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.








inShare.0

Lactation Consultants help new Moms

Lactation Consultants Increase Breast-feeding

Megan Brooks
December 20, 2013





Comment





Print






Editors' Recommendations
Primary Care Protocol May Increase Exclusive Breast-feeding
Hospital Accreditation Doesn't Ensure Breastfeeding



Topic Alert



Personal Alert


Receive an email from Medscape whenever new articles on this topic are available.
Personal Alert Add Pregnancy to My Topic Alert
















Drug & Reference Information
Counseling the Breastfeeding Mother
Human Milk and Lactation
Breast Embryology








Pre- and postnatal visits with a certified lactation consultant (LC) coupled with electronic reminders for healthcare providers to discuss breast-feeding at prenatal visits may boost breast-feeding duration and intensity, new research shows.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months after birth, followed by continued breast-feeding for 1 year or more as other foods are introduced. Yet less than 75% of infants in the United States are breast-fed at all, and fewer than half are still being breast-fed at 6 months, according to the Centers for Disease Control and Prevention (CDC). Under the Affordable Care Act, private insurers must cover professional breast-feeding support without cost-sharing.

In 2 separate clinical trials, Karen Bonuck, PhD, from the Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University in New York City, and colleagues found that integrating professional LCs into routine care alone or combined with electronic prompted guidance (EP) from prenatal care providers increased breast-feeding at 3 months postpartum.

The studies were published online December 19 in the American Journal of Public Health.

In the Best Infant Nutrition for Good Outcomes (BINGO) trial, 666 primarily low-income women were randomly allocated to 1 of 4 groups: LC alone, LC+EP, EP alone, and usual care (the control group). The LC protocol included 2 prenatal sessions, a hospital visit, and regular telephone calls postpartum though age 3 months or until breast-feeding ceased.

The study team followed-up with the women periodically to assess breast-feeding "intensity," defined as the percentage of all feedings during the last 7 days that were breast milk. They defined high intensity as 80% or more of feedings involving breast milk, medium intensity as 20% to 79%, and low intensity as 19% or less.

At 3 months, high-intensity breast-feeding was greater in the LC+EP group (17.3%; odds ratio [OR], 2.72; 95% confidence interval [CI], 1.08 - 6.84) and the LC-only group (20.5%; OR, 3.22; 95% CI, 1.14 - 9.09) compared with usual care (8.1%).

In addition, women in the LC+EP group were more likely to initiate breast-feeding, do "any" breast-feeding (vs none) at 1 month, and breast-feed exclusively at 3 months postpartum compared with the control group. The EP group did not differ from the control group on any outcome.

The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) study included 275 women from more economically diverse backgrounds (compared with BINGO participants), many more of whom planned to breast-feed exclusively (62% vs 37% in BINGO).

They were randomly allocated to a usual care control group and a group receiving both the LC+EP interventions. For the PAIRINGS primary outcome of exclusive breast-feeding at 3 months, rates were significantly higher with LC+EP than usual care (16.0% vs 6.2%; OR, 2.86; 95% CI, 1.21 - 6.76).

As in BINGO, any breast-feeding and both high- and medium-intensity breast-feeding were more likely with LC+EP than usual care.

Finding Was Robust in Tough Groups

The researchers point out that black/non-Hispanic, younger, overweight and less-educated women are known to have some of the lowest rates of breast-feeding, and together, these women made up a large majority of those enrolled in the BINGO and PAIRINGS trials.

The findings were "robust in what is traditionally thought of as a difficult-to-support breast-feeding population," Dr. Bonuck noted in an interview with Medscape Medical News.

Although neither trial came close to attaining exclusive breast-feeding for 6 months, as advocated by the American Academy of Pediatrics, about 95% of women in the 2 trials at least started breast-feeding, which exceeds the goal of 82% that the CDC has proposed in its Healthy People 2020 report, Dr. Bonuck points out.

"This study is significant because it shows that integrating lactation consultants into prenatal care increases breastfeeding rates among low income racial/ethnic minority women," Tonse N.K. Raju, MD, chief of the National Institutes of Health's Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in news release.

"We need additional studies to see if this and other interventions can enhance breastfeeding by these women beyond a few months," Dr. Raju added.

This research was supported by the National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities. The authors have disclosed no relevant financial relationships.

Am J Public Health. Published online December 20, 2013. Abstract






Comment

Tongue-ties interfere with successful breastfeeding

Low-risk snip may help tongue-tied infants breastfeed



Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.

Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.

Photo Credit: © 2013 Thinkstock


Lack of training remains an obstacle to treatment of a relatively common cause of breastfeeding problems, warn experts.

An estimated 4-10% of babies have "tongue-tie," or excess tissue anchoring the tongue to the floor of the mouth. Also known as ankyloglossia, the condition can make it difficult for some infants to breastfeed, resulting in slow weight gain, colic and early weaning. It's also linked to poor milk supply, nipple trauma and infections in nursing moms.

But the simple fix — a quick snip of the offending tissue with surgical scissors or a zap with a laser to release the tongue — seldom features in pediatric literature or training.

Called a frenotomy, the voluntary procedure has almost "no risk if done correctly" and often results in immediate improvements in both the ease and comfort of feeding, says Lawrence Kotlow, a pediatric dentist from Albany, New York. He performs the surgery six to eight times a day.

"It doesn't require anesthesia or stitching, it takes maybe 20 seconds to do, the baby is put on the breast immediately afterwards and most parents find a significant difference because now the baby can have a deeper latch."

Even so, it can be difficult to find a physician to perform the procedure, as both diagnosis and treatment of tongue-tie remain a longstanding source of controversy in the medical community.

The Canadian Paediatric Society hedges that the procedure "cannot be recommended," except in cases where "the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary."

Similarly, a recent CMAJ Practice article suggests reserving the procedure for newborns with feeding difficulties caused by "severe" tongue-tie.

A systematic review of 17 studies suggested that "frenotomy is a safe procedure that may facilitate breastfeeding in women who may otherwise have given up," but acknowledged that most studies were not randomized and therefore not a good indication of "any true benefit" (Arch Dis Child 2011;96:A62-3).

One such trial recently showed that frenotomy for infants with mild or moderate tongue-tie "did not result in an objective improvement in breastfeeding" at the end of a five-day period.

However, the study's authors noted that 17% of those randomized to "usual care" did not last five days before the mothers demanded a frenotomy, and 15% switched to bottle feeding. After the five days, most women in the comparison group opted for a frenotomy for their infant.

According to the authors, it's unclear "how many women would have given up breastfeeding if frenotomy had not been available in a few days' time."

In the absence of clear cut evidence, few doctors outside of specialty breastfeeding clinics even assess for tongue-tie, says Dr. Howard Mitnick, a breastfeeding management expert at the Goldfarb Breastfeeding Clinic at Jewish General Hospital in Montréal, Quebec. His clinic is "overwhelmed" with frenotomy referrals from across the province. "There are major chunks of Canada where no one's doing them … because you don't look for something you can't deal with."

Adding to the confusion, there's no standard way in which physicians diagnose the condition. Some doctors identify tongue-tie based solely on anatomical criteria, such as the degree of fusion between the tongue and the floor of the mouth. Others look for signs of limited function, such as an inability to raise or stick out the tongue.

In both cases, it's hard to attribute feeding problems to tongue-tie without a "baseline expertise" to rule out other possible causes, says Mitnick. "Lots of the women I see are struggling with breastfeeding, and the baby has the anatomy of a tongue-tie, but it's not a tongue-tie problem; it's a confidence, knowledge or positioning problem."

According to Dr. Jack Newman, founder of the International Breastfeeding Centre in Toronto, Ontario, "most physicians have no idea how to diagnose a tongue tie, at least the more subtle ones."

"We see babies in our clinic who have very significant tongue ties, yet the parents were told by the doctor that there was no tongue-tie," he wrote in an email. "And most physicians will not release a tongue tie because they don't know how."

The fact that dentists and lactation consultants often know more about the condition than physicians can further complicate the issue.

"If the family doctor doesn't recognize it, and a nonphysician says it's there, you run into a conflict," says Kotlow.

Ultimately, the losers in these scuffles are the babies and parents, who may spend months bouncing from one provider to another in search of a solution.

Mitnick argues that the wait-and-see attitude adopted by many physicians puts mothers at unnecessary risk of having to supplement poor milk supply with formula or giving up breastfeeding entirely. "We know very well that if babies are not exclusively breastfed there are genuine medical concerns, so if the alternative is frenotomy, it should be seriously considered, especially when the risks of the procedure are so low."


DOI:10.1503/cmaj.109-4675

— Lauren Vogel, CMAJ




Copyright 1995-2013, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

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?

Addressing breastfeeding myths | womenshealth.gov

Addressing breastfeeding myths | womenshealth.gov

Rethinking Rice Cereal with Babies

Rethinking Rice Cereal







©iStockphoto.com/SylvieBouchard
©iStockphoto.com/SylvieBouchard


more articles


©iStockphoto.com/Basnik


Panic Over Pesticides


©iStockphoto.com/Brosa


Path To Childhood Obesity May Begin In Utero





©iStockphoto.com/najin
Got Breast Milk?


by Deborah Pike Olsen
November 09, 2013

When it’s time for babies to eat food other than breast milk or formula, many parents reach for baby cereal—particularly rice cereal. For years, pediatricians have recommended that babies’ first food be iron-fortified cereal, particularly rice, which has a low risk for allergic reaction.

Recently, concerns have been raised about the levels of arsenic in rice and rice-based products, including baby cereal. New research on the topic from the U.S. Food and Drug Administration (FDA) has led that agency and others, including the American Academy of Pediatrics (AAP), to take a closer look at rice cereal and offer more recommendations on introducing solids to your baby.

What is arsenic?
Arsenic is a chemical element in the earth’s crust, present all around us, in both organic (naturally occurring) and inorganic forms. Both forms can be found in water, air, soil, and foods. Organic forms are released from volcanoes and through erosion of mineral deposits; inorganic arsenic, the more toxic form, is added to the environment through human activities such as burning coal, oil, gasoline, and wood, mining, and the use of arsenic-containing compounds in pesticides, herbicides, and wood preservatives.

The Environmental Protection Agency (EPA) describes inorganic arsenic as a carcinogenic (cancer-causing) agent. Several studies have linked inorganic arsenic with increased risk of skin cancer, as well as cancer of the prostate, liver, bladder, kidney, nasal passages, and lungs. For children, long-term exposure may cause lower IQ scores; exposure in utero and early childhood may increase mortality risk in young adults. Low level exposure can cause nausea, vomiting, stomach pain, circulatory problems, damage to blood vessels, a “pins and needles” feeling in the hands and feet, and redness and swelling of the skin.

Experts currently don’t know what level of arsenic is dangerous to public health. Since 2011, the FDA has analyzed samples of rice and rice products. As FDA Commissioner Margaret A. Hamburg, MD explains, the agency is “committed to ensuring that we understand the extent to which contaminants such as arsenic are present in our foods, what risks they may pose, whether those risks can be minimized, and to sharing what we know.”

Research
The FDA has monitored arsenic levels in food for nearly two decades, with the latest analysis being its most ambitious and far-reaching effort to date. The report provides data on 1,300 samples of rice products, 200 first reported in 2012 and an additional 1,100 tested in 2013. Products included in the analysis ranged from over-the-counter cookies and rice snacks to infant formula and baby cereal, ready-to-eat and hot cereals, rice “milks,” and more.

The FDA measured levels of inorganic arsenic and total arsenic for each product type. The FDA focused on rice because, unlike other crops, rice readily absorbs arsenic from the environment.



Results
FDA researchers found that arsenic levels varied widely from sample to sample within the same product. For the various products, levels ranged from 0.1 to 7.2 micrograms of inorganic arsenic per serving. However, serving sizes also varied.

In the absence of dietary limits, it is hard to know how to interpret these results, but the full text is available online. Readers can consider the relative risks of such products as rice cakes, rice milks, brown rice, and more. (Note that brand details about samples are not provided.)



Recommendations
The Illinois attorney general’s office conducted similar testing in 2012 in conjunction with Consumer Reports. Based on the “troubling” results, Consumer Reports and Illinois Attorney General Lisa Madigan have called on the FDA to set federal maximum levels for arsenic in food, especially baby food, and to caution the public about eating large amounts of rice and feeding it to small children. In fact, the next step in the FDA’s process will be risk assessment.



In the meantime, parents can take the following steps to minimize the risk of arsenic exposure for themselves and their children:
•Choose a different first food for babies. Former chair of the AAP’s nutrition committee Dr. Frank Greer notes that the group has “been trying to move people away from the use of rice cereal for the first weaning food … because it does not really provide that much nutrition.” Some experts suggest starting with meat, poultry, or tofu, which are iron-rich foods. Currently, the AAP’s position on introducing solids is that there is not sufficient evidence to show that introducing solids in any particular order is beneficial. Instead, the organization suggests babies should be offered a wide variety of nutrient-rich foods, including a variety of grains, within the first year to reduce exposure to arsenic from rice. Other good first-food options include sweet potatoes, squash, carrots, avocado, apples, pears, bananas, and peaches.
•For babies with gastroesophageal reflux (GERD) tendencies, consult a pediatrician. While rice cereal has traditionally been recommended as a thickener for these infants, the FDA notes that “wheat, barley and other grain-based infant cereals also readily absorb liquid and are similarly effective for infants with esophageal reflex tendencies.” Parents should talk with their child’s doctor.
•Avoid rice milk for children younger than age 5. Some of the highest levels of arsenic were found in products marketed as “rice milk.”
•Eat a balanced diet, with a variety of grains. Everyone should consume a varied diet. For nutrition guidance, the ChooseMyPlate website can be a good place to start.
•Limit rice consumption. Consumer Reports provides specific recommendations of servings per week for children and adults, noting, “for infants, children, and pregnant women, risks may be heightened.”

The Maternal Bond — News Room - UNC Health Care

The Maternal Bond — News Room - UNC Health Care

Your new baby and visitors

Bringing Baby Home: Four Ways to Manage Visitors

March 19, 2013

Bringing Baby Home: Four Ways to Manage Visitors
Bringing your new baby home for the first time can be one of the most exciting moments in your life! Before you ease into the calm and comfort of your home sweet home, prepare to be greeted by supportive friends and family. At times, it’s lovely to have visitors, but let’s be honest, it can also be exhausting. Blogger Amy Morrison recently shared a post on managing guests after birth. Here are some tips to help you relax and get support needed to ease into motherhood.

1.) Ask For Help
It’s easy to be overwhelmed by all the new responsibilities of being a mom. Don’t hesitate to ask guests for help. They’ll be thrilled to lend a hand and help you and your bundle of joy get comfortable in your new home.

2.) Make the Visit
Every family has one (or five) people who tend to visit for just a bit longer than most might prefer. If you’re not up for a marathon chat, offer to make the trip to see that person yourself (with your little one, of course). This way, you can choose to keep the visit short and sweet, or linger little longer if you’d like.

3.) Spread Out Guests
It’s okay to space out your visitors (and we don’t mean a few hours apart). Feel free to take a few weeks to get the hang of being a mom, and limit the amount of guests you have during this time. You’re a new mom whose life has just taken an exciting turn. Take some time to simply enjoy the giggles, smiles, and incredible little being you have by your side.

4.) Place Your Order
After diaper changes, breastfeeding, cleaning, playing, giggling and cuddling, it’s easy to lose track of your own mealtime. Remember, eating well and staying hydrated is one of the best ways to maintain breastmilk supply. So, say “yes” when visitors offer to bring over food. Moms deserve little treats too!

Insurance companies may cover breast pumps, supplies and consults

Healthcare Insurers Graded on Support for Breastfeeding Moms: Anthem and Aetna Score Highly National Breastfeeding Center has released a scorecard of healthcare insurance companies based on coverage policies for breastfeeding support. Share on TwitterShare on FacebookShare on Google+Share on LinkedInEmail a friend . . Insurers are now tasked with making sure that healthcare dollars are spent more wisely and invested in long-term preventive care. To do less than their best for their littlest members is simply not good enough. New York, NY (PRWEB) September 06, 2013 Anthem and Aetna both score highly out of 100 healthcare insurance companies graded by the National Breastfeeding Center (NBfC). Research was conducted to see how the insurance industry is responding to the Patient Protection and Affordable Health Care Act (PPACA), specifically the part of the law concerning coverage of breastfeeding support, a provision which went into effect on August 1, 2012. “It has been a year since the mandate went into effect," says Susanne Madden, COO, of the National Breastfeeding Center, "so there has been plenty of time for insurers to adjust to the law. We wanted to see how insurance companies are performing when it comes to supporting nursing mothers and their babies." Madden says that the NBfC research uncovered a wide range of insurance company policies and compliance. "We were encouraged to find that some insurers really recognize the importance of improving breastfeeding and support the intent of the mandate by covering fully qualified lactation care providers and effective breastfeeding equipment. But many more provide only the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience." "We weren't surprised to see Aetna near the top of the score card," says Beverly Curtis, the Executive Director of NBfC. Aetna was quick to open its network to lactation care providers who have certification as International Board Certified Lactation Consultants (a designation awarded by an independently-accredited program). Curtis points out, "it is important that insurance companies support care delivered by independently certified professionals as these are the providers best qualified to address and improve lactation care." Madden said that the Anthem Group of companies came to the top of the list due to such provisions as covering home visits and allowing pumps to be dispensed from both providers and medical supply companies. "Companies should see our score card as a helpful tool for evaluating their breastfeeding support policies," Curtis says, "and like Aetna and Anthem, aspire to be the best in this critical area of mother and infant healthcare insurance coverage.” NBfC assessed commercial insurance companies’ published policies and guidelines and assigned a grade based on the adequacy of coverage provided. Using The Verden Group’s Policy Search tool to locate official Medical Policies and Google to search insurers’ member and public domains for guidelines and newsletters that contained information about each company’s breastfeeding coverage, “we believe we’ve conducted a comprehensive review of the information available,” says Madden. Why grade insurance companies on their breastfeeding support policies at all? "The purpose of the mandate is to improve breastfeeding initiation and duration rates," Curtis replies. "It follows that mothers should receive lactation counseling support from a provider educated in lactation care.” Madden agrees and says "It's the best way to insure that the care provided is appropriate to each mother’s concern or issue and that each has access to breast pumps that perform appropriately according to her medical or societal needs. Insurers are now tasked with making sure that happens, and that healthcare dollars are spent more wisely and invested in preventive care. To do less than their best for their littlest members is simply not good enough. We want to bring attention to that," Madden concludes, "and prompt insurers to do even better going forward." ****** National Breastfeeding Center (NBfC) The National Breastfeeding Center (NBfC) provides expertise to corporations/employers, hospitals/health systems, healthcare providers and organizations to improve breastfeeding promotion and support. Our unparalleled experience in the business of medicine, blended with our broad insurance experience and deep clinical knowledge, delivers powerful insights and innovative solutions. For more information on the NBfC, visit http://www.NBfCenter.com. Share on TwitterShare on FacebookShare on Google+Share on LinkedInEmail a friend PDF Version PDF Printer Friendly VersionPrint Contact Susanne Madden, COO National Breastfeeding Center +1 855-777-6232 1 Email .Beverly Curtis, Executive Director National Breastfeeding Center 855-777-6232 2 Email . Attachments Insurers Breastfeeding Policy Scorecard Insurers Breastfeeding Policy Scorecard Healthcare Insurers Scorecard for Breastfeeding Support Model Policy Model Policy Guidelines for Insurance Company Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies .

Infographic: Breastfeeding - It's only natural | womenshealth.gov

Infographic: Breastfeeding - It's only natural | womenshealth.gov

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

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.

Should nursing Moms avoid certain foods?

Should breast-feeding moms avoid certain foods? Here are some tips to put nursing moms and their babies on the right track. By Chanie Kirschner Fri, Aug 02 2013 at 2:15 PM Related Topics: Healthy Eating, Raising Healthy Kids breast-feeding foods Photo: Oksana Kuzmina/Shutterstock Breast-feeding is a wonderful gift you can give your baby. And while you should always maintain a balanced diet, what you eat while you’re a nursing mom is especially important since the foods you eat are nourishing your baby as well. So what should you avoid while breast-feeding? “There are no foods that mothers ought to avoid while breast-feeding,” says Dr. Nancy Brent, noted pediatrician, lactation consultant and medical director at the Breastfeeding Center of Pittsburgh. “In fact, most mothers can eat anything they want while breast-feeding. However, if your baby is fussy and you’re noticing other unusual gastrointestinal symptoms, such as bloody or mucus-y stools, try cutting out dairy and then soy.” If you eat something and notice that two feedings later (about the time for that food to enter your breast milk) your baby is especially fussy, you might try cutting out that food and seeing how your baby responds. “Then, after two weeks, gradually add that food back into your diet and see if your baby tolerates it,” Brent advises. She’s quick to add, though, that without any gastrointestinal symptoms, infant fussiness is likely not the result of maternal diet, and can be a sign of overtiredness, colic or acid reflux. Though foods mentioned above may or may not have an effect on your breast milk, there are certain things you should avoid while you’re breast-feeding to ensure your baby’s health. First item on the list? Alcohol. The American Academy of Pediatrics says that an occasional drink for a breast-feeding mom is OK, and Brent agrees. “Generally, a woman can have one drink of beer or wine two to three times a week. She should time it immediately after a feeding. If she's feeling the effects, then the alcohol is in her milk. If she's still feeling a little drunk when it's time to nurse next, she needs to give a bottle of previously expressed milk or formula.” You can “pump and dump” the milk to avoid engorgement and clogged milk ducts. Either way, too much alcohol can harm your baby, and it’s important to monitor your intake. Another thing to avoid while you’re breast-feeding is caffeine. While a morning cup of coffee is OK, experts say to limit your daily intake to no more than 300 mg a day. That’s generally one cup of fresh-brewed coffee, though actual amounts of caffeine may vary a little. If you’re like me and you just like the taste, feel free to go crazy on instant decaf — there’s only 2 mg of caffeine in a cup. Be watchful of other things that contain caffeine, such as chocolate or caffeinated tea. (If you’re unsure how much caffeine that certain food items have, check out this chart.) Finally, trim your seafood intake while you’re breast-feeding, especially if white tuna, swordfish or mackerel is your thing. That’s because these types of seafood are known to contain high levels of mercury, which could potentially harm your baby’s nervous system in high doses. If you do like seafood, choose fish that are typically low in mercury, such as wild-caught Alaskan salmon. Salmon is also high in omega-3s and protein, two essential nutrients for breast-feeding moms. You don’t need to go crazy to avoid specific foods while you’re breast-feeding. Just be smart about your intake and feel confident knowing you’re doing the best you can for you and your baby. Happy nursing! Related breast-feeding stories on MNN: •What not to eat when you're pregnant •More U.S. mothers breast-feeding, CDC says •Breast-feeding mama gets happy surprise at restaurant

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.

Press Release from the USLCA

United States Lactation Consultant Association FOR IMMEDIATE RELEASE Celebrity Breastfeeding and the United States Lactation Consultant Association RALEIGH, N.C. --- Somehow it is news that one celebrity is breastfeeding a two-year-old and another "refuses" to breastfeed. The royals are not immune from infant feeding hype as speculation surrounds Kate Middleton. Will she or won't she? That breastfeeding regularly tops tabloid headlines speaks volumes about our cultural conflicts. Breastfeeding is seen as healthy and good...but potentially scandalous if it takes place in public or beyond infancy. Breastfeeding is viewed as good mothering...but may "ruin" the idealized female body. The American Academy of Pediatrics takes the stand that breastfeeding is not a lifestyle choice, but an important public health initiative. It is the desire of the United States Lactation Consultant Association (USLCA) that every woman have the opportunity to be fully informed about breastfeeding so that she may make the best decision for herself and her family. Women need to know that it is not breastfeeding, but rather pregnancy itself that changes breast latitude and longitude. Women need to know that breastfeeding offers significant protection from breast and ovarian cancer and reduces the risk of type 2 diabetes, high blood pressure, and heart disease. And they need to know that breastfeeding offers their children protection from a host of illnesses and chronic diseases such as ear infections, obesity, respiratory infections, sudden infant death syndrome (SIDS), and even some childhood cancers. And once they do make the decision to breastfeed their babies, women need support to do so. A study published in the journal Pediatrics found that only a third of women meet their own breastfeeding goals. A British study recently concluded that breastfeeding may help children climb the social ladder. The child of Prince Charles and Kate Middleton is unlikely to have difficulty with that climb. Children of celebrities have a head start, too. USLCA is concerned for the children whose mothers don't make headlines. We support the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and Michelle Obama in their call for more Baby-Friendly Hospitals so that breastfeeding gets off to a good start. And we urge Congress to continue funding for breastfeeding peer counselors through the Women, Infant, and Children's (WIC) supplemental food program so that the most vulnerable women and children are more likely to benefit from the health, cognitive, emotional, and social perks of breastfeeding. Breastfeeding support comes from employers, businesses, families, and health care providers. Mother-to-mother counseling and encouragement is invaluable. But when designing breastfeeding support policies and programs and when help in overcoming challenges is needed, International Board Certified Lactation Consultants (IBCLC) are the ones to call. In the maze of breastfeeding helpers, only the IBCLC is required to demonstrate completion of specific college-level, health sciences courses, complete ninety hours of education specific to lactation, and spend hundreds if not thousands of hours in clinical practice before sitting for a rigorous international exam. For healthy mothers and babies, for climbing the social ladder, for the health of the nation, breastfeeding is worth the IBCLC. For more information or to find an IBCLC in your area, visit www.uslca.org.

Don't be a "Strong Mom"

When Big Pharma “Strong” Arms Mothers, We All Lose By Contributor on May 6, 2013 Mother feeding newborn sonCorporations have a very bad habit of telling moms how to be. Or better yet, co-opting some very common “mom” archetypes for their marketing pursuits. For decades, we were told “Choosy Moms Choose Jif.” More recently, “It Moms” were more likely to choose a particular fabric softener. This week, infant formula maker Similac has taken on the dubious role of connecting their brand to “Strong Moms” — those supportive, they say, of a less judgmental environment for mothers. This new affinity for strength is being launched with a Strong Moms Summit on May 7th in New York City featuring a number of high-profile mom bloggers. Please forgive me for being suspect. It is certainly true that there is way too much pressure on mothers today, and we all could take a proverbial “chill pill” on the mommy-bashing. But when a multi-million dollar pharmaceutical giant (Similac is owned by Abbott Laboratories) plows millions of dollars into telling mothers to be “strong” and “non-judgmental,” I think I’m rightfully engaged in a side-eye glance. Selling women messages that sound good on the surface but actually undermine them has been a corporate tactic since at least the 1950s. We aren’t really being supported to be strong moms–whatever that means anyway — we are being sold the idea of “strong” as a marketing tool for corporate interests. There’s a big difference and all parents should take note of the dangerous undercurrents. What I typically find most insulting is that these corporations are counting on moms not knowing better. That we are so weary from the pressures of motherhood, that we will hang on to any messaging that appears to be a “release valve” without delving one centimeter beneath the surface to find the real facts. Apparently “strong” does not mean savvy. Because one centimeter beneath the surface of Similac’s “Strong Moms” Summit and online campaign you will find that framing of infant formula use around a “lifestyle choice” that is not to be judged has been its primary marketing strategy for decades. Ah, choice. It used to be such a powerful word–one that conjured up women’s suffrage, the feminist movement and our battle for reproductive rights. The problem today is that “choice” has been taken out of the context of women’s rights and misconstrued into a dirty and insidious word. In its most disgusting reiteration it is being marketed to women and girls by corporations — in this case, by infant formula marketers, who are more concerned with profits than infant health outcomes. Women have been led to believe that the “choice” between formula feeding and breastfeeding is merely a matter of inclination–a personal decision, a feather in the cap of liberation. And since choices are individual, they have no social consequences; women are therefore relieved of responsibility of considering the broader implications of their decisions. And once I make my choice, no one is to challenge me. We can’t talk about it. And if you do, you are judging me. This is dangerous territory for all women and mothers as the issue of breastfeeding vs. formula feeding is turned into a mere lifestyle choice as opposed to a child health matter. No wonder Similac is supporting so-called non-judgment. What is really happening is that by leaving each other alone in our so-called non-judgmental circles, we are simply leaving the current unjust system in place and discouraged from forming opinions about the value of different choices. With this type of continuous marketing messaging, we lose the ability to have critical discussions about where the real choices lie and which “choices” are merely illusions. Most problematically for the future of mothers, it deters us from addressing the systemic problems such as improving child care options, increasing the market for part-time work, the lack of a paid federal maternity leave, and other deep-rooted, anti-family policies that actually devalue mothering and shape our infant feeding choices, and prevent us from being active agents of change because we are being told that many aspects of mothering from our infant feeding to work decisions are “choices” and, therefore, private matters. Choice becomes the silencer on a dangerous handgun. In this context, choice is not liberation. It is suffocation. In this context, Similac is asking moms to be strong when they really want us weak and silenced. Framing the infant feeding conversation as an empowerment experience erases the context of corporate interests and deep pocketed marketing machines that have always put profit motive ahead of infant health and the health of mothers and our actual empowerment, for that matter. Let’s face it, this isn’t the first time that women have been sold on an ideal that sounded good on the surface but was actually manipulated to undermine them. It’s been over 50 years since Betty Friedan’s The Feminine Mystique ripped the veil off the problem behind a very good-looking pretense of waxed floors, perfectly applied lipstick and domestic bliss in the 1950s to help women breakthrough a malaise they didn’t know existed. At that time, the idea that women were naturally fulfilled by devoting their lives to being housewives and mothers was borne out of similar cultural forces and commercial interests. It was presented as if this was the woman’s choice, when in fact cultural forces dictated that preparing for marriage and motherhood even from the teenage years was her only option. Meanwhile, the dialogue around the real issues that could actually significantly impact our lives and the health of all infants has been suffocated while we clamor behind choice and non-judgment and use it as a shield to deflect our mommy guilt. Our ability to build conversation and support among each other has been quashed because we won’t discuss what we have been told is a private choice. With so much individualism embedded in our views about choice, there is little room for examining interdependence or acknowledging individual fallibility of our choices. It is women and infants who are paying the price for this so-called freedom of choice. Until “choice” is presented with accurate information, then choice is just a mirage. What’s more, we have to understand the difference between choice and options. Having unequal options doesn’t make for true choice. And truly strong moms don’t need big pharma’s underhanded and predatory marketing ploys under the guise of a summit. Thanks, but no thanks.

Breastfeeding nipple shield info

Support for Using Nipple Shields Posted on February 27, 2013 by bfcpgh By Wendy Eson A nipple shield is a thin piece of flexible silicone designed to help a baby who is having trouble latching onto the breast. It is worn over the mother’s nipple during breastfeeding. It is important to assess the need for a shield on an individual basis. Nipple shields are not considered a routine part of breastfeeding and are to be used under the supervision of a lactation consultant. Ideally, they are for short-term use. In addition, they are often helpful in getting a baby back to breast after the introduction of bottle-feeding. They are not designed for nipple pain. BREASTFEEDING SITUATIONS WHERE A SHIELD MAY BE HELPFUL •A baby who is born preterm or late preterm, which is 34-37 weeks gestation. These babies often have trouble with latching at the breast and can tire easily during feeds. There is evidence that nipple shields help these babies keep more active at the breast. •A mother with flat or truly inverted nipples. Caution should be used in determining flat nipples. A good majority of new mothers have some fluid retention in their breasts shortly after giving birth. This is especially true for a mother that has received a lot of IV fluids in labor or certain medications. Nipples in these mothers often appear “flat” due to retained tissue fluid. The areola is also firm, making it difficult for a baby to latch. Mothers should be taught to soften the areola by compressing it with the fingers (Check out this link on Reverse Pressure Softening). This helps move fluids back toward the chest wall and softens the areola. It also draws the nipple out, making latch easier for baby. Mothers can also be shown how to form the end of the breast into a wedge or a “breast sandwich.” This helps baby take in more of the areolar tissue, ensuring a good deep latch at the breast. •A baby who has become accustomed to the firm texture of a bottle nipple. In this instance, a shield can be a good tool in getting baby back to breast. •Rarely, a shield can be used for sore nipples. Once latch has been reviewed and corrected and other issues have been ruled out, a mother with sore, cracked nipples may benefit from a shield as nipples are healing. Having a baby at the breast with a nipple shield is better than not having a baby at the breast, however the shield must be used correctly. Mother’s should observe for good urine and stool output and appropriate weight gain. If this is in order, mother can be assured that baby is effectively transferring milk from the breast. Mother’s should be taught to observe for a good latch with a shield. The baby’s lips should be well flanged, with chin in deep to the breast. If baby is just on the tip of the shield, causing the shield to indent around the nipple, baby may get less milk. Additionally, mothers need to watch for clogged ducts, as the shield can cause reduced milk transfer. A mother whose breasts still feel full after feeding with a nipple shield may consider pumping afterwards to effectively empty to the breast. HOW TO WEAN BABY FROM A NIPPLE SHIELD By definition, to wean from something is to detach from gradually. A mother should allow herself and baby several weeks to come off the nipple shield. Here are some helpful tips: •Always ensure proper latch, bring baby in close and wait for a wide open gape. •With your index finger and thumb, compress the area around the areola to make a breast sandwich or wedge. This makes the nipple firm. Once baby is brought on deep, hold the sandwich until you feel baby suckling well. •Consider pumping to elicit let-down, providing baby with a quick reward. Pumping also helps to elongate the nipple. •Feed baby when somewhat sleepy and not too hungry. They are often easier to put to breast and willing to nurse. •Try latching baby with shield and removing it once let-down has happened. Swiftly place baby back at breast. This “bait and switch” may take several attempts. If baby becomes frustrated with this, allow him to nurse with the shield. The goal is to have a happy baby at the breast. •If it is easier to latch baby at breast with the shield for nighttime feeds, aim for removing it during some of the daytime feeds. DO NOT CUT OFF THE TIP OF THE NIPPLE SHIELD! THIS MAKES FOR SHARP EDGES AND CAN HURT THE BABY. Be patient with yourself and baby as you wean from the shield. Enjoy the time when baby is at the breast and commend yourself for giving your baby the benefits of breast milk!

Breastfeeding...It's only natural

HHS offers moms knowledge, help, and support through a new breastfeeding initiative, It’s Only Natural Today, Surgeon General Regina M. Benjamin, MD, MBA announced the launch of It’s Only Natural, a new public education campaign that aims to raise awareness among African American women of the importance of and benefits associated with breastfeeding and provide helpful tips. It's only natural. mother's love. mother's milk “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed,” said Surgeon General Benjamin. “By raising awareness, the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends and the community.” Breastfeeding offers mothers and their babies a healthy start. According to the Centers for Disease Control and Prevention, nearly 80 percent of all women in the United States—regardless of status, race, or income — start out breastfeeding. Among African American women, the breastfeeding rate is almost 55 percent — up from just 35 percent in the 1970s. However, while these rates are improving, breastfeeding rates among African American women remain lower than the rates of other ethnicities in the U.S., particularly among those living in the south. This gap may indicate that African American mothers face barriers to meeting breastfeeding goals and need additional support to start and continue breastfeeding. It’s Only Natural was specifically designed to provide materials that reflect the experience of African American moms. It’s Only Natural was developed to equip new moms with practical information and emotional support from peers, as well as tips and education about the benefits of breastfeeding and how to make it work in their own lives. All of the material is uniquely crafted for African American women. Materials include: •video testimonials from new moms talking about the challenges they have overcome, providing breastfeeding tips, sharing their individual stories, and much more; •articles on a variety of topics ranging from laws supporting breastfeeding to how to fit breastfeeding into your daily life; •two fact sheets, which contain proper holding and latching techniques, as well as information on managing discomfort and how much milk is enough; and •radio public service announcements. To learn more about the campaign, visit www.womenshealth.gov/ItsOnlyNatural. ###