Breastmilk Power! Premies, priorities and practice – March/April 2013

 

More Rock Stars of Lactation™ presented at our second online breastfeeding conference, Breastmilk Power!. This was held online during March – April 2013 and had delegates from 45 countries.

 

Alice Allan MA, IBCLC

Alice Allan is a trainer who retrained as a lactation consultant after the birth of her second daughter. She worked with the UK’s Breastfeeding Network in London as a peer-supporter at the Whittington hospital and in the community. In Addis Ababa she volunteers at a large government hospital and trains doctors and nurses from a variety of institutions including midwives from the Hamlin Fistula midwifery school. Elsewhere in remote, rural Ethiopia she trains health workers about lactation. She is also a La Leche League leader.

Keeping Faith in the Essentials: supporting premature babies in low resource settings – Ethiopia

Working with prem babies in low resource countries can blind carers to the richest resource of all, the mother. Alice Allan, a lactation consultant working in Addis Ababa looked at the progress being made, and the challenges still facing premature babies in Ethiopia. According to the recent WHO ‘Born too soon report’, Ethiopia is ranked 172 out of 184 countries for deaths due to complications of preterm babies. It is reported that 2,612,700 preterm babies are born in Ethiopia, of which 32,700 die from complications, including an inability to breastfeed.

 

Kimberly Seals Allers BA MS

Kimberly Seals Allers is an award-winning journalist, and a leading consultant and commentator on breastfeeding issues in the African American community. She is currently an IATP Food and Community Fellow, funded by the Kellogg Foundation, with a mandate to increase awareness of “the first food”—breast milk, in vulnerable communities. Kimberly was also recently selected by the United States Breastfeeding Committee as a lead commentator for the nationwide “Break Time for Nursing Mothers” federal campaign. A former writer at Fortune and senior editor at Essence magazine, Kimberly is a respected advocate whose thoughtful and provocative online commentaries on motherhood, breastfeeding and infant health disparities received over 10 million page views last year. She recently signed a deal with St. Martin’s Press to write her fifth book, a groundbreaking book on the social, political and economic influences on the American breastfeeding culture to be released in 2013.

In March 2012, Kimberly launched Black Breastfeeding 360°, a first of its-kind online multimedia content library on the black breastfeeding experience. She is the founder of MochaManual.com, an award-winning pregnancy and parenting website for mothers of color, and author of The Mocha Manual™ series of books, including The Mocha Manual to a Fabulous Pregnancy (Amistad/HarperCollins), which was nominated for an NAACP Image Award.


No Mother Left Behind: Reducing Racial Disparities in Breastfeeding Rates

For over 40 years, breastfeeding rates among African American women have significantly lagged white women. The impact of fewer breastfed babies in the African American community cannot be ignored when you consider that the infant mortality rate among African American babies is 2.4 times higher than for white babies. The CDC has said that increasing the number of breastfed babies could reduce this disparity by as much as 50%, because a higher majority of African American babies are born pre-term. These infants, born too small, too soon or too sick need mother’s milk the most to increase their chances of survival and future health. Increasing breastfeeding among African American women is a critical priority and can help reduce infant mortality and improve the health and vitality of all African American babies.

This presentation explored the cultural nuances of breastfeeding in the African American community to better help lactation specialists connect with and communicate with African American clients. It improved competency in the barriers affecting African American women. Eight specific barriers were discussed along with practical information on messaging to African American women. Also presented were Kimberly’s findings of her recent project in Jackson, Mississippi, Birmingham, Alabama, and New Orleans, Louisiana examining the critical role of community as it relates to breastfeeding success among African American women. The presentation gave breastfeeding supporters the knowledge and cultural competency so that no mother is left behind.

 

Carol Bartle RN, RM, IBCLC, PGDip (Child Advocacy), MHSc

Carol Bartle has a nursing, midwifery and lactation consultant background and is a member of the board of consultants for La Leche League New Zealand and a new member of the International Lactation Consultants Association, Ethics and International Code Committee. Carol is a BFHI Assessor in New Zealand and has worked with the BFHI programme since 2000. She has a post- graduate diploma in Child Advocacy and a Masters of Health Sciences from the University of Otago. Carol’s thesis explores mothers’ experiences of initiating lactation and establishing breastfeeding in a neonatal intensive care environment. Major interests include ethics, NICU infant feeding issues and mother-baby well-being, infant feeding in emergencies, The International Code, breastfeeding and infant feeding politics, mother-to-mother peer counselling, and mothers and babies in prison. Carol works as the Canterbury Breastfeeding Advocacy Coordinator in Christchurch New Zealand.


Maternal and infant rights in the NICU: ‘Mother-Care’, lactation, breastfeeding and issues of ownership

This session presented data from a qualitative research project and interviews with mothers who had babies admitted into a neonatal intensive care unit. It also examined issues with mother-baby separation, authoritative knowledge, NICU culture, mother knowledge and mother-well-being and argue that caring for a baby in a NICU setting also requires attention be paid to ‘Mother-Care’ as a part of ‘best practice’. The theory of salutogenesis, or the generation of well-being, will be presented in the context of how mothers (and fathers) may achieve the three components of meaningfulness, manageability and comprehensibility, suggested as being necessary for well-being, while their baby is in a neonatal unit.

This presentation explored how application of the Baby Friendly Hospital Initiative and the Ten Steps to Successful Breastfeeding could provide more protection, not only for lactation and breastfeeding, but also for maternal bonding and infant attachment, within a human rights and ethics framework.

Hyunjeung and White-Traut describe mothers’ experiences in the neonatal intensive care unit as “hovering around the edges of mothering”. As ordinary acts of mothering, lactation and breastfeeding endeavours become challenging within the neonatal unit a process of ‘unbonding’ is an ever present possibility. Neonatal environment system changes and ways of supporting mother-[parent]-well-being, lactation and breastfeeding were discussed.

 

Alison Baum MA, MSc

Alison Baum is the CEO and Founder of Best Beginnings, which she set up in 2006 as a catalyst for change to radically reduce child health inequalities in the UK. Best Beginnings works collaboratively, innovatively and from the evidence base to help parents make positive healthcare choices and enable professionals to support those choices. Using her leadership and executive production experience from her days at the BBC, Alison has pioneered the development of DVD resources to improve both clinical and parental knowledge and improve the health outcomes for babies born sick or prematurely.

Before setting up Best Beginnings, Alison was a producer and director for the BBC. She made science and health programmes such as Horizon and Animal Hospital and played a key role in the BBC internal change programme. Alison has an MA from Oxford University in Pure and Applied Biology and an MSc from UCL in Neuroscience.

Small Wonders: A Catalyst for Change towards More Family Centred Care

The child health charity Best Beginnings has developed the Small Wonders Change Programme to support cultural shift towards more family-centred care in neonatal units in ways which will improve health and wellbeing outcomes with a particular focus on increasing breastmilk expressing and breastfeeding as well as Kangaroo Care.

At the heart of the Small Wonders National Change Programme is the Small Wonders DVD that follows fourteen families with premature and sick babies on their journey from birth, to first contact with their baby, to one year on. Amongst the 12 films on the DVD are films on expressing breastmilk, transition to independent feeding, holding your baby and preparing for home.

Best Beginnings went through a rigorous process of consultation and piloting to develop the Small Wonders DVD to ensure the DVD delivers to both the evidence of effective practice and the needs of parents of sick and premature babies. This included consulting more than 200 professionals and over 100 parents during the production process and then piloting the DVD with staff and parents in Yorkshire and Humber and Scotland. Due to the in-depth process of engagement and consultation that underpinned the production process, the DVD is endorsed by 28 organisations including several Royal Colleges and UNCIEF.

To maximise the impact of the Small Wonders DVD, Best Beginnings has recruited a network of 417 Small Wonders Champions (mostly neonatal staff and midwives) who have volunteered their time to champion the Small Wonders DVD and Change Programme in their hospitals. The DVD was officially launched in June 2012. To-date the charity has distributed 76,000 copies of the DVD across 141 neonatal units in the UK. In addition the Small Wonders DVD is being used in pre-registration and post-registration training of healthcare professionals.

In her talk, Alison Baum will share clips from the DVD, talk about the consultation process that underpinned its production and share insights from market research with parents who viewed “rough-cuts” that informed the content and style of the final DVD. She will highlight how equal effort has been put into the effective embedding of the DVD as into the making of the resource and outline how Best Beginnings has recruited and is supporting Small Wonders Champions to be catalysts for change in their hospitals.

 

Nils Bergman MB ChB, MPH, MD

Dr Bergman’s primary professional interest revolves around Kangaroo Mother Care (KMC), and the underlying perinatal and developmental neuroscience. His diverse background explains his broader public health approach to supporting and promoting the global dissemination of maternal-infant skin-to-skin contact. For the last five years he has been devoting himself full time to this, and is a popular speaker at conferences and workshops. When not travelling and lecturing, he researches with the University of Cape Town, developing a brain monitor that will read the autonomic nervous system.

After graduating from the University of Cape Town, Dr Bergman started his medical career as a mission doctor in Manama Mission, Zimbabwe. It was there that he began his work with KMC. During his seven years in Zimbabwe he completed a doctoral dissertation (Clinical Pharmacology, MD = unsupervised PhD) on deadly scorpion stings. He initiated Home Based Care programmes for HIV/AIDS. He introduced KMC to South Africa in 1995, and after 5 years, KMC became official policy for care of prematures in the hospitals of the Western Cape province. During this time he completed a Masters in Public Health. He was for 6 years Senior Medical Superintendent of the Mowbray Maternity Hospital and five Midwife Obstetric Units, overseeing 18,000 births per year. His last posting was as a technical advisor to the health department on health reform.


Kangaroo Mother Care for Premature Babies

Skin-to-skin contact is the actual intervention underlying what is commonly called Kangaroo Mother Care (KMC). This includes several components, chiefly Skin-to-skin contact (SSC), then breastfeeding, and then support with early discharge. KMC is becoming increasingly accepted, but a coherent scientific rationale is lagging. Dr Berman presented such a rationale, built on the central dogma of all biological processes: the DNA makes proteins, which make the brain, which with more DNA makes everything else. The adaptation in epigenetics, sensory experience for developmental neuroscience, and reproductive fitness in evolutionary biology converge holistically in this understanding. The common thread in all these is the environment. The “Environment of Evolutionary Adaptedness” (EEA) for humans is the mothers’ chest, defined in essence as “maternal-infant skin-to-skin contact” (SSC).

The environment is never static, and the EEA spans a spectrum from “expected” through “harsh” to “hostile”. Genetic and neurological adaptations in harsh environments allow the organism to achieve “reproductive fitness”, by trading optimal development and well-being for a shorter lifespan with rapid reproduction. The mechanisms whereby this is achieved have recently been revealed, they are triggered by maternal separation, leading to “toxic stress”, autonomic activation with high cortisol. The concept of “allostasis” further elaborates how long term adverse effects follow from early life events. The basis of this understanding comes from mammal research on maternal neonate separation models.

Dr Bergman’s own recently published research was presented showing that separation from mother trebles autonomic nervous system tone, and dramatically impacts quality of sleep, compared to SSC. These finding are consistent with the science presented. In terms of our evolutionary biology, this suggests that infants should not sleep alone, and any clinical care in the absence of mother may be experienced as “toxic stress”. SSC is currently seen as a non-invasive intervention; the challenge for the future is to view it as the normal care environment. Working with nature in this way, even very preterm infants will better tolerate any needed invasive care.
Early in 2012, the AAP published a summary of the above scientific rationale, entitled “Early adversity, Toxic Stress and the role of the Paediatrician” (Garner). This fails however to emphasise the relevance of this research to the neonatal period. Dr Bergman explained this, arguing that the smaller and younger a newborn is, the less resilience it has, and the more in need of mothers’ body it is. The required technology should then be added as required. Amazingly, in this environment infants at 28 weeks show suckling behaviours, and can exclusively breastfeed by 32 weeks.

 

Liz Brooks JD, IBCLC, FILCA

Liz Brooks is a lactation consultant in working in private practice (since 1999) and a lawyer (since 1983). She received her certification as IBCLC in 1997, after volunteering for six years as a lay breastfeeding counselor. Before she left the active practice of law (to stay at home with her three children), Liz worked as a criminal prosecutor, a Congressional lobbyist and a federal litigator. Her legal expertise is in ethics, lobbying, administrative and criminal law.

Liz is familiar by training and experience with the array of challenges faced by lactation consultants each day. As an IBCLC, Liz has worked in: private practice (offering home visits); a hospital setting (offering prenatal education, “rounding” on breastfeeding mothers and babies in the full-term and Level III NICU nurseries, and providing in-service education to nurses, doctors and midwives); a non-profit, community-based breastfeeding clinic (providing IBCLC service to mothers on a sliding fee scale).

Liz has been on the Board of Directors of the International Lactation Consultant Association (ILCA: Secretary 2005-11; President 2012-14); she is the United States Lactation Consultant Association Alternate to the United States Breastfeeding Committee (since 2011) and is an Elected Representative on their Board of Directors (2012-14). She remains active in her local USLCA chapter PRO-LC. Liz was designated Fellow of the International Lactation Consultant Association (FILCA) in 2008, the inaugural year for the program.

Liz authored a book, Legal and Ethical Issues for the IBCLC, published in 2013 by Jones & Bartlett. She was lead author in one chapter in each of two other books on similar topics, and is a self-published author of HIPAA privacy documents for the private practice IBCLC.


You want it; They own it! Copyright Law and Ethics

How can you get your hands on some excellent breastfeeding pictures for the client handout you are writing? Why not just download that great photo from that nifty website? This session defined the four areas of intellectual property (IP) law, focusing particularly on copyright law around the world. Participants learnt about IBLCE Code of Professional Conduct Principle 2.5, requiring IBCLCs to respect IP laws. They learnt how to protect their own materials from unauthorized use, and how to obtain permission to use copyright-protected materials from others. Also given were the websites and links for several sources of permission-for-use-granted lactation materials, available for immediate use.

 

Uwe Ewald MD, PhD

Professor Ewald has over 30 years experience as a paediatrician and has been a professor in Neonatology for nearly 20 years. During his career he has produced 140 peer reviewed publications and has been involved in many organisations and projects on improvements of neonatal care. He has been an international speaker at many conferences and supported a multitude of students during his career.

His recent research projects are focused on change processes of culture/climate in the NICU, and the implementation of new care routines, research and knowledge translation, family centered care, kangaroo mother care and breastfeeding.

Breastfeeding in a Modern NICU in Sweden – A Family Centred Approach

Today almost all very preterm infants are separated from their parents in the Neonatal Intensive Care Units (NICUs). Separation is suggested to be a critical initiator of a process leading to later behavioural and emotional problems both of the infant and the mother. Compared to healthy term infants, preterm infants are developmentally immature and cannot be fully breastfed right after birth. The busy and often hostile NICU environment adds further obstacles to the initiation of breastfeeding. The mother-infant relationship is also negatively affected by institutional authority, emotional exhaustion and considering breastfeeding as a productive process, not a mutual and successful experience.

Recent research has shown that breastfeeding can be initiated early, also in very preterm infants if physiological stable, and in a supportive context in which behavioural cues are acknowledged. Physical closeness such as skin to skin contact support both breastfeeding and emotional closeness. Mother-baby dyads who applied kangaroo care are more likely to initiate and breastfeed for longer time. In order to facilitate this physical and emotional closeness the organisational culture and care patterns need to be changed. The configuration of the hospital care space must facilitate maximum/continuous contact between mother and baby as well as other key family members. There are large and systematic differences related to cultural and contextual issues, such as parental involvement, implementation of family-centred care and staff practices. The experience from the change process in a NICU in Sweden was presented.

 

Veronica Garea ME (Nuc Eng), MS, PhD (Eng Phys), IBCLC

Dr Veronica Garea has worked in breastfeeding promotion and support since 1998. She is an IBCLC. She also holds a ME in Nuclear Engineering, a MS in Math and a PhD in Engineering Physics. She is currently the head of the Department of Safety and Environmental Impact at INVAP, in Argentina. She is also adjunct faculty at the Universidad Nacional de Rio Negro and has acted as invited lecturer at Instituto Balseiro. She is an independent consultant in nuclear safety for the International Atomic Energy Agency.


Breastfeeding and Radioactivity

The effect of radiation is often misunderstood and inappropriate decisions are made as a consequence. Radiation and breastfeeding are often thought as incompatible. However, there are few instances when radiation use or application implies cessation or suspension of breastfeeding. This presentation offered information on the effects of different uses of radiation and radioisotopes on breastfeeding mothers and their babies and information to aid in decision making.

 

Karen Kerkhoff Gromada MSN, RN, IBCLC, FILCA

Karen Kerkhoff Gromada is currently employed as a Nurse-Lactation Consultant Educator by TriHealth Hospitals (Cincinnati, OH, USA) after more than a decade of maintaining a small independent LC practice. In addition to developing continuing education materials for staff, she also provides direct mother-baby lactation consultant services.

During the 1990s, she worked as an adjunct clinical instructor for the departments of Parent-Child Nursing, and Community, Adult and Psychiatric (CAP) Nursing at the University of Cincinnati, College of Nursing. Karen also has work experience in labor and delivery, childbirth education and early postpartum discharge care.

A La Leche League leader since 1975, she formed the first LLL group for mothers of multiples in 1977 after the birth of her twin sons and she continues to lead this group. The experiences of mothers in this group have provided the basis for her book Mothering Multiples: Breastfeeding and Caring for Twins or More (LLLI). She has written numerous general and multiples-specific breastfeeding-related articles and chapters for professional and lay publications, and is a well-known speaker on numerous breastfeeding-related topics. A former ILCA president (1994-1996), Karen was among the first group to be designated Fellow of the International Lactation Consultant Association (FILCA) in 2008.

Breastfeeding Twins, Triplets or More

The dramatic increase in multiple births over the last two decades has resulted in a corresponding increase in research and clinical literature investigating various aspects of parenting multiples, including breastfeeding. For the last several years, survey data indicates that women giving birth to twins and higher-order multiples plan to initiate breastfeeding at approximately the same rate as women with single-birth infants, yet breastfeeding duration for this subgroup generally is lower. Research may have identified factors related to breastfeeding multiples, but few offer practical solutions for improving outcomes. Clinically based articles often discuss strategies for breastfeeding multiples, but many focus mainly on breastfeeding mechanics rather than on the physiological and psychosocial issues that profoundly influence the woman breastfeeding multiples. Lactation Consultants and other members of the family’s healthcare team must put all the puzzle pieces together in a holistic manner if they are to offer effective yet sensitive strategies for managing the typical, yet multiples-specific, breastfeeding challenges this special situation presents. This session offered an overview of the recent literature addressing breastfeeding multiples and related factors, synthesized the findings into a cohesive whole, and considered the process for developing clinical interventions for breastfeeding issues associated with multiple-birth infants.

 

Heather Harris BN, MMid, IBCLC

Start where you are, use what you have, do what you can.” Thus said legendary tennis player, Arthur Ashe many years ago. It is fitting advice for anyone who finds themselves working in communities where there is little or no organised health care provision. As a midwife I have spent part of the last 11 years working with a large INGO providing emergency care in diverse cultural and environmental situations.

The results of civil war results in the breakdown of health care infrastructures, with poverty and malnutrition leading to an increase in premature and growth restricted babies being born. Adequate care of these very vulnerable neonates when there is virtually no technology available is a constant challenge and over the years I learned to think “outside the box” to enable survival for many of our tiny babies who eventually went home with their mothers.

This presentation will explore what some of the challenges and solutions were and how local staff were able to embrace the notion that many very small babies can survive by applying what Arthur Ashe said. We found that if we were able to keep these babies “warm, pink and sweet” and involved the mother in all aspects of their care, many survived and went home fully breastfeeding and thriving.


Use What You Have, Do What You Can

Despite research supporting the critical importance of skin to skin between mother and baby after birth, hospital protocols such as weighing and dressing babies and separating mother and baby may significantly disrupt early mother-infant interactions. This may have unintended negative effects on bonding and attachment as well as the initiation of breastfeeding. The evidence for this was discussed along with what this meant for early parenting and for those who care for babies and parents, in normal and adverse circumstances.

 

Kathleen Marinelli MD, IBCLC, FABM, FAAP

Dr Marinelli is an Associate Professor of Pediatrics at the University of Connecticut School of Medicine, and a neonatologist and director of Lactation Support Services at Connecticut Children’s Medical Center, Hartford, CT, USA. She graduated from Cornell University and Cornell University School of Medicine and was a pediatric intern, resident, nephrology fellow and neonatology fellow at Children’s National Medical Center, George Washington University, Washington DC.

She was in the first group of 20 physicians to be recognized internationally with the designation of “Fellow of the Academy of Breastfeeding Medicine” (FABM), and is serving her tenth year on the ABM Board of Directors, also chairing the Protocol committee. She represents ABM on the United States Breastfeeding Committee, where she Chairs the Media/Public Relationship Committee and was elected USBC Chair-elect in August 2012. She is a member of the American Academy of Pediatrics (AAP) Section on Breastfeeding, and since 2000 has served as the AAP Connecticut Chapter Breastfeeding Coordinator. She was instrumental in drafting and passing comprehensive breastfeeding in the workplace legislation in Connecticut in 2001, and Jury Duty Legislation in 2012. She volunteers on a medical advisory committee to Baby-Friendly USA. While serving on many state and local committees and organizations she is also active in the Connecticut Breastfeeding Coalition.

A long-time believer in the use of pasteurized donor human milk when needed, she was founding Medical Director of the New England Mother’s Milk Bank and is currently co-Medical Director of the developing Mothers’ Milk Bank of the Western Great Lakes. She has authored a number of chapters, monographs, research articles, and ABM protocols. Her research interests center on breastfeeding and the use of human milk in the neonatal intensive care unit, cup feeding, donor milk and donor milk banking, and the education of medical professionals.


Human Milk and Breastfeeding for Very Low Birth Weight Infants: Nature’s Contribution to Technology’s Miracles

The historical importance of human milk in the survival of premature babies is recognised and Dr Marinelli discussed the current evidence-based rationale for the key role of human milk in the therapeutic regimen of VLBW (Very Low Birth Weight) infants. She looked at the use of both mother’s own milk and donor milk for VLBW infants and consider the challenges of breastfeeding a VLBW infant in the NICU. As the developmental transitions toward exclusive breastfeeding in this population are explored, it is necessary to identify supportive practices in a NICU environment which value the use of human milk in VLBW infants.

 

Jane Morton MD, FAAP, FABM

Dr Jane Morton has had a long, fulfilling career as a general pediatrician, She has also had a long-standing interest in breastfeeding, from understanding its clinical benefits to practical solutions for mothers having difficulty in providing breastmilk to their infants. Over the years, she has conducted research on human milk and breastfeeding and has designed and implemented systems and policies to help breastfeeding mothers. She produced award winning videos on this topic, including Breastfeeding: A Guide to Getting Started, A Preemie Needs His Mother: Breastfeeding a Premature Baby and Making Enough Milk, the Key to Successful Breastfeeding. These have been translated and widely used in thousands of hospitals to train both staff and new mothers. As an executive board member of both the Academy of Breastfeeding Medicine and the American Academy of Pediatrics Section on Breastfeeding, she enjoyed working to enlarge the footprint of breastfeeding, both nationally and internationally.

For a 5 year period, she joined the neonatology clinical faculty at Stanford to develop the Breastfeeding Medicine Program. In that position, she had the opportunity to design a nationally recognized educational program and publish a study with the AAP on the efficacy of a breastfeeding curriculum for physician residents in training. She was an advisor to the California Perinatal Quality Care Collaborative, and was a key author of the toolkit Nutritional Support for the Very Low Birth Weight Infant. She co-authored the book Best Medicine: Human Milk in the NICU. She has published extensively and presented her original research and educational workshops internationally. She will gave two presentations for this iLactation conference.


Game-changing Research about Breastmilk Expression: Early Hand Expression and Hands-on Pumping

In considering milk production in mothers of preterm and term infants, Dr Morton reviewed the research on hand expression used in the first 3 postpartum days and hands-on pumping used after lactogenesis and the influence of these techniques on milk production and composition. She discussed the clinical implications and subsequent research.

The scope of the problem of insufficient milk production in mothers of both term and preterm infants was covered and the rationale for hand expression used in the first postpartum days and the influence of this technique on subsequent milk production.

Baby-Friendly Bedside Care for Low and High Risk Infants: A Shared, Sustainable, Proactive Model

There is a need for change in early breastfeeding management practices. Dr Morton looked specifically at the low risk mother-infant dyad and the high risk mother-infant dyad, and discussed her “Share the Care: 5-point Plan”. There is convincing evidence that change is needed and the rationale for re-prioritizing 3 objectives, A, B, and C
A – attachment (latch and transfer)
B – breastmilk production
C – calories (to meet appropriate nutritional parameters)
to C, B and A for high risk mother-infant dyads were discussed. Finally she considered how a sustainable model of care could provide efficiency, a stable, expanded skill base, and accountability.

 

Josephine Nalugo BA(SS), Cert IYCF

Josephine Nalugo graduated with Hon BA(SS) and is a certified National Trainer in Infant and Young Child Feeding and a member of IBFAN Uganda. She is the mother of two breastfed daughters Chantal, eight years old, and Charlene, five years old, from whom she derives her inspiration. The two children have started a project “Shaping the future of breastfeeding” teaching other children about breastfeeding and how to support breastfeeding mothers through coloring, shading, reading and performing the Seven Acts of Kindness.

For the last eight years, Josephine has supported mothers to breastfeed in Uganda. Her membership to the International Lactation Consultants Association (ILCA) through the Partner Program supported by Wisconsin Association of Lactation Consultants (WALC) has earned her a great deal of opportunity to present and attend Lactation conferences. Josephine started a not-for-profit community based initiative in 2005 to support the vulnerable rural mothers to breastfeed. Activities conducted are not limited to breastfeeding, and include among others breastfeeding training and counseling, growth monitoring, complementary feeding parties, hygiene and sanitation, income generation, food security through vegetable/fruit growing and animal keeping. Josephine is a determined open minded person who seeks to learn and share her experience with all individuals regardless of where you come from to enable her move forward – this is how she linked to iLactation.

What about the Lifetime Investment? Breastfeeding – the Ugandan Experience

In this presentation Josephine introduced Uganda and the breastfeeding situation there. She highlighted the beliefs and practices associated with breastfeeding and having children in Uganda, and discussed the status of the Practices, Policies and Programmes of Infant and Young Child Feeding, and she introduced the initiative to support vulnerable rural mothers and mentioned some of her own recommendations for the way forward.

 

Jacquie Nutt BSc, GradCertEd, IBCLC

 

Jacquie Nutt is a lactation consultant in private practice in Wellington, South Africa. She was raised in Zimbabwe but moved with her family to South Africa in 2000.

She has been working with breastfeeding babies for over 20 years in many capacities, having been a La Leche League Leader since 1991 and an IBCLC since 1999. In Zimbabwe, she was appointed as a representative of La Leche League to advise the Zimbabwe Infant Nutrition Committee. This committee oversaw the implementation of the baby feeding regulations based on the WHO Code of Marketing of Breast Milk Substitutes. She was the South African coordinator for the International Board of Lactation Consultant Examiners from 2003 to 2011.

Jacquie organised the first meeting that grew into the milk bank in Cape Town in 2002, now known as Milk Matters. With the help of many committed volunteers and paid staff, it has grown to supply donor milk to 27 hospitals in the Western Cape, with over 1000 donors. Milk Matters has helped other hospitals set up their own milk banks.

Establishing a Donor Milk Bank: Not Rocket Science

While breastfeeding is the biological norm, there are occasions when babies are not able to access their mothers’ milk. Donor milk banking can best fill the gap – so why are there not more milk banks around? This presentation explored the basic principles of milk banking and concluded with a report of the speaker’s practical experience in setting up a low-resource milk bank at the local hospital, supported by Milk Matters.

 

Gillian Opie MBBS, IBCLC, FRACP(Paed)

Dr Opie is a full time Neonatal Paediatrician at the Mercy Hospital for Women, Melbourne, Australia. In 1997 she became an International Board Certified Lactation Consultant and has been an invited speaker at national and international lactation conferences speaking on topics of neonatal paediatric interest. She is a member of the editorial board of the online International Breastfeeding Journal and in the past has been a Baby Friendly Hospital Initiative assessor and educator as well as a Director of both the Australian Lactation Consultants Association and the Lactation Consultants of Australia and New Zealand. In 2011 with Kerri McEgan she opened the first donor human milk bank in Melbourne.

Current research includes the Proprems trial of Probiotics to prevent sepsis in preterm infants and the DAME trial assessing Diabetes and Antenatal Milk Expression. Future research will have a strong donor milk banking focus.

Sugar not Spice: Blood Glucose Management in the Preterm Infant

The normal physiology of glucose homeostasis was discussed including the role of counter-regulatory hormones and the effect of different substrates on blood glucose levels in preterm infants. Evidence was presented to support the accepted definition of hypoglycaemia in the preterm infant. Influences of maternal disease states in pregnancy on glucose control in the preterm fetus were included although the management of the term infant of the mother with gestational diabetes was not the focus of the presentation. The focus was upon monitoring and management strategies required to maintain safe blood glucose levels in both the well and unwell preterm infant. Particular methods that could be applied to the late preterm infant with emphasis on the use of breastmilk were considered.

 

Jill Rabin MS, CCC-SLP/L, IBCLC

Jill Rabin is a pediatric speech pathologist and international board certified lactation consultant. She has been working primarily with the 0-3 population for 26 years. She was hospital based for 14 years, where she worked in two Chicago hospitals as both a speech pathologist and lactation consultant. At Advocate Illinois Masonic hospital in Chicago, she developed a feeding program to facilitate smooth transition to oral feedings for all babies in the special care nursery and participated as part of a weekly diagnostic team that provided developmental follow-up to premies.

Currently, she has a private practice in the Chicagoland area where she primarily sees at-risk and special needs breastfeeding patients, children with Down syndrome and children with feeding aversion through the early intervention system. She often follows her Down syndrome patients as breastfeeding newborns until they age out of the early intervention system. She also works at the New Mother New Baby lactation center in Northbrook, where she teaches classes on transitioning babies to solid foods, and holds an educational group called the North Shore Down Syndrome Awareness group where families and their children meet for social and educational purposes. It is her hope to build a collaborative relationship between speech pathologists and lactation consultants with the goal of increasing the possibility of successful breastfeeding, especially with at risk infants.

Breastfeeding and Premies – Identifying Risk Factors for Oral Aversion

Participants learnt about oral motor milestones and sucking patterns in premature infants. Effects of neurological, respiratory and gastrointestinal issues and their influence on feeding and in creating the likelihood of a feeding aversion were discussed. Participants were able to identify risk factors for premies and high-risk infants for developing feeding aversion. Different methods of intervention and ideas for prevention of feeding aversion were also addressed.

 

Mary Kay Smith RN, IBCLC, FILCA

Mary Kay Turner Smith has been assisting breastfeeding women for more than 25 years; as a La Leche League Leader since 1982 and as a board certified lactation consultant since 1988. She is also a Registered Nurse and Certified Childbirth Educator. She is one of the original members of MILC (Metro Illinois Lactation Consultant Association) and a founding member of NILCA (Northern Illinois Lactation Consultant Association). Currently she is serving as the President of MALC (Michigan Association of Lactation Consultants). She is a member of the Michigan Breastfeeding Network (A Healthy Mothers, Healthy Babies chapter), BirthNetwork, a local organization supportive of natural childbirth and attachment parenting, and AHWONN. In 2008, she was awarded the honor of being named a Fellow of the International Lactation Consultant Association; an award instituted to recognize leaders and mentors in the field of lactation consultation.

Mary Kay has presented at many local, regional and national conferences on breastfeeding and has published numerous articles on breastfeeding for parents and health care professionals. She is currently employed at Henry Ford Hospital in Detroit, Michigan, USA as a lactation consultant.


Ten Ps for Premies: Best Practice Guidelines to Support Breastfeeding in the NICU

Breastfeeding of premature or sick babies offers unique challenges. The development of the Ten Ps for Premies identifies ten practices to support breastfeeding in the Neonatal Intensive Care Unit (NICU). It includes practices that promote human milk as the primary source of nourishment and help transition the baby to effective breastfeeding. These guidelines are for sick full term infants as well as preterm infants.

Due to improved technology in the area of preterm birth, the age of viability has become lower year by year. Mothers face unique challenges; those related to the situation of prematurity as well as the stress of a life event with an uncertain outcome. The provision of breast milk supports superior nutrition as well as improved physical and cognitive development of the prematurely born infant. The stress of a complicated pregnancy, the need for extended bed rest to delay delivery, and the potential for experiencing a cesarean birth combined with a lack of knowledge and social and economic factors, all impact the success of initiating and maintaining milk production and the ability for mother and baby to bond and nurture each other as baby grows.

 

Barbara Wilson-Clay BSEd, IBCLC, FILCA

Barbara Wilson-Clay has been in private practice in Austin, Texas, USA, specializing in physician-referred difficult breastfeeding cases since 1987. She helped found The Mothers Milk Bank at Austin, a non-profit community milk bank, and served on its board of directors for 11 years, the last 2 as Vice President. As a volunteer lobbyist in the Texas legislature during each legislative session since 1993, Barbara has been instrumental in helping pass legislation promoting breastfeeding rights. Her corporate clients include Motorola, IBM, and Apple Computer for whom she has developed workplace lactation support and lactation rooms.

Barbara’s research and commentaries have appeared in The Journal of Human Lactation, Current Issues in Clinical Lactation, Birth Issues, Breastfeeding Abstracts, The International Breastfeeding Journal, the ICEA Journal, and Archives of Disease in Childhood. She serves on several editorial review boards. Barbara served as the ILCA representative to the International Board of Lactation Consultant Examiners (IBLCE), and has been a La Leche League Leader since 1981. She was named a Fellow of the International Lactation Consultant Association (FILCA) in 2008.

Barbara is co-author of the text book, The Breastfeeding Atlas, and numerous multi-lingual patient and professional educational materials.

Breastfeeding the Small for Gestational Age Infant

Clinical breastfeeding management strategies have been well-described for the premature and near-term infant. Less well-understood are the risks, special feeding issues, and potential outcomes of term infants who experience intrauterine growth restriction (IGUR) and are born Small-for-Gestational-Age (SGA). This case study presented a review of the literature and a description of the breastfeeding management of a 2267 gram term infant born to a first-time mother. The presentation emphasized strategies to prevent excessive loss of infant birth weight and to maximize early growth and neurodevelopment with exclusive human milk feeding.