A journey toward knowing

After spending the week in Deerfield Beach, Fla. at the 26th Annual International Breastfeeding Conference, I find myself relating to speakers Cristiano Boccolini, PhD and Patricia Boccolini, PhD. In their presentation, Evaluating the International Code of Marketing of Breast-milk Substitutes in Brazil: Multi-NBCAL Study, they shared that they’d acquired about two terabytes worth of data to analyze! That is a whopping undertaking. 

I can feel my brain buzzing trying to process the massive amount of data I acquired from all of the brilliant minds of conference presenters and participants alike.

I’ll share just a few points: 

I challenged myself to somehow synthesize the week’s worth of info for the blog and realized that its common thread isn’t necessarily related to the content of the material. Of course it all falls under maternal child health, (and we know “all roads lead to breastfeeding) but the overarching theme I realized this year is that knowledge is a non-linear journey. 

The presenters are so influential and inspiring because the knowledge they share is not connected to their ego; they recognize that change can be hard, but accept its inevitability. They don’t allow their ideas to become stale, and they welcome new perspectives and honor others’ experiences. 

Funnily enough, on my flight to the conference last year, I read Wise Eyes, Fresh Eyes in the January 2019 issue of Southwest The Magazine. Chip Conley, an Airbnb executive, is quoted: 

“‘Instead of power being distributed in the traditional physics of wisdom– from the top down, old to young– the wisdom is now going in both directions.’”  (p 54-56)

The conference speakers embody this sentiment, creating space for discussion from all representations and recognizing themselves as lifelong learners. 

In other airplane reading, Andile Dyalvane, a ceramic artist who stamps his work with industrial objects, is quoted in Architectural Digest’s October 2019 edition: “‘Everything we do has an impact.’” (p 72)

If this is true, then everything we do should be with intention. 

Last week, we heard some harrowing statistics and stories as they relate to mothers and babies and their families:

This stuff is enough to knock you off your feet, but with the spirit and investment of the conference presenters, I’m hopeful that we will continue marching forward, improving maternal child health outcomes and working toward a more just world.    

Ancient bodies in a modern world

There’s a sitcom by a brilliant woman that I started watching as a college student, and I just so happened upon it the other day while I snuggled my sleeping little guy the day before he started his first day of preschool. I managed to get through an episode and chuckled quietly, appreciating the satire. 

There’s a scene where two characters banter about fixing things that aren’t broken. Funny how a parody about corporate complexities got me thinking about maternal child health.

Source: United States Breastfeeding Committee.

Our health system is infamous for fixing things that aren’t broken. We haphazardly employ technology, often times without considering the consequences. It should go without writing, that there is a place for technology and intervention. For instance, about 10 to 15 percent of birthing bodies require a c-section. In these cases, it’s a life saving procedure. But when the operation occurs unnecessarily, there can be tremendously negative ramifications. 

In her most recent piece, Birthing Ancient Babies Into a Modern World, Guest blogger Donna Walls, RN, BSN, ICCE, IBCLC ANLC  explores time-tested systems that are often jeopardized by current medical practice and culture.  

For further reading, I would encourage you to check out anthropologist Wenda Trevathan’s book Ancient Bodies, Modern Lives  which addresses a range of women’s health issues and offers insight into medical consequences. 

 

Birthing Ancient Babies Into a Modern World

Guest Blog Post by Donna Walls, RN, BSN, ICCE, IBCLC ANLC

Newborns are often seen as helpless, but when we take a closer look this isn’t altogether true. 

They actually have many ways in which to adapt to life outside the uterus; systems that have been in place for millennia and are often misunderstood by medical science.

Jaundice 

Photo by Kelly Sikkema on Unsplash

A prime example is the bilirubin molecule. The molecule can cause jaundice, or at worst can cause encephalopathy or kernicterus. Modern medicine has determined that jaundice needs to be aggressively treated and kept at as low a level as possible. Interestingly though, about 70 percent of newborns are clinically jaundiced. Doesn’t it seem strange that something that occurs in the majority of newborns is deemed pathological?

When scientists began investigating the bilirubin molecule, it was found to have antimicrobial and anti-inflammatory effects. (Hansen, 2018) So, can bilirubin be a first line of defense against infections or sepsis in newborns? This ancient system in newborns might be misunderstood, resulting in over-treatment and potentially jeopardizing an effective way to reduce the risk of infections. 

Of course, ongoing monitoring of bilirubin levels is important to prevent kernicterus, but this phenomenon deserves further investigation to test whether jaundice should be treated as aggressively as current practice suggests. 

Vernix 

Vernix–that cheesy substance found on newborns’ skin– is another example of how infants’ innate protective mechanisms are not well understood or utilized in modern medicine. 

In the drive for cleanliness in hospitals, the practice of bathing newborns as quickly as possible after birth became a routine practice. Medical asepsis became a priority (and often still is),  over mother-baby attachment and bonding. 

In fact, there are many benefits to leaving the baby “unwashed” and the vernix intact. Studies show that vernix has an antimicrobial effect,  (Singh, 2008), a moisturizing effect and is thermoregulating. If undisturbed, vernix will be absorbed into the newborn skin in about five days. 

Stress response 

Maternal hormones, present in all mammals, elicit a strong protective response toward our offspring. (Saltzman, 2011) Newborns, too, demonstrate a stress response when separated from their mothers. Infants begin frantic crying, show hyperarousal with increased stress hormone levels, heart rate, blood pressure and glucose utilization. (Bergman, 2013)

Still, modern practice often separates the dyad. Parents are often told “they need their rest” or that their baby needs to be taken to the nursery for exams and/or vital signs, when these goals are easily achieved with baby in close proximity to the mother. 

Parent baby separation can send a subtle message that health care providers (HCPs) can do a better job of caring for the newborn than the parent can. For instance, removing the baby from the mother immediately after birth to be warmed in an artificial warmer, ignores the mother’s ability to warm her baby on her chest (Kolsoom, 2018).

When we provide care that does not build parents’ confidence to care for their babies, we have not delivered the best care possible. 

HCP’s job is to honor and facilitate the ancient system of mother baby attachment and bonding through policies, practices and our words to ensure the best health outcomes. 

Colostrum and milk 

Human milk is tailored specifically to the needs of our offspring. Studies by Lozoff (2013) clearly demonstrate the constituents of human milk not only support infant nutritional needs, but also provide necessary immunities and other protective factors. The amount of lactose and the concentration of human milk affects feeding patterns and parenting styles. 

Biologically, our newborns require frequent feedings (roughly 10 to 12 each 24 hours) demonstrated by the high water content (dilute) of human milk, and constant close contact between mother and newborn facilitate this frequent feeding pattern. Again, common medical practice requires, or at least encourages, newborns to spend time in the newborn nursery away from their parent. 

Breast-seeking behavior 

Additionally,  where technology has largely interrupted newborn instinct, newborns aren’t given the opportunity to recognize their mother’s smell, another way of facilitating mother-infant bonding and initiating breastfeeding. 

Irrefutable evidence shows that immediate, uninterrupted skin-to-skin contact after birth allows baby to successfully complete its first feeding.  Instinctive breast-seeking behaviors ensure the newborn will receive the colostrum needed to maintain blood sugar and body temperature. 

In the 1970s a Swedish midwife, Ann-Marie Widstrom, observed a specific pattern of movements as the newborn accomplishes the first feeding. These movements, the nine stages, are universal in healthy newborns and provide the most stable environment for their immediate adaptation. (Brimdyr, 2017)

It has been documented that very few maternity care facilities allow the time for newborns to complete the 9 stages and self-attachment to the breast which can affect an entire breastfeeding relationship.  Care protocols too often place the emphasis on the “tasks” of initial vital signs, drying, weighing and assessments often leading to transfer from the labor area. 

But when newborn instinct is left to proceed uninterrupted, mothers glean benefits too; as the newborn crawls to the breast, it kneads the fundus of the uterus to prevent maternal hemorrhage. 

Source: United States Breastfeeding Committee (USBC)

All of these phenomena considered, several questions arise:

How did a system that routinely separates mothers and babies become the norm?

Why do we place the needs of the system– staffing, policies, artificial time constraints– ahead of time-tested newborn and maternal abilities? 

How did mothers become socialized into allowing their newborns to be taken away when our biology strongly encourages mothers to keep them protectively close?  

Why is it that we do not change “the system” to prioritize what is most certainly the biological norm, the safest and most stable place for the newborn?

References

Agosti M1, Tandoi F, Morlacchi L, Bossi A. (2017)  Nutritional and metabolic programming during the first thousand days of life. Pediatr Med hir.  Jun 28;39(2):157. doi: 10.4081/pmc.2017.157.

Baker-Rush, M. (2015) International Journal of Childbirth Education . Jul, Vol. 31 Issue 3, p44-47. 4p. 

Bergman, J., Bergman, N. (2013) Whose Choice? Advocating Birthing Practices According to Baby’s Biological Needs. J Perinat Educ. Winter; 22(1): 8–13. doi: 10.1891/1058-1243.22.1.8

Brimdyr, K, Cadwell, K, et al, (2017). An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth. Maternal & Child Nutrition, doi.org/10.1111/mcn.12571

Charpak, N (2016), Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 139(1):e20162063

Condo, H. et al. (2019) Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath. Journal of Obstetric, Gynecologic & Neonatal Nursing,  DOI: 10.1016/j.jogn.2018.12.008

Dunfield, K. (2014).  A construct divided: Prosocial behavior as helping, sharing, and comforting subtypes.  Frontiers in Psychology, 5, 1-13.

Hansen, R. et al. (2019) Adaptive response of neonatal sepsis-derived Group B Streptococcus to bilirubin. Scientific Reports volume 8, Article number: 6470 

Kolsoom, S., et al. (2018) The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor. Int Breastfeed J. 2018; 13: 32. Published online  Jul 16. doi: 10.1186/s13006-018-0174-9

Li J, Li Y. (2018) Birth with dignity from the Confucian perspective. Theor Med Bioeth.Oct;39(5):375-388. doi: 10.1007/s11017-018-9460-1.

Lozoff, M. (2013) Childrearing and Infant Care Issues A Cross Cultural Perspective. Nova Science Publishers, Inc. NewYork, NY.

McNabb, M., Oudshoorn, C. (2011) Moves to transform maternity AIMS Journal Volume 23, Issue 3, Pages 19-21 

Mobbs, E.  (2016) Imprinting, latchment and displacement: a mini review of early instinctual behaviour in newborn infants influencing breastfeeding success Acta Paediatrica. 28 April 2015 https://doi.org/10.1111/apa.13034

Odent, M. (2009) “The instincts of motherhood: Bringing joy back into newborn care” Early Human Development. Volume 85, Issue 11, November, Pages 697-700 https://doi.org/10.1016/j.earlhumdev.2009.08.053

Saltzman,W.., Maestripieri, D.,The Neuroendocrinology of Primate Maternal Behavior. Prog Neuropsychopharmacol Biol Psychiatry. Jul 1; 35(5): 1192–1204. Published online 2010 Oct 1. doi: 10.1016/j.pnpbp.2010.09.017

Taking ‘if’ out of the equation

In a remote town called Patmara in Nepal, there’s little doubt that women can breastfeed, Beth Amy Carter, MSN, RN, CNM of Montezuma County Health Department’s Montelores Nurse Family Partnership (NFP) reports. 

“Everybody breastfeeds,” she says. 

Carter poses with one of the health workers in the town of Patmara.
“She was so kind to me and stuck by my side the whole time we taught at her village,” Carter says.

Carter had the opportunity to venture to Patmara to teach women’s health alongside colleagues and friends visiting on a research visa. After a couple of flights, and a hike up the valley, she spent three weeks teaching health care workers and village women about female anatomy, cycles, birth and beyond. 

What she learned was how effective simple support can be. 

Carter explains:

“The four health workers in that village are each responsible for 19 families. They make home visits and hold monthly teaching for the families in their village. 

The health care workers are not necessarily highly educated, but they are trained to support [the women]. They know about the 1,000 Golden Days…and just by supporting the women in the community, they have changed the health of their babies and breastfeeding durations.

Pretty amazing what dedicated, compassionate women can do to support one another.”

 She notes that these health care providers are unpaid volunteers.

Carter used a knit uterus– complete with a removable endometrial lining and egg– that one of her colleagues created as an educational tool.

Because people in Patmara don’t consistently have access to clean water or safe artificial formula milks, breastfeeding is the expectation. 

Health care providers measure infant and children’s weight once a month for the first five years of life.

“If someone falls off [the growth curve], then they supplement,” she continues. 

This phenomenon is what Carter brought back to share with the families she works with through NFP in her corner of the world. 

“…Let’s remove that doubt,” she says of breastfeeding. “If you need support, we will support you, but take the ‘if’ out of this equation.” 

Once a practicing nurse-midwife, Carter says that her work with NFP better meets her mission to serve families; it allows her to create long(er)-term relationships.

The goal is to enroll expecting mothers before their 28th week of pregnancy to ensure ample prenatal support and education. In rural Montezuma, Carter says it’s not always prenatal care they’re focused on; sometimes there are substance abuse issues to address and other unhealthy behaviors. 

Montelores NFP serves a large Ute Native American population. Generational trauma affects infant feeding in this community. 

“In a lot of situations, we are the only [ones] committed to modeling positive, healthy behavior,” Carter says. “We are consistent– always there for them. We are not there to do it for them, but we facilitate their success.” 

On a mission to create a more breastfeeding-friendly community, Carter and colleagues designed a Baby Oasis at the Montezuma County Fair over the summer. The pop-up pavillion featured comfy spaces with beautiful fabrics for mothers to feed their babies. Healthy snacks were provided in partnership with the local WIC office. 

Montezuma County Fair Baby Oasis
From left to right:
Delilah Mott (WIC), Carter behind her, Deborah Meyers RN (NFP), Donna Pettigrew (WIC), and Christa Zubieta RN (NFP) in the front.

Carter says she appreciated watching mothers nurse their babies together, chatting as they did. 

“Part of the goal has just been to build community,” she notes. “It seems like young women have a harder time building a young mom support group, so we are trying to help make those connections so they can support one another.” 

Carter and her colleagues also recently completed the Lactation Counselor Training Course (LCTC), and she says they are motivated to share the knowledge they gained with other health care providers in their area.

“The information was just fabulous,” Carter says.

Montelores NFP has partnered with Pinon Project to better serve families in the area too. Together they are in the process of establishing a breastfeeding committee. 

In September, they will host Celebrate the Bump and Beyond, a free family conference modeled after a professional conference with breakout educational sessions.  

Carter is optimistic about the future of families in her community. 

“I work with fabulous nurses who are passionate about supporting women,” she says. “It’s really neat to have the privilege to do that. We have the chance to build a community to change what health looks like here.”

Upcoming presentation on human milk for babies born with unique challenges

Bethany Gallagher, MS, CCC-SLP, CLC, CNT is a Senior Speech and Language Pathologist who has over 14 years of experience working in a level 2 NICU.

“Initially my interests focused on helping children with special needs communicate and quickly spread to treating and feeding the NICU, neonate, and infant population,” Gallagher says. 

Source: United States Breastfeeding Committee
(Photo by Sara D. Davis)

“After years of working with babies in the NICU and other settings, it became clear that best practices for these little ones had to involve their caregivers and educating mothers and parents on how to provide the best chance at success in this life,” she goes on. “Becoming a mother myself for the first time also pushed me into this field as I appreciated how much loving advice and support I received from healthcare specialists.”

Gallagher is currently part of an interdisciplinary lactation and feeding team at Mt. Washington Pediatric Hospital which she helped to create. Their lactation team is comprised of one IBCLC, RN, one Dietician, CLC, one RC, CLC and two CCC-SLP, CLCs. She’s helped develop a variety of other programs like Video Fluoroscopic Swallow Studies and a Fiberoptic Endoscopic Evaluation of Swallowing clinic. 

Gallagher tells the stories of two incredible mothers she worked with who persevered infant feeding challenges.

C.H. came to us as a former 26 week premature infant whose twin brother passed away not long ago at 3 weeks of age.  Mom had maintained her supply and was pumping for C.H., however he had not been cleared to eat by mouth when he was admitted to our level 2 NICU. Through working with mom and C.H. for about five weeks, C.H was discharged home to mom fully breastfeeding with bottles used only for caloric supplementation. 

Skylar was admitted inpatient for failure to thrive at the age of two and a half months and had been inpatient for 6 weeks when I saw her.  Mom stopped pumping when baby was admitted and it was discovered that Skylar needed a liver transplant. Mom was upset and shocked and realized the best/only thing she could do for her baby was provide breastmilk.  Mom began the relactation process and was able to re-establish milk supply within 2 to 3 weeks with diligent pumping. 

Gallagher and her colleagues often see babies with medical challenges and families enduring unthinkable situations, but she says the most grueling challenge she sees for her patient population is the lack of supported leave time after becoming a parent. 

Source: United States Breastfeeding Committee.

“There are enough challenges in becoming a new parent without worrying about returning to your job three months (best case) after becoming a parent,” she begins.  “This is especially true for babies that require extended hospitalization, as these parents are often required to return to work before their baby is home. It is difficult enough being a new parent without the worry of losing your job and therefore your ability to provide housing, healthcare insurance, food, and necessities for daily life.”  

Gallagher  will present  A Review of Congenital and Genetic Disorders and Their Potential Impact on Breastfeeding and Benefits of Premature Infants Receiving Breast Milk and Strategies to Safely Feed Them alongside colleagues Kate Hale, MS, CCC-SLP, CLC, CNT and Lorilyn Russell, MS, RD, LDN, CLC at the upcoming International Breastfeeding Conference

The craniofacial and genetic disorders presentation will feature “before and after success story pictures that are adorable and of actual patients we have treated and helped through the years,” Gallagher reports. 

Her other work will cover nutritional information of human milk and its importance for babies born prematurely. 

Gallagher says she is most looking forward to connecting with different disciplines and learning from a variety of expertises.   

“…And,” she adds, “the nightly happy hour is always an added bonus.” 

Register for the conference to connect with Gallagher and others here

LCP dedicates over four decades to making sure mothers are taken care of

In her 43 year career serving families, Paula Hart, BS, RN, IBCLC, CCE has watched maternal child health care evolve and devolve. She’s accomplished a lot in those four decades including coordinating an outpatient breastfeeding clinic, facilitating breastfeeding support groups, creating Mothers Offering Mothers Support (MOMS) Lactation Resource Centers, becoming an instructor for The Institute for the Advancement of Breastfeeding and Lactation Education (IABLE) and actively participates in the Northern Illinois Breastfeeding Task Force and State of Illinois Breastfeeding Task Force among other projects. 

But there is one thing she hasn’t done: attend an International Conference. That will change in just a few weeks at the upcoming International Breastfeeding Conference where she will present I Have My Certification… What’s Next? Helping Mothers Reach Their Breastfeeding Goals–Without Giving Away the Store alongside Healthy Children Project faculty Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE. Hart and Richter will cover information about starting a private practice for lactation support as well as open discussion about sharing and networking with other professionals. 

“I am so excited,” Hart says.  

Hart’s passion lies in helping mothers feel successful about their feeding goals. 

She says her work with the outpatient breastfeeding clinic really helped her realize her passion, and the clinic space made it easier to better serve moms. Moms and babies were invited for a one hour, one-on-one, free session with a lactation specialist, and Hart and her colleagues opened communication with the mothers’ other care providers to ensure continuity of care. 

“Many women need that lifeline after they leave the hospital,” Hart comments. 

Of course, support prenatally is vital too, so Hart worked on a home visiting program with the State of Illinois Department of Human Services which served a “hugely diverse population.” 

Last year, Hart retired from her position at the hospital to help take care of her then youngest granddaughter, but it wasn’t long before she was conjuring up her next project: MOMS Lactation Resource Centers, private practice lactation support.  

“I need to make sure that moms are still being taken care of,” she says. 

She goes on to explain, that many parents are faced with what seem like insurmountable infant feeding challenges, and they are, she says, if you don’t have resources. 

There’s a common thread that has helped Hart help so many others. 

“Listen first,” she says.  “A lot of our moms just really need to be heard.” 

And it’s clear that this strategy makes a lasting impact. 

Recently, Hart was approached by a mother and her young children at a local store.  

“You helped me breastfeed her!” the mother exclaimed. 

Hart contemplates: “It has taken me to almost the end of my nursing career, but after all of these years, I know that each and every step I took was valuable.”