Elyse Blair, RN, BSN, ANLC, IBCLC , Healthy Children Project Faculty Emerita, has spent most of her almost 50 year nursing career helping the smallest and most medically complex infants. Blair worked as a labor and delivery nurse for the first several years of her career, but she was always curious about the babies who spent time in the neonatal intensive care unit (NICU). After taking some time off after the birth of each of her sons, Blair returned to work with the same interest in the NICU setting.
“The curiosity was still really revved up about these babies,” Blair shares.
Eventually, that curiosity evolved into a passion that would lead her to play an integral role as a lactation care provider in a 100+ bed NICU at an Atlanta hospital.
Blair was instrumental in developing and implementing lactation programs at the special care nursery, starting conversations with neonatologists about human milk and breastfeeding. Up against a glaring deficit in lactation and breastfeeding education and training for medical students that still exists to this day, Blair was successful in advocating for human milk feedings for these medically complex babies. While feedings do not always occur directly at the breast, (although it’s been documented that a clinically stable preterm singleton infant initiated breastfeeding at 27.9 weeks postmenstrual age) once human milk feedings were established either by gavage, cup or spoon-feedings, Blair reports that their necrotizing enterocolitis (NEC) rates dropped markedly. NEC is common among very low birth weight (VLBW) infants and can lead to death.
“The babies were just not as ill,” she says. [For more on the effects of human milk on NEC, visit https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-necrotising-enterocolitis/ ]
Determined to eliminate corporate pressure in her unit, Blair spurred a policy that prohibits formula company and breast pump company representatives from accessing care providers and families during their stay.
Blair recalls an incident where she caught a formula company representative reading a patient’s chart on the postpartum unit.
“The reps all know that breastmilk is the best thing,” Blair begins. “The reps wives all came to us for lactation consults. They’re just good at peddling a product. It’s just not ethical.”
In order to normalize breastfeeding at her institution further, Blair advocated for language changes on pre-admission paperwork. Wording like “Do you plan to breast or bottle feed” was changed to “How long to do plan to breastfeed or provide breastmilk.”
Blair started a program called the Mother’s Express, a two hour luncheon where parents from her NICU could interact with peers. Their hospital provided the meal, and Blair brought in speakers like social workers and psychologists specializing in the preterm population and other professionals. She says this is one of her accomplishments she is most proud of.
“Parents came in droves,” Blair remembers groups of 50 to 60 parents coming at a time, nodding to the importance of peer-to-peer support. “Parents made lasting relationships.”
Blair also fondly remembers the yearly preemie birthday party her NICU hosted for the babies they cared for.
“It was amazing to see many of these children just thriving,” she says.
The increasingly incredible outcomes of premature babies Blair notes, are often due to what she considers the most significant change she’s witnessed over the course of her career as it relates to care of infants in the NICU: surfactant. Surfactant is a substance that treats respiratory distress syndrome and some other respiratory conditions in underdeveloped neonatal lungs. Aerosolized surfactants have often decreased the need for intubation.
“There is a striking difference for parents when there are less tubes and wires all over their babies’ bodies,” Blair says. “Parents of fragile babies are often extremely cautious, but we want them to participate in their baby’s care.”
Family-centered care can increase parental confidence and positively influence infant health outcomes; however, it is interesting to note a phenomenon that Dr. Renée Flacking reported on at the 2019 Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives conference.
Healthy Children Project’s Cindy Turner-Maffei, MA, ALC, IBCLC covered her presentation in a previous blog post: “Maintaining evidence-based is a never-ending process requiring not only ongoing uptake of new information, but also ongoing monitoring and evaluation of practice. Renée Flacking’s initial conference plenary focused on the decrease in exclusive breastfeeding that seems to be occurring in Swedish Neonatal Intensive Care Units (NICU), perhaps particularly in those that utilize single family care NICU rooms vs. open-bay NICU units. Dr. Flacking described how in earlier days parents were told that providing human milk was ‘the only thing’ they could do for their babies; today Swedish parents are welcomed to stay in the NICU with their babies, they know firsthand the importance of skin-to-skin contact, responsive parenting, etc.. Renée also discussed how when the parents are in charge of the baby, as in family care, the staff may tend to back off on strong messaging that is perceived as ‘pressure’ to breastfeed. Even in a country where breastfeeding is perceived as normal and breastfeeding support abounds, seemingly positive changes in policy and practice have the potential to create unintended negative side effects.”
Dedicated to evidence-based care, Blair actively taught for Healthy Children Project– evidence-based research, education and care being a pillar of the organization– for more than two decades. Today, she continues to work with students completing the online Lactation Counselor Training Course (LCTC). She was a member of the Eisenhower Foundation Delegation on Breastfeeding and Human Lactation to Russia and Romania and has also traveled to Latvia, Egypt, and Germany, teaching and supporting new parents and their special care babies. She wrote the monograph A Guide to Breastfeeding Your Special Care Babies and co-authored the 2nd edition of Maternal and Infant Assessment for Breastfeeding and Human Lactation. Blair is the proud grandmother of her “heart lights” Millie (11), Charlotte (9), Goldie (5).
Beyond Blair’s work, Our Milky Way has covered special care babies extensively.
Read about Bethany Gallagher’s, MS, CCC-SLP, CLC, CNT experience as a Senior Speech and Language Pathologist working in a level 2 NICU here.
Noel Wier, BSN, RN, CLC and her colleagues at a level IV NICU in Colorado are helping moms with babies born with special challenges prove that they can and do breastfeed with proper support and determination. Read that story here.
Angie Cordero, CLC breastfed her baby born with spina bifida. Read their story here.
Jennifer Cloer’s, CLC premature births inspired her to donate milk to other babies in need. Read that story here.
NICU nurse and lactation professional Donna Warr, RN, IBCLC works with families participating in Lee Memorial Health System’s Golisano Children’s Hospital of Southwest Florida NICU’s program called “Heart-to-Heart” Care which offers parents an opportunity to provide their babies with a sense of closeness while they are separated through sense of smell. Learn more here.
Alongside Blair’s professional work, we would like to acknowledge Lois D. W. Arnold’s, PhD, MPH, ALC significant contribution to the use of human milk in NICUs, Ragnhild Maastrup’s RN, IBCLC, PhD work with preterm infants and their families and Renée Flacking’s, RN, PhD ongoing research.