ABM updates protocol on contraception and breastfeeding

The long awaited protocol revision on Contraception and Breastfeeding by Drs. Pamela Berens and Miriam Labbok is out. This revision on a crucial topic has useful information for those counseling mothers regarding contraceptive choices. One to two times a month I encounter a mother in my consultative breastfeeding practice who has been placed on some type of hormonal contraceptive and now she is struggling to make milk. In this revision there are a few new tables and a section describing in depth the individual contraceptives choices, summarizing the evidence and the associated studies. The bottom line remains: “Until more extensive well designed research exists , it would be prudent to consider hormonal contraceptive methods as potentially having some risk of decreasing the mother’s milk supply.” Options such as Lactational Amenorrhea Methods (LAM) and Natural Family Planning (NFP) and emergency contraception are discussed and associated management issues are also addressed. As with all ABM protocols, this protocol benefitted from formal feedback from our expert board members and reviewers, ensuring that it not only has practical information but also has an international approach. Share it with your colleagues and leave a copy at a work station!

Maya Bunik, MD , MSPH, is Co-Chair of the ABM Protocol Committee and a Fellow of the Academy of Breastfeeding Medicine. She is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice. 

Blog posts reflect the opinions of individual authors, not ABM as a whole.

Cultural considerations for breastfeeding among Latina women

I am looking forward to being part of an expert panel on cultural issues with breastfeeding at next week’s ABM meeting. I plan to talk aboutpostpartum customs, special foods, importance of elders and fathers, galactogogues and other beliefs as they relate to breastfeeding in Latinas. I will also describe some examples from Central and South American countries of why not all Latinas are alike.

I will share published work on the practice of combination feeding—why los dos…and suggest some strategies for avoiding unnecessary supplementation.  I also have some interesting observations from my recent field work with home visitors in rural Guatemala. Other topics will be the assumptions for some Latinas in the US that breastfeeding for 3 months is enough, nursing babies too long can make them weak or ill-mannered. I continue to see in my clinical work and research that self-efficacy and prenatal intent is so important for exclusivity. Happy to hear any ideas you have on this topic. Hope to see you in Cleveland next week.

Maya Bunik, MD, MSPH is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice. She is a Fellow of the Academy of Breastfeeding Medicine and serves as the Protocol Committee Co-Chair.

She is a featured speaker at the ABM 19th International Meeting, November 13-16, 2014.

Blog posts reflect the opinions of individual authors, not ABM as a whole.

 

Breastfeeding Management: It’s so much more than just the latch

Breastfeeding initiation and the period of the first month after birth for the mother and infant can often be complicated by medical and psychosocial challenges which may be difficult for lactation specialists alone to address. In a published article in March 2014 in the Journal of Human Lactation, we describe an integrated mental health approach which we have coined the ‘Trifecta†Approach’ as a model of breastfeeding management. († We borrow the term Trifecta which is a betting term for predicting 1st , 2nd and 3rd places in a horse race. It is also synonymous with the likes of winning an Oscar award for a movie). Our breastfeeding consultation clinic developed a multidisciplinary team comprised of : 1) a pediatrician specializing in breastfeeding medicine (myself), 2) a lactation consultant (nurse with IBCLC), and 3) a clinical psychologist specializing in infant mental health and child development.

The Trifecta Conceptual Model

The lactation consultant and I take the detailed history on mother and baby together, and try to include a pre- and post- feeding weight and assist with latch and positioning.
Since breastfeeding often gets the blame if the baby is not growing well, we occasionally need to obtain other laboratory studies (e.g. Vitamin D levels) or pulse oximetry monitoring (e.g. low oxygen levels due to snorty breathing helped detect a congenital laryngeal problem that required surgery).

We also offer practical advice about ‘simplifying your life’ in the first week and recognizing the reality of having a new baby:

• Minimizing hosting ‘afternoon teas’ (or even dinners) for visitors to admire the new baby
• Enlisting help with meals i.e. simplified meal plans, creative with take-out meals and use of paper plates
• Taking a break from laundry, cleaning, chores and running errands
• Getting much needed rest with having someone take the ‘baby out of the building’ so that mother can sleep in a quiet house

After we complete our assessment and make plans for follow-up, our psychologist goes in for a debrief of sorts and reviews the Edinburgh Postpartum Depression Screen (EPDS) score. Our psychologist is able to get more information about previous mental health issues and provide more advice about self-care. We find that most families need help with the dramatic change that happens in their partnership after baby and the shock that for most this is ‘not the warm fuzzy Downy TV commercial’ they expected!!