Tag Archives | mothers

The Best and Worst Places in the Industrialized World for Breastfeeding Support

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Canadian RN and IBCLC Fleur Bickford on her blog Nurtured Child and she has graciously allowed us to republish it here.  You will have the opportunity to hear Fleur speak at this year’s ILCA Conference on the topic “Social Media as a Means to Protect, Promote and Support Breastfeeding”.

Written by Fleur Bickford

Photo via Save the Children

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme.

This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the best and worst places in the world to be a mother and the Infant and Toddler Early Feeding Score in this companion blog post.

The Breastfeeding Policy Scorecard for Developed Countries is new this year, and it provides an interesting look at support for breastfeeding in the industrialized world. Rankings are based on maternity leave laws, right to daily nursing breaks, percentage of hospitals that are baby friendly, state of policy support for the International Code of Marketing of Breastmilk Substitutes and breastfeeding practices. Of the 36 countries listed, Norway ranks first with a score of 9.2 and the USA ranks last with a score of 4.2. Canada ranks 31st with a score of 5.4.

From the report, we see that Norway is doing a wonderful job of supporting breastfeeding
mothers:

“Norway tops the Breastfeeding Policy Scorecard ranking. Norwegian mothers enjoy one of the most generous parental leave policies in the developed world. After giving birth, mothers can take up to 36 weeks off work with 100 percent of their pay, or they may opt for 46 weeks with 80 percent pay (or less if the leave period is shared with the father). In addition, Norwegian law provides for up to 12 months of additional child care leave,  whichcan be taken by both fathers and mothers. When they return to work, mothers have the right to nursing breaks as they need them. Nearly 80 percent of hospitals have been certified as “baby-friendly” and many provisions of the International Code of Marketing of Breast-milk Substitutes have been enacted into law. Breastfeeding practices in Norway reflect this supportive environment: 99 percent of babies there are breastfed initially and 70 percent are breastfed exclusively at 3 months.”

Compare this to the USA:

“The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country – and one of just a handful of countries worldwide – where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as “baby-friendly” and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months.”

The differences between Norway and the United States is staggering (and Canada isn’t doing much better than the United States). For all the talk about “Breast is best”, North America is doing a very poor job of providing parents with the support they need to actually give their babies the “best”. Most mothers want to breastfeed. Breastfeeding initiation rates are high, but breastfeeding drops off rapidly in the early weeks after birth. This happens not because mothers don’t want to breastfeed anymore, but because they haven’t received the support they need to continue. Breastfeeding is natural, but it is also something that requires community support. Conditions during birth and the first 72hrs after birth are critical for establishing breastfeeding (hence the importance of hospitals being Baby Friendly) and it is important that mothers have sufficient time off of work to establish their breastfeeding relationship which encourages a longer duration of breastfeeding.

Although not specifically about breastfeeding, below are some other key points about the United States from the report that should really be cause for alarm:

In the United States, mothers face a 1 in 2,100 risk of maternal death – the highest of any industrialized nation. In fact, only three developed countries – Albania, Moldova and the Russian Federation – perform worse than the United States on this indicator. A woman in the U.S. is more than 7 times as likely as a woman in Ireland or Italy to die from a pregnancy- related cause and her risk of maternal death is 15 times that of a woman in Greece.

The U.S. under-5 mortality rate is 8 per 1,000 births. This is on par with rates in Bosnia and Herzegovina, Montenegro, Slovakia and Qatar. Forty countries performed better than the U.S. on this indicator. This means that a child in the U.S. is four times as likely as a child in Iceland to die before his or her 5th birthday.

The United States has the least generous maternity leave policy of any wealthy nation. It is the only developed country – and one of only a handful of countries in the world – that does not guarantee working mothers paid leave.

The United States is also lagging behind with regard to preschool enrollment and the political status of women. Performance in both areas places it among the bottom 10 in the developed world.”

An interesting (and again alarming!) point about Canada from the Save the Children Canada website:

“Norway’s under 5 mortality rate is half that of Canada (3 deaths per 1000 live births vs 6 deaths per 1000 live births).”

The risks of not breastfeeding are well documented, and there is plenty of research on the best ways to encourage breastfeeding duration and exclusivity. The statistics from this report for the countries at the top of the Breastfeeding Policy Scorecard show that interventions such as requiring hospitals to be Baby Friendly, providing adequate paid maternity leave and supporting the International Code of Marketing of Breastmilk Substitutes DO work. This report should be a wake-up call for the countries at the bottom of the scorecard!

Below is the full list of where the 36 countries placed on the Breastfeeding Policy Scorecard. For the full details, and to see the score for each country, please refer to section 1:43 of the full report:

  1. Norway
  2. Slovenia
  3. Sweden
  4. Luxembourg
  5. Austria
  6. Lithuania
  7. Latvia
  8. Czech Republic
  9. Netherlands
  10. Germany
  11. Estonia
  12. Poland
  13. Portugal
  14. France
  15. Belgium
  16. Ireland
  17. Italy
  18. Switzerland
  19. New Zealand
  20. Cyprus
  21. Denmark
  22. Greece
  23. Slovak Republic
  24. Spain
  25. United Kingdom
  26. Finland
  27. Israel
  28. Japan
  29. Hungary
  30. Liechtenstein
  31. Canada
  32. Iceland
  33. Monaco
  34. Australia
  35. Malta
  36. United States
Fleur Bickford is a mother of two, an RN, IBCLC and retired LLLL. She worked in obstetrics as an RN for several years before taking time off to raise her family. During that time she gained experience in labour and delivery, post partum care and pediatrics. As a Leader for La Leche League Canada, she served as a member of both the Professional Liaison Department and the Social Media Advisory Committee. Currently, Fleur works in private practice in Ottawa, Ontario as owner and operator of Nurtured Child, and she is President of Ottawa Valley Lactation Consultants. Fleur maintains a blog, and is very active on both Twitter (@NurturedChild) and Facebook (NurturedChild).
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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.

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

Doreen says:

August 1, 2011 at 10:35 pm (Edit)

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

Doreen, you raise an important issue for IBCLCs everywhere! 

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

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

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

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

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

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

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

Liz Brooks JD IBCLC FILCA

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

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The Breastfeeding Team

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

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

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

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

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

Lynn Rempel, RN, PhD

Associate Professor, Chair,

Department of Nursing

Brock University

lrempel@brocku.ca

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

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Patient Access

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

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

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

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

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Happy Birthday!

When I meet someone for the first time and they ask what my profession is, I usually receive a raised eyebrow when I tell him/her that I am a lactation consultant.  This raised eyebrow is typically followed by either, “What type of consultant?” or “Wow, I could have used you when I had my kids (followed by a 5 minute soliloquy of her breastfeeding challenges),” or “Well, why would someone need a lactation consultant?  Isn’t breastfeeding easy?”  As lactation consultants, we are often working on our own or with other health professionals who don’t truly appreciate all we do for mothers and their families.  We don’t just help mothers breastfeed….we nurture a mother’s self-confidence as she enters the full-time profession of motherhood.

To be a successful lactation consultant does not mean that we make a ton of money (wouldn’t that be nice???)  Instead it means that we provide gentle, emotional (and breastfeeding!) support  to those families who need it the most.  But where do we receive our support?  Sure, we attend professional development seminars and workshops.  We might network with colleagues.  We might volunteer at our local county breastfeeding coalition.  All in all, we could use more support, just like our moms.

In answer to our need for support, we would like to introduce ILCA’s newest support system: Lactation Matters, the official blog of the International Lactation Consultant Association.  In this blog, you will hear from authors about their latest research, in 600 words or less!  You will learn tips from colleagues who are setting up outpatient clinics, non-profit organizations, and private practices.  You will be exposed to international news about breastfeeding from around the world.  All of our articles will be focused on supporting lactation consultants and breastfeeding professionals with pertinent research, tools and tricks of the trade, and global movements in breastfeeding promotion.  It serves as the perfect complement to ILCA’s monthly member newsletter, e-Globe.  Lactation Matters will help us take one more step to meeting ILCA’s vision and mission: Our vision is a worldwide network of lactation professionals. Our mission is to advance the profession of lactation consulting worldwide through leadership, advocacy, professional development, and research.

We look forward to sharing our knowledge and experiences with you.  We hope that it will nurture your education and self-confidence as a health-care professional and lactation consultant.  We also hope it will inspire you to share your knowledge and experiences with us as well!   If you find an article that you feel your colleagues would benefit from, please link to it from your Facebook page or Twitter account and add comments to the bottom of the blog to keep the conversation going.  If you are interested in submitting an article to Lactation Matters, please contact us at lactationmatters@gmail.com.

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

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

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