Breastfeeding Medicine

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Archive for the ‘Protocols’ Category

ABM’s Model Maternity Policy Supportive of Breastfeeding: More than just a protocol revision

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The new ABM Clinical Protocol #7 could have just been the revision of an outdated protocol. That was my idea when I received Wendy Brodribb’s invitation to help update the 2011 Breastfeeding Hospital Policy protocol. Being the national coordinator of the Baby-Friendly Initiative in Spain, a member of the BFHI coordinator’s network, and a practicing pediatrician, I am fully aware of the importance of a breastfeeding supportive policy in hospitals, so I was passionate about being part of the update of this specific protocol. I knew the subject, it was just an update and it was also about teamwork with great colleagues: Melissa Bartick, Paula Schreck and Cadey Harrell and the supervision of the ABM protocol committee. Before me I saw an idyllic task that seemed simple and rewarding even for a non-native English speaker. Thus I gladly accepted the challenge and was grateful to be able to contribute to ABM’s mission.

Slide1However, I had not envisioned the ambitious team we had formed! Soon it was clear that my “simply reviewing and updating” plan was to become an absorbing, demanding, and exciting piece of work to produce a completely new and comprehensive protocol. The last two months trying to meet the deadline were exhausting but really exciting with transoceanic telephone conversations and chats, and continuous emails. Working on the same document while adjusting our different timelines in mid-August (we took turns to write fervently while the others were sleeping) was really fun!

The social inequalities and structural determinants that result in health injustice are the same that interfere with a happy breastfeeding experience. These interferences and the lack of adequate protection and support for breastfeeding unjustly burdens the health of women and infants (the most vulnerable part of society) at risk, especially if they belong to disadvantaged classes or countries with the least resources. Health professionals and health care facilities can be part of the problem, or they may become part of the solution. Read the rest of this entry »

Written by amalactancia

November 27, 2018 at 5:28 pm

I’m grateful for a community of physicians who care deeply about breastfeeding

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Last week, more than 400 health professionals gathered in San Francisco for the Academy of Breastfeeding Medicine’s 23rdInternational Conference. The conference drew participants from 25 counties and 41 US states, including 259 physicians from medical specialties ranging from neonatology to breast surgery.

drmilke

Members of Dr. Milk at ABM 2018

We kicked off with two pre-conference courses, “What every physician needs to know about breastfeeding (WEPNTK)” and “What every physician needs to know about breastfeeding II.” WEPNTK covers the anatomy and physiology of breastfeeding that many of us missed in medical school. WEPNTK II covered more advanced clinical issues, like maternal risk factors for low milk supply, management of tongue tie, therapeutic ultrasound for mastitis, and postpartum depression.

ABM is unlike any other medical conference that I attend because the audience spans multiple medical specialties and brings together clinicians from around the world. The conference committee faces the daunting task of selecting speakers that address the interests of both subspecialists and general practitioners across the translational continuum from basic science to public policy. And as an international conference, our speakers are selected to include perspectives on breastfeeding policy and public health from around the globe. Read the rest of this entry »

Written by astuebe

November 22, 2018 at 10:08 am

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

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

Of goldilocks and neonatal hypernatremia

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A heart-wrenching story has been circulating on social media about an exclusively breastfed baby who suffered brain damage after 4 days of ineffective feeding. The mother,  Dr. Christie del Castillo-Heygi, is a physician, and she shares how she was reassured that all mothers can make milk, and did not realize until she engaged a lactation consultant at 96 hours postpartum that her child was profoundly dehydrated.

It’s a tragic story. Dr. del Castillo-Heygi is petitioning public health leaders to warn all parents about the risk of irreversible brain damage with exclusive breastfeeding. That warning would directly challenge efforts across the US, and around the world, to emphasize the value of exclusive breastfeeding and the risks of unnecessary supplemental feeding. This push for exclusive breastfeeding is part of efforts to implement the Baby Friendly Hospital Initiative, a set of quality improvement efforts that increase the likelihood that women achieve their personal breastfeeding goals. For healthy infants, supplementation can interrupt the demand-drives-supply physiology of breastfeeding, reduce a mother’s milk supply, confuse baby’s latch, and expose the infant’s gut to allergens that may impact lifelong health.

So who’s right? Well, it’s complicated – and my sense is that this debate reflects the challenges of ensuring that families have the knowledge and support they need to initiate and sustain breastfeeding in the early weeks after birth.

We might start by acknowledging, once and for all, that not all mother-baby dyads are able to breastfeed exclusively. Reproductive physiology is not infallible. 10.9% of women have difficulty getting pregnant or carrying a baby to term. 15 to 20% of pregnancies end in miscarriage, 10% of infants are born preterm, and 1 in 100 infants are stillborn. Similarly, less than 100% of women can exclusively breastfeed. Read the rest of this entry »

Written by astuebe

January 31, 2016 at 10:00 am

ABM updates protocol on contraception and breastfeeding

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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.

Written by mayabunik

January 21, 2015 at 10:27 pm

Mastitis Protocol Updated

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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.

Written by kmarinellimd

July 3, 2014 at 1:14 pm