IBCLC Detailed Content Outline: Clinical Skills Focused CERPs - Section VII

Hospital visits from a Peer Counselor just after delivery can have a tremendous impact on breastfeeding for mom and baby. Evidence-based research shows that Peer Counselors can share an important role in the success of breastfeeding for families. Peer Counselors making an early connection and reminding families that there is someone here to help them with their breastfeeding journey, now and after mom and baby discharge from the hospital, can be very comforting for those nervous new parents. Often, a short visit from a Peer Counselor to reassure a new mother that she is right on track with breastfeeding is just what mom needs to encourage her for the learning period she is going through. Learn about the success stories of a Peer Counselor Program from the implementation of hospital visitation through years of success in hospital visits and the difference it has made in their Peer Counselor Program participation and breastfeeding numbers.

There are challenges to getting Peer Counselor hospital visits started. It may not be as easy to get your foot in the door as you would think. We will discuss some of the red tape situations you may encounter as you start trying to set up hospital visits. Adding hospital visits to your Peer Counselor activities can have a positive impact on your Peer Counselor Program and increase breastfeeding rates for your area.

We are aware that an increasing number of babies are exposed to opiates, to methadone, to cannabis and cocaine through maternal breastmilk. In this presentation, I will discuss the pharmacokinetics of the medications and how this impacts the clinical care of the babies both immediately after delivery and later on. We need mothers to be open and honest about any drugs which they have taken in order that we may care for the baby appropriately if it is exhibiting clinical symptoms. This impacts on safeguarding issues but our aim should be to help the mother consider the impact on her baby using evidence-based information and to maintain breastfeeding appropriately. What are the long- and short-term implications of exposure for mother and baby? Is there sufficient research? As always, more questions than answers.

Collaboration is the foundation of the work of lactation professionals. As allied health providers, the team approach is at the centre of our professional relationships. Differences in professional practice and standards of care are aggravated by health care systems that are fragmented and operate in silos, while the high emotion and urgency of infant feeding concerns interfere with reasoned collaborative decision-making. Where adequate training, workplace policies and management oversight fail, conflicts within the team may escalate to incivility, lateral violence and bullying. IBCLC must be able to name and act when conflict crosses these boundaries.
At a policy level, the problems facing breastfeeding are among the most "wicked" of public health's "wicked problems".

In perpetually resource- limited settings, the challenges of policy-making, good governance and innovative programs require effective collaboration and co-operation within and across organizations.
Limited time and energy is available for the enormous work required to provide excellent care to families and create societies that fully support them to breastfeed their children for as long as they wish to. Moreover, because of the intensity of the "wicked" problems we face and the urgency of resolving them both in individual cases and at the policy level, conflict and erosion of trust often occur. Because we cannot only work with those we would like to work with to accomplish our goals, we must learn "stretch collaboration", explored using Adam Kahane's model of working in absence of friendliness, agreement or trust.

The majority of women begin breastfeeding at birth. Within the first 6 weeks, however, breastfeeding rates fall dramatically. To help women hang in with breastfeeding beyond the first weeks, we must first understand why they struggle. Learn what the research is saying and what you can do in your practice to help women meet their breastfeeding goals. IBCLC’s who specialize in the early weeks of breastfeeding will share case examples based on over 20 years of working with breastfeeding families.

Despite 90% of women experiencing breast and nipple pain during breastfeeding, mothers rarely receive adequate knowledge and skills for breastfeeding pain self-management and cease breastfeeding. Our randomized control trial (RCT) pilot study tested the feasibility, acceptability, and efficacy of a breastfeeding self-management intervention (BSM) on breast and nipple pain and breastfeeding outcomes. Sixty women were recruited after delivery and completed survey measures of pain and breastfeeding outcomes, pain sensitivity testing and a biological sample to assess genetic risk for pain at baseline. Both groups completed pain and breastfeeding outcomes surveys via texting links using REDCap 7.4. Women in the intervention group received biweekly nurse-lead texting and cloud-based educational modules addressing breast and nipple pain and breastfeeding challenges. The BSM intervention was acceptable and sustainable for 94% of the women who continued to breastfed to 6 weeks. Acute breast and nipple pain at 1 and 2 weeks were significantly reduced and was associated with pain sensitivity polymorphisms, suggesting a genetic risk profile of pain-associated breastfeeding cessation.

Participants will be invited to holistically consider the postpartum needs of birth parents. Through an invitation to walk through the various aspects of their human journey - from the spiritual and cultural, to the emotional, the cognitive and the physical- participants will be invited to think critically and holistically about the human needs of those on their journey towards giving birth and after giving birth. Emily will use these directions to invite participants to support professionals in asking their patients and clients: what they want out of their pregnancy/postpartum journey? Who and what is within their constellation of support, and how? How do we support our parents in accessing their own agency to ask for support in the event that they experience the symptoms of postpartum mood and anxiety disorders?

In 2020, only 25.6% of dyads in the US were exclusively breastfeeding at six months. One contributing factor to low exclusivity rates is the absence of a specialized physician who provides dyad care. Consequently, pediatricians and obstetricians provide lactation education and support in the primary care setting. Little is published about perceptions of and roles related to lactation practices in primary care settings, and no survey instrument exists to investigate these topics. A 58-question survey was developed, validated, and subsequently distributed to primary care providers (PCPs) in the field of maternal and child health to help define current perceptions and practices related to lactation care and referrals. In this pilot study, responses were received from 40 PCPs in the Southeastern United States and included in the analysis. Results highlight areas of strengths and areas for improvement in current practices of PCPs with regards to lactation services. These data can be utilized as a framework for developing interventions and/or programs that will improve lactation care in primary care settings.

Lactation professionals can provide invaluable assistance to Muslim families seeking to successfully breastfeed. However, cultural differences and a lack of understanding of Islamic culture could create barriers between professionals and the families they are trying to support. It is crucial that professionals and health care providers are aware of and acknowledge the unique role that culture and religion can play in this dynamic, both to prevent obstacles to breastfeeding and to encourage breastfeeding through culturally specific methods and arguments.

This presentation will show how to adapt your approach, language and content to ensure effective and sensitive care that will be more readily accepted by the mother and her family. It explores what the Qur’an says about breastfeeding and delves into traditional and cultural Islamic attitudes and practices surrounding breastfeeding. Moreover, it will explore the father’s role in Muslim culture and offer religious justification to encourage him to support breastfeeding, as well as issues of wet-nursing, milk sharing and adoption (as it relates to breastfeeding) within the Islamic context. As a participant, you will be encouraged to challenge your own assumptions about Islamic traditional and cultural practices and to use new knowledge gained to empower others to reflect on the benefits of being a culturally sensitive and responsive lactation professional and health care provider.

Every day, around the world, many mothers are faced with the complex task of managing the initial onset, or continuation, of their lactation following a late miscarriage, stillbirth, neonatal or infant loss. This presentation explores findings from a multi-year, multi-site Australian study conducted with bereaved families and health professionals that confirmed the limited nature and scope of lactation care currently available to bereaved families.

This presentation will provide evidence of the need and benefit of approaching lactation after infant death using a biopsychosocial care framework, so that bereaved families are able to make informed decisions from the full array of lactation management options that may be available including: suppression, sustained expression, breastmilk donation or using milk as memento. The challenges involved in providing bereaved lactation care will be acknowledged and discussed. Health professionals will be advised on what information and support bereaved families need and want, how and when this information may be best provided and who may be best placed to offer lactation care to bereaved families.

Due to the global shortage of mental health professionals, many primary care providers have become the first-line responders to a wide variety of psychiatric concerns. While lactation consultants and breastfeeding support counselors are not called upon to diagnose and treat mental health disorders, they nonetheless often become enmeshed in the topic due to the holistic nature of breastfeeding management. An understanding of the major psychiatric topics that can arise during lactation consultation is therefore a valuable asset.

In this presentation, we will describe mental health benefits and drawbacks of breastfeeding, and explore the controversy surrounding the “breast is best” campaign as it regards maternal mental health. We will also briefly explore the pharmacological and non-pharmacological options in treatment of major psychiatric disorders (e.g. generalized anxiety, major depressive disorder, bipolar mood disorder, schizophrenia) as they relate to lactation. Finally, we will review the scientific literature related to potential long-term mental health effects of breastfeeding on babies.