IBCLC Detailed Content Outline: Clinical Skills / Education and Communication Focused CERPs - Section VII B

The field of Human Lactation is a new profession. Much of what we use comes from apprenticeship programs and hard learned lessons from a mother’s own personal experience. The lactation profession needs to investigate several of their practices and policies to discover what is evidence based and what is anecdotal evidence. This presentation explores the practices commonly employed in breastfeeding (growth monitoring, infant positioning, the use of assisted feeding devices, and counseling skills) to determine which are evidence based and which will require further study if they are to be used in clinical practice.

Within the lactation world, it is widely accepted that optimizing infant feeding practices and normalize breastfeeding, we must frame breastfeeding as the physiological norm and not breastfeeding as the risk behaviour. For example, breastfeeding does not reduce the risk of type II diabetes, but rather not breastfeeding increases the risk of type II diabetes. Most of us have had this framing drilled into us during our training and can deftly turn around any headline to reflect the correct wording.

It is, indeed, scientifically correct that breastfeeding is the physiological norm for human: artificial feeding is no more “normal” for the human baby than using a wheelchair to be mobile. However, health communication is about more than delivering scientifically accurate facts to the target population. In motivating parents to initiate breastfeeding and then maintain exclusive breastfeeding for 6 months and alongside complementary foods for at least 2 years and beyond, the science of health behaviour is often overlooked.

In this session, we will discuss some of the major models of health behaviour change and how risk is perceived and acted up on within these models, drawing from both maternal-child health and other public health. We will review the rationale for using risk-based language as well as the evidence for different perspectives, including the use of social marketing strategies.

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.

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.

Lactation professionals often accompany clients through the process of making difficult decisions: The client who wants to exclusively breast/chestfeed but loves that their partner gives infant formula each evening; The client who wants to and doesn’t want to stop pumping simultaneously; The parents who feel unsure about a potential frenotomy procedure; The client with breastfeeding aversion, desperately struggling with their 18 month old. Lactation professionals aim to provide empathetic care and to give the evidence needed to make informed decisions, and yet there are times where this is not enough and where clients continue to struggle to choose what works best for them. Here, learners will explore some Motivational Interviewing strategies that will actively empower clients, resulting in a significant shift in lactation practice overall. Discover how the strong desire to inform, advise and fix client problems can significantly reduce positive outcomes, and how a focus on the client’s own ‘change talk’ and ‘sustain talk’ can actively mobilize them towards their goal. Learn specific tools to immediately apply in consultations so parents feel deeply supported, feel motivated towards change, feel ownership of their plan, and to ultimately increase the likelihood of their success.

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.

Many preterm infants remain vulnerable following discharge from the neonatal intensive care unit (NICU). Health challenges persist beyond the NICU including respiratory illness, breastfeeding progression, bottle feeding incoordination, behavior and development issues, impaired growth, infrequent stooling, and gastroesophageal reflux. Preterm infants are up to two times more likely than full term infants to be hospitalized in the first year of life. Parents are challenged to transition their premature baby home and to keep them home!

Community-based, specialized follow-up services following NICU discharge have a powerful impact. The Neonatal Transition Team in Calgary, Alberta, Canada provides post-NICU follow-up for very-low-birth-weight infants and their families. The team consists of community health registered nurses with advanced skill in premature infant outcomes, feeding and neurodevelopmental assessment, and a consultation partnership with nutritional and feeding specialists. While home visits have been the backbone of this service, the team questioned the feasibility and acceptance of virtual care and completed a three month quality improvement pilot. This virtual care pilot demonstrated optimization of health-care resources by providing safe, high-quality care at a reduced operational cost. The pilot was instrumental in the team’s management during the SARS-COVID-19 pandemic. Virtual care has been fully operationalized into the service delivery model and expanded to serve other newborns with feeding or growth challenges.