.

Look for new stories about these amazing clinicians every 2 weeks on the blog!

Amber McCann, IBCLC, Lactation Matters Volunteer
Robin Kaplan, M.Ed., IBCLC, Lactation Matters Co-Editor

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A BFHI Update – ‘Call to Action for Breastfeeding Support from the Surgeon General ‘

How do you see the Call to Action impacting Baby Friendly in the United States? (Maybe even internationally?)

The United States now has a strong, evidence based national policy on infant and young child feeding that specifically calls for expanding implementation of the Baby-Friendly Hospital Initiative (BFHI). This is an extremely important turn of events and status change.  BFHI is also specifically mentioned in the White House Obesity Report, and possibly even more importantly, in The Joint Commission’s recent Speak Out campaign. Internationally, Baby Friendly USA (BFUSA) has always been a strong collaborator with other nations’ BFHI Authorities and I would expect this collaboration to increase.

What changes are you hoping to see?

The Director of Health of my state met with our state Lactation Consultant chapter in early August, and within two weeks convened a high-level meeting of organizations to begin discussions on moving BFHI ahead. That’s amazing progress! Several states have conducted in-depth surveys of maternity facilities (in addition to encouraging hospitals to respond to the Center for Disease Control’s mPINC surveys), developed interim goals and local incentive programs, held Hospital Summits, and more.  Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey of maternity care practices and policies that is conducted by the CDC every 2 years beginning in 2007. The survey is mailed to all facilities with registered maternity beds in the United States and Territories.  I expect the Call to Action will resonate with and inspire the entire public health professional community, at every level.

Why is this Call to Action coming at a critical time?

I’m tempted to say “It’s about TIME!” The momentum for breastfeeding has escalated in the past ten years in the US, partly due to the collaborative work of the US Breastfeeding Committee. The economic conditions are encouraging everyone (individuals and companies) to re-think spending patterns; health decision-making is becoming more transparent; and virtually everyone is calling for better health outcomes. Over 40,000 IBCLCs around the world are working with other health care providers to provide the up-close one-to-one clinical support for mothers and babies. Without this rich network of support, mothers would face far more avoidable problems.

How will the Call to Action impact not only hospital-based lactation consultants, but lactation consultants in private practice, as well?

There’s something in the Call to Action for everyone. As an lactation consultant in private practice myself, I was thrilled to see a call for appropriate reimbursement for my services as an LC, regardless of other credentials or licenses. I’m currently in graduate school and was very excited to see a call for more research on breastfeeding. The Call to Action’s recognition of lactation consultants as important players on the health care team was extremely gratifying.

Linda J. Smith, BSE, FACCE, IBCLC, FILCA
Bright Future Lactation Resource Centre Ltd.
6540 Cedarview Ct., Dayton OH 45459-1214
Phone (937) 438-9458   Fax (937)-438-3229
www.BFLRC.com

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United States Lactation Consultant Association’s Response to the Call to Action for Breastfeeding

The Surgeon General’s Call to Action for Breastfeeding offers opportunities for US-based IBCLCs in virtually every one of its twenty action steps. From #1, give mothers the support they need to breastfeed their babies to #20 improve national leadership on the promotion and support of breastfeeding. IBCLCs play key roles and the United States Lactation Consultant Association (USLCA) is actively involved to promote, equip, and empower members. USLCA is working hard to ensure that IBCLCs are represented in discussions with both policymakers and caregivers in a variety of venues. The Call to Action strengthens the voice of the lactation professional and gives IBCLCs the credibility and clout to do what they do best for mothers, for babies, and the health of the nation.

USLCA is responding to the Surgeon General’s Call to Action by networking and relationship-building with organizations such as the Academy of Breastfeeding Medicine, AWHONN, the American Academy of Pediatrics, United States Breastfeeding Committee, National WIC, and Texas WIC Association. In every discussion, language is emphatically clarified so that a breastfeeding support person translates directly into IBCLC, as per the Surgeon General’s specific and strategic recommendation.

USLCA recognizes the responsibility for IBCLCs to provide the best care possible as they work with employers to develop breastfeeding-friendly workplaces, with hospitals as they move along on the Baby-Friendly journey, with educational institutions creating curricula to incorporate lactation care into health care education, with public health entities as they expand services for maternal and infant care, and for individual families as they seek to achieve their breastfeeding goals. To that end, USLCA publishes its peer-reviewed Clinical Lactation and presents cutting-edge educational programs each month via webinar technology.

USLCA encourages its members to be politically engaged at community, state, and national levels, participating in state Breastfeeding Coalitions and advocating for IBCLCs in a wide cross-section of settings. As Milk for Thought traveled the nation in the Big Pink Bus, USLCA members participated in community rallies at every stop. USLCA President, Laurie Beck, MSN, RN, IBCLC, participated in the documentary chronicling the tour and promoting breastfeeding.

The Surgeon General’s Call to Action is a wonderful tool to advocate for communities that support breastfeeding at every juncture with the goal of health care that begins with breastfeeding. IBCLCs are key figures in the Call to Action and USLCA is responding to the call by providing education, support, and advocacy for IBCLCs.

Laurie Beck, RN, MSN, IBCLC, RLC
President of USLCA on behalf of the USLCA Board of Directors

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Clinicians in the Trenches – Colette Acker

Please welcome Colette Acker, our first clinician to be highlighted in our monthly series, Clinicians in the Trenches.  In this new series, Lactation Matters will take you into lives and businesses of fellow colleagues around the world, allowing them to share their knowledge, expertise, and wisdom.

Colette M Acker, IBCLC lives in Glenside, Pennsylvania with her husband, Rodney.  They have three children who are now in the teen/young adult age range.  Nursing her own children led to her passion for assisting other mothers.  She became a volunteer breastfeeding counselor in 1995, an IBCLC in 1998, and co-founded the Breastfeeding Resource Center (BRC) 5 years later.  Although Colette loves working with new moms and babies, the multi-tasking life of the director of nonprofit calls for much more and never leaves her bored!  Outside of lactation, Colette’s favorite stress release is running and has developed a new addiction to Zumba classes.

1. What is the Breastfeeding Resource Center (BRC)?

The BRC is a nonprofit organization committed to providing expert clinical and educational breastfeeding services.  We offer a variety of lactation services from the prenatal period through weaning. We provide problem-solving consultations, back-to-work planning, and weight checks, along with other consultations designed to meet a mother’s individualized needs. Weekly support group meetings and low cost parent classes complement our outreach efforts. The BRC is an asset to the medical community by providing supervised clinical opportunities, as well as being a resource of evidence-based information. All services are offered on a sliding scale of payment to ensure access for all families.

2. Why did you decide to start a non-profit?

Two colleagues and I were on our way to our ILCA affiliate meeting and were dreaming.  We fantasized about a place where women could go if they were having difficulty with breastfeeding, planning to return to work, needing assistance in choosing the right products, or just needing some support and reassurance.  We also imagined it being a valuable resource for healthcare professionals serving breastfeeding families.  We were currently working in the private practice arena and we knew many moms couldn’t afford the service.  We felt strongly that this center should be accessible to all families, regardless of income.

3. What are your biggest challenges running a non-profit?

The biggest challenge is finding funding to allow the BRC to provide LC visits on a sliding scale of payment. Thirty three percent of our budget needs to be obtained through fundraisers, donations, and grant funding. All of these take a lot of time and effort by many people. The employees of the BRC wear many hats. Janice McPhelin, our Director of Development, is an IBCLC who works with moms on a daily basis and needs to jump into grant writing whenever a free moment arises. This hat-switching life can be very crazy, yet it also makes the job more interesting!

4. What resources have been most helpful to sustain your non-profit?

The greatest part about running a nonprofit center is that you are not alone. We have 16 members on our Board of Directors. We’ve found volunteers with expertise from all walks of life such as accounting, law, grant writing, physicians, RNs, and event planners. Developing a strong board with experience in the areas where the BRC needs the most help is vital. Also, creating a strong community among our clients has led to a large volunteer base. It is amazingly touching to see our clients so appreciative of our work that they volunteer time to keep it going strong!

5. What advice would you give to an LC who wanted to open a non-profit center similar to yours?

Prepare for a wild ride!  I’d suggest learning everything you can about running a nonprofit.  There are many opportunities available in most communities and on the web such as www.Nonprofitwebinars.com. Plan on working long hours with little pay until funding becomes accessible. Discover your weaknesses and find board members and volunteers to fill that gap. Collect emails and join social networks for the most efficient and inexpensive way to spread the word. Become a strong member of your community by participating in health fairs, the chambers of commerce, as well as partnering with other nonprofits that target a similar audience.

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Summary of the Surgeon General’s Call to Action to Support Breastfeeding

On January 20, 2011, Surgeon General Regina M. Benjamin issued a “The Surgeon General’s Call to Action to Support Breastfeeding,” outlining steps that can be taken to remove many of the challenges faced by women who want to breastfeed their babies. The Surgeon General identified 20 evidence-based actions that are needed, including establishing worksite policies and programs that are supportive to employees who are breastfeeding, implementing maternity care practices in hospitals and birthing facilities that do not sabotage breastfeeding, reducing marketing of infant formula products, and ensuring access to services provided by International Board Certified Lactation Consultants (IBCLCs). The Call to Action asks six segments of society to step forward and take responsibility for removing breastfeeding barriers within each of their respective spheres of influence.The twenty action steps within the six categories have numerous suggested implementation strategies.

Mothers and their Families: recognizes the need for mothers to be informed by their health care providers of the importance of breastfeeding, and that health care providers support mothers in their efforts to breastfeed.
Communities: asks for community-based support for breastfeeding mothers from public health programs, including the provision of peer counseling support, and around the clock breastfeeding support from community organizations. Manufacturers of infant formula should be held accountable for marketing their products within the guidelines of the International Code of Marketing of Breastmilk Substitutes and health care providers should not serve as advertisers of infant formula.
Health Care: requests that hospitals accelerate their efforts to achieve the Baby-Friendly designation, ensure access to skilled, professional lactation care services following hospital discharge, provide training in lactation care in undergraduate and graduate educational programs for health professionals, encourage insurers to reimburse for services provided by IBCLCs, and increase availability of banked donor milk.
Employment: calls for paid maternity leave, the establishment of lactation support programs by employers, and the adoption of child care standards that support breastfeeding mothers.
Research and Surveillance: identifies the need for new research regarding the most effective ways to increase breastfeeding rates among populations with low rates, conduct analyses of the cost effectiveness of breastfeeding, and provide a better evidence base for making clinical decisions in challenging situations.
Public Health Infrastructure: urges the creation of a federal interagency work group on breastfeeding, and increasing the capacity of the United States Breastfeeding Committee and affiliated state coalitions.

The Call to Action represents a significant tool for use in validation of the importance of both breastfeeding and the role that the IBCLC plays in assuring that all mothers and infants receive the level of lactation care and services that they need. The document can be used in numerous ways to improve access to evidence-based care in the hospital, to provide post discharge lactation care in the community, and in settings where mothers experience the most difficult challenges to breastfeeding, such as the workplace. The Call to Action functions as a guide or roadmap for those wishing to make changes, as it places the responsibility for breastfeeding improvement on all the segments of society that interact with mothers or who have an influence on how lactation support is provided. It provides suggestions on how best to reduce barriers, and challenges health care providers, institutions, organizations, agencies, the Government, employers, and insurers to all do their part to see that mothers and infants receive the support to which they are entitled.

Action 11 specifically recommends, “Ensure access to services provided by International Board Certified Lactation Consultants.” It goes on to ask that IBCLCs be designated as “covered providers” and that reimbursement should be provided independent of licensure. Adherence to these recommendations will go a long way in reducing disparities and providing access to care that can be financially out of reach for mothers when insurers refuse reimbursement for lactation care and services provided by IBCLCs. Use this document to your advantage, whether you work in a hospital, clinic, agency, or private practice. There is so much room for improvement that we should make sure that we have all of the tools at our disposal in our work to help mother and babies breastfeed. To obtain copies of the Call to Action see:

http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf

Summary http://www.surgeongeneral.gov/topics/breastfeeding/executivesummary.pdf

MarshaWalker, RN, IBCLC

Marsha Walker has worked with breastfeeding mothers since 1976, first as a volunteer counselor with Nursing Mothers Counsel in California and eventually as the Director of the Breastfeeding Support Program at Harvard Pilgrim Health, a large HMO in Massachusetts. Much of her time is currently spent advocating for breastfeeding on the state and federal levels. She is the executive director of the National Alliance for Breastfeeding Advocacy (NABA) which is the organization that monitors the Code in the US. Marsha also sits on the Board of Directors Baby Friendly USA, Massachusetts Breastfeeding Coalition, and Best for Babes. She represent USLCA to the US Department of Agriculture’s Breastfeeding Promotion Consortium and represent NABA to the US Breastfeeding Committee.

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Ethical Issues in Breastfeeding Support

Born in Brooklyn, New York, Dr. Gartner received his undergraduate education at Columbia University and his medical degree from Johns Hopkins University. Returning to New York after internship in Pediatrics at Hopkins, he continued his training in Pediatrics at the Albert Einstein College of Medicine, specializing in neonatology and pediatric liver disease. The great majority of his basic laboratory and clinical research has been in the area of neonatal jaundice, with particular reference to its relationship to breastfeeding. He continued his combined work in bilirubin metabolism and breastfeeding in Chicago and has now published more than 200 papers on this subject and on other aspects of breastfeeding.

Dr. Gartner was Founding Chair of the Executive Committee of the Section on Breastfeeding of the American Academy of Pediatrics from 1998 to 2006. He is also a Past- President of the Academy of Breastfeeding Medicine, of which he is a founder, and a Past-President of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, which he also helped found. He lectures regularly on breastfeeding issues. He is currently Chair of the ABM Ethics Committee.

At the 2011 ILCA Conference in San Diego, CA, Dr. Gartner presented this plenary session titled, “Ethical Issues in Breastfeeding Support.”

Lawrence M. Gartner, M.D., FAAP
Professor Emeritus
Departments of Pediatrics and OB/GYN
The University of Chicago

Ethics is the discipline dealing with what is good and bad or what is right and wrong.  Every health practitioner must adhere to the highest standards of ethical behavior and assure that their practice provides the best possible care for their patients.   As breastfeeding practitioners, we take responsibility for our patients, both the mother and the child, and we must give them every reason to trust our knowledge and our judgment.

To fulfill these ethical standards the practitioner must know the proven scientific facts and accepted practices in the field.  These must always be presented to the patient honestly and completely.  At the same time we must recognize that the mother makes the final decision, based on the information that has been presented to her.  It is never acceptable to use coercion.

Other ethical concerns are to assure confidentiality of all information obtained in the course of caring for the patient. Records must be secure at all times.  Discussion of patients with colleagues or students should be discrete and private, protecting the identity of the patient.  The patient’s privacy must be honored during examinations.  Students may be present at the interview or examination  only with the specific consent of the patient.  One must be aware of cultural differences and  avoid bias in making decisions.  All procedures must be performed only after obtaining fully informed written consent.

Among the most difficult and challenging ethical issues is that of avoiding conflict of interest.   Financial interest in a product that one recommends or provides is a conflict of interest and may result in a recommendation that is not necessarily in the best interest of the patient.  In the practice of breastfeeding an seo consultant, the renting or selling of breastfeeding pumps and supplies is particularly troubling.

In the world of breastfeeding, commercialism or the marketing and sale of products for profit, independent of health care practitioners, has become a major force and often brings a great deal of marketing pressure on breastfeeding mothers and their families.  Most prominent among these are the infant formula companies and their efforts to promote sale of their breastmilk substitutes through practices that are considered unethical or highly questionable.  As practitioners we must make every effort to distance ourselves from their marketing ploys.  Thus, we should not distribute their “educational” materials or hang their posters in our offices.  We also must avoid the subtle temptations of a free lunch or a gift from them as these have been shown to bias our prescribing practices.

We must also have ethical awareness with regard to the hospitals, clinics and other institutions in which we may work or be employed.  These may have conflicts of interest or policies that are not in the best interest of the breastfeeding dyad.  They may provide discharge gift bags possibly because they are being given a grant from the company.  Employees and those who use these facilities can influence the administration to change these unethical practices into ethical ones that improve the environment for breastfeeding.

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