GOLD Learning Speakers

Policy makers often describe mother-infant sleep in fairly black-and-white terms, and try to condense their message into a single declarative statement: don’t sleep with your baby. Recent research, however, shows that mother-infant sleep is considerably more complex than it is usually portrayed. This presentation discusses new findings from the U.S. sample of the Survey of Mothers’ Sleep and Fatigue (n=4789). These findings describe the groups most likely to bedshare including differences by ethnic-group, income, employment status, partner status, maternal age, income, and education. There are substantial ethnic-group differences on the percentage of mothers who feed in chairs and recliners (e.g., African American mothers have very low rates of these dangerous behaviors). There are also large ethnic-group differences in where mothers and their partners think babies should sleep, and this will govern behavior. Using the full sample of the Survey (N=6410), this presentation also examines sleep location by feeding status. Breastfeeding/bedsharing mothers do the best of all groups on measures of sleep, depression, and anxiety. In contrast, formula-feeding/bedsharing mothers do worse on every measure, suggesting that bedsharing while breastfeeding is a very different physiological condition to bedsharing while formula-feeding. In summary, the findings of both analyses suggest that a single message for all groups will not be effective. It is important to take into account the many different ways that mothers and babies sleep in order to promote safe mother-infant sleep.

Working in perinatal care can be deeply rewarding. It can also lead to job-related burnout and secondary traumatic stress. Secondary traumatic stress, or compassion fatigue, can occur when witnessing traumatic events in the workplace. This can occur when witnessing infant death or traumatic births, or when there is too much work, or work that doesn’t seem to make a difference, and little institutional support. A recent survey by AWHONN of 464 Labor & Delivery nurses found that more than a third reported moderate-to-severe symptoms of traumatic stress as a result of incidents they encountered on the job. This has serious implications for both patients and providers. Burnout and Compassion fatigue/secondary traumatic stress can lead to physical and mental health sequelae for professionals who experience them. It can also have a negative impact on the care provided. Self-care is essential for being able to provide care to others. In this seminar, participants will learn about the causes and consequences of both burnout and secondary traumatic stress/compassion fatigue. The good news is that there is hope for recovery. Participants will learn some specific strategies for integrating self-care into their care for others.

We do not live in a perfect world. Many new mothers have experienced abuse and adversity as children. They often wonder whether they will perpetuate the cycle of violence that they have experienced. They may also have a history of depression and wonder whether this has harmed their children. Fortunately, we can offer new mothers hope. Recent studies have found that breastfeeding helps mothers mother—even when there is a history of abuse. It not about the milk; it’s the physical act of breastfeeding. Breastfeeding improves maternal sleep, lowers the risk of depression, lessens anger and irritability, and even attenuates the negative effects of past sexual assault. Breastfeeding offers mothers a chance to do things differently—to be a different kind of parent. When it comes to overcoming adversity, breastfeeding makes all the difference.

A number of recent studies have raised questions about the way we understand depression in new mothers. For example, what is the role of depression in breastfeeding cessation and does mothers’ prenatal intention to breastfeed make a difference? Researchers have also found that epidurals lower the risk of depression, but the sample sizes are often small. Finally, a concerning trend has emerged regarding the link between depression, PTSD, and preterm birth. Women with depression or PTSD are at increased risk for preterm birth. The World Health Organization has recently identified preterm birth as the single greatest cause of infant mortality worldwide. These findings also have important implications for racial/ethnic disparities in both preterm birth and infant mortality. This presentation will summarize and synthesize these recent studies and present new findings from the Survey of Mothers’ Sleep and Fatigue that address the link between birth interventions and depression in mothers.

Can events from childhood influence a woman’s current mothering experience and her health and well-being? Yes, they can, but they don’t have to be the blueprint for the rest of her life. This session provides an overview of the latest research on the effects of Adverse Childhood Experiences; their impact on breastfeeding; how they can affect a woman’s body, mind and spirit; and what she can do to cope.

Depression research contains many conclusions that appear to contradict each other regarding the role of breastfeeding. For example, breastfeeding lowers the risk of depression, but depression increases the risk that breastfeeding will fail. Moreover, breastfeeding problems increase women's risk of depression. These findings are not as contradictory as they may seem. By understanding the underlying physiological mechanism, we can understand these seemingly paradoxical findings. This presentation will describe the link between the stress and oxytocin systems, and how they relate to both maternal mental health and breastfeeding. When the stress system is upregulated, depression and breastfeeding difficulties follow. Conversely, when oxytocin is upregulated, maternal mental health and breastfeeding rates improve. This talk also includes the role of birth interventions and mother-infant sleep, as well as practical strategies that increase oxytocin.

Fed is Best is a foundation with a major social media presence who seek to warn parents and practitioners about the dangers of insufficient exclusive breastfeeding. Through their social media campaigns that have galvanized a backlash against exclusive breastfeeding, lactation care providers, and the Baby-Friendly Hospital Initiative. Although lactation specialists disagree with much of their content, they have raised awareness about mothers who do fall through the cracks of our care system and may suffer as a result. The steep drop-off in rates of exclusive breastfeeding is an indication of this. This presentation will examine three provider-level barriers that negatively impact breastfeeding and what we can do to improve care so that mothers will reach their breastfeeding goals.

Depression research contains many conclusions that appear to contradict each other regarding the role of breastfeeding. For example, breastfeeding lowers the risk of depression, but depression increases the risk that breastfeeding will fail. Moreover, breastfeeding problems increase women's risk of depression. These findings are not as contradictory as they may seem. By understanding the underlying physiological mechanism, we can understand these seemingly paradoxical findings. This presentation will describe the link between the stress and oxytocin systems, and how they relate to both maternal mental health and breastfeeding. When the stress system is upregulated, depression and breastfeeding difficulties follow. Conversely, when oxytocin is upregulated, maternal mental health and breastfeeding rates improve. This talk also includes the role of birth interventions and mother-infant sleep, as well as practical strategies that increase oxytocin.

Trauma affects at least one third of childbearing women. Although a common experience, many breastfeeding counselors do not feel confident in working with trauma survivors. Should they ask about it? How do you stay within your scope of practice? This session will provide an overview of the types of trauma women are most likely to experience (childhood abuse, birth trauma, sexual assault, partner violence, natural disaster, and combat), and provide strategies for working effectively and comfortably with trauma survivors. This session also provides an overview of research showing that breastfeeding actually helps trauma survivors cope and lessens the risk of intergenerational trauma.

Working in perinatal care can be deeply rewarding. It can also lead to job-related burnout, secondary traumatic stress, and moral injury. Secondary traumatic stress (compassion fatigue), or moral injury, can occur when witnessing traumatic events in the workplace. This can occur when witnessing infant death or traumatic births, or when there is too much work, or work that doesn’t seem to make a difference, and little institutional support. Unfortunately, this is remarkably common among caregivers for perinatal women. Burnout, compassion fatigue, and moral injury can lead to physical and mental health sequelae for care providers and have a negative effect on the care they provider. Self-care is essential for being able to provide care to others. In this presentation, participants will learn about the causes and consequences of burnout, compassion fatigue, and moral injury. Fortunately, there is hope for recovery. Participants will learn some specific strategies for integrating self-care into their care for others.