Changing Outcomes for Breastfeeding Families Lecture Pack

This Academy of Breastfeeding Medicine Lecture Pack 2019 consists of presentations which were originally presented at the 24th Annual International Meeting of the Academy of Breastfeeding Medicine in the UK.
The 24th Annual International Meeting features world-class speakers providing cutting-edge research and clinical information on current issues in breastfeeding medicine, spanning both maternal and child health. Physicians, registered nurses, lactation consultants, and other professionals will have the opportunity to continue their professional education in a highly respected, stimulating environment, while earning continuing education credits.

$75.00 USD
Total CE Hours: 5.25   Access Time: 5 Weeks  
Lectures in this bundle (7):
Durations: 45 mins
Breastfeeding and Perinatal Mood Disorders: Circuits and Circumstances

Dr. Maria Enrica Bettinelli is Lecturer of Pediatrics, University of Milan, Italy School of Medicine. As IBCLC since 2003, her research focuses on how overcoming barriers to implement breastfeeding support in the community and to promote mother and babies well-being in the perinatal period and the first years of life, adopting nurturing care approach. She has authored peer-reviewed publications on baby friendly community, breastfeeding rates in Lombardy, and the maternal and child health effects of lactation.
Her current research includes the clinical management of breastfeeding difficulties and how emotional experiences impact on breastfeeding decision. As Director of Milan Breastfeeding Network in Milan, Dr. Bettinelli leads an interdisciplinary team of clinicians, nurses and midwives that is developing new approaches to management of breastfeeding difficulties and to sharing breastfeeding education. Dr. Bettinelli is a member of the Italian Society of Pediatrics and Italian Society of Neonatology, chairs the Task Group of Education and Conference 2020 of ELACTA Board 2018-2020 and is a member of the ELACTA Board 2018-2020, and since 2012 is a member of the Academy of Breastfeeding Medicine.
Dr. Bettinelli attended University of Milan School of Medicine where she graduated with her M.D. in 1986. She completed her Residency in Pediatrics in 1989 and in Neonatology in 1991 at University of Milan and went on to complete her medical experience at Mangiagalli Hospital in Milan. Dr. Bettinelli obtained her MSc in Perinatal Mental Health in 2019.
She lives in Milan, Italy with her husband and her daughter.


Objective 1: Understand relationship and mechanisms linking breastfeeding, attachment and perinatal mental health;
Objective 2: Learn how breastfeeding can reduce risk of perinatal mood disorders;
Objective 3: Manage and support breastfeeding in case of mothers affected by perinatal mood disorders.


Abstract:

Breastfeeding, attachment, and perinatal mental disorders share the same neurobiological circuits and neurosciences have shown there are connections acting both in a protective and negative sense. Relational experiences in the early years of life put the basis for future physical and mental health. Avoiding early toxic stress is essential in preventing mental problems later. Maternal depression, and in general perinatal mental disorders of parental figures, especially of the mother, have a well-documented negative effect on infants and children, altering the mechanism of responsive interaction. Depressed mothers do not engage with their children and fail to respond to their signals. Children find this situation stressful, and there may be permanent effects arising from being raised by chronically depressed parents.
According to recent studies, breastfeeding helps reduce early toxic stress, as well as allowing optimal nutrition. The responsive interaction mode is the basis of the relationship established with breastfeeding. So breastfeeding has a significant impact on the mental health of children and adolescents. The way mothers respond to their children's needs is the key to understanding these long-term effects. When mothers respond consistently to the signals of their children, they lay the foundations for the resilience of their children. By understanding that the success of breastfeeding is linked to perinatal maternal mental health, we can create awareness when counseling the breastfeeding mother.


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Durations: 45 mins
Peter S Blair, BSc, MSc, PhD
Reducing SIDS Risks Whilst Promoting Breastfeeding
England Peter S Blair, BSc, MSc, PhD

Peter has a background in Medical Statistics and a particular interest in infant and childhood epidemiology. Born in Manchester, England, he studied Mathematics (BSc Hons) and Medical Statistics (MSc) before moving to Bristol where he completed his doctorate (Epidemiology of Sudden Infant Death Syndrome) in 1998. From his work on several major observational studies he is a recognised expert with over 100 publications in the SIDS field and was made an honorary fellow and advisor to UNICEF (UK) on infant care practices in 2009. In 2014 the Queen’s Annual Prize for Further and Higher Education was awarded to the University of Bristol based on Peter and his colleague Peter Fleming’s contributions in this field. He is the elected Chair of the International Society for the study and prevention of Perinatal and Infant Death (ISPID) and chair of the epidemiological working group. He is also a senior consultant methodologist for both the University of Bristol Trials Unit and the NIHR Research Design Service. He lives with his partner Helen and two sons, Jacob & Sam, aged 19 and 21 years.

Objective 1: Delegates will be able to discuss the epidemiological evidence around the divergence in public health approaches to hazardous sleeping environments;
Objective 2: Delegates will be able to describe the impact public health approaches may have on international SIDS rates;
Objective 3: Delegates will be able to discuss the epidemiological evidence surrounding the promotion of dummy use.


England Peter S Blair, BSc, MSc, PhD
Abstract:

Although the evidence suggests that promoting breastfeeding will reduce the risk of SIDS, some of the other risk-reduction advice given to parents seems counter-intuitive in terms of enabling breastfeeding. This talk will take a closer look at the epidemiological evidence (or lack of it) surrounding the promotion of dummy use, putting babies to sleep in cardboard boxes, the divergence in public health approaches to hazardous sleeping environments and the impact this may be having on international SIDS rates.

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Durations: 45 mins
Fiona Clare Dykes, PhD, MA, RM, ADM, FHEA
Influencing a Paradigm Shift in the Unicef UK Baby Friendly Initiative (BFI)
England Fiona Clare Dykes, PhD, MA, RM, ADM, FHEA

Fiona Dykes is Professor of Maternal and Infant Health and leads Maternal and Infant Nutrition and Nurture Group (MAINN), at University of Central Lancashire, Preston, UK. Fiona has a particular upon the global, socio-cultural and political influences upon infant and young child feeding practices; her methodological expertise is in ethnography and other qualitative research methods. Fiona is the Conference Convenor and Chair of the Scientific Review Committee for the MAINN Conference, a three day, international, peer reviewed event established in 2007 and held bi-annually in the UK and, more recently, on alternate years overseas (Sydney, Australia, Sweden and Florida). She is a member of the editorial board for Maternal and Child Nutrition. Fiona is author of Breastfeeding in Hospital: Mothers, Midwives and the Production Line (Routledge) and co-author, with Dr Tanya Cassidy of Banking on Milk: An ethnography of donor human milk relations (Routledge). She is also joint editor of several books including Infant and Young Child Feeding: Challenges to implementing a Global Strategy (Wiley-Blackwell) and Ethnographic Research in Maternal and Child Health (Routledge).

Objective 1: Delegates will be able to explain importance of relationships being central to breastfeeding at an organizational, family, and staff-parent level;
Objective 2: Delegates will be able to investigate the ways in which we can shift the focus from breastfeeding as a mechanistic and productive process, concerned primarily with nutrition to a relational one;
Objective 3: Delegates will be able to describe the influence of culture and paradigmatic stance upon our way(s) of conceptualising infant and young child feeding and breastfeeding.


England Fiona Clare Dykes, PhD, MA, RM, ADM, FHEA
Abstract:

In this presentation, Fiona Dykes describes a program of research that has significantly contributed to a paradigm shift in the Unicef UK Baby Friendly Initiative (BFI). In 2013, Unicef UK BFI published a revised set of evidence-based standards for all maternity and children's services placing a particular emphasis on mother-infant relationship building rather than the previous specific emphasis on breastfeeding (Unicef UK 2013).

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Durations: 45 mins
Christine Mcintosh, BSc, MBChB, Dip.O&G, Dip.PAed., FRNZCGP
Confident Conversations; Empowering Parents to Make Choices to Prevent their Baby from Sudden Unexpected Death in Infancy
New Zealand Christine Mcintosh, BSc, MBChB, Dip.O&G, Dip.PAed., FRNZCGP

Christine is both a General Practitioner and senior lecturer in the Dept. of Paediatrics at The University of Auckland. She has taken a career long interest in Sudden Unexpected Death in Infancy and is now a doctoral candidate with Prof. Ed Mitchell. She also has a Primary care liaison role at her local district health board and is a clinical editor for primary care web-based Auckland Regional HealthPathways. Her current programme of research involves implementing and evaluating a web-based SUDI risk assessment tool with wrap around care planning for babies at higher risk, in the Counties Manukau Health District Health Board area in Auckland, New Zealand.

Objective 1: Delegates will be able to describe current understanding of Sudden Unexpected Death in Infancy;
Objective 2: Delegates will be able to discuss how individualised SUDI risk assessment can inform conversations in clinical care around SUDI protection care including breastfeeding and related behaviours such as bed sharing;
Objective 3: Delegates will be able to apply a systematic SUDI risk assessment for targeting SUDI protection care in higher risk populations.


New Zealand Christine Mcintosh, BSc, MBChB, Dip.O&G, Dip.PAed., FRNZCGP
Abstract:

Sudden Unexpected Death in Infancy (SUDI) is the sudden death of a baby who was thought to be healthy in the 24 hours prior to death. SUDI remains as a leading cause of post neonatal death in many countries and indigenous and marginalised population groups are the most affected. Experts agree that most SUDI deaths could be prevented, however successful SUDI prevention programmes require system wide, consistent SUDI prevention advice and programmes tailored for higher risk groups.
The Safe Sleep Calculator is a SUDI risk assessment web-based tool that considers 15 SUDI risk factors and provides individualised recommendations on risk reduction. It enables clinicians to provide objective individualised advice for families on infant care behaviours to reduce SUDI risk. The experiences of implementing the Safe Sleep Calculator in a primary care setting and, in a district health board area in New Zealand, will be described.


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Durations: 45 mins
Dr. Natalie Shenker, BM, BCh (Oxon), PhD (Imp)
Resurgence and Role of Human Milk Banking
England Dr. Natalie Shenker, BM, BCh (Oxon), PhD (Imp)

Dr Natalie Shenker is a former surgeon, scientist, and the cofounder of the Human Milk Foundation, which aims to ensure more babies are fed with human milk. As well as supporting a range of educational and research studies, the HMF aims to ensure assured access to screened donor milk through a network of human milk banks based on the cost-effective innovative model of the Hearts Milk Bank (HMB). Milk banks provide screened breastmilk to premature babies whose own mothers need time to establish breastfeeding, protecting them from a range of life-threatening complications and supporting the mother to breastfeed. The HMB has been operating in the UK for 18 months, and has supported neonatal units as well as families in the community where breastfeeding is impossible or taking time to establish.

Objective 1: Delegates will be able to recite the history of milk banking;
Objective 2: Delegates will be able to list the roles of milk donation in public health, including beyond the NICU;
Objective 3: Delegates will be able to describe the physiology and significance of an exclusive human milk diet.


England Dr. Natalie Shenker, BM, BCh (Oxon), PhD (Imp)
Abstract:

Evolution has created human milk as a way to protect the baby postnatally, patterning the immune system and microbiome, and providing diverse developmental cues for each organ system to develop normally. Milk also provides nutrition. When screened donated human milk (DHM) is available, mothers facing the most stressful circumstances of having an ill premature baby tend to have high chances of establishing breastfeeding. If donor milk is used appropriately as a bridge to lactation, they are less likely to perceive that their bodies have failed. The work of the Hearts Milk Bank over 2 years have laid the foundation for a UK-centred drive to upscale milk bank capacity, facilitate research to determine the optimal use of donor milk, and support a shift in perception about the role of human milk, underpinned by the latest science.

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Durations: 45 mins
Ending Sponsorship of Paediatricians by BMS Companies – Case Study of RCPCH

Tony Waterston is a retired consultant paediatrician who worked mainly in the community in Newcastle upon Tyne, UK. He spent 6 years working in Zambia and Zimbabwe and directed the Royal College of Paediatrics and Child Health Diploma in Palestinian Child Health teaching programme in the occupied Palestinian territories. He was an Editor of the Journal of Tropical Pediatrics and is on the Executive Committee of the International Society for Social Pediatrics. His academic interests are child poverty, advocacy for child health and children's rights. He is currently the lead moderator of CHIFA (HIFA's sister forum on child health and rights).

Objective 1: List the reasons why sponsorship of paediatric associations by BMS manufacturers is harmful to breastfeeding;
Objective 2: Describe process which led to the ending of sponsorship by the RCPCH;
Objective 3: Apply the methods of advocacy to end global sponsorship of paediatric associations by BMS manufacturers.


Abstract:

I shall summarise the problems created by sponsorship of paediatric associations by the manufacturers of Breastmilk Substitutes, using findings from the literature. I shall then present the experience of the Royal College of Paediatrics and Child Health (RCPCH) in the UK, over the last 20 years since efforts were first made by the membership to end the sponsorship by several formula manufacturers including Nestle and Danone. Following a number of motions passed at the AGM over successive years, members voted in 2017 to end sponsorship. Following this the leadership carried out a consultation of the whole membership which led to the policy of sponsorship being re-affirmed. In 2019, following a change in leadership and the publication of two critical papers in prominent medical journals, the policy was changed to end all sponsorship by BMS manufacturers. The essential ingredients of this successful advocacy were lobbying by members over a long period of years; the publication of critical data in medical journals; and the election of officers sympathetic to a change of policy.

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Durations: 45 mins
Founders’ Lecture: Insights into the Biomechanics of Breastfeeding: What Can Engineering-Based Studies Tell Us About the Process?

"Prior to 1993, Michael researched the basic physiology of breastfeeding, specifically the mechanisms of milk transfer, and how it affects milk composition (in Oxford). After moving to Bristol, he ran an outpatient clinic to support breastfeeding women, applying this earlier knowledge to resolve common problems of breastfeeding.
He has been a member of the Royal College of Midwives’ Breastfeeding Working Party, producing the handbook ""Successful Breastfeeding"". He was also Acting Director of MIDIRS in 1990; and was the Director of UNICEF-UK’s “Baby Friendly Initiative” from 1993 to 1995.
He co-authored (with Mary Renfrew) a structured review of practices which promote or inhibit breastfeeding, with evidence-based guidelines, entitled “Enabling Women to Breastfeed” (HMSO 2000), and has collaborated on the production of several videos.
At Leeds University, he coordinated two large-scale research studies:
-‘LIFT’ (Looking at Infant Feeding Today), which focused on the feeding intentions of socio-economically disadvantaged women, exploring the psychological factors underlying their choice and whether these are open to modification;
-‘SUREmilk’ (SUrveillance of REsidues in human milk’) which comprised a set of pilot studies aimed at testing the feasibility of establishing a regional archive of breast milk samples, to explore possible contamination in breast milk.
Most recently he has undertaken two fresh series of 2D ultrasound studies, the first being largest series of breastfeeding studies undertaken to date, and a second one of bottle-feeding by breast-fed babies.


Objective 1: Delegates will be able to list the seven key forces responsible for milk transfer from the breast;
Objective 2: Delegates will be able to discriminate the two distinct methods by which babies remove milk from the breast;
Objective 3: Delegates will be able to appraise the methodology of two recent engineering-based models of breast milk removal;
Objective 4: Delegates will be able to list at least one physiological event which is absent from the models, and evaluate whether this is likely to affect the findings.


Abstract:

Understanding how a baby extracts milk from the breast is essential to practising sound, effective breastfeeding management. This is necessary to optimise milk transfer from mother to baby, in turn, allowing one to maximise the transfer of calorie rich nutrients (predominantly breast milk fat).
For several centuries, received wisdom was that babies extract milk from the breast by a combination of baseline suction, compression and relaxation of the baby’s jaws against the breast, and rhythmical application of waves of pressure applied to the underside of the breast/nipple held within the baby’s mouth by the tongue. Based on this premise the core principles of WHO/UNICEF training were established, focusing on optimising the ‘positioning’ and ‘attachment’ of the baby at the breast, in order to maximise the effectiveness of milk transfer.
In the past decade, this received wisdom was challenged by the use both of modern ultrasound equipment and engineering-based modelling of breast anatomy (specifically the milk duct system) and the baby’s sucking action. A key novel claim was made that the baby can generate localised, ‘added’ suction with its tongue to enhance milk transfer; this has since been confirmed, although the evidence is that this novel mechanism remains secondary to the core process of peristaltic expression by the tongue. In contrast, the engineering-based studies have proved contradictory, providing new insights yet posing fresh challenges. To date, however, they have not produced a definitive view, nor have they altered the core underpinnings of best breastfeeding practice and management.
In the field of Medicine, it is recognised that the validity of Randomised Controlled Trials (RCTs) should be evaluated by a set of quality control standards, and the Critical Appraisal Skills (CASP) framework is a way of achieving this. No such quality standards or guidelines exist for evaluating engineering-based models of a physiological process. So, in order to address the veracity of the conclusions drawn, I have sought to evaluate the assumptions made in these models; whether or not they are valid; and whether specific elements are missing from current models which might affect their outcome.
Certain physical assumptions, made during the modelling process, are known to be incorrect, but have been made in order to simplify the modelling process (i.e. the ducts are rigid). Further ways in which the modelling process departs from known physiology include the view that negative suction pressure is the exclusive force in these models, without any contribution being made by the progressive peristaltic pressure exerted by the baby’s tongue. The models also make the core assumption that the milk duct system remains patent throughout a feed, thereby ignoring the occlusive impact of the baby’s jaw closure with each suck. The inclusion of any one of these natural processes would radically alter the conclusions from modelling, thereby disproving the claim that ‘suction alone can explain milk extraction’ while giving greater credence to the suggestion that ‘suction alone may not fully explain milk extraction’.
One feature consistently missing from such analyses is the clinical implications arising from them, and what they add to our understanding in terms of how to help mothers and babies breastfeed more effectively. To this end, the pivotal role played by peristaltic tongue movements, essential to effective breastfeeding, will be identified and elaborated, so providing evidence as to why the core management principles of ‘Positioning’ and ‘Attachment’ remain central to breastfeeding success.


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Accreditation

CERPs - Continuing Education Recognition Points
GOLD Conferences has been designated as a Long Term Provider of CERPs by the IBLCE--Approval #CLT114-07
This program is approved for 5.25 CERPs (3.75 L- CERPs, 1.5 R-CERPs)

CMEs - Continuing Medical Education
This program is aproved for 5.25 AMA PRA Category 5.25 Credits. These credits are applicable to Physicians, Nurses, Nurse-Midwives and those that require AMA PRA Category 1 Credits.

Additional Details

Viewing Time: 5 Weeks

Tags / Categories

Breastfeeding and Lactation

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