Breastfeeding Medicine

Physicians blogging about breastfeeding

On finding #MyPeopleABM: Physicians share what ABM means to them

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Jennifer Caplan, MD, FAAP, IBCLC
North Scottsdale Pediatric Associates, AZ USA
I joined ABM after going to an AAP conference in 2008 with my nursing baby. At the conference, I ended up spending almost the entire time with the Section on Breastfeeding because my baby was not interested in staying with my husband—so I brought her with me. And I felt more comfortable hanging out with the breastfeeding crowd. I ended up riding in an elevator with some of the organizers and one of the women told me I should join ABM.

I had been so energized by the discussions at that conference—learning how to do frenotomies, hearing about the “Ban the Bag” efforts in Massachusetts, finding out about Baby Friendly Hospitals for the first time. So, I joined ABM and attended my first conference in 2009.

Being at an ABM conference is amazing. I’m really not a conference person—networking does not come easily to me, I don’t really like the marketing/advertising hall, but I do love learning about new things. ABM is the only conference I really enjoy going to. I always come away from the conference with at least a dozen new ways to practice and a new energy to spread my knowledge to others. And I love the people I meet at ABM conferences—so many perspectives, so many different ways they express their passion for supporting the mother-baby dyad. After another couple conferences, I had been convinced to become a lactation consultant.

I usually make it to the ABM conference, but even in years where I don’t go, I still get a lot out of my membership. I probably use the protocols more than anything else—always the most up to date, comprehensive source on breastfeeding topics. I enjoy seeing the new research coming out in the journals. And just knowing I’m a part of an amazing group that is a political force for advancing breastfeeding and advocating for women is important to me. Read the rest of this entry »

Written by drmilkarizona

May 5, 2017 at 5:06 pm

Surgeons who pump: #ILookLikeASurgeon

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If you follow trends on social media, you have seen the viral tweets and pics from women surgeons who have copied the New Yorker magazine cover showing three women leaning over an operating table.   These posts share two common hashtags:  #ILookLikeASurgeon and #NYerORCoverChallenge.  As an admin for the 7,000+ member Dr. MILK online physician mother breastfeeding support group, I wanted to see this picture taken from the perspective of a multi-tasking surgeon mother who fits in pumping her milk between cases and a very hectic schedule.  I asked our members to try and coordinate OR schedules and pumping schedules to make this happen.  Three superstar OB GYNs from Baylor College of Medicine created this pic while at Texas Children’s Pavilion for Women in Houston, TX.  They don’t literally pump their milk while leaning over an operating table, but this picture represents the duality of surgeon moms who balance patient care needs with meeting the nutritional needs of their infants.  Their stories of breastfeeding/pumping challenges and successes will hopefully encourage mothers of all walks of life to confront and remove barriers to maintaining a milk supply while at work and #normalizePumping.

Here’s what their workday looked like when they managed to take this picture:  One doctor had a delivery and then a c-section while the second had a fetal surgery.  The third surgeon was performing a robotic hysterectomy.  They tried to coordinate the photo between the delivery and c-section but timing wasn’t right, and then just before the fetal surgery the three women rushed into an empty OR to make it happen.  Read the rest of this entry »

Written by drmilkarizona

April 28, 2017 at 12:16 pm

ABM Releases Revised Supplementation Protocol

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During a time of abundant research surrounding the long term implications of feeding practices in the neonatal period on maternal and child health, it is of utmost importance that healthcare professionals are guided by the best available evidence regarding infant feeding while caring for breastfeeding dyads. We know that despite the recommendations against routine formula supplementation, this practice is commonplace in hospitals worldwide for a myriad of reasons. In developing ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate (Read the protocol here) newborn physiology and management of breastfeeding mothers were highlighted to impress upon healthcare professionals the delicate balance involved in helping mothers establish exclusive breastfeeding in the early postpartum days. Many mothers set out with the goal of exclusive breastfeeding, but still in many countries, few reach their feeding goals. Studies clearly demonstrate that when healthcare teams have a clear understanding of these topics, provide antenatal education, and implement supportive hospital practices, the need for supplementary feedings in term neonates is rare.

Preventing the need for supplementation altogether should be a common goal for all members of the healthcare team. It has been well established in the literature that exclusive breastfeeding protects mothers and infants from various poor health outcomes, is cost effective, and is the physiologic norm. Thus, the authors of this protocol dedicated substantial time and focus on practices that have been shown to reduce this need, which include many of the ten steps required by the Baby Friendly Hospital Initiative. The revised protocol contains an algorithm for caring for the breastfeeding dyad before and during the birth hospital stay and responding to common concerns.

It is important to recognize true medical indications of supplementary feedings as well as the preferred choice and volumes of supplement, which are appropriately outlined in this protocol, re-emphasizing that, while there is a time and place for formula use, a mother’s own expressed milk or donated human milk in volumes that mimic normal breastfeeding physiology are preferable to breast milk substitutes. The preference for donor human milk over formula use has been suggested by the Academy of Breastfeeding Medicine for years, and is further supported by emerging research on the long term health consequences of the infant microbiome and the role that breast milk substitutes may have on individual health outcomes years down the road.

Educating ourselves as healthcare providers about how best to support mothers in their breastfeeding journey is crucial to their success in meeting their personal feeding goals. This revised clinical protocol highlights supporting evidence and contains information and strategies needed to provide state-of-the-art care and support.

Written by drharrel

April 4, 2017 at 12:22 pm

The Burden of Proof

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October is a busy month for me. I usually travel twice that month, once for the American Academy of Pediatrics Section on Breastfeeding Medicine meeting, and then again for the annual Academy of Breastfeeding Medicine meeting. One of my partners (who doesn’t have children) comes up to me and says: “Why are there so many meetings about breastfeeding? I mean we all know that’s the best thing for babies and we all should recommend it. How many meetings, research studies do you really need?” At first, I was stunned…not bad, not good, just surprised, I guess.

This reminds me of when I had invited Dr. Christina Smillie to Children’s Hospital of the King’s Daughters (CHKD)/Eastern Virginia Medical School (EVMS) to speak at our 1st Virginia AAP Breastfeeding conference in 2009. The first night I had her speak to the MPH school at EVMS. As Dr. Smillie always does, she gave a wonderful talk on the public health reasons, risks of death with sub-optimal breastfeeding, how breastfeeding is natural, etc. After 60 minutes of slides, statistics and videos, a male public health researcher raised his hand and asked: “So why isn’t everyone doing this…why aren’t BF rates at a 100%?” Dr. Smillie and I just smiled knowingly at each other.

2After I thought about it, I explained to my partner that while there is so much new research/things discovered about breastmilk and its properties, I told her, that as a field, Breastfeeding Medicine is constantly battling critics and having to ‘prove’ our medicine. Whether it’s against the various industries, hospital systems, colleagues, or even other physicians, Breastfeeding medicine has to prove its worth. I was telling another ABM member about this conversation and I remarked at how I had attended an acne lecture at the AAP conference. As a general academic pediatrician, I wanted to get some new information, learn the research on various conditions that I commonly see in my practice. And it hit me like a ton of bricks. The dermatologist, while very knowledgeable and a good speaker, was quoting statistics from the 70’s and 80’s…that would be 1970/1980. Of course she spoke about the newer drugs being used, but the pathophysiology and meds/ointments used to treat this condition, well that data was over 25 years old! Read the rest of this entry »

Written by NKSriraman

January 8, 2017 at 10:20 am

Trust and test weights

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“Nobody seems to trust test weights in our unit.  What are we doing wrong?”

To “test weigh” a baby means to measure how much milk she has transferred by simply weighing her — clothing, diaper and all — before and after breastfeeding.  Test weights are often used in term infants using precise scales such as the Medela BabyWeigh.  A few studies have supported the utility of test weights in preterm infants: these include a Swedish study favorably comparing babies cared for in NICUs using test weights vs NICUs that did not (earlier attainment of exclusive breastfeeding and earlier discharge) as well as a small study from the illustrious LCs at my own institution describing the development of a technique for accurately performing test weights.

It still seems, though, that NICU providers and even parents have a tendency to distrust test weights in premies learning to breastfeed.  Some of this distrust, especially for the providers, is probably a residuum of earlier studies using less precise scales and/or less consistent, accurate weighing techniques.  (It is true that we NICU folks tend to love our numbers, and we prefer that they have as many significant digits as possible.) I suspect another large part of the distrust has to do with the fact that premies who are learning to feed don’t consistently transfer the same volume of milk even when their feeding quality seems to be subjectively “good.”  As with learning to walk or talk, learning to feed is an incremental and not a linear process… but when numbers-focused, pattern-seeking people see “inconsistency” in the amount transferred, we think “that can’t be right.” Finally — just perhaps — part of the distrust might be with breastfeeding itself.  If we can’t measure it or control it, we can’t trust it. And if parents hear us expressing distrust of breastfeeding, they are probably more likely to distrust it as well. Read the rest of this entry »

Written by neobfmd

January 6, 2017 at 4:46 pm

Short report on the Baby-Friendly Hospital Initiative Congress

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Submitted on Behalf of the World Alliance for Breastfeeding Action (WABA) and the Academy of Breastfeeding Medicine (ABM)

Dr Felicity Savage, FABM, Chair of WABA.

Dr Rukhsana Haider, FABM, Co-Chair of WABA.

Introduction

The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by WHO and UNICEF, with the aim of protecting, promoting and supporting breastfeeding in maternity facilities worldwide.  To be designated “Baby-Friendly”, facilities are required to follow the Ten Steps to Successful Breastfeeding and the Code of Marketing of Breastmilk Substitutes.

Since 1991, great progress has been made, and 20,000 maternity facilities world-wide have been designated Baby-Friendly. However, in the last decade, progress has slowed down, and the total number of designated facilities still represents less than one third of all maternities in the world. Also it has been difficult to maintain the necessary standards as the BFHI assessment procedure often lies outside normal hospital accreditation processes.

The 25th Anniversary of the launch of the BFHI seemed an appropriate time to review progress and consider the need for the development of revised or new guidelines. Read the rest of this entry »

Written by rhaiderbd

January 5, 2017 at 7:52 am

AAP New Policy Statement on Donor Human Milk for the High Risk Infant

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While the birth of neonatology was in the late 1800s with the development of the incubator, it was only in the 1970’s when the modern NICU was established with the neonatal respirator. More advanced respirators and other technologic developments, including important medications such as surfactant and nitric oxide, have dramatically improved the outcome of preterm infants. Yet, one of the most important “new developments” to improve the care of these infants, is feeding an exclusive human milk diet. It is now clear that exclusive breastmilk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD and ROP, while increasing infant brain volume and neurodevelopment in infancy, childhood and adolescence. 

Therefore, it is noteworthy that three AAP committees, the Committee on Nutrition, the Section on Breastfeeding and the Committee on Fetus and Newborn, the committee that writes policies for neonatologists, combined to write a policy statement supporting the use of pasteurized donor human milk in high risk preterm infants, with priority for those less than 1500 grams, when mother’s milk is not available. It states that the use of donor human milk in preterm infants is consistent with good health care. It recognizes that the use of donor milk is limited by its availability and affordability. It asserts boldly that the use of donor human milk should not be limited by an individual’s ability to pay. It urges health care providers to advocate for policies that assure reimbursement for its cost, while expanding the growth of milk banks by improving governmental and private financial support. Read the rest of this entry »

Written by galactodoc

December 22, 2016 at 8:13 am