Marie's Outlook

What’s an IBCLC’s Role with Emergency Preparedness & Breastfeeding?

I admit it. The first time I ever heard about “emergency preparedness” in the context of breastfeeding — years ago, before Harvey, before Irma, and before Katrina — my immediate reaction was a smart-alecky: “Just tell mothers to go ahead and breastfeed! After all, breasts don’t require any electrical power!”

My point was correct, but it was very short-sighted.

Breastfeeding can be the difference between life and death in cases of hurricane or other natural disaster. If you are already certified as an International Board Certified Lactation Consultant or a Certified Clinical Lactationist, you have plenty of expertise to help. If you have other breastfeeding support experience–or even just breastfeeding experience–you can help. Here are eight roles I see for breastfeeding advocates in an emergency situation.

Assist with emergency preparedness in advance.
Become a part of your community’s emergency preparedness planning and facilitate breastfeeding-supportive policies before disaster strikes. Or, if you teach breastfeeding classes or mothers’ groups, talk with them about what they can do in an emergency–what they can do about milk storage, engorgement, and so on. (I’ve talked about this on my weekly show, “Born to be Breastfed,” and there are other sources that are helpful from the World Health Organization, the American Academy of Pediatrics, and others.

Dispel the myths.
– Mothers will be so stressed that they will automatically lose their milk
– Mothers who are malnourished won’t make good (or enough) milk.
– Breastfed babies need extra water to stay hydrated.

People say these things even when there isn’t an emergency, but they seem to say them more–and louder–when there is. They’re not true. Unless a mother is seriously starving, she will continue to make adequate amounts of nutritious milk because her bodily stores will kick in to cover deficits of her currently-compromised nutritional status. Also, human milk is made up of about 87% water, and breastfeeding releases hormones that keep mothers and babies calm.

Help aid workers to understand that formula carries many risks.
In an emergency, aid workers are quick to distribute formula. But even if ready-to-feed bottles are being distributed–meaning that mothers won’t have to worry about mixing formula, or cleaning feeding gear with contaminated water–the formula comes with risks.

Once the formula is opened and the baby has had his fill, how will the leftover formula be safely stored? Without refrigeration, that’s a germy problem waiting to happen. Even under the best of circumstances, the formula might not “agree” with the baby, and at the very least he will be uncomfortable—or possibly have a serious adverse reaction or outcome. And, each replacement feeding reduces the “demand” and therefore the “supply” of her milk. If a breastfeeding mother and her baby can be kept together safely, then they should continue breastfeeding, no formula needed.

Teach mothers low-tech (or no tech!) tricks.
Mothers might not have electricity to power their breast pump. Using a car adapter might be a option (just remember that gasoline might be in short supply), so using a manual pump or hand expression can work well in this situation, even though it might not be something a mother would choose to do on a regular basis.

If a woman is having trouble with a let-down, and experiencing extreme engorgement, a warm jar can be used to help draw the milk out.

Of course, the “no-tech”-est trick of all is to have the mother stay with her baby to breastfeed directly!

Share guidelines for dealing with frozen stored milk.
If a power outage occurs, simple strategies like keeping the freezer full with the door closed is a good idea. Neighbors may be unaffected by the power outage, or they may have a generator. They may be willing to keep some bottles of frozen milk (labeled with contact information). Putting milk into one of those insulated chests or bags, while not ideal, is better than nothing.

Consider the risk/benefit of cross nursing or milk sharing.
Before you start worrying about the possibility of disease transmission through milk from a woman other than the infant’s mother, just remember, formula may carry a bigger risk. In some cases, cross-nursing might be critical to a baby’s survival, as we saw during an earthquake in China in 2008.

Facilitate relactation.
Whether it’s been three weeks, three months or three years, women who have lactated before can lactate again. It’s essential for an expert to know the principles for helping a woman to relactate.

Help mothers who have lost a baby.
We don’t want to think about this, but it does happen. You’ll need all your sensitive counseling skills for helping the grieving mother. But you’ll also need to know how to help them either suppress lactation, or give them the courage to offer to breastfeed an orphan, or express their milk to donate to an available resource.

What have you done in your community about this issue?

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