GOLD Learning Speakers

- Before the discovery that HIV could be transmitted through mothers’ milk, breastfeeding’s role in protecting against death and disease had enjoyed an era of unprecedented global promotion. But from 1985 onwards, the possibility of transmission of a lethal virus through mothers’ milk led to profound changes in infant feeding advice. Banned outright in Europe and America, replaced by formula-feeding only to be later re-endorsed in resource-poor settings, and now enjoying a relaxation of previous prohibitions in industrialized countries, breastfeeding in the context of HIV has come full circle. Is it any wonder that health-workers are confused? This session tracks which research influenced HIV and infant feeding policy, and when. It describes a journey spanning promotion of maternal infant feeding choice in the face of an uncertain outcome to a clear recommendation based on up-to-date evidence about child-survival. Twenty-five years later breastfeeding enjoys a renewed endorsement regardless of a mother’s HIV-status. Please note this is NOT a live presentation and is a bonus recording from GOLD Lactation Online Conference 2013. You may have already viewed this presentation, but an additional educational hour can be claimed.

In biological terms, successful breastfeeding demands that the baby survives and thrives on his mother’s milk. “Not-enough-milk” (either real or perceived) has long been recognized as the most common reason why mothers abandon breastfeeding. Ways to identify for the mother whether a baby is “getting enough” are discussed. The causes of inadequate breastmilk intake include physiological/anatomical conditions in mother/baby, poor lactation management or other more obscure causes. While planning interventions to enhance breastmilk production and improve infant intake, it is important to protect the baby’s nutritional status. Simultaneously implementing strategies to increase the mothers’ breastmilk supply while caring for a high-need baby can be immensely challenging. Each client will need constant support, reassurance and re-evaluation. Turning such a difficulty around, with the goal of eventually returning to exclusive breastfeeding, can be one of the most fulfilling and rewarding situations that an IBCLC can work with.