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Clinicians in the Trenches: Francisca Orchard from Santiago, Chile

Screenshot 2014-10-20 10.41.26

By Francisca Orchard, CNM, IBCLC

I became a certified midwife 20 years ago, assisting women in labor since my early adult days. I came into this field with an eye toward low intervention birth and respect for mothers, with special emphasis on the humanization of birth. This was probably because, during my internships in hospitals, I saw very little respect for women and a lot of poor treatment of them.

In the 1990s, I worked in a neonatal intensive care unit where the promotion of breastfeeding in preterm infants was a priority. Later, I also received doula training in the U.S. and earned a diploma in infant massage in London.

In 2011, I achieved my goal of becoming an International Board Certified Lactation Consultant® (IBCLC®). The road was not easy for me. The year I took the exam was the first time in Chile the exam was given at the same time as in the rest of the world.

Since then, I have been working in breastfeeding promotion, and consulting in support of perinatal health professionals. I began a prenatal education program for pregnant women and their families that promotes breastfeeding and respectful delivery to reduce the number of caesarean section deliveries in Chile, and to increase our prevalence of exclusive breastfeeding to 6 months of life.

In Chile, we have 43% of mothers still breastfeeding at 6 months, but there is a huge disparity in breastfeeding rates related to women’s income.  We have an urgent need to follow mothers during the first days after maternity hospital discharge, where most abandon exclusive breastfeeding. We also struggle with  health professionals who, due to their lack of knowledge about breastfeeding, are perhaps our biggest barrier to breastfeeding duration. Most pediatricians encourage the use of artificial supplements instead of working with mothers and babies early to help them continue breastfeeding.

Currently, I am a member of the Chilean Committee on Breastfeeding and the Lactation Committee of the Chilean Society of Pediatrics. Some months ago, I collaborated with a multidisciplinary team of psychologists and photographers on a project called “Breastfeeding Mothers.” We created a space where women of different ethnicities and Chilean places were professionally photographed in different breastfeeding situations.  It is a beautiful work with more than 50 photographs. We are awaiting funding to publish it for breastfeeding promotion in Chile.

In my daily work, I consult with women and babies with breastfeeding difficulties and write articles of interest to our community.As of this writing, I am one of only 2 IBCLCs in Chile. During World Breastfeeding Week, I traveled to different cities in Chile to participate in breastfeeding promotion activities. Additionally, I work on an advisory team of the ministry of health. We are working toward implementing the Baby Friendly Hospital Initiative in Chile during 2015. The Chilean government is also discussing the approval of human milk banks.

It is an exciting time in Chile with so much going on to support and promote breastfeeding. I am thankful for the International Lactation Consultant Association’s® resources that help me inform my community about the competencies and value of IBCLCs, and to increase our numbers throughout Latin America.

chiliPhoto via the author


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?


World Breastfeeding Week 2013: The Health Care System Circle of Support in Papua New Guinea

By Amber McCann, IBCLC

On this blog during World Breastfeeding Week, we have been highlighting the work of breastfeeding supporters in each of the 5 Circles of Support mentioned in this year’s theme. We have been honored to have interviews with support happening in the workplace, in the community, in the government, and with families in crisis. The final circle of support is the health care system.

I have been so honored to serve as the co-editor, along with Decalie Brown, of this blog for the past year. It was exciting to attend this year’s ILCA Conference in Melbourne, Australia and I came away so encouraged and excited about where our field is headed. After the conference, I was able to travel to a remote area in the highlands of Papua New Guinea to spend some time with my best friend, a family practice doctor at a mission hospital in Kudjip.

As an IBCLC who has worked in both private practice and in a private medical office, my experience with breastfeeding support within a hospital was practically zero. I have spent the past 10 days shadowing my friend as she and the nurses on the maternity ward provided compassionate care to the women who come to birth at their hospital.

IMG_3272I was quite sure when I arrived that I wouldn’t have anything to teach or any way to provide support in this culture. Papua New Guinea has one of the highest maternal and infant mortality rates in the world and yet, I mistakenly assumed that breastfeeding was so a “way of life” that my help wouldn’t be needed. Culturally, breastfeeding is the assumed method of infant feeding. Formula is hard to acquire and formula marketing is outlawed. Women have been breastfeeding for generations and breastfeeding in public is the norm.

But, I came to realize that, even with so many of the things that I imagined would make breastfeeding “easier” in the United States where I live, women will always be in need of trained, evidence-based lactation care. 

Fortunately, for women being cared for in the Kudjp hospital and several others Papua New Guinea hospitals, there is a wonderful organization called Susu Mamas. They provide nurses and mentoring mothers who share prenatal education as well as postnatal support in breastfeeding and infant care. They come daily to the hospitals and work with new mothers to establish breastfeeding, trouble shoot challenges, and provide education to hospital staff. In addition to the hospital care they give, in some locations, they also provide family planning and HIV testing. They also established a national breastfeeding hotline in 2008.

IMG_3451While thankful for the support being provided to the women I encountered, I had to get in on the action! I was surprised one afternoon to hear Dr. Jim Radcliffe, a surgeon who has served at this hospital for over 25 years, call down the hall “Amber, you’re needed in the ER for a lactation consult!” I hurried over to find a young mother of a 7 month old who reported that she had no milk and that her baby had failed to gain weight in some time. After taking as full of a history as my understanding of their culture and my terrible Pidgin (with the help of an interpreter) allowed, I examined her breasts. She reported that she had never made any milk and had been feeding the baby bananas and pineapple since he was two months of age. I was heartbroken to examine her breasts and realize that she had insufficient glandular tissue. I quickly asked if she knew of anyone else who would be willing to breastfeed her baby (as feeding another’s child is common in PNG) and referred the baby to the doctor on call in the pediatrics ward. This mama listened intently to my counseling and offered up her dry breast to her fussy baby. Even with no milk, the baby quieted and relaxed into his mother’s arm with her breast for comfort. I praised her for the way her mothering was meeting the needs of her baby and while finding appropriate nutrition for her young child would be challenging, I’m thankful for the smile she gifted us with.

IMG_3460I also realized that many breastfeeding challenges like sore nipples, engorgement, and thrush were universal! One mother came to the hospital and required a C-section (my first surgical observation!). We followed her closely in the days after and she struggled a bit with pain. Many of the women in Papua New Guinea have very long, pliable breasts (likely from not wearing a bra regularly). They simply lay the babies in their lap and their breasts reach easily to their child…no football (or rugby!) hold here! Ronda was mimicking the positioning she had seen all her life but her breasts were much shorter, leading to a very shallow latch. We changed her position and provided some pillow support as she learned and a huge smile appeared on her face.

I am heading home soon and will carry these experiences from my time at the hospital in Kudjip into my practice in the US. I am grateful to have had the experience of observing and participating in the important work of providing breastfeeding support in a hospital setting. I am honored by the warm welcome I received from the nurses and hospital staff and also from the mothers who I encountered. Breastfeeding support literally saves lives, especially in a place like Papua New Guinea and I’m so glad to be a part.

* And on a funny note, in Pidgin (a language spoken by many in PNG), “susu” is the term used for breasts, breastfeeding…anything having to do with milk. I heard the term “kalabus belong susu” being used to describe a bra. The translation? Prison of the breast! Take that, Victoria’s Secret! 🙂

Amber McCann, IBCLC

Amber McCann, IBCLC is a  board certified lactation consultant with the Breastfeeding Center of Pittsburgh. She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition to her work as the co-editor of Lactation Matters, the International Lactation Consultant Association’s official blog, she has written for a number of other breastfeeding support blogs including for HygeiaThe Leaky Boob, and Best for Babes and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms.


World Breastfeeding Week 2013: The Response to Crisis and Emergency Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of lactation professionals in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Ali Maclaine, UK

photo 2Ali Maclaine is currently the Senior Humanitarian Nutrition Advisor for Save the Children based in London. Save the Children works in 120 countries worldwide and in many of the emergency affected countries, they are undertaking breastfeeding support through their Infant and Young Child Feeding in Emergencies (IYCF-E) program. The level of support varies from messaging, group education sessions, or peer support to one-on-one counseling. As well as providing support themselves, Save the Children often works with partners and undertakes trainings so that others can also learn about the life-saving importance of breastfeeding, especially in emergencies. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Response to Crisis and Emergency”. Can you describe for us a bit about the work you are currently doing in the field of lactation to support breastfeeding mothers in crisis? How did you become involved in this work? When emergencies happen, what might a day of support look like?

Following the completion of my Masters in Public Health Nutrition, I was a Consultant on a report called ‘Cracking the Code’ that looked at violations of the International Code of Marketing of Breastmilk Substitutes worldwide. This work increased my interest in breastfeeding. My first field placement with Save the Children was following the 2006 conflict in Lebanon. I saw how an influx of donations of breastmilk substitutes were undermining breastfeeding. I also saw the effects of common myths and misconceptions on breastfeeding and the lack of skilled breastfeeding support. During that crisis and in all the others I have worked in subsequently (Philippines, Indonesia, Haiti, East Africa, Syria, etc), the thing that I see is that breastfeeding mothers and their support circle often do not know how robust breastfeeding is. They instead seek formula to ease the burden of the breastfeeding. Many kind hearted people give formula as they want to help babies in emergencies but are not aware of the risks of artificial feeding during an emergency. Breastfeeding saves lives.

However, I have also seen many mothers who have sought breastfeeding support during emergencies and have not been able to find it – either the health workers have disappeared, are too busy, or they are not trained about the emergency aspects of breastfeeding. They often repeat the normal breastfeeding messages which do not have the impact or relevance during an emergency. For example, families are often encouraged to exclusively breastfeeding for 6 months when, in reality, they simply need to get through the next 24 hours while caring for their family in a shelter.

Where we have the funding to have dedicated IYCF-E activities, we are able to provide key messages to mothers and into the wider community. We also provide mother-baby caravans/areas where mothers can go to breastfeed, meet other mothers and access skilled breastfeeding support, as well as be a part of educational sessions. There is also support for relactation and wet nursing.

The World Breastfeeding Week organizers stated “This circle of support represents the need for support if a woman finds herself in an unexpected and/or serious situation, with little control. Situations that require special planning and support could include natural disasters, refugee camps, divorce proceedings, critical illness of mother or baby, or living in an area of high HIV/AIDS prevalence with no support for breastfeeding.” Can you expand a bit on what some of the unique challenges are that breastfeeding women and babies who are in crisis face?

Breastfeeding women and babies have a number of challenges during emergencies:

  • There are often a huge number of additional myths and misconceptions that undermine breastfeeding during conflicts. Common emergency related myths/misconceptions are: Stress drying up breastmilk, lack of food or change of food negatively affecting breastfeeding, tension or even grief being passed on to the baby.
  • Many of the countries that we are currently working in are Muslim and populations are commonly displaced. Muslim mothers often will not breastfeed in public or even in tents, which they may share with other men. Hence, there needs to be dedicated private breastfeeding spaces.
  • Often there are huge donations and untargeted distributions of breastmilk substitutes (often labeled in the wrong language or near/past use-by-date) which are given to caregivers, and even to breastfeeding mothers. We have found that if a mother is given these, she is much more likely to use it and that it can then lead to breastfeeding difficulties and undermines breastfeeding. Often, these donations are only given for a short time, meaning that as her breastmilk supply has been affected, the mother has to then find formula and the money to continue to feed her child.
  • People often think that when the volume of breastmilk is diminishing, it can’t be increased. They mistakenly believe that there is no hope for increasing the supply that might have been impacted by the crisis.
  • There is often a lack of skilled support for breastfeeding mothers in emergencies. The health workers may have also been affected by the emergency, may be taking care of their own families, and there may be a lack of health workers who have been trained on breastfeeding before the emergency.
  • There is a lack of funding for programs to support breastfeeding in emergencies. Donors pay lip-service about the importance of breastfeeding but don’t give the money.
  • Communities often do not prioritize breastfeeding support during emergencies as a NEED. This is an issue we are increasingly looking at as “accountability to beneficiaries” is a key issue and we must prioritize our emergency responses based on what the community says it needs. Whilst this works in terms of shelter and water, I think that this methodology is flawed for identifying the need for breastfeeding support. The community leaders are rarely women and culturally, it would be difficult in some circumstances for women to tell their community leaders/outsiders about the need for breastfeeding support.

The challenges and need for support for women in crisis is ongoing. But there is hope! What are some of the most recent initiatives that have made breastfeeding for women in crisis easier? What are your hopes for the future?

Save the Children is creating an IYCF-E Toolkit, which it is hoping to get input in from other NGOs including those from the IFE Core Group which should ensure that we can provide breastfeeding support in a quality way quickly in emergencies. We also have partners who have undertaken work on the psycho-social support needs of breastfeeding mothers in emergencies that all agencies are trying to learn from.

My hope for the future is that health and nutrition workers in emergency prone countries are taught about breastfeeding in emergencies during their training so that they are equipped to support mothers during the additional stress of an emergency. Also,  that during an emergency, breastfeeding support is regarded as part of our key work – that every person that works in the field in an emergency response is aware of the need and how to support breastfeeding mothers. I hope that we are systematically able to provide the quality support that breastfeeding mothers need in that context.


World Breastfeeding Week 2013: The Family and Social Network Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Katya Lokshina, Russia

katyaKatya is a former linguist turned IBCLC serving in Moscow, Russia. She is the mother of three children and was proud to be the first Russian La Leche League leader. She was one of the group of 12 first-ever Russian speakers in 2011 to pass the IBCLC exam in the former Soviet countries. She now leads a popular mother-to-mother support group and works as a private lactation consultant. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Family and Social Network”. Can you describe for us a bit about the work you are doing in the field of lactation to support breastfeeding families? How did you become involved in this work? What does a typical day of supporting breastfeeding families look like?

I am the mother of three children and providing breastfeeding support is both my day AND night job! I must balance my private life with that of being a breastfeeding professional. On a typical day, I get a few calls from mothers. While my children are at school, I do home visits. Sometimes driving to a mother’s home can take up to 1.5 hours due to the heavy traffic in Moscow. Russian women rarely get professional breastfeeding support at the hospital but things are slowly changing.

Being not only an IBCLC but also a La Leche League leader, I encourage expectant mothers to visit a breastfeeding support group. Watching other mothers and babies and talking with them can go a long way towards building a foundation for a successful breastfeeding relationship.

I believe that EVERY mother can be a huge promoter of breastfeeding! At the hospital, at family gatherings, at the playground, in the doctor’s office, and in many public places like shopping malls, cafes, on an airplane – simply by breastfeeding our babies and kindly answering questions and comments from others (those from teenagers and kids are most important!), we are doing a great job of supporting breastfeeding.

The World Breastfeeding Week organizers stated “Husbands, partners, fathers, family, and friends compose the mother’s immediate and continuous support network. Social support includes community support – at the market place, within a religious context, at a neighborhood park, etc. Support during pregnancy reduces stress. Support during labour and birth empowers the mother. Societal support increases the mother’s confidence in her ability to breastfeed beyond the early weeks and months.” Can you expand a bit on what some of the unique challenges breastfeeding women and their babies face in your community? What is the reaction to breastfeeding women who feed in public? How is your group providing support?

As a La Leche League leader, I am able to observe the mothering styles from many different countries. Russians are less afraid of feeding in public than their American counterparts. Still, there is much to do in this field. Many Russian mothers are not willing to bring their babies into a public place at all. We are afraid of “infections” and, especially in the first weeks, of the “evil eye”. We’d rather ask for a home visit from a doctor or lactation consultant than come to an office or support group. BUT, it is gradually changing! I can see a difference after 8 years of working in the field. 

The challenges and need for support for breastfeeding support is universal. What has encouraged you in the last year when working with breastfeeding families? What are your hopes for the future?

My encouragement is my environment. With every year, I find more and more breastfeeding mothers offering their help to La Leche League. I have become acquainted with many highly-skilled professionals and I’ve met wonderful pediatricians, surgeons, general practitioners, and midwives, all of whom are well informed about supporting breastfeeding families. It is a pleasure to cooperate with them. This makes me very optimistic about the future of Russian babies!


World Breastfeeding Week 2013: The Government and Legislation Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Susanna Scurry, Australia

photo sueWe were able to interview Susanna while at the 2013 ILCA Conference in Melbourne, Australia. Susanna is a midwife, and lactation consultant since 2005 and also a Baby Friendly Hospital Initiative (BFHI) assessor and educator. She was also on the board of Australian Lactation Consultant Association (ALCA) and Lactation Consultants of Australia and New Zealand (LCANZ). She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Government and Legislation”. Can you describe for us a bit what work you are currently doing or hoping to do in the field of lactation and the government? How did you become involved in this work? What would a typical day of working at the government level, supporting breastfeeding look like?

I am a big fan of Marilyn Waring, a New Zealand economist who states “An economic model that does not value clean air, clean rivers, forests, unpaid work by women, and breastfeeding is unsustainable.” I am all for an economic system that promotes, protects, and supports normal birthing, breastfeeding, and sustained home visits to parents . I support anything that is making a community better for today’s parents, as they say , “it takes a village to raise a child”! What I value for future generations, including for my 6 lovely grandchildren, is for a sustainable future.

My focus is on women’s health. For many years, I have been advocating for a human milk bank in our neonatal unit and family centered care in our NICU facility as well as a public IVF clinic in Newcastle along with community birthing, and palliative and aged care. I talk about the public health implication of not using breastmilk and also my support of BFHI. I truly believe it is “from the cradle to the grave”. If we had skin to skin contact throughout life, we would have a much kinder world.

The World Breastfeeding Week organizers stated “Women who plan to breastfeed or who are already breastfeeding benefit from the support of international documents, protections for optimal infant feeding, plus active and well funded national commissions. Legislation that combats aggressive marketing of breastmilk substitutes and enacts paid maternity leave also benefits breastfeeding women.” Can you expand a bit on what some of the unique challenges are that women in your community face that could be improved through legislation?

I appeared before the Productivity Commission to argue the case for paid parental leave. I am proud of the four month paid parental leave granted but I think twelve months would be better and will continue to argue for this. I have also lobbied for many years for the implementation of the WHO Code in Australia. The Marketing in Australia of Infant Formula (MAIF) agreement is a toothless tiger and I would like to see it gone. Australia had a Parliamentary Inquiry into breastfeeding in 2007 and all of its recommendations should be implemented.

What are some of the current initiatives, laws, and policies that support breastfeeding women in your community? What are your hopes for the future?

We need to expand BFHI into the community, pediatric offices, child care centers, etc. We also need to reclaim breastfeeding in our culture. Australia needs, at a federal level, to have a paid breastfeeding coordinator as recommended by the World Health Organization and breastfeeding representation at an International level as well. I will continue to work towards these goals.


World Breastfeeding Week 2013: The Workplace and Employment Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of IBCLCs in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Vergie Hughes, USA

IMG_3126We were able to interview Vergie while at the 2013 ILCA Conference in Melbourne, Australia. Vergie has a long history of working in maternal child health and for the past 27 years, she has been an IBCLC. In addition to her work described here, she is the program director for Lactation Education Resources where she provides education for lactation consultants (and lactation consultants-to-be) all over the world. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Workplace and Employment”. Can you describe for us the work you are doing in the field of lactation to support working mothers? How did you become involved in this work? What does a typical day of supporting working mothers look like?

I have been the lactation consultant working on a contract with America Online (AOL) for more than 10 years now. I have worked in many areas of lactation over the years, but this is one of the most fun. I teach prenatal breastfeeding classes, have phone and email contact with the mothers [who are employed by AOL] over the months of pregnancy and during the time they are establishing lactation. Some even call me from the hospital, since we have an established relationship. Then, we keep in contact regarding any questions that come up and as they plan to return to work. The continuity of support with these mothers is so rewarding and often lacking in other work venues.

AOL is wonderful in that it provides 3 months of maternity leave and a pumping room with a hospital grade breast pump in each facility. Those things really make it easier for mothers to maintain breastfeeding when they do return to work.

The World Breastfeeding Week organizers stated “Employed women face challenges and need support at working and breastfeeding. The opportunities for mother support are as varied as the work women do, but usually involve facilitating mother-baby contact or expression and storage of breast milk.” Can you expand a bit on what some of the unique challenges are that women who work away from their babies face?

I do think that the women that I work with at AOL have an ideal situation since they are in an office environment with good support. It is not so easy for women who work in an outdoor environment, a busy retail environment, or in a setting with an unsupportive supervisor or co-workers. A lactation consultant can be the key person to help this mom problem solve her pumping situation and suggest strategies for persevering in a hostile workplace.

The challenges and need for support for women who are working outside of the home have been present for many years. But there is hope! What are some of the most recent initiatives, laws, and policies that have made breastfeeding for women in the workplace easier over the years? What are your hopes for the future?

I do think that support for breastfeeding has improved over the past few years. In the United States, the new Affordable Care Act regulations have made breast pumps more available to mothers, which is good. However, the quality of these pumps and the quick availability is often lacking.

The regulations regarding workplace accommodation of lactating mothers has been supportive of women who request time and a place for breast pumping. Hopefully, a supervisor would provide these accommodations for the breastfeeding mother because it is the “right thing to do”. But, if not, then the mother has the support of the regulations to push for the time and facilities that she needs.


Just When You Didn’t Plan Anything for World Breastfeeding Week…..

World Breastfeeding Week brought about wonderful opportunities to engage with our communities about the incredible impact of breastfeeding.  This is one IBCLCs account of her thought process as she navigated doing a live, on-air television interview.

By Denise Altman, RN, IBCLC, LCCE

One day last week, after seeing my patients, I checked my messages and listened to one from a reporter wanting to ask me some questions about World Breastfeeding Week (WBW). My knee jerk reaction was either to not return the call-I had been at the beach for a week and was woefully behind-or hand her off to another IBCLC practicing in a pediatric office. However, I just don’t have it in me to pass up a marketing opportunity, so I called her back.

She sounded young, and was calling about WBW in general but she also wanted to know what exactly I do. She didn’t know much about the Affordable Healthcare Act but knew that there were parts that addressed breastfeeding . She wanted help with a story angle and maybe a live interview.

Story angle? Role of the lactation consultant? Oh yeah, this is worth pursuing.

I spent about ten minutes just talking, and hit her with enough stuff to get her excited. I
then added the suggestion of also having mama and baby on camera. Sold! She wanted a
live remote tomorrow morning at 7:30am. She had to confirm with her producer and I had to figure out how to mange this new activity on a full schedule, so we decided to touch base by phone at the end of the day.

After hanging up, I started thinking….who do I want?

I need a working mama who looks professional but not too “businessey”. Nice round happy baby who is easy going. Both available at short notice. Mama is willing to be primed and focused but can articulate well without script.

Wait a minute! I have a speech therapist in my patient population (this is why I always ask what people do for a living)! I remembered how she communicates, that she works with kids and understands the science as well as the parent perspective. Score!

Next, I have to decide on my two key points (one for each hand). This is my focus for every interview question so I stay on track.

Breastfeeding is Normal.
IBCLC are the Experts.

In between the mental gyrations, I have to do a home visit to see a mama, and of course, line up my on camera mama and consider back up. I emailed the reporter resources from the ILCA website such as What is an IBCLC?, How IBCLCs Make a Difference, and 10 More Reasons to Breastfeed. There is a ton of support materials already created and the added benefit is that the reporter knows then where to go for future stories or additional info. I also suggested live remote from chiropractor’s office where I do classes-it’s a thank you to the doc, plus the space is soothing and quiet, rather than a busy, cold newsroom. I sent a short list of common myths (along with truth statements) and recommended this as the focus of the interview.

Finally, I rearranged my patient schedule for the next morning. Then, I sent a “heads up”
on my personal social media outlets. I think I have done as much as I can, but there must
be something more.

Can I make this opportunity go further?

Once I called the reporter again about the final details, and then suggested that she
continue coverage for the full week. Then I pitched three additional story ideas with
contact info:

  1. A local NICU (the first or only in the state?) that has started using donor milk that has previously had an unheard of necrotizing enterocolitis rate.
  2. Healthy Carolina’s Lactation Program, which is helping to institute corporate lactation wellness program within our local university.
  3. Local Big Latch On event which could highlight lots of nursing mamas and babes in one handy spot.

After then phone call, I then gave various organizational contacts a heads up that TV reporter may call. Not only could they get positive exposure for breastfeeding support, but
is a great way to build or strengthen community relationships.

The night before, I didn’t sleep very well. I hate doing stuff on TV because my double chin always shows, and I tend to talk fast when I get excited about a topic. I decided to channel Leigh Anne O’Connor, who many private practice IBCLCs would vote “Most Likely To Get Her Own TV Show”! She is an IBCLC in New York who often appears in TV and radio spots. She always appears very calm and focused (maybe its her acting background).

In the morning, the reporter tells me that the producer has given not one, but two segments due to all of the good information she presented! I dressed carefully, trying to look both professional and approachable, wearing a pressed blouse with my business logo on it. When the mama arrived, we quickly discussed the focus for her-normal, working mother, benefits from professional standpoint as well as family focus. She nailed all of it, and the baby was so cute reaching for the mic, that I was hard pressed not to laugh through the whole thing. In my head, I repeated “Normal and IBCLC”.


As she was packing up, the young reporter told me she is one of 12 kids, all breastfed.
When she called home the previous night and shared what she was covering and why, her
mama told her she was proud of her for doing this kind of story.

The world is round.

Because of a call that I didn’t want to return, and a TV appearance I didn’t want to do,
breastfeeding support had a good day in South Carolina.

Denise Altman is a private practice LC in Columbia, South Carolina, USA, and author of two textbooks for healthcare professionals; “History and Assessment: Its All in the Details” and “Mentoring Our Future“. A frequent conference speaker, she enjoys sharing topics and stories “from the trenches”. Her professional picture has been photo shopped to remove her double chin. You can reach Denise at


World Breastfeeding Week: Breastfeeding in Ireland

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

By Geraldine Cahill, IBCLC

The promotion of breastfeeding has been a key government health policy in Ireland since the 1990’s and yet the prevalence of breastfeeding is still incredibly low. The Growing up in Ireland Longitudinal Study has shown that Ireland has the lowest breastfeeding rate in Europe. Less then 50% of babies are still breastfeeding when they leave the hospital and less than 15% are still breastfeeding by six months. As happens in the rest of the Western world, levels of breastfeeding were likely to increase with educational levels. Some of the reasons given for not breastfeeding at all, were inconvenience and fatigue or simply having a preference for feeding formula (48%). Ireland has a long way to go to meet the goal of breastfeeding being the normal way to feed a baby.

How do I as an IBCLC in Private Practice view the state of Breastfeeding in Ireland?

There are currently 197 IBCLCs in Ireland. Most of them are working in the hospital systems as midwives and some are employed as nurse specialists in breastfeeding. Additionally, a number work as public health nurses who visit the mothers in their homes after birth (but these nurses also have other responsibilities within the community and don’t just deal with mothers and newborns). The lactation consultants who work in private practice tend to have come from parent-to-parent support groups such as Cuidiú (Irish word for “caring support”) and La Leche League.

Cuidiú, a parent-to-parent support organization which provides education  and support for all parents (from birth to the teen years), is inundated with requests from women all over the country for training to become Breastfeeding Counselors – and with help from government grants are doing so. La Leche League of Ireland is also reporting the same surge of interest in training, with attendance at their groups on the rise. There are support groups in the major centers of Dublin and Cork every day of the week and many IBCLC’s in Ireland are involved with this work.

Social marketing has had a huge impact in Ireland. We have big urban centers but also many rural mothers. These mothers have set up groups to support themselves and some of these groups have asked IBCLCs to join them.  They have asked because they know this format is mostly about peer support but they want the information on their boards to be correct so that “we don’t give incorrect information or overstep our boundaries”.

One of those mothers, Aideen Ni Cheilleher, has singlehanded done as much work as the rest of us put together over the last year in the area of connecting people together to support one another. She found herself with a year off work, with a newborn, a toddler and a 7 year old, while living in Kerry in a very rural area. In order to get support for herself in her tandem nursing, she set up a facebook group called Extended Breastfeeding in Ireland.  The group grew quickly, with 100 members within 24 hours of being started.  She now has 750 members! These mothers are very committed to breastfeeding and using breastfeeding as a parenting tool but felt isolated and alone in this journey. Now, there is a buzz and a sense of possibility about the future that hasn’t been around in a long time.

The statistics in Ireland have, for so long, concentrated on the lack of breastfeeding that in
some ways, the success of those who continue to feed has not been recognized. I asked those who have met or are meeting their breastfeeding goals, “What do you feel about the State of Breastfeeding in Ireland?” Among the usual complaints about the lack of support and good education in the hospital setting, there were lots of positives, such as the fact that there are so many parent-to-parent groups and that they have better access to support because they can find it online. They also commented that they realize THEY are the community now and feel encouraged to run events and make the changes themselves.

For me, what I hold onto is changing things one family at a time, being there for
mothers when they need support, providing information and letting them get on with the job of changing society as only this younger generation are capable of doing.

Geraldine Cahill has been an IBCLC since 2007 and works in Private Practice. She provides home visits for Mums in the early postpartum period and also provides consults at Touchstone Medical Practice. In addition, she runs Breastfeeding Classes for mothers alongside and complemetary to her work as a Childbirth Educator. Geraldine is also the current President of Cuidiú (a parent to parent support group) and represents them on the Irish National Breastfeeding Strategy and Implementation Committee.   She is also on the Education and Membership Committees of ILCA working with other IBCLC’s to enhance the educational needs of her profession.


World Breastfeeding Week: New Breastfeeding Bill in Israeli Parliament

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

Written by Ellen Shein, IBCLC, LLLL

Photo by Shaare Zedek Medical Center in Jerusalem (permission requested)

In 2011, a member of of the Israeli Parliament, Danny Danon,  proposed a bill for encouraging breastfeeding and limiting the activities of formula companies in the hospitals in Israel. Some of the main hospitals are government run, which means that for the past 30 years, the hospitals have had a hand in promoting the use of formula on a widespread level. Up until the present, many hospitals in Israel have received ONE KIND of infant formula for free from the major importers and manufacturers here.  Additionally, these hospitals have been paid millions of shekels for this exclusivity! Money from these companies have funded many salaries of nurses and of course has helped pay for much needed medical equipment. It is therefore, very difficult in today’s financial crunch to imagine hospitals surviving without these large sums.

These practices, of course, are in direct conflict with the directives and recommendations of the World Health Organization’s International Code of Marketing of Breastmilk Substitutes. The current bills states that hospitals will now have to purchase formula by tender and that the formula provided to mothers who choose not to breastfeed will NOT be limited to one specific brand. Statistics show that if a mother is given formula A in the hospital, she will stick with that brand.

Over the years, there have been overtures in Israel which have succeeded in preventing formula reps from handing out free samples in the hospitals, well-baby clinics and physicians’ offices. The companies have managed however to get a hold of statistics lists which include the names and addresses of new families and are still aggressively marketing their products.  This is done by making sure that each new mother receives formula samples by mail or in “gift packages” for new mothers handed out by one of the largest pharmacy chains.  Additionally, there are other private schemes which send stewardesses to the homes of 25,000 babies each year!

There is much dissention and objection to this new law. Many of the parliament members see this as an affront to women making a free choice in regards to how to feed their babies. In my opinion, the main mistake was to refer to this law as “encouraging breastfeeding” when in fact it should be about the “protection of the infant by freedom of feeding choices”. Part of the law includes a paragraph suggesting that the mother who chooses NOT TO breastfeed must sign a form stating that she is aware of the many benefits of breastfeeding yet chooses not to. This form should have nothing to do with breastfeeding and everything to do with formula feeding. Everyone knows the benefits of breastfeeding, but how many moyhers really know what those little bottles of formula are made of and what the negative outcomes can and most likely will be affecting their babies?  Many mothers have already chosen their method of feeding before arriving at the hospital and, here in Israel, we have a great track record of nearly 87 percent of all mothers initiating breastfeeding. We do not have to encourage the masses to breastfeed. What we need to do is inform those that choose NOT TO of the risks of formula feeding.

No one talks of the benefits of clean air when talking about the hazards of smoking, nor do they tiptoe around the damaging results of alcohol and drug consumption. But for some reason, no one seems to have the courage to stand up and point out the potential health risks that mothers who choose formula subject their babies to.

In early July, there was another finance committee meeting in the Knesset (Parliament) to which breastfeeding advocates were invited. There were representatives from La Leche League of Israel, the Israel Association of Certified Lactation Consultants (an ILCA affiliate) and a few other grass roots organizations. Unfortunately, we were not able to speak at this meeting, but are hopeful that this bill will ultimately be passed. It has passed a first reading, and now, it will probably wait til after the summer recess.

With a bit of language changing and letter writing, we are hopeful that most of the parts of this bill will pass. We are doubtful that the signing of any document will go through unless the Members of Knesset change the wording a bit and change the focus towards helping to improve health outcomes for babies, and not on encouraging breastfeeding.

Ellen Shein has been an IBCLC since 1987.  She began with La Leche League International and served on its Board of Directors from 2005 – 2011, representing Africa and the Middle East.  Currently, she is the Chairperson of the Israel Association of Certified Lactation Consultants. In addition, she is in private practice with Malhiv Breastfeeding and Support Center for New Mothers.


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