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Incorporating New Research In Your Practice: Guest Post By Sue Cox, IBCLC


In part one of this series Sue Cox, AM, BM, IBCLC, FILCA, presented research to inform our discussions around how milk handling (including shaking expressed milk and/or breast massage) changes the components of the milk, including fat distribution.

In part two Sue presents research on other common questions, including whether to feed on one side or both and interventions including nipple shields and nipple creams.

Both breasts at each feed? Research: One or both breasts at each feed

In 1984 we carried out research (Cox, 1984) to find out whether mothers followed the suggested feeding regime or whether they developed their own. At that time mothers were told to only offer the breast five times each day. They were also told to always use both breasts at each feed-time.

Length of breastfeeds was strictly regimented. Mothers were told to only allow their baby to breastfeed for:

2 minutes, on the birth day, then

3 minutes on the second day,

5 minutes on the third day,

7 minutes on the fourth day, 

10 minutes on the fifth day,

And from then on just offer 10 minutes.

Mothers stayed in hospital for 5-7 days and rooming-in was rare. When the babies returned to the nursery on the third and fourth day we noted that many of them had very wet and dirty nappies (diapers), they vomited excess milk, and they sucked their hands and cried.

We had read of some of the newest research from the UK (Baum, 1980) which showed changes (increases) in fat levels from the beginning to the end of a feed. Therefore, we decided to suggest to the mothers that if their breasts were feeling really tight on the second or third day, or if they had used one breast per feed with a previous baby, that they might like to try just using one breast at each feed until they recognized their baby wanted more milk and/or their breasts were less firm.

Our findings showed that of the 155 mothers: 3% were discharged early; 27% fed from both breasts at all feeds; 8% fed from one breast during the period when their breasts were distended and were discharged feeding from both breasts; and 62% fed from alternate breasts at each feed before and after discharge (Cox, 1988).

Following further research on breast capacity (Daly et al., 1993; Cregan & Hartmann, 1999) and research on breast hypoplasia (Huggins et al., 2000) we now understand that we cannot give advice about one or both breasts per feed or the frequency of feeds because this is dependent on an individual mother’s breast capacity.

Point baby’s chin towards the area of the blocked duct? Research: ensure good breast drainage over every 24 hour period instead of concentrating on angle of baby’s mouth

Ultrasound studies of breast anatomy (Ramsay, 2005) show that the ducts do not radiate out through a breast segment in an organized way, but instead begin under the areola and travel out through the breast in a randomized fashion.

Nipple creams and lanolin? Research: short term relief only

In 1988 mothers were dissuaded from using anhydrous lanolin as pesticides were found in the lanolin. A purer form of lanolin later became available, but only one prospective controlled clinical trial has been done to support its use (Abou-Dakn, 2011.) This study indicates that it may be helpful in comparison to expressed breast milk in the first three days of treatment.

In my experience 1,800 mothers who birthed in our maternity unit annually chose to breastfeed their babies. After we stopped using lanolin and other nipple creams in 1988, our maternity staff became very skilled in finding the cause of nipple pain and strategies to prevent and/or treat nipple trauma and pain were developed instead of using the “quick fix” of lanolin.

Rubber nipple shields prevented weight gain in infants? Research: use of silicone shields in a small percentage of mothers could be effective if appropriate follow-up is conducted

The main nipple shield used 20 to 30 years ago was made of rubber.  Following research to quantify milk transfer, it was found that the poor areolar stimulation through the rubber shield led to only 42% of available milk being transferred to the baby (Woolridge at al.,1980).

In the hospital where I practiced as an IBCLC, two incidences of babies having been admitted to the pediatric ward with poor weight gain at 6 weeks of age led to further exploration of the issue of rubber nipple shield use. Both mothers had been given a rubber nipple shield during their maternity stay. Following discussions with staff, it was decided that nipple shields would no longer be distributed. This increased the midwives’ skills at assisting mothers with breastfeeding.

Some years later, following much discussion in the literature, we decided to do a pilot study to quantify how many mothers and babies could be helped by using the newer, thin silicone nipple shields (Cox & Paine, 1997). We found that silicone nipple shields were an advantage to 2.2% of mothers and their infants as long as they were followed up to ensure adequate output and that weight gain was continuing during all the time they were using a nipple shield.

These experiences confirmed for me that developing new policy and procedures should always be supported by current research.

Finally, Sue recommends that IBCLCs consider their rationale before making alterations to their current clinical practice or before creating new policies and procedures. Using new clinical skills and techniques can be extremely beneficial, and we should strive to remember that they are “in development” until the qualitative or quantitative research is produced to support them.  In fact, as a profession we are called to propose and conduct research in collaboration with other disciplines to further our ability to assist mothers and babies. Sue leaves us with this reminder: “Development and growth of a respected profession is based on evidence. Listen to new ideas and seek validation of what you hear from the evidence.”

Abou-Dakn M et al., (2011) Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol, 24(1):27-35.

Baum JD, (1980) Flow and composition of suckled milk. Medica Amsterdam

Joanna Briggs Institute (2009) The Management of Nipple Pain and/or Trauma Associated with Breastfeeding Best Practice, Evidence based information sheets for health professionals, 13(4).

Cox SG (1984 ) One breast per feed: A solution for the crying baby. Proceedings of the International Confederation of Midwives conference, Sydney, Australia.

Cox SG (1988) Why do some babies prefer only one breast at each feed? Breastfeeding Review 13:85-6.

Cox SG & Paine K (1997) The importance of follow-up of infants when the mother is using a nipple shield for breastfeeding. Unpublished data.

Cregan, MD & Hartmann PE (1999) Computerized breast measurement from conception to weaning: clinical implications. J Hum Lact 15(2):89-96

Daly SE, Owens RA, Hartmann PE. (1993) The short-term synthesis and infant-regulated removal of milk in lactating women. Exp Physiol, 78(2):209-20.

Huggins KE, Petok ES & Mireles O (2000) Markers of Lactation Insufficiency: A study of 34 mothers. Current Issues in Clinical Lactation, 25-35.

Kent JC et al., Breast volume and milk production during extended lactation in women. Exp Physiology, 84(2):435-47.

Ramsay DT et al., (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. J Anat, 206(6):525-34.

Woolridge MW, Baum JD, Drewett RF (1980) Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev, 4(4):357-64.


Announcing the Journal of Human Lactation’s Cover Photo Contest!

Every year, we change the 4 photos on the Journal of Human Lactation’s (JHL) cover. JHL is your journal, and we want to feature your photos! The 4 photos portray the broad field of human lactation, from the IBCLC helping new mothers (picture: the caring professional with a breastfeeding mom; teaching a class, etc) along with the harder science of lactation (picture: test tubes of milk; microscope slides, etc). Please send us your photos! We are looking for shots representing a range of backgrounds, contexts, and cultures.


  • Keep photo clear with minimal background interference
  • Photos should be jpeg files: 300ppi .jpg; at least 2100 pixels wide x 1500 pixels high
  • Email photos to:
  • We may not be able to respond to each message separately, but as confirmation of your submission, you should receive an auto-response message
  • Include your name (assuming you are the photographer) and full contact information with preferably a second email address


  • Deadline – November 8, 2013: NO EXCEPTIONS!
  • If a recognizable person features in the photo (ie, face of mother/baby/clinician etc), you must have a photo consent form. If your photo is a contender for publication, we will require subjects to sign a specific consent form, so only send photos if you know you can obtain permission from the subject.
  • As the photographer you will need to sign non-exclusive copyright – in other words, you allow JHL to use the photo, but you are free to use it elsewhere as you choose.
  • If we believe the photo is a potential winner, we will contact you again before the deadline to talk to you and ensure we have the correct forms.

Questions? Email


Don’t Miss These FREE Articles from the Journal of Human Lactation

Even though we’ve wrapped up our World Breastfeeding Week celebration for 2013, The Journal of Human Lactation (JHL) is still celebrating all month long with FREE access to their journal. JHL is the premier quarterly, peer-reviewed journal publishing original research, commentaries relating to human lactation and breastfeeding behavior, case reports relevant to the practicing lactation consultant and other health professionals who assist lactating mothers or their breastfeeding infants, debate on research methods for breastfeeding and lactation studies, and discussions of the business aspects of lactation consulting.

JHL is offering free access to a number of their most-read articles through August 31, 2013. While ILCA members receive and have access to JHL as a member benefit, the availability of the free articles is especially beneficial for our colleagues from other disciplines.  Please share widely these resources to pediatricians, obstetricians, midwives, nurses, educators, researchers and general public.

Free articles from JHL (through August 31, 2013) include:

Breastfeeding and Telehealth

Breastfeeding Protection, Promotion, and Support in the United States: A Time to Nudge, A Time to Measure

Education and Support for Fathers Improves Breastfeeding Rates: A Randomized Controlled Trial

Impact of Male-Partner-Focused Interventions on Breastfeeding Initiation, Exclusivity, and Continuation

Provision of Support Strategies and Services: Results from an Internet-Based Survey of Community-Based Breastfeeding Counselors

Breastfeeding Duration in Relation to Child Care Arrangement and Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children

What are your favorite JHL articles from the past year?  How have they impacted your practice?


ILCA Conference Speaker Highlight: Patricia Martens

During the weeks leading up to the 2013 ILCA Conference, we will be highlighting a number of conference speakers.  Watch this space every Thursday for more profiles.

pat_martensWe are so pleased to have Dr. Patricia Martens as one of the speakers at our conference in Melbourne in just a few short weeks.

Dr. Martens is a Professor in University of Manitoba’s Faculty of Medicine, the Director of the Manitoba Centre for Health Policy, and IBCLC since 1987 (designated Fellow of ILCA in 2011). Patricia has spoken over 300 times in the last decade, and published over 200 articles.  She co-edited the 2nd and 3rd editions of ILCA’s Core Curriculum, writing the chapter on statistics and research design.  She enjoys making statistics and epidemiology relevant to healthcare providers.

On Saturday, July 27th, at 8:00am, Dr. Martens will be presenting a plenary session at this year’s conference entitled “Breastfeeding: A Public Health Imperative”. This session will focus on the population and public health perspectives of breastfeeding promotion, protection and support.

In addition, she will be presenting a workshop session, sharing from her wealth of knowledge and experience. Plan now to attend the following session:

Research Workshop on Thursday, July 25

  • 2:00pm: Taking the Mystery out of Planning Research Studies

For more information about our upcoming conference and to register, please visit the Conference Page on our website.


Research Matters: Get Involved!

By Cathey Horsfall

iStock_000017674946XSmallResearch lies at the heart of IBCLC practice, but only a small proportion of IBCLCs will actively contribute to the international research body during their careers.  This is a missed opportunity. Research not only provides a vehicle for changing opinions and practice, it is also a great way of showcasing the profession alongside the traditional medical disciplines. Essentially, it is a great marketing tool at a local and international level.

For those who don’t work within the health care facilities in their communities, breastfeeding supporters are often trying to change whole organizations from the outside. This is phenomenally hard and it can seem almost impossible to get other medical professionals to even consider that we might have something to offer.

Why is published research important?

Published research is obviously very important to drive improvements in our own maternal/neonatal care and breastfeeding practices but it doesn’t end there.

Published research is how we say to the rest of the world, “this is what our community can demonstrate is true,” and “our work has been examined critically” and “it has been found to be of caliber and importance.”  In short it is how we get others to take formal notice of what we are doing.

It is also how a group can demonstrate its superiority in a field.  Look through the recent research on breastfeeding.  How much of it has been done by a team with an IBCLC at the core? How much of it is truly innovative? If IBCLCs really want to be being considered as the pinnacle of breastfeeding knowledge, it is essential that they are heavily involved in pushing the boundaries of international knowledge into the subject.

Published research also gives us statistics.  Statistics can be extrapolated, correlated and most importantly costed. As a sales person, give me evidence of worth and I can sell the profession.  Give me none and I am left with nothing to sell.

In short, published research can be used to improve maternal care, raise respect for the field, and also to convince those on the inside of our medical institutions that IBCLCs are worth backing.

“We have all the evidence we need in practice-based observation”

The harsh realities of the sphere IBCLCs operate in is that companies and health services are never going to make financial decisions based on practice-based evidence.  Quite frankly, why should they?

In order to raise the overall chances of IBCLC employability within health services, the IBCLC profession as a whole will need to start to get a lot more of what they know documented.

Practice-based observations have their validity, but without documentation it is hard to share knowledge amongst yourselves reliably, let alone use it to convince the (doubtful) outside world of the benefits of a service etc.

The documentation required by external agencies needs to be in the form of good, sound research … the sort that will stand up to scrutiny.  It needs to be well planned, and well executed.  Ideally, it needs to be done in conjunction with other health professionals, including both the mainstream and the more alternative practitioners, working in the same research team.

This is way too much work/costs too much

It doesn’t have to mean a huge amount of work personally, nor does it have to cost a lot to do.

  • Begin with small scale studies – Use these to approach health professionals to look to broaden them out.  Approach your existing caseload if appropriate.
  • Choose your subject matter and methods with care – Clearly, you do not have the resources of a large research department so cut your cloth accordingly.
  • Pair up with other IBCLCs with similar interests Part of the difficulty in doing research is in getting good quality, larger scale data sets.  Perhaps this can be overcome by working with other IBCLCs etc.  This can also be a good way of building up skills in experimental design etc.
  • Look outside the IBCLC field for support You don’t have to limit your research team selection to IBCLCs.  Many volunteer breastfeeding supporters would be happy to get involved in research, if only we were asked.
  • Look for fundingYou don’t necessarily have to foot the bill yourself.  There are grants etc available out there that you may be able to access once you have done a small pilot or written a proposal.  You may even be able to approach your local University or teaching hospital in order to find resource to help you do the leg work.
  • Consider it an investment in the future The links that you form with your local educational institutions, medical organisations, and the like, may prove invaluable to increasing your involvement.  Consider it a marketing exercise for you and your skills.

Research really does matter

Research really does matter and can make a big difference.  Why not think about doing something? Most breastfeeding supporters have an area of knowledge in which they feel most comfortable.  Why not focus on that.  Perhaps ask yourself: “what basic questions are unanswered in existing literature, and what can I do to try and fill that gap?”

Cathey Horsfall is a trainee Breastfeeding Counsellor with the Association of Breastfeeding Mothers, UK.  She has two children under four and holds an eclectic set of qualifications including a B.ed (Hons) and a post graduate business qualification from Cambridge University, UK. She has spent the last ten years working in commercial organisations where the importance of good marketing and brand awareness were felt very keenly.  Most recently, she has written for a large UK public relations company, giving her a strong understanding of just how important it is to actively lobby and constantly ensure that potential customers are exposed the skill and strengths possessed.


ILCA Announces New Educational Initiative to Advance Research-Based Education and Skills (FREE WEBINARS)

ILCA is pleased to announce a new educational initiative to advance research-based education and skills in our profession.

Through the end of June, 2013, both ILCA members and non-members may attend ILCA’s live webinars webinars at no charge.

During that time, access to all live webinars is free and you will pay only if you want continuing education credit. Webinar recordings and handouts will be posted on ILCA’s CERPs onDemand™ site within 2 weeks after the live presentation. Those who wish to receive credit can purchase the recorded webinar and print their certificate online. This also provides full access to the recorded webinar and materials for the length of time it is available online.

We extend this free service to our valued members to express our appreciation for your continued support of ILCA and its mission to advance the profession. This free access to live webinars also demonstrates to potential new members ILCA’s commitment to professional development and the valuable services available to members. Be sure to pass this information on to colleagues and invite them to take advantage of this special educational initiative.

Visit ILCA’s webinar page now to begin registering for your free live webinars! If you elect to purchase the continuing education credit, remember that ILCA members receive a 50% discount on all purchases on the CERPs onDemand™ site.

Liz Brooks, ILCA’s president, has this to say about the exciting initiative:

“ILCA is a professional association committed to providing high quality evidence-based information to our members, and other practitioners with interest. These free webinars meet Goal Two of our recently revised Strategic Plan:  “Promote professional development through member services” via continuing education opportunities, use of technology, and offerings that promote the advancement and education of IBCLCs … who hold the essential credential for lactation support. Bringing people *to* ILCA to show them *what* ILCA does, and has to offer, is one way to build new membership.  It reminds our current members of the value of their membership. The line-up of excellent researchers and presenters, offering their highly relevant and interesting material, ought to captivate any IBCLC.  This simple notion of free, excellent education, is one way to attract those who love to learn, and to learn from the best.  They will be similarly attracted to ILCA’s incredible Journal of Human Lactation, to the rest of our on-line learning modules and webinars, and to our penultimate educational offering, the annual conference.  If  folks need CERPs, those are easily obtained for the customary fees (half off for current members!).  If folks just want great education, pure and simple, this is a great opportunity.  Regardless, attendees will learn the latest evidence-based practice, making them better clinicians serving breastfeeding families.  There is no downside in that!”

What webinars will you be signing up for?

Please share this information with friends and colleagues.


Are Oligosaccharides a Key to Reducing HIV in Breastfed Babies?

One of the most fascinating mysteries of our time is the low rate of mother-to-infant transmission of HIV via the milk of an infected mother. In the absence of antiretroviral drug therapy (ART), 10-15% of babies born to infected mothers acquire the virus from breastmilk; when both mother and infant are treated with ART, this incidence can be reduced to 2% or less.

Several components of human milk have been shown to offer protection to those more than 85% of babies who don’t get HIV after repeated exposures. Immunoglobulins, like IgA, IgG, and IgM provide specific immune response to certain pathogens; lactoferrin accomplishes various tasks, to include killing bacteria and preventing  surviving bacteria from multiplying. In a study released earlier this year, researchers at Duke University in North Carolina reported that HIV-specific B-cells found in the colostrum of infected mothers actually neutralize the virus. An international team of researchers based in California, New York, Boston, and Zambia, in a study released on August 15 by the American Journal of Clinical Nutrition (Bode, et al., 2012) identifies yet another protective component: human milk oligosaccharides.

Oligosaccharides are plentiful in breastmilk, and there are over 130 of them (Smith, 2008). They are made from chains of simple sugars, and they do a few things that make them superheroes in the fight against pathogens – any invading virus or bacteria. Oligosaccharides are PREbiotics, which act like food for good bacteria in the baby’s gut. Prebiotics feed and promote the proliferation of PRObiotics, which crowd out pathogens. Another important, protective function of oligosaccharides is that they prevent pathogens from attaching to the gut lining. They do this either by attaching to the part of the bacteria or virus that would attach to the baby’s gut, or by themselves attaching to the gut epithelium and, in essence, occupying all of the “docks” where pathogens might seek to put down a mooring. Oligosaccharides are most plentiful in the earliest days, weeks, and months of breastfeeding, decreasing in number and volume as the baby gets older. Oligosaccharides are undigestible, which allows them to populate the baby’s intestine; the large volume of oligosaccharides is part of what causes a newborn to stool often, perhaps every time he breastfeeds.

This mechanism is also protective against HIV and other viruses, because the frequency of the bowel being emptied doesn’t give pathogens time to “set up shop” and get down to the business of infecting the baby. This is one possible explanation for why the protective effect of breastfeeding against HIV may wane as the baby gets older. Of the 12.1% of infants who acquired HIV through their mother’s breastmilk, 68.2% of those transmissions occurred after 6 months (Iliff et al., 2005). The addition of complementary foods may also cause or allow for breaches in the infant’s gut integrity; it is through these breaches that HIV can be acquired. The findings reported by Bode, et al. are exciting. We already knew that oligosaccharides play a significant role in keeping babies healthy and free from infection, but recognizing that, in high enough concentrations, they actually protect infants from a pathogen that is present in the milk is remarkable. In nations where the risk of infant death from gastrointestinal or respiratory infections is higher than the risk of transmission of HIV from an infected mother to her baby, understanding why and how a mother’s own milk gives her infant his best chance for survival can provide important teaching points for public health workers, especially when cautioning against mixed feeding of these vulnerable infants. Additionally, these innate protective factors in human milk offer insight into how a vaccine against HIV might be developed for use in adults at risk of acquiring the virus.


Bode, L., Kuhn, L., Kim, H., Hsiao, L., Nissan, C., Sinkala, M., Kankasa, C., et al. (2012). Human milk oligosaccharide concentration and risk of postnatal transmission of HIV through breastfeeding. American Journal of Clinical Nutrition (ePub ahead of print). doi: 10.3945/ ajcn.112.039503

Friedman, J., Alam, S. M., Shen, X., Xia, S. M., Stewart, S., Anasti, K., Pollara, J., et al. (2012). Isolation of HIV-1-neutralizing mucosal monoclonal antibodies from human colostrum. PLoS One 7(5). doi: 10.1371/journal.pone.0037648

Iliff, P. J., Piwoz, E. G., Tavengwa, N. V., Zunguza, C. D., Marinda, E. T., Nathoo, K. J., Moulton, L. H., et al. (2005). Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 19(7), 699-708.

Smith, L. (2008). Biochemistry of human milk. In R. Mannel, P. J. Martens, & M. Walker (Eds.), Core Curriculum for Lactation Consultant Practice (pp. 269-284). Sudbury, MA: Jones & Bartlett.

Diana Cassar-Uhl, IBCLC and La Leche League Leader, enjoys writing to share breastfeeding information with mothers and those who support them.  In addition to her frequent contributions to La Leche League International’s publication Breastfeeding Today, Diana blogs about normalizing breastfeeding in American culture at and has been a guest blogger at Best for Babes and The Leaky Boob.  Diana can be found lecturing at breastfeeding education events around the United States.  She is pursuing a Master of Public Health, and upon graduation hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition.  Mother to three breastfed children, Diana recently retired after serving as a clarinetist on active military (Army) duty in the West Point Band since 1995.


Can A Cow Jump Over the Moon (or Produce Human Milk)?

By Maryanne Perrin, MBA

Photo by law_keven via Flickr Creative Commons

“Hey diddle diddle,
The cat and the fiddle,
The cow jumped over the moon.”

How many of us have lulled little ones to sleep with the lines from this old English nursery rhyme? Today’s news headlines claim cows are performing another impressive trick –producing human milk – thanks to the wonders of genetic engineering. And while cow tricks are amusing in nursery rhymes, in the field of infant nutrition they deserve a lot more scrutiny. So let’s take a closer look at the claims of human-milk-producing cows.

What’s Been Engineered Into Cows’ Milk

In recent years, scientists in China have genetically modified cows to produce human lysozymes, an antimicrobial protein (1) that disrupts the cell wall of gram-positive bacteria. They’ve also created a cow that produces human lactoferrin, another important antimicrobial protein (1) that destabilizes the cell wall of both gram-positive and gram-negative bacteria. A 2011 study out of The Netherlands found that the lysozyme content of human milk was 3,000 times greater than that of bovine milk, and that the lactoferrin content was 75 times greater (2). Clearly the greater concentrations of these antibacterial proteins in human milk are important for infants, given the immature nature of their gastrointestinal tract. But does adding a genetically engineered human protein to cow milk provide the same immunological benefits to humans (many more studies will be needed to establish safety and efficacy) and are there other important human milk compounds missing from engineered cows’ milk?

What’s Still Missing?

We’ve learned a lot over the past few decades about the make-up of human milk (and there’s still more to be discovered and understood!). Two of the most obvious areas where human milk and bovine milk differ in their nutrient make-up are in proteins and carbohydrates.

Proteins: Both the quantity and nature of proteins differ between human and bovine milk. For example, human milk has substantially less total-protein and casein-protein than cows’ milk, while it has significantly higher concentration of several proteins associated with the development of the mucosal immune system. The Netherland study showed that of the 268 proteins identified in human milk, 121 of these proteins (45%) were not found in cow milk (2).  Notable differences include the high concentration of immunoglobulin A, a human milk protein customized to bind pathogens found in the mother’s (and thus the baby’s) environment, and CD14, a protein involved in detecting gram-negative bacteria and activating the innate immune system.

Carbohydrates: Human milk has a higher concentration and more diverse portfolio of oligosaccharides, (a short chain of sugar molecules) than cow milk (3). Human Milk Oligosaccharides (HMOs) pass through an infant’s gut undigested, and serve as a prebiotic for the development of a healthy gut microflora. They also appear to act as a very shape specific “lock and key” to bind pathogens. While much research remains to be done in this field, recent studies have shown HMOs to be protective against NEC in an animal model, and to be associated with a reduced transmission of HIV.

Today’s scientific advances will allow us to continue to identify health-promoting compounds in human milk and then manufacture them using various biotechnologies. But “human milk” cannot be created by bolstering cow milk with one or two important proteins, as evidenced by the hundreds of unique proteins and hundreds of unique and changing oligosaccharides in human milk (not to mention living cells and bacteria) that work collectively to support an infant’s immature immune system. Re-engineering all of that into a single cow is a mighty big challenge – probably even bigger than jumping over the moon!

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer


1. Hanson, L.A. (2005). Human milk: Its components and their immunobiologic functions. In J. Mestecky, M. Lamm et al (Eds.), Mucosal Immunology 3rd Edition ( 1795-1827). Oxford: Elsevier Academic Press.

2. Hettinga K, van Valenberg H, de Vries S, Boeren S, van Hooijdonk T, et al. (2011) The
Host Defense Proteome of Human and Bovine Milk. PLoS ONE6(4): e19433. Doi:10.1371/

3. Mehra R, Kelly P. Milk oligosaccharides: Structural and technological aspects. International Dairy Journal. 2006; 16(11): 1334-1340.


FREE Access to the Journal of Human Lactation during August in celebration of World Breastfeeding Week

The Journal of Human Lactation (JHL) is the premier quarterly, peer-reviewed journal publishing original research, commentaries relating to human lactation and breastfeeding behavior, case reports relevant to the practicing lactation consultant and other health professionals who assist lactating mothers or their breastfeeding infants, debate on research methods for breastfeeding and lactation studies, and discussions of the business aspects of lactation consulting.

In celebration of World Breastfeeding Week, JHL is offering free access to a number of their most-read articles through August 31, 2012. While ILCA members receive and have access to JHL as a member benefit, the availability of the free articles is especially beneficial for our colleagues from other disciplines.  Please share widely these resources to pediatricians, obstetricians, midwives, nurses, educators, researchers and general public.

Free articles from JHL (through August 31, 2012) include:

Human Colostrum and Breast Milk Contain High Levels of TNF-Related Apoptosis-Inducing Ligand (TRAIL) by Riccardo Davanzo, Giorgio Zauli, Lorenzo Monasta, Liza Vecchi Brumatti, Maria Valentina Abate, Giovanna Ventura, Erika Rimondi, Paola Secchiero, and Sergio Demarini

Maternal Request for In-hospital Supplementation of Healthy Breastfed Infants among Low-income Women by Katie DaMota, Jennifer Bañuelos, Jennifer Goldbronn, Luz Elvia Vera-Beccera, and M. Jane Heinig

Expansion of the Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations for Three Guiding Principles by Kerstin Hedberg Nyqvist, Anna-Pia Häggkvist, Mette Ness Hansen, Elisabeth Kylberg, Annemi Lyng Frandsen, Ragnhild Maastrup, Aino Ezeonodo, Leena Hannula, Katja Koskinen, and Laura N. Haiek

Milk and Social Media: Online Communities and the International Code of Marketing of Breast-milk Substitutes by Sheryl W. Abrahams

Development of a Postnatal Educational Program for Breastfeeding Mothers in Community Settings: Intervention Mapping as a Useful Guide by Hanne Kronborg and Gerjo Kok

Barriers, Facilitators, and Recommendations Related to Implementing the Baby-Friendly Initiative (BFI): An Integrative Review by Sonia Semenic, Janet E. Childerhose, Julie Lauzière, and Danielle Groleau

Breastfeeding at NICU Discharge: A Multicenter Italian Study by Riccardo Davanzo, Lorenzo Monasta, Luca Ronfani, Pierpaolo Brovedani, and Sergio Demarini

A Model Infant Feeding Policy for Baby-Friendly Designation in the USA by Lori Feldman-Winter, Diane Procaccini, and Anne Merewood

What are your favorite JHL articles from the past year?  How have they impacted your practice?


Breastmilk and Breast Cancer Research {A Follow-Up}

Photo by honey-bee via Flickr Creative Commons

Recently, we ran a series (Part 1 and Part 2) on the work of Dr. Kathleen Arcaro, using breast milk to help determine breast cancer risk.  The response to the posts was overwhelming with both posts together being read by over 3,600 people. We are confident that, with the help and encouragement of IBCLCs, women all over the country can be involved in this exciting research.

Dr. Arcaro is now looking for a new set of breastmilk samples:  those from women who either currently have or have previously had breast cancer.  These samples can be either fresh or frozen.

If you know of a mother who fits this profile, please have them contact Beth at (413) 545-0813 or email her.  If not, please help by spreading the word however you like – Facebook, Twitter, etc.

Thank you!


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