Tag Archives | Jennie Bever Babendure

The Top Lactation Matters Blog Posts of 2012!

As we wind up 2012, we thought we’d take a look back at our most read blog posts of the year. It has been an exciting year at Lactation Matters, as we have passed our 100,000 views mark. We are well on our way to our second 100K and we’re looking forward to adding new regular features and bringing in dozens of new writers in 2013. If you are doing something new and innovative in your practice, have a tip or technique to share, or want to tell us about how IBCLCs are impacting breastfeeding families around the world, please send us an email to lactationmatters@gmail.com. We look forward to hearing from you!

Here are our top 5 blog posts of 2012!

5464706246_6acccd82f6A Closer Look at Cultural Issues Surrounding Breastfeeding: This fantastic post, by Emma Pickett, an IBCLC in the UK, highlighted not only some of the unique cultural beliefs surrounding breastfeeding around the world but also turned some of our most common beliefs on their ears.

gennaAn Interview with Catherine Watson Genna: As IBCLCs, we are constantly on the look out for new insights into infant behavior that will help us to educate and encourage new mothers. Cathy’s observations of how infants use their hands in regards to feeding has changed practice and helped parents to work WITH their infants and not against them. In this interview, she explains why allowing infants to use their hands is important.

Pic for Jennie post 4

Synthetic Oxytocin and Depressed Newborn Feeding Behaviors – Could There Be a Link?Jennie Bever Babendure explores how birth practices can impact breastfeeding and how labor induction and augmentations can be sabotaging neonatal feeding reflexes, which can throw road blocks down in front of even the most committed breastfeeding efforts.

KimberlyPublicity-300x200Why Beyonce Nursing in Public is So Significant: Robin Kaplan interviewed Kimberly Seals Allers about the impact of an African American celebrity (let’s face it…Beyonce is THE African American celebrity!) on breastfeeding. “Celebrities can help create a lifestyle cache and trendiness, particularly among young women, that helps broaden our ideas about who breastfeeds in the black community.”

imagePumping Strategies for the Working MotherOur most popular post of the year (by over 6,000 page views!) was this practical one by Wendy Wright, of Lactation Navigation in San Diego. In it, she highlights why workplace lactation support is so vital as well as answers the critical questions from mothers going back to their place of employment like “How often should I pump once I return to work?” and “How much milk will I need each day?” .

We give a HUGE thank you to all of our contributors this year. 2012 was an absolutely stellar year for Lactation Matters and we look forward to watching this blog grow in 2013!

0

If YOU Don’t Advocate for Mothers & Babies, Who Will?

Written by Jennie Bever Babendure, PhD, IBCLC

As IBCLCs, part of our Code of Professional Conduct  (IBLCE November 1st, 2011)calls on us to adhere to the World Health Organization’s (WHO) International Code of Marketing of Breast-Milk Substitutes and Subsequent Resolutions.  For those of us who hold this Code in high esteem, the news that WHO is accepting corporate funding and instant payday loans for its obesity initiative is enough to turn our stomachs many times over. According to the article, the Pan American Office of the WHO (based in Washington, D.C.) has begun to accept funding from fast food makers, among them the food giant and WHO Code violator Nestle.

As I struggled to reconcile the idea that an organization focused on world health would accept funding to fight obesity from the organizations that stand the most to gain from creating it, I began to feel crushing discouragement. How on earth can we, as a small band of mothers and breastfeeding professionals supporting the WHO Code, compete with multinational corporations with seemingly endless supplies of money? How can we succeed at supporting the WHO Code when the WHO is taking money from one of the worst offenders?

This is the point in the story when the hero has been soundly defeated. She goes back home with her eyes on the ground kicking stones in the path. She decides she will never win, so she might as well give up and just make noodles for the rest of her life (oh wait, I think that might be from one of my son’s favorite movies).

After a long night of frustration, writing, and a little alcohol, I chose to reframe the issue as a CALL TO ACTION. And if the WHO violating the WHO Code isn’t a call to action slapping me in the face, I don’t know what is!

But what can we do?

Most of us are doing our darndest to help mothers and babies start and continue breastfeeding in the face of tremendous marketing and cultural pressure to do otherwise. We stay awake nights worrying about how to best help a mother struggling with thrush or low supply, pour over research on tongue-tie and search the web for resources for new mothers. What more can we do?

The time has come for us to see our roles expand.  Our job as lactation professionals must not only be to provide individual breastfeeding support, but also to advocate for maternal and child health on a larger scale. If we don’t begin to protest the status quo and work to change the political and cultural barriers that mothers face in their attempts to reach their breastfeeding goals, we will be fighting the same battles for the next 100 years. The International Baby Food Action Network (IBFAN) has long been at this fight. They shouldn’t have to fight alone.

In many places, we are beginning to see policies and legislation changing. We need to harness that momentum to move the tide even further. Now more than ever, mothers and babies need us to advocate for them and they need us to empower them to demand change themselves. Not just in the clinic or hospital, but in the grocery stores and restaurants, in the hallways and on the floor of congress. When mothers and babies protest a mother being asked to leave for nursing in public, we need to show up. When our congressmen and women debate policies that impact breastfeeding, we need to show up. When a news station wants to run a story on breastfeeding, we need to show up. When the WHO takes money from Nestle, we need to show up!

For some, showing up means planning and attending nurse-ins and rallies, for others it is talking, blogging and posting information on the cultural and political barriers to breastfeeding on websites, twitter and Facebook pages. Still others have the ability to influence corporations and other organizations they are a part of by changing the way they do business, who they work with, and how they support their employees. Even beginning to have conversations with the mothers you work with about choosing to support companies that uphold the WHO Code can have an impact!

We can also leverage our resources by joining forces with other organizations working to improve maternal and child health. In addition to IBFAN and the World Alliance for Breastfeeding ActionNatasha K. Sriraman has written about the organization 1000 Days for the Academy of Breastfeeding Medicine.  With a goal of improving life by improving maternal and infant nutrition in the first 1000 days –pregnancy through the second birthday—1000 days seems like a natural ally of lactation consultants and maternal-child health advocates.  Working with like-minded organizations will increase our ability to impact policies and legislation that prevent corporations like Nestle from sabotaging breastfeeding in both developed and developing countries by marketing their products directly to mothers.

When I was younger, I was under the illusion that if something important were happening, someone else would take care of it. As I’ve gotten older I’ve realized that is rarely the case. When the WHO takes money from a formula company, something is terribly wrong. If we don’t do something about it, who will?

If you are interested, please consider joining the “Friends of the WHO Code” Facebook Group to discuss violations of the WHO Code, especially those on social media, and how we can empower lactation professionals, volunteers and mothers to stand up for its importance.

Jennie Bever Babendure, PhD, IBCLC: I am mother to 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates. For more research news and commentary, check out my blog at www.breastfeedingscience.com. I can be reached at jennie.bever@gmail.com.

16

What a Difference a {National Breastfeeding} Month Makes!

Written by Jennie Bever Babendure, PhD, IBCLC

ILCA Marketing Committee

Although my oldest son is the reason I got into lactation, my youngest has borne the brunt of my lactivist enthusiasm by virtue of being born after I became an IBCLC. For the first week, his every latch was overanalyzed and photographed, and my researcher self will admit to saving an ounce of breastmilk for future study everyday for the first 2 months after he was born. Along those same lines, we celebrated his 9 month birthday by attending ILCA’s 2012 Conference, the unofficial preparty for World Breastfeeding Week, and in the United States, National Breastfeeding Month. There, we met up with friends and lactation rockstars (some of whom are one in the same!) and I not only increased my breastfeeding knowledge, but also began to see the potential of social media in breastfeeding advocacy and support.

For those of us in the US, August 1 not only marked the first day of World Breastfeeding Week and Month, but also the day that many of the breastfeeding provisions of the Affordable Care Act went into effect—Hooray!! Starting that week, my Facebook and Twitter feeds were all a flutter with breastfeeding twitter parties, and excitement about the Great Nurse In on the US Whitehouse Lawn! For me, the highlight of the week was being part of The Big Latch On in San Diego. Arriving just in time for the Official Latch On, Noah and I mingled with the crowd and basked in the glow of happy mothers, sweet babies and supportive partners, and were lucky enough to have our picture taken. We were having so much fun that my family had to drag us out of that event to go to the beach.

Our celebration continued the following week when we got the chance to visit lactation rockstar (and former editor of Lactation Matters), Robin Kaplan at her breastfeeding support group. For those of you who don’t know, in addition to helping mothers and babies in person, Robin has a wonderful blog and has recently started an online radio show, aptly named The Boob Group. Robin chatted with me and helped mothers while Noah made a game of stealing toys from unsuspecting members of the support group who were not yet mobile….

That week my newsfeeds were humming with news stories, blogs and tweets about Mayor Bloomburg’s push to make New York City hospitals Baby Friendly. Although much of what went out from the news media was misinformation, it was heartening to see so many mothers and bloggers speak up, (even this one on CNN.com) to talk about the importance of the Baby Friendly Hospital Initiative and what it really means for hospitals, mothers and babies.

Meanwhile there were wonderful blog posts all over the internet in honor of World Breastfeeding Month. Some of my favorites were from people and organizations that celebrate breastfeeding all year long, such as this post from Best for Babes, 100 words (by Lactation Matters editor Amber McCann) and this one from Diana Cassar-Uhl. Mainstream parenting site The Bump even got on board, proclaiming Aug 15 Public Display of Breastfeeding Day, and asking mothers to tweet about where they were nursing their babies.

For the rest of the month Noah and I celebrated by breastfeeding anywhere and everywhere!

At the beginning of our celebration of World Breastfeeding Month, my little Noah was still toothless and the media outlets were reporting that reality TV personality, Snooki, pregnant with her first child, was hesitant to try breastfeeding. Now Noah’s sporting 2 sharp little incisors and Snooki is nursing! I can’t help but think–What a difference a month makes!

How did you Celebrate World Breastfeeding Month?

Send us your stories and photos!

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

1

Increasing breastfeeding duration: One Sling at a Time!

Written by Jennie Bever Babendure, PhD, IBCLC

Author Jennie Bever Babendure with her little one

By now, most of us in the lactation field have heard of Kangaroo Mother Care (KMC). Maybe you’ve even been lucky enough to hear Nils Bergman speak passionately about the work he’s done using KMC, and its benefits for premature infant thermal regulation and brain development. Most importantly for those of us in the lactation world, the skin-to skin contact (SSC) used in KMC is associated with increased breastfeeding duration. Despite all the attention SSC and KMC have received, no one has yet looked at the impact on breastfeeding of mother/infant body contact beyond the first hours after birth in term infants.

A recent article in Acta Paediatrica by Continisio, Continisio, Filosa and Tagliamonte, set out to remedy this by designing an intervention to increase mother/infant body contact in the first month of life. 100 Italian mothers were given information on breastfeeding as well as a cloth baby carrier. They were shown how to put their (clothed) infants into the carrier and asked to wear the baby in the carrier as often as possible, and for at least 1 hour per day during the baby’s first month. Control mothers were given information on breastfeeding only.

What they found surprised even me, a sling-wearing, card-carrying member of the babywearing fan club.

Photo by hugabub via Flickr Creative Commons

Mothers in the intervention group were 1.8 times more likely to still be breastfeeding at 2 months and 2.9 times more likely to still be breastfeeding at 5 months and breastfed their babies significantly more often (times per day/ night) at 1 and 2 months. Mothers in the intervention were also more likely to be exclusively breastfeeding at 2 and 5 months. In addition, the majority of the mothers who used the baby carrier felt it was useful for breastfeeding as well as bonding, understanding of baby needs, and getting things done.

Wow!

For me, these results are staggering. The intervention is simple, requires minimal skill to administer, and mothers and babies are not only getting the health advantages of longer and more exclusive breastfeeding, they’re also getting more bonding time and getting things done! It is for this last reason, I would imagine, that women the world over have chosen to carry their babies in cloth carriers for thousands of years. They, like many mothers who use cloth carriers these days, likely could have told us that babywearing makes breastfeeding easier. Thanks to this study, we now know that it also helps mothers breastfeed longer and more exclusively.

This study provides solid evidence that increased mother/baby contact through the use of a baby carrier can increase breastfeeding duration and exclusivity. Although this study was done with only one type of carrier, I would guess that most carriers that allow mothers to wear their new babies close to their chests (as in KMC) would be of similar benefit.

One of my favorite resources for all things babywearing is www.thebabywearer.com. They have reviews, forums, and information on buying, making, and using baby carriers of all kinds. Be sure to check out the resources on their homepage on safe positioning. Like any type of baby gear, baby carriers must be used properly, and it’s important to check to make sure that any baby carrier you use has not been recalled.

I’m not sure I would have made it through the first few months without a baby carrier. In fact as I finish this post, my son is snuggled against my chest in a carrier while we sway back and forth to Neil Diamond.

Have you or the mothers you work with used a baby carrier? Have you found it to make breastfeeding easier?

Pisacane A, Continisio P, Continisio GI, Filosa C, Tagliamonte V. Use of baby carriers to increase breastfeeding duration among term-infants: the effects of an educational intervention in Italy. Acta Paediatrica 2012:epub ahead of print.

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

10

How can we best support mothers to reach their breastfeeding goals?

Written by Jennie Bever Babendure, PhD, IBCLC

Photo via laurabl @ Flickr

Despite the recent media attention on toddler breastfeeding, a majority of women in the US and many other countries struggle to reach even 6 months of breastfeeding. To help mothers reach their breastfeeding goals, researchers have long created and studied support interventions. On May 16th, a review and meta-analysis was released by the Cochrane Collaboration looking at breastfeeding support interventions at the highest tier of evidence, randomized and quasi-randomized controlled trials. The study, “Support for healthy breastfeeding mothers with healthy term babies” focused on the effectiveness of 52 postnatal support interventions from 21 countries between 1979 and 2011 looking at primary outcomes of breastfeeding duration and exclusivity in healthy full term babies born to healthy mothers. 1

While some of their findings came as no surprise, others are very telling for the future of our efforts to increase breastfeeding duration and exclusivity all over the world.

What we might have expected:

1. Taken as a whole, support interventions reduced the number of women who stopped breastfeeding before 6 months and reduced the number of women who were no longer breastfeeding exclusively at 4-6 weeks and at 6 months.

2. Face to face support was more effective than telephone support

What we might not expect:

3. Support interventions were more effective in populations in which breastfeeding initiation was high.

Support is more effective when women are already motivated to breastfeed.

4. Lay support was more or as effective as professional support in reducing breastfeeding
cessation.

As the most common reason mothers cite for stopping breastfeeding is the perception of not enough milk, encouragement and education from a peer counselor, community health worker, or other lay supporter can be exactly what a mother needs to reach her goals.

Most significantly, the study found that:

5. Interventions in which mothers had to ask for support, travel a distance to access
support, and in which only one interaction was provided were NOT effective at increasing
breastfeeding duration and exclusivity.

The review goes on to conclude that “Support that is only offered if women seek help is unlikely to be effective. This indicates that women should be offered predictable, scheduled, ongoing visits.” For most countries, providing this type of proactive support to all mothers would require systematic change. Most of the reviewed studies provided support by home visits or telephone calls to mothers soon after birth and continuing for many weeks postpartum. Home visits by lactation consultants, nurses, midwives, and peer counselors have demonstrated positive results, as has an intervention to incorporate lactation consultations into the regular pediatric office visits. For a more in-depth discussion of the need for proactive support, see my most recent post at www.breastfeedingscience.com.

Based on the above findings it is clear that if we are to create systematic, sustainable impacts on how mothers feed their children, we need to think about how ongoing proactive support for breastfeeding mothers can best tie into our existing culture. Given the recent movement towards sustainability and health, our community has an opportunity to put forth a unified front and effect change to ensure that routine lactation support is as normal as a pediatric check-up.

The 203 page study is freely accessible in its entirety here.

1. Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2012; 5.

Editor’s Note:  Please take the opportunity to read Jennie’s companion post to this one on her blog. In it, she highlights how formula companies have figured out how to make their product available to mothers in the ways mentioned above and makes suggestions for ways that lactation professionals could change their thinking on such matters.

Jennie Bever Babendure, PhD, IBCLC

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

7

Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link?

Written by Jennie Bever Babendure, PhD, IBCLC

The ever increasing rates of labor induction and augmentation have caused many to begin to ask if the use of synthetic oxytocin to start or augment labor may impact mothers and babies after birth. In an Acta Paediatrica article published online ahead of print, Ibone Olza-Fernandez and her colleagues asked this question by looking at neonatal feeding reflexes in relation to oxytocin dosage during labor1. In this small pilot study, researchers documented the total dose of oxytocin given during labor to induce or augment contractions in 20 first time mothers. On day 2 of life, and at least 1 hour after breastfeeding, they placed babies skin to skin with their mothers in biological nurturing positions to elicit Primitive Neonatal Reflexes, including those involved in breastfeeding. When 3 observers blind to the oxytocin dose coded videotapes of these 20 minute sessions, they found a significant correlation between higher doses of synthetic oxytocin during labor and the absence of sucking behavior in infants. In fact, many of the newborns whose mothers received higher doses of oxytocin spent a large part of the 20 minutes skin to skin crying.

When the authors later followed up with the mothers about breastfeeding status at 3 months, they found another surprising correlation: mothers who were exclusively breastfeeding at 3 months had received a lower average dose of oxytocin during labor than mothers who were not breastfeeding exclusively.

Findings of this study are limited in that this was a very small pilot of only 20 women, and all received oxytocin either to augment or induce labor, thus the study lacks an important control group of mothers who did not receive oxytocin. As such, the authors are careful to point out that the results should be interpreted with caution. The relationship found between oxytocin dose and infant suck in this study is a correlation only, and provides no evidence that higher doses of oxytocin caused the depression in sucking behavior. (Click this link for a great discussion of why we can’t say a correlation indicates cause.)

In addition, all study mothers received epidural anesthesia, thus the depressed sucking behavior could be related to maternal dose of anesthesia (which was not recorded), precipitating increased need for labor augmentation. However, as studies in rodents have shown reduced food intake in response to oxytocin injection, and previous clinical research has demonstrated an association between intrapartum oxytocin administration and risk of artificial feeding independent of epidural anesthesia, the idea that synthetic oxytocin might have an impact on breastfeeding behavior is an intriguing hypothesis that deserves further study2-8.

I joke that the picture below shows me ‘under the influence’ of oxytocin. If you look closely, I look just the tiniest bit love-crazed. Could oxytocin, a hormone that can inspire such intense bonding actually have a negative effect at high doses? I’ll keep a close watch as further research unfolds!

For more research commentary, check out Jennie’s new blog: www.breastfeedingscience.com

1. Olza Fernández I, Marín Gabriel M, Malalana Martínez A, Fernández-Cañadas Morillo A, López Sánchez F, Costarelli V. Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica 2012.

2. Arletti R, Benelli A, Bertolini A. OXYTOCIN INHIBITS FOOD AND FLUID INTAKE IN RATS. Physiology & Behavior 1990;48(6):825-830.

3. Jordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: An International Journal of Obstetrics & Gynaecology 2009;116(12):1622-1632.

4. Benelli A, Bertolini A, Arletti R. OXYTOCIN-INDUCED INHIBITION OF FEEDING AND DRINKING – NO SEXUAL DIMORPHISM IN RATS. Neuropeptides 1991;20(1):57-62.

5. Olson BR, Drutarosky MD, Chow MS, Hruby VJ, Stricker EM, Verbalis JG. OXYTOCIN AND AN OXYTOCIN AGONIST ADMINISTERED CENTRALLY DECREASE FOOD-INTAKE IN RATS. Peptides 1991;12(1):113-118.

6. Ounsted MK, Boyd PA, Hendrick AM, Mutch LMM, Simons CD, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .2. NEURO-BEHAVIORAL STATUS OF INFANTS. Early Human Development 1978;2(3):241-253.

7. Ounsted MK, Hendrick AM, Mutch LMM, Calder AA, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .1. SOME PERINATAL AND POSTNATAL PROBLEMS. Early Human Development 1978;2(3):227-239.

8. Wiklund I, Norman M, Uvnas-Moberg K, Ransjo-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009;25(2):E31-E38.

Jennie Bever Babendure, PhD, IBCLC

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

22

Implications of Obesity in Breastfeeding Women – A Follow-Up

Lactation Matters would like to thank all of our readers who left comments about the Implications of Obesity in Breastfeeding Women article.  Your comments clearly raised some very important issues about how we, as lactation consultants, should use research articles to guide our practices.  Fortuitously one of our guest bloggers, Jennie Bever Babendure, has significant research experience with cellular and animal models of obesity.  She has graciously offered her insight into understanding this research article and its relevance to our practice.  Again, we thank you for your thoughtful comments about this research study and the conversation it helped to create.

 

Response by Jennie Bever Babendure, PhD, IBCLC (email: jennie.bever@gmail.com)

“In light of the advice given to speak with mothers about the impact of a high fat diet on lactation, it’s important to point out that feeding rats high fat chow (which is also higher calorie) is a way researchers induce obesity in rats. This was done 6 weeks before the rats got pregnant, so they were already obese before pregnancy and lactation.

As a result, this study cannot separate the effects of a high fat diet during pregnancy and lactation from the effects of preexisting maternal obesity.  Had the 2 sets of rats consumed the same amount of calories on low or high fat diet, we might be able to draw conclusions about dietary fat’s impact on lactation in rats. However, the rats fed a high fat diet consumed more calories and were obese before they even became pregnant. As such, this study does not provide sufficient evidence to recommend that human mothers consume low fat diets when pregnant or lactating to improve lactation outcomes.

As this study was written for the research community, I don’t think the authors made a point to clarify that they were using high fat feeding primarily to study the impact of obesity, not necessarily dietary fat content, on lactation.  In the interest of evidence-based practice, I felt it was important to make this distinction.  This study doesn’t demonstrate that consuming a diet with a higher percentage of fat during pregnancy and lactation leads to lactation problems in humans, but rather suggests that preexisting diet-induced obesity leads to delayed onset of full lactation, and changes in the mammary gland in rats.”

 

0

Can a Change in Pediatric Office Policy Begin to Change the Culture of Infant Feeding?

Written by Jennie Bever Babendure, PhD, IBCLC

In the February issue of Breastfeeding Medicine, Ann M. Witt and her colleagues analyze the impact of integrating lactation consultants into a pediatric practice1.  Although providing referral to or in-office lactation services if requested is not a new idea, what makes this study unique is the systematic change made to schedule ALL breastfeeding newborns with a lactation consultant for their first pediatric office visit.

How did this work?  At the time of the study, the American Academy of Pediatrics (AAP) policy dictated that all healthy term breastfeeding infants be seen at the pediatric office within 3-5 days of hospital discharge2.  In 2009, the study practice changed their policy to routinely schedule these visits with an in-office IBCLC precepted by a physician.  IBCLC’s spent 45-60 minutes with the patient, then discussed the history and breastfeeding evaluation with an available physician who spent about 5 minutes in the room evaluating the patient and deciding on a treatment plan.   Follow up phone calls and in-person visits were scheduled, as well as a routine visit with the primary physician at 2 weeks of age.  More than 45% of patients had multiple visits with a practice IBCLC, and a limited survey indicated high maternal satisfaction with the new policy.  IBCLC’s were employed 4 hours a day 5 days a week in the practice to meet the need for these visits and follow up.  As the physician evaluated the patient at the 3-5 day visit, it was reimbursed as a general medical visit, which sufficiently covered IBCLC salaries.

How did this impact breastfeeding?  In 2007, all infants were seen in the office by 2 weeks of age unless jaundice or weight gain problems were identified in the hospital.  The practice employed an RN, IBCLC 3 days a week to provide phone support for breastfeeding problems as well as in-person consultations.   When researchers compared infant feeding method  in retrospective chart review between 2007 and 2009 patients, they found that non-formula feeding (breastfeeding) went up by 10-15% at all time points from 2-9 months, demonstrating a significant increase in breastfeeding intensity following the intervention.

When I first read this study, I was struck by the brilliant simplicity of this idea.  By integrating lactation consultants into the existing medical structure, mothers and babies got automatic breastfeeding help and follow-up, and physicians could follow AAP policy and monitor jaundice and weight gain as well have a large influence on the on-going health of their patients with minimal input of time or cost and no additional formal training.  As I continued to think about this study, I realized that this policy has a much broader impact.  By making this systematic change to their office policy, they have changed the culture of infant feeding in their practice.  Routinely scheduling the first office visit with an IBCLC sends a strong message to patients.  It says:  “Your physicians know you want to breastfeed, and feel breastfeeding is so important to your child’s health that we will do everything we can to help you through the challenges.”

I can’t help but imagine the impact if all pediatric practices were to adopt this model.  Would these actions speak louder than our words?  Would they whisper or shout: Breastfeeding is a public health issue3, we’re here to help you make it happen.

1.  Witt AM SS, Mason MJ, Flocke SA., Source1 Department of Family Medicine CWRU, Cleveland, Ohio. Integrating routine lactation consultant support into a pediatric practice. Breastfeeding Medicine 2012;7(1):38-42.

2.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115(2):496-506.

3.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2012;129(3):e827-e841.

Jennie Bever Babendure, PhD, IBCLC

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

2

Do Children See Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

With the recent push to Bring Breastfeeding back to Sesame Street, and deletion of breastfeeding images by Facebook, this month’s article seems particularly timely. In countries where the act of breastfeeding is often done behind closed doors and breastfeeding imagery is controversial—what do children say about how babies are fed?

In the Dec 2011 issue of BIRTH, Angell, Alexander and Hunt explore this issue looking at infant feeding awareness in primary school children1.  In this small pilot study in southern England, 56 children ages 5/6, 7/8 and 10/11 were read a story about a hungry newborn baby, and asked to finish it with drawings and text about how the baby would be fed, then invited to talk about their work with a researcher.

36% of the children depicted breastfeeding, with 13% of 5/6 and 7/8 year-olds and 83% of the 10/11 year-olds referring to breastfeeding in their drawings or text.  The younger children tended to be confident and articulate in their descriptions of breastfeeding, while the 10/11 year olds were more hesitant. The 10/11 year-olds were more likely to illustrate mothers in awkward poses in their drawings, and to use euphemisms and gestures to describe breastfeeding.   They were also more likely to indicate they had learned about breastfeeding in school, while the younger children demonstrated detail from personal experience.

Formula was depicted by 55% of children evenly distributed across age groups, many of whom also described breastfeeding or solid foods. Although the researchers identified little difference between the responses of boys and girls, the impact of school-based teaching was evident in the responses of the 10/11 year-olds as children from urban schools seem to have more detailed working knowledge of breastfeeding gained from school curricula than did rural school children.

This study is consistent with others that demonstrate a greater awareness of bottle feeding among both children and adults.  The authors point out that while bottle feeding imagery is everywhere, most children and adults in the UK have never seen a friend or family member breastfeed.  I would venture to guess that the same is true in the US.   Despite the fact that my 5 year old son has been proudly pointing out nipples on mother animals in his picture books since he was old enough to talk, and has a good working knowledge of the mechanics of a breast pump, I was a bit surprised to learn that I am the only person he has ever seen breastfeed.

Importantly for the authors and for breastfeeding advocates, these findings demonstrate a real opportunity.   In spite of the awkwardness of the 10/11 year olds in discussing breastfeeding, the school-specific differences in breastfeeding knowledge suggests that they are receptive to learning about infant feeding.   Angell, Alexander and Hunt conclude that in the UK, an evidence-based standardized infant feeding curriculum in primary school may be a promising first step to breaking down culturally entrenched barriers and increasing the success of later breastfeeding promotion efforts.  Should the US and other countries follow suit, this type of education could have wide-reaching influence both on attitudes towards breastfeeding and on public health for generations to come.

1. Angell C, Alexander J, Hunt JA. How Are Babies Fed? A Pilot Study Exploring Primary School Children’s Perceptions of Infant Feeding. Birth 2011;38(4):346-353.

Jennie Bever Babendure, PhD, IBCLC

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

7

Do Interruptions Interfere with Early Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

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

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

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

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

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

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

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

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

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

Jennie Bever Babendure, PhD, IBCLC

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

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

13

Powered by WordPress. Designed by WooThemes

Translate »