IBCLC Detailed Content Outline: Development and Nutrition / Maternal Focused CERPs - Section I B
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A Sensory Motor Approach to Neuromuscular Re-Education Post Frenotomy
Lori L. Overland, M.S., CCC-SLP, C/NDT, CLC is a licensed speech and language pathologist with her neurodevelopmental certification and certificate as a lactation counselor. Lori is currently working on her IBCLC under the mentorship of Dr. Tina Smilie M.D., IBCLC, and Cathy Watson-Genna IBCLC. Lori’s private practice focuses on infants, toddlers and preschool children with oral sensory-motor/feeding disorders. Lori has co-authored two books: A sensory motor approach to feeding, and Functional assessment and treatment of tethered oral tissue. In addition to her private practice, Alphabet Soup, Lori is a member of the TalkTools® speakers’ bureau, and has lectured on sensory-motor/feeding disorders around the United States and internationally. Lori holds degrees from Hofstra University and Adelphi University.
This session will focus on functional assessment and treatment of tethered oral tissue in the breastfeeding infant. Participants will understand the importance of task analysis of the motor skills to support sucking, prior to referring an infant for a release. Post op treatment has focused on active wound management (Ghaheri, B. 2017) rather than neuromuscular re-education. This approach multidisciplinary approach encourages lactation consultants to partner with body works specialists and speech pathologists to develop the underlying motor skills to support sucking.
Marion Rice, Ed.D., IBCLC is the Executive Director of the Breastfeeding Coalition of Oregon (BCO). BCO is the statewide entity that serves to build and link families, community partners and geographic and culturally specific coalitions to support, promote and protect breastfeeding in Oregon. The Breastfeeding Coalition of Oregon works to address the Surgeon General's Call to Action to Support Breastfeeding by working to provide technical assistance, support and training to 20 (and more emerging) breastfeeding coalitions throughout the state. Marion is working to understand and address the impact of racial inequity on breastfeeding support and on helping all families reach their breastfeeding goals to improve the lifelong health of their babies. She sees breastfeeding as a social justice issue, and tries to reveal and address public policy and practice that inadvertently discourage women from reaching their breastfeeding goals and helping to maintain family economic security. Marion believes breastfeeding is unifying and builds cultural bridges and personal relationships for deeper personal understanding of the commonalities of the human experience.
Kimberly Seals Allers is an award-winning journalist and a leading commentator, speaker and consultant on breastfeeding issues, with an expertise in African American women and racial disparities in breastfeeding. As a consultant and speaker, Kimberly works with organizations looking to better understand the cultural barriers and community influences that impact breastfeeding continuation rates in vulnerable communities. She is also the founder of Shift Strategies, a health communication consulting firm helping organizations increase programmatic outcomes with more effective communication strategies. Kimberly has designed and developed strategic messaging campaigns and exploratory community-based projects examining the role of “place” in breastfeeding success and pioneered the concept of “first food deserts” and “First Food Friendly” communities. She is the director of The First Food Friendly Community Initiative (3FCI), a W.K. Kellogg Foundation funded pilot program to create and accredit breastfeeding-supportive community environments. A former writer at Fortune and senior editor at Essence magazine, Kimberly is an IATP Food & Community Fellow, connecting the “first food” to the broader food movement. Kimberly was also selected as a lead commentator for the United States Breastfeeding Committee’s “Break Time for Nursing Mothers” federal campaign. Previously, she served as the editorial director of the Black Maternal Health Project of Women’s eNews. Kimberly fifth book, The Big Let Down—How Big Business, Medicine and Feminism Undermine Breastfeeding will be released in July 2016 by St. Martin’s Press.
This session will look at challenges to reducing the barriers to greater availability of banked human milk within the context of breastfeeding inequities, disparities in birth outcomes and the state of motherhood in the United States. The session will provide participants with understanding of the evidence around the inequities in preterm birth and infant mortality rates of specific cultural groups and the importance of advancing human milk banking and breastfeeding as a primary strategy for improving the health of the most vulnerable citizens, babies through an equity lens.
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Mary Regan has a strong clinical background in perinatal nursing, with specific training and expertise in bio informatics. She trained as a certified nurse midwife in the United Kingdom and spent over 19 years working as a perinatal nurse specialist where she gained considerable expertise in pregnancy related health issues. She has been the PI on many State-funded grants and has received NIH funding for a grant focused on women’s decision making about birth (R21 HD059074-01A1) and the vaginal microbiota in preterm birth (R01NR014826-02). The findings from the R21 have been presented internationally and multiple publications have disseminated the findings. The R01 is in its final year and to date over 200 women have been recruited from the birthing population in Baltimore and followed for six month through pregnancy and to the post part period. Dr. Regan works as an Associate Professor in the School of Nursing at the University of Maryland. She serves on the board of Improving Birth.
Emerging research about the role of the gastro intestinal microbiota (GI) and host physiology provides mechanistic understanding that elucidates the relationship between diet and preterm birth (PTB). This presentation evaluates the current evidence about those relationships ( diet, the vaginal and GI microbiota and PTB). The studies that taken together suggest that diet modulates changes in the composition, stability and diversity of the vaginal and GI microbiota, resulting in microbial states that increase the likelihood of PTB. Understanding the critical role that diet, the vaginal and GI microbiota plays in PTB is essential for developing clinical interventions that leverage the capacity of the microbiota to optimize health outcomes.
Carol has been a therapeutic bodyworker in Portland, Oregon for over 26 years. She is a retired home birth midwife. She specializes in infant and maternal Craniosacral Therapy.
Carol is convinced that if women are appropriately supported in growing, birthing and nurturing their babies, their lives will improve. When women's lives improve their children's health improves. Healthy children grow up to be healthier adults who create healthier communities and a saner, more peaceful world. Carol believes that when things are out of balance even the smallest intervention can bring about great healing. Our need for it is so great.
Carol is passionate about using her CST skills to gently make space in maternal bodies so babies can assume ideal positions for gestation and birth. She is currently developing specialized prenatal yoga classes to support and enhance the maternal bodywork techniques she practices and teaches.
Topic: Where Should We Dig? Not All Gold Is Buried Under the Tongue - [View Abstract]
In this session Carol Gray will make a compelling argument for an idea that is not mainstream – even among radical homebirth midwives. As a midwife she has long recognized that the baby who couldn't descend into mom's pelvis and get born presents a problem. Carol has since recognized that the baby who drops deeply into mom's pelvis and stays there long (days, weeks or months) before the onset of labor presents an even bigger problem. Babies know how to position themselves for birth. They ought to be able to bob in and out of mom's pelvis until labor begins. When they drop down and stay down it's because they are stuck. In this session Carol will show the anatomy and the biomechanics of this problem. She will describe the aftermath: things like torticollis, plagiocephaly, breastfeeding difficulties, scoliosis, cesarean birth, inductions, etc. Carol will also give some resources for how we can help.
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Nekisha Killings is an equity strategist, internationally board-certified lactation consultant, and maternal and child health advocate who speaks, teaches, and facilitates on topics related to equity and dismantling bias across various sectors.
When she is not home educating 4 future world changers, she acts as a Director of Equity, Inclusion and Belonging at Lactation Education Resources and consults organizations on creating and implementing strategies to better support marginalized communities.
Nekisha holds a Masters in Public Health and penned the chapter titled Cultural Humility in the latest Core Curriculum for Interdisciplinary Lactation Support text. Nekisha is on a mission to normalize brown breasts and nipples in health education, thereby better equipping healthcare providers to accurately assess and treat people of color.
Nekisha's work is rooted in a compassion and candor that could only have been cultivated in years of supporting new parents during their first days of parenthood. Nekisha is an active duty military spouse who has been awarded the Spouse of the Year designation for her volunteer efforts supporting families.
Topic: Breast Assessment and Non-White Skin Tones - [View Abstract]
Topic: BreastSide Manner: A Patient-Centered Approach to Lactation Support - [View Abstract]
Topic: Marching Orders: Developing Practical and Impactful Care Plans - [View Abstract]
Is a red spot always a key indicator of mastitis? What about the deep purple trademark of vasospasm? How does eczema present on non-white skin? Performing a standard breast assessment may cause clinicians to overlook or misidentify key indicators of maladies in patients that are not fair skinned. Learn how you can improve your assessments and familiarize yourself with other ways to identify common conditions in patients populations that may not have been featured in your textbooks.
Diana West is an IBCLC in private practice. She is the co-author of “Sweet Sleep: Naptime and Nighttime Strategies for the Breastfeeding Family,” the 8th edition of La Leche League International’s “The Womanly Art of Breastfeeding,” “The Breastfeeding Mother’s Guide to Making More Milk,” the clinical monograph “Breastfeeding After Breast and Nipple Procedures,” and ILCA’s popular “Clinician’s Breastfeeding Triage Tool.” She is the author of the “Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.” She is on the Editorial Review Board for the “Journal of Clinical Lactation,” a La Leche League Leader and the Director of Media Relations for La Leche League International. She has a bachelor’s degree in psychology and is the administrator of the popular BFAR.org, LowMilkSupply.org, and LactSpeak.com websites. She lives with her three sons and one husband in the picturesque mountains of western New Jersey in the United States.
Topic: Mothers Speak Out: Top Five Traits of a Great Lactation Consultant - [View Abstract]
Topic: Mothers Speak Out: Top Five Traits of a Great Lactation Consultant - [View Abstract]
Topic: Postpartum Nipple Pain: Causes, Treatments, and Empathy - [View Abstract]
Topic: Sleep Training: History, Research, and Outcomes - [View Abstract]
Topic: Sweet Sleep: Bedsharing for Breastfeeding Mothers and Babies - [View Abstract]
This session presents a detailed discussion of breast assessment techniques and criteria, with photos contributed by colleagues around the world.
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Breast Milk and Sleep: Circadian Rhythms in Human Milk
Briana Tillman received her undergraduate degree in International Relations from the United States Military Academy at West Point. She has been a La Leche League Leader for 9 years and is a board certified lactation consultant. After spending 10 years as a stay-at-home mom, she is currently attending medical school at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. She loves spending time with her husband and three elementary-school-aged children—as a family they like to play board games, go camping, and play bluegrass and chamber music.
Topic: Breast Milk and the Microbiome - [View Abstract]
Many of us are aware of human milk’s amazing ability to provide for our infants’ changing nutritional needs with age. Recent research suggests that its composition shifts in synch with mom’s circadian rhythms as well, giving breastfed babies a leg up in neurological development, chrononutrition and sleep patterns. This presentation discusses the diurnal cycles of the following breast milk components: wakefulness vs. sleep-inducing amino acids, hormones (such as melatonin), trace elements, and even some nucleotides. Clinical implications include improving use of pumped breast milk. The presentation concludes with a brief look at other factors related to breastfeeding and infant sleep, including SIDS rates, skin-to-skin, and room sharing.
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Briana Tillman received her undergraduate degree in International Relations from the United States Military Academy at West Point. She has been a La Leche League Leader for 9 years and is a board certified lactation consultant. After spending 10 years as a stay-at-home mom, she is currently attending medical school at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. She loves spending time with her husband and three elementary-school-aged children—as a family they like to play board games, go camping, and play bluegrass and chamber music.
Topic: Breast Milk and the Microbiome - [View Abstract]
Recently, much scientific inquiry has turned to the new frontier of the “microbiome", the many microscopic beings living commensally or symbiotically in and upon the human body. Breast milk’s contribution to the development and sustenance of healthy gut bacteria is immense, in that it not only provides bacteria for the initial seeding, but also contains an ideal nutrient base designed to promote beneficial flora while simultaneously discouraging pathogens. This presentation will explore the relevant theories and understanding of these processes.
We will delve into the long-term health outcomes associated with the microbiome, including obesity, diabetes, brown-to-white fat ratio, gastrointestinal concerns, and allergies. This presentation will also explore the impact of breast milk storage and pasteurization techniques on its microbiologic activity. Additionally, we will look at other aspects of the microbiome as they relate to skin-to-skin contact, vaginal birth and breastfeeding.
Finally, we will describe bacterial roles in infant neurological development, allergies, digestion, immunity, and future obesity. Healthcare practitioners need to be aware of the benefits of microbial diversity in order to effectively counsel new parents, especially those with infants at risk for immunological or digestive concerns.
Mariana Colmenares Castano was born in Mexico City, and from an early age she was fascinated by animals and nature.She studied medicine at the National University of Mexico (UNAM), and foundher passion as a pediatrician doing her residency at the National Pediatric Institute. When her first child was born she witnessed the lack of knowledge and commitment to breastfeeding within the medical profession, and so she decided to specialize in breastfeeding medicine. She certified as a Lactation Consultant (IBCLC) in 2011.Mariana is a member of the International Lactation Consultant Association, the Academy of Breastfeeding Medicine, and a proud founding member of the National Lactation Consultant Association of Mexico (ACCLAM), where she served on the Board of Directors as Education Coordinator (2014-2019). She is part of board director for the Academy of Breastfeeding Medicine for a 3 year period (2019-2022) and recently named as secretary for the Academy of Breastfeeding Medicine. Mariana is a member of the team for Breastfeeding Country Index BFCI, a project from Yale University and Universidad Iberoamericana. She is consultant for the National Health Institute in Mexico and has collaborated with UNICEF in breastfeeding projects and part of the steering committee for the WHO. She has spoken at national and international conferences, co-published numerous articles and co-authored a chapter for the National Academy of Medicine. At the moment she is a Clinical Fellow in Community Paediatrics in London.
Topic: Breastfeeding The Baby With Congenital Heart Disease - [View Abstract]
Topic: Breastfeeding with Insufficient Glandular Tissue - [View Abstract]
Topic: Clinical Assessment and Management of Jaundice in the Newborn - [View Abstract]
Topic: Oral Colostrum Care as an Immunological Intervention in the NICU - [View Abstract]
Breastfeeding is the normative way to feed babies all over the world. We have access to a large amount of scientific evidence that supports it. Advocates of breastfeeding such as health care professionals that protect, promote and support the breast/chest feeding dyad can struggle sometimes with women or babies who cannot breastfeed as the World Health Organization suggests. Mothers with low milk supply are often supported by family, friends and health care with well meaning advice and remedies to help them do their best. Women who have insufficient glandular tissue (IGT) struggle with their milk supply, despite good breastfeeding management. It is common to see families with this issue during their second or third lactation failure without really understanding what might be going wrong. These babies can have dehydration in the neonatal period, hypernatremia or even death without anybody that could help with a correct diagnosis or help with achievable goals that can benefit both mother and baby. It is of great importance to help with accurate diagnosis that can also benefit psychologically and can help parents choose to continue breastfeeding with breast/ chest supplementation.
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Divya Sinha Parikh MD, IBCLC, FAAP is a board certified pediatrician practicing in Columbus, OH. She received her medical training at The University of Pittsburgh School of Medicine and completed her residency in general pediatrics at Rainbow Babies and Children’s Hospital at Case Western Reserve University. During residency, she created a breastfeeding medicine clinical rotation.
Within her practice, she has extensive experience managing lactation concerns and has taken a special interest in mentoring current and aspiring breastfeeding providers. She has presented her work at local and national meetings.
Rachel Walker received her master’s degree in exercise science and wellness from Old Dominion University and a PhD in nutritional sciences from Penn State University. Her PhD work focused on lipid metabolism and insulin resistance. She has over 3 years of experience teaching both nutrition and exercise science courses.
In 2020, she was selected for a research fellowship from the United States Department of Agriculture for her study, ‘The Role of Metabolic Health and Lipid Metabolism in Human Lactation and Milk Composition’. Her current research is focused on the effects of insulin resistance during pregnancy and lactation, especially with the goal of developing therapies to improve lactation.
She has presented her research at numerous national meetings. Rachel’s proudest achievement is becoming Mommy to her 3 children, Clark, Lee, and Nora.
The fat content of breastmilk is remarkably important for infant health outcomes. Therefore, it is important to understand what factors affect breastmilk fat profile. Total fat is the main determinant of energy in breastmilk, and varies with time of day, length of lactation, and duration of the feed. Maternal factors also influence milk fat, including BMI, parity, and diabetes. Long-chain polyunsaturated fatty acids, like docosahexaenoic acid and arachidonic acid, are vital to the structure and development of the infant brain, and attaining the correct balance is important for optimal development. Breastmilk fatty acid concentration, especially the polyunsaturated fatty acids docosahexaenoic acid and arachidonic acid, are vital to infant brain development. Fatty acid concentrations primarily depend on diet and vary significantly between populations, but other maternal factors can also affect the fatty acid content of breastmilk.
Breastmilk fat content has significant implications for clinical practice. First, it is necessary to optimize clinical methods for human milk fat measurement, such as bedside human milk analyzers. Second, understanding milk fat variation will help optimize breastmilk fortification for infants in neonatal intensive care units. Finally, variability in donor milk also makes estimation of fat and energy in milk banks difficult, with important clinical implications for preterm infants who cannot receive mother’s own milk.
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