After announcing my resignation as chair of the Boone, Clinton and Montgomery County Breastfeeding Coalition and spreading the news, unanimously I've heard, "Not interested in taking over the position." The real tragedy is that I spent hours and hours establishing our coalition as a non-for-profit and gathering the appropriate resources to best offer lactation stations, pump rentals, support groups, and provider networking within our three counties. We have a savings account and this blog.
While I had no intentions of abandoning the coalition, I am not in a position to make the changes our counties so desperately need. Working outside the hospital infrastructure, I am limited in my influence.
My clientele base currently, is supported in their choice to breastfeed. The vast majority exclusively breastfeed through six months, and they are all offered provider support, a mother support group, and have available to them a good source of lactation supplies and tools as they might prove necessary. More importantly, my responsibilities with Believe Midwifery Services have escalated so that I can commit to little else.
Rather than kill the coalition entirely and have someone later have to recreate the wheel, I've decided to continue the coalition in blog. I'll maintain the non-for-profit status, the bank account, and will continue to be a resource, but primarily through writing and sharing my findings and thoughts here. The support group will continue, hosted by Believe Midwifery, and we'll continue to offer ourselves as a Hygeia retail center. January Gilley CLC is working towards her IBCLC and certainly has interest in offering a support group in Montgomery County. We can support her in those efforts, and as always, the Lactation Station will continue in Thorntown Turning Leaves Festivals. Beyond that festival however, I can not commit at this time.
Maybe another passionate breastfeeding advocate will surface within the community and be eager to continue the walk. Until then, I'll carry the torch.
Saturday, January 28, 2012
Wednesday, January 11, 2012
Resignation
I would like to announce my resignation, pending replacement, as chair of the Tri-County Breastfeeding Coalition. Please share the word among the community, so we can find an enthusiastic leader able to jump in and make great strides within our community for breastfeeding families. Further details will be shared at our upcoming meeting this Friday at 10am, with replacement to assume leadership in March.
Saturday, December 17, 2011
Reflux and Cow Milk Allergy: Is there a link?
Reflux seems to be the hot ticket diagnosis for newborns and many are prescribed pharmaceuticals to manage symptoms or are instructed to initiate a dairy elimination diet. GER, or gastroesophageal reflux, is present in virtually every infant however. It is a normal physiologic event. Respectfully, it can also be quite dangerous, even fatal, but discerning between a scenario that is truly pathological is important as interventions imposed on an otherwise normal physiologic process can undermine breastfeeding and lead to early weaning, imposing risks of its own.
Reflux is considered physiologic when the infant thrives well and experiences no complications. Regurgitation of at least one episode per day occurs in half of all newborns through three months of age infants, increasing to more than two-thirds of all infants by four months of age, finally decreasing to 5% of children between the ages of ten and twelve months. Symptoms can be normal through two years of age.
Pathologic GER is reflux associated with other manifestations, such as, failure to thrive or weight loss, feeding or sleeping problems, chronic respiratory disorders, esophagitis, hematemesis, stricture, sideropenic anemia, apnea, apparent life-threatening episodes or sudden infant death syndrome, and Sandifer's syndrome. Recurring respiratory symptoms is an atypical presentation without the regurgitation and vomiting, but reflux just the same.
Food allergy is actually a secondary GER, and is considered GERD or GER disease. This diagnosis is difficult to make. Infections, metabolic and neurologic disorders are also causes for secondary GER.
Cow milk intolerance defines any reproducible clinical adverse reaction to cow milk, and is suggested with increased total or specific blood immunoglobulin (Ig) E or positive skin-prick test, but no reliable routine test is available for definitive diagnosis. Cow milk allergy is reported in 0.3% to 7.5% of infants, most before the fourth month of life. In breastfed infants, allergy occurs in approximately 0.5% of babies.
Approximately 30% to 70% of infants with cow milk allergy manifest dermatological symptoms, and 20% to 30% manifest respiratory symptoms. Meaning, more than half with cow milk allergy demonstrate symptoms involving more than one major system. Clinical response to an elimination diet and a challenge is the diagnostic principle for food allergy. Diagnosis of specifically cow milk protein enteropathy ideally necessitates the proof of small bowel damage with patchy partial villous atropy and increased intraepithelial lymphocytes.
Natural tolerance in infants who are affected by cow's milk is frequently achieved within the first years of life. A quarter find remission by two years of age, half by three, and 78% by 6 years of age. GER and cow milk allergy are generally self-limiting symptoms, possibly interrelated, with only a small proportion of infants who will continue to have the disease-related symptoms after early infancy.
Soy-protein-based formula is NOT recommended in the initial treatment of cow milk allergy (CMA), although most infants with IgE-mediated CMA may do well on soy formula, particularly after the age of 6 months. Soy is not effective in preventing allergy and the atopic manifestations are comparable in the cow milk verses soy groups.
Breastfed infants have less and shorter reflux episodes three and four hours after feeding, which is believed to be contributed to more quiet sleep, improved clearance rate, and enhanced gastric emptying, and may be related to differences in macronutrient content such as lipids and other components such as growth factors. When a CMA-related GERD is suspected, a dietetic trial with complete avoidance of CMP (with calcium supplementation when required) in the maternal diet is suggested for 3 to 4 weeks. When helpful, CMP should be reintroduced in the maternal diet to prove any casual relationship.
However, prior to recommending an elimination diet in our practice, the Nurse Midwives investigate thoroughly the breastfeeding relationship for oversupply. This alone can cause colitis and is easily rectified. Probiotics are vital, as Lactobacillus is quite beneficial for atopic dermatitis and of course, gut health. Finally, although it is politically incorrect for a midwife to suggest ditching store bought milk for raw milk, I don't believe humans were created to drink orange juice without consuming the orange, nor do I believe we were created to consume cow's milk without all the components removed through pasteurization, or frankly with all the preservatives, antibiotics, fortifiers and hormones. Can we diagnosis a cow milk allergy if real cow milk isn't even being consumed?
Salvatore, S. & Vandenplas. Y. (2002). Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics, 110(5), 972-983.
Reflux is considered physiologic when the infant thrives well and experiences no complications. Regurgitation of at least one episode per day occurs in half of all newborns through three months of age infants, increasing to more than two-thirds of all infants by four months of age, finally decreasing to 5% of children between the ages of ten and twelve months. Symptoms can be normal through two years of age.
Pathologic GER is reflux associated with other manifestations, such as, failure to thrive or weight loss, feeding or sleeping problems, chronic respiratory disorders, esophagitis, hematemesis, stricture, sideropenic anemia, apnea, apparent life-threatening episodes or sudden infant death syndrome, and Sandifer's syndrome. Recurring respiratory symptoms is an atypical presentation without the regurgitation and vomiting, but reflux just the same.
Food allergy is actually a secondary GER, and is considered GERD or GER disease. This diagnosis is difficult to make. Infections, metabolic and neurologic disorders are also causes for secondary GER.
Cow milk intolerance defines any reproducible clinical adverse reaction to cow milk, and is suggested with increased total or specific blood immunoglobulin (Ig) E or positive skin-prick test, but no reliable routine test is available for definitive diagnosis. Cow milk allergy is reported in 0.3% to 7.5% of infants, most before the fourth month of life. In breastfed infants, allergy occurs in approximately 0.5% of babies.
Approximately 30% to 70% of infants with cow milk allergy manifest dermatological symptoms, and 20% to 30% manifest respiratory symptoms. Meaning, more than half with cow milk allergy demonstrate symptoms involving more than one major system. Clinical response to an elimination diet and a challenge is the diagnostic principle for food allergy. Diagnosis of specifically cow milk protein enteropathy ideally necessitates the proof of small bowel damage with patchy partial villous atropy and increased intraepithelial lymphocytes.
Natural tolerance in infants who are affected by cow's milk is frequently achieved within the first years of life. A quarter find remission by two years of age, half by three, and 78% by 6 years of age. GER and cow milk allergy are generally self-limiting symptoms, possibly interrelated, with only a small proportion of infants who will continue to have the disease-related symptoms after early infancy.
Soy-protein-based formula is NOT recommended in the initial treatment of cow milk allergy (CMA), although most infants with IgE-mediated CMA may do well on soy formula, particularly after the age of 6 months. Soy is not effective in preventing allergy and the atopic manifestations are comparable in the cow milk verses soy groups.
Breastfed infants have less and shorter reflux episodes three and four hours after feeding, which is believed to be contributed to more quiet sleep, improved clearance rate, and enhanced gastric emptying, and may be related to differences in macronutrient content such as lipids and other components such as growth factors. When a CMA-related GERD is suspected, a dietetic trial with complete avoidance of CMP (with calcium supplementation when required) in the maternal diet is suggested for 3 to 4 weeks. When helpful, CMP should be reintroduced in the maternal diet to prove any casual relationship.
However, prior to recommending an elimination diet in our practice, the Nurse Midwives investigate thoroughly the breastfeeding relationship for oversupply. This alone can cause colitis and is easily rectified. Probiotics are vital, as Lactobacillus is quite beneficial for atopic dermatitis and of course, gut health. Finally, although it is politically incorrect for a midwife to suggest ditching store bought milk for raw milk, I don't believe humans were created to drink orange juice without consuming the orange, nor do I believe we were created to consume cow's milk without all the components removed through pasteurization, or frankly with all the preservatives, antibiotics, fortifiers and hormones. Can we diagnosis a cow milk allergy if real cow milk isn't even being consumed?
Salvatore, S. & Vandenplas. Y. (2002). Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics, 110(5), 972-983.
Saturday, December 3, 2011
Lanolin verses Expressed Breastmilk on Painful and Damaged Nipples
I'll be honest, my first go-to is the hydrogel. This is an entirely anecdotal intervention however. We don't often have breastfeeding difficulties in our practice, and when we do it is often a baby that needs a chiropractor or has a tongue tie, which is immediately corrected by a little snip at the 48 hour home visit. More common nipple pain seems to be a phenomenon of hospital born babies, or rather a multitude of interventions. Every now and then however, a mom will present with what I uses to be oh so familiar... damaged nipples from a poor latch.
Evidence has been brief about how to best treat damaged nipples, outside of fixing the latch of course. A 2010 study by Abou-Dakn, Fluhr, Gensch & Wockel compared highly purified anhydrous (HPA) lanolin verses expressed breastmilk for the treatment of painful and damaged nipples associated with breastfeeding. Eighty-four mothers were included in the study and results were rated by a Nipple Trauma Score. Outcomes favored the HPA lanolin group, reaching statistical rates for healing rates, nipple trauma and nipple pain.
Now we need a study comparing the HPA lanolin and the hydrogel. Either way, I tell my nurses that if they give a client lanolin or a hydrogel, they also need a lactation consultant. Neither should be a matter of routine.
Evidence has been brief about how to best treat damaged nipples, outside of fixing the latch of course. A 2010 study by Abou-Dakn, Fluhr, Gensch & Wockel compared highly purified anhydrous (HPA) lanolin verses expressed breastmilk for the treatment of painful and damaged nipples associated with breastfeeding. Eighty-four mothers were included in the study and results were rated by a Nipple Trauma Score. Outcomes favored the HPA lanolin group, reaching statistical rates for healing rates, nipple trauma and nipple pain.
Now we need a study comparing the HPA lanolin and the hydrogel. Either way, I tell my nurses that if they give a client lanolin or a hydrogel, they also need a lactation consultant. Neither should be a matter of routine.
Colic Ease
Wish Garden was generous in donating Colic Ease for our review and it was a hit for the Andrews family.
"Yes, it has helped. We use it instead of the Gripe Water, and instead of the Gas Drops we were using. We also see our chiropractor once a month, and this past visit, her second cervical vertebrae and another down the middle of her spine were out. He said one of them control the enzyme release from the liver, and she was not breaking down the milk like she needed to. After the adjustment, she has been a completely different baby. We still use the Colic Ease at least once a day though, and she is doing great with it!"
Colic Ease Ingredients Include: Fennel seed, Catnip leaf, & Peppermint leaf extracted into approx. 60% vegetable glycerine, 30% Rocky Mountain spring water and 10% grain alcohol.
It is typically priced at $12.99 for a one ounce bottle, and can be found at Believe Midwifery Services.
"Yes, it has helped. We use it instead of the Gripe Water, and instead of the Gas Drops we were using. We also see our chiropractor once a month, and this past visit, her second cervical vertebrae and another down the middle of her spine were out. He said one of them control the enzyme release from the liver, and she was not breaking down the milk like she needed to. After the adjustment, she has been a completely different baby. We still use the Colic Ease at least once a day though, and she is doing great with it!"
Colic Ease Ingredients Include: Fennel seed, Catnip leaf, & Peppermint leaf extracted into approx. 60% vegetable glycerine, 30% Rocky Mountain spring water and 10% grain alcohol.
It is typically priced at $12.99 for a one ounce bottle, and can be found at Believe Midwifery Services.
Wednesday, November 30, 2011
Breastfeeding Trends by Ashley Kenyon RN
Ashley is the new chair of the Howard County Breastfeeding Coalition and a Registered Nurse and Practice Educator for Believe Midwifery Services. While researching breastfeeding trends to increase her own knowledge base, Ashley discovered the 1940s to have a great impact on declining breastfeeding rates. She thought our readers might enjoy her findings.
Widespread acceptance of oral contraceptives may have resulted in the decline of breastfeeding.
The belief that infants needed to be on a schedule and fed at certain times made the irregular feedings of breastfeeding seem unrealistic for busy mothers.
Pediatricians recommended formula in the 1940s, and mothers listened to them.
Sexualization of the breast may have caused may to feel uncomfortable with breastfeeding.
Separation of mother and infant during the day and night is seen as independence and is often sought after. This separation however, can make night nursing difficult for some mother infant pairs to start breastfeeding off on the right foot.
Little support was offered to mothers in the postpartum period and they began to believe formula feeding would be easier.
Formula became easily available and marketed as an acceptable substitute.
The use of anesthesia during labor and birth made breastfeeding difficult at first and with no support women may give up during this early period.
Formula is often given when the infant is in the hospital nursery.
Physicians often recommend formula when infants have various problems.
Formula companies began finding new ways to improve formula and make it closer to breastmilk.
Many times physicians do not discuss or encourage breastfeeding.
Because formula was available for a cost many wealthy woman felt they were purchasing the best for their babies.
Medical community began encouraging early weaning.
Nurses and doctors were not properly trained to help mothers and babies successful breastfeed.
Widespread acceptance of oral contraceptives may have resulted in the decline of breastfeeding.
The belief that infants needed to be on a schedule and fed at certain times made the irregular feedings of breastfeeding seem unrealistic for busy mothers.
Pediatricians recommended formula in the 1940s, and mothers listened to them.
Sexualization of the breast may have caused may to feel uncomfortable with breastfeeding.
Separation of mother and infant during the day and night is seen as independence and is often sought after. This separation however, can make night nursing difficult for some mother infant pairs to start breastfeeding off on the right foot.
Little support was offered to mothers in the postpartum period and they began to believe formula feeding would be easier.
Formula became easily available and marketed as an acceptable substitute.
The use of anesthesia during labor and birth made breastfeeding difficult at first and with no support women may give up during this early period.
Formula is often given when the infant is in the hospital nursery.
Physicians often recommend formula when infants have various problems.
Formula companies began finding new ways to improve formula and make it closer to breastmilk.
Many times physicians do not discuss or encourage breastfeeding.
Because formula was available for a cost many wealthy woman felt they were purchasing the best for their babies.
Medical community began encouraging early weaning.
Nurses and doctors were not properly trained to help mothers and babies successful breastfeed.
Sunday, November 13, 2011
IBLCE Disciplinary Procedures
On October 31st, 2011, IBLCE announced the immediate release of their new IBLCE Code of Professional Conduct, which replace the former Code of Ethics. This professional group has had more controversy surrounding its professional code than any other group I have been a member. At one point, the code stated that lactation consultants were not to contradict the client's medical provider. In a field whose evidence largely opposes the standard of care and with its experts passionate about changing the tides, this particular rule created concern enough for several to turn their back on their once respected organization. Again, our leaders are being questioned.
IBLCE offered two weeks within which stakeholders and the public at large were solicited to comment on the draft, many of which were, in fact, incorporated in the final Code of Professional Conduct. The final version can be found here. The surprise is, IBLCE also crafted a new Ethics and Discipline process that was not discussed with its members at large prior to release. Big changes include:
The current E&D procedures now applies only to those holding the IBCLC credential, as opposed to the previous Code of Ethics applying to "any and all applicants for any IBLCE examination," causing students and aspiring lactation consultants to pay attention to professional ethics expected of them if they hoped to sit the exam. This change also means that those seeking professional liability insurance as a student may find great difficulty, as removal of these sensible standards leaves insurance companies without confidence that students are also under similar expectations as their mentors.
Another important change is in the detailed process of how a case would proceed against an IBCLC for whom a complaint was filed, and found initially to have merit. The OLD Discipline Procedures set out a formal administrative hearing, including the accused's right to counsel, and an opportunity to hear and cross-examine witnesses, even though the formalities of trial evidence were not required. A record was to be kept (presumably in case of an appeal). All procedures were done under oath and although lengthy, it was a "rather lovely description of a hearing designed to protect the rights of the accused while permitting examination of allegations of misconduct," states Elizabeth Rooks JD, IBCLC.
The NEW E&D Procedures have retreated from this process, significantly. Currently, the committee chair has "sole discretion" to determine if a compliant that comes into the IBLCE is frivolous or invalid. One person is now the gatekeeper for all procedures that are to follow. No justification. No accountability. Ultimate power. If such complaint is deemed to have merit, the accused will be mailed a copy of such procedures, a summary of the compliant, and a list of the E&D Committee members. The accused is not allowed to see the original complaint, rather a summary. It is unclear if the accused is even made aware of who filed the compliant. The accused has 30 days to respond.
A three-member review subcommittee is then appointed to "clarify, expand or corroborate the information provided by the submitter." The review committee can contact the complainant, or the accused, for additional information and may, at their discretion, contact any other individual who may have knowledge of the facts. This here, is the great concern. Elizabeth Rooks JD, IBCLC states, "It is unheard of, at least in USA judicial proceedings, for judges and their courthouse clerical staff to go out in search of evidence. Rather, they ask the parties and their lawyers to proffer evidence, under oath and rules of evidence designed to promote the veracity of the facts."
The Review Subcomittee would them make a finding, and recommendation of sanction, which it presents to the full E&D Committee. There is no formal hearing or trial-type proceedings, no hearing of witnesses, and the rules of evidence are not applicable. Legal counsel is not expected to participate in the process, unless requested by the accused and approved by the E&D Panel. Although, the IBLCE may consult IBLCE legal counsel. Nothing under oath. No right to face the accuser. No right to see the original compliant. All investigatory proceedings conducted in private, and in confidence, without the accused there. Investigations may be conducted sui generis by those serving in an adjudicatory capacity. Accused must seek and be granted permission to use a lawyer, but IBCLE has legal counsel assured all along the way. Appeal on grounds of material errors of fact only, yet the record containing the facts alleged and investigated is under seal.
Not sure our quest to gain credibility as a genuine, independent yet interdependent profession within the infrastructure of maternal and child healthcare will be respected with a professional group demonstrating utterly lay disciplinary actions. Lactation consultants are questioning the background of the IBLCE board members, and more specifically the IBLCE's legal counsel. Once again, I am grateful my job doesn't depend solely on my lactation credentials.
IBLCE offered two weeks within which stakeholders and the public at large were solicited to comment on the draft, many of which were, in fact, incorporated in the final Code of Professional Conduct. The final version can be found here. The surprise is, IBLCE also crafted a new Ethics and Discipline process that was not discussed with its members at large prior to release. Big changes include:
The current E&D procedures now applies only to those holding the IBCLC credential, as opposed to the previous Code of Ethics applying to "any and all applicants for any IBLCE examination," causing students and aspiring lactation consultants to pay attention to professional ethics expected of them if they hoped to sit the exam. This change also means that those seeking professional liability insurance as a student may find great difficulty, as removal of these sensible standards leaves insurance companies without confidence that students are also under similar expectations as their mentors.
Another important change is in the detailed process of how a case would proceed against an IBCLC for whom a complaint was filed, and found initially to have merit. The OLD Discipline Procedures set out a formal administrative hearing, including the accused's right to counsel, and an opportunity to hear and cross-examine witnesses, even though the formalities of trial evidence were not required. A record was to be kept (presumably in case of an appeal). All procedures were done under oath and although lengthy, it was a "rather lovely description of a hearing designed to protect the rights of the accused while permitting examination of allegations of misconduct," states Elizabeth Rooks JD, IBCLC.
The NEW E&D Procedures have retreated from this process, significantly. Currently, the committee chair has "sole discretion" to determine if a compliant that comes into the IBLCE is frivolous or invalid. One person is now the gatekeeper for all procedures that are to follow. No justification. No accountability. Ultimate power. If such complaint is deemed to have merit, the accused will be mailed a copy of such procedures, a summary of the compliant, and a list of the E&D Committee members. The accused is not allowed to see the original complaint, rather a summary. It is unclear if the accused is even made aware of who filed the compliant. The accused has 30 days to respond.
A three-member review subcommittee is then appointed to "clarify, expand or corroborate the information provided by the submitter." The review committee can contact the complainant, or the accused, for additional information and may, at their discretion, contact any other individual who may have knowledge of the facts. This here, is the great concern. Elizabeth Rooks JD, IBCLC states, "It is unheard of, at least in USA judicial proceedings, for judges and their courthouse clerical staff to go out in search of evidence. Rather, they ask the parties and their lawyers to proffer evidence, under oath and rules of evidence designed to promote the veracity of the facts."
The Review Subcomittee would them make a finding, and recommendation of sanction, which it presents to the full E&D Committee. There is no formal hearing or trial-type proceedings, no hearing of witnesses, and the rules of evidence are not applicable. Legal counsel is not expected to participate in the process, unless requested by the accused and approved by the E&D Panel. Although, the IBLCE may consult IBLCE legal counsel. Nothing under oath. No right to face the accuser. No right to see the original compliant. All investigatory proceedings conducted in private, and in confidence, without the accused there. Investigations may be conducted sui generis by those serving in an adjudicatory capacity. Accused must seek and be granted permission to use a lawyer, but IBCLE has legal counsel assured all along the way. Appeal on grounds of material errors of fact only, yet the record containing the facts alleged and investigated is under seal.
Not sure our quest to gain credibility as a genuine, independent yet interdependent profession within the infrastructure of maternal and child healthcare will be respected with a professional group demonstrating utterly lay disciplinary actions. Lactation consultants are questioning the background of the IBLCE board members, and more specifically the IBLCE's legal counsel. Once again, I am grateful my job doesn't depend solely on my lactation credentials.
Thursday, November 10, 2011
From Tina Cardarelli IBCLC - Indiana State Breastfeeding Coordinator:
On paper we wanted to improve our ranking on the CDC Breastfeeding Report Card for “number of IBCLC’s per 1,000 births” which is a great marker for access to care. Since 2009 when we began this program, we had 2.67 IBCLC per 1,000 births and in 2011 we rose to 3.33 per 1,000 births. Access to specialized breastfeeding care in Indiana now surpasses any of our neighboring Midwestern states but remains well below higher performing states. The full impact of these programs will not be felt until the 2012 Report Card when I expect a huge increase. In addition to the test scholarships, we offered free study guide textbooks and free and low cost 45 hour LCERP study courses with Linda Smith. We are proud to have played a role in improving access and bringing new talent into the field with a focus on populations, hospital, communities and agencies that did not previously have an IBCLC.
On paper we wanted to improve our ranking on the CDC Breastfeeding Report Card for “number of IBCLC’s per 1,000 births” which is a great marker for access to care. Since 2009 when we began this program, we had 2.67 IBCLC per 1,000 births and in 2011 we rose to 3.33 per 1,000 births. Access to specialized breastfeeding care in Indiana now surpasses any of our neighboring Midwestern states but remains well below higher performing states. The full impact of these programs will not be felt until the 2012 Report Card when I expect a huge increase. In addition to the test scholarships, we offered free study guide textbooks and free and low cost 45 hour LCERP study courses with Linda Smith. We are proud to have played a role in improving access and bringing new talent into the field with a focus on populations, hospital, communities and agencies that did not previously have an IBCLC.
Thank-you Tina Cardarelli!! Our Coalition Appreciates You!!
Thursday, November 3, 2011
Lactation Degree
Several years ago, I was one of the first graduates in the country with a degree in lactation. At the time there were two universities offering such degrees and the vast majority of our profession were utterly unaware of the availability of an academic preparation for our field. In fact, my nursing associates poked fun - "Well, if you can get a degree in lactation, then you can officially get a degree in anything!"
Today I learned that both Ivy Tech State College and the University of Indianapolis are exploring the potential to offer an associates degree in lactation. Fantabulous! I look forward to hearing future up-dates.
Today I learned that both Ivy Tech State College and the University of Indianapolis are exploring the potential to offer an associates degree in lactation. Fantabulous! I look forward to hearing future up-dates.
Wednesday, November 2, 2011
Should Neonates Sleep Alone?
Morgan, Horn & the popular Nils J Bergman (2011) published the article, "Should Neonates Sleep Alone," in the journal of Biological Psychiatry. Their conclusion is that separation of the newborn from its mother has a profoundly negative impact on the quiet sleep duration and is a stressor for the human neonate, as they are ill equipped to cope with such separation. The impact is far from benign.
Code of Ethics for IBCLCs
Received an e-mail from IBLCE this week...
"After a process of detailed review and thoughtful revisions based on stakeholder feedback, the International Board of Lactation Consultant Examiners® (IBLCE®) announces a new Code of Professional Conduct (CPC) which replaces the IBLCE Code of Ethics.
New Disciplinary Procedures and a Complaint Form accompany the new Code of Professional Conduct."
An active discussion on Lactnet is focusing on the soft stance of the board regarding the International Code of Marketing. Should an IBCLC who works for a formula manufacture have her certificate removed? The board says not.
Go-Lacta
A client of mine recently asked my opinion on Go-Lacta. I honestly had never heard of it, so did a little reading.
Go-Lacta is a galactagogue, which are special foods, drinks or herbs which people believe can increase a mother's milk supply. You might be familiar with Fenugreek or Blessed Thistle. Go-Lacta is the Asian counterpart, obtained from the leaves of the Malunggay tree (YouTube video here). In most parts of the Philippines, women take malunggay leaves mixed in chicken or shellfish soups to enhance breast milk production. The mechanism of action has not been explained but it was effective as a galactogogue and has been used by generations of nursing mothers.
One double-blind, randomized controlled study by Estrella et al (2000) demonstrated a 51-58% increase in milk supply in preterm mothers exclusively pumping on day four, and even greater on day five, at 152-176%. No reported adverse effects were seen in either group.
An earlier study in 1996 was conducted by Almirante and Lim, which demonstrated the lactating-enhancing effect of malunggay leaves as evidenced by a greater increase in maternal serum prolactin levels and percentages of gains in the infant's weights among the lactating mothers who took the malunggay leaves. The same authors repeated the study in hypertensive mothers and had similar outcomes.
100% vegan 100% plant-based 100% natural
A bottle of 60 capsules costs $19.95.
Go-Lacta is a galactagogue, which are special foods, drinks or herbs which people believe can increase a mother's milk supply. You might be familiar with Fenugreek or Blessed Thistle. Go-Lacta is the Asian counterpart, obtained from the leaves of the Malunggay tree (YouTube video here). In most parts of the Philippines, women take malunggay leaves mixed in chicken or shellfish soups to enhance breast milk production. The mechanism of action has not been explained but it was effective as a galactogogue and has been used by generations of nursing mothers.
One double-blind, randomized controlled study by Estrella et al (2000) demonstrated a 51-58% increase in milk supply in preterm mothers exclusively pumping on day four, and even greater on day five, at 152-176%. No reported adverse effects were seen in either group.
An earlier study in 1996 was conducted by Almirante and Lim, which demonstrated the lactating-enhancing effect of malunggay leaves as evidenced by a greater increase in maternal serum prolactin levels and percentages of gains in the infant's weights among the lactating mothers who took the malunggay leaves. The same authors repeated the study in hypertensive mothers and had similar outcomes.
100% vegan 100% plant-based 100% natural
A bottle of 60 capsules costs $19.95.
Thursday, October 27, 2011
Breastfeeding Promotion Act. The Breastfeeding Promotion Act of 2011 (H.R. 2758, S. 1463) amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace. It also ensures that executive, administrative, and professional employees, including elementary and secondary school teachers (in addition to non-exempt employees covered by the previous amendment), have break time and a private place to pump in the workplace. Click here for more information.
Stolen from Tina Cardarelli's Breastfeeding News
Stolen from Tina Cardarelli's Breastfeeding News
Friday, October 21, 2011
Long-Chain Polyunsaturated Fat
Through my career, the focus on long-chain fatty acids has changed significantly. It seemed to gain the greatest attention when added to infant formula and advertisements claimed infants who consumed such milk would have increased IQ.
Certainly in our midwifery practice, the Nurse Midwives encourage supplementation of long-chain fatty acids during the antenatal period, particularly second trimester, because pregnant women are nearly incapable of consuming enough in their diet due to current levels of mercury contamination.
In the first year of life the brain increases rapidly in weight from 350g to about 1000g. It then represents 10% of total body weight and, as the brain has a relatively low (65%) water content it accounts for 10-15% of the dry weight at this time. The solids of the brain are composed mainly of lipid (60%), subdivided into phospholipids, sphingolipds, gangliosides and cholesterol, with the phospholipids (65%) predominating in the cerebral cortex.
Formula manufactures recognized the deficiency of long-chain polyunsaturated (LCPs) fats in artificial breastmilk compared to human milk. The cerebral cortex requires significant amounts of these LCPs, especially arachidonic docosatetraenoic, docosapentaenoic acid of the n-6 series and docosahexaenoic of the n-c series, especially in the first year of life. Remember its controversial entry into the market during the turn of the century?
DHA and AA was added to infant formula, sourced from fish eyeballs or grown on fungus, and done so without prior testing or FDA approval. Those persuaded to pay high dollar for the new and improved formula were in fact, the population researchers would study to determine safety. Ethical? No. Legal? Yes. The FDA does not monitor nutritional supplements.
There is no doubt that brain function in breastfed babies and those who are supplemented with artificial human milk are different. In fact, evidence demonstrates that those who do not receive human milk are not as intelligent as those who are - or rather, they don't reach their own potential. It seems the first four months, with regards to long-chain fatty acids, is the critical period. Artificially fed babies clearly needed the addition of DHA and AA to the basic formula of artificial breastmilk. The methods in which this was introduced however, is what seems to have shocked the lactation community.
Women were persuaded that this new formula was either the key to a smart child, or that their milk was somehow now insufficient. Lactation consultants worked to dispel the misconceptions and earnestly resisted maternal or neonate supplementation of any kind (iron, vitamin D, essential fatty acids, flouride, etc.) in fear this would encourage the belief that breastmilk was inferior.
Now a decade and a half into my career, and in a position that allows me to drop my defenses, I am interested in ways a mother can supplement her diet to improve her health and that of her newborn. It is a basic principle that breastmilk is better. There is no argument and my clients appreciate that fact without my having to persuade them. Our clients also recognize that we live in a contaminated world and a convenience-based society with an overwhelming dependence on convenience foods, so while pregnant and breastfeeding, renewed energies for improving their health surfaces.
Evidence does show that while breastmilk is overwhelmingly stable, maternal supplementation of DHA does in fact increase both maternal plasma phospholipids and milk lipids. Consumption of two high-DHA eggs a week does not appear to have negative effect on total-serum-cholesterol, but can elevate DHA concentrations. Low-EPA, high-DHA fish oil is also effective maternal supplements for increasing breastmilk DHA.
One study (Helland, Smith, Saarem, Saugstad & Drevon, 2003) demonstrated that maternal supplementation of very-long-chain n-3 PUFAs during pregnancy and lactation (from cod fish oil), as compared to long-chain n-6 PUFAs (from corn oil), increases mental processing scores of children at the age of four. Higher maternal intake of DHA resulted in higher maternal plasma levels and thereby increased transfer of DHA to the fetus. IQ points were increased by 4 points among school children (cod fish oil verses corn oil), with no harmful side effects. Head circumference and mental processing skills were also significantly different between the two groups.
It is important to note, that simply because breastmilk offers minimal amounts of DHA, does not mean it is not sufficient for optimal growth and development. Supplementation should not be recommended across the board, but diet should be evaluated and supplementation introduced as appropriate
(Jensen, Maude, Anderson, & Heird, 2000).
Certainly in our midwifery practice, the Nurse Midwives encourage supplementation of long-chain fatty acids during the antenatal period, particularly second trimester, because pregnant women are nearly incapable of consuming enough in their diet due to current levels of mercury contamination.
In the first year of life the brain increases rapidly in weight from 350g to about 1000g. It then represents 10% of total body weight and, as the brain has a relatively low (65%) water content it accounts for 10-15% of the dry weight at this time. The solids of the brain are composed mainly of lipid (60%), subdivided into phospholipids, sphingolipds, gangliosides and cholesterol, with the phospholipids (65%) predominating in the cerebral cortex.
Formula manufactures recognized the deficiency of long-chain polyunsaturated (LCPs) fats in artificial breastmilk compared to human milk. The cerebral cortex requires significant amounts of these LCPs, especially arachidonic docosatetraenoic, docosapentaenoic acid of the n-6 series and docosahexaenoic of the n-c series, especially in the first year of life. Remember its controversial entry into the market during the turn of the century?
DHA and AA was added to infant formula, sourced from fish eyeballs or grown on fungus, and done so without prior testing or FDA approval. Those persuaded to pay high dollar for the new and improved formula were in fact, the population researchers would study to determine safety. Ethical? No. Legal? Yes. The FDA does not monitor nutritional supplements.
There is no doubt that brain function in breastfed babies and those who are supplemented with artificial human milk are different. In fact, evidence demonstrates that those who do not receive human milk are not as intelligent as those who are - or rather, they don't reach their own potential. It seems the first four months, with regards to long-chain fatty acids, is the critical period. Artificially fed babies clearly needed the addition of DHA and AA to the basic formula of artificial breastmilk. The methods in which this was introduced however, is what seems to have shocked the lactation community.
Women were persuaded that this new formula was either the key to a smart child, or that their milk was somehow now insufficient. Lactation consultants worked to dispel the misconceptions and earnestly resisted maternal or neonate supplementation of any kind (iron, vitamin D, essential fatty acids, flouride, etc.) in fear this would encourage the belief that breastmilk was inferior.
Now a decade and a half into my career, and in a position that allows me to drop my defenses, I am interested in ways a mother can supplement her diet to improve her health and that of her newborn. It is a basic principle that breastmilk is better. There is no argument and my clients appreciate that fact without my having to persuade them. Our clients also recognize that we live in a contaminated world and a convenience-based society with an overwhelming dependence on convenience foods, so while pregnant and breastfeeding, renewed energies for improving their health surfaces.
Evidence does show that while breastmilk is overwhelmingly stable, maternal supplementation of DHA does in fact increase both maternal plasma phospholipids and milk lipids. Consumption of two high-DHA eggs a week does not appear to have negative effect on total-serum-cholesterol, but can elevate DHA concentrations. Low-EPA, high-DHA fish oil is also effective maternal supplements for increasing breastmilk DHA.
One study (Helland, Smith, Saarem, Saugstad & Drevon, 2003) demonstrated that maternal supplementation of very-long-chain n-3 PUFAs during pregnancy and lactation (from cod fish oil), as compared to long-chain n-6 PUFAs (from corn oil), increases mental processing scores of children at the age of four. Higher maternal intake of DHA resulted in higher maternal plasma levels and thereby increased transfer of DHA to the fetus. IQ points were increased by 4 points among school children (cod fish oil verses corn oil), with no harmful side effects. Head circumference and mental processing skills were also significantly different between the two groups.
It is important to note, that simply because breastmilk offers minimal amounts of DHA, does not mean it is not sufficient for optimal growth and development. Supplementation should not be recommended across the board, but diet should be evaluated and supplementation introduced as appropriate
(Jensen, Maude, Anderson, & Heird, 2000).
Tuesday, October 18, 2011
Domperidone
Lactnet has been buzzing about the controversial pharmaceutical, Domperidone. It is a wonder drug in our profession, but one the Food and Drug Administration (FDA) argues is dangerous.
Over the last few months, USLCA has been working in conjunction with Dr. Thomas Hale from the Infant Risk Center at Texas Tech University towards obtaining approval from the FDA for the use of Domperidone for breastfeeding mothers experiencing with an insufficient milk supply. Domperidone was once the gold standard for those select mothers suffering with insufficient milk supply, but for the past few years, practitioners have been unable to (or only with great difficulty) offer this option.
Dr. Hale and the USLCA have worked with the FDA to obtain Orphan Drug Designation for Domperidone, defined as those intended for the safe and effective treatment, diagnosis, or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S. Safety and efficacy must still be established through adequate and well controlled studies, bu the orphan qualifies for grants to conduct such studies. Once the required studies are conducted, they are submitted to the FDA for marketing approval. USLCA and Dr Hale are currently apply for grants with the hope of eventually obtaining marketing approval for Domperidone. Mothers throughout the country, owe Dr. Hale a standing ovation for his efforts and successes.
US Lactation Consultant Association September eNews
Over the last few months, USLCA has been working in conjunction with Dr. Thomas Hale from the Infant Risk Center at Texas Tech University towards obtaining approval from the FDA for the use of Domperidone for breastfeeding mothers experiencing with an insufficient milk supply. Domperidone was once the gold standard for those select mothers suffering with insufficient milk supply, but for the past few years, practitioners have been unable to (or only with great difficulty) offer this option.
Dr. Hale and the USLCA have worked with the FDA to obtain Orphan Drug Designation for Domperidone, defined as those intended for the safe and effective treatment, diagnosis, or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S. Safety and efficacy must still be established through adequate and well controlled studies, bu the orphan qualifies for grants to conduct such studies. Once the required studies are conducted, they are submitted to the FDA for marketing approval. USLCA and Dr Hale are currently apply for grants with the hope of eventually obtaining marketing approval for Domperidone. Mothers throughout the country, owe Dr. Hale a standing ovation for his efforts and successes.
US Lactation Consultant Association September eNews
Saturday, October 1, 2011
CLC course in INDIANAPOLIS
Healthy Children's Center for Breastfeeding is holding a Certified Lactation Counselor (CLC) Course in Indianapolis from February 27 – March 2 2012!!
“The Center for Breastfeeding's Certified Lactation Counselor training program is a forty hour course designed to provide a solid, up-to-date, research based body of information regarding lactation as well the art of counseling. This course is offered at a variety of locations throughout the United States and around the world, training over 1,500 participants annually. Learners are engaged in over forty hours of didactic and experiential activities during this five-day course. On the final day, an examination is offered by the Academy of Lactation Policy and Practice (ALPP). The exam consists multiple choice questions (some of which refer to photographs). A certificate, and the designation Certified Lactation Counselor (CLC), is awarded by the Academy of Lactation Policy and Practice to all learners who pass all of the competencies and who agree to comply with the Scope of Practice and the Code of Ethics. Participation in the exam is not required of learners. However, it is only after successful completion of the course and examination that the Lactation Counselor Certificate is conferred. Participants of the course receive continuing education credits regardless of the outcome of the examination. The certificate expires after three years, and may be renewed by submission of a minimum of 18 hours of continuing education.”
“The Center for Breastfeeding's Certified Lactation Counselor training program is a forty hour course designed to provide a solid, up-to-date, research based body of information regarding lactation as well the art of counseling. This course is offered at a variety of locations throughout the United States and around the world, training over 1,500 participants annually. Learners are engaged in over forty hours of didactic and experiential activities during this five-day course. On the final day, an examination is offered by the Academy of Lactation Policy and Practice (ALPP). The exam consists multiple choice questions (some of which refer to photographs). A certificate, and the designation Certified Lactation Counselor (CLC), is awarded by the Academy of Lactation Policy and Practice to all learners who pass all of the competencies and who agree to comply with the Scope of Practice and the Code of Ethics. Participation in the exam is not required of learners. However, it is only after successful completion of the course and examination that the Lactation Counselor Certificate is conferred. Participants of the course receive continuing education credits regardless of the outcome of the examination. The certificate expires after three years, and may be renewed by submission of a minimum of 18 hours of continuing education.”
Wednesday, September 28, 2011
Influence of Heat Treatments on Milk Components
When I first started donating milk, I had many human milk advocates question why others would risk obtaining milk directly from the donor, as opposed to a human milk bank where donors are screened and milk is pasteurized. I attempted to rationalize that while I appreciate the benefits of screening and pasteurization, there certainly are benefits of human milk lost during the pasteurization process that many recipients desire.
As more evidence presents regarding HIV and breastfeeding, particularly flash boiling human milk of those with HIV prior to feeding the child, interest regarding the influence of heat treatments on the milk components grows.
Linda Smith (2006) has compiled some data for us:
Cellular components of human milk is destroyed at 62.5 degrees Celsius for thirty minutes. They are completely destroyed via freezing.
Lipids are stable through boiling, but increased breakdown occurs into that of fatty acids after freezing and thawing.
Minerals are stable through pasteurization and freezing.
Two-thirds of Lactoferrin is lost after thirty minutes of posteurization at 62.5 degrees.
Secretory IgA is stable at 56 degrees of pasteurization for thirty minutes, but destroyed with boiling.
Lysozymes are stable when pasteurized at 62.5 degrees Celsius for thirty minutes, but mostly destroyed after 15 to 30 minutes of boiling.
Other immunoglobulins are stable when pasteurized at 56 degrees Celsius for thirty minutes.
Bifidus factor and Gangliosides are stable through boiling.
As more evidence presents regarding HIV and breastfeeding, particularly flash boiling human milk of those with HIV prior to feeding the child, interest regarding the influence of heat treatments on the milk components grows.
Linda Smith (2006) has compiled some data for us:
Cellular components of human milk is destroyed at 62.5 degrees Celsius for thirty minutes. They are completely destroyed via freezing.
Lipids are stable through boiling, but increased breakdown occurs into that of fatty acids after freezing and thawing.
Minerals are stable through pasteurization and freezing.
Two-thirds of Lactoferrin is lost after thirty minutes of posteurization at 62.5 degrees.
Secretory IgA is stable at 56 degrees of pasteurization for thirty minutes, but destroyed with boiling.
Lysozymes are stable when pasteurized at 62.5 degrees Celsius for thirty minutes, but mostly destroyed after 15 to 30 minutes of boiling.
Other immunoglobulins are stable when pasteurized at 56 degrees Celsius for thirty minutes.
Bifidus factor and Gangliosides are stable through boiling.
Mother's Diet & Milk Composition
I am frequently asked about how mom's diet might affect her milk composition. I don't mean specifically which foods should a breastfeeding mother avoid. The answer to that question is none (unless a known allergy has been identified), but more specifically, how can human milk be altered by maternal diet?
This question first interested me many years ago when it was suggested that a diabetic mother not breastfed because the glucose in her milk may negatively impact baby, if it were to become too high or too low. However, a little research demonstrated that in fact, glucose is quite stable in human milk and most certainly, breastfeeding provides a plethora of benefits to both the diabetic mother and her child.
Later in my career, I wondered if a failure to thrive baby might be benefited by maternal supplementation of essential fatty acids. I learned that this component is somewhat vulnerable to manipulation in the maternal diet; therefore, the recommendation has some merit. At the same time, I learned that babies whose mother have had gastric by-pass surgery can suffer consequences if she is not sufficiently obtaining necessary vitamins and minerals.
While human milk is quite stable, in spite of mother, there is some room for caution and certainly some room for manipulation. Currently, I am attempting to manipulate human milk in my practice by supplementing mothers with Vitamin D, rather than routinely supplementing babies.
Here are a few facts for your pocket brain (Linda Smith, 2006):
Milk Component
Total Milk Volume = Not affected by mother's diet, except possibly in maternal starvation conditions
Carbohydrates = Not affected by maternal diet
Proteins = Not affected by maternal diet
Lipids = Fatty acid profile can be affected, although total fats are unaffected
Cellular Components = Not affected
Immune Factors = Not affected
Fat-soluble vitamins = Slight variance related to fat levels in milk
Water-soluble vitamins = ARE affected by maternal diet
Minerals = Macronutrient elements, iron, chromium, and cobalt are NOT affected, yet there is possible affect to human milk with iodine, fluoride, zinc, manganese, selenium, and lead
This question first interested me many years ago when it was suggested that a diabetic mother not breastfed because the glucose in her milk may negatively impact baby, if it were to become too high or too low. However, a little research demonstrated that in fact, glucose is quite stable in human milk and most certainly, breastfeeding provides a plethora of benefits to both the diabetic mother and her child.
Later in my career, I wondered if a failure to thrive baby might be benefited by maternal supplementation of essential fatty acids. I learned that this component is somewhat vulnerable to manipulation in the maternal diet; therefore, the recommendation has some merit. At the same time, I learned that babies whose mother have had gastric by-pass surgery can suffer consequences if she is not sufficiently obtaining necessary vitamins and minerals.
While human milk is quite stable, in spite of mother, there is some room for caution and certainly some room for manipulation. Currently, I am attempting to manipulate human milk in my practice by supplementing mothers with Vitamin D, rather than routinely supplementing babies.
Here are a few facts for your pocket brain (Linda Smith, 2006):
Milk Component
Total Milk Volume = Not affected by mother's diet, except possibly in maternal starvation conditions
Carbohydrates = Not affected by maternal diet
Proteins = Not affected by maternal diet
Lipids = Fatty acid profile can be affected, although total fats are unaffected
Cellular Components = Not affected
Immune Factors = Not affected
Fat-soluble vitamins = Slight variance related to fat levels in milk
Water-soluble vitamins = ARE affected by maternal diet
Minerals = Macronutrient elements, iron, chromium, and cobalt are NOT affected, yet there is possible affect to human milk with iodine, fluoride, zinc, manganese, selenium, and lead
Soy Formula
Compiled from Health Education Associates and other references:
Soy formula has the highest incidence of wheezing, rhinitis and otitis. Chandra 1989
Soy is at least as allergenic as cow's milk. Eastham, Kjellman, Mendoza, Arment, Chandra, Gruskay, Ellis
Adverse reactions follow within three weeks. Fomon, Powell, Ingkaran, Haffejee, Iacono, Redel
Soy is associated with poorer response to vaccinations. Zoppi, Businco, Hahn-Zoric
Soy fed infants have higher rates of illness. Zoppi, Businco, Lonnerdal
Soy formulas have zinc deficiency and low selenium concentrations. Lonnerdal, Smith, Fitzherbert
Soy formulas have high levels of manganese. Lonnerdal, Smith
Soy formulas have high levels of aluminum. Freundlich, Hawkins, Greer
Soy formulas are associated with increase risk of autoimmune thyroid disease. Fort et al.
Soy formulas are associated with increased risk of diabetes. Fort, AAP 1994
Soy formulas may have long-term effects on cholesterol metabolism. Mott, Kallio, Cruz
Soy has plant steroids (phytoestrogens) that may effect human babies. Lonnerdal, Whitten, Landau, Cruz, Irvine, Clarkson, Sheehan
Soy formula has no lactose, which may affect brain development.
Soy formula has the highest incidence of wheezing, rhinitis and otitis. Chandra 1989
Soy is at least as allergenic as cow's milk. Eastham, Kjellman, Mendoza, Arment, Chandra, Gruskay, Ellis
Adverse reactions follow within three weeks. Fomon, Powell, Ingkaran, Haffejee, Iacono, Redel
Soy is associated with poorer response to vaccinations. Zoppi, Businco, Hahn-Zoric
Soy fed infants have higher rates of illness. Zoppi, Businco, Lonnerdal
Soy formulas have zinc deficiency and low selenium concentrations. Lonnerdal, Smith, Fitzherbert
Soy formulas have high levels of manganese. Lonnerdal, Smith
Soy formulas have high levels of aluminum. Freundlich, Hawkins, Greer
Soy formulas are associated with increase risk of autoimmune thyroid disease. Fort et al.
Soy formulas are associated with increased risk of diabetes. Fort, AAP 1994
Soy formulas may have long-term effects on cholesterol metabolism. Mott, Kallio, Cruz
Soy has plant steroids (phytoestrogens) that may effect human babies. Lonnerdal, Whitten, Landau, Cruz, Irvine, Clarkson, Sheehan
Soy formula has no lactose, which may affect brain development.
Tuesday, September 27, 2011
Dr. Hale
I've posted a few times about a workshop I attended many months ago now, actually just over a year ago, with Dr. Thomas Hale. It most certainly was one of the best workshops I've attended on breastfeeding. I am still gaining insight from my notes.
One area of lactation that seems to be changing daily is our understanding of breastfeeding and HIV. Dr. Hale shared that HIV transmission occurs with breastfeeding involution, so while exclusively breastfeeding, risk is nil. This makes perfect sense with what we already knew to be true about HIV and breastfeeding, those exclusively breastfed did not become infected, but infants who were supplemented with formula were at risk. I'll admit that because our practice does not care for HIV clients, I have failed to keep up-to-date on this subject matter, but for curiosity's sake, I'd love to stumble across a great article that sums up what we know to be true today (not necessarily what our nation's recommendations are).
Another interesting suggestion Dr. Hale offered is a reminder that progesterone can inhibit milk synthesis, but we don't know when this occurs in individuals, and clearly it seems to vary from woman to woman. Although it is believed progesterone receptor sites are eliminated in the first week, experts are questioning if some women in fact, maintain receptors. His suggestion was to start with the mini-pill and if tolerated, the Depo or IUD could then be administered.
When increasing milk production, synthesis depends on increasing the number of lactocytes, emptying of the breast, and maintaining moderate levels of prolactin. This takes six to seven days to increase lactocytes so a recommendation of "staying naked in bed" must last six to seven days to gain big effect.
Reglan is a medication administered to those with low supply (particular due to the controversial nature of domperidone), which is rather unfortunate because Reglan does cause depression in 12-13% of women, and tartive dyskanesia in others, particularly if taken longer than three months. Dr. Hale's recommendation was after three to four weeks of (30-45mg/day divided in three doses) therapy, to decrease to 10 mg a week. As well, Reglan is only effective for women with low levels of prolactin. Other causes of decreased supply are not benefited. He suggested measuring prolactin levels prior to the onset of therapy, although if there is no increase in supply in the first week, one can discontinue.
These sheets really will be kept for many years, there is just so much wisdom in them. Every medication typically offered was discussed and phenomenal notes were provided. I certainly recommend attending any workshop he may be speaking, as I can't think of another presenter that I gained more valuable information from.
One area of lactation that seems to be changing daily is our understanding of breastfeeding and HIV. Dr. Hale shared that HIV transmission occurs with breastfeeding involution, so while exclusively breastfeeding, risk is nil. This makes perfect sense with what we already knew to be true about HIV and breastfeeding, those exclusively breastfed did not become infected, but infants who were supplemented with formula were at risk. I'll admit that because our practice does not care for HIV clients, I have failed to keep up-to-date on this subject matter, but for curiosity's sake, I'd love to stumble across a great article that sums up what we know to be true today (not necessarily what our nation's recommendations are).
Another interesting suggestion Dr. Hale offered is a reminder that progesterone can inhibit milk synthesis, but we don't know when this occurs in individuals, and clearly it seems to vary from woman to woman. Although it is believed progesterone receptor sites are eliminated in the first week, experts are questioning if some women in fact, maintain receptors. His suggestion was to start with the mini-pill and if tolerated, the Depo or IUD could then be administered.
When increasing milk production, synthesis depends on increasing the number of lactocytes, emptying of the breast, and maintaining moderate levels of prolactin. This takes six to seven days to increase lactocytes so a recommendation of "staying naked in bed" must last six to seven days to gain big effect.
Reglan is a medication administered to those with low supply (particular due to the controversial nature of domperidone), which is rather unfortunate because Reglan does cause depression in 12-13% of women, and tartive dyskanesia in others, particularly if taken longer than three months. Dr. Hale's recommendation was after three to four weeks of (30-45mg/day divided in three doses) therapy, to decrease to 10 mg a week. As well, Reglan is only effective for women with low levels of prolactin. Other causes of decreased supply are not benefited. He suggested measuring prolactin levels prior to the onset of therapy, although if there is no increase in supply in the first week, one can discontinue.
These sheets really will be kept for many years, there is just so much wisdom in them. Every medication typically offered was discussed and phenomenal notes were provided. I certainly recommend attending any workshop he may be speaking, as I can't think of another presenter that I gained more valuable information from.
Monday, September 26, 2011
PUMPING MILK at WORK?
Holly Hopkins shared with us during our most recent coalition meeting:
Dr. Hoffmann is seeking mothers who are pumping in the workplace, to consider sharing your insights and experiences. She is a professor at Purdue University and is interested in learning from moms who used to pump at work, are currently pumping at work, started pumping at work but had to stop, or had planned to pump at work but were unable to do so.
She's requesting a thirty minute interview, and can be reached by e-mail or phone: 765-496-2225.
Your interview would be part of her sociological study of moms who return to work and continue to breastfeed. Your responses would be completely confidential, as required by Purdue's research rules.
If you only have time for a brief survey, please visit her website.
Dr. Hoffmann is seeking mothers who are pumping in the workplace, to consider sharing your insights and experiences. She is a professor at Purdue University and is interested in learning from moms who used to pump at work, are currently pumping at work, started pumping at work but had to stop, or had planned to pump at work but were unable to do so.
She's requesting a thirty minute interview, and can be reached by e-mail or phone: 765-496-2225.
Your interview would be part of her sociological study of moms who return to work and continue to breastfeed. Your responses would be completely confidential, as required by Purdue's research rules.
If you only have time for a brief survey, please visit her website.
Coalition Meeting
This past Friday, the Coalition met for the month of September, 2011. Penny Lane MSN, CNM, IBCLC was present as the coalition's chair, with January Gilley CLC the coalition's treasurer. Holly Hopkins MSN, CNM, CLC, Ashley Kenyon RN, Kristen Kile RN, and Erin Syslo, Infant Toddler Specialist were also present.
Introductions were shared, with very brief review of the coalition's history. Members shared their hopes for the coalition, which consisted of efforts to reach young mothers, extending greater efforts towards making the community aware of our efforts, recommitting to offering Lactation Stations at county festivals, and establishing a thriving support group in both Montgomery and Clinton County.
The coalition plans to terminate the established yahoo group, replacing this method of communication with both the blog and our Facebook page.
The Thorntown Turning Leaves Festival is this weekend. Volunteers needed.
Believe Midwifery Services plans to assume responsibility for the breastpump program. A hospital grade pump will be purchased initially and then items for purchase will follow.
A Hale, Medications and Mother's Milk, text was donated to the newly established Howard County Breastfeeding Coalition. It was suggested the second be donated to our local pediatrics office.
Penny shared that the State Breastfeeding Task Force has recently changed to the "Indiana State Breastfeeding Coalition," and meets quarterly. Smaller focus groups have been created, which our members were encouraged to attend. Interest was voiced for both the Community Outreach group, led by Dane Nutty, and the Educating the Provider, leader unknown. However, further information regarding objectives were desired.
Believe Midwifery Services is offering a FREE Breastfeeding Class for parents in October. Please promote! And Penny Lane MSN, CNM, IBCLC plans to offer a Breastfeeding Class for Providers in the next few months...date to be announced.
Erin Syslo, Infant Toddler Specialist shared her efforts to educate day care providers, both facility and in-home, within Clinton and Boone County about caring for the breastfed baby. A sample breastfeeding policy for the child care setting is available on the IPN website or another sample is here. The state has provided magnets that will also be distributed with feeding tips and breast milk handling information. The coalition will compile a list of resources, have them printed and available for Erin, so when she begins her visits in the spring of 2012, she can share with day care providers.
Next Meeting: The THIRD FRIDAY of December, at 10am.
Introductions were shared, with very brief review of the coalition's history. Members shared their hopes for the coalition, which consisted of efforts to reach young mothers, extending greater efforts towards making the community aware of our efforts, recommitting to offering Lactation Stations at county festivals, and establishing a thriving support group in both Montgomery and Clinton County.
The coalition plans to terminate the established yahoo group, replacing this method of communication with both the blog and our Facebook page.
The Thorntown Turning Leaves Festival is this weekend. Volunteers needed.
Believe Midwifery Services plans to assume responsibility for the breastpump program. A hospital grade pump will be purchased initially and then items for purchase will follow.
A Hale, Medications and Mother's Milk, text was donated to the newly established Howard County Breastfeeding Coalition. It was suggested the second be donated to our local pediatrics office.
Penny shared that the State Breastfeeding Task Force has recently changed to the "Indiana State Breastfeeding Coalition," and meets quarterly. Smaller focus groups have been created, which our members were encouraged to attend. Interest was voiced for both the Community Outreach group, led by Dane Nutty, and the Educating the Provider, leader unknown. However, further information regarding objectives were desired.
Believe Midwifery Services is offering a FREE Breastfeeding Class for parents in October. Please promote! And Penny Lane MSN, CNM, IBCLC plans to offer a Breastfeeding Class for Providers in the next few months...date to be announced.
Erin Syslo, Infant Toddler Specialist shared her efforts to educate day care providers, both facility and in-home, within Clinton and Boone County about caring for the breastfed baby. A sample breastfeeding policy for the child care setting is available on the IPN website or another sample is here. The state has provided magnets that will also be distributed with feeding tips and breast milk handling information. The coalition will compile a list of resources, have them printed and available for Erin, so when she begins her visits in the spring of 2012, she can share with day care providers.
Next Meeting: The THIRD FRIDAY of December, at 10am.
Friday, September 23, 2011
Lactation Matters
Lactation Matters, a new blog published by ILCA, has launched a new feature called, "Clinicians in the Trenches." Their hope is to highlight those who are doing outstanding work in the field of lactation and encouraging others through innovative care practices.
The first story was entered today, focusing on Colette Acker and The Breastfeeding Resource Center.
If you know someone who is bringing light a new idea within their practice, share! Robin Kaplan and Amber McCann can be reached here. They ask that you include "Clinician in the Trenches" in the subject line. Every two weeks a new clinician will be featured.
The first story was entered today, focusing on Colette Acker and The Breastfeeding Resource Center.
If you know someone who is bringing light a new idea within their practice, share! Robin Kaplan and Amber McCann can be reached here. They ask that you include "Clinician in the Trenches" in the subject line. Every two weeks a new clinician will be featured.
Friday, September 16, 2011
Friday, September 9, 2011
No Joke
A new father, observing his wife breastfeed their newly born daughter for the first time, said to one of the nurses that works for me, "So, I wonder who was the first person to actually try this?" She said everyone in the room just starred and he had no awareness of just how ignorant that statement was. I am rather alarmed too, but it does in fact demonstrate how far from nature our culture has veered.
Wednesday, September 7, 2011
Coalition Meeting
September 23rd is our next breastfeeding coalition meeting at 10am, prior to our support group meeting at noon. We haven't met for quite a while, so please join us to catch up and get back into the work we love, supporting breastfeeding women. We anticipate having a few new members and will be hosting a speaker who will discuss how to support the breastfeeding mother whose baby is in childcare while she works.
If you have any topics you'd like me to add to the agenda, please e-mail me or leave a comment to this post. I plan to discuss lactation stations, pump rentals, support group, and identifying a new action plan for our coalition.
If you have any topics you'd like me to add to the agenda, please e-mail me or leave a comment to this post. I plan to discuss lactation stations, pump rentals, support group, and identifying a new action plan for our coalition.
Erin Syslo, Infant Toddler Specialist
Certified Trainer for The Program for Infant/Toddler Care
Wednesday, August 24, 2011
Review of Baby GooRoo Book Marks
This past week, while visiting the local WIC World Breastfeeding Celebration, I discovered a bookmark by babygooroo.com that I just fell in love with, The Scoop on Poop. I immediately visited the company's website, hoping to order a bundle for my clients and discovered that rather than having the opportunity to order fifty of the one bookmark, I had to place an order for a bundle of four different bookmarks, including, Keep Your Baby Safe from SIDS, Signs that Your Baby is Positioned Well, and Signs that Your Baby is Well Fed.
As a midwife in private practice and a lactation consultant, I am super critical about reading material I provide my clients. In fact, I write most of them myself, but haven't created the perfect visual for baby poop during the first few days. Not wanting to make the investment and be disappointed by risk-based public health focused material, as opposed to evidence-based, empowering material for informed parents, I sent an e-mail requesting the opportunity to review their bookmark package. They kindly responded, and sent a few additional items. Joy!
This is the best picture I can provide you for the bookmarks. The printing quality alone - large size on sturdy card stock with glossy lamination - is quite impressive for the price of only $0.35 for the bundle. Each are quite visually appealing.
The Scoop on Poop marker is especially cute. "Nothing comes out the bottom unless something goes in the top!" One side illustrates what to expect the first week, with large diaper graphics specific to either meconium, transition or breastmilk consistency stool. A note at the bottom reminds mom when to call for help and I must note, is both accurate and provider-friendly ("health care provider" rather than exclusively physician).
On the reverse side of the marker, diaper quantities are illustrated with smaller detail to the consistency to the stool, which helps the parents count diapers appropriate for each day of life through the first week. "A stool is a stain the size of your baby's fist, or at least 1 teaspoon of solid material."
The second marker, Signs that Your Baby is Well Fed, does not disappoint. The front size lists all the various indications that baby is "full" or well-fed, with an endearing African American baby at the top. The reverse side has the same baby pouting and exclaiming, "I'm hungry!" with another list of signs baby is not well-fed. The lists are quite thorough and again, the marker is provider-friendly and visually appealing. Certainly happy to add both of these to my practice's educational material.
The third, Signs that Your Baby is Positioned Well, offers all the important indicators, in very clear and easy to understand terms, that baby is well latched and sucking effectively. On the reverse side, a list of all the important assessment points of poor latch with an illustration of a shallow latch. Again, the author has used a dark toned baby, to represent diversity beyond "vanilla."
Keep Your Baby Safe from SIDS, was the book mark I was most concerned would give instructions that would oppose those we teach in our practice. We are advocates of bed-sharing and teach our families how to do so safely. This marker does not oppose bed-sharing specifically, listing on either side instructions with how to lie baby safely down to sleep. Regular check-ups with the baby's doctor and obtaining immunizations are among the recommendations for preventing SIDS.
My above statement about having to order the bookmarks in a bundle was incorrect. Each bookmark can be ordered individually in bulk.
Breastfeeding Ready, Set, Go! was another generous gift sent by the gooroo baby company and again, I am rather impressed. I appreciate greatly the baby pictures, which not only perfectly illustrate the specific point being discussed, but are quite diverse and adorable. Teaching points are brief and reader-friendly for all literacy levels, yet also engaging and thorough. This booklet is printed on card-stock and bound with a metal ring. I imagine having one of these in the reception area for clients to browse through or maybe available in a retail store to purchase as a gift for a new mother. The price is very reasonable at only $5.75.
My only suggestion would be to add Dr. Hale's website information as a resource for mothers discerning if any particular medication is safe while breastfeeding. Referring them exclusively to their health care provider (again, appreciate the provider-friendly terminology) will often lead to the recommendation to pump and dump, as even pediatricians and sadly, midwives, are unaware of Dr. Hale's vast resource. If I were to someday have a bit of money, I would happily add these booklets to the free materials provided to each of our clients.
Finally, the fourth edition of the Amy Spangler Breastfeeding booklet was included in my mailing. I have seen these numerous times throughout my career, available in several hospitals I have been employed, but inconsistently offered to mothers. I suspect that is simply because Medela offers a similar pocket-size book free to anyone who is willing to ask and Amy Spangler's booklet is $3.00 each (an incredible deal in itself!). If ordered in bulk orders 100+, they are priced even lower.
I do wish rather than discussing the advantages of breastfeeding, the author would take a more risk-based approach. Babies aren't smarter if breastfed; they are less so if provided food other than human milk.
A question and answer teaching approach is used, which I believe many mothers appreciate. The breast anatomy is up-to-date and dinner-and-dessert style breastfeeding is recommended. A dose of vitamin K is recommended at birth for the newborn, and daily supplementation of vitamin D. The vitamin D dose is out-of-date however, and no mention of supplementing mother in lieu of baby is discussed.
This critical lactation consultant placed her order today for each of the above items and very much looking forward to distributing them within our breastfeeding classes.
As a midwife in private practice and a lactation consultant, I am super critical about reading material I provide my clients. In fact, I write most of them myself, but haven't created the perfect visual for baby poop during the first few days. Not wanting to make the investment and be disappointed by risk-based public health focused material, as opposed to evidence-based, empowering material for informed parents, I sent an e-mail requesting the opportunity to review their bookmark package. They kindly responded, and sent a few additional items. Joy!
The Scoop on Poop marker is especially cute. "Nothing comes out the bottom unless something goes in the top!" One side illustrates what to expect the first week, with large diaper graphics specific to either meconium, transition or breastmilk consistency stool. A note at the bottom reminds mom when to call for help and I must note, is both accurate and provider-friendly ("health care provider" rather than exclusively physician).
On the reverse side of the marker, diaper quantities are illustrated with smaller detail to the consistency to the stool, which helps the parents count diapers appropriate for each day of life through the first week. "A stool is a stain the size of your baby's fist, or at least 1 teaspoon of solid material."
The second marker, Signs that Your Baby is Well Fed, does not disappoint. The front size lists all the various indications that baby is "full" or well-fed, with an endearing African American baby at the top. The reverse side has the same baby pouting and exclaiming, "I'm hungry!" with another list of signs baby is not well-fed. The lists are quite thorough and again, the marker is provider-friendly and visually appealing. Certainly happy to add both of these to my practice's educational material.
The third, Signs that Your Baby is Positioned Well, offers all the important indicators, in very clear and easy to understand terms, that baby is well latched and sucking effectively. On the reverse side, a list of all the important assessment points of poor latch with an illustration of a shallow latch. Again, the author has used a dark toned baby, to represent diversity beyond "vanilla."
Keep Your Baby Safe from SIDS, was the book mark I was most concerned would give instructions that would oppose those we teach in our practice. We are advocates of bed-sharing and teach our families how to do so safely. This marker does not oppose bed-sharing specifically, listing on either side instructions with how to lie baby safely down to sleep. Regular check-ups with the baby's doctor and obtaining immunizations are among the recommendations for preventing SIDS.
My above statement about having to order the bookmarks in a bundle was incorrect. Each bookmark can be ordered individually in bulk.
Breastfeeding Ready, Set, Go! was another generous gift sent by the gooroo baby company and again, I am rather impressed. I appreciate greatly the baby pictures, which not only perfectly illustrate the specific point being discussed, but are quite diverse and adorable. Teaching points are brief and reader-friendly for all literacy levels, yet also engaging and thorough. This booklet is printed on card-stock and bound with a metal ring. I imagine having one of these in the reception area for clients to browse through or maybe available in a retail store to purchase as a gift for a new mother. The price is very reasonable at only $5.75.
My only suggestion would be to add Dr. Hale's website information as a resource for mothers discerning if any particular medication is safe while breastfeeding. Referring them exclusively to their health care provider (again, appreciate the provider-friendly terminology) will often lead to the recommendation to pump and dump, as even pediatricians and sadly, midwives, are unaware of Dr. Hale's vast resource. If I were to someday have a bit of money, I would happily add these booklets to the free materials provided to each of our clients.
Finally, the fourth edition of the Amy Spangler Breastfeeding booklet was included in my mailing. I have seen these numerous times throughout my career, available in several hospitals I have been employed, but inconsistently offered to mothers. I suspect that is simply because Medela offers a similar pocket-size book free to anyone who is willing to ask and Amy Spangler's booklet is $3.00 each (an incredible deal in itself!). If ordered in bulk orders 100+, they are priced even lower.
I do wish rather than discussing the advantages of breastfeeding, the author would take a more risk-based approach. Babies aren't smarter if breastfed; they are less so if provided food other than human milk.
A question and answer teaching approach is used, which I believe many mothers appreciate. The breast anatomy is up-to-date and dinner-and-dessert style breastfeeding is recommended. A dose of vitamin K is recommended at birth for the newborn, and daily supplementation of vitamin D. The vitamin D dose is out-of-date however, and no mention of supplementing mother in lieu of baby is discussed.
This critical lactation consultant placed her order today for each of the above items and very much looking forward to distributing them within our breastfeeding classes.
Sunday, August 21, 2011
Eats on Feets
Eats on Feets, an on-line networking group for human milk sharing, has created quite a stir within the lactation community. The organization has chapters all over the world, connecting those in need of milk with those who are willing to donate, each within the same community. The individual chapters do not organize or manage milk sharing. They do however, offer information in effort to assist parents in making an informed decision about milk sharing. While the main website hosts a forum, Facebook is a popular connection point. You can find the Indiana chapter simply by searching "Eats on Feets Indiana."
Saturday, August 6, 2011
Friday, August 5, 2011
Ornery Boys
My twelve-year-old son, Noah, was a cruel older brother today and did a "titty-twister" on my four-year-old son, Samuel. I have no idea where they learn these ornery things. Samuel of course did it right back to Noah with all his little-tough-guy effort, and Noah screeched, "Now I am going to get cancer!"
Noah then returned the favor once again, and Samuel cries out, "AHH!! Now I am not going to be able to get pregnant!!"
Noah then returned the favor once again, and Samuel cries out, "AHH!! Now I am not going to be able to get pregnant!!"
World Breastfeeding Week
The Boone County WIC Department has asked me to speak about the benefits of breastfeeding at their World Breastfeeding Week Celebration. I am thrilled to do it. The topic however, is a bit daunting. My gut reaction, and honestly what I might present is in fact, that I can't think of a single benefit. I can't.
Human babies were created to be fed human milk from his or her mother's breast.
If I were asked to speak about the benefits of having a healthy renal system, I would in fact be sharing the great disadvantages and heart-ache associated with dialysis. The same would be true if I were to discuss the advantages of having a healthy respiratory system. The only real benefit comes in not having to live on a ventilator. I am grateful my musculoskeletal system is also intact, preventing me from having to suffer the great disadvantages of living in a wheel-chair or being bedridden. My breasts function and my child suckled with great success. I do not, nor do my boys, have to suffer the consequences of not having been breastfed.
Women who breastfeed are not super moms. Breastmilk is not liquid gold. It is milk created specifically for human babies. Anything else is inferior.
Had I not been so blessed in my own breastfeeding experience, each of my boys would have had an increased risk for nearly all infectious diseases, from the simple ear infection to meningitis. They might potentially have faced debilitating allergies or a compromised immune system, even cancer or diabetes. Their mere survival would have been less likely had we not had such a successful breastfeeding experience.
My boys are all at the very top of their class. (I suppose I should be forthright and share that they are educated at home, so they are the only student in their particular class. I suppose that means they could have the worst scores in their class too!) They are very bright boys and human milk is certainly part of that success. This particular point is one that is quite controversial. It seems to hit the hot button for many people. Breastfeeding has in fact been associated with enhanced performance on tests specific to cognitive development and while these differences are slight, they can make the difference between independent living and assisted living, or SAT scores that provide a full scholarship to college or a hefty student loan. The American Academy of Pediatrics has long recognized this "benefit." Research in this one particular area is over-overwhelmingly solid. The wheel is round. Not breastfeeding does hamper intelligence.
As for me, had I not breastfed my children, I would most certainly have increased my risk for breast cancer, as well as uterine, ovarian, and endometrial cancer. Osteoporosis and diabetes would have more greatly impacted my life as well. I certainly might suffer these devastating conditions, but if I do, they should not enter my life as early or be as significant had I not breastfed for as many years. If for no other reason though, the emotional health risks associated with not breastfeeding is certainly enough to get my husband on his knees praying for a fruitful breastfeeding relationship. I was a happier woman and he was a happier man.
The research is honestly quite daunting. Decades ago, we knew virtually nothing. Today, there is a plethora of evidence demonstrating the disadvantages associated with not breastfeeding, from health consequences, to the financial strain on our nation, to even increased child abuse. I would suggest that in spite of all we currently do know, we have only begun to understand the complexities of human milk and the breastfeeding relationship.
The World Health Organization recommends exclusive breastfeeding through the first six months of life and thereafter, complementary foods while breastfeeding continues for up to two years of age or beyond.
This year's theme for World Breastfeeding Week is 3D. WABA suggests that advocates of breastfeeding tend to be two-dimensional. We focus on time (from pre-pregnancy to weaning) and place (the home, community, health care system), but neither has much impact without a THIRD dimension - communication. We live in a time where individuals and global communities connect across small and great distances at an instant's notice. New lines of communication are being created every day, and we have the ability to use these information channels to broaden our horizons and spread breastfeeding information beyond our immediate time and place to activate important dialogue.
Boone County has a Breastfeeding Coalition and I encourage each of you to join. We were established in 2006 and this past year were one of two Indiana Breastfeeding Coalitions awarded as the Coalition of the Year. Our coalition in particular was granted this honor because of our blog, which is just one step towards advocating for breastfeeding 3D.
Human babies were created to be fed human milk from his or her mother's breast.
If I were asked to speak about the benefits of having a healthy renal system, I would in fact be sharing the great disadvantages and heart-ache associated with dialysis. The same would be true if I were to discuss the advantages of having a healthy respiratory system. The only real benefit comes in not having to live on a ventilator. I am grateful my musculoskeletal system is also intact, preventing me from having to suffer the great disadvantages of living in a wheel-chair or being bedridden. My breasts function and my child suckled with great success. I do not, nor do my boys, have to suffer the consequences of not having been breastfed.
Women who breastfeed are not super moms. Breastmilk is not liquid gold. It is milk created specifically for human babies. Anything else is inferior.
Had I not been so blessed in my own breastfeeding experience, each of my boys would have had an increased risk for nearly all infectious diseases, from the simple ear infection to meningitis. They might potentially have faced debilitating allergies or a compromised immune system, even cancer or diabetes. Their mere survival would have been less likely had we not had such a successful breastfeeding experience.
My boys are all at the very top of their class. (I suppose I should be forthright and share that they are educated at home, so they are the only student in their particular class. I suppose that means they could have the worst scores in their class too!) They are very bright boys and human milk is certainly part of that success. This particular point is one that is quite controversial. It seems to hit the hot button for many people. Breastfeeding has in fact been associated with enhanced performance on tests specific to cognitive development and while these differences are slight, they can make the difference between independent living and assisted living, or SAT scores that provide a full scholarship to college or a hefty student loan. The American Academy of Pediatrics has long recognized this "benefit." Research in this one particular area is over-overwhelmingly solid. The wheel is round. Not breastfeeding does hamper intelligence.
As for me, had I not breastfed my children, I would most certainly have increased my risk for breast cancer, as well as uterine, ovarian, and endometrial cancer. Osteoporosis and diabetes would have more greatly impacted my life as well. I certainly might suffer these devastating conditions, but if I do, they should not enter my life as early or be as significant had I not breastfed for as many years. If for no other reason though, the emotional health risks associated with not breastfeeding is certainly enough to get my husband on his knees praying for a fruitful breastfeeding relationship. I was a happier woman and he was a happier man.
The research is honestly quite daunting. Decades ago, we knew virtually nothing. Today, there is a plethora of evidence demonstrating the disadvantages associated with not breastfeeding, from health consequences, to the financial strain on our nation, to even increased child abuse. I would suggest that in spite of all we currently do know, we have only begun to understand the complexities of human milk and the breastfeeding relationship.
The World Health Organization recommends exclusive breastfeeding through the first six months of life and thereafter, complementary foods while breastfeeding continues for up to two years of age or beyond.
This year's theme for World Breastfeeding Week is 3D. WABA suggests that advocates of breastfeeding tend to be two-dimensional. We focus on time (from pre-pregnancy to weaning) and place (the home, community, health care system), but neither has much impact without a THIRD dimension - communication. We live in a time where individuals and global communities connect across small and great distances at an instant's notice. New lines of communication are being created every day, and we have the ability to use these information channels to broaden our horizons and spread breastfeeding information beyond our immediate time and place to activate important dialogue.
Boone County has a Breastfeeding Coalition and I encourage each of you to join. We were established in 2006 and this past year were one of two Indiana Breastfeeding Coalitions awarded as the Coalition of the Year. Our coalition in particular was granted this honor because of our blog, which is just one step towards advocating for breastfeeding 3D.
Thursday, July 14, 2011
Boobie
Noah, my almost thirteen-year-old, was invited to a girl's house for her birthday swim party last weekend. He was the only boy and was quite thrilled with the invite. After returning home and sharing about his wonderful time, he said, "Mom, wanna hear about my super embarrassing moment?"
"Well, they call their little brother (who is probably about seven years-old), Boobie. I asked why they nicknamed him that and her older sister said because he was breastfed until he was a year-and-a-half!!"
Noah (having been breastfed until he was four-and-a-half) responded sheepishly, "Yeah. That's a really long time."
Ha! Ha! Ha! Ha! Ha!
"Well, they call their little brother (who is probably about seven years-old), Boobie. I asked why they nicknamed him that and her older sister said because he was breastfed until he was a year-and-a-half!!"
Noah (having been breastfed until he was four-and-a-half) responded sheepishly, "Yeah. That's a really long time."
Ha! Ha! Ha! Ha! Ha!
Tuesday, July 5, 2011
Saturday, July 2, 2011
Off Topic: Let's Discuss Aluminum
Vaccines are a controversial topic among breastfeeding families, so I don't fear its discussion here will fall on deaf ears. Since the H1N1 crisis, I've had questions about aluminum in our vaccines. Is it the new thimerosal?
Aluminum is added in a number of vaccines and although it is a naturally occurring substance, even harmless when swallowed, is it safe when injected into newborns? The FDA has quite a bit of information about aluminum toxicity on their website. I was actually surprised to learn that aluminum is found in intravenous solutions, like dextrose solutions, and can reach toxic levels with prolonged parenteral administration if kidney function is impaired (including premature babies). TPN, which many tiny premature babies are offered as their sole source of nutrition, causes a build-up of aluminum in the bone, urine, and plasma. This is fairly difficult evaluate however, but can be very serious, and the FDA takes this very seriously. The ASPEN suggests, and the FDA requires, that all injectable solutions be limited to 25 mcg; as this is believed to be a safe level.
The disconnect then comes when we evaluate the aluminum level in vaccines. Using the 5 mcg/kg/day criterion, Robert Sears MD (2008) discovered that a 12-pound, two-month-old baby could safely receive 30 mcg of aluminum per day but a newborn who gets a Hepatitis B injection on its first day of life would receive 250 mcg of aluminum.
Each vaccine lists the level per shot of aluminum on its packaging. DTaP ranges from 170-625 mcg, depending on the manufacturer, and Pediatrix is listed as 850 mcg! Even more alarming, two-month-old babies are receiving several vaccinations at once, multiplying their aluminum levels to upwards of 1225 mcg.
Has the use of aluminum in vaccinations been researched? Dr Sears comments in his Mothering, 2008 article, "Is Aluminum the New Thimerosal?" that not only was he unable to find any evidence that the issue had been researched, but the American Academy of Pediatrics warns that aluminum can cause neurological harm.
The older vaccine DTP was the first to contain aluminum and at such low levels, there was no concern. Then in the 1980s, the PedVaxHib was released containing aluminum, then HIB and later Hepatitis B in the 1990s. The turn of the century brought Pneumoncoccus and even Hepatitis A, each containing aluminum. Administering four vaccines certainly goes beyond insignificant levels of aluminum for a young child, but even more alarming, this seems to have escaped everyone's attention.
Why not just remove aluminum as has been done with thimerosal? Apparently, it isn't that simple. Aluminum is an adjuvant; meaning, it helps vaccines work more effectively. "When the metal is mixed with the vaccine, the body's immune system more easily recognizes the vaccine and creates antibodies against the disease," (Sears, 2008, p 51). Thimerosal was easier to omit because it had nothing to do with the efficacy of the vaccine. However, why does one brand of HIB vaccine require aluminum to make it work and another does not? Why does one brand of DTaP vaccine contain four times as much aluminum as another?
For a current list of vaccines and their thimerosal contents, go to www.vaccinesafety.edu/thi-table.htm
Providers can be diligent about ordering vaccinations that contain less or no aluminum. They can also be mindful of giving only one aluminum-containing vaccine at a time.
Sears, R. (2008). Is aluminum the new thimersol? Mothering, 146, 46-53.
Aluminum is added in a number of vaccines and although it is a naturally occurring substance, even harmless when swallowed, is it safe when injected into newborns? The FDA has quite a bit of information about aluminum toxicity on their website. I was actually surprised to learn that aluminum is found in intravenous solutions, like dextrose solutions, and can reach toxic levels with prolonged parenteral administration if kidney function is impaired (including premature babies). TPN, which many tiny premature babies are offered as their sole source of nutrition, causes a build-up of aluminum in the bone, urine, and plasma. This is fairly difficult evaluate however, but can be very serious, and the FDA takes this very seriously. The ASPEN suggests, and the FDA requires, that all injectable solutions be limited to 25 mcg; as this is believed to be a safe level.
The disconnect then comes when we evaluate the aluminum level in vaccines. Using the 5 mcg/kg/day criterion, Robert Sears MD (2008) discovered that a 12-pound, two-month-old baby could safely receive 30 mcg of aluminum per day but a newborn who gets a Hepatitis B injection on its first day of life would receive 250 mcg of aluminum.
Each vaccine lists the level per shot of aluminum on its packaging. DTaP ranges from 170-625 mcg, depending on the manufacturer, and Pediatrix is listed as 850 mcg! Even more alarming, two-month-old babies are receiving several vaccinations at once, multiplying their aluminum levels to upwards of 1225 mcg.
Has the use of aluminum in vaccinations been researched? Dr Sears comments in his Mothering, 2008 article, "Is Aluminum the New Thimerosal?" that not only was he unable to find any evidence that the issue had been researched, but the American Academy of Pediatrics warns that aluminum can cause neurological harm.
The older vaccine DTP was the first to contain aluminum and at such low levels, there was no concern. Then in the 1980s, the PedVaxHib was released containing aluminum, then HIB and later Hepatitis B in the 1990s. The turn of the century brought Pneumoncoccus and even Hepatitis A, each containing aluminum. Administering four vaccines certainly goes beyond insignificant levels of aluminum for a young child, but even more alarming, this seems to have escaped everyone's attention.
Why not just remove aluminum as has been done with thimerosal? Apparently, it isn't that simple. Aluminum is an adjuvant; meaning, it helps vaccines work more effectively. "When the metal is mixed with the vaccine, the body's immune system more easily recognizes the vaccine and creates antibodies against the disease," (Sears, 2008, p 51). Thimerosal was easier to omit because it had nothing to do with the efficacy of the vaccine. However, why does one brand of HIB vaccine require aluminum to make it work and another does not? Why does one brand of DTaP vaccine contain four times as much aluminum as another?
For a current list of vaccines and their thimerosal contents, go to www.vaccinesafety.edu/thi-table.htm
Providers can be diligent about ordering vaccinations that contain less or no aluminum. They can also be mindful of giving only one aluminum-containing vaccine at a time.
Sears, R. (2008). Is aluminum the new thimersol? Mothering, 146, 46-53.
Mastitis 101
Mastitis is most often caused by Staphylococcus aureus and Escherichia coli bacteria. These bacteria typically enter the nipple via a crack caused by a poor latch; however, some women seem to be more prone to breast infections, potentially due to anemia, thinner skin, or because of extreme engorgement. Symptoms include a red, sore spot on the breast, followed by a red line progressing along the plugged duct, fever and chills. Mothers typically share that they can't get off the couch, like they were suddenly overcome with a really bad flu. Sometimes babies refuse to nurse because the milk is said to have a slightly saltier taste due to the higher level of sodium in the inflamed tissue.
The most typical medical management is antibiotics, although this is certainly not the gold standard among lactation consultants. Antibiotics are not without harm. Most importantly, they are too often initiated prematurely. There's a fine line between plugged ducts and mastitis. Plugged ducts can also be quite painful and inflammation may be present, but the fever is typically absent. Antibiotics are not helpful in this scenario, and in fact, only introduce risk.
Instead mothers should be encouraged to breastfeed, to massage the affected area gently, to apply heat, and most importantly, a thorough discussion with regards to optimal latch should be prioritized by the provider. In fact, bras are quite often the culprit.
Even in the face of an actual infection, antibiotics can often be avoided. Twenty-four hours has often proven to be enough time to rid mothers from all signs of infection, most likely due to the plethora of blood circulating through the breast. Time might be all that is necessary, while allowing baby to suckle at the breast at his or her leisure.
Dr. Jack Newman shares that 50 percent of women in his clinic avoid antibiotics, and I would venture to guess that only about ten percent require antibiotics in our practice. This is assuming early symptoms are taken seriously. No bras should be worn during the engorgement days. Foot massages are nice. Daily Immune by WishGarden is an herbal remedy that can assist a mother through recovery, or better, assist in the prevention of mastitis. Cabbage Leaves should be in the refrigerator of every new mother, as they have a long history of offering cool relief for the engorged breast. Avoiding caffeine can also prove beneficial to mothers who otherwise seem particularly prone to suffering mastitis.
If mastitis still rears its ugly head, the homeopathic remedy Phytolacca at a dose determined by an experienced midwife can prove effective. Our practice has experience with WishGarden's Mastitis Remedy and Mastitis Compresses and each mother has shared tremendous relief with these products. We have also used a pokeroot recipe rubbed on the breast, castor oil compresses, a cold poultice of raw potato, lecithin, Vitamin C, echinacea and zinc supplements. If mastitis repeats, it is wise to have the mother assessed for anemia.
The most typical medical management is antibiotics, although this is certainly not the gold standard among lactation consultants. Antibiotics are not without harm. Most importantly, they are too often initiated prematurely. There's a fine line between plugged ducts and mastitis. Plugged ducts can also be quite painful and inflammation may be present, but the fever is typically absent. Antibiotics are not helpful in this scenario, and in fact, only introduce risk.
Instead mothers should be encouraged to breastfeed, to massage the affected area gently, to apply heat, and most importantly, a thorough discussion with regards to optimal latch should be prioritized by the provider. In fact, bras are quite often the culprit.
Even in the face of an actual infection, antibiotics can often be avoided. Twenty-four hours has often proven to be enough time to rid mothers from all signs of infection, most likely due to the plethora of blood circulating through the breast. Time might be all that is necessary, while allowing baby to suckle at the breast at his or her leisure.
Dr. Jack Newman shares that 50 percent of women in his clinic avoid antibiotics, and I would venture to guess that only about ten percent require antibiotics in our practice. This is assuming early symptoms are taken seriously. No bras should be worn during the engorgement days. Foot massages are nice. Daily Immune by WishGarden is an herbal remedy that can assist a mother through recovery, or better, assist in the prevention of mastitis. Cabbage Leaves should be in the refrigerator of every new mother, as they have a long history of offering cool relief for the engorged breast. Avoiding caffeine can also prove beneficial to mothers who otherwise seem particularly prone to suffering mastitis.
If mastitis still rears its ugly head, the homeopathic remedy Phytolacca at a dose determined by an experienced midwife can prove effective. Our practice has experience with WishGarden's Mastitis Remedy and Mastitis Compresses and each mother has shared tremendous relief with these products. We have also used a pokeroot recipe rubbed on the breast, castor oil compresses, a cold poultice of raw potato, lecithin, Vitamin C, echinacea and zinc supplements. If mastitis repeats, it is wise to have the mother assessed for anemia.
Friday, July 1, 2011
Getting a Good Night's Sleep
"Common sense tells us that night waking is not a pathological abnormality but a temporary disturbance," states Peggy O'Mara in her Mothering, 2007 editorial, March edition. Here are her ideas:
- Accept night waking as normal.
- Sleep when baby sleeps.
- Don't turn on the light or change diapers when the baby wakes at night to nurse.
- Don't count how many times you're awake at night.
- Don't look at the clock in the middle of the night.
- Nap on weekends, or whenever you can get help with the baby.
- Carry on.
Monday, June 20, 2011
Volunteer Opportunity
To meet the needs of breastfeeding mothers and families, the Indiana Mother's Milk Bank is once again providing Lactation Stations at the Indiana State Fair. This year, they have expanded to THREE stations and with 5 additional days to the fair's duration, THEY NEED YOUR HELP!!
There are no requirements for volunteers, just a willingness to help mothers, infants, and families. Volunteers will help make sure mothers are comfortable, refill and distribute information, and pass out promotional items. Fathers, you are also asked to volunteer!!
Volunteers receive free admission to the fair, free parking, and a t-shirt. Please contact Fernanda Agnes, IMMB Lactation Station Coordinator by e-mail at feagnes@immb.org. Questions can also be asked of the IMMB Program Manager, Dane Nutty, at 317-536-1670 or by email at dnutty@immb.org.
The Lactation Station will also be supporting the Indiana Black Expo and volunteers are needed from Thursday, July 14th, through Sunday, July 17th. Contact Fernanda to volunteer.
There are no requirements for volunteers, just a willingness to help mothers, infants, and families. Volunteers will help make sure mothers are comfortable, refill and distribute information, and pass out promotional items. Fathers, you are also asked to volunteer!!
Volunteers receive free admission to the fair, free parking, and a t-shirt. Please contact Fernanda Agnes, IMMB Lactation Station Coordinator by e-mail at feagnes@immb.org. Questions can also be asked of the IMMB Program Manager, Dane Nutty, at 317-536-1670 or by email at dnutty@immb.org.
The Lactation Station will also be supporting the Indiana Black Expo and volunteers are needed from Thursday, July 14th, through Sunday, July 17th. Contact Fernanda to volunteer.
Monday, May 30, 2011
Breastfeeding Matters
Based on an article in Lancet in 2003, breastfeeding prevented an estimated 1,301 thousand deaths, whereas insecticides prevented 691 thousand, complementary feeding saved 587 thousand, the H influenzae type B vaccination saved 403 thousand, zinc supplementation saved 351 thousand and clean water, sanitation, and hygiene saved 326 thousand lives. Where do we focus our money and attention in educating for improving maternal and child health?
Long-term Pumping Tips
I can preach and preach about exclusive breastfeeding and how working to feed on the breast is worth every bit of effort mother's invest, but for those that genuinely must face long-term pumping, Linda Smith IBCLC offers a few tips:
First, buy or rent a good quality pump with vacuum pressure of 100-250 pounds and the ability to cycle at 30-60 times per minutes. Plan to spend at least $200. You get what you pay for when it comes to pumps. I once heard a lactation consultant say, buying a breast pump from a formula company is like trusting someone to pack your parachute that would profit if it didn't open. There are fewer than five high quality breast pump manufactures. Speak to your local lactation consultant before purchasing a pump, but also LEARN TO HAND-EXPRESS!
A woman's breasts will release most of their stored milk in the first 10-20 minutes. Be prepared to pump about twenty minutes every two-to-three hours, with one four-to-five hour stretch once per day. The goal is to mimic your baby's feeding pattern. Do not allow the milk to engorge your breasts. This will cause your milk supply to dwindle.
Each woman is different. Some women's breasts dump quicker. Others release slower. Some breasts store more. Some less. A small-breasted woman may need to pump more often than a woman with more glandular tissue and more storage capacity.
The milk-producing cells settle into a production rate that maintains total volume at about fifteen percent more than what baby demands per day. To increase supply, increase demand. Work to empty more frequently and more thoroughly. To decrease volume, allow some milk retention. It takes 1-4 days for the breasts to respond to new demands.
Maintain your supply at about fifteen percent more than baby needs. This allows you to freeze a bit more than baby requires currently. Your little one may have a growth spurt. If you find all your milk is used up without opportunity to freeze additional supply, pump more frequently to increase your supply as baby would otherwise nurse more often to do the same.
What you eat and drink has very little to do with milk composition. Additional fluids affect bladder function, not milk supply. A good diet is important to you, as is brushing your teeth and wearing your seat belt, but it does not directly alter your milk composition.
Hormonal contraceptives may cause a sudden and possible permanent drop in milk supply. Even progesterone-only products may affect some women. Be cautious.
Maintaining a milk supply usually becomes easier with time and then mother's can be a bit more neglectful with their routine.
Long-term milk production may suppress fertility in the same way long-term breastfeeding does. Don't count on it however.
Maintaining a milk supply for a baby is a separate issue from how the milk is fed to the baby and the mother-baby relationship. Pay as much or more attention to the baby as the pump.
Linda J Smith (1998)
First, buy or rent a good quality pump with vacuum pressure of 100-250 pounds and the ability to cycle at 30-60 times per minutes. Plan to spend at least $200. You get what you pay for when it comes to pumps. I once heard a lactation consultant say, buying a breast pump from a formula company is like trusting someone to pack your parachute that would profit if it didn't open. There are fewer than five high quality breast pump manufactures. Speak to your local lactation consultant before purchasing a pump, but also LEARN TO HAND-EXPRESS!
A woman's breasts will release most of their stored milk in the first 10-20 minutes. Be prepared to pump about twenty minutes every two-to-three hours, with one four-to-five hour stretch once per day. The goal is to mimic your baby's feeding pattern. Do not allow the milk to engorge your breasts. This will cause your milk supply to dwindle.
Each woman is different. Some women's breasts dump quicker. Others release slower. Some breasts store more. Some less. A small-breasted woman may need to pump more often than a woman with more glandular tissue and more storage capacity.
The milk-producing cells settle into a production rate that maintains total volume at about fifteen percent more than what baby demands per day. To increase supply, increase demand. Work to empty more frequently and more thoroughly. To decrease volume, allow some milk retention. It takes 1-4 days for the breasts to respond to new demands.
Maintain your supply at about fifteen percent more than baby needs. This allows you to freeze a bit more than baby requires currently. Your little one may have a growth spurt. If you find all your milk is used up without opportunity to freeze additional supply, pump more frequently to increase your supply as baby would otherwise nurse more often to do the same.
What you eat and drink has very little to do with milk composition. Additional fluids affect bladder function, not milk supply. A good diet is important to you, as is brushing your teeth and wearing your seat belt, but it does not directly alter your milk composition.
Hormonal contraceptives may cause a sudden and possible permanent drop in milk supply. Even progesterone-only products may affect some women. Be cautious.
Maintaining a milk supply usually becomes easier with time and then mother's can be a bit more neglectful with their routine.
Long-term milk production may suppress fertility in the same way long-term breastfeeding does. Don't count on it however.
Maintaining a milk supply for a baby is a separate issue from how the milk is fed to the baby and the mother-baby relationship. Pay as much or more attention to the baby as the pump.
Linda J Smith (1998)
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