IBCLC Detailed Content Outline: Psychology, Sociology, and Anthropology Focused CERPs - Section V

Despite the best efforts of the health care community, many rural women during pregnancy do not have access to obstetrical health care providers or a hospital that delivers near their home. This decreased access to services may lead to poor pregnancy and neonatal outcomes and when a woman has a high-risk pregnancy, access to care becomes a critical issue. Due to this disparity in access to care and maternal/infant outcomes, it is essential that health care providers and communities examine different ways to improve access. Connected health and telehealth technology is an innovative way to reduce access to care issues and assist women in having a healthier pregnancy, ideally improving maternal and neonatal outcomes.

The body’s ability to process sensory information provides the basis of all function. Interestingly, our most foundational sense of movement is often overlooked as a component of lactation support. In this presentation, we will tie together research in neurology, primitive reflexes, mental health, and sensory integration to demonstrate the significant impact vestibular function has on the quality of lactation and infant/caregiver relationships. Participants will enhance their observational skills and explore ways to provide support for body/breastfeeding dyads using a vestibular processing perspective. Experiential activities will offer participants the opportunity to play with movement and reflect on personal experiences to enhance self-awareness and compassionate care.

While lactation support spans the time from the prenatal period through weaning, there is less available information about the process of weaning. We know that there are a variety of reasons why families need or desire to stop lactation. We also know that there are emotions and logistics involved in ending a breastfeeding/chestfeeding relationship. Depending on the goals, timeline, and individual context of each dyad there are a variety of factors that need to be considered by the family. Unfortunately, these families often feel that the clinical information and emotional support available for weaning is lacking.

Evidence-based support presented in a compassionate manner can make a world of difference to the individual's decision-making process and overall weaning experience. For lactation supporters and professionals, being able to support families who are stopping lactation and/or ending their breastfeeding/chestfeeding relationship is a vital skill. This presentation will offer research-based information about the reasons for weaning, steps lactation supporters and professionals can take when working with families, and scripts for compassionate phrasing while offering this important information and support.

We know that responsive feeding gets breastfeeding off to the best start. New parents are told that breastfed babies often feed 8 – 12 times a day, but in practice many new mothers will find themselves breastfeeding more frequently than this. Research exploring breastfeeding frequency is however conducted primarily with younger infants, focuses simply on breast versus bottle, or was funded by industry.

This presentation reports novel findings from a research study of 18,000+ mothers with a baby or child aged 0 – 5 years old. It examines how often babies feed during the day and night for each age range by milk feeding type, mode, and approach (e.g. schedule versus responsive) and how frequent day and night feedings remain the norm for breastfed babies into the preschool years. The data also explores differences in maternal perceptions of infant variations in hunger e.g. in response to growth spurts, variations over different days, and cluster feeding, highlighting how breastfeeding mothers describe a more varied pattern of infant feeding compared to those formula feeding.

Together the findings challenge notions that most babies breastfeed between 8 – 12 times per 24 hour and that irregular patterns or varied numbers of feeds are normal for breastfed infants. Although many breastfeeding practitioners will recognise this pattern, these findings will provide both an addition and challenge to the scarce existing research literature on infant feeding patterns.

Preterm infants are at increased risk for impaired neurodevelopmental outcomes (Stoll et al, 2010). There is evidence supporting the differences in outcomes related to how we provide care to preterm infants and the effects of the environment in which the care takes place. One of the most effective ways to reduce impaired infant outcomes is inviting parents to actively participate in care activities and provide Kangaroo Care (Boundy et al., 2016; Charpak et al., 2017). Despite international recommendations, empirical evidence, and an implementation science project focused on strengthening Kangaroo Care in neonatal intensive care units in British Columbia, Canada, implementation has been slow due to various barriers to uptake (Charpak et al., 2020; Coutts et al., 2021; WHO, 2020). A ‘one size fits all’ approach cannot guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers. The uptake of Kangaroo Care relies on the involvement of parents and healthcare providers and their understanding and commitment to the evolving paradigm shift in neonatal care. This transition requires environmental and social supports, systems level change of philosophies of care, and assistance for healthcare providers to recognize their changing role.

Male breastfeeding support is evidenced to influence breastfeeding behaviors. Fathers play a vital role in determining women's choice to breastfeed. Many studies regarding fathers' breastfeeding influence included participants from a variety of ethnic backgrounds. Only a few studies examined African American men's breastfeeding attitudes. Within the U.S. disparity context, Black African immigrant breastfeeding experiences have not been measured.

The social and cultural breastfeeding experiences of Congolese Immigrants compared to those of African Americans were explored, analyzed, and contrasted. In the immigrant study, the breastfeeding cultural practice's visibility enables the breastfeeding perceptions of Congolese fathers. They identify their Congolese origin as a warrant for breastfeeding decisions and practice. Breastfeeding is a natural process that does not require prior deliberations between expectant couples. Breastmilk is valued for its God-given virtues rather than its medical benefits.

In the cultural context of African American, family, and friends enable breastfeeding support perceptions. Personal experiences and knowledge of breastfeeding benefits are predictors of breastfeeding decisions. However, there is not a cultural, existential framework supporting breastfeeding. This study's findings and recommendations guided the development of a dynamic African American men breastfeeding support toolkit designed to utilize existing public health structures.

The benefits of breastfeeding are well known. Less known is how pervasive and long-lasting the effects of sexual abuse can be. As many as 1 in 3 women are survivors of contact sexual abuse. And, unfortunately, sexual abuse is rarely over when it's over.

Most new parents state that they want to at least “try” breastfeeding. And yet everyone knows someone for whom breastfeeding “didn’t work”. While informed care can sometimes help families stick with breastfeeding, even well-intended support can be triggering. Providers who deal with new families must have a working knowledge of sexual abuse as well as a trauma-informed approach in order to effectively support breastfeeding families. Learn how abuse can impact ability and desire to breastfeed, red flags that could indicate a history of sexual abuse and practical tools to support all families in a sensitive way.

Weaning is an inevitable component of breast/chestfeeding. Many families have expressed feeling unprepared for the experience and the challenges they face in that journey. This presentation will explore the current research and lived experiences of weaning among different families and cultures. We will discuss strategies that were both effective and ineffective in the weaning process, time period in which families began the weaning process as well as tips and tricks from the parent perspective that lead to successfully weaning their child. Weaning will be discussed in the context of the impact on both the parent and the child.

Cultural ideology promotes the idea that pregnancy and childbirth are the happiest time in women’s lives; yet, there are more psychiatric admissions around the child-bearing years than at any other time in the female life cycle. Perinatal depression looks different in terms of its symptom presentation than other types of major depressive episodes and the psychological issues that determine treatment are unique to this phase of life, not only for the new mother, but for the entire family. This presentation focuses on symptom recognition, risk factors and treatment options looking at the impact of maternal depression on the developing mother-infant attachment.

Some women who initiate breastfeeding will not meet their duration goals. There are a number of factors that contribute to undesired weaning. For a woman who ceases breastfeeding before she desires to do so, it can be devastating. For the lactation professional or peer supporter, this can also feel like failure. Grief counseling and ethical principles are applicable to supporting a mother grieving the loss of the breastfeeding relationship she desired. This presentation uses case studies to address the questions of how breastfeeding supporters ethically and compassionately support mothers who end their breastfeeding journey before they wish to, how lactation professionals and peer supporters can manage our own feelings in these situations, and what are the ramifications of these cases as we continue to share accurate breastfeeding information in the face of media-driven culture in which infant feeding is loaded with guilt, shame, and fear.