Tag Archives | breastfeeding

Breastfeeding Center of Pittsburgh’s Dr. Nancy Brent Named A “Pediatric Hero”

Dr. Nancy Brent, Medical Director of the Breastfeeding Center of Pittsburgh and a pediatrician at Kids Plus Pediatrics in Pittsburgh, has been named one of Baby Talk magazine’s seven national Pediatric Heroes for 2012. The award, announced at the recently concluded American Academy of Pediatrics National Conference and Exhibition in New Orleans, honors “the most innovative and inspiring doctors” in the country.

Dr. Brent was honored as a Pediatric Hero for her nationally acclaimed work in promoting and supporting breastfeeding, and in training physicians to do the same. A board-certified pediatrician since 1984 and an International Board Certified Lactation Consultant (IBCLC) since 1990, Dr. Brent has spent more than two decades at the forefront of Breastfeeding Medicine, leading the way both locally and nationally to bring critical, often hard-to-find services and support to breastfeeding mothers and babies, as well as to the doctors who care for them.

Ellen Rubin, an IBCLC who works at the Breastfeeding Center says,

“As a relatively new IBCLC, I could not have asked for any better opportunity than to work with Dr. Nancy Brent. She’s an an IBCLC-Pediatrician and an amazing teacher who always takes the time to share her knowledge and experience with me and the many residents and medical students who visit our clinic. Dr. Brent’s approach to breastfeeding is very well-rounded. While addressing each baby’s needs and well-being, she also takes into account each mother’s experience in the nursing relationship. Her medical expertise is a great asset, especially when babies are not gaining weight or are consistently fussy. So many complications are erroneously blamed on breastfeeding, and it makes a big difference when a medical professional can get to the root of a problem before breastfeeding is disrupted.”

Since 2006, Dr. Brent has served as the Medical Director of the Breastfeeding Center of Pittsburgh, the region’s leading resource for front-line breastfeeding medicine, support, and clinical care. Dr. Brent’s hard work and leadership have helped make the Breastfeeding Center of Pittsburgh a nationally recognized model in lactation services, and the first and only Advisor to the United States Breastfeeding Committee. Before joining Kids Plus Pediatrics and helping to create the Breastfeeding Center of Pittsburgh, Dr. Brent worked for 20 years in the department of Pediatrics at Mercy Hospital. During her time at Mercy, she created and directed the Maternal Infant Lactation Center, which provided patient care, research, and professional education for pediatric residents. Many of the pediatricians she trained in her time at Mercy are now her colleagues at Kids Plus: IBCLC pediatricians and a staff of Lactation Consultants who, under her direction, provide consults and medical care through the Breastfeeding Center of Pittsburgh.

Dr. Brent is a member of ILCA, the American Academy of Pediatrics, the Academic Pediatric Association, the Pittsburgh Pediatric Association, and the Academy of Breastfeeding Medicine. She is co-chairperson of the Allegheny County Breastfeeding Coalition and a member of the Pennsylvania Breastfeeding Coalition.

Join us in congratulating Dr. Nancy Brent, IBCLC for the stellar work she is doing to support mothers and babies!

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A Day in the Life of Breastfeeding Support and Promotion in Public Health

By Lisa Akers, MS, RD, IBCLC, RLC

I have worked in public health for over a decade and it never ceases to amaze me the number of people who truly do not understand public health or the work that public health officials seek to accomplish. Public health by nature is preventative medicine. Public Health can better be described as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” (1920, C.E.A. Winslow). According the World Health Organization, public health is “an organized effort by society, primarily through its public institutions, to improve, promote, protect and restore the health of the population through collective action.” Public health seeks to prevent disease and is not in the business, necessarily, of treating disease. Breastfeeding, by nature, is disease prevention and by this fact alone, is positioned high on the national public health agenda.

It is important to understand these facts before understanding my role in breastfeeding promotion and support in public health. I am, in fact, the State Breastfeeding Coordinator for the Commonwealth of Virginia. My job is to manage breastfeeding support and promotion endeavors for the state. My responsibilities vary from day-to-day, but they typically includes such things as the development of public policy, media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding and WIC Breastfeeding Peer Counselor Program; collaboration with numerous non-profit and academic entities, and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. This is by no means a comprehensive list, but simply a taste of the many things that I do from day-to-day.

Our emphasis in public health is on educating the practitioner as well as educating the general public in the support and promotion of breastfeeding. Since this article seeks to give readers an idea of what a typical day looks like in the field of public health, let me first start by painting a vivid picture for you.

You are a new breastfeeding mother, who has just given birth two weeks ago to a baby girl. You are a single mother, who receives no financial support from family or friends. You are concerned about making ends meet and providing for your daughter, so you plan to return to work within the next week. You currently work two part-time jobs at a retail establishment and a local restaurant. You make too much money to qualify for federal aid or entitlement programs, but luckily do quality financially to receive WIC benefits. Your biggest concern at the moment is continuing to breastfeed while returning to work and also being able to afford quality childcare that is supportive of breastfeeding for your daughter.

This is a typical scenario that is seen day-in and day-out both internationally and nationally. From the time that I start work every day, this is the scenario that continually plays in my mind. On a typical day, I am managing several million dollar budgets to ensure that this breastfeeding dyad is both supported and protected. These budgets help to run the breastfeeding support endeavors for the WIC program (including the WIC Breastfeeding Peer Counselor Program), support statewide policy initiatives related to breastfeeding, provide training opportunities and curricula to both clinicians and childcare providers, provide technical assistance to businesses and employers seeking to better understand and comply with the Patient Protection and Affordable Care Act, and provide training opportunities to public health personnel seeking to improve their knowledge of lactation management. On any given day, I handle correspondence from constituents, WIC participants, employers, childcare providers, clinicians, colleagues, and many others. A day in the life of public health breastfeeding support and promotion is ever-changing and never dull!

Public health gives me the autonomy and utilizes my creativity in many ways. One such way is in the development of numerous educational initiatives for clinicians and public health personnel. Most recently, this came to fruition in the development of two web-based educational opportunities for clinicians. The first is a web-based learning initiative, www.BreastfeedingTraining.org, which seeks to expand clinician’s knowledge of lactation management. The second web-based performance improvement initiative, www.BreastfeedingPI.org, seeks to improve the individual practice of clinicians. Both offer continuing education units and were developed in collaboration between the public and private sector in an effort to increase the knowledge base of healthcare professionals. Yet another avenue of education was in the development of an internship opportunity for WIC personnel. Most recently, we created an IBCLC internship for WIC personnel seeking to become IBCLCs with the ultimate goal of having at least one IBCLC in each WIC clinic site. This, not only, will help support the new breastfeeding mother in the above mentioned scenario, but will also aid in increasing the morale of WIC staff and WIC breastfeeding peer counselors, who seek job advancement and satisfaction.

Whether it be through education, policy, financial management of programs, or other avenues, my satisfaction in working to support and promote breastfeeding in public health comes from seeing the mother pictured in the scenario above reach her full potential.

Lisa Akers is a Registered Dietitian (RD) and an International Board Certified Lactation Consultant (IBCLC). She completed her Bachelor and Master of Science Degrees in Clinical Dietetics from James Madison University. Lisa has been working in the field of public health and human lactation for over 12 years. Her current position as the State Breastfeeding Coordinator. In addition, Lisa serves as the List Serve Coordinator for the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee. She also served as an Expert Workgroup member for the Academy’s Evidence Analysis Library, as a reviewer for the Academy’s most current position paper on the Promotion and Support of Breastfeeding, and as a reviewer for the reproductive section of the Nutrition Care Manual. Lisa is also the current 2012 World Breastfeeding Week Coordinator for the International Lactation Consultant Association.

In her spare time, Lisa enjoys sewing, quilting, and taking long motorcycle rides with her
husband in the Blue Ridge Mountains of Virginia where she currently resides.

4

A Closer Look at Cultural Issues Surrounding Breastfeeding

By Emma Pickett, IBCLC

As lactation consultants, we’ve been reading about breastmilk for a long time. It makes a nice contrast from the science of oligosaccharides to learn about the importance of goat meat soup to a lactating mother in Somalia or about the huge variety of cultures worldwide that emphasizes the importance of a mother avoiding ‘cold’ foods postpartum to seek spiritual balance. When it comes to reading about different cultural practices surrounding breastfeeding, there’s a lot that is simply fascinating.

Photo by mrcharley via Flickr Creative Commons

There’s a fabulous article by a breastfeeding mum named Ruth Kamnitzer which I would encourage you to read. In it, she talks about her experiences as a Canadian mother moving to Mongolia. She describes how feeding in public becomes a very different experience when complete strangers bend down to kiss your baby’s cheek – while he is feeding! Then, as he pops off in surprise, the giver of the kiss gets a face full of milk and everybody laughs. Try and picture that scene taking place in your local mall!

We enjoy reading about the fact that Japanese kindergarten admission forms might ask matter-of-factly whether a child has weaned from the breast. Or, that in Korea, an IBCLC declaring a baby to be beautiful would be going against the cultural practice of not commenting that a baby is healthy, fat or beautiful for fear of making the mischievous Gods jealous.

But once we’ve satisfied that natural boob and baby-obsessed curiosity, how do we balance our desire for evidence-based practice with some of the cultural messages that may seem harder to support?

Cultural practices fit into only 3 categories: beneficial, harmless or harmful.

Many Muslim families wish to practice the sunnah of ‘tahneek’. A softened date is sometimes rubbed on the baby’s palate before the first feed so the baby will enter ‘a sweet world’. Traditionally, if a date cannot be found, anything sweet will do. An IBCLC might guide a family towards a clean finger dipped in glucose water rather than the boiled hard candy from uncle’s pocket.

Other beliefs are more of a struggle. One study of 120 cultures showed that 50 withheld the infant from the breast for 48 hours or more due to the belief that colostrum was “dirty”, “old”, or “not real milk”. In central Karnataka in India, 35% of infants were still not breastfeeding at 48 hours, yet at 1 month 94% were. A mother who may be reluctant to give colostrum feeds in a western hospital may be passionately committed to exclusive breastfeeding later on.

Some of us can be a little smug when it comes to looking at cultural practices from around the world. We may feel uncomfortable when we hear of the lives of women in Kenya who are strongly instructed to avoid breastfeeding after quarrels to prevent “bad blood” entering the milk and affecting baby. This may mean breastfeeding is paused or a mother’s rights are infringed by family members or neighbors , yet she doesn’t speak up for fear of conflict. Several cultures – traditional groups in Papua New Guinea and the Gogo tribe of Tanzania among them – emphasize the need for the woman to be celibate during breastfeeding. A mother may be torn between her desire to breastfeed – in an environment when food after weaning may not be plentiful – and her desire to satisfy her husband. A husband who is often not expected to also remain celibate.

Those descriptions may be hard to hear but I have no doubt there are women pitying the cultural constraints put upon many woman living in Western industrialized cultures. These poor mothers are still often expected to be separated from their healthy babies after birth. Their baby may sleep in a separate area of a large building (“the hospital nursery”) because culture says “that’s best”. These poor mothers feel obliged to feed according to the clock and feel like failures if their babies feed more frequently. The babies in this culture are often weaned prematurely because the breast is over-sexualized and it’s deemed inappropriate for older children to feed at the breast. Many of us live in a culture that values privacy, scientific “measurement”, control, infant independence. It’s hard to imagine a set of cultural norms more incompatible with breastfeeding.

Is any of this really any less harmful in the long-term than avoiding colostrum feeding?

As an IBCLC, how do you educate yourself about the cultural issues within your community?

With a background of teaching in inner-city London, Emma Pickett, IBCLC came to breastfeeding support after she had her first child in 2004. She trained as a breastfeeding counselor with the UK-based charity the Association of Breastfeeding Mothers (ABM). Now sitting on their central committee, Emma continues to volunteer on the National Breastfeeding Helpline and the ABM’s own helpline as well as running three support groups in North London. Emma qualified as an IBCLC in 2011 and has a private practice alongside her voluntary work. Her work focuses on how breastfeeding impacts on a woman’s sexuality and relationships but also crucially how the sexualization of Western society affects the initiation and continuation of breastfeeding. She is keen to encourage open dialogue in an area which even breastfeeding supporters sometimes shy away from. You can her discuss Breastfeeding and Sexuality on a recent episode of The Boob Group

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Supporting Active Duty Military Mothers as an IBCLC

By Robyn Roche-Paull, BS, IBCLC, and LLL Leader

As the author of the book, Breastfeeding in Combat Boots, I am often asked by my fellow lactation consultants how to best support active duty military mothers who wish to continue breastfeeding while serving their country. Currently, women comprise nearly 20% of the active duty force in the United States. Most women on active duty are of childbearing age, and at least 15% will become pregnant while on active duty. At this time, 38% of the women in the military are mothers (nearly 80,000 personnel) and, of the children born to active-duty mothers, nearly 40% are newborn to five years of age. As more women enter military service, the number of women planning to breastfeed while remaining on active duty will continue to increase as well. Many active-duty women are choosing to breastfeed because of the benefits for themselves and their infants. Unfortunately, most are not reaching the goals set by Healthy People 2020 and the American Academy of Pediatrics for breastfeeding because of a lack of information and support.

Throughout the United States and overseas, there are Active Duty, Reserve, and Guard military women who are interested in breastfeeding after their return to work at six weeks postpartum. In addition to full-time employment, military mothers also face body weight and physical training standards, uniform issues, hazardous materials exposure, long shifts and inconsistent work schedules, prolonged separations due to deployments, and a military culture that does not always value the role of a mother. However, just like their civilian counterparts, military mothers who are breastfeeding also need information on the basics of breastfeeding, common concerns and pumping. As lactation consultants, you can be on the front lines of providing this much-needed care.

Major Beth Lane,USAF, C-17 pilot pumping in the crew “Breast” area

Here are some of the most important things to know when helping a military mother (all of these topics and more are covered at my website):

  • Basics & Common Concerns: The basics of breastfeeding and mother’s common concerns are the same for everyone. Military women deal with sore nipples, engorgement, plugged ducts, thrush and mastitis just like the rest of us. The difference here is that they may not have the luxury of staying in bed for the weekend to recover. Keep in mind that they may be wearing heavy gear or not drinking enough fluids due to their work environment that can lead to some of the above problems.
  • Policies: Be aware of the breastfeeding policies of the various branches of the military, what they provide (and don’t provide) and where to find them. In a nutshell, the US Air Force, Army, Coast Guard, Navy and Marine Corps all provide at least 6 months deferment from deployment (the Navy offers 12 months) after the birth of the baby. The Air Force, Marines and Navy policies also specify a time and place to pump. More detailed information about each of the policies and downloadble PDFs can be accessed at www.breastfeedingincombatboots.com/militarypolicies.
  • Pumps/Pumping/Hand Expression: The average military mother works a 12-hour shift and will need to express her milk at least 3-4 times. She needs the proper pump, one that can last through a year’s worth of heavy-duty pumping and that will keep her milk supply up. Many enlisted mothers try to save money with cheap or used pumps. Steer them towards the personal-use pumps from companies who produce a powerful and efficient pump. Include teaching on hand expression, which is a lifesaver out in the field with no electricity and go over safe storage and handling guidelines according to the Academy of Breastfeeding Medicine protocol.
  • HAZMAT (Hazardous Materials): Many mothers in the military work in job specialties that require working with hazardous materials such as jet fuel, lead, or solvents. While there is a lack of information on the safety and transfer of these substances into breastmilk (the latest edition of Medications and Mother’s Milk has information on jet fuels and lead), take the opportunity to go over their exposure levels, ask for copies of the Material Safety Data Sheet, and remind them to wear their personal protective gear. It is important that mothers weigh the risks of theoretical contamination at work against the know risks of formula before making a decision to wean.
  • Physical Training (PT): All military members are required to pass semi-annual physical fitness testing and maintain weight standards. US Military mothers have 180 days from the birth to meet those requirements. While breastfeeding is known to help women lose weight, some mothers have difficulty losing the last 5-10 pounds until they wean. Go over safe weight loss tips, and myths regarding exercise and breastfeeding.
  • Deployments & Training: Deployments and training away from home are a fact of life in the military. While mothers are deferred from deployment for 6 -12 months (depending on the branch of service), they are not exempt from participating in training exercises or schools. Many mothers will face the prospect of leaving a fully breastfed baby at 6 months and will need information on pumping in the field or overseas and how-to ship breastmilk.

Robyn, with her own son at 3 months, in her uniform

There are many other ways that you can support military breastfeeding mothers such as setting up Active Duty Breastfeeding Support Groups or programs at your local clinic, hospital or private practice. Create or sponsor a loan program for hospital-grade pumps (this is especially useful for the junior and mid-level enlisted personnel, many of whom struggle due to their low pay). Provide education and training to the local military physicians and commanders of the base or post on the basics of breastfeeding and why it is in their best interest to support their breastfeeding mothers. The Business Case for Breastfeeding can be easily adapted for military commands, and has been used to great success at The Navy and Marine Corps Intelligence Training Center (NMITC) already.

Finally, advocate, advocate and advocate for these mothers. They are waging a never ending battle against a culture that values warriors, not breastfeeding mothers. Often these mothers are far from home, without any family nearby, dealing with unsupportive commands and supervisors that don’t understand breastfeeding at all. You may be their only source of information and support. Remind them that breastfeeding in normal and achievable. Due to regulations that disapprove of breastfeeding in uniform, many military women do not ever see another military mothers breastfeeding. Share positive breastfeeding success stories with the active duty moms you see, as they are going to hear plenty of negative stories from everyone from the clerk at the Commissary to their co-workers. Remind them that breastfeeding in the military is not all or nothing. Any amount of breastfeeding they can do, and any amount of breastmilk they can provide is better than nothing! Above all be flexible, supportive and understanding. Unless you have breastfed in a pair of combat boots you cannot know the amount of fortitude, determination and perseverance it requires to be successful. These women deserve our thanks for Giving the Breast for Baby and Country!

This article does not reflect the views nor is it endorsed by the US. Military.

Check out ILCA E-Globe for a feature about Robyn and her recent trip to Aviano Air Base. in Italy

Robyn Roche-Paull, BS, IBCLC, and LLL Leader is the author of the award-winning book Breastfeeding in Combat Boots. In her private practice she primarily helps military mothers balance returning to active duty while continuing to breastfeed. Robyn is not only an advocate for active duty military mothers who wish to combine breastfeeding with military service, she is also a US Navy Veteran who successfully breastfed her son while on active duty as an aircraft mechanic. Robyn frequently contributes to various breastfeeding publications and blogs about breastfeeding in the military at her website www.breastfeedingincombatboots.com and has been a guest blogger at Best for Babes, baby gooroo and The Feminist Breeder. Robyn can be found lecturing at breastfeeding conferences and military bases around the United States and overseas. Robyn is currently enrolled at Hampton University’s Accelerated Bachelor of Science Nursing degree program and lives in Virginia Beach, Virginia with her husband of 18 years, a Chief Petty Officer in the US Navy. She is the mother of 3 long-term breastfed children now 16, 13 and 9. Visit her at www.breastfeedingincombatboots.com and on Facebook at www.facebook.com/breastfeedingincombatboots, you can also follow her on Twitter at www.twitter.com/BFinCB.

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American Academy of Pediatrics Section on Breastfeeding Launches New Facebook Page

By Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM

The internet has increasingly become a tool for people seeking health By Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM
information. A Pew Internet and American Life survey in 2011 showed that 80% of internet users have visited a website for information or support for a specific health problem, 19% of whom searched for information on pregnancy and childbirth.

Social media has increasingly become a tool for organizations, such as the American Academy of Pediatrics (AAP), to share information pertinent to the goals, mission, vision, publications and achievements. It has become a way to promote new products. It increases awareness about current issues, and can, unfortunately, generate misinformation which can be quickly disseminated widely. As the AAP is the recognized authority on the care of children, in addition to provide accurate information to physicians and breastfeeding mothers, we see this misinformation as a problem which needs to be addressed.

The American Academy of Pediatrics Section on Breastfeeding recently launched a new Facebook page.  It was created to:

    • Raise awareness of activities, products, and resources produced by the Section on Breastfeeding.
    • Highlight our members achievements.
    • Recruit new pediatricians to our membership.
    • Highlight pertinent evidence-based practices and publications.
    • Present evidence-based information in response to trends on social media which may be detrimental to the experience of new breastfeeding mothers.
    • Join in the discussions, currently occurring in social media about breastfeeding.

The Facebook page has the potential to be many things but it will not be a place for our section’s members to offer clinical advice.  It will be for the dissemination of information only. 

We invite IBCLCs and other breastfeeding professionals and volunteers to come “like” our page and engage in the conversation with us. A strong collaboration between pediatricians and other members of a baby and their family’s health care team is vital to their breastfeeding success.

Click HERE to connect with the American Academy of Pediatrics Section on Breastfeeding’s new Facebook page.

0

A Day in the Life of US Hospital Based IBCLC…

By Christine Staricka, IBCLC

I’d like to open a window for you to see what I experience during the 24-72 hours after birth as a hospital-based IBCLC in the United States.  It may or may not surprise you, but it will definitely broaden your perspective.

A typical day for me and my colleagues begins with accessing a current census report of mothers in the postpartum unit, the NICU, and the pediatrics unit.  Prioritizing patients is one of the most difficult tasks I face.  The reason is simple: every nurse correctly believes that her patient is the most important and needs to be seen immediately. In many cases, when I tell a nurse that her patient will be seen later rather than sooner, I listen to her case assessment and help her by making specific suggestions on how to help get through the next feeding or two.  Every day, I teach as many nurses as I do moms, reinforcing both clinical and assessment skills and reframing perspective in terms of infant health outcomes.

Collecting information on dyads is a time-consuming task.  I consult the charts; check the white board on which nurses write feeding status and significant outcomes for each dyad; talk to nurses and pediatricians; and most importantly, I talk to the mother while I observe her baby at her breast.

Often a postpartum mom is medicated, stressed from a difficult or long birth, and overwhelmed by the sheer number of hospital employees knocking on her door for various reasons. Talking to the new mother is an exercise in proper communication skills to overcome her reluctance to let another stranger into her world and to build credibility and a sense that I am there to advocate for her and her baby.

I ask for her opinion on breastfeeding progress, mentally comparing it with information I have already gathered.  Often she expresses a vastly different picture. She may feel it’s going terrible because the baby wanted to nurse all night and is clearly not getting enough milk, while the nurse has assessed the latch and notes that baby has had 5 stools and 2 wet diapers in the first 24 hours.  Or the mom may say it’s going fine even though it hurts a lot, and she knows that’s normal because all her friends told her that breastfeeding is supposed to hurt; however, the baby lost more than 7% of birth weight in 36 hours and has a high bilirubin level for his age.  Sometimes the answer is obvious but most times, it takes more detective work:  “Tell me about your birth…”

The more you talk, the more opportunity is created to educate, correct myths, and address misperceptions.  In the hospital, many times the moms I see are not yet aware they need help.  She may not even truly want help.  That puts an extra burden on me to discern how much I can assist, and I’ve learned through experience to sense from her responses when it is advisable for me to ask explicitly whether she would like me to work with her, what were her original feeding goals, and how she would like to proceed while still in hospital.

During my hours on the floor, I wear a pager so that patients and staff can find me in the building.  We maintain a lactation helpline where any mom in the community can leave a voicemail if she needs breastfeeding support and I also see moms on an outpatient basis as needed after they have been discharged home.

I do a LOT of paperwork. I am required to document every contact with a mother, short or long, phone or in-person, and also some with nurses where I give specific instructions on how to help.  I am required to document those contacts on my own daily activity log, as well as documenting them in legally-approved patient charting methods, all of which are handwritten in our facility and are subject to subpoena by the courts in case of litigation.  When I have contact with the mother of a baby in NICU, I document in the baby’s chart, plus I also make notes on the contact on an individual dyad tracking sheet to assist with continuity of care among lactation consultants because the physical charts for those babies are not easily accessible to us. I sign in multiple places in patients’ charts that I have provided required education on those topics, and I collect feeding statistics from mothers for hospital reporting requirements.  I compile multiple types of breastfeeding statistics for various purposes within the hospital; sometimes those reports influence policy and procedural changes, a very rewarding direct outcome of my efforts.

I facilitate a monthly breastfeeding support group sponsored by the facility. I assist in formal staff education events held annually for each individual unit within the Maternal Child Health Department.  Our lactation staff doubles as the Parent Education staff (and thus required to maintain current certification as Childbirth Educators) so we are responsible for teaching Childbirth Education Series, Prenatal Breastfeeding Classes, and hosting weekly maternity Orientation Tours of the facility for pregnant women and their partners, in addition to teaching a daily Discharge Class for patients discharging home that day. We create handouts for parents which meet Baby Friendly standards and IBCLC Standards of Care. I am sometimes called upon to assist hospital employees who themselves are facing breastfeeding and/or pumping challenges as they return to work and advocate for them as needed. I collaborate with the local Women, Infants, and Children (WIC) services to ensure individual mothers in need get breastpumps and basic breastfeeding support as needed.

I often wish I was able receive feedback and validation which comes from building a relationship with my patients.  Almost everyone I see disappears into the ether and I never know if I affected them.  Fortunately, there are those beautiful few who call with questions, who come back in for more help, who send lovely thank-you cards, who attend support group, and whose babies I am privileged to see as they grow up.  I feel comfortable speaking for all my hospital-based IBCLC peers in saying that the rewards we reap from just a tiny few of those we meet in our demanding professional setting are enough to make us happy to see the multitudes every day.

Christine Staricka became a Certified Lactation Educator through UCSD while facilitating local breastfeeding support groups. She studied independently while accumulating supervised clinical hours and passed the exam in 2009 to become an IBCLC. She holds a BA in Business Management from University of Phoenix. She has contributed to USLCA’s eNews and she moderates a community-based breastfeeding information and discussion page on Facebook at Facebook called BakersfieldBreastfeeds. She enjoys tweeting breastfeeding information as IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of whom have been or still are breastfeeding. She is partial to alternative rock and grunge music, especially Pearl Jam, and attends as many concerts as financially possible with her husband of 18 years.

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IBCLCs Play a Critical Role in the US Best Fed Beginnings Program

By Debi Ferrarello, MSN, MS, IBCLC

The National Initiative for Children’s Healthcare Quality (NICHQ) launched it’s CDC-supported Best Fed Beginnings program with the ambitious goal of preparing 90 US hospitals for Baby-Friendly designation by September, 2014. The 90 hospitals were selected from 235 applicants and represent 29 states with dubious distinction of having the lowest breastfeeding rates and the highest rates of supplementation during the hospital stay. The 90 hospitals were further divided into three geographical cohorts of 30
hospitals each.

IBCLCs gathering at the recent NICHQ Region B conference in Baltimore.

Each hospital has a “core team” that includes a senior administrator, at least one physician, a nurse leader, a bedside nurse, a data manager, a team leader, a senior lactation consultant, and a mother who does not work for the hospital and has given recently given birth at the hospital. This model addresses administrative “buy-in” issues by requiring senior administrator participation. In fact, the senior administrators have their own track tailored especially for their needs. Since creating a community that supports breastfeeding is a goal of Baby-Friendly, involving a mother from the community makes so much sense!

Recently, hospital core teams from “Region B” gathered in Baltimore, MD for a two day learning session (and Baltimore’s famous crabcakes on our own!). National public health leaders such as CDC’s Laurence Grummer-Strawn and Charles Homer, MD, MPH, president of NICHQ and on faculty at Harvard University, kicked off the event and energized the crowd. Over the course of two days, participants learned more about why breastfeeding is so important, how hospital practices make a difference, and what teams can do to transform the culture. We heard specifics about Baby-Friendly designation directly from Trish Mac Enroe and Liz Westwater of Baby Friendly USA. ILCA members Lori Feldman-Winter, MD, MPH, IBCLC and Anne Merewood, PhD, IBCLC provided specific strategies for success. Pediatrician Sahira Long, MD, gave insights into providing culturally appropriate care. We learned Continuous Quality Improvement (CQI) techniques that are essential to measure our baseline, develop strategies for change and chart our progress as we strive to support breastfeeding from the prenatal period, throughout childbirth and the hospital stay, and into the postpartum period. Finally, we heard from hospitals in our region who have already become Baby-Friendly as they shared trials and triumphs that we could all relate to.

Each participating hospital made a “story board” or video about their hospital, their goals, their successes, and challenges. Pennsylvania Hospital Core Team members enjoyed seeing what others have done and were proud to share our history of “rooming-in” dating back to 1765! Debi Ferrarello, Susan Meyers, Brittany Stofko, Kelly Wade, Pam Powers, and Karen Anastasia in front of their hospital story board.

So what do IBCLCs need to know about this initiative? IBCLCs need to know that after years of pushing that boulder up the mountain alone, there is suddenly an army of folks pushing right along with us…And we need to welcome the newcomers to the task. We need to be prepared to graciously play support roles as leaders who may never before have considered breastfeeding suddenly “discover” it. Many of the hospital team leaders are IBCLCs, meaning that we need to quickly become experts in CQI tools that were never part of The Exam and develop the essential skills to effectively lead an interdisciplinary team through a complex and multi-layered transformation. This is challenging work, but then again, IBCLCs have always be up for a challenge!

Best Fed Beginnings brings opportunities for IBCLCs. In order to become Baby-Friendly, hospitals need to make sure that all of their nurses have at least 20 hours of breastfeeding education, including five hours of competency-based demonstration. IBCLCs can teach classes and conduct skills labs for the competency education. While hospitals are not required to employ IBCLCs for Baby-Friendly designation, many do hire IBCLCs to care for their patients, as well as to provide education for other staff members. And finally, as hospitals invest resources into breastfeeding support, the visibility of those with expertise in lactation care rises. IBCLCs become far more valuable in the eyes of the hospital and the community. This is all good for IBCLCs, and ultimately for mothers and babies!

Debi Ferrarello, MSN, MS, IBCLC is honored to lead the NICHQ Core Team for the nation’s first hospital—Pennsylvania Hospital in Philadelphia.  Over the years she has worked in private practice, co-founded the nonprofit communty-based Breastfeeding Resource Center with Colette Acker, IBCLC, and led hospital-based lactation programs.  She conducts breastfeeding-related research, writes and speaks about breastfeeding, and is passionate about breastfeeding as public health.  She currently serves on the board of the United States Lactation Consultant Association. 

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Reducing the Breastfeeding Disparities Among African American Women: A Commentary from ROSE, Inc.

Reaching Our Sisters Everywhere, Inc. (ROSE) seeks to enhance, encourage, support, and promote breastfeeding throughout the USA, by working to reduce the breastfeeding disparities among African American women. We also seek to strengthen the health of their families through, mentoring, breastfeeding support groups, social support, outreach, education, health policies and social marketing. ROSE works with national groups to strengthen local groups that serve African Americans who breastfeed.

It is our understanding that a storm is brewing in the lactation community among International Board Certified Lactation Consultants (IBCLC) and the several other lactation certifying organizations to gain the title of grand matron of the breastfeeding world. The African American community needs all the breastfeeding management assistance we can get in order to overcome the breastfeeding disparities in our community. ROSE is grateful for the work that you all do. We understand that breastfeeding promotion is not enough. To be successful, mothers may need hours of skilled help that is provided when needed. We are of the position that there is a need for several levels of lactation managers. There is a need for the novice, the beginner, the intermediate and the expert lactation specialist. We are of the position that EVERY informed person can help a mother to breastfeed. We are in NEED of every advocate who wishes to be involved with lactation management, to be applauded and welcomed to the table of breastfeeding protection. Everyone does not NEED a cardiologist. Everyone does not need a specialist. However, when a specialist is needed, it is wonderful to be able to refer to the IBCLC.

Becoming and maintaining the designation as an IBCLC is a complicated and expensive process. Many of us, concerned with addressing the disparities of breastfeeding in the African American community do not have the luxury of the time that it takes nor the necessary funds to be involved in this complicated process. This is what we have been told by African American health care providers and community organizers as we travel. That some sort of designation is important for the provider of direct lactation services in the hospital, is an underlying theme. We are of the firm belief that EVERY person, that has contact with and cares for mothers and babies in the hospital, should be trained to assist mothers in the hospital with skin to skin, latch and pumping when necessary. Our goal is to have every African American woman who has successfully breastfed a baby help another African American woman breastfeed her baby. Most of these women will never be an IBCLC.

Reaching Our Sisters Everywhere, Inc. recently coordinated a Breastfeeding Summit which involved African American healthcare providers, community advocates, organizations, and government representatives from throughout the United States. We came together to ponder, discuss and debate the breastfeeding disparities in the African American community. We also celebrated. We celebrated the many accomplishments of the breastfeeding advocates that were gathered. This was an African American “Dream Team” of breastfeeding experts. There were 49 persons who assisted with the planning and execution of the summit. Three were African American IBCLC’s. Ten were African American CLC’s. All were experts at what they brought to the table to assist African American women breastfeed their babies.

Discussions during the Summit included: reforming healthcare through breastfeeding, exemplary lactation projects, consulting with doctors on effective initiatives, samples of breastfeeding support programs, saving our babies, reclaiming our breastfeeding experience, a continuum of care from the hospital to the neighborhood which featured primary care, hospital, community and public health and bridging the gap on breastfeeding disparities. These were the concerns of the experts on the planning committee. They were confirmed to be significant issues in our community by those in attendance. The raging debate about what certifying body should reign supreme in lactation management cannot distract us as we seek to save our babies. We could, however use your help with special situations when the occasion arises. ROSE will continue to be about the business of increasing initiation rates and duration rates of breastfeeding in the African American community.

You may contact ROSE, Inc. by sending email to BreastfeedingRose@gmail.com or visiting their website at BreastfeedingRose.org.

Kimarie Bugg MSN, MPH, is President and CEO of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Kim has been a bedside breastfeeding counselor in a large metropolitan hospital, managed perinatal and breastfeeding projects and programs at the state level, and has served as a technical advisor to Best Start, as well as for the US Baby Friendly Hospital Initiative. Kim was a founding member and officer of Georgia breastfeeding task force (coalition) and SEILCA. Kim was trained at Wellstart International and has traveled throughout the United States and several foreign countries training healthcare professionals to manage lactation. Kim previously worked for Emory University, school of medicine, department of pediatrics as a nurse practitioner. She also provides the training for Georgia’s WIC Breastfeeding Peer Counselors, a proud position held since 2005. Kim is married to Dr. George Bugg Jr, a neonatologist and they have five breastfed children.

Mary Nicholson Jackson, CLC, works in a large urban hospital as a breastfeeding consultant and is the co-president of the Georgia State Breastfeeding coalition. Mary is Vice President of ROSE She is on numerous committees and task forces that address breastfeeding and lactation management in the community. She previously worked with Healthy Mother, Healthy Babies of Georgia. Mary is married and the mother of three adult children. She has three grandchildren.

Betty Neal, R.N., MSN, is a founding member of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Betty has worked in women’s health for over 30 years. She completed certification as a Women’s Health Nurse Practitioner from Emory University. She recently retired from the State of Georgia Department of Human Resources, DeKalb County Board of Health as a public health nurse and program administration where she managed, developed and implemented numerous statewide and local public health programs. Her past experiences include instruction in a baccalaureate nursing program and mother-baby nursing in a large urban hospital. She has an passion for mothers and babies and believes we must support and ”nurture our mothers who will nurture our babies”.

Andrea Serano, a ROSE Inc. staff member, is from North Hollywood CA., and attended Mount St. Mary’s College with a major in Healthcare Policy and minor in Business Administration. During her course of studies, she participated in the Washington Semester Program- Transforming Communities at American University. She has interned at the U.S. Department of Health and Humans Service in the Office on Women’s Health and at Great Beginnings for Black Babies. Andrea has participated in breastfeeding awareness movements through the use of social media and hopes to one day establish a young women’s development center in the country of Belize.

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World Breastfeeding Week: Supporting Hmong Women in Sacramento, CA

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

At Lactation Matters, celebrating World Breastfeeding Week means not only highlighting breastfeeding in the many countries on earth, but also  in the individual cultures in each country.  One size does not fit all!  Today, we share an interview with Yang Her, an IBCLC working with the Community Resource Project WIC program in Sacramento, CA. She has worked tirelessly for many years to encourage and support the Hmong mothers in the community to breastfeed.

Photo by United Nations Photo via Flickr Creative Commons

The Hmong people are a group of Asian people, originally from mountainous regions of China, Vietnam, Laos, and Thailand. Many came to the United States as refugees following the communist takeover of Laos, settling primarily in Wisconsin, Minnesota and California with Sacramento being home to one of the largest populations.  Breastfeeding support that focuses on the unique cultural needs of a mother is always important.

How did you come to be an IBCLC?  What personal and/or professional experiences led you down the path? 

I had my first child, Leo, in June 1989 and was not able to breastfeed him because I didn’t have any breastfeeding education. While I was pregnant with him, there were a number of controversial of breast cancer commercials on television. 3 days after our birth, I woke up with body aches, as well as very painful and lumpy breasts.  All I could remember was what I had watched on TV and wondered if I was at risk for breast cancer!  I was scared and called my doctor right away. When I got to the doctor’s office that morning, he said not to worry and explained a bit about engorgement.  He gave me a tiny white pill (I had no clue what it was called) and told me to give Leo formula. That same day and through the night, the pain in my breasts went away slowly. By day 4, I resumed breastfeeding but Leo was fussy and pulled away from my breasts. By day 5, my breasts are soft and from that day on, my milk dried up. Leo was on formula and he didn’t tolerate it well. He would vomit with one formula or gets diarrhea or constipation with the other. I also had to return to work after 6 weeks but had to quit shortly after my return because my son was sick so often.  When I was pregnant with my 2nd child, Allen, I was determined to breastfeed and learned as much as I can about breastfeeding. I breastfed Allen for 3 1/2yrs and loved the experience and went on breastfeeding my 3rd and 4th child.

Several years later, in 994, I was a WIC participant and was recruited as a Hmong breastfeeding peer counselor.  I worked in that capacity for a year and learned that I was not the only mother that didn’t know much about breastfeeding. My passion to advocate, educate, promote, and support breastfeeding mothers grew. I continued working with WIC as a nutrition counselor as well as a breastfeeding educator. It was so rewarding that I went on to pursue my CLE in 1999 and became an IBCLC in 2005.

What are the cultural  norms of breastfeeding in the Hmong culture?  What specific challenges are there in working with this population of mothers and babies?

Photo by nikkodem via Flickr Creative Commons

Back in our homeland, almost every Hmong mother breastfeds.  The child and mother hardly separates from each other and if they do, the time is brief and the baby is fully fed before the mom goes anywhere. Mothers always carry their babies either on her chest or her back with a baby carrier.  Whenever the baby shows hunger cues, the mother would remove the baby from the carrier and breastfed, and then once the baby is content, she carries the baby again.  This is how she continues to do her daily tasks whether it’s cooking, sewing, cleaning, or farming. Hmong mothers are very creative in caring for their infants while maintaining their roles as a wife, mother, and daughter in-law. A mother can wear 20 different hats and would still be able to breastfeed her infant. There was no such thing as pumping and storing for separation periods.

Here in the USA, their roles may still be the same, however, breastfeeding their infants on demand has shifted by the fact that they are not always with their infants.  There are a number of strict cultural beliefs about pumping and milk storage that effect the ease with which breastfeeding can continue in these circumstances such as:

Food and breastmilk cannot be stored in one place. This means, a breastfeeding mother who works or in school will need to buy a new refrigerator or freezer just to store her pumped breastmilk.

Breastmilk cannot be leaked anywhere. Culturally, there is a significant risk if anyone other than her infant accidently ingests or touches her breastmilk.   The in-laws may discourage a mother from breastfeeding by telling her that if she breastfeeds, she would need to stay home because they will not take the risk of touching her pumped breastmilk.

What I have witnessed is Hmong mothers who are married to Hmong men are more likely to not breastfeed. On the flip side, Hmong mothers who are married outside of the race are more likely to breastfeed.  When I asked for their reasons, almost always, it’s the Hmong belief that prevents the mothers from breastfeeding.  The cultural beliefs is often not discussed with the mother until she decides to breastfeed. I look forward to sharing more about these beliefs in my upcoming book.

Can a Hmong LC like me make a difference providing breastfeeding education?  It is possible if I can find a solution to the Hmong belief and restriction of human milk.  I know I have a long way to go but I also believe that where there’s a well, there’s a way.  It’s a matter of time.

What is one of your most rewarding experiences as a breastfeeding professional?

One of my most rewarding moments is when a breastfeeding mother comes to her appointment feeling discouraged, sad, and in pain and walks out of my office at the end of a consult feeling confident, understood, and knows that she’s not alone in her journey to successfully breastfeeding.

Thank you, Yang Her, for the work you are doing among Hmong women!

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Education, Social Media & Motherhood

Written by Deirdre McLary for her blog, Breastfeeding Arts

I was recently discussing the upcoming ILCA conference and the business of breastfeeding, both locally and nationally with a friend and dear colleague. Part of our discussion was on the business of education and helping mothers grow their confidence and wisdom before baby arrives. The models for education can be both face to face; through class time and instruction, or online via email and social media. Knowledge is power, as the expression goes. How do we, as breastfeeding educators, grow that knowledge base for expectant mothers, and how can we expand our reach so that your transition to new motherhood is a smooth one?

As both an IBCLC and a childbirth educator & doula, I know all too well how few families seek out empowering childbirth & breastfeeding education.

But are enough women turning to seeking prenatal education? I don’t think so. What I do know, and see repeatedly, is that those women who do not seek good prenatal education have a greater likelihood of feeling overwhelmed and isolated. I know this because they call me desperate for help and support.

A solid network of education, support and resources should be cultivated prior to baby’s arrival. This will help the mother navigate those first weeks of baby blues and postpartum healing. Not all mothers, mind you, have a difficult transition. One of the many benefits to consider is not just the knowledge base a mother will take into birthing and breastfeeding, but also the relationship she has now established! Wise Woman to New Mother! She has her tribe, someone she can now turn to postpartum to seek answers and support. As my colleague says, “a friend in her pocket”!

Social media and online support can be a wonderful conduit for support and wisdom. Sixteen years ago, when I was pregnant with my first, I researched something on the “then pretty new” internet. I brought it to the attention of my OB, who I subsequently left for the care of a midwife. You know why? He scoffed and said, “Are you going to trust some quack you find off the internet?” and immediately dismissed my researching things outside his care. (That quack was Ina May Gaskin). Well, I did trust what I had read. Those were my instincts kicking in and my ability to trust myself.

I encourage all pregnant mothers to seek out advice online from reputable IBCLC businesses and online communities! (Editor’s Note: Check out Australia’s new Virtual Breastfeeding Cafe) There are many wonderful resources with excellent professionals happy to help you find your way. As a La Leche League leader, the concept of “mother to mother” support is still, in my opinion, one of the best conduits of postpartum sisterhood out there! And now that “mother to mother” care can be found online, on many a Facebook page, blog, Twitter or Listserv. It’s not always easy getting out of the house as a new mother. While I never want online communication to replace face-to-face connection, there are a wealth of relationships available there.

It all comes back to education and support! Whether it’s private or group prenatal classes (each has its advantages), a private lactation consult in the comfort of your home, an online consult via email or even a Twitter chat (for example, #bfcafe) — all are great ways to stay connected to a professional who only wants the best for you — normal, healthy birthing which leads to normal, healthy breastfeeding!

How have you, as an IBCLC or breastfeeding professional, helped mothers to receive prenatal education and support?

Deirdre McLary is the founder of BREASTFEEDING ARTS and has provided expert IBCLC Lactation Support, Doula Care and Childbirth Education since 1997 in the Hudson Valley, NY area. Deirdre is deeply committed to raising childbirth, breastfeeding and parenting awareness throughout her area by providing compassionate, holistic & open-minded options for anyone who seeks them. She is a board certified lactation consultant (IBCLC), a labor support and post partum doula, La Leche League leader, childbirth educator, and new parent mentor. She has also held leadership positions in The Metropolitan Doula Group, La Leche League, River Doulas and The International Cesarean Awareness Network.

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