The AAP and its relationship with an infant formula manufacturer

The American Academy of Pediatrics, a well-respected group of physicians, has allowed their logo to be placed on the tag of Mead Johnson's Enfamil-infant formula discharge bag. Because The AAP clearly promotes breastfeeding due to the undeniable health benefits; this collaboration sends an opposing message. The AAP, maternity hospitals, obstetricians, pediatricians, and all allied health services should avoid the practice of dispersing formula or discharge bags. These are not free samples meant to assist new mothers. Distributing formula companies' discharge bags or printed materials is only providing free advertisement for the formula companies. Unfortunately this practice undermines new mothers breastfeeding endeavors. www.BabyFirstLactation.com

IBLCE Calls Upon the American Academy of Pediatrics to Terminate Arrangement with Formula Manufacturer


As a certification body, the International Board of Lactation Consultant Examiners® (IBLCE®) typically only issues statements directly related to IBCLC® certification matters.

However, due to IBLCE’s strong support of the International Code of Marketing of Breast-milk Substitutes, IBLCE is compelled to take the somewhat unusual step of calling upon the American Academy of Pediatrics to terminate its recent arrangement with a formula manufacturer which included the printing of the AAP logo on the formula company discharge bags.

This arrangement does not accord with some of AAP’s own policy statements as well as the evidence base regarding the importance, and primacy of, breastfeeding.

Therefore, IBLCE calls upon the AAP to terminate this arrangement and to demonstrate its commitment to optimal health and nutrition by unequivocal support and promotion of breastfeeding.








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Early skin-to-skin contact promotes breastfeeding, benefits baby : OBGYN News

Early skin-to-skin contact promotes breastfeeding, benefits baby : OBGYN News

The co$t of infant formula

Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding

September 3, 2013

Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding
Of course, there are many benefits of breastfeeding to consider for both mom and baby, but what about cost? We all know that starting a family means a significant financial commitment – in other words, babies are expensive. No matter what your budget is like, it’s important to plan ahead and prepare for the lifestyle change that a new baby brings.

Whether you’re about to welcome a little one into the world or thinking about your current breastfeeding journey, you might be wondering how much breastfeeding costs. But first, take a look at the cost of not breastfeeding:

Powdered formula, the least expensive type of formula, usually costs between $20 and $30 per large can and formula-fed babies will likely need about 1-1.5 cans of formula per week. Feeding formula means spending $80-$150 or even upwards of $250 per month if your baby requires special formula due to allergies or other special nutritional needs. This means that in one year, your family could spend $960 (low end) to $3,000 (high end) on formula.

Compare that to breastmilk – perfect, complete nutrition without having to mix bottles or carry extra feeding gear – which is totally free. The Surgeon General of the United States notes that following optimal breastfeeding practices can save $1,200–$1,500 in the first year of your baby’s life when compared to buying formula. With that in mind, even spending a couple hundred dollars on a breastpump and supplies winds up costing considerably less than purchasing formula for your baby. We all know about the health benefits of breastfeeding, but don’t forget that healthier infants can also require fewer doctor visits, which lowers healthcare costs (and less time out of work for mom + dad). You can find more of the Surgeon General’s cost-saving benefits of breastfeeding here.

We can also take a look at the big picture. A study published in the Official Journal of the American Academy of Pediatrics found that the United States could save $13 billion per year (in direct and indirect health costs) and prevent almost 1,000 infant deaths if 90% of families chose to breastfeed their babies exclusively for 6 months.

Breastfeeding saves money (and lives) while creating a lifelong bond between you and your little one.

What made the biggest impact on your decision to breastfeed?

Early skin-to-skin contact linked to higher breastfeeding rates

Early skin-to-skin contact linked to higher breastfeeding rates

Health Insurance Lactation Assistance

Many Breast-Feeding Moms Unaware Of Health Law Help By Lisa Stiffler and Seattle Times | Kaiser Health News, Published: August 27 . New moms crave information, whether it’s car-seat safety ratings, the pros and cons of pacifiers or how best to sooth a colicky infant. So it’s a little surprising that many moms aren’t up to speed on how the Affordable Care Act could benefit them. The law has specific requirements targeting moms, including coverage for breast pumps and consultants to help breast-feeding mothers. “So many moms don’t know about the benefit,” said Cary Seely, director of provider relations at Pumping Essentials, a California-based company selling supplies and services to assist in breast-feeding. While many of the changes mandated by the Affordable Care Act will benefit low-income Americans by expanding access to health insurance, the Obama administration has tried to build support among a wide swath of the public. Officials routinely tout reforms included in the new law that are designed to help the middle class. Among them are provisions that mandate insurance coverage regardless of pre-existing conditions; allow adult kids to stay on their parents’ insurance plans until they’re 26; require free preventive services such as mammograms, colonoscopies and flu shots — and institute the breast-feeding provisions. But in a recent poll, only 36 percent of Americans surveyed said the law “will make things better” for the middle class. When Whitney Courson, of Seattle, was pregnant earlier this year with her first son, a friend advised her that her insurance might pay for a breast pump, which generally costs $200 to $400 for an electric model. She forgot about the tip, even putting the pump on her baby-gift registry, hoping someone would buy it for her. Then another parent mentioned the benefit at a childbirth class. This time, Courson called a representative at Premera Blue Cross, her insurance provider through her husband’s job at Amazon.com, and learned it would cover the cost of a breast pump. She bought one and had her baby, Nicholas, in July. She loves the ability to pump and store milk so that she can bottle-feed her son when she needs to, or so that someone else can feed him in her absence. “Now I’m telling everybody I know, ‘Call your insurance, this is amazing,’ ” she said. The Affordable Care Act provision supporting breast-feeding went into effect for new health-insurance plans a year ago, but many plans didn’t incorporate the benefit until January 2013, when they were renewed. One hurdle to more widespread use of the provision is the vague language used to describe it, leaving insurance companies to come up with their own interpretations of what it means. Many plans require women to purchase their supplies from an approved medical-device provider, while other others will allow a mom to get reimbursed for a purchase made anywhere. Some will pay only for a handheld, nonelectric device, while others cover more premium pumps. The rule is even more unclear on the lactation-support provision, with no definition of who is qualified to assist a woman trying to breast-feed. When Courson initially found breast-feeding difficult, she again turned to her insurance provider. “I had so many questions and concerns. I wanted to see a lactation consultant so I called insurance just to see.” Courson learned that she had coverage for counseling, and found a provider who would visit her home. Now more than a month after delivering Nicholas, breast-feeding is going well. “Knowing this kind of care is available and covered … that is huge,” she said. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente. Reprints

Great 4th Trimester Info

The Fourth Trimester – AKA: Why Your Newborn is Only Happy in Your Arms. July 6, 2012 tags: 4th trimester, baby calming, baby colic, baby only happy if being held, baby wants sleep, baby won't sleep, baby won't stop crying, babycalm, babycalming, babywearing, can't put baby down, contented baby, controlled crying, fussy baby, Gina Ford, gripe water, happiest baby, high needs baby, how to calm a crying baby, how to put baby in a routine, how to relieve colic, how to settle baby, how to stop a baby crying, how to treat baby colic, in utero, newborn colic, newborn help, skin to skin, stop baby crying, The Baby Whisperer, the fourth trimester, treatments for colic, womb to world . 67 Votes Quantcast “My baby is only happy in my arms, the minute I put her down she cries” “He sleeps really well but only when he’s laying on my chest, he hates his moses basket” “She cries every time we lay her on her play mat” “He hates going in his pram, he cries the second we put him in it”. How many times have you heard these comments from new parents? How many times have you said them yourself? I’ve lost count of the amount of times I have been asked these questions! What amazes me though is that society in general doesn’t get it, they don’t get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! How to calm a crying baby, treat colic, baby wants sleep, baby won't sleep, baby won't stop crying, baby cries unless in my arms, newborn colic, unhappy baby, fussy baby, gina ford routine, find my local antenatal classes, find local baby classes We spend more than time though, the ‘putting babies down’ industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on………………having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn’t enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn’t consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak. “Empathy: the intellectual identification with or vicarious experiencing ofthe feelings, thoughts, or attitudes of another.” To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world – but which world? The world they have spent most of their life in, their ‘womb world’ or the world they are in now – our world. To fully understand we must appreciate the enormous transition they have made – a concept known to many as ‘The Fourth Trimester’ -some make the womb to world transition easily, others less so and it is this latter group in particular “the clingy babies” we can learn so much from through this concept. “Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to “behave.” If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he’s labeled an “easy baby”; if he does not adapt readily, he is labeled “difficult.”” – Dr. William Sears. So lets quickly compare the two different ‘worlds’ your baby has lived in: The fourth trimest, womb to world, life in utero, why babies cry, how to calm a crying baby Pretty different huh? On top of this the big thing to understand is that in utero the baby’s world was constant, each day was the same, the stimulation didn’t change, but now they are born each day is different – ever changing, ever stimulating! the fourth trimester, 4th trimester, womb to world, newborn colic, why is my baby only happy in my arms, babywearing You’ll find a more in-depth discussion on this idea and much more in my BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world. how to calm a crying baby, find local antenatal classes, stop baby colic, treat colic, how to get baby to stop crying, how to get baby to sleep, baby classes, babycalming The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help – but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally. Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don’t already know, you will soon learn what your baby likes best and that’s what matters, that it is unique to *your* baby. Prescriptive ‘do this/don’t do this’ baby calming lists don’t help anybody – because they forget they are dealing with individuals – both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won’t work, some you won’t like – and that’s OK! because really it isn’t about these tips it’s about you and your baby getting to know each other! Movement The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride. Swaddling Imagine how snug your baby was at the very end of your pregnancy inside of you – now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don’t want to or indeed can’t then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby’s hunger cues if you are feeding on demand: Never swaddle over your baby’s head or near his face Never swaddle your baby if he is ill or has a fever Make sure your baby does not overheat and only swaddle with a breathable/thin fabric Only swaddle your baby until he can roll over** Always place your baby to sleep on his back Do not swaddle tightly across your baby’s chest Do not swaddle tightly around your baby’s hips and legs, his legs should be free to “froggy up” into a typical newborn position. Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before. ** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Skin to Skin Contact Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin – the love and bonding hormone – in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you. Bed-Sharing Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it’s a subject that makes society very uncomfortable, but…it is an *amazing* baby calmer! It’s really important that you think about how bedsharing will work and follow some important safety guidelines HERE. babywearing, baby carrier, baby sling, moby wrap, good carrier for a newborn baby, good sling for a newborn baby Babywearing Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of “quiet alertness” – a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us – yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands! Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby’s spine whilst not placing any pressure on your baby’s growing hips – newborns should always be carried facing inwards with a “frog leg” pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an ‘in arms’ position – i.e: how your baby would be held if you were holding them! This great picture from JePorteMonBebe highlights this newborn hold position perfectly. Babywearing is a great way for dads to bond with babies! It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling – it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up: babywearing, safe babywearing, ticks guide for safe babywearing, how to choose a baby sling, how to choose a baby carrier Position The “tiger in the tree” position below, taken from baby yoga, is often magical, stopping a crying baby in an instant! newborn colic hold, baby colic hold, tiger in the tree, tiger in a tree, baby yoga Noise Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A white noise CD such as the one by BabyCalm HERE can be played on loop whilst your baby sleeps to help keep them calm. Feed If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine – whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby’s skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier. Deep Bathing The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby’s tears in seconds – even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer. Outside If all else fails many babies stop crying the minute they hit the open air – I’m not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air – but it works! attachment parenting book, fourth trimester book, babycalm book, babycalming book, parenting book If you like this article you’ll find many more suggestions and discussions on baby sleep, colic, babywearing, co-sleeping/bed-sharing and much more in my newly released BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world! Written by: Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd) You can read more of Sarah’s articles HERE. Share this: Twitter538 Facebook10K+

Pacifiers? Good or Bad?

Don’t Cry as Pacifiers Go Bye-Bye August 15, 2013 By Cindy Hutter Mixing Pacifiers and Breastfeeding Just because a mother is breastfeeding doesn’t mean her baby can never use a pacifier. The American Academy of Pediatrics recommends that breastfeeding babies only be given pacifiers after breastfeeding is established, typically after one month. In hospitals around the country the break-ups are happening. Pacifiers and babies are no longer being seen together. These once ubiquitous partners are now going their separate ways as hospitals are tossing pacifiers and other artificial teats following evidence that they can interfere with breastfeeding. Since beginning work to create an environment that supports breastfeeding—including removing artificial teats—Providence Hospital in Washington, DC, has seen its exclusive breastfeeding rates climb from 4 percent in July 2012 to 55 percent in April 2013. Texas Health Huguley Hospital in Forth Worth similarly has seen its exclusive breastfeeding rate rise from 33 percent in January 2013 to 49 percent in June. Break-ups are never easy. Hospitals purging the pacifiers say that educating staff and mothers as well as slowly ramping up removal efforts were vital to the successful systems change. “Once our team was educated about the drawbacks of pacifier use we shared it with physicians and got their buy-in. Then we started talking to the nurses and they saw that the pacifiers weren’t needed. This buy-in is what has made the removal so successful for us,” says Sharon McMillian, RN, director of the Maternal and Infant Health Unit at Providence Hospital. McMillian is part of a team at Providence that is participating in Best Fed Beginnings, a national quality improvement project that aims to help hospitals improve maternity care and increase the number of “Baby-Friendly” hospitals in the United States. The Baby-Friendly designation is granted to facilities that adhere to the evidence-based Ten Steps to Successful BreastfeedingExternal Link. One of the steps calls for giving no pacifiers or artificial nipples to breastfeeding infants because they interfere with the development of optimal breastfeeding habits. Lori Feldman-Winter, MD, MPH, faculty chair of the Best Fed Beginnings project, explains that sucking on a pacifier often leads to unrecognized hunger cues that would otherwise result in more breastfeeding. Also, the way a baby positions its mouth and tongue when sucking an artificial nipple is different than when at the breast. Going back and forth between the breast and artificial nipples is associated with breastfeeding problems such as poor suckling technique and damage to the mother’s nipple. A poster used at Texas Health Huguley Hospital to support their change efforts. A poster used at Texas Health Huguley Hospital to support their change efforts. Sharing this education with mothers has made all the difference. Providence Hospital’s Bilingual Parent Educator, Soledad Sheppley, RN, describes the education that mothers receive on pacifier use both prenatally and as inpatients as pretty extensive. And so far, it’s helped to reduce the number of mothers asking for pacifiers. Ragan Steelman, RN, IBCLC, a member of a team at Texas Health Huguley Hospital participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, says when mothers at Huguley ask for pacifiers, staff first provide evidence-based education about the risks of pacifier use, including how it masks infants’ signs of hunger, reduces the number of feedings at the breast, interferes with effective feeding, delays milk production, reduces the volume of milk, and may contribute to painful latches. When it came time to make the shift at Texas Health Huguley, the team started with a few small tests to gain confidence and momentum for the change. “Staff support helps a lot in making a large-scale change like this,” says Steelman. “We start small by getting a few team members to be advocates and by finding supportive leaders to help push along those who weren’t quite as receptive.” Providence did the same. The team started with a test group and a small sample. It monitored the results for a few days, made adjustments and then expanded the test group. Providence Hospital’s Nurse Educator Lisa Cleveland, RN, says it didn’t take long for word of mouth about the change to start happening, so when the unit was ready to officially adopt the practice of no pacifiers, the job was easier. “Peers were communicating to each other about what they are doing and the excitement around the effort,” reflects Cleveland. “Using the small tests of change process has made our job more effective.” When the change was ready to be scaled up across the unit at Huguley, Steelman and her team made a pacifier discard bucket right near the circumcision table, one of two places a pacifier is allowed because it is used for pain management. The second place is in a unit for infants requiring higher levels of care. The team also put up “no pacifier zone” signs that reminded staff if they have one to throw it away. “Know that what you’re doing is improving the well-being of moms and babies. Be persistent and consistent,” recommends Steelman. To test the success of removing artificial teats at Providence, McMillian occasionally goes to the postpartum unit or the nursery and asks for pacifiers, even insisting there is a secret stash. Her efforts are quickly rebuffed, as staff reminds her there are no pacifiers anymore. “I was pleasantly surprised by how easy it was to remove the pacifiers once staff were educated and we took the time to scale up the change,” says McMillian. For more stories, sign up for NICHQ's monthly e-newsletter and follow NICHQ on Facebook and Twitter.

How to be the Best Post-Partum Visitor in 15 Minutes or Less

Resources How To Be The Best Post Partum Visitor In 15 Minutes Or Less How To Be The Best Post Partum Visitor In 15 Minutes Or Less Have a friend who had a baby and you're on the roster to drop off a meal? Here's everything they want you to know and do, but are too shy and polite to say and ask. They are tired. Breastfeeding is still awkward and having people around makes it more awkward. The mother is recovering physically, either from a surgical birth, or from the equivalent of a triathlon where the prize was a grapefuit sized head flying out of her vagina. Either of these things makes you sore and tired. They would like to see you, but don't want to be tired out by a long visit. You are not going to stay longer than 15 minutes, no matter how polite the parents are in saying you can stay longer. If your visit/meal drop off scheduled for 5.30. BE ON TIME. Make plans for 6:15 so that you HAVE to leave. Read More Before you walk in the door, put your game face on. Set a timer, on your phone or watch for 15 minutes. When it goes off, get out of there! Remember that you are going to be a quiet, productive blessing. This visit is NOT about you. It is not about the parents hosting you and putting on a cup of tea so you can sit and visit and hold the baby. Think about how you would feel if you had either had surgery or ran a triathlon. What would you want people to do for you? This visit is about blessing the parents and making their life a little bit easier. Your prize is getting a quick peek at the cute new human. Here's how to play out your 15 minute visit: 1. Bring a healthy meal. Include a salad or fresh vegetables. Only use disposable dishes. There is nothing more annoying than a) having to wash more dishes when you have a new baby and b) having to try to return dishes to all sorts of random people when you have a new baby 2. In addition to your meal, bring cut up veggies and fruit, unsalted trail mix or nuts, or other such healthy snacks for daytime munching for mom to eat while she's nursing. 3. Go into the kitchen and spend 5 minutes clearing off a counter, washing a sink-full of dishes, loading the dishwasher etc. Don't ask permission, just do it. Then set the table for their dinner. 4. Before you leave your house, put some paper towels and some powdered bathroom cleaner like Commet or Ajax in a baggie. Stick it in your purse. While you are at the house, go and use the washroom...and while in there do a three minute bathroom shine-up, using your paper towels and cleaner. 5. Coo over the baby, but wash your hands before touching it. 6. If they want to eat right then, heat the food up and put it on the table, give everybody kisses and then leave. 7. Take the garbage out when you go. In and out. This will be the best visit the parents will have had. They will love you and you will be awesome in their books forever. You can come back and have a longer visit when the parents have adjusted to their new normal.

Postpartum depression screening

The Efficacy of Postpartum Depression Screening By Jane Collingwood How effective is postpartum depression screening? More than one in 10 new mothers is thought to experience significant postpartum depression. The condition has a substantial impact on the whole family, and while effective treatments are available, fewer than half of cases are detected in routine care. Postpartum depression is typically diagnosed a month to a year after childbirth. Women experience a combination of low mood, fatigue, anxiety, irritability, feelings of being unable to cope and difficulty sleeping. It is distinct from the “baby blues,” which is a short-lasting state of low mood suffered by up to 80 percent of mothers within three to four days following birth. Postpartum depression is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being diagnostically distinct from major depression, although the manual does contain a “Postpartum Onset” specifier for patients with an onset within four weeks of giving birth. Formal screening in the U.S. is often carried out using the Edinburgh Postnatal Depression Scale, a 10-item, self-rated instrument also used throughout Europe, New Zealand and Australia. A threshold score of 12.5 was shown in one Australian study to accurately detect major depression. It can be quickly scored, and a woman who meets a threshold score can be assessed in more detail. Dr. Mike Paulden of the University of York, UK, and colleagues recently investigated the utility of the Edinburgh Postnatal Depression Scale for widespread screening of new mothers. They write on the website of the British Medical Journal that widespread screening via questionnaire “has been advocated but is controversial.” Universal screening needs to be balanced against a high rate of false positives, that is, women with an incorrect diagnosis of depression. Although the Edinburgh Postnatal Depression Scale is the most frequently researched, and “performs reasonably well,” the team concludes that it “does not represent value for money for the National Health Service.” Nevertheless, a worrying number of women with postpartum depression are overlooked in primary care clinics. Victoria Hendrick, associate professor at the University of California at Los Angeles, writes, “The mother’s suffering, coupled with the burden that her depression places on the family and the potential detrimental impact on the relationship between mother and child and the child’s cognitive and social development, call for prompt and effective methods of screening for postpartum depression.” She adds, “Postpartum depression is a highly treatable condition. A variety of interventions, including antidepressants and psychotherapy, can be helpful. A principal challenge remains in more effectively screening for and identifying this common diagnosis.” In a study of 214 women who brought their children to a general pediatric clinic, 86 (40 percent) reported high levels of depressive symptoms on the psychiatric symptom index. But only 29 of this group were identified as depressed on a questionnaire given by the pediatricians. The researchers, from Case Western Reserve University in Cleveland conclude that pediatric health care providers did not recognize most mothers with high levels of self-reported depressive symptoms. They suggest that pediatricians may benefit from extra training, and asking directly about maternal wellbeing or using a structured screening tool to identify mothers who are at risk. Postpartum depression risk factors include history of depression, abuse, or mental illness, smoking or alcohol use, fears over child care, anxiety before or during pregnancy, background stress, poor marital relationship, lack of financial resources, the infant’s temperament or health problems such as colic, and lack of social support. C. Neill Epperson, MD, of Yale University School of Medicine, points out that when the onset of postpartum depression is abrupt and symptoms are severe, women are more likely to seek help early in the illness. In cases with a gradual onset, treatment is often delayed, if it is ever sought. Detecting the condition is often complicated by several factors, he adds. For example, most women expect a period of adjustment after having a baby and may not recognize that what they are experiencing is not within the norm. Women may also be reluctant to admit that something is wrong, out of shame and fear. In addition, women may worry that they will be “locked up” or their baby taken away. “Another complicating factor is that women who did not receive their perinatal care from a family physician are often confused about whom to turn to,” says Dr Epperson. “To overcome these significant impediments to the identification of postpartum depression, family physicians should develop formal mechanisms for identifying symptoms.” When a new mother appears to be depressed, he suggests that health care providers “conduct a careful history and physical assessment,” consider her circumstances, and then use a reliable screening questionnaire. References Hendrick, V. Treatment of postnatal depression. The British Medical Journal, Vol. 327, November 1, 2003, pp. 1003-1004. Paulden, M. et al. Screening for postnatal depression in primary care: cost effectiveness analysis. The British Medical Journal, 2010;340:b5203. Postpartum Major Depression: Detection and Treatment Heneghan, A. M. et al. Do pediatricians recognize mothers with depressive symptoms? Pediatrics, Vol. 106, December 2000, pp.

What is the WHO Code and why is it important?

Defeating The Formula Death Star: Using Social Media to Advocate for the WHO Code Posted April 1st, 2013 by Jeanette McCulloch and Amber McCann As presented at the 8th Breastfeeding and Feminism Symposium: March 21, 2013 “Oh no. It looks like the Death Star.” – WHO Code advocate Last year, the world’s largest infant formula company, Nestle, rolled out a new center for managing its social media, described by Reuters as Nestle’s site for reaching consumers and “engaging with the online enemy.” Nestle’s new “digital acceleration center,” designed to both reach consumers and manage conflict, “looks like mission control” with walls of screens where red lights flash when online dissent is detected. Advocates for the fair marketing of formula were disheartened but not surprised to see this well-funded effort to reach mothers and diffuse controversy. How infant feeding choices are marketed matters. It matters enough that formula companies are reported to spend more than $50 million annually in the US alone. It matters enough that the World Health Organization developed an entire set of rules (known as the WHO Code) around how formula should – and should not – be marketed worldwide. Now, the efforts to ensure accurate information about feeding choices have moved online to social media. Those that defend those rules – WHO Code advocates – are working to ensure that those rules are upheld online. But defenders of the WHO Code are up against formula companies that are better-funded and are using the most up-to-date tools and strategies for reaching mothers using the Internet. Sound like David and Goliath? Once you see the technological power of the digital acceleration team, you will see why the online efforts of the formula companies feels like the Death Star of the Star Wars franchise fame. This “formula Death Star” is not going unchallenged. Using the incredible capacity of social media for the advocacy, education, and the mobilization of grassroots efforts, a rag-tag group of rebel forces–online WHO Code activists–are working to protect the WHO Code and breastfeeding families everywhere. What is the WHO Code? The International Code of Marketing of Breastmilk Substitutes (commonly called the WHO Code) was written with the goal of reducing the impact of marketing practices that aim to mislead new and expectant mother into believing that infant formula is nutritionally, immunologically, and otherwise comparable to breastmilk. Despite common misconceptions, the code DOES NOT limit access to or use of formula or related products. The code addresses marketing–and for good reason. When marketing spending on formula goes up, breastfeeding rates go down. The WHO Code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (the United States cast the lone dissenting vote). Thirty-two countries have adopted the code as national law, with 76 others adopting portions of it as law. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law. As providers who work with women, we believe in their capacity to make the best choices for their families, when presented with evidence-based information. If that’s our goal, we have two options: • We can increase marketing budgets for breastfeeding to the levels of formula companies. In the past years, they have spent at least $50 million..OR • We can uphold the WHO Code. We want to make abundantly clear that our support of the WHO Code comes from a desire to ensure ALL families have good information, not from any motivation to instill guilt or shame in families who use formula. The WHO Code does not limit options for mothers. It takes away the barriers to informed choice. As Bettina Forbes of Best for Babes puts it: “The only people who should feel guilty are those who know about the negative impact of formula marketing and do it anyway.” Meeting Us Where We Are Means Using Social Media Social media represents a revolution in communication that rivals the introduction of the printing press. For those of us of childbearing age, the notion of checking into Facebook on our iPhones, tweeting a photo of our dessert or going to Pinterest for a classic recipe instead of our family cookbooks, is second nature. Ninety-three percent of the “Millennial Generation” (those born after 1982 and who “get” technology because they grew up with it being an integral part of their lives) are communicating online, and in the United States, nearly 3 of 4 of them are using a social networking Website, such as Facebook, Twitter, or Pinterest. While the stereotype of the white, suburban mom certainly exists, we access social media widely, regardless of race, ethnicity, or socioeconomic status. We as mothers are the “power users” of social media…and marketers know it! These changes are having a significant impact on how we talk about, learn about, and share information around birth and breastfeeding. More than half of all women responding to one survey expressed their intention to share their birth experience, as it happens, on social media. Moreover, time online increases after the birth—44% of US women spend more time online after a new baby is born, and the likelihood that a new mother will seek breastfeeding information and support online is high. We Are Seeking Information About Health Care — Including Breastfeeding — Online Research tells us that health care providers continue to be the “first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the United States.” Eighty percent of U. S. Internet users have sought health care information online, and birth and related topics are an area of focus. We are using social media not only to seek information online, but we are also sharing our knowledge with others . . . and our iPhones make it as easy as sending a tweet or replying to a Facebook status update. The savvy marketers at corporations who produce infant formulas are fully aware of these changes. We argue that it is our responsibility, as advocates for breastfeeding families, to understand these changes. We know that there is POWER in using social media to reach and rise up and converse with mothers to affect change. Formula Companies Are Making Significant Investments In Social Media Savvy institutions understand what we’d teach in any “Social Media 101” presentation: social media is an unprecedented tool for listening to and engaging with an audience. Nestle has become a leading example of the use of social media both to reach consumers and to manage conflict and dissent. Nestle is the world’s largest food company and is also among the world’s most controversial corporations. Nestle was founded on the formulation of artificial infant milk. However, Nestle is not alone in its use of social media to reach parents. 10 out 11 infant formula brands commonly available in the United States, have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive websites. How Do the TOP Breastfeeding Profiles Stack Up? Nestle and other formula companies have used large budgets to build their audiences. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004 and Nestle has been reported to have doubled their social media spending in recent years. Compare this to the resources of top breastfeeding organizations. La Leche League International, the breastfeeding advocacy organization with the most significant financial resources had total revenues of $1.5 million in 2011 and spent a little over $115,000 on “public relations, external relations, and advocacy.” Other organizations, like KellyMom, Best for Babes, and Breastfeeding USA have small budgets and rely largely on volunteer efforts. The result? Although all of these organizations make a significant impact on the women they reach, compare the total number of all of their followers on Facebook: about 145,000 as of this writing, to that of Gerber (the Nestle owned brand that manufactures Good Start formula) at more than five million followers. Nestle has used its significant financial resources to hire social media experts and develop tools that have made it a shining example of effective corporate social media strategy. Nestle’s “Digital Acceleration Team” has a trained staff that monitors every mention of Nestle’s brands across various social media platforms. Team members identify negative “emerging issues” by the volume of mentions and respond to those with a high level of engagement with a scripted playbook for team members. http://www.youtube.com/watch?v=ktsMa8hfgY0 The Formula Death Star, as it has become known to WHO Cde activists, can feel overwhelming, both because it limits our capacity to reach families and because it can feel impossible to influence change at the world’s largest food company. However, it is encouraging to remember that Nestle developed these tools in response to its inability to manage an onslaught of angry advocates and consumers. In 2010, Greenpeace activists were able to enact significant changes in how Nestle sources palm oil, thanks to a YouTube video spoof that garnered over 1.5 million views, along with a resulting social media campaign that netted more than 200,000 e-mail complaints. Policy change at Nestle, based on calls from all of us, is possible. Examples of Efforts to Support the WHO Code Online Although Nestle may have the Death Star, rebel forces are pulling together to provide much needed social media support for the WHO Code. A recent campaign demonstrates the power of social media to organize individuals, even without an official organizing body like Greenpeace. A blog post exposing that the Pan-American Health Organization — the regional representative in the Americas for the World Health Organization–accepted more than $150,000 in donations from Nestle sparked outrage among activists who were concerned that the fox was helping to buy the hen house. Within days, a private Facebook group was birthed and experienced rapid growth to 400 members, now at almost 1000 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO. Members shared impromptu trainings on Twitter use and etiquette, researched the money trail, and quickly developed strategy, including a decision to target WHO and call for a rejection of the Nestle funding. The result: A relatively small group of consumers and advocates, through the use of Facebook and Twitter alone, were able to force the World Health Organization to respond. More importantly, the group began to organize and mobilize motivated individuals (including breastfeeding professionals, volunteers, families, researchers, and advocates!) who will come to the next battle more organized and prepared to engage. How The Rebel Forces Can Defeat The Death Star As the Greenpeace example shows, social media provides all of us with a unique opportunities to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change its policies; but this will not come without significant work. Some areas that need support: Ongoing consumer support and education around the WHO Code: In our experience, families generally are unaware of the WHO Code, or, if they have heard of it, they believe that it limits access to formula rather than limiting the marketing of breastmilk substitutes. The importance of the WHO Code needs to be distilled into social media-friendly images and infographics to build awareness and support for all future efforts. Ongoing education of maternal health advocates. The WHO Code is about more than just breastfeeding. Anyone concerned with infant and maternal health should be aware of and providing support for the adoptions and enforcement of the WHO Code worldwide. Bring even more social media savvy to the table. After Nestle’s run-in with Greenpeace, it brought in a top notch social media strategist to revamp its approach and provide training for its social media team. Nestle uses sophisticated tools to monitor and respond to issues. The Friends of the WHO Code–and any group hoping to use social media for impact–needs people on hand who are savvy in the use of social media and the funding for some basic tools to make the job collaborative. Keep doing what we know best. One the greatest results of the PAHO/WHO crisis was the assembly of a worldwide community with much work still to do. This and other groups need to use traditional community organizing strategies, incorporating social media to create a more level playing field. To learn more about what you can do to help promote the WHO Code through social media, join the group “Friends of the WHO Code” on Facebook. An earlier version of this post originally appeared in Science and Sensibility. You might also like: Read more: http://www.momsrising.org/blog/defeating-the-formula-death-star-using-social-media-to-advocate-for-the-who-code/#ixzz2PGC4jDLa

Breastmilk is a gift

www.askthelactationconsultant.com

6 minute film on the billion dollar formula industry

Breast is Best

www.bottledupthefilm.com

Home About Evidence Giving Birth Based on Best Evidence Can Hospitals Keep Moms and Babies Together after a Cesarean? © by Rebecca Dekker, PhD, RN, APRN of www.evidencebasedbirth.com In my previous article on skin-to-skin care after a C-section, I wrote that skin-to-skin care after a C-section has many benefits for moms and babies. However, I have come to realize that women cannot do early skin-to-skin if they are routinely separated from their babies after a C-section. In order to do early skin-to-skin, women and newborns must stay together—a process known as “couplet care.” However, the vast majority of women are separated from their babies after a C-section. Why don’t more women and babies receive couplet care? Is it possible for hospitals to make the switch from routine separation to routine couplet care after a Cesarean? Keep reading to find out. What is the history of mother-infant separation after birth? Separation of human mothers and newborns is unique to the 20-21st centuries and has been a complete break from natural human history. In the past, infant survival depended upon close and virtually continuous mother-newborn contact. The practice of routinely separating mothers and newborns started around 1900. At the time, most women received general anesthesia that made them and their babies incapable of interaction after birth. Because mothers couldn’t care for their babies, hospitals created central nurseries to care for newborns, and infants were typically separated from their mothers for 24-48 hours. Separation from parents was also meant to ”protect” infants from maternal illnesses (Anderson, Radjenovic et al. 2004). In her book Hypnobirthing, Marie Mongan described her experience of being separated from her infant in the 1950′s… My head was held as the ether cone was forced onto my face. That was the last I remembered. I awakened sometime later, violently ill from the ether, and was informed that I had “delivered” a beautiful baby boy, whom I would be able to see in the morning…. My husband saw our son only through the window of the nursery for the next five days, as no one was allowed to visit when “the babies are on the floor.” Our family bonding was nonexistent. When did things begin to change? In 1961, Dr. Brazelton published a classic study showing that general anesthesia was harmful to newborns (Brazelton 1961). As a result of his research, more people began to move away from using general anesthesia during birth, which resulted in mothers and infants being more alert—and capable of interaction—immediately after birth (Anderson, Radjenovic et al. 2004). In addition, most mothers who give birth by Cesarean receive regional anesthesia instead of general anesthesia, so these mothers, too, are usually alert after giving birth. Furthermore, in the past 30 years, an abundance of research evidence has shown that when mothers and babies are kept close and skin-to-skin after birth, outcomes improve (Moore, Anderson et al. 2012). It is very important for you to understand that when researchers study human mother-newborn contact, keeping mothers and babies together is always considered the “experimental” intervention. In contrast, when researchers study other non-human mammals, keeping mothers and babies together is the control condition, while separating newborns from their mothers is “experimental” (Moore, Anderson et al. 2012). What is routine practice today? Although most mothers now are capable of taking care of their babies after birth, and despite the fact that research overwhelmingly supports couplet care—hospital practices have been very slow to change. Routine separation of moms and babies during the recovery period still happens at 37% of vaginal births in the U.S., with rates ranging widely from state to state. In Alaska, only 5% of babies are separated from their mothers after a vaginal birth, while in Mississippi, 81% of infants are separated from their mothers after a vaginal birth. (Centers for Disease Control, 2010) After most C-sections, babies are sent to the nursery for routine care Credit: brettneilson How often are women separated from their infants after a C-section? Separation of mothers and infants is very common after a surgical birth or C-section. In the U.S., 86% of women who give birth by C-section are separated from their babies for at least the first hour (Declercq, Sakala et al. 2007). With more than one-third of U.S. women now giving birth by Cesarean, this means that a substantial proportion of mothers and babies experience a critical delay in bonding, skin-to-skin contact, and breastfeeding. Research shows that most of the time when babies are separated from their mothers after a C-section it is so that the hospital can provide routine mother/baby care in separate rooms—not because the babies need any kind of special care (Declercq, Sakala et al. 2007). When infants are brought to the nursery while their mothers recover separately, it is common for a nurse to give a first feeding of formula (Elliott-Carter and Harper 2012). What are the benefits to keeping moms and babies together? To read the benefits of keeping moms and babies together, please refer to my article on skin to skin care after a Cesarean. To summarize, babies who receive couplet care—in other words, who stay with their mothers and receive early skin-to-skin care—are 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who receive routine hospital care. You can read about the many other benefits of early skin-to-skin care—and the potential harms of separating mothers and babies— here. Submitted by an anonymous reader. Dads can do skin-to-skin care, too. Everyone can stay together. Are there any potential harms to keeping moms and babies together after a C-section? It is important to know that some mothers may not capable of independently caring for their infants immediately or for several hours after a C-section. For example, if mothers received strong sedatives, are nauseous, or were sleep-deprived for many hours before the Cesarean, then they may need supervision or assistance in caring for their newborns. The mother’s level of awareness and her ability to remain awake when caring for and feeding infants must be assessed and closely monitored by nursing staff, especially when a Cesarean follows a prolonged labor or when sedative drugs have been given (Mahlmeister 2005). In this case, then the father or partner can do skin-to-skin with the infant. Is it possible for hospitals to keep moms and babies together after a Cesarean? Yes, it is possible for hospitals to keep moms and babies together after a Cesarean. Two different hospitals have published quality improvement reports describing how they switched from routine separation to routine couplet care after C-sections (Spradlin 2009; Elliott-Carter and Harper 2012). As both reports were very similar, I will focus on the most recent article by Elliott-Carter (you can read the article for free in its entirety here). Why did this hospital decide to make the change? In 2011, nurses at Woman’s Hospital in Baton Rouge, Louisiana, led a switch from routine separation after Cesareans to couplet care—keeping moms and babies together. The hospital was motivated to change for several reasons, including a desire to stay competitive with other hospitals and repeated requests from patients to not be separated from their babies. Perhaps most compelling, the staff felt it was simply “not fair” that moms who gave birth vaginally were allowed to stay with their babies, while moms who had C-sections were automatically separated from their babies. The C-section rate at Woman’s hospital was 40%, and they have more than 8,000 births per year. So making this change affected 3,200 families per year. How did the hospital change to couplet care? Amy and her baby Kareanna stayed together after a Cesarean– which allowed them to do very early skin-to-skin care. One of the first things the hospital did was put together a leadership team to plan for the change. This team included nurse managers from labor and delivery, postpartum, and newborn care, as well as pharmacists and materials management. The team communicated the plan to other groups (such as medicine). One of the team’s challenges was finding a large enough space where moms and babies could recover together after a C-section. They ended up choosing overflow labor and delivery suites that were big enough to accommodate the couplet. They also modified the existing recovery room (PACU) so that it could be used in case the overflow rooms were full. They moved curtains to make each patient’s space big enough for both mothers and infants to recover together, and they put a radiant warmer for the infant in each recovery space. The team had to make several other small changes. They had to train the recovery (PACU) nurses in neonatal resuscitation. They made sure baby blankets were placed in the heated blanket warmer, and that appropriate medications for both moms and babies were stocked in each room. Perhaps most importantly, staff made a commitment to provide care where the mothers and babies were, instead of always taking the baby away to the nursery. Although taking the baby to the nursery was easier and more convenient for the staff, they realized that keeping the couplet together was best for moms and babies. It took about 6 weeks from the beginning of this process until couplet care was fully implemented. How did it go for this hospital in Louisiana? In the first year after starting couplet care, the percentage of infants who were separated from their mothers dropped from 42% to 4%. Nurses stated that everyone was extremely satisfied with the change—including staff, physicians, and mothers. Nurses report that mothers are able to have skin-to-skin contact earlier, and that the first breastfeeding session goes smoother. Inspired by the bonding they witnessed between moms and babies, nurses decided to delay administration of erythromycin ointment and the vitamin K shot until after the initial breastfeeding. As nurses from the Woman’s Hospital said, “If a hospital that delivers 8,000 infants annually can find a way to decrease the separation of mothers and newborns, concerned nurses everywhere should be able to implement this type of care.” In the ideal situation, mom does skin-to-skin in the operating room. The family is never separated during recovery. So what is the bottom line? Evidence has shown that it is possible—and best practice—for moms and babies to stay together after a Cesarean. If a hospital staff member tells a mother that it is “impossible” for her to stay with her baby after a C-section, that statement is false. Making the switch from routine separation to couplet care can be done—some hospitals have already done so. Although couplet care may be more inconvenient for staff in the beginning, in the end, keeping mothers and babies together after a Cesarean is what is best. Mothers who want to do very early skin-to-skin care and interact with their babies after a C-section should talk with their providers about this mother-friendly and baby-friendly practice. Moms should also talk with their anesthesiologists to make sure that they do not receive sedative drugs unless medically necessary, as these drugs may make some women incapable of early interaction with their newborns. If you want to read more medical research: These researchers describe how critically ill babies had a higher mortality rate when they were separated from their mothers after birth. These researchers found higher cortisol (stress) levels in infants who were not held by their mothers after birth. In this small randomized, controlled study, researchers experimented with keeping moms and babies together after a C-section. Not surprisingly, the intervention group had earlier first mother-baby contact, earlier first feedings, and more stable infant body temperatures. In this landmark study, researchers randomly assigned mother-baby pairs to several different groups, and one of the groups was assigned to mother-baby separation for 2 hours after birth. Mothers and babies who were separated for 2 hours had a higher risk of poor maternal/infant bonding outcomes one year later. This risk was not alleviated by “rooming in” for the rest of the hospital stay. In this animal study, baby horses were separated from their mothers for one hour after birth (intervention group) or left undisturbed with their moms (control group). The separation increased the risk for poor bonding and other adverse social outcomes. If you Google “hospital”, “couplet care” and “cesarean” you will find a large number of hospitals that already offer this mother-friendly and baby-friendly practice. If you liked this article, you may be interested in: The evidence for skin-to-skin care after a C-section An interview with a mother who received skin-to-skin care in the operating room An interview with a mother who asked to stay with her baby after a Cesarean An interview with a doula who helps facilitate skin-to-skin care in the operating room Our Facebook album with amazing photos of skin-to-skin care in the operating room References: 1.Anderson, G. C., D. Radjenovic, et al. (2004). “Development of an observational instrument to measure mother-infant separation post birth.” J Nurs Meas 12(3): 215-234. 2.Brazelton, T. B. (1961). “Effects of maternal medication on the neonate and his behavior ” Journal of Pediatrics 58: 513-518. 3.Centers for Disease Control (2010). Maternity Care Practices Survey. Accessed online January 5, 2013. 4.Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14. 5.Elliott-Carter, N. and J. Harper (2012). “Keeping mothers and newborns together after cesarean: how one hospital made the change.” Nursing for Women’s Health 16(4): 290-295. 6.Mahlmeister, L. R. (2005). “Couplet care after cesarean delivery: creating a safe environment for mother and baby.” J Perinat Neonatal Nurs 19(3): 212-214. 7.Moore, E. R., G. C. Anderson, et al. (2012). “Early skin-to-skin contact for mothers and their healthy newborn infants.” Cochrane Database Syst Rev 5: CD003519. 8.Spradlin, L. R. (2009). “Implementation of a couplet care program for families after a cesarean birth.” AORN J 89(3): 553-555, 558-562.

Breast pump basics

Breast Pump Basics a. Breast shield: Cone-shaped cup that fits over the nipple and surrounding area. b. Pump: Creates the gentle vacuum that expresses milk. The pump may be attached to the breast-shield or have plastic tubing to connect the pump to the breast shield. c. Milk container: Detachable container that fits below the breast shield and collects milk as it is pumped. Consumer Updates RSS Feed2 Share this article (PDF 508 K)3 On this page: Choosing the Right Pump for You Should You Buy or Rent? Keeping It Clean These days, many new mothers return to the workplace with a briefcase in one hand—and a breast pump kit in the other. For those moms working outside the home who are breastfeeding their babies (and those who travel or for other reasons can’t be with their child throughout the day), using a breast pump to “express” (extract) their milk is a must. The Food and Drug Administration (FDA) oversees the safety and effectiveness of these medical devices. New mothers may have a host of questions about choosing a breast pump. What type of breast pump should they get? How do they decide ahead of time which pump will fit in best with their daily routines? Are pumps sold “used” safe? back to top Choosing the Right Pump for You Kathryn S. Daws-Kopp, an electrical engineer at FDA, explains that all breast pumps consist of a few basic parts: a breast shield that fits over the nipple, a pump that creates a vacuum to express the milk, and a detachable container for collecting the milk. There are three basic kinds of pump: manual, battery-powered and electric. Mothers can opt for double pumps, which extract milk from both breasts at the same time, or single, which extract milk from one breast at a time. Daws-Kopp, who reviews breast pumps and other devices for quality and safety, suggests that mothers talk to a lactation consultant, whose expertise is in breastfeeding, or other health care professional about the type of breast pump that will best fit their needs. Questions for new moms to keep in mind include: How do I plan to use the pump? Will I pump in addition to breastfeeding? Or will I just pump and store the milk? Where will I use the pump? At work? When I’m traveling? Do I need a pump that’s easy to transport? If it’s electric, will I have access to an outlet? Does the breast shield fit me? If not, will the manufacturer let me exchange it? back to top Should You Buy or Rent? There’s also the decision of whether to buy or rent a breast pump. Many hospitals, lactation consultants and specialty medical supply stores rent breast pumps for use by multiple users, Daws-Kopp notes. These pumps are designed to decrease the risk of spreading contamination from one user to the next, she says, and each renter needs to buy a new accessories kit that includes breast-shields and tubing. “Sometimes these pumps are labeled “hospital grade,” says Daws-Kopp. “But that term is not one FDA recognizes, and there is no consistent definition. Consumers need to know it doesn’t mean the pump is safe or hygienic.” Daws-Kopp adds that different companies may mean different things when they label a pump with this term, and that FDA encourages manufacturers to instead use the terms “multiple user” and “single user” in their labeling. “If you don’t know for sure whether a pump is meant for a single user or multiple users, it’s safer to just not get it,” she says. The same precaution should be taken for “used” or second-hand pumps. Even if a used pump looks really clean, says Michael Cummings, M.D., an obstetrician-gynecologist at FDA, potentially infectious particles may survive in the breast pump and/or its accessories for a surprisingly long time and cause disease in the next baby. back to top Keeping It Clean According to FDA’s recently released website on breast pumps4, the first place to look for information on keeping the pump clean is in the instructions for use. In general, though, the steps for cleaning include: Rinse each piece that comes into contact with breast milk in cool water as soon as possible after pumping. Wash each piece separately using liquid dishwashing soap and plenty of warm water. Rinse each piece thoroughly with hot water for 10-15 seconds. Place the pieces on a clean paper towel or in a clean drying rack and allow them to air dry. If you are renting a multiple user device, ask the person providing the pump to make sure that all components, such as internal tubing, have been cleaned, disinfected, and sterilized according to the manufacturer’s specifications. Cummings notes that there are many benefits to both child and mother from breastfeeding. “Human milk is recommended as the best and exclusive nutrient source for feeding infants for the first six months, and should be continued with the addition of solid foods after six months, ideally until the child is a year of age,” he says. The benefits are both short- and long-term. In the short-term, babies can benefit from improved gastrointestinal function and development, and fewer respiratory and urinary tract infections. In the long-term, children who have been breast fed may be less obese and, as adults, have less cardiovascular disease, diabetes, inflammatory bowel disease, allergies, and even some cancers. Cummings adds that moms and their families benefit by the bonding experience and economically as well, since a reduction in acute and chronic diseases in the baby saves money. For women considering this option, FDA ‘s website5 offers resources and information on breast pumps and breastfeeding. These include information on the selection and care of the pumps, in addition to describing signs of an infection or injury related to their use. This article appears on FDA's Consumer Updates page6, which features the latest on all FDA-regulated products. January 14, 2013

Too Few Breastfeeding Studies Done

Is the Medical Community Failing Breastfeeding Moms? By Lisa Selin DavisJan. 02, 20130 Share inShare2 Tamar Levine / Gallery Stock Email Print Share Facebook Twitter Tumblr LinkedIn StumbleUpon Reddit Digg Mixx Delicious Google+ Comment Follow @TIMEHealthland The doctor blamed it on the baby. “She’s not absorbing your milk,” he told Colleen Kelly, in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, “She’s not latching properly.” Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as “failure to thrive.” The baby’s kidneys were x-rayed and blood taken, but doctors found nothing wrong. Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn’t been able to produce enough breast milk—could that be happening to her? No, they said. That was an old wives’ tale. But they never even looked at her breasts. “It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening,” Kelly says. That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.” (MORE: Breast-Milk Donors Come to the Rescue of a New Mom with Breast Cancer) When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?” ED, she points out, is within the purview of many doctors’ services, and insurance will cover Viagra, but lactation dysfunction? It doesn’t even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure. No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it’s all the more important that the medical community have the tools and knowledge to help mothers breastfeed—or to figure out why they can’t. Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how. (MORE: 20 Ways To Make Breast-Feeding Easier) What do doctors learn about breast-feeding in medical school? “We learned that it’s what’s best for baby,” said my own pediatrician. “But that’s it.” They’re introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what’s happening at the anatomical level? Not so much. “It’s an hour, or a half a day, and [students] don’t remember anything,” says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all. Why so little heed? “When most of the people who are currently leaders were in training, breast-feeding was really uncommon,” says Stuebe. Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow’s milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). “It’s generational for doctors to think it would be necessary to know anything about breast-feeding.” It didn’t help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there’s a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag. In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it? This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues—improving the baby’s latch and such—but can’t write prescriptions, check hormone levels or offer a diagnosis. (MORE: Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms?) That’s what a breast-feeding doctor—an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine—would have done in Kelly’s case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn’t make milk) on mom and baby to see if any physical or anatomical factors were affecting supply. In the mother, they might check the shape of her breasts, to see if they were hypoplastic—a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk—or evaluate her hormone levels, ask if her breast size had increased during pregnancy. Perhaps they’d prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have “demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation.” But Kelly’s doctors weren’t trained in human lactation, and they told her what many women with lactation failure have been told before: “We’ve never seen this before. You’re the only one.” Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others. But even Dr. Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.” It’s a “normal mammalian function,” he said. Almost everyone can do it. (MORE: Q&A With Breast-Feeding Mom Jamie Lynne Grumet) Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help. Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’” Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all fellows of the physicians’ organization Academy of Breastfeeding Medicine (ABM). At Wolynn’s practice, all six of the pediatricians on staff are also certified lactation consultants. ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They’ve successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics. And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment.” Of course, we’re low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. “It’s probably the most promising times we’ve seen,” says Wolynn. “We’re in the early phases of what I’m hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty,” says Evans. “It’s a whole new area of medicine.” (MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals) Still, there’s work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure. And if we’re going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can’t sustain them—with 4 million births a year, that’s 200,000 moms who need extra help. Doctors practicing today—especially those treating pregnant women and new mothers—need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early. Perhaps most importantly, we need to stop demonizing mothers who can’t breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ…but none of those matter if your baby is failing to thrive because of malnutrition. In Kelly’s case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe—she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, “she’s happy, healthy and fine,” Kelly says. But her guilt and shame continued long after the baby recovered. It wasn’t until weeks later, in another doctor’s office, that Colleen happened upon an article that calmed her: some women, it said, can’t breastfeed, for physical reasons. If only her doctors had read that article, too. MORE: Can a Formula Company Really Promote Breast-Feeding and Fight Child Obesity? Read more: http://healthland.time.com/2013/01/02/is-the-medical-community-failing-breastfeeding-moms/#ixzz2GyaT1Ekh

October 1st, Child Health Day

United States Lactation Consultant Association Press Release

Date: October 2012 Contact: Scott Sherwood For immediate release Tel. 919-861-4543 Email:executivedirector@uslca.org Child Health Day The United States Lactation Consultant Association (USLCA) joins the nation in celebrating Child Health Day on Monday, October 1. For 90 years, the United States Health Resources and Services Administration (HRSA) has set aside the first Monday in October to focus the nation's attention on children's health. It is sobering to consider that for the first time in history type two diabetes is emerging as a significant chronic disease in children and childhood obesity continues its upward trend. Breastfeeding is the primary way to promote optimal health for children. Breastfeeding offers varying degrees of protection from obesity, diabetes, infections, some childhood cancers, and Sudden Infant Death Syndrome (SIDS). An analysis of studies related to breastfeeding and obesity found a 30% decrease in the odds of overweight for a child breastfed for 9 months when compared with a child never breastfed. Additionally, a study published in the journal Pediatrics found that the risk of SIDS almost doubles in infants who are not breastfed. School performance is important to children's health and well-being. Several studies have found that breastfed children have higher IQs and do better in school from the early grades through adolescence, even when parents' IQ and education and the child's living conditions are taken into consideration. According to the Center for Disease Control and Prevention's 2012 Breastfeeding Report Card, breastfeeding initiation is on the rise. This is good news. However the number of babies who are exclusively breastfed for six months as recommended by the American Academy of Pediatrics and other major health-related organizations remains low. From the first prenatal appointment, to the mother's return to school or work, and throughout the baby's first year, breastfeeding must be promoted, protected, and supported until it becomes the cultural norm. It is everyone's job to promote breastfeeding, support mothers, and protect families. As Surgeon General Dr. Regina Benjamin says,"The time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding." International Board Certified Lactation Consultants (IBCLCs) are health care professionals with the expertise to help families at every step of the way. IBCLCs teach breastfeeding classes, work in hospitals to help get mothers and babies off to a good start, problem-solve in out-patient sites such as physician offices, health centers, WIC sites and home care to help overcome breastfeeding trials, and work with employers to facilitate a successful back-to-work experience. IBCLCs help mothers achieve their breastfeeding goals and can help meet national goals related to child health. For more information or to locate an IBCLC, visit www.uslca.org

USLCA message

USLCA

Message from the President This is a great time for IBCLCs. With the Affordable Care Act including lactation care as a covered health benefit, the services of IBCLCs may be accessible to more mothers than ever before. USLCA is advocating for IBCLCs and bringing information to you as it becomes available. At the Board of Directors meeting held just prior to the ILCA conference, we updated our mission, vision, values, and strategic plan. You will note the strong emphasis on the IBCLC. Take a look at the new Mission, Vision, and Values Statement: MISSION To advance the IBCLC within the United States through leadership, advocacy, professional development, and research. VISION The IBCLC is the recognized professional authority in lactation in the United States. VALUES: 1. Uphold high standards of professional practice 2. Respect and promote cultural diversity 3. Collaborate with integrity in relationships 4. Operate nationally while being mindful of regional, local and Individual needs 5. Demonstrate responsibility to our community by promoting the best lactation care for the foundation of good health

The Florida Breastfeeding Law & You

You have the right to breastfeed in public - it is the law.
Florida Legislation February 1993
Section 1. The breastfeeding of a baby is an important and basic act of nurture which must be encouraged in the interests of maternal and child health and family values. A mother may breastfeed her baby in any location, public or private, where the mother is otherwise authorized to be, irrespective of whether or not the nipple of the mother's breast is covered during or incidental to the breastfeeding.
House Bill  #HB 231 Fl. ALS 4; 1993 Fl. Laws ch. 4; 1993 Fl. HB 231 Fl. Stat. 383.015 /
800.02 - 800.04 / 847.001(later 827.071)
 For further info please contact The Florida Lactation Consultant Association
www.flca.info
or www.babyfirstlactation.com