Barbara Wilson-Clay became a La Leche League Leader in 1982. She certified as an IBCLC and entered private practice in Austin, Texas in 1987. Barbara was named a Fellow of the International Lactation Consultant Association in 2008. She recently retired from her practice, which specialized in difficult breastfeeding situations. With a client load of 400-450 visits yearly, Barbara garnered a wealth of clinical and counseling experience and a trove of clinical teaching photos. In partnership with Kay Hoover, she created The Breastfeeding Atlas, which was translated into Chinese in 2019 by Fudan University Press. A Korean translation will be published in September 2020.
Barbara has been a citizen advocate for breastfeeding in the Texas legislature and helped pass a landmark law protecting breastfeeding rights. She is one of the co-founders of the non-profit Mothers Milk Bank at Austin, and retired as Vice President of the Board of Directors in 2010. She continues to serve on the Advisory Board. Barbara's research and commentaries have appeared in the Journal of Human Lactation, Archives of Disease in Childhood, the International Breastfeeding Journal, and others. She has served on various editorial review boards and contributed chapters to several lactation textbooks.
Infants born at term following an uneventful birth generally require no breastfeeding interventions aside from a supportive environment. However, even in populations of women who are well-motivated to breastfeed, fully one third of infants demonstrate sub-optimal breastfeeding behavior in the first week postpartum. Risk factors have been identified that predict which mother-infant pairs may require extra assistance to protect the option to fully breastfeed once conditions stabilize. Careful assessment of the dyad helps identify who will need the most help. Such assessment is necessary to protect the infant from excessive weight loss and, because the calibration of milk supply is a time-sensitive event, serves to protect the potential for a full milk supply. Midwives must be familiar with new research that recommends that, in the presence of risk factors, milk expression should begin in the first hour after birth, with expressed colostrum being delivered to the infant by spoon or cup.
Pioneer researchers, clinicians, and breastfeeding advocates laid the foundations for modern lactation science. Many of their names are now forgotten, although they sounded the alarm about the risks of bottle feeding early in the last century and deplored the trend away from breastfeeding. Their dedication contributed to the development of the WHO Code of Marketing of Breast-milk Substitutes in 1981, and their research contributed to the scientific basis for today's clinical practices. Thanks to advances in both science and technology we are now able to help many more mothers nurse their babies. However, enormous economic disparities exist between communities, and access to care and equipment varies widely. Technologies that we depend upon to support breastfeeding are unavailable in many areas. Even in normally secure communities, large footprint natural disasters, wars, refugee crises and unforeseen events can disrupt lives. However, no matter the circumstances mothers continue to give birth and newborns must receive adequate early immunological protection, warmth, and nutrition if they are to survive. Therefore, it is important to look back at some of the low tech solutions of the past and preserve this knowledge in our tool kits so that we know how to protect breastfeeding when the lights go off.
Clinical management of the breastfeeding mother and infant begins with accurate assessment of the issues that are affecting normal function. While breastfeeding is a dyadic activity, this presentation focuses on the infant. Specifically, the learner is invited to look closely at the individual baby, to observe facial tone and structure, and to identify any anomalies or restrictions in range-of-motion (such as those resulting from torticollis) that may negatively impact ability to breastfeed. Videos and photos will demonstrate both normal and abnormal presentations. Interventions will be proposed to assist infants who are unable to breastfeed so that they may continue to receive human milk, ideally from their own mothers, with an eventual goal of breastfeeding, if possible.
Asking questions is an important part of our journey as health care providers. Learning is never ending and critical analysis of our own knowledge gaps along with taking measures to fill those gaps, is a crucial part of being able to provide our clients with the best possible care. This presentation will help you to assess where those knowledge gaps are for yourself and provide an opportunity to ask your questions surrounding everything from how to present information in sensitive situations, identifying and managing difficult breastfeeding problems, community advocacy strategies, practice ethics and resources for further learning.
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