IBCLC Detailed Content Outline: Clinical Skills / Ethical and Legal Issues Focused CERPs - Section VII C

In emergencies, breastfeeding saves lives - and yet, regardless of the location or type of disaster, breastfeeding and complementary feeding practices are eroded during an emergency. Infant and young child feeding in emergencies (IYCF-E) requires a multi-sectoral approach to meet the needs of both breastfed and non-breastfed children. Where do the skills of breastfeeding counsellors, educators and IBCLCs fit into the IYCF-E response? What competencies do IBCLCs need to provide clinical care in a humanitarian setting and how can IBCLCs obtain those (if they don’t already have them)? Bring your thoughts, experiences and questions and join us for a facilitated discussion about the role of skilled breastfeeding support in protecting infants and young children in emergencies.

Global trends in breastfeeding rates only show modest increases between 2000 and 2015. Currently, about 40% of babies below 6 months are exclusively breastfed and several barriers on the structural, setting, and individual levels exist. Continuous support for mothers across the 1000 days from conception has been shown to be effective in increasing the duration and exclusivity of breastfeeding. WABA’s Warm Chain campaign places the mother-baby dyad at the core and strives to link different actors by coordinating efforts at all levels to provide a continuum of care during the first 1000 days. The warm chain needs to be protected, promoted, and supported. Protection includes implementation and monitoring of the International Code of Marketing of Breastmilk Substitutes as well as coordination to ensure that all the linkages in the chain are working well. Promotion entails providing information about the roles and responsibilities of each actor along the timeline. Support includes increasing knowledge, skills, and competencies of multi-professional teams in order to provide optimal support for breastfeeding. Achieving a warm chain of support for breastfeeding will help increase breastfeeding rates, thus ensuring improved survival, health, and well being. The short and long-term positive effects impact individuals, societies, and the planet.

Human rights violations related to childbearing are an international phenomenon. Such violations have only recently been recognized by organizations like the World Health Organization and the United Nations, and avenues for accountability and redress remain limited across the globe. Nonetheless, empowering health care providers, including lactation professionals, with the confidence and courage to be human rights defenders is a critical step in vanquishing these harms and protecting people from conception through lactation.

Lactation support may be time-limited when caring for multiple families with varying degrees of complexity and needs. Prioritizing between parents and within the individual cases, employing critical thinking skills, and identifying the chest/breastfeeding family’s needs is essential to efficient workflow. Competing priorities can be stressful and draining. Mindfulness empowers those providing care the clarity to prioritize needs and increase satisfaction for both family and lactation support team.

The presentation will consist of actual lactation scenarios varying in complexity and diverse work environments. Participants will interact via the chat box to triage cases, rank interventions and create a collaborative discipline list. We will end with a brief mindful activity.

Adhering to the International Code of Marketing of Breastmilk Substitutes and relevant subsequent WHA resolutions (the Code) is a personal and professional obligation for IBCLCs and breastfeeding helpers and advocates. Beyond that, we are often called upon to provide advice and support to the organizations we work for and support in respect of their Code obligations.

One of the most challenging experiences on a parent’s lactation journey is managing return to work. When lactating workers have access to both time and space for expressing breast milk, they are more likely to meet their breast/chestfeeding goals, yet many struggle to access these simple accommodations. Participants will gain an understanding of how workplace conditions influence lactation, become familiar with key legal principles protecting lactating parents in the workplace, and, learn strategies to ethically support their clients in reducing workplace barriers to continued lactation.

The profession of lactation consultant has grown around the world and has evolved enormously since its inception in 1985. At first, the development of the profession provided skilled breastfeeding counsellors with a role that aligned with the medical model, provided a career pathway, and provided evidence of lactation skills and experience.

Over the years, the certification has grown and now there are over 33,000 International Board Certified Lactation Consultants© (IBCLC©) in 125 countries with the exam now offered in 17 languages. Lactation consultants are now recognised at national and global levels as providers of expert lactation care, and they work within a “landscape” of varied roles and qualifications, each of which brings their own important skill set. IBCLCs play many roles, ranging from advocate to clinical expert, from policy consultant to researcher. The profession has evolved in response to sociocultural change and global issues. One major change has been the increasing importance of technology and the internet, driven partly by the fact that the consumers of breastfeeding care are the most internet involved generation in history, with a particularly rapid transition in response to the COVID-19 pandemic. Major shifts have included the recognition of structural racism, health disparities, inequities in health care and in breastfeeding support, the importance of building a more diverse workforce, recognition of the gendered nature of lactation care and the need for inclusion for people of all genders, breastfeeding as a reproductive right and as a human right of the breastfeeding dyad, and the impact of how babies are fed on many other spheres, including climate change and public health.

Breastfeeding facilitates good health in infants and mothers, and for all humans throughout life. Medical professionals should be advocates for breastfeeding, and physicians could be one of the most influential advocates. However, many medical students, residents and physicians have very limited opportunities to learn about breastfeeding and human lactation during their medical education. From another point of view, breastfeeding is a private experience as well as a scientific matter. If a physician or a partner successfully breastfeeds, she/he may become a more effective advocate for breastfeeding. So, it is imperative to provide medical students, residents, and young physicians with education about breastfeeding and to enable them to experience successful breastfeeding personally, in order for them to promote and support breastfeeding among their patients.

The Academy of Breastfeeding Medicine is an international organization of physicians who protect, promote, and support breastfeeding, and one of its goals is to develop and disseminate the standard for physician education around breastfeeding and human lactation. ABM has developed protocols and statements for health care providers to utilize for breastfeeding management.

The WHO/UNICEF revised Ten Steps to Successful Breastfeeding in 2018, includes in Step2 “Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding”. This included physician education. There are many ways to educate physicians, and ABM materials could be one option.

Food/nutrition is a basic need of individuals. Unethical, uncontrolled marketing practices have added to age-old confusions and misconceptions. Products are subtly portrayed as essential and convenient to “modern parents”.
Since the time that WHO/UNICEF has declared an International Code, many WHA resolutions have been resolved. Convention on the Rights of the Child accepts the right to enjoy a highest attainable standard. Innocenti Declaration was adopted on Protection, Promotion and Support of Breastfeeding.
It is important to support woman, by enacting legislation and adopting its enforcement and by providing adequate paid maternity benefits/leave.
The Indian government has enacted the Infant Milk Substitutes, Feeding Bottles & Infant Foods Act.
People should be vigilant enough to realize that legislations are not merely pieces of paper. Health workers have a moral and ethical responsibility to provide health education and report violations by becoming a “Watch-guard”.
Even after many legislations, some manufacturers are behaving as if these recommendations don’t affect them and have ignored or just given lip services. Health workers, and the general population has a great influence on decision making. There is need to follow laws in spirit rather than words.

During a time when lactation professionals are facing unprecedented negativity on top of the usual challenges, it’s easy to get drawn into the conflict or to start wondering if what we do makes a difference. How do we lift one another up to maintain a positive focus on using our knowledge and skills to guide families who are feeling scared and confused? How do we set aside our biases to make sure we’re listening to all sides? How do we connect and collaborate with other professions to expand the network of support for new families? This panel discussion focuses on answering those questions and providing steps that can be taken to promote collaboration both within the field of lactation and with other members of the health care team to improve breastfeeding knowledge translation and mobilization. This is your chance to hear from Dr. Amy Brown, Christy Jo Hendricks and Joy MacTavish as they share their thoughts on this hot topic during our panel discussion titled “Lifting up the Lactation Profession”.