Birth is a significant life event and generally a happy one. Although labor is often challenging, it can also be empowering, with mothers experiencing elation and strength. Unfortunately, for other women, birth can be difficult, can be overwhelming, and can lead to psychological trauma. Some women may experience depression and posttraumatic stress disorder (PTSD) following their births. These effects can last for years and can cause difficulties in women’s relationships with their partners and their babies. Difficult births can also negatively affect breastfeeding. This article describes the prevalence of PTSD after childbirth and summarizes the symptoms so that International Board Certified Lactation Consultants (IBCLCs) can help recognize it and refer mothers to appropriate resources.
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- Go to article: Childbirth-Related Posttraumatic Stress Disorder: Symptoms and Impact on BreastfeedingSource:
Lactation consultants understand the mechanisms and research supporting breastfeeding's positive impact on infant mortality reduction, including lifelong health outcomes and associated cost savings. Lactation services can enhance the success of programs intended to improve infant mortality rates, health outcomes, and cost effectiveness.
As leaders serving the Ohio Lactation Consultant Association (OLCA), we pursued engagement with Ohio Department of Medicaid policy chiefs to ensure incorporation of these facts as programs are created to improve health and optimize allocation of Medicaid resources.
After a productive meeting, we specifically proposed that professional lactation services be standard care and fully integrated across the healthcare continuum regardless of setting and ability to pay.
- Go to article: Breastfeeding Information and Support Across Multiple Sources: Identifying Opportunities for Coordinated Care
Breastfeeding Information and Support Across Multiple Sources: Identifying Opportunities for Coordinated Care
To support mothers to breastfeed for recommended durations, information and support are needed from multiple sources. Our previous research indicated not all mothers in our community receive support, with mothers at greater risk of breastfeeding cessation (e.g., lower educational attainment, enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), receiving supports at lower rates. In addition, receiving support was not always linked to breastfeeding outcomes. Building from these findings, the current report presents a case study of one community and calls for efforts to coordinate care across contexts. Perspectives are provided by lactation professionals in WIC and hospital settings. In addition, a mother who experienced inconsistencies in information and support when she encountered breastfeeding challenges discusses her experiences. Clinical implications are provided for coordinating care across community and healthcare contexts in our community and beyond.
- Go to article: Implementing International Board-Certified Lactation Consultants Intervention into Routine Care: Barriers and Recommendations
Implementing International Board-Certified Lactation Consultants Intervention into Routine Care: Barriers and Recommendations
The Surgeon General’s 2011 Call to Action on Breastfeeding (U. S. Department of Health and Human Services, 2011) encourages greater use of International Board-Certified Lactation Consultants (IBCLCs) to increase breastfeeding rates. The objective was to examine IBCLCs’ experiences as part of a routine, primary-care based team serving low income, minority populations, and to elicit their recommendations for implementing IBCLC support as routine in prenatal care. Using a predesigned interview guide, a debriefing session was held with three IBCLCs who served as interventionists in two NIH-funded randomized controlled trials (RCTs) of breastfeeding promotion interventions. Themes were identified through coding and analysis of the session transcript. The results indicated that healthcare provider (HCP) support for breastfeeding was undermined by inadequate education and experience, often resulting in support "in name only." In addition, IBCLCs rapport and expertise—with both women and the healthcare team—helped overcome individual- and system-level barriers to breastfeeding. IBCLCs’ acceptance and integration into the primary-care team validated their work and increased their effectiveness. IBCLCs comments suggest that mothers cannot rely solely upon their healthcare providers for breastfeeding education and support. IBCLCs integrated into routine antenatal and postpartum care are pivotal to encouraging and reinforcing a woman’s choice to breastfeed through education, as well as emotional and skill-based support.
- Go to article: Case Study of a Mother With Polycystic Ovarian Syndrome Who Breastfeed Both Her Biological and Adoptive Infants Born 5 Months Apart
Case Study of a Mother With Polycystic Ovarian Syndrome Who Breastfeed Both Her Biological and Adoptive Infants Born 5 Months Apart
Polycystic ovarian syndrome (PCOS) and infertility are common. These mothers may also have inadequate breast tissue, hormonal imbalances, and low milk supply. Most clinical case reports on PCOS do not have positive outcomes. This case report features a mother with PCOS who breastfed her biological and adoptive infants born 5 months apart and experienced a milk oversupply.
Black women in the United States have lower rates of initiation and duration of breastfeeding compared to other racial/ethnic groups. Social support for breastfeeding, as well as breastfeeding self-efficacy, has been reported as an influence on breastfeeding outcomes. This study analyzes the relationship between breastfeeding self-efficacy and network support for breastfeeding in a sample of Black women. Results showed that network support for breastfeeding does not have a direct effect on breastfeeding duration and pattern, but it does have a significant influence on breastfeeding self-efficacy. These results provide theoretical support for clinical interventions designed to enhance the support network as a way of improving breastfeeding self-efficacy, particularly for women at risk for early weaning.
- Go to article: Summary of Peer-to-Peer Milk Donors’ and Recipients’ Experiences and Perceptions of Donor Milk Banks (Gribble, 2013)
- Go to article: Can Breastfeeding Ease the Effects of Racism and Discrimination?Can Breastfeeding Ease the Effects of Racism and Discrimination?Remembering Miriam Labbok?
Marijuana is one of the most widely used recreational substances in the United States, with high rates of use during peak childbearing years. Medical marijuana use is also becoming more widely accepted in the United States, with legalization in 17 states and the District of Columbia. The available literature suggests that maternal marijuana use during breastfeeding is associated with potentially negative outcomes for infants and children. Adverse effects can include feeding difficulty, lethargy, and delayed cognitive and motor development. Mothers considered heavy or chronic users of marijuana are advised to not breastfeed infants. The aim of this article is to examine the prevalence of marijuana use, the potential effects on breastfed infants, and current recommendations from lactation experts.
For some mothers, insufficient milk supply impacts their ability to fully breastfeed their infants. Many of these mothers seek holistic options to increase their milk supply. Placenta medicine, or postpartum placenta consumption as a purported galactogogue, appears to be a practice on the rise in the United States. There is some limited historical research, and more recently some phenomenological data, about the practice of placenta as a galactogogue. However, little is truly known about the benefits and risks of placentophagy, in general, or specifically as a galactogogue. This article reviews existing literature and proposes a further call for research regarding the safety and efficacy of placenta consumption.
The number of bariatric procedures has increased dramatically in recent years because of rising obesity rates in the United States. Because many undergoing this procedure are women of childbearing age, weight loss not only provides them better health outcomes in pregnancy but also presents challenges. Guidelines are needed for women of childbearing age considering pregnancy who are undergoing bariatric procedures and desire to breastfeed their infants. Findings from this retrospective study suggest that pregnant postbariatric women would benefit from high-risk prenatal clinic referrals to address supplemental needs. Prenatal referrals to lactation consultants and registered dietitians for improved nutritional status and better breastfeeding preparation may improve breastfeeding outcomes for the dyad. Referrals to dietitians and lactation consultants may provide continuity of care throughout the childbearing year including the early part of the infant’s life.
Breast abscesses appear to be occurring more frequently in both our practices, perhaps because of the presence of "super bugs" in our evolving environment. Understanding how quickly breast pain can fulminate into an invasive abscess allows for healthcare providers (HCP) to be vigilant in follow-up with those women presenting with breast fullness, without pain or fever, when they have either recently been treated for mastitis or are currently taking antibiotics for mastitis.
The Hispanic population in the United States is growing, and healthcare providers are challenged to design targeted, culturally appropriate programs to improve health outcomes related to breastfeeding.
This study was designed to detect the exclusive breastfeeding (EBF) rate among Hispanic women who chose education plus peer support versus peer support only. In addition, this study further evaluates ¡Tengo Leche!, an educational program previously evaluated in the literature.
The sample (n = 103) consisted of Hispanic pregnant, low-income, and uninsured women. A two-group quasi-experimental design was used to test the educational intervention combined with peer support (n = 35) versus stand-alone peer support (n = 68). The education-plus group (n = 35) voluntarily participated in the education portion. All participants received the inpatient peer counseling. The participants' breastfeeding intention was gathered through chart review.
EBF at discharge was significantly higher (c2 = 4.51, p = .02) among mothers in the education plus peer support group, who were more likely to be exclusively breastfeeding at discharge (46.7%) versus the peer-support-only group (24.6%).
The outcomes of this study may provide guidance for designing culturally competent interventions with a focus on cost-effective and outcome-driven interventions to increase EBF.
Feeding effectiveness of late preterm infants may vary between feedings and over time, creating confusion and frustration for parents and clinicians. An assessment tool for late preterm infants may assist mothers to recognize breastfeeding behavior more clearly. Although tools are available, none have been tested specifically with late preterm infants. We sought to determine the inter-rater reliability of the Preterm Infant Breastfeeding Behavior Scale scores for late preterm infants between mothers and a health professional.
A one-group observational non-experimental design assessed inter-rater reliability (24 hours [n =23] and 48 hours [n =11] after birth).
The scale's six components were scored independently; agreement ranged from 81.8% to 100% for all components.
The tool was reliable and could be used to help clinicians and parents accurately understand feeding patterns and behaviors assisting with feeding decisions.
- Go to article: Enhancing Lactation Support in the NICU During the COVID-19 Pandemic by Implementing a Primary Care Model
Enhancing Lactation Support in the NICU During the COVID-19 Pandemic by Implementing a Primary Care Model
Meet the needs for additional lactation support in the NICU during the Covid-19 pandemic due to restriction in visitors, hours, and other stressors impacting the Mother and infant dyad.
During the Covid-19 pandemic, a large southeast U.S. research hospital implemented a new model of providing Lactation Consultation in a Level IV NICU. The Primary Care nursing model utilized in the NICU focuses on the infant and mother's individual needs and assists in the development of a caring and supportive environment.
The response to the Primary Care Lactation Consultant has well received and has resulted in the early identification of any Lactation concerns. Parents are reassured, knowing whom to contact with questions. The Lactation Consultant can set mutually agreed upon goals with the mother and include input from the other family members and the healthcare team.
In the future, the model and outcomes of Primary Care by Lactation Consultants in the NICU will focus on additional study and evaluation. In the interim, the parents at this facility have benefited from the family-centered care that focuses on the infant and parents.
Purpose: This qualitative study investigated maternal views on effective support strategies in the face of breastfeeding difficulties.
Methods: In semistructured interviews, 15 women who had encountered breastfeeding problems reflected on their experiences.
Results: Participants reported that managing breastfeeding problems was complex and that the level of provider competence in addressing these difficulties was variable. Social media emerged as a highly prevalent source of support among women facing breastfeeding problems.
Discussion: Virtual and face-to-face support strategies are compared; implications for providers are reviewed.
- Go to article: Book ReviewBreastfeeding Management for the Clinician: Using the Evidence, Fourth Edition
What is the prevalence of tongue-tie (the proportion of total cases in a population)? Is the incidence (occurrence of new cases) increasing or are clinicians simply identifying it more often? The most reliable way to estimate incidence and prevalence is through population-based epidemiological studies. So far, these are limited. However, there has been some research that allows us to approximate rates. Our expert panel offers their judgment on two questions: What is the approximate percentage of babies with tongue-tie? And is incidence increasing?
Posterior tongue-tie is another controversial topic in the tongue-tie world. A posterior tongue-tie is a class-IV tongue-tie. It may be submucosal (i.e., underneath the mucous membrane covering). Babies with this kind of tie are often misidentified as having a short tongue. Revision is more involved, and there is disagreement about whether this condition exists, and to what extent. Our panelists weigh in on this topic.
Recent literature suggests that when breastfeeding goes well, it may protect mothers from the deleterious effects of postpartum depression. Using a phenomenological approach, the objective of this research was to provide insight into the lived experience of breastfeeding in mothers with postpartum depression. Two major themes emerged from the participants’ perceptions of breastfeeding with postpartum depression: (a) Breastfeeding in the Dark: Despite difficulties associated with establishing and maintaining the breastfeeding relationship, breastfeeding through depression meant bonding with baby and maintaining a semblance of control; (b) Breastfeeding Under Wraps: Mothers perceived a lack of support to breastfeed their babies and delayed seeking support for their symptoms of depression out of fear of being stigmatized. This study underscores the need for heightened awareness regarding perinatal and postnatal screening for depression. The early identification of women at risk for postpartum depression will offer healthcare professionals the capacity to engage women and their families in a participatory manner to work through natural challenges associated with establishing and maintaining the breastfeeding relationship.
- Go to article: “Bfed” Texting Program and “Breastfeeding: A Smart Choice” Class: Using Cell Phones to Reach Gen Y Mothers
“Bfed” Texting Program and “Breastfeeding: A Smart Choice” Class: Using Cell Phones to Reach Gen Y Mothers
Santa Barbara County Public Health Department Nutrition Services and Women, Infants, and Children program in California are meeting the needs of Generation Y mothers through the first of its kind two-way texting program for breastfeeding peer counselor participants called “Bfed.” In addition, there is a prenatal breastfeeding class that has topics that use the phone with apps, video clips that include actual successful breastfeeding peers, and a YouTube site to view at a later time. Class participants actually use their cell phones during class instead of having to turn them off.
Mothers with persistent, reoccurring issues with plugged milk ducts in their breasts are usually in great amounts of pain and, therefore, at great risk for premature weaning. Why some mothers struggling with this issue seems unclear, but there is a treatment option that can offer immediate relief and perhaps a permanent resolution of these trouble areas in the breast. Using ultrasound treatment of the affected area of the breast is a highly effective, last resort treatment, but most IBCLCs do not have access to healthcare providers to refer to for this procedure. In this article, plugged duct treatments will be discussed with a focus on the specifics of using ultrasound for resolving this issue.
Sherry Payne, MSN, RN, CNE, IBCLC, is the executive director of Uzazi Village, a nonprofit organization devoted to decreasing pregnancy-related health disparities in the urban core of Kansas City. She also facilitated the 2014 Lactation Summit: Addressing Inequities Within the Lactation Consultant Profession. Ms. Payne speaks frequently around the country to professional audiences on topics related to lactation and birth disparities. One of the many barriers that aspiring International Board Certified Lactation Consultants (IBCLCs) of color face is acquiring clinical hours. The Uzazi Village Lactation Consultant Mentorship Program is an innovative solution connecting aspiring IBCLCs from the Kansas City community to the Uzazi Village Breastfeeding Clinic, which provides free services to area families.
Although formula supplementation is well known to have detrimental effects on the duration and exclusivity of breastfeeding, on the maternal milk production, and on the health outcomes of mothers and infants, there are immediate and long-lasting effects on the infant’s gut microbiome. Breast milk is an important element modulating the metabolic and immunological programming relative to a child’s health. An unfavorable or abnormal microbial colonization during early life interferes with many functions in the gut and facilitates invasion of pathogens and foreign or harmful antigens. Alterations of the gut environment (such as from supplementation with formula) are directly responsible for mucosal inflammation and disease, autoimmunity conditions, and allergic disorders in childhood and adulthood. Clinicians and parents will benefit from knowledge of this side effect of formula supplementation.
Lactation advocacy, promotion, and counseling has undergone a number of changes in the African American community. From programs funded by the government to contemplative reviews of the business of lactation, the breastfeeding rates of Black women have made an unhurried increase. With straightforward acumen, Kathi Barber shares her reflections on working in the field.
Breastfeeding rates among children who have a serious illness or congenital condition are lower than the general population. There are many barriers to maintaining lactation during a child's illness, and specific training issues among staff working in pediatric departments.
This is a narrative review of some of the most common challenges highlighted during a literature search prior to a research study that is being undertaken to explore this phenomenon in greater detail.
There are many identified challenges for families of sick children. Lactation may be threatened or discontinued if the barriers are not adequately addressed. Lactation professionals working in any setting may work with families who are coping with difficulties that require more support.
Breastfeeding sick children, and those with complex medical conditions, requires adaptations and more specialized skills. Many families feel unsupported by their medical teams. Recommendations are made for collaborative working between pediatric medicine and surgery, nursing, oncology, radiology, dietetics, anesthetics, pain management, play therapy, child psychology, palliative care, social support, and lactation support.
- Go to article: Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers’ Sleep and Fatigue
Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers’ Sleep and Fatigue
The controversy around mother–infant bedsharing continues to grow. In order to make sound policy recommendations, policy makers need current data on where infants sleep and how families handle nighttime feedings. The present study is a survey of 4,789 mothers of infants 0–12 months of age in the U.S. The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Recommendations for promoting safe infant sleep are made.
- Go to article: What Happens to Breastfeeding When Mothers Lie Back? Clinical Applications of Biological Nurturing
Human neonates are born with an innate ability to find the breast, latch and feed. Unfortunately, some of these very reflexes can also hinder babies’ efforts to breastfeed depending on the mother’s posture. This article provides a brief overview on the mechanisms of biological nurturing (BN) and describes how practitioners can help mothers trigger innate feeding mechanisms so that they do not become barriers to breastfeeding.
The beneficial flora inhabiting the intestinal tract of an infant is extremely important for health, both in the short and long term. The establishment and further development of a healthy gut microbiome is a complicated interaction of factors in the infant. There are many elements that influence the development of the gut flora that extend beyond birth method and type of feeding. Maternal antibiotic use during pregnancy and during delivery is a common practice and can decrease the diversity of friendly biota in the mother and therefore decrease the amount and variety introduced to the infant. Antibiotic use in the mother while breastfeeding also has implications for health and diversity of the infant’s gut bacteria because varying amounts of antibiotic medications transfer into breast milk. The use of probiotics is a common complimentary therapy that is used for a wide variety of reasons and is frequently used during pregnancy and lactation.
Since the mid-1990s, women have been using the Internet to offer breastfeeding support to one another. As technology has rapidly changed, mothers have kept up with the pace and found ways to embrace the changes, using them to their advantage. It is essential for all who work with breastfeeding mothers in a professional capacity to understand the generational differences that exist, oftentimes between mothers and providers. For lactation professionals, it is valuable to know how mothers use the Internet, and the platforms they are using, for breastfeeding support. Whether it is through social media platforms or blogging, lactation professionals have more ways than ever before to help mothers by offering their expertise in online settings.
Despite efforts to achieve the World Health Organization’s best practice standards for a Baby-Friendly status, only 54% of babies discharged from a tertiary-care hospital in 2015 were exclusively breastfed. This is despite an initiation rate for breastfeeding of 92%. This report describes maternal and nurse beliefs about exclusive breastfeeding, supplementation, and human milk banking. To help us understand our high levels of formula supplementation, we surveyed 94 mothers and 75 nurses and found differing beliefs about formula supplementation and the use of human donor milk. The breastfeeding policy was not being followed. Maternal and nurse breastfeeding education, along with up to date breastfeeding policies, are essential for organizations to meet the World Health Organization’s standards to achieve Baby-Friendly status.
- Go to article: The Frequency and Resolution of Nipple Pain When Latch is Improved in a Private Practice
This study examined the frequency and resolution of nipple pain in 61 consecutive cases in a private practice. Out of 61 consultations, 37 mothers reported pain during feeds, either exclusively or combined with another problem. For 24 of these 37 mothers, the pain ended by improving the latch. For the 13 other mothers, there were additional problems associated with the pain that required further intervention. The majority of consultations for pain were resolved simply by improving the baby’s positioning at the breast. This implies that it is important to address latch issues from the very first days of the baby’s life.
Updated lactation support hospital staffing and post-birth recommendations for FTE and per 1,000.
- Go to article: Candida and Breastfeeding: A Critical Commentary on the Dilemmas Around Diagnosis, Treatment, and Management
Candida and Breastfeeding: A Critical Commentary on the Dilemmas Around Diagnosis, Treatment, and Management
The etiology of nipple pain in breastfeeding women can be challenging for healthcare professionals. The most common cause of nipple pain or damage in breastfeeding women is poor latch and positioning of the baby at the breast (Duncan, 2015). However, when position and attachment is not identified as the cause, controversy exists as to the etiology of the pain with nipple or breast thrush identified as a probable suspect.
The literature was reviewed to explore the diagnosis and management of thrush in breastfeeding women.
There is a lack of robust evidence in the literature to support an accurate diagnosis of candida as the cause of nipple and/or deep breast pain in breastfeeding women. Diagnosis and management strategies vary between the USA and Europe.
It is important that clinicians supporting and working with breastfeeding women are aware of the differential diagnosis for both breast and nipple pain, as well as utilize their clinical skills effectively to offer the correct treatment and management to women presenting with candida like symptoms (Amir et al., 2013, Wilson-Clay & Hoover, 2017). Culture and sensitivity of mothers expressed milk may be supportive of a diagnosis; however, analysis of mothers' milk is not without its challenges. Breastfeeding women should not be treated for potential candida infection with a traditional clinical examination alone.
- Go to article: Maternal Obesity and Breastfeeding A Review of the Evidence and Implications for Practice
A myriad of factors influence the sub-optimal breastfeeding rates in the U.S. Among these factors is maternal obesity (BMI > 30 kg/m2), which has been found to negatively impact breastfeeding initiation and duration for some women. Obesity increases women’s risk for various complications throughout the perinatal period, which may impact breastfeeding and the long-term health and well-being of women and their children. However, adequate lactation support that upholds a respectful consciousness regarding the potential breastfeeding challenges of women with obesity can assist these women to successfully meet their breastfeeding goals. This review summarizes the literature on the impact of maternal BMI on breastfeeding duration, and maternal and infant risk factors that may complicate lactation for women with obesity. Recommendations for assessing and supporting the needs of mothers with obesity to best achieve their breastfeeding goals are provided.
- Go to article: Empowering Mothers: What Lactation Consultants Can Learn from Successful Poverty Alleviation Programs
Parents often perceive infant gastroesophageal reflux (GER) as a serious problem. Frequently, GER is explained as a normal process, but there are instances where parents’ concerns are valid. Provided are 3 case studies from the private practice of an IBCLC. Each case initially presented with what sounded like normal infant GER. Upon further evaluation, with close follow-up and more detailed history taking, each case required advanced medical attention. These cases highlight the unique role of the IBCLC in helping to assess GER, the value of working as a team member with baby’s physicians, and the importance of listening carefully to parental instincts and concerns.
Low milk production is a common reason for early breastfeeding cessation. Breast hypoplasia is one possible reason for an inability to make a full milk supply.
This article explores endocrinological changes which may link polycystic ovary syndrome (PCOS) and breast hypoplasia.
Stein-Leventhal syndrome—named after two American gynecologists—was the original name for PCOS, and minimal mammary gland tissue was included in the syndrome. Common characteristics of PCOS, including insulin resistance, obesity, hyperandrogenism, and low progesterone levels, may be involved in the pathogenesis of breast hypoplasia.
Lactation professionals should be aware of breast hypoplasia markers and common features of PCOS to help identify women at risk of low milk production to facilitate timely and optimal support for infant feeding.
- Go to article: Decreased Breastfeeding as One Factor on a Short List That Causes Pandemics of Allergic and Autoimmune Disease
Decreased Breastfeeding as One Factor on a Short List That Causes Pandemics of Allergic and Autoimmune Disease
Postindustrial society is plagued with pandemics of noninfectious, immune related illnesses. These diseases, which include allergic, autoimmune, and neuroinflammatory diseases, are not found in preindustrial societies, and are apparently caused by a limited number of environmental factors. These factors, essentially incompatible with human genetics, are each associated with a wide range of immune diseases. The most influential of these factors is a loss of diversity from the ecosystem of the human body, a condition termed "biome depletion." This state affects all postindustrial humans during and after fetal development, and remains the strongest challenge for modern medicine to overcome in the field of immunology. Fortunately, progress is being made. On the other hand, other factors associated with pandemics of allergic and autoimmune disease are within the control of each individual rather than the medical establishment. These factors include unrequited or chronic psychological stress, vitamin D deficiency, and substitution of breast milk with infant formula. Decreased breastfeeding in particular has a profound effect on immunity, probably through multiple mechanisms that involve increased stress levels, alterations of the human biome, and direct modulation of the immune system by mechanisms that remain largely uncharacterized. Given the synergism of these factors that adversely affect immunity in postindustrial culture, the importance of avoiding as many of these factors as possible is emphasized.
The COVID pandemic challenged IBCLCs and other heathcare providers to determine how to meet the needs of new families while maintaining safety for both patients and caregivers. In addition, both workplace and personal stressors triggered by ongoing changes increased the risk of compassion fatigue.
Initial patient support was offered at a free-standing lactation medicine clinic. After office closure, lactation services moved to multiple pediatric offices.
Although the worksite changed after the first six weeks of the pandemic, direct patient care providing lactation support remained uninterrupted, and continues to this day. The IBCLCs are addressing the issue of compassion fatigue with awareness along with peer to peer support.
- Go to article: Supporting Breastfeeding Among Women on the Autistic Spectrum: Disability, Difference, and Delight
Professionals supporting breastfeeding mothers who are on the autistic spectrum by providing information, guidance, and clinical considerations for lactation in settings that are medical, psychological, or private practice in lactation support, may benefit from this comprehensive overview. The author outlines relevant symptoms and discusses how the practitioner-patient relationship could be impacted by characteristics associated with high-functioning autism and Aspergers, and includes a case study interview with a mother who has Aspergers. Practical guidelines for lactation support are included.
Approximately nine to ten percent of women present with flat, retracting or inverted nipples, making latching an infant to the breast more difficult. Various products including breast shells, the Niplette™, the Latch Assist™, an electric pump, and a converted syringe are recommended to help elongate and stretch the nipple in order to assist with latching the baby. A new product called Supple Cups is available that gently stretches and elongates the nipple, making latching easier. Twelve women with flat, retracting, or inverted nipples who were pregnant or having difficulty breastfeeding were asked to try Supple Cups. Ten of the twelve women (83%) were able to consistently latch their babies and breastfeed after using Supple Cups. Eight women (67%) eventually exclusively breastfed their infants. In summary, Supple Cups are an inexpensive, easy-to-use product that can be very effective at protracting flat, retracting, and inverted nipples.
Childhood obesity rates are rising and breastfeeding is documented as a potential protective mechanism to combat obesity risk in children. The purpose of this review of literature was to examine the duration of breastfeeding required to produce a significant reduction in obesity risk during childhood. Our findings indicate breastfeeding as a preventative measure for obesity in children is evident. However, the duration of breastfeeding required to achieve significant benefits remains uncertain.
Background: Nipple pain and trauma are frequent complaints of new mothers, and a variety of treatments have been proposed and investigated for efficacy. Numerous studies have examined the efficacy of nipple creams, but there is no published data describing patterns of use in breastfeeding women.
Aim: To describe the use of topical nipple treatments by a cohort of first-time mothers in Australia
Methods: A cohort of 360 nulliparous women were recruited in Melbourne, Australia, and the question, “In the last week, have you used any creams or ointments on your nipples?” was included in a questionnaire on breastfeeding practices administered at 6 time points.
Results: In the first week after giving birth, 91% (307/336) of women used a topical treatment on their nipples. The most popular treatment was purified lanolin, with nearly three quarters of women (250/336) reporting its use. At 8 weeks postpartum, 37% (129/345) continued to use topical treatments, and 94% (320/340) of women continued to breastfeed.
Conclusion: Widespread use of topical nipple creams is concerning not only because it may indicate a high rate of nipple pain but also because this is a disruption to the natural environment where the newborn is establishing breastfeeding.
Infant formula must be not only safe but also effective in doing what it is supposed to do, meaning it must be nutritionally adequate. Regulatory agencies have given a great deal of attention to the safety of infant formula, but they have not given enough attention to the issue of nutritional adequacy. In 1981, the Codex Alimentarius Commission said, “Infant formula means a breast-milk substitute specially manufactured to satisfy, by itself, the nutritional requirements of infants during the first months . . .” However, in new rules published in June 2014, the only functional test of infant formula required by the U.S. Food and Drug Administration (FDA) was to require research as whether infant formula led to adequate physical growth. The research is to be done by the manufacturers. The FDA issued no clear guidance on how the research findings were to be assessed and used. The FDA could do much more to ensure that parents, healthcare workers, and relevant government agencies know how different methods of infant feeding compare in relation to their nutritional adequacy.
After losing an infant, grieving mothers may still have to cope with postpartum issues, including lactation. This article reviews and addresses care options for lactation concerns after pregnancy, neonatal, or infant loss. Currently, lactation care and advice after loss varies greatly. Lactation consultants are instrumental in providing mothers with anticipatory guidance and evidence-based care. Implementing system-wide training and education regarding this topic will help families receive the information they need to deal with the physiological aftermath of infant loss.
Healthcare providers typically use an infant’s weight loss in the first days of life as a measurement of effective feeding. Additional feeding volumes are often recommended when the infant reaches weight loss of seven to ten percent of their birth weight. This study examined the relationship of the amount of maternal intravenous fluids (IV) given during labor, and infant maximum weight loss during hospital admission. The method was a retrospective cross-sectional review of medical records for 186 healthy mothers and their infants who delivered at a Baby Friendly™ certified hospital in southwest Ohio. Maternal average IV mL per hour positively correlated with infant maximum weight loss.
Breast massage is not new. It is a "handy" technique that has been studied for decades and praised for its many uses in establishing and sustaining lactation, overcoming breastfeeding difficulties, and preventing or treating maternal and infant problems. This article reviews some of the studies examining various breast massage and breast-compression techniques, and proposes possible indications for their use.
Knowing the importance of helping parents create healthy sleep environments is an important first step in supporting new parents—and one that is not new to lactation consultants. The next steps can be the more challenging step—finding ways to clearly and easily help parents understand the importance of responsiveness in care. This can be a particular challenge when so much best practice information focuses experimental research with animals and research with humans, now documents the detrimental effects of early stress on brain development. These effects can occur not just in response to intense and repetitive stressful situations, but with some probability may also occur in situations of parenting that is not responsive. Below, and in the article that follows, are some resources for parents that address the biologically and ethologically based reasons that cry-it-out and sleep-training programs are detrimental to infants’ development—negatively, impacting neurological structures, stress responses, physical health, and socioemotional well-being.
Dental caries and prolonged breastfeeding still trigger much debate among professionals and parents. Some mothers are still being told to discontinue breastfeeding their toddlers because of cavities in the mouth. Parents often feel very discouraged and upset when they are forced to stop breastfeeding their toddlers. Dental caries is one of the most common chronic diseases in childhood, and is a disease of multifactorial etiology. This paper reviews the literature on dental caries and breastfeeding. This review revealed that there was no conclusive evidence that prolonged breastfeeding increased the risk of early childhood cavities.
- Go to article: Pediatric Nurses’ Knowledge and Attitudes Regarding the Provision of Breastfeeding Support in a Pediatric Medical Center
Pediatric Nurses’ Knowledge and Attitudes Regarding the Provision of Breastfeeding Support in a Pediatric Medical Center
Breastfeeding is the biological norm for infant feeding and nutrition. Successful breastfeeding depends, in part, on the support of the nursing staff caring for the breastfeeding dyad. Many infants are admitted to pediatric hospitals during the period when breastfeeding skills are being established, and mothers look to pediatric nurses to provide breastfeeding support and resources. There are few studies describing pediatric nurses’ knowledge of and attitudes towards the provision of breastfeeding support in pediatric medical centers. The purpose of this descriptive survey study was to determine knowledge and attitudes of pediatric nurses regarding the provision of breastfeeding support. The Theory of Reasoned Action provided the framework for the study. A convenience sample of 92 pediatric nurses, on three inpatient units at a pediatric medical center, completed a 40-item breastfeeding survey. Seventy-seven complete surveys were returned for a usable response rate of 84%. Results indicated that pediatric nurses have moderate breastfeeding knowledge and attitudes. The pediatric nurses who had personal breastfeeding experience had significantly higher knowledge and attitude scores. Findings suggest the need for evidence-based educational programs to improve pediatric nurses’ knowledge of and attitudes towards the provision of breastfeeding support in pediatric medical centers.
- Go to article: Evidence-Based Chiropractic Care for Infants: Rationale, Therapies and Outcomes, by Joyce Miller
Barbara D. Robertson and Dr. Anne Eglash discuss Dr. Eglash’s latest thoughts on breast and nipple pain. Unresolved breast and nipple pain are one of the top reasons for early weaning. Dr. Eglash has a breastfeeding medical practice and helps mothers frequently to help resolve their chronic breast and nipple pain. Old treatments are discussed in the context of new research findings and new treatment possibilities are explored.
The Haakaa and other similar style silicone breast pumps have become very popular over the past few years. There is very little research on this type of pump.
The results of two online surveys on Haakaa and other similar style silicone breast pump use are presented: one for families and one for professionals.
With over 5,100 responses from families and over 500 responses from professionals, this new information helps reveal what is actually happening with families and the use of this common tool.
The majority of families and professionals are familiar with this type of pumpand have had positive experiences with it. A small number of families had negativeexperiences, especially when the pump was mis-applied or they had no instruction on use of the pump. IBCLCs need to provide accurate information as to when this type of pump might be an appropriate tool and instructions as how to use it properly.
Some argue that forcing babies into independent sleeping is good for them, increasing health and well-being. They argue that making babies learn to settle themselves at night helps them establish self-regulatory skills and makes them stronger. These practices are supposed to put babies on a road toward healthy physical outcomes, ensuring good sleep patterns. They are supposed to lead to emotional well-being, by ensuring children’s ability to control themselves and establish selfreliance. These beliefs suggest that their advocates know very little about human development. It is a dangerous state of affairs.
- Go to article: Exploring the Impact of Offering an Undergraduate Lactation Elective Course as a Strategy for Normalizing Breastfeeding
Exploring the Impact of Offering an Undergraduate Lactation Elective Course as a Strategy for Normalizing Breastfeeding
More breastfeeding interventions targeting female and male undergraduates before they become parents are needed to foster accurate breastfeeding knowledge, positive attitudes toward breastfeeding, and a greater intent to breastfeed. This study aimed to assess the impact of completing a lactation elective course on undergraduates' breastfeeding knowledge, attitudes, and intention.
Pre- and postcourse surveys were administered to 96 undergraduates from various majors enrolled in a lactation elective.
From pre- to postcourse, this study found significant increases in undergraduates' breastfeeding knowledge, attitudes, and intent.
Because most undergraduates in the United States become parents only after graduation, universities have an opportunity to foster the knowledge and attitudes needed to breastfeed successfully. As breastfeeding knowledge and attitudes in men and women are strong predictors of breastfeeding intent, initiation, and duration, offering undergraduate lactation elective courses is a promising strategy to improve future parents' breastfeeding knowledge, attitudes, and intention, helping to normalize breastfeeding and improve breastfeeding rates.
Kentucky continues to have one of the lowest state breastfeeding rates in the country. In 2014, the majority of the birthing hospitals in Kentucky implemented a practice change to the healthcare model known as Birth Kangaroo Care (BKC) as an effort to increase breastfeeding initiation. The goal of this study was to identify current practices and barriers to implementing BKC.
An evaluation/surveillance study that incorporated an Internet survey to collect information about the practices and policies of BKC in birthing hospitals in Kentucky was completed.
The response rate was 54% (n = 25). The birthing hospitals responders to the survey (84%) reported that a BKC policy was established after the educational intervention. Data identified two perceived barriers regarding uninterrupted BKC. One barrier was the interruption by family members to hold the newborn, and the second was a delay in BKC for medical evaluations of the baby by staff members.
Breastfeeding rates after implementation of the BKC policy in Kentucky birthing hospitals showed a statistically significant (p = .02) improvement of “ever breastfed” infants.
Obesity is quickly becoming a national epidemic with serious implications for the entire medical field, including lactation (Rasmussen et al., 2004). Obesity is a complex medical condition. Many in the medical and scientific communities classify obesity as a disease (Conway & Rene, 2004). Treatment options include a number of advances in weight-loss surgery (WLS) with resultant effects on pregnancy and corresponding challenges in the field of lactation and the care of nursing mothers. This article explores some of those advances with practical applications for lactation professionals.
Government agencies that regulate infant formula have been concerned about its safety, worrying about things like contamination with bacteria and insect parts. Questionable formula has been subject to government-ordered recalls. This attention reinforces people’s confidence that national governments are ensuring the quality of infant formula. However, national regulatory agencies generally just assume that various versions of infant formula and other foods are safe for children (Kent, 2011). While many others have commented on safety issues relating to infant formula, few have paid attention to another important point. Safety is about ensuring that the product does not cause direct harm—but that is not enough. There are things infant formula is supposed to do. The quality of infant formula depends not only on its safety, but also on its nutritional adequacy.
Nipple shields have a long and somewhat controversial history. Nearly every published article in recent years reports positive breastfeeding outcomes for mother/baby dyads who used a nipple shield. Its use may be warranted if infants have sucking difficulties, or are having problems latching to flat or inverted nipples. In addition, they can be useful for mothers who dread breastfeeding because of nipple pain, are experiencing hyperlactation, or have histories of sexual abuse. It is time to recognize the possible uses for nipple shields that can help create favorable results for breastfeeding couplets.
Do parents have any alternatives to surgery for addressing tongue-tie? Our panelists agree that latch issues should be assessed first. Other modalities include physical therapy, speech therapy, chiropractic, and craniosacral therapy. In addition, infants should be assessed for other issues, such as torticollis, that may co-occur with tongue-tie. For some parents, complementary techniques may be all that they need to address tongue-tie–related issues. For other parents, surgical release will still be necessary.
Tongue-tie can cause many serious breastfeeding problems and even lead to breastfeeding cessation. As the mothers’ stories listed in “When Tongue-Ties Were Missed: Mothers’ Stories” attest, healthcare providers often do not correctly identify when a baby has a tongue-tie. Assessing tongue-tie is essential. What should clinicians look for? Which professionals should be the ones identifying and identifying tongue-tie? Assessing tongue-tie is the focus of this article.