Seeing Past Old Practices

The ancient peoples quickly found that one does not pour new wine into old wineskins. If they did, the wine would ferment and burst the skins. (Presumably, if they did not know, the consequences would become abundantly apparent!) Learning from experience, they used new wineskins for new wine. They learned from the evidence before their eyes that if they didn’t, the wine would be ruined, and the skins would be ruined.

Unquestionably, we all want to avoid ruination. What is less clear is whether we, in caring for breastfeeding mothers, allow ourselves and our clients to see the evidence before our eyes.

I continually encounter people–health care professionals in general, candidates for the IBLCE exam–trying to force the old ways of doing things onto today’s mothers and newborns. We have piles and piles of evidence to show the efficacy of hospital practices, such as rooming-in, early skin-to-skin contact and more, yet some give the impression that these practices are optional, unrelated to breastfeeding outcomes, or trumped by other factors presumed to be more important. Many continue to give out discharge packs containing formula, or to allow mothers to sleep through the night during their hospital stay because someone in the system values a “policy” or patient satisfaction survey result over the evidence. Yet we wonder why the rates of exclusive breastfeeding for newborns less than 1 month old continue to be so low!

Plenty of evidence shows that the continuation of these “old ways” has a ruinous effect on breastfeeding rates at 6 months.

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Few of us wake up in the morning expecting to encounter the odd, unexpected, or impossible. Each day, we assume that life will pretty much roll along, and we’ll do what we usually do, see what we usually see, and go on our merry way.

Sometimes, though, we do come across things that are seemingly odd, unexpected, or impossible. The key word is “seemingly.” Who would have thought that one woman could–in just five years’ time–produce and donate 16,321 fluid ounces of milk? That’s about 128 gallons of milk! Yet, Amelia Boomker, a technical analyst and mother of four, has been recognized by Guinness World Records for that. (And reportedly, it’s an undercount: About 7,000 ounces of milk donated in 2005 were not included in that total.)

How is it that one woman can make–and donate to someone else’s children–so much milk beyond her own children’s consumption, when so many women say they don’t make enough to feed even one child?

During the past 30 years, I’ve heard hundreds of women say they don’t have enough milk. I’ve heard the media say that formula is a very acceptable alternative for all of those women who “can’t breastfeed,” or “can’t make enough milk.” Does Ms. Boomker have some kind of super-human power? Does she have super-human breasts?

No, not at all! Ms. Boomker has a super sense of generosity and commitment to doing the right thing–for her own children and others. But she manages these goals with much the same anatomy as other mothers.

All women have the opportunity to make a lifelong difference for children–their own, or someone else’s. Some do breastfeed for a year, or longer. All too often, breastfeeding in public, they are looked upon as odd. Some do express their milk for moths; one mother I know had a child who was completely unable to take oral feedings, and she expressed her milk for over 2 years. Such dedication may be unexpected in a country where formula is ubiquitous, but she did it. And expressing “super” quantities of milk for someone else’s child? It does seem impossible, but clearly, it has been done.

Not all of us need to do the odd, the unexpected, or the impossible. But maybe we need to look for those opportunities, and believe that we can.

 

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The Help You Need

Many women approach pregnancy with a “we’re in this together” mindset. After attending Lamaze or Bradley method courses as a couple, they feel confident that the husband/partner will be a good labor support person. A “doula” seems like an unnecessary expense, then. An extravagance, if you will.

I’m always a bit concerned about these mothers-to-be. The little voice in my head objects—no first-time dad has any idea what he’s in for, and no first-time mom can know if their husband/partner will be able to be supportive during childbirth. But if they find out he can’t provide what they need then, they’ll be missing out on a kind of support they really do need.

Now, I think it’s great that modern fathers are involved and present for their babies’ arrival into the world. I’m not suggesting that men be relegated to hospital waiting rooms, as they were in the 1960s. A baby’s birth is an important moment for both parents.

However, I’ve worked in labor/delivery enough to know that even the most devoted, compassionate husbands can: get sleepy at 2:30 AM … feel helpless watching a beloved wife suffer through painful contractions … turn his head away when she pukes … and become frightened when the situation seems unfamiliar or dangerous. It’s easy to lose sight of what kinds of support the mother needs at this time.

Most men are not well-prepared for the real experience of childbirth. Even if he has seen a film of a baby being born, the man hasn’t seen his partner sweat through labor, gobble ice chips, or vocalize the pain of childbirth. Even during a healthy, uncomplicated delivery, a dad is likely to experience the fear that something dreadful will happen to the woman he loves or the baby he’s never met.

The doula is an expert at labor support. She has both extensive training and experience. She becomes neither nonchalant nor panicked if the planned labor/birth experience starts to go awry. She is objective, and she stays awake from the start until the end. She can—and will—be present with the mother if the father needs to get a cup of coffee, a rest for his hand the mother has squeezed until it’s numb, or a nap.

Studies show that the presence of a doula during childbirth improves outcomes for both mothers and babies (e.g., lower risk of low birth weight babies, lower risk of birth complication for mothers and babies, greater likelihood of breastfeeding initiation, lower risk of cesarean delivery, lower risk of epidurals, and more! As doula Teresa Bailey and I discussed on my radio show, doulas make a big difference in birth and breastfeeding outcomes! The bottom line: I encourage every mother and father to have a doula at their baby’s birth.

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– Kimberly Seals Allers, award-winning journalist and commentator, will be a guest on “Born to be Breastfed,” on Voice America’s Health & Wellness Channel on February 24, 2014. –

Herndon, VA, February 17, 2014 — Marie Biancuzzo, host of “Born to be Breastfed” on Voice America’s Health and Wellness Channel, announced today that Kimberly Seals Allers will be a guest on her radio show on February 24th from 6 PM to 7 PM ET. Discussion will focus on breastfeeding in the African American community.

“Rates of breastfeeding initiation and duration continue to be lower among black mothers than those of other ethnic groups,” explained Marie Biancuzzo. “Kimberly and I will be discussing cultural norms, particular challenges, and ways of supporting families in breastfeeding.”

Join Marie at 6 PM ET (3 PM PT) to learn more about this topic. Families who are interested in listening live can tune into Voice America Health & Wellness channel. The show will also be available through iTunes. Questions will be accepted during the live show, or by e-mail in advance to radio@borntobebreastfed.com

About Marie Biancuzzo
Marie Biancuzzo, RN, MS, IBCLC is an experienced breastfeeding professional who aims to cut through the misinformation, bust the myths, and help families figure out what science they can trust. A clinical nurse specialist and international board certified lactation consultant, Marie has more than 3 decades of experience in community and teaching hospitals, counseling mothers, and teaching health care providers. From the mother’s bedside to the university classroom to the international continuing education arena, Marie has honed her skills at helping listeners to clarify the facts empower the family. Author of two books and multiple articles, Marie is passionate about helping parents and providers to be good consumers of health care and scientific information. As the Director of Breastfeeding Outlook, Marie helps nurses and other breastfeeding educators learn what they need to know; through her private practice and this show, Marie helps families, too.

About Kimberly Seals Allers
Kimberly Seals Allers is an award-winning journalist and nationally-recognized commentator on motherhood and breastfeeding in the African American community. A former senior editor at Essence magazine, she is the author of “The Mocha Manual” series and co-author of “Giving Notice: Why the Best and Brightest are Leaving the Workplace.” In 2011, Kimberly was named an IATP Food and Community Fellow for the Kellogg Foundation’s effort to increase awareness of the “first food”—breast milk—in vulnerable communities. She has been selected by the United States Breastfeeding Committee as a lead commentator for the national “Break Time for Nursing Mothers” campaign, and writes for several popular online parenting sites. Her next book, on the social, political and economic influences of U.S. breastfeeding culture, will be published by St. Martin’s Press this year. Kimberly is a divorced mother of two and lives in Queens, NY. She is online at www.MochaManual.com and BlackBreastfeeding 360°.

About VoiceAmerica/World Talk Radio, LLC
World Talk Radio, LLC is the world leader in online media broadcasting and the largest producer and distributor of live internet based talk radio and TV, delivering over 1,000 hours of programming weekly on its VoiceAmerica Network (http://www.voiceamerica.com) and WorldTalk Radio Network (http://www.worldtalkradio.com) as well as live and on-demand video content on VoiceAmerica.TV (http://www.voiceamerica.tv). Featuring more than 200 hosts broadcasting to eight niche community based channels: its flagship VoiceAmerica Variety Channel, VoiceAmerica Health & Wellness Channel, VoiceAmerica Business Channel, VoiceAmerica Sports, 7th Wave Channel, The Green Living Channel, VoiceAmerica Kids Channel and World Talk Radio Variety Channel. VoiceAmerica TV offers targeted and exclusive video programming channels. World Talk Radio, LLC is one of the pioneers in internet broadcasting, producing and syndicating online audio and video, offering an innovative, effective and comprehensive digital broadcast platform. Digital Publishing through its 10 years of broadcast and media experience along with our seasoned staff of Executive Producers, Production and Host Services Group, World Talk Radio, LLC provides an internet radio and video platform for new, emerging and veteran media personalities to expand and monetize their business and brand in an online digital medium.

To learn more about the new radio program, visit the Voice America Health and Wellness Channel website: http://www.voiceamerica.com/Channel/248/voiceamerica-health-and-wellness

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Many of the health care providers who come to my IBLCE exam prep course talk to me about preparing for their changed life with the IBCLC. Often, they express frustration with the “rules” of the health care organization that employs them. For most, this is a hospital. They find themselves either abiding by the rules, make the rules, enforcing the rules, or fighting against the rules of their hospital.

Are you a hospital-based nurse? Does this ring a bell for you? Is that a bell that you (or any caregiver) really wants to hear?

The word “hospital” comes from the Latin root hospes, which means “stranger” or “foreigner,” and hence, “a guest in a particular place or shelter.” The root for the word hostel or hotel or hospital is also the root for the word hospitality, a word that refers to the relationship between the guest and person who provides the shelter. I recognize that the day-to-day operations of hostels, hotels—and yes, hospitals—require rules. What bothers me about hospital rules is that they have rules for such basic human needs as eating and sleeping—and that they try to apply these rules to the tiniest and most vulnerable members of our society: newborns. They must eat now. They must not eat them. They may eat if their serum glucose is lower than X. They may not eat if it is time to do some other activity (a hearing test, a bath, etc.) on the hospital’s schedule.

Rules can be useful. But until our hospitals are a little more hospitable, we caregivers need to help make some serious changes. We are more than a place of shelter—we are a place of care, at the start of the baby’s life.

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Myths

Over thirty-plus years in maternal-child nursing, I have heard a lot of reasons for why mothers believe they can’t breastfeed, or why they don’t want to. More often than not, their reasons are based on myths rather than facts.

Perhaps the reason I’ve heard most often is that the mother’s “breasts are too small.” Hmm. As a reason for not breastfeeding, it doesn’t make much sense. The truth is: Breast size is not an indication of breast milk production, at all!

Some myths about breastfeeding have been handed down from generation to generation. (For example, some women have heard they need to “prepare” their nipples in advance by toughening them up with brisk rubbing of a washcloth or loofa. Ouch! Not true!) Others seem modern in origin, although it can be hard to know the original source.

Although some of the myths do include a kernel of fact, it’s always important to track down good, credible sources before making any breastfeeding decision. If you have read my book, listened to my radio show, or attended one of my courses, you’ve probably heard me say at least a dozen times: Women need to make informed choices. Informed choices are those based on facts—not myths!

I spend a good deal of time busting misinformation about breastfeeding, guiding mothers I care for from myths they hear to facts they need to know. Informed decision-making is a major key to health and happiness.

For more about this topic, be sure to tune in on Monday 2/10/14 at 6 PM for “Born to be Breastfed” on the VoiceAmerica online radio network. This week’s episode addresses “Ten Myths Why You ‘Can’t’ Breastfeed.”

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Whooo-hooo! I just finished teaching the Comprehensive Lactation Course in Orlando. What a thrill!

The first course of a new year is always exciting, although I always feel a little wary. It’s the time to put all of my preparations into action for the first time. For example, this year’s course syllabus totals 337 dense, action-packed pages. I started writing those 337 pages during the summer, and finished just in the nick of time. I’m hyper aware that I’m helping everyone to prepare for–and pass–the IBLCE exam. I want everything to be just right so that goal is realized. As many years as I’ve done this, I’m always nervous about the first one out of the gate in January.

This was definitely a memorable course, rich with contributions from our community of breastfeeding advocates. We all loved Qamariyyah’s story about how she convinced a mother who was determined to formula-feed to instead breastfeed her firstborn; she later breastfed her whole brood and told all of her friends to breastfeed, too! Someone immediately pointed out that Qamariyyah had changed more than the life of one child or one family; she had changed the feeding behavior and health outcomes of at least one generation–likely more than one generation–of children in that and other families.

We all learned from Ana’s clinical experiences with malaria, and a Elizabeth’s clinical experiences with tuberculosis. I think we all felt amazed that despite her perilous postpartum course, Sage had a successful breastfeeding experience. Then, I think everyone was grateful when Shona stood up to draw an illustration when we needed one; I can’t draw anything! And, let’s face it, no one could resist the entertainment that Cherie and Karen provided! How many times did the room rock with laughter?

I think it would be fair to say that everyone or nearly everyone asked a question, contributed a story, or shared an insight. It was a great group. I had a blast. I hope everyone else enjoyed the week as much as I did!

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Q & A: Metabolite

WITHOUT LOOKING IT UP: A metabolite could be MOST accurately described as a substance which:

a. may or may not be pharmacologically active
b. triggers therapeutic reactions in the body
c. results from peak plasma concentrations
d. frequently results in serious consequences

Of course, this question is unlikely to be included in the IBLCE exam as-is, but knowing this information may help you decode a more complex exam item. The best answer here is “a.”

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Finally, the American Academy of Pediatrics (AAP) has updated its statement “The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics.” The news is both favorable and reassuring: “Only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants.”

In what may be a nod to the 12-year period since the last statement on this topic was issued, the authors decide to identify authoritative sources for the latest research about medications, rather than to tackle the impossible goal of summarizing all we know about possible medications. “More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed … Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication.”

Note that use of several narcotic pain medications (codeine, hydrocodone, and oxycodone) is discouraged. (Remember the FDA’s codeine warning in 2007?)

In addition, the long-term effect of psychoactive drugs on the nursing infant should be handled cautiously, with risk-benefit counseling, and possible monitoring of infant growth and neurodevelopment. Concern is also noted about several drugs for substance abuse.

Health care professionals who care for breastfeeding women are encouraged to read the full text of this article.
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Caring for each other

Most of us who entered this profession because we wanted to “take care of people” have indeed done so. We care about our clients. Our day isn’t done until we have taken care of them … helped them to feel better … counseled them in caring for their new babies … supported them in breastfeeding. But how does that translate into our professional development?

I want to tell you about a dedicated woman I know. Let’s call her “Julie.” She had waited a long time and worked very hard in order to be eligible to sit for the IBLCE exam. She had completed her 90 hours of lactation-specific education as required by the IBLCE and logged her clinical hours. Julie even submitted her application and payment ahead of time, she was so eager to take this next step in her career. She had paid for all of her preparation herself.

In June, Julie called me. Nearly in tears, she told me that her application for the IBLCE exam had been rejected. She had not done the required Health Sciences Education. Julie hadn’t even started it. Why? Because she didn’t realize that she— and all others who are not recognized by IBLCE as healthcare professionals—need to complete those 5 learning programs (plus basic life support, which most of us call CPR.)

I, and all of my staff, felt so badly for her. Julie has to wait another year to be eligible to take the exam for another year.

That’s why I’m asking for your help. I want you to help me put some of that urge to “take care of people” into taking care of your colleagues. If you know someone who may be outside of IBLCE’s “healthcare professional” category and who is working towards being an IBCLC, please forward this message to her.

I want all of the “Julies” to know Breastfeeding Outlook can help them meet their professional goals. We offer 5 out of the 6 Healthcare Sciences Continuing Education topics as an online learning program. (Due to the hands-on nature of the subject matter, we assume the sixth—CPR—will be completed locally.)

Thank you for helping us take care of each other.

Note: Please see the IBLCE

    Health Sciences Education Guide

for details about this requirement.

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