Breastfeeding Complications Online Course(s) & Continuing Education

Breastfeeding can trigger particular negative emotions and intrusive thoughts, these can include experiencing the phenomenon of breastfeeding/nursing aversion and agitation, or having the medical condition of Dysphoric Milk Ejection Reflex. Mothers. These don't preclude having postnatal depression or postnatal mood disorders.

Understanding the nuances and variations in all these conditions and symptoms can lead to better referral, intervention and treatment for those struggling with negative emotions associated with breastfeeding. Being prescribed antidepressants when you have D-MER or Aversion will not always alleviate the symptoms or help the situation.

We cover the literature about when breastfeeding can make someone feel bad, sad or mad, and what we know can help alleviate these negative emotions so as a lactation specialist or health care professional you will become well adept at assessing, referring, signposting, supporting and treating those who struggle. The information and skills you will gain will particularly help in complex cases or cases where there seems to be a missing link.

Mast Cell diseases are rare but still underdiagnosed. Even among specialists, there is a lack of consensus on terminology, diagnostic techniques and even diagnostic criteria. Clinically, mast cell diseases manifest in divergent ways. Triggers, symptoms, management and treatments differ widely from patient to patient. To date, there is no cure, just palliative management of this chronic, sometimes life-threatening condition. Because of this, there is a poor understanding of Mast Cell-related issues in the broader medical community, particularly in the realms of pregnancy, birth and lactation.
This webinar will provide participants with a general overview and understanding of the various types of Mast Cell Diseases including Mast Cell Activation Syndrome (MCAS), Mast Cell Activation Disease (MCAD) and Mastocytosis. Participants will learn how to put this knowledge into practice to provide their Mast Cell clients with specialized, empathetic, and supportive care. It will discuss how to provide patient-centered care, the importance of coordinated care and the crucial role lactation specialists play within their client’s multidisciplinary health care team. It will examine Mast Cell treatments that are compatible with lactation.
Additionally, light will shed on approaches lactation specialists can utilize to empower their clients with the tools needed to establish and maintain the breastfeeding relationship desired, including helping clients manage their parenting and breastfeeding expectations given the limitations imposed by their disease.

Craniofacial anomalies (CFA) are a common anatomical malformation that affects the craniofacial region; they present either as cleft lip (CL), cleft palate (CP), or cleft lip and palate (CL/P) with varying degrees of severity. The incidence depends on the population’s ethnicity and geography. Infants with CFA can experience feeding difficulties either at the breast or at the bottle because they can have issues with their suck, swallow, breathe sequence and milk transfer.

This presentation will provide an overview of the anatomy of CFA. Techniques on how best to support families with CFA infants who wish either to breastfeed, maintain lactation or transition towards breastfeeding post-surgery will be discussed. Health care professionals involved in the care sometimes lack the expertise of supporting breastfeeding and often only recommend maternal pumping and specialised bottles. There is limited research about feeding infants with CL/P directly at the breast. A clinical case will be presented to illustrate clinical techniques and sequence of care.

A common misconception among care providers and families is that babies born with an oral cleft cannot breastfeed/chestfeed. This presentation corrects that misconception by exploring cleft types and their expected breastfeeding/chestfeeding outcomes and sharing tools that lactation specialists can use to more effectively support parents when their baby is born with a cleft lip/palate. In particular, during the neonatal period, the lactation specialist is uniquely positioned to support parents to make informed decisions about their feeding choices and create a going home care plan to help them achieve their breastfeeding/chestfeeding goals in the long term.

Dysphoric milk ejection reflex (D-MER), is not a new phenomenon. In the past, it was almost like Voldemort, the Problem That Must Not Be Named. But for over 10 years now, it has had a name and been brought into daylight. Though still not widely known or understood by many, the hypothesis of the mechanism and possible sustainable solutions are becoming better documented all the time. D-MER has been the subject of two case studies, one case series, and a qualitative research study. Two other studies as also in process at this time.

Mothers with D-MER feel, as a reflexive response with every single milk release, a wave of negative emotions ranging (depending on severity) from homesickness to hopelessness and despair, perhaps even anger and suicidal ideation. These emotions dissipate shortly after milk release and reoccur with the start of every MER, whether with breastfeeding, expressing or with spontaneous releases. Many sufferers keep the problem to themselves preferring the weaning of their baby to being incorrectly labeled as depressed or victims of abuse. Upon experiencing D-MER mothers are initially convinced the problem is physiological and not psychological, and they are correct.

As both a lactation consultant and a sufferer of D-MER, I first named and identified D-MER over 10 years ago. Now, through the case studies that have been done, collaboration with other medical and breastfeeding care providers, and the collection of information from the anecdotal reports from over 1,000 mothers, there is now a foundation of understanding of D-MER. Though the evidence base for D-MER is still mainly unestablished at this time, there are many professionals always working to bring evidenced-based information to the study of human lactation. This is exactly what the slow work and understanding of D-MER is about; the process of bringing new information into the light for further research and understanding.

In the PowerPoint presentation that I have to present, I discuss how D-MER presents, its tell-tale manifestation, and its spectrum and intensities. The presentation also explains the currently proposed mechanism of the MER anomaly, how health care providers can identify a mother it D-MER and how to help and support mothers with the condition.

Birth and breastfeeding/chestfeeding are intimately woven together although many separate the two. One's labor and birth process however, have a direct impact on how their nursing journey begins. Naturally, most infants can independently progress through the fetal to neonatal transition and produce a baby-led latch within the first hours of life. However, the process of birth is often unpredictable and many birthing families are regularly faced with common or unexpected labor interventions that can adversely affect milk supply and the initiation and receptivity of breastfeeding/chestfeeding for the infant. Some of the most common interventions include: IV fluids, induction of labor, epidurals, and continuous electronic fetal monitoring. These maternity care practices come with unintended consequences that directly impact lactation. Furthermore, studies indicate that many of these interventions are done more for convenience as opposed to medical reasoning. In order to promote, protect and support breastfeeding/chestfeeding for birthing families, providers and other members of the healthcare team should be encouraged to work in tandem; using effective communication and facilitating open dialogue. By including families in every aspect of their birth and postpartum period, self-efficacy and confidence is increased and trust is developed, setting the foundation for increased initiation and duration of human milk feeding.

Breast cancer is the most frequent malignant tumor during reproductive age. Around 1/10000 nursing mothers are diagnosed with breast cancer every year. In this rare and difficult situation, patients and healthcare providers should be knowledgeable about the prognostic and practical implications of such an event. Chemotherapy may pass into the milk and breastfeeding is usually contraindicated during chemotherapy. Weaning should be gradual, to avoid breast inflammation and mastitis. A thorough psychological support should be given to the nursing mother to help her into the oncological trajectory.
On the other hand, the number of young breast cancer survivors is increasing and more and more patients enquire about the possibility of subsequent pregnancies and breastfeeding. The breast treated with conservative surgery and subsequent radiation is less responsive to hormonal stimulation, with reduced glandular hyperplasia and hypertrophy. Milk production is usually decreased in the previously affected breast and surgery may affect duct integrity. Nonetheless, each breast has the capability to self regulate milk production according to the baby’s suckling habits, and many evidences support the notion that one breast is enough. Specific education programs should focus on adequate baby positioning, correct latching and reinforcement of the advantages of on demand breastfeeding. Data from our group demonstrate the feasibility of breastfeeding after breast cancer, but qualified lactation counseling to support patients and caregivers is needed.

Aversion to breastfeeding or agitation while breastfeeding is known to occur in some women who breastfeed while pregnant, or who tandem feed a newborn and a toddler. However, it is a little researched area, and the paucity of published literature around breastfeeding aversion and agitation reveals a significant gap in the literature. My presentation presents the findings of an exploratory online survey that sheds light on what appears to be a commonly experienced phenomenon of aversion and agitation whilst breastfeeding, which varies in form, severity and duration. BAA is characterised by feelings of anger or rage, a skin crawling sensation and an urge to remove the suckling infant, but can also be feelings of agitation and irritability whilst the infant is latched. Mothers who experience BAA still continue to breastfeed, but have feelings of guilt and shame about BAA and are often confused about having feelings of BAA. Research is needed to understand the reasons for BAA, its causes, triggers and strategies to minimize the experience in breastfeeding mothers.

Breastfeeding a baby with Down syndrome can bring many challenges to both mother and baby and many women are told they will be unable to breastfeed. This presentation will give examples of women who have faced different challenges breastfeeding their babies with Down Syndrome, yet had successful breastfeeding outcomes with the right support and information. This will include case studies with specific tips and suggestions that will help the lactation professional in offering support to these families. These women have faced many challenges including; prematurity, low muscle tone, breastfeeding into toddlerhood and a toddler who did not start breastfeeding until his mother had another baby when he was 2 ½ years old! This presentation will cover the most common challenges that families face when breastfeeding a baby with this condition and the possible solutions for them.

When a baby is born with a cleft lip, cleft palate, or cleft lip and palate, how the infant will be fed is an immediate and compelling issue to resolve. Once the baby is feeding competently at the breast or with a bottle, the family may receive little to no feeding support between the early weeks after birth until the recovery period following lip or palate surgery. While full breastfeeding (directly at the breast, without compensations or devices) is theoretically possible once the lip and palate are repaired, some babies have difficulty returning to direct breastfeeding or chestfeeding, and babies who have never been breastfed or chestfed, lack the oral skills to do so. In this presentation, I will discuss what “scaffolding for success” means in the context of breastfeeding and chestfeeding with an oral cleft. I will cover how to counsel parents at each significant stage of the baby’s cleft care timeline, how to support a parent’s unique feeding goals, how to break down a feeding goal into smaller, achievable steps, techniques for supporting at the breast feeding for babies with unrepaired clefts, best practices for achieving a full milk production, mixed feeding, feeding tools, and how to support developmentally appropriate feeding skills before and after cleft repair surgery.