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.