Academy Of Breastfeeding Medicine Research Articles

Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023).

Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.

Breastfeeding Medicine Across the Globe.

Breastfeeding Medicine Across the Globe.

Review of ABM Clinical Protocol #36: The Mastitis Spectrum

Recent scientific evidence debunks the concept of milk ducts obstructed by a collection of milk as it is not physiologically or anatomically possible.1 The Mastitis Spectrum is a recently revised guideline which challenges the common belief that ‘blocked ducts’ precede inflammatory mastitis, potentially followed by infective mastitis. The evidence now demonstrates that mastitis encompasses a spectrum of conditions, from mild to severe. Moreover, traditional strategies to augment milk removal to counteract milk stasis and breast massage to relieve ductal obstruction from milk ‘plugs’ lacks physiological validity. The Academy of Breastfeeding Medicine (ABM) Medicine Clinical Protocol #36 details management recommendations for all eventualities of The Mastitis Spectrum and will be referred to as the ABM Protocol in this review. The protocols can be found at: https://www.bfmed.org/protocols.

Updates from the Academy of Breastfeeding Medicine.

Breastfeeding MedicineAhead of Print Updates from the Academy of Breastfeeding MedicineAnn KellamsAnn Kellams—Ann Kellams, MD, FABM, President, Academy of Breastfeeding MedicineSearch for more papers by this authorPublished Online:8 May 2023https://doi.org/10.1089/bfm.2023.29243.alkAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Updates from the Academy of Breastfeeding Medicine." Breastfeeding Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Ann Kellams.Updates from the Academy of Breastfeeding Medicine.Breastfeeding Medicine.ahead of printhttp://doi.org/10.1089/bfm.2023.29243.alkOnline Ahead of Print:May 8, 2023PDF download

Perinatal Care during the COVID-19 Pandemic

Background: Following the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and considering its capacity for rapid mutation, there have been many studies and articles on this novel coronavirus over the past three years. Therefore, providing knowledge and directions for management of SARS-CoV-2, for hospital staff is crucial. Hence, we collected the research information from different perspectives and summarized the guidelines for perinatal care on the topic of SARS-CoV-2, and for possible future viral pandemics. Methods: A systematic review aimed at assessing the publications written in English and Chinese, offering different perspectives on the topic of perinatal care concerning SARS-CoV-2, was conducted using PubMed and Google Scholar from 2020 to 2022. In addition, we summarized the guidelines from the Taiwan Association of Obstetrics and Gynecology, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Maternal Immunization Task Force and Partners, and Academy of Breastfeeding Medicine. Results: Due to physiological changes, pregnant patients may be prone to have complications, especially pre-eclampsia, affecting morbidity and mortality. Most neonates of coronavirus disease (COVID-19) infected mothers did not show any clinical abnormalities due to the infection. However, compared to the general population, infected neonates needed more invasive ventilation care, while the proportion of asymptomatic neonates was less than that in the general population. Further, long term complications are still under investigation. Evidence of vertical transmission via the placenta and umbilical cord is rare but not absent. Paxlovid (nirmatrelvir/ritonavir) can be administered to patients with comorbidities, and indications for cesarean delivery does not include COVID-19 infection. Vaccination against COVID-19 should not be delayed during pregnancy and lactation. Conclusions: Obstetricians and gynecologists should pay more attention to pregnant women with SARS-CoV-2 because of the physiological changes and higher risks of complications, morbidity, and mortality. Early prevention with vaccination in pregnant women is the key to controlling the COVID-19 pandemic, from which we can learn how to manage the next pandemic.

ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants.

A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).

Investigation of some biomarker levels in breast and artificial feeding women in Thi-Qar province

Breastfeeding is defined as the mother/child act of milk transference, according to the Academy of Breastfeeding Medicine (ABM). The Breastfeeding Academy has also defined commercial infant formula as; artificial breastmilk substitutes, in accordance with the International Code of Marketing of Breast-milk Substitute’s language (ABM, 2008; WHO, 1981). Aim of this study is to provide evidence about biomarkers that associated to the age of the mothers, sex of the infant and the type of lactation and discussing this effect on the activities of the body. In lactating women, BMI shows significant positive correlation with age and cholesterol, Ca+2 shows significant positive correlation with phosphorus,HDL shows significant negative correlation with (phosphorus & Ca+2), cholesterol shows significant positive correlation with LDL and significant negative correlation with HDL, then LDL shows significant negative correlation with HDL, Ferritin shows significant negative correlation with HDL. PTH shows significant negative correlation with VD3. In non-lactating women, age shows significant positive correlation with phosphorus, Ca+2 shows significant positive correlation with (cholesterol & LDL) & cholesterol shows significant positive correlation with (RBS, LDL & HDL). In conclusion, the study revealed significant difference in different biomarkers between the lactation and non-lactation women groups.

P10 - Let's examine the evidence for Tongue Tie and Lip Tie Surgical Treatment

The topic of Tongue and Lip Ties is likely to spark conversation and lively debate among parents, midwives and various other health practitioners. How have these minor variations of normal infant anatomy created controversy and division among practitioners, particularly in relation to breastfeeding? Over the past decade the frequency of oral surgeries performed in infants’ mouths has increased exponentially – over 800%. This has been largely driven by social media where breastfeeding mothers are referred by “tie savvy experts” to “preferred providers” to have their babies’ “ties revised”. Consequently, a collaborative “ties industry” has been developed to provide oral surgeries, as well as pre and post “body work” therapies to infants, at considerable expense to their parents. However, have breastfeeding rates increased to match the huge number of oral surgeries being performed? Have all breastfeeding relationships been helped by oral surgery to babies’ mouths, or have some been harmed? What evidence exists to support the multiple oral surgeries performed in babies’ mouths, or the after-care interventions being recommended and carried out? Midwives who are at the front-line with birthing women and supporting the initiation of breastfeeding have a key role in accurate identification of ankyloglossia, as well as a responsibility to collaborate with practitioners who provide evidence-based care when referring babies for surgical treatment. Evidence-based consensus statements published by the Australian Dental Association and the Academy of Breastfeeding Medicine will be examined to provide guidance to clinicians who support breastfeeding families dealing with infant ankyloglossia. A video demonstration of an infant frenotomy performed by simple scissor division will provide insight into the procedure, with the opportunity for practical Q & A with the presenter.

Answering the Call: Ways to Get Involved in the Work of the Academy of Breastfeeding Medicine

Answering the Call: Ways to Get Involved in the Work of the Academy of Breastfeeding Medicine

Combating Pervasive and Misleading Formula Marketing Practices Is All of Our Responsibility.

Breastfeeding MedicineVol. 17, No. 6 President's CornerFree AccessCombating Pervasive and Misleading Formula Marketing Practices Is All of Our ResponsibilityAnn KellamsAnn Kellams—Ann Kellams, MD, IBCLC, FAAP, FABM, President, Academy of Breastfeeding Medicine Search for more papers by this authorPublished Online:8 Jun 2022https://doi.org/10.1089/bfm.2022.29210.alkAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month, I would like to call your attention to a ground-breaking report that was recently released by the World Health Organization (WHO) and UNICEF, entitled “How the Marketing of Formula Milk Influences Our Decisions on Infant Feeding.”1The report highlights the findings of an international research study performed by an independent research firm, M&C Saatchi World Services. Data was collected from eight countries, including China, Mexico, South Africa, and the United Kingdom of Great Britain, with >8,500 pregnant women, mothers, and 300 health care professionals surveyed. Additionally, over 100 focus groups and 80 in-depth interviews were conducted. Although marketing is a pervasive part of all of our lives, the report calls out the fact that the marketing of formula can impact feeding decisions that can have tremendous individual and public health consequences. Deciding how to feed an infant should be based on sound evidence and information, ideally obtained from health professionals, and not influenced by commercial interests.Here is a summary of several key findings with quotes directly from the report: 1.Marketing of formula is “pervasive, personalized, and powerful.”2.These companies use “manipulative marketing tactics that exploit parents' anxieties and aspirations.”3.Formula marketing “distort[s] science and medicine” making “false and incomplete scientific claims” to sell their product(s)4.These companies target health professionals5.Strategies used “undermine parents' confidence” in breastfeeding; messages are “slick and misleading”6.Immediate counter-measures at the level of governments, health professionals, and associations.For those of us in breastfeeding medicine, many of these findings may not come as a surprise. We are used to “swimming upstream,” and advocating for the rights and support of breastfeeding families.A number of action items are highlighted, including one that is specifically relevant to the mission of the Academy of Breastfeeding Medicine (ABM): “Protect the integrity of science and medicine.” The ABM lists “Knowledge and Research” as one or our key domains. We strive to promote, distill, and disseminate evidence-based research that improves clinical care and is globally accessible. As members of ABM, we have a responsibility to find ways to spread the word about the importance of breastfeeding, the best ways to support breastfeeding families, and how to appropriately manage breastfeeding concerns.We need to find ways to “actively counter” misleading and inaccurate commercially driven information. We need to normalize breastfeeding, not because it is “best” but because it is the physiological norm against which all other substances must be compared.As health care professionals, we also need to commit to divesting from formula companies in the name of public health. At ABM, we are very proud to not accept sponsorship from companies that are not WHO code compliant. Does this mean our membership and our conferences are more expensive? It does. We feel strongly that we all need to stop using our time and effort to provide these corporations with “cheap advertising.” When they sponsor our events, or we wear their lanyards, or recommend nonmedical use of their products, we both knowingly and unknowingly endorse their product.Health care professionals have a strong influence on families' practices and attitudes toward infant feeding. These companies profit when breastfeeding fails, and we must preserve the integrity of our role of trusted health experts, not tarnish it. We must use our influence to make sure all families have the most up-to-date accurate information about infant feeding so they can make the best decision for themselves, and then, we must do everything in our power to help remove obstacles and manage any concerns that arise so that as many infants as possible are able to breastfeed.Reference1. World Health Organization. How the marketing of formula milk influences our decisions on infant feeding. Available at https://www.who.int/publications/i/item/9789240044609 (accessed April 29, 2022). Google ScholarFiguresReferencesRelatedDetails Volume 17Issue 6Jun 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Ann Kellams.Combating Pervasive and Misleading Formula Marketing Practices Is All of Our Responsibility.Breastfeeding Medicine.Jun 2022.550-550.http://doi.org/10.1089/bfm.2022.29210.alkPublished in Volume: 17 Issue 6: June 8, 2022Online Ahead of Print:May 25, 2022PDF download

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

BackgroundIn the past 10–15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports.MethodsAn online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer’s V correlation, and binomial logistic regression.ResultsOf 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93).ConclusionsComplications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

COVID-19 Vaccine in Pregnant and Lactating Women: A Review of Existing Evidence and Practice Guidelines.

Coronavirus 2019 (COVID-19) has created a global pandemic that is devastating human lives, public healthcare systems, and global economies. Multiple effective and safe COVID-19 vaccines have been developed at an unprecedented speed due to the efforts of the scientific community, and collaboration between the federal government and pharmaceutical companies. However, the continued exclusion of pregnant and lactating women from the COVID anti-viral and vaccine trials has created the paradox of a lack of empirical evidence in a high-risk population. Based on the experience of similar prior vaccines, animal developmental and reproductive toxicology studies, and preliminary findings from human studies, various healthcare professional advisory committees (Advisory Committee on Immunization Practices, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and Academy of Breastfeeding Medicine) have issued guidance supporting COVID-19 vaccination in pregnant and lactating women. In this article, we summarize the available data on the efficacy and safety profile of COVID-19 vaccination in pregnant and lactating women, review the challenges of vaccine hesitancy, and include recommendations for healthcare providers.

Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender.

Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender.

Of Blindness, Elephants, and Multidisciplinary Collaboration.

Of Blindness, Elephants, and Multidisciplinary Collaboration.

Recent SPN Position Statements

Recent SPN Position Statements

The Question of Whether to Use Supplementation in Infants

The Academy of Breastfeeding Medicine’s protocol on supplementation states that weight loss is not an automatic marker for the need for supplementation in infants but is an indicator for additional evaluation. Excessive weight loss may be an indication of inadequate milk transfer or low milk production, but before automatically ordering formula supplementation, a thorough evaluation of the feeding session should be completed. Feeding issues need to be addressed as soon as possible because formula supplementation is not always medically indicated. Conversely, if formula supplementation is needed, it should be provided. The Newborn Weight Tool (NEWT) was created to allow health care providers plot a newborn’s weight and compare it with a large sample of newborns during the first days of life. It is a visual indicator of feeding success. Use the NEWT for any infant identified as having excess weight loss before ordering formula supplementation. The NEWT was initially implemented during daily interdisciplinary patient care rounds as a decision-making tool offering evidence to guide the plan of care. The team plots the weights on the tool and proposes a feeding plan based on results. Use of the NEWT has evolved, moving from the conference room during rounds to the bedside, becoming a collaborative and informed decision-making process between parents and the care team. Between Fiscal Years 2018 and 2019, breastfeeding exclusivity rates increased from 55% to 62%. We attribute this improvement in part to use of the NEWT. After implementation of the NEWT, the number of infants medically supplemented with formula for weight loss decreased to an average of 3 per month. We continue to use the NEWT and collect data related to those infants who are medically supplemented with formula to reverse weight loss. Implementing this innovative way to evaluate breastfeeding success has led to autonomy in nursing practice and empowers nurses with evidence to drive best newborn feeding practices. It has also led to earlier interventions for feeding issues that can affect length of stay as well as readmission rates for dehydration.

Physician Mothers and Breastfeeding: A Cross-Sectional Survey.

Objectives: To explore infant-feeding intentions and behavior of physician mothers as well as their breastfeeding enablers and obstacles. Study Design: A cross-sectional online survey was conducted among female physicians with at least one biological child recruited through the Academy of Breastfeeding Medicine. The main outcomes were duration of exclusive breastfeeding (EBF) and duration of any breastfeeding (BFD). We determined predictors of EBF and BFD. Results: The 570 participants reported intention to breastfeed at least 12 months in 78.1% of cases. Breastfeeding rates were 97.8%, 85.5%, and 55.4% at birth, 6, and 12 months. EBF rates were 88.5%, 76.3%, and 40.9% at birth, 3, and 6 months. Younger participant age, breastfeeding discontinuation not due to work-related demands, and heightened maternal satisfaction with BFD were associated with longer EBF and BFD. EBF at birth, less maternal stress, availability of time to express milk, and collegial support were associated with longer EBF. Longer maternal BFD goal, longer maternity leave, existence of laws or regulations to support breastfeeding among working mothers, later child order, and lower level of maternal depression were associated with longer BFD. Conclusions: Maternal infant-feeding intentions and work-related factors both play important roles in physician mothers' infant-feeding behavior. Longer maternity leave, regulations to support breastfeeding among working mothers, and workplace support might significantly improve physician mothers' BFD.

A summary of best evidence on breast milk expression of premature infants' mothers in maternal separation

Objective To retrieve, assess and summarize the best evidence on breast milk expression of premature infants' mothers in maternal separation so as to provide high-quality evidence for medical staff to carry out breast feeding guide. Methods Guidelines, systematic reviews, recommended practices and evidence summaries were retrieved in the UpToDate, WHO, Academy of Breastfeeding Medicine (ABM) , Cochrane Library, Joanna Briggs Institute Library, Registered Nurses' Association of Ontario (RNAO) , National Guideline Clearinghouse (NGC) , PubMed, Embase, Chinese Biological Medicine, Chinese National Knowledge Infrastructure, WanFang data, VIP and the evidence-based nursing database of Fudan University from January 2008 to December 2018. Results A total of 7 literatures were included, two guidelines, one clinical decision, two systematic reviews and two evidence summaries. A total of 19 evidences were gathered in 7 aspects, such as training for medical staff, parents' education, selection of breast pump, preparation before expression, operational skills of breast expression, measures for increasing lactation and expression effects monitor. Conclusions Clinical medical staff should lay down the individualized nursing measures for maternal women to ensure breast milk collected as soon as possible, gain enough breast milk and fill the bill of growth and development of premature infants. Key words: Infant, premature; Breast milk; Expression; Lactation; Mothers