Archive for the ‘policy’ Category
In case you missed it, the Academy of Breastfeeding Medicine Protocol #4, “Mastitis“, by Dr. Lisa Amir, was published in Issue #5 (May/June) of Breastfeeding Medicine. The good news (or the bad news, depending on how you look at it) is that not much has changed since the previous version was published in 2008. There are slightly expanded discussions of methicillin-resistant staph aureus and secondary candidal infections, and a brief explanation of fluid mobilization for symptomatic treatment of a swollen breast. The style has been changed to include fewer paragraphs and more bulleted lists, which makes for easier reading and reference. And of course the references have been updated. It is of the high caliber we expect these clinical protocols to be, and relates the state of the art as it exists for the diagnosis and management of Mastitis today. If you haven’t had a chance to take a look at it, check it out in Breastfeeding Medicine Volume 9, Number 5, 2014 pages 239-243, or go to the Academy of Breastfeeding Medicine website, and check under the Protocols and Statements tab.
Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the United States Breastfeeding Committee.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.
With more than half of women with infants employed, simple workplace accommodations are critical for breastfeeding success. By helping moms understand their rights as a breastfeeding employee and plan for their return to work, lactation care providers can support a successful transition so that working moms are supported to reach their personal breastfeeding goals.
The federal “Break Time for Nursing Mothers” law requires employers to provide break time and a private place for hourly paid employees to pump breast milk during the work day. The United States Breastfeeding Committee’s Online Guide: What You Need to Know About the “Break Time for Nursing Mothers” Law compiles key information to ensure every family and provider has access to accurate and understandable information on this law. Read the rest of this entry »
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 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!! Read the rest of this entry »
Some public health messages everyone can agree with: Never drink and drive. Always put your infant in a car seat. Other public health messages seem to ask us to do the impossible: Teenagers must never have sex. Mothers must never share a bed with their infants.
Advice around the US urges parents never to bed share, reinforced by the official stance of the American Academy of Pediatrics. Scary ads abound. One ad shows a queen-sized bed with a headstone in place of headboard reading “For too many babies last year, this was their final resting place.” Another shows a baby in an adult bed with a meat cleaver, stating “Your baby sleeping with you can be just as dangerous,” and another ad says “Your baby belongs in a crib, not a casket.”
The fact is, across the United States and the world, across all social strata and all ethnic groups, most mothers sleep with their infants at least some of the time, despite all advice to the contrary, and this is particularly true for breastfeeding mothers.1-4 Unfortunately, we also know that parents who try to avoid bed sharing with their infants are far more likely to feed their babies at night on chairs and couches in futile attempts to stay awake, which actually markedly increases their infants’ risk of suffocation.5 According to a 2010 study of nearly 5,000 US mothers, “in a possible attempt to avoid bed sharing, 55% of mothers feed their babies at night on chairs, recliners or sofas. Forty–four percent (25% of the sample) admit that they [are] falling asleep with their babies in these locations.”6 This is truly disturbing.
The advice to never sleep with your baby has backfired in the worst possible way. Rather than preventing deaths, this advice is probably even increasing deaths. In another study, parents of two SIDS infants who coslept on a sofa did so because they had been advised against bringing their infants into bed but had not realized the dangers of sleeping on a sofa.5 In fact, deaths from SIDS in parental beds has halved in the UK from 1984-2004, but there has been a rise of deaths from cosleeping on sofas.7 Read the rest of this entry »
I’m waiting for my flight home from the 1,000 Days U.S. Leadership Roundtable, a spectacular meeting that was held today at the Gates Foundation in Washington, DC. Stakeholders in nutrition and maternal-child health gathered to discuss how we can galvanize support for nutrition during the 1,000 days from conception to age 2. This is the time when our youngest citizens build their bodies and brains, laying the foundation for long-term health. Investing in optimal nutrition during these crucial days improves health and productivity across a lifetime.
For too many of our children, however, this foundation is fractured. Poverty, food insecurity, and commercial pressures prevent moms and babies from achieving their full potential. During the meeting, 1,000 Days executive director Lucy Sullivan shared daunting statistics about the challenges facing children in America. One in eight infants and toddlers in the US lives in deep poverty, defined as less than half the poverty line. Food insecurity affects 20% of families with children under 6. One in 20 children – 5% — experience very low food security, defined as multiple indications of disrupted eating patterns and reduced food intake. This food insecurity has lasting consequences, leading to chronic diseases, impaired school performance, and, paradoxically, increased risk of obesity.
Breastfeeding is one of the single best preventive health measures for mothers and children, Sullivan said, but families in poverty are less likely to initiate or sustain breastfeeding. The barrier is not lack of information – it is lack of support and policies that enable mothers to initiate and sustain breastfeeding, especially in areas with high rates of poverty and racial disparities.
How can this be, in one of the wealthiest nations in the world? As one roundtable participant noted, we don’t think of food insecurity as a problem in America, and certainly not as a threat to our nation’s future. Read the rest of this entry »
One afternoon in my lactation clinic, I saw two mothers who came to see me because they couldn’t make milk. One was pregnant with her second child, and the other was considering a third pregnancy. Each described how they had looked forward to breastfeeding, taken classes, put their babies skin-to-skin and birth, offered the breast on demand, and then waited, for days, and then weeks, for milk that never came in. As the second mother came to the end of her story, she said, “No one ever told me this could happen. Have you ever heard of a woman not being able to make milk?”
“Yes,” I said. “There’s one in the very next room.”
The dogma is that inability to breastfeed is rare – “like unicorns,” one blogger wrote – but I was seeing an awful lot of unicorns in my clinic. I couldn’t help but wonder – how often does breastfeeding come undone? Read the rest of this entry »
In the fallout from the breastfeeding sibling study, I’ve been struck by the intensity of conversations about shame and guilt. A colleague and friend posted on Facebook:
This study is for my patients who have taken every tea, herb and drug to raise their milk supply, and are afraid to be seen in public giving their babies formula. They shun the social support they need from other mothers because bottle feeding has become so stigmatized. I see such relief on their faces when I tell them that they are outstanding mothers raising healthy babies, and am glad to have some evidence behind that.
A father commented on the ABM Blog:
I sat in pre-natal class with my wife as a bunch of women were given the implicit message that they were not real women or good mothers if they did anything but breast feed. And a lot of these women; young women, bought into that message wholeheartedly. I was appalled.
Others attacked the paper — and the conversations around it — for sugar coating the truth for mothers who formula feed:
Breast is best no matter what, now I understand there are mothers who have tried and fail. For medical reasons or another.But the truth is there is not that many. A lot of mommies make the choice to do formula over breastfeeding. But why should the breastfeeding community sugar coat the truth to spare a formula feeding mothers feelings by not saying the whole truth breastmilk benefits and nutrients far out way formula hands down. Except it firmuka mommies and companies we need to support mothers who can’t keep doing it find other options like donor milk from a fellow friend or a breast sister to keep this poison out of our babies bellies. I mean do you see cigarette companies saying smoking doesn’t really kill it just makes you sick. No they have to say smoking is harmful and we as adults have to make an informed choice. Which is what the breastfeeding community wants women to do. Do not just give formula because you hear it is the same as breastmilk because it is not even on the same playing field. It us like comparing apples to oranges IMO.
The study in question doesn’t actually speak to any of these concerns— Bimla Schwarz and I have blogged about the limitations of the analysis and its implications. Yet these issues of shame, guilt, autonomy and informed consent are crucial to understand and address if we want to improve health and wellbeing for mothers and infants. There is tremendous anger and angst that poisons conversations about breastfeeding and prevents us from finding common ground. Read the rest of this entry »