Where are they now? An update from Nicole Bridges PhD, B Comm (Hons), SFHEA, MPRIA

Then

Amidst trolls who lurk, misinformation that muddies, and insidious marketing,  Nicole Bridges’s PhD, B Comm (Hons), SFHEA, MPRIA (she/her) work illuminates the helpful spaces on the internet. Almost a decade ago, her publication The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online, found that “social networking sites (SNSs) provide support from the trusted community” that is “immediate…practical and valuable…”

In our 2017 coverage, Dr. Bridges pointed out how social media can compliment face-to-face interaction between breastfeeding dyads and lactation care providers, how it can offer moms “access to the collective wisdom of the whole tribe” as opposed to the perspective of one lactation professional, and how it can facilitate social interaction offline.

and now.

Dr. Bridges now serves as the Director of Academic Program for Communication, Creative Industries and Screen Media and is a Senior Lecturer in Public Relations in the School of Humanities and Communication Arts at Western Sydney University. For over two decades, she has been a volunteer breastfeeding counselor with the Australian Breastfeeding Association.

We’re pleased to have caught up with Dr. Bridges as she reflects on the past and future.

Q: What is the most significant change you’ve noticed in maternal child health in the last decade?

A: The increased use and evolution of social media tools to support breastfeeding. The COVID-19 pandemic amplified this and demonstrated how useful social media and online communities can be to supporting families in times of need.

Q: What is the most helpful/profound lesson you have learned about maternal child health in the last decade?

A: That (unfortunately) there is still so much more work to be done and that volunteer peer support organisations like the Australian Breastfeeding Association are needed more than ever before.

Q: Is there a current project, organization, initiative, endeavor or trend in lactation and breastfeeding that excites you most?

A: It will be interesting to see how the introduction and evolution of AI tools can be used to support breastfeeding into the future.

Q: What’s your best piece of advice for the next generation of maternal child health advocates?

A: Always place the parents and children at the centre of everything you do.

Q: Where do you envision yourself in the next 10 years?

A: I do hope that I am still a volunteer peer counsellor 10 years from now and that I can still continue to support breastfeeding families in this role and as a researcher in this area.

Check out Dr. Bridges’ publications since her work was last featured on Our Milky Way:

  • Rowbotham, S., Marks, L., Tawia, S., Woolley, E., Rooney, J., Kiggins, E., Healey, D., Wardle, K., Campbell, V., Bridges, N. and Hawe, P. (2022), ‘Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia’, Health Promotion Journal of Australia, vol 33, no 1 , pp 151 – 161.

  • Bridges, N., Howell, G. and Schmied, V. (2019), ‘Creating online communities to build positive relationships and increase engagement in not-for-profit organisations’, Asia Pacific Public Relations Journal, vol 20 .

  • Bridges, N., Howell, G. and Schmied, V. (2018), ‘Breastfeeding peer support on social networking sites’, Breastfeeding Review, vol 26, no 2 , pp 17 – 27.

Centers for Disease Control and Prevention (CDC) changes their breastfeeding policy for HIV-infected mothers

Without major announcement, in February 2023,  the Centers for Disease Control and Prevention (CDC) changed their breastfeeding policy for HIV-infected mothers and no longer recommend advising against breastfeeding.

Photo by Paul Hanaoka

The new recommendation gets closer to the updated 2010 World Health Organization (WHO) guideline on HIV and infant feeding. Before 2010, “WHO guidance on HIV and infant feeding (UNICEF et al., 2003; WHO et al., 2006) recommended an individualized approach in which women living with HIV would be counselled on feeding options according to their household circumstances.”

The new CDC guideline acknowledges that, “For mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero,” as determined in the PROMISE Study.

The guideline goes on to recommend “patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making.” Read the full document here.

Organizations like the National Institute of Health Office of AIDS Research, the Infectious Disease Society of America and National Association of County and City Health Officials announced the new guidance, but it has gone largely unacknowledged in the field of lactation.

“This change in HIV policy serves as a reminder to always check sources. New research findings and policy reconsiderations make it imperative that the most up-to-date information is available to the families we serve,” Healthy Children Project’s Karin Cadwell PhD, RN, FAAN, IBCLC, ANLC comments.

Photo by Wren Meinberg

In the U.S., HIV diagnoses among women have declined in recent years; still, nearly 7,000 women received an HIV diagnosis in 2019. (The CDC has commented on the effect of the COVID-19 pandemic: “Data for 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state and local jurisdictions. While 2020 data on HIV diagnoses and prevention and care outcomes are available, we are not updating this web content with data from these reports.”)

How does the U.S. compare in their recommendations to other high-income countries?

The British HIV Assocation’s 2018 guidelines for the management of HIV in pregnancy and postpartum states that “Women who are virologically suppressed on cART with good adherence and who choose to breastfeed should be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation and the requirement for extra maternal and infant clinical monitoring” among other recommendations for helping manage lactation in HIV-positive mothers.

Photo by Laura Garcia

A National Health Service (NHS) Greater Glasgow and Clyde document Management of infants born to HIV positive mothers reads: “There is now evidence from developing countries that breast feeding while mum’s viral load is fully suppressed is safe, and BHIVA/CHIVA no longer regard a decision to breast feed as grounds for referral to child protection services. For HIV positive women who choose to breast feed, maternal HAART should be carefully monitored and continued until one week after all breastfeeding has ceased. The mother’s viral load should be tested monthly to ensure that HIV virus remains undetectable; this testing will be undertaken by the obstetric/ID team. It is recommended that breastfeeding be exclusive, and completed by the end of 6 months.”

You can learn more about Canada’s approach here and Switzerland’s here.

For more, check out  Lacted’s Clinical Question and the CDC’s Preventing Perinatal HIV Transmission.