Breastfeeding Dyads Research Articles

The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II).

The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).

Effects of household composition on infant feeding and mother-infant health in northern Kenya.

Households with alloparents, individuals other than the mother who care for an infant, can shift members' roles and affect mother-infant health. To investigate how household composition relates to infant feeding and infectious disease risk in mother-infant dyads, the team utilized data from breastfeeding dyads (n 208) surveyed during a prolonged drought and food scarcity in northern Kenya. Households were classified by the presence/absence of potential alloparents, distinguishing non-siblings and siblings of the infant. Regression models for breastfeeding frequency, complementary feeding status, and recent infections (n 83) evaluated these outcomes' associations with household type while accounting for food insecurity, adjusted for infant age, infant sex, and maternal age. Household type was unassociated with breastfeeding frequency, but the presence of non-sibling alloparents interacted with food insecurity, predicting increasing breastfeeding frequency as food insecurity intensified among dyads living with non-sibling alloparents. Households with non-sibling alloparents were also inversely associated with complementary feeding but had no association with infection. Households with siblings were inversely associated with (protective against) infant and maternal infection. Further research is needed to understand the interactive influence of household social and food ecologies on mother-infant diet and health under diverse cultural rules and norms for alloparenting.

Determinants of exclusive direct breastfeeding using constructs from the breastfeeding relationship scale

ABSTRACT Objectives This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months. Background The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale’s constructs and EDBF. Methods A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother’s age, education, marital status, parity, prior breastfeeding experience, infant’s age, weight, and sex. Results Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (β = 0.33, p < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (β = 0.35, p < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (β = 0.08, p = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p < .001) and prior breastfeeding experience (OR = 2.31, p = .006). Conclusions Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.

Microbial Interrelationships across Sites of Breastfeeding Mothers and Infants at 6 Weeks Postpartum.

Infancy is a critical life stage for the establishment of the gut microbiome. Human milk contains a unique microbial ecosystem that serves as a continuous source of commensal bacteria for the infant. However, the origin of the human milk microbiota, how it is influenced by breastfeeding exclusivity, and its role in infant gut microbiota assembly are not clear. To interrogate these questions, we examined the relationships among fecal, oral, breast skin, and human milk microbiota of 33 exclusively breastfeeding (EBF) and mixed-feeding (MF; human milk + infant formula) mother–infant pairs at 6 weeks postpartum. Here, we show that MF infants have a significantly more diverse oral microbiome comprised of lower relative abundances of Streptococcus and Gemella and higher abundances of Veillonella. Using both SourceTracker2 and FEAST, we demonstrate breast skin and infant saliva as the principal contributing sources to the human milk microbiota. Of the sampled sites, human milk and maternal stool were predicted to contribute the largest fraction to the infant fecal microbiome, but the majority of the community was estimated to arise from unknown sources. Lastly, we identified twenty-one significant co-occurrence relationships between bacteria in human milk and on other maternal and infant body sites. These results demonstrate several unique microbial interrelationships between breastfeeding dyads, providing insight into potential mechanisms of microbial assembly in early life.

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

BackgroundLactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold vary widely, with limited evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions.MethodsUltrasound measurements were conducted in five breastfeeding dyads, infants aged 4–20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully.ResultsUltrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention.ConclusionThese preliminary findings suggest that changes in fit and hold impact on infant tongue movement and contour. Further research investigating short- and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads

Breastfeeding MedicineVol. 16, No. 4 ABM Position StatementAcademy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding DyadsYvonne LeFort, Amy Evans, Verity Livingstone, Pamela Douglas, Nanette Dahlquist, Brian Donnelly, Kathy Leeper, Earl Harley, Susan Lappin, and the Academy of Breastfeeding MedicineYvonne LeFortAddress correspondence to: , Yvonne LeFort, MD, FRNZCGP, FCFP, FABM, IBCLC, Milford Breastfeeding Clinic, 50 East Coast Rd Milford, Auckland 0620, New Zealand. E-mail Address: milfordbreastfeedingclinic@gmail.comSearch for more papers by this author, Amy EvansSearch for more papers by this author, Verity LivingstoneSearch for more papers by this author, Pamela DouglasSearch for more papers by this author, Nanette DahlquistSearch for more papers by this author, Brian DonnellySearch for more papers by this author, Kathy LeeperSearch for more papers by this author, Earl HarleySearch for more papers by this author, Susan LappinSearch for more papers by this author, and the Academy of Breastfeeding MedicinePublished Online:12 Apr 2021https://doi.org/10.1089/bfm.2021.29179.ylfAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byA Retrospective Cohort Study of the Impact of Upper Lip Tie Release on Breastfeeding in Infants Parhom Towfighi, Stephanie Y. Johng, Michelle M. Lally, and Earl H. Harley16 May 2022 | Breastfeeding Medicine, Vol. 17, No. 5Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022 Adrienne E. Hoyt-Austin, Laura R. Kair, Ilse A. Larson, Elizabeth K. Stehel, , Elizabeth Stehel, Lawrence Noble, Melissa C. Bartick, Sarah Calhoun, Laura Kair, Susan Lappin, Ilse Larson, Yvonne LeFort, Nicole Marshall, Katrina Mitchell, Susan Rothenberg, Tomoko Seo, Gina Weissman, Nancy Wight, Lori Feldman-Winter, Adora Okogbule-Wonodi, Michal Young, and Deena Zimmerman16 March 2022 | Breastfeeding Medicine, Vol. 17, No. 3 Volume 16Issue 4Apr 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Yvonne LeFort, Amy Evans, Verity Livingstone, Pamela Douglas, Nanette Dahlquist, Brian Donnelly, Kathy Leeper, Earl Harley, Susan Lappin, and the Academy of Breastfeeding Medicine.Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads.Breastfeeding Medicine.Apr 2021.278-281.http://doi.org/10.1089/bfm.2021.29179.ylfPublished in Volume: 16 Issue 4: April 12, 2021PDF download

Using Simulation to Teach Breastfeeding Management Skills and Improve Breastfeeding Self-Efficacy.

Breastfeeding rates in the United States continue to be variable and are not meeting benchmarks established by Healthy People 2020. The literature indicates that although breastfeeding knowledge of providers is paramount in the success of breastfeeding mothers, most receive minimal education regarding breastfeeding management. Recognizing a lack of opportunities for nursing students to practice breastfeeding management during clinical rotations, a breastfeeding simulation program was implemented for students prior to beginning Maternal Child Health clinicals. Students reported increased confidence in caring for breastfeeding dyads and enhanced comfort when providing care to a breastfeeding mother (breastfeeding self-efficacy). This hands-on educational approach can be utilized for any provider working with breastfeeding dyads.

The Alchemy of Connection: A Fundamental Ingredient When Supporting Breastfeeding Dyads

BackgroundEvery encounter in lactation care should aim to set the ground for an emerging human connection between the lactation consultant (LC) and the breastfeeding mother. Cultivating connection is as important as adequate clinical competencies and effective communication skills.MethodsThe article proposes a hermeneutics of care that articulates elements that enhance the understanding between the LC and the circumstances and realities of the breastfeeding dyad in the context of diagnosis, management, and healing. These elements can be best described by Martin Buber's (2013) I–Thou approach, which we use to enter into a relationship.ResultsWhen the LC has the courage and humility to convey her full presence for that mother and her circumstances, connection has been primed. The quality and depth of the LC– breastfeeding mother relationship, in turn, enhances diagnosis and healing options, particularly in chronic cases.ConclusionsThe “alchemy of connection” opens the ground for a relation of mutual trust between the LC and the mother and her world, which supports better breastfeeding care.

Assessing the Breastfeeding Dyad: A Guide for Speech-Language Pathologists

Purpose More than 80% of U.S. mothers initiate breastfeeding; for many of them, direct breastfeeding is an important goal. Speech-language pathologists (SLPs) who assess infants with feeding concerns, however, are generally much more familiar with assessing bottle-feeding. The purpose of this tutorial is to assist SLPs in building on their existing assessment skills in order to provide effective, evidence-based options for mothers who wish to breastfeed their infants. Conclusion SLPs can assist families in meeting their breastfeeding goals through effective assessment of breastfeeding dyads.

Exploration of Responsive Feeding During Breastfeeding Versus Bottle Feeding of Human Milk: A Within-Subject Pilot Study.

Background: Responsive feeding promotes optimal feeding patterns and growth trajectories. Breastfeeding is thought to facilitate responsive feeding, but research to date has been limited to comparing formula-feeding and breastfeeding dyads. Using a within-subject approach, we aimed to assess maternal responsiveness to infant cues during two human milk feeding sessions differing by feeding modality (breastfeeding versus bottle feeding). Materials and Methods: Nine mother-infant dyads (infants ≤6 months) were recruited from the Halifax Regional Municipality, Nova Scotia, from April to May 2018. Two human milk-feeding sessions, directly from the breast and from a bottle, were video-recorded in participants' homes, then scored using the validated Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. The second half of feeding sessions were coded for infant satiation cues. Results: All women earned a college degree or higher, and were partnered. Mothers were aged mean ± standard deviation 33.2 ± 4.0 years; infants were 14.6 ± 6.9 weeks old and six (67%) were female. Mothers were more sensitive to infant cues during breastfeeding (NCAST Maternal Sensitivity to Cues sub-scale score, 15.0 ± 1.0) than bottle feeding (13.4 ± 1.6; p = 0.016). There was a significantly longer latency from feeding session midpoint to the first satiation cue during breastfeeding (minutes:seconds; 3:00 ± 1:53 versus 0:45 ± 1:18 bottle feeding, p = 0.038). There was no difference in the number of infant cues by feeding modality. Conclusions: Despite the small sample with high socioeconomic status, this pilot study highlights differences in maternal responsiveness to infant cues by feeding modality with human milk, which warrants further investigation.

An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

To describe nurses' support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support. Institutional ethnography. The mother/baby unit of a tertiary care hospital with 4200 births per year. Registered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period. Data were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method. Data analysis yielded three themes that described these nurses' support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents' expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies. Nurses' support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.

Correlation between maternal and infant cortisol varies by breastfeeding status

ObjectiveThe objective of this study was to examine associations of mother and infant salivary cortisol, measured three times over the course of a day, and assess whether these varied by breastfeeding status. MethodsWe conducted a cross-sectional study of 54 mothers and their infants aged 4–11 months. Mothers collected their own saliva and that of their infants upon awakening, 30min after waking and at bedtime. Breastfeeding status was reported by mothers and cortisol level was measured in saliva in μg/dl using standard techniques. We used generalized linear models to evaluate relationships between maternal and infant cortisol levels, and assessed whether the relationship differed by breastfeeding status: formula only compared to partial and full breastfeeding, adjusting for infant sex, race, age, maternal education, and family income. ResultsThirty-four infants received formula only and 20 were either partially or fully breastfed. Breastfeeding was associated with higher household income, higher maternal education, and white race. Cortisol levels were higher among breastfed infants at all three time points. After adjustment, maternal cortisol levels were related with infant cortisol at bedtime only (regression estimate 0.06; 95% CI: 0.10, 1.1; p=0.02). The adjusted association between bedtime maternal and infant cortisol was stronger among breastfeeding dyads than among formula-feeding dyads (regression estimate 1.0; 95% CI: 0.1, 2.0; p=0.04 vs. 0.6; CI: −0.1, 1.3; p=0.10). In addition, we assessed the influence of maternal education and household income in our adjusted model; income strengthened the observed association, whereas maternal education did not change the estimate. ConclusionsBreastfeeding mothers and infants had significant correlations for cortisol at bedtime, while formula-feeding dyads did not. These data suggest that several factors may contribute to cortisol synchrony observed in mother/infant dyads, including the transfer of cortisol in human milk, physical interaction such as skin-to-skin contact, and shared environment. In addition, our findings support household income as a possible contributor.

The relation of human milk lutein, choline, and docosahexaenoic acid content to recognition memory abilities of 6‐month‐old breastfed infants (247.4)

OBJECTIVE: The aim of this study was to explore the relation of human milk lutein, choline, and DHA with recognition memory abilities of 6‐month‐olds.METHODS: Two hundred breastfeeding dyads were enrolled when the infants were 3‐4 months of age. Milk samples were obtained and analyzed for fatty acids, lutein, and choline. One hundred two of the 200 were invited at age 6 months to participate in an electrophysiology session. Recognition memory was tested with a 70‐30 oddball paradigm during which high‐density 128‐lead event‐related potential (ERP) data were collected. Sixty‐seven infants provided usable ERP data; of those, 59 had complete nutrient data. The differences between latency to minimum, minimum amplitude, and mean amplitude when viewing familiar and novel stimuli were analyzed by averaging activity at 6 different collections of leads (Frontal Right, Frontal Central, Frontal Left, Central, Midline, and Parietal) and subjecting the data to stepwise regression modeling.RESULTS: Final regression models revealed significant interactions. The lutein by free choline interaction was significant for the difference in latency scores at Frontal Left and Central areas (p&lt;0.05 and p&lt;0.001, respectively). Higher choline levels with higher lutein levels were related to better recognition memory. The DHA by lutein interaction was significant for the parietal area in mean amplitude and minimum amplitude (p&lt;0.05). Recognition memory was higher when DHA was high and lutein was low.CONCLUSION: Interactions between human milk nutrients appear important in predicting infant cognition, and there may be benefit associated with specific nutrient combinations.Grant Funding Source: Nutrition Obesity Research Center (NIH grant), University of North Carolina at Chapel Hill, The Bill

Risk factors for early lactation problems among Peruvian primiparous mothers.

The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as < or = 10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as > or = 10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), < 8 breastfeeds during the first 24 h (days 0 and 3), and gestational age < 39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score < 8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.