It seems that everything in the parenting realm is up for debate, as differing opinions and standards may ultimately drive a wedge of fear between many mothers and mother’s intuition. “Recommendations” change with the season it seems, like the first introduction of solid food, and guidelines for car seat safety. The majority adapt to the changes and use them as a guide, even as a common ground among other mothers in social settings.
Photo copyright: Jennifer Canvasser
Why, then, when it comes to the health and well-being of the most fragile among us (babies born prematurely), does a lack of basic rights (especially for life-saving human milk) prevail? Statistically, it is clear that breastmilk is best. The American Academy of Pediatrics (AAP) advises that breast milk can help prevent or treat diseases such as necrotizing enterocolitis (almost 90% reduction, compared to formula1), gastrointestinal tract infections (64% reduction, and lasting two months post breastfeeding), and type 1 and 2 diabetes (30%; 40% reduction, respectively), to name a few, and that ”the potent benefits of human milk are such that all preterm infants should receive human milk”. Furthermore, per the AAP, “Lower rates of sepsis and NEC indicate that human milk contributes to the development of the preterm infant’s immature host defense.”2 Jane Morton, MD, FAAP states, “Unquestionably, breast milk is far superior to any formula designed for babies, and even more critical for the health of the premature baby.”3 Yet, the majority of hospitals (as much as 60%4) in the United States do not use donor milk, and many take it a step further by supplementing with conventional cow-based formula-fortifier, sometimes against the wishes of parents.
Barriers to human milk for those in NICU span beyond hospital regulation. Most insurance plans in the United States do not cover the costs associated with using donated breast milk (from a milk bank), which can be a hefty financial load to bare when already faced with medical expenses related to birth and the NICU. Few, if any, financial resources are available to parents in regards to donor milk. A lack of resources, support, and education can also be a deterrent for anyone when it comes to providing breast milk to NICU babies in particular. For example, not knowing how or where to donate milk; how or where to obtain pasteurized donor milk, or not being informed of the benefits of breast milk (especially breastfeeding) for premature babies.
A mother may experience a delay in lactation immediately following birth. Her supply may not easily increase (especially in an emergency situation, or a preterm birth) as it would if baby were directly breastfeeding on demand. New moms, especially in a critical situation, do not know how to breastfeed, nor how to pump. Providing resources, education, and assistance for mothers in a hospital setting will help both physically and emotionally for a mother to flourish in feeding her child. Hospital NICUs undeniably need to revamp lactation support policies, as well as provide a comfortable environment in which a mother can express milk or breastfeed.
Babies may be taken quickly from mother after birth (as in an emergency situation). It may be days before mom and baby are reunited, and possibly longer still before mom is able to touch or hold baby. During this time especially, support and education from the hospital itself is vital… for comforting mom, for preparing her and helping establish a milk supply, and for giving both mom and baby the freedom and ability to cuddle via skin-to-skin, bond, and thrive. Allowing as much skin-to-skin as possible leads to higher success of breastfeeding and/or pumping and provides numerous benefits to baby.5
Milk Banks typically provide monetary assistance for the shipment of milk from a donor to the bank. These organizations work with individuals to ensure that the process is stress and worry free. Donors are screened, and milk is pasteurized and cultured, to ensure the highest quality for fragile babies. The Human Milk Banking Association of North America provides a list of milk banks. Human Milk for Human Babies is an organization that provides informal breast milk donation, allowing mothers to connect personally. Milk donated exchanges hands directly between donor and recipient.
Jennifer Canvasser, founder of NEC Society, and mother of twins born prematurely, both of whom spent a length of time in the NICU at the University of Michigan Motts Hospital, knows firsthand the challenge of fighting for the right to human milk for babies. When faced with aversion, what can be done? With whatever energy a parent of a NICU infant has, Canvasser suggests, “Ask what are the policies around human milk for fragile babies? Do you have a program? Do you provide the infants with an exclusive human milk diet?”
Having an infant in a NICU is emotionally and physically demanding. Readily available resources for parents in regards to providing human milk for their baby (whether via mom or donor) could lessen some of the burden for parents. In addition, raising awareness of the need for human milk for fragile infants, sharing stories and experiences publicly, and working with healthcare professionals and administrations can be a start to ensuring the basic rights of those born prematurely: a safe environment, access to proper nutrition, and a fighting chance!
Organizations such as NEC Society and Best for Babes, along with recent documentary “The Milky Way” are actively doing just that. Says Canvasser of NEC Society’s current mission, “Our focus is on changing practices and reducing the incidence of necrotizing enterocolitis. We strive to empower NICU families and create real change in NICU practices that will better protect fragile babies. The first step is awareness and empowering families.”
How can an individual help to raise awareness? Simply put: talk. Discuss openly the benefits of breastmilk (especially for infants born prematurely) to friends and family, speak with the local hospital about policy, reach out to local media about possibly covering the story, meet with healthcare professionals to ensure accurate information is being spread and used, advocate on behalf of someone who’s experienced a loss as a result, or is currently in the midst of the battle. When emotionally ready, share with others. As the late Maya Angelou asserted, “There is no greater agony than bearing an untold story inside you.”
Human milk nourishes, protects, and heals. Every baby, regardless of circumstance, deserves the right to thrive.
1 “Necrotizing Entercolitis Risk”. US National Library of Medicine National Institutes of Health. NCBI. April 2012. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357630/>
2 “Breastfeeding and the Use of Human Milk”. Pediatrics. Vol. 129. pp. e827-e841. Official Journal of the American Academy of Pediatrics. 27 Feb 2012/1 March 2012. Web. <http://pediatrics.aappublications.org/content/129/3/e827.full#content-block>
3 “AAP Policy on Breastfeeding and the Use of Human Milk”. Breastfeeding Initiatives. 28 May 2014. American Academy of Pediatrics. Web. <http://www2.aap.org/breastfeeding/policyonbreastfeedinganduseofhumanmilk.html>
4 “Fast Facts: Miracle Milk”. NEC Society. 06 May 2014. Web. <http://necsociety.org/>
5 “Holding your baby close: Kangaroo Care”. March of Dimes. Web. 2014. <http://www.marchofdimes.com/baby/holding-your-baby-close-kangaroo-care.aspx>
The term lactation consultant or LC has become the title for someone with expert knowledge in breastfeeding; an allied health professional who specializes in the clinical management of breastfeeding. They may be employed in hospitals, public health programs, and private practice. They work with moms and babies to address breastfeeding issues and concerns. They may also teach classes, assist with establishing breastfeeding, and promote and protect breastfeeding.
Origin of the term “Lactation Consultant”
The term “LC” originated as a short form of “IBCLC” or International Board Certified Lactation Consultant because, as you can see, that term is a mouthful.
“LC” is not trademarked and does not hold a professional standard like “IBCLC” does, so one will occasionally find a practicing LC who is not an IBCLC. Consumers (mothers and families) and other professionals (doulas and doctors) need to be aware of this.
As well, not all those who work as “lactation consultants” in health centers or breastfeeding support centers are IBCLCs. Some employers encourage employees to pursue the credential but don’t mandate it for employment. Many times, nurses with some breastfeeding education fill these jobs.
The International Board of Lactation Consultant Examiners (IBCLE) awards the title of International Board Certified Lactation Consultant to only the candidates who meet the comprehensive pathway and pass an international exam. This allows IBLCE to establish the highest standards in lactation and breastfeeding care worldwide and to certify only the individuals who meet these standards.
La Leche League Leader
All the roles are important, but they provide their own distinct scope, responsibilities, and abilities. They can all work together to provide comprehensive support. One does not replace the other.
Primary roles of caregivers
As you can see, I’ve broken this down into three primary roles.
3. Clinical management
Educators teach you about the normal and expected processes of childbirth and breastfeeding. They typically call themselves childbirth educators and lactation educators.
They teach the normal process of birth & breastfeeding and what you can expect when having a baby and breastfeeding, as well as encourage and promote breastfeeding to others.
This information helps you make decisions, helps you know if you are on track, gives you references for getting the birth and breastfeeding relationships you want, and helps answer your questions.
Educators typically teach community classes in group settings.
Support people are those who have additional training in supporting mother, baby, and family during crucial times: birth and breastfeeding.
They’re typically doulas and La Leche League (LLL) leaders. Doulas are usually paid professionals, and LLL is a mother-to-mother volunteer peer support group. These roles offer the encouragement and motivation you need to get through the processes of birth and breastfeeding.
They’re well versed in normal and expected outcomes. They know to watch for red flags to ensure they can guide you to further resources and caregivers if you have come outside the normal, expected process.
Their job is to provide physical and emotional support, encouraging you to ask questions of your caregivers to make sure you’re well informed about what occurs. They have resources and guidelines to reassure you that you’re indeed in the realm of normal, and if things deviate from normal, they can point you in the direction of more resources. They are not health care professionals and do not perform medical tasks.
Lastly, we have the clinical management professionals.
These are the folks responsible for the clinical and medical bits of the scenario. They look at the facts and figures, histories, and red flags to determine if the scenario is within the normal and expected category and making a plan from there if it not. They are the big picture thinkers. They have the clinical experience of birth &breastfeeding that fall outside normal expectations and how to manage them.
All of these people have a place in the realm of support and care giving; what is important is that people know their role and responsibly and respect the others. Where it becomes problematic is when the client/consumer is expecting one thing and gets another because they have the various people confused for another and their expectations are not met and they think it is because “that” person did not do their job. In the case of this article, we are really looking at how an IBCLC stands out.
Let’s say a mom thinks that a Lactation Educator is an IBCLC, and her breastfeeding issue does not resolve after a consultation. She looks for more help and calls a La Leche League leader who determines that the issue is outside their scope and needs a recommendation to an IBCLC. When the LLL Leader suggests this, the moms says, “I already saw one and they did not help.” This hurts all of the support people. The educator gets a bad rep because she did not help, but it is the IBCLC profession that gets the bad rep because of the misunderstanding of the different roles and expectations. And LLL could not help because the needs were not within their scope. Moms need to know with some clarity what their expectations are and who the best person is to meet their expectations based on role, scope and experience.
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