Lactation Consultants Research Articles

Employment Requirements for IBCLCs: An Analysis of Job Postings

Objectives:The International Board of Lactation Consultant Examiners (IBLCE) sets strict criteria for the IBCLC credential. While all IBCLCs meet rigorous criteria, including specified health sciences background requirements, employers may require an IBCLC to have an additional credential. This practice may limit the availability of IBCLCs. The aim of this study was to determine what qualifications employers prefer or require for lactation care professionals.Methods:Three job posting websites in the United States were reviewed throughout the summer of 2022 for lactation consultant postings. During the study period, 448 unique lactation consultant job postings were identified.Results:Overall, 76% of job postings required an additional credential beyond the IBCLC, and there was a statistically significant preference for registered nurses (RNs;p< .005). This trend held true for inpatient hospital jobs specifically (p< .005). Public health jobs had a statistically significant preference for no additional credential (p< .005).Conclusions:According to the IBLCE, all IBCLCs are equally prepared to provide clinical lactation care. Employers, especially those with inpatient facilities, who require an IBCLC to be an RN are placing an additional barrier on the availability of qualified lactation professionals. Further research should explore the reasons behind these additional qualifications and the impact on the quality of lactation care provided.

Impact of early postnatal support by lactation consultant on breastfeeding outcomes in urban population: A prospective observational study

Abstract Background: Early breastfeeding support helps in achieving exclusive breastfeeding by reducing the incidence of painful breast problems. A comparison of the impact of lactation counselling by lactation consultants and nursing staff would help to optimise care. Methods: In this prospective study conducted in the maternity ward of a private sector tertiary care hospital in an urban area, breastfeeding outcomes such as achievement of exclusive breastfeeding and incidence of painful breast problems such as sore nipples and breast engorgement as well as breastfeeding technique were compared between two groups of mother–newborn dyads receiving support from lactation consultants (study group) and maternity ward nursing staff (control group), respectively. Results: A total of 477 mother–newborn pairs were enrolled. Sixty-three out of 225 mothers (28%) in the study group complained of sore nipples as against 122 out of 252 mothers (48.4%) in the control group (odd ratio [OR] 0.414, 95% confidence intervals [CI] 0.282–0.607, P < 0.001). Breast engorgement was reported in 45 mothers (20%) in the study group and 117 mothers (46.4%) in the control group (OR 0.288, 95% CI 0.191–0.434, P < 0.001). Two hundred and three newborns (90.2%) from the study group were discharged on exclusive breastfeeding as compared to 149 newborns (59.1%) in the control group (OR 0.156, 95% CI 0.094–0.260, P < 0.001). Conclusions: Lactation consultants are significantly better than nursing staff at improving breastfeeding outcomes by providing trained support to optimise breastfeeding position and attachment, thereby preventing painful breast problems.

Insights into feeding preterm infants in Aotearoa, New Zealand: a mixed-method study

Optimal nutrition is essential for preterm infants as they face many barriers to achieving exclusive breastfeeding (EBF) and successfully introducing complementary foods (CF)(1). There is limited evidence of early feeding practices of preterm infants in Aotearoa, New Zealand (NZ). We aimed to investigate the facilitators and barriers to EBF and CF introduction in preterm infants in NZ. A nationwide self-completed electronic questionnaire was disseminated via social media to mothers of preterm infants. The survey collected quantitative data on hospital feeding practices, breastfeeding rates, timing of CF introduction, and fussy eating behaviours. Relationships between feeding practices and maternal and infant characteristics, such as ethnicity and level of prematurity, were explored using the Chi-Square statistical test in SPSS. Qualitative information regarding mothers’ experiences with breastfeeding, CF introduction, type of education and support received about the nutrition of preterm infants were collected for thematic analysis using Nvivo. The survey started in April and will close on 20th August 2023. Here we present preliminary findings of a subset of responses collected to date, and full results will be available for the conference. Up to 1st August 2023, 201 mothers had completed the survey. Most mothers self-identified as of New Zealand European (58%) and Māori (13%) background. Most infants (39%) were older than 12 months of chronological age (CA) and born moderate or late preterm (32+0 – 36+6 weeks’ gestation, 70%). Almost 50% of mothers required in-hospital supplementation of mothers’ milk (infant formula, 28% and donor breastmilk, 20%), and 44% of mothers were EBF at the time of hospital discharge. EBF for 5-6 months of CA was reported by 21% of mothers, and 46% provided any breastmilk for more than 6 months of CA. Among mothers who had introduced CF (n = 138), 74% reported introducing CF between 5-8 months of CA, and the infant’s first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 47%, and food fussiness was significantly associated with a decreased frequency of vegetable (p<0.001) and fruit (p = 0.004) consumption. Challenges with breastfeeding included the infant’s feeding difficulties, low milk supply, maternal stressors, lack of support and education from health professionals. Challenges to CF introduction included fussiness and maternal fears such as choking and lack of confidence. Support from lactation consultants and previous experience with introducing CF were the most common enablers for breastfeeding and timely CF introduction, respectively. Our findings provide the first insight into the early feeding practices of preterm infants in Aotearoa, New Zealand. This information will support strategies to improve the nutritional management of preterm infants by increasing awareness of common challenges mothers face to achieve the recommended breastfeeding guidelines and CF practices in this vulnerable population.

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).

Information Seeking Behavior and Strategies to Increase Milk Supply Among Breastfeeding Mothers in the United States.

Background: Some breastfeeding mothers try to increase their milk supply through pharmaceutical, dietary, and behavioral strategies that vary in effectiveness. Information seeking behaviors may influence which strategies mothers use. Objective: To describe where mothers obtain information about increasing milk supply, describe the perceived influence of each information source on decision-making about strategies for increasing milk supply, and explore associations between information sources and mothers' use of galactagogues (i.e., pharmaceutical and dietary strategies) and behavioral strategies. Methods: Women who were currently breastfeeding and living in the United States were recruited through Facebook advertisements to complete an online survey between December 2020 and February 2021. Descriptive statistics were calculated, and chi-square tests compared participants' use of galactagogues and behavioral strategies by information sources. Results: Participants were 1,351 breastfeeding mothers (81% non-Hispanic white; 47% first-time breastfeeding; 21% Special Supplemental Nutrition Program for Women, Infants, and Children participants). Nearly all participants (97%) obtained information about increasing milk supply from at least one source, most commonly lactation consultants (68%), Facebook (61%), search engines (50%), websites (47%), and nurses (41%). There was high variability in the perceived influence of each source on decision-making. Galactagogue use was higher among participants who obtained information from the internet (Yes: 68% vs. No: 43%, p < 0.000), social media (Yes: 65% vs. No: 40%, p < 0.000), family and friends (Yes: 65% vs. No: 53%, p < 0.000), and lactation consultants (Yes: 63% vs. No: 54%, p < 0.002). Behavioral strategies were more commonly reported among participants who accessed these same sources, maternal health care professionals (Yes: 98% vs. No: 91%, p < 0.000), and pediatricians (Yes: 98% vs. No: 94%, p = 0.001). Conclusion: Breastfeeding mothers commonly obtained information about increasing milk supply from a variety of sources. Information sources accessed were associated with mothers' use of galactagogues and behavioral strategies for increasing milk supply.

Assessing the Landscape of Lactation Education: Results of a Pilot Survey.

The field of lactation currently uses breastfeeding rates to measure effectiveness. While monitoring breastfeeding outcomes can provide insight into the successes of lactation consulting as a profession, the improvement of breastfeeding outcomes is a multifactorial issue. In order to facilitate the growth of lactation education processes, understanding experiences during training and perceptions of readiness of current International Board Certified Lactation Consultants (IBCLC) for clinical practice is necessary. The aim of this survey was to provide a baseline assessment of the current landscape of the lactation profession through data related to certification, job market, practice confidence after passing the International Board of Lactation Consultant Examiners (IBLCE) certifying examination, and perceptions of specializations. A cross-sectional study design was used to assess the experiences of practicing IBCLCs. Non-probability convenience sampling was implemented from December 2021 through January 2022. A total of 281 unique responses were recorded with complete data on variables of interest. The majority of respondents were white females under age 50 located in the United States. The majority of respondents were certified through a Pathway 1. The largest barrier to certification was reported to be a lack of clinical/mentorship opportunities. Respondents were significantly more confident in providing entry-level support to dyads when mentored by four or more preceptors. Diversification of the field of lactation is necessary to provide appropriate support to lactating families in the United States. Additionally, addressing the barrier of accessing clinical/mentorship opportunities is essential for continued growth of the field of lactation.

Exploring Breastfeeding Mothers’ and Lactation Consultants’ Experiences of Lactation Consultancy Throughout the Restrictions Put in Place Due to the COVID-19 Pandemic

Background Breastfeeding rates in Ireland are among the lowest in the world. Lactation consultancy provides mothers with support and information on how to cope with any challenges they encounter. There is emerging evidence that COVID-19 restrictions impacted access to and the quality of breastfeeding support. The aim of this study was to explore breastfeeding mothers’ and lactation consultants’ experiences of breastfeeding support throughout the COVID-19 restrictions in Ireland. It also aimed to explore what adaptations had to be made to the delivery of lactation consultancy and how these changes impacted mothers’ experiences of breastfeeding support. Methods A qualitative research design was chosen. Semi-structured interviews were conducted with eight participants, three breastfeeding mothers and five lactation consultants. Interviews were conducted online via Zoom, audio-recorded and transcribed. The data were analysed using thematic analysis. Results Five key themes were identified: ‘Lack of Support’, ‘Adapting to COVID-19 Restrictions’, Emotional Response to COVID-19 and Restrictions’, Vaccination as a Barrier to and Facilitator of Support’ and Inconsistency of Lactation Support Across Ireland’. Both lactation consultants and mothers identified similar issues however, slight variations within lactation consultants' perceptions of mothers’ and mothers’ attitudes towards online services were seen. An unanticipated finding was the lack of support in hospitals pre-COVID-19. Conclusions Both mothers’ and lactation consultants’ experiences of lactation consultancy were impacted by the COVID-19 restrictions. Although exacerbated by COVID-19, the lack of support in hospitals existed before COVID-19. Provision of better breastfeeding support is required. Increased availability of lactation consultants and the implementation of breastfeeding rooms within hospitals is required in addition to debrief counselling sessions for lactation consultants. Further research is required to understand the unavailability of lactation consultants in hospital settings and to identify how to manage breastfeeding support in future emergency situations.

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland.

Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF. Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

Role of a multidisciplinary approach in maternal health and mental health outcomes

A multidisciplinary approach to maternal health signifies the integration of diverse healthcare professionals working collaboratively to address the complex needs of expectant and postpartum women. This approach acknowledges the intricate interplay between physical health and mental well-being during pregnancy, childbirth, and the postpartum period. In this framework, a team comprising obstetricians, midwives, psychologists, psychiatrists, nurses, social workers, and other specialists works together to provide holistic care. This teamwork ensures a comprehensive assessment of the physical and psychological aspects of maternal health. For instance, obstetricians focus on the physical health of the mother and baby, while mental health professionals assess and manage conditions, such as perinatal depression, anxiety, or postpartum mood disorders. Lactation consultants and nutritionists are also able to identify mental health concerns based on the time and anatomy of their consultations. The multidisciplinary team approach discussed will suggest the employment of early screening tools to detect mental health concerns by obstetricians and midwives, allowing for timely interventions and personalized care plans. This approach not only addresses immediate mental health issues but also prevent long-term complications that might affect both the mother and child. Furthermore, this collaborative model promotes education and support for mothers and their families. It empowers women with information about mental health during pregnancy and postpartum, equipping them to recognize symptoms and seek assistance when needed. In addition, it provides social and emotional support, reducing the stigma often associated with maternal mental health challenges. By engaging the expertise of various professionals, the multidisciplinary approach enhances the quality of care, leading to improved maternal mental health outcomes. It contributes to healthier pregnancies, reduces the risk of postpartum mental health issues, and fosters an environment where mothers receive comprehensive support, positively influencing the well-being of both the mother and child eventually.

Role of lactation specialists in maternal health and improvement of maternal mental health

Lactation specialists, comprising certified lactation consultants or counselors, play a significant role in fostering and safeguarding maternal mental health throughout the perinatal period. Their expertise in breastfeeding support transcends mere technical guidance, extending into the realm where emotional support and mental health advocacy converge. During consultations, lactation specialists create a safe, empathetic space, allowing mothers to openly discuss concerns and challenges related to breastfeeding. This nurturing environment fosters trust and confidence, which is crucial for mothers navigating the complex journey of breastfeeding. Importantly, breastfeeding itself is deeply intertwined with maternal mental health. Lack of milk, lack of breastfeeding support, and painful experiences all negatively affect maternal mental health greatly. Lactation specialists, attuned to emotional cues and stressors during breastfeeding interactions, play a critical role in identifying signs of distress or anxiety. They offer compassionate listening and, when necessary, provide resources or referrals to mental health professionals for specialized support. Moreover, these specialists serve as educators, equipping mothers with knowledge about the emotional aspects of breastfeeding and its potential impact on mental well-being. By empowering mothers with information and strategies to manage stress or challenges, lactation specialists contribute significantly to mitigating potential mental health concerns during the perinatal period. Beyond individual consultations, lactation specialists often facilitate support groups or communities for breastfeeding mothers. These forums create a sense of camaraderie and solidarity among mothers, alleviating feelings of isolation, which is a common trigger for maternal mental health challenges. Their multifaceted approach emphasizes the holistic nature of breastfeeding support, recognizing its impact on both the physical health of the child and the mother’s mental well-being. By providing comprehensive care that combines technical guidance with emotional support, lactation specialists play a vital role in promoting and preserving maternal mental health during the transformative phase of childbirth and early motherhood.

Multicomponent perinatal breastfeeding support in women with BMI >25: The Latch On multi-centre randomised trial.

To investigate the effectiveness of a multicomponent breastfeeding support intervention on breastfeeding prevalence at 3 months among women with a body mass index (BMI) >25 kg/m2. Multicentre multicomponent randomised controlled trial. Four maternity centres in Ireland. A total of 225 primiparous women and their nominated support partners. Participants were aged 18 years and over, with BMI ≥25 kg/m2, carrying a singleton pregnancy and without contraindication for breastfeeding. The intervention included an antenatal group breastfeeding education session for participants and their support partners, followed by a planned postnatal breastfeeding assessment and telephone support for up to 6 weeks by a lactation consultant. Any breastfeeding at 3 months postpartum. Any breastfeeding prevalence was 68.7% (n = 68) in the intervention group and 62.1% (n = 59) in the control group at 3 months postpartum (odds ratio 1.33, 95% confidence interval 0.72-2.46, p = 0.36). Any and exclusive breastfeeding rates did not significantly differ at any other time point. More women in the control group accessed support from private lactation consultants (intervention 23.5% [n = 12], control 45.3% [n = 24], p = 0.02). The control group had higher than expected breastfeeding rates, and the study found no evidence of effect on the primary outcome. Providing comprehensive education and support for women intending to breastfeed remains of paramount importance.

Skilled lactation support using telemedicine in the neonatal intensive care unit.

NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation. Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge. Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

Missed care and equitable breastfeeding support: An integrative review of exposure to in-hospital care by patient characteristics and breastfeeding outcomes.

To synthesize the literature on breastfeeding outcomes associated with exposure to internationally recognized best practices, such as the Baby-Friendly Hospital Initiative, for patients in the United States during the postpartum period, contextualized within the Missed Care Model. The authors employed Whittemore and Knafl's integrative review framework and the 2020 PRISMA guidelines for data extraction, synthesis, reporting and assessment. Five electronic databases were searched for articles published between 2007 and 2023. Eligible articles reported on exposure to breastfeeding best practices and outcomes or the experiences, views, perceptions and attitudes of parents, nurses or lactation consultants regarding hospital breastfeeding support. Extracted data were compared to identify in-hospital exposure to breastfeeding best practices and breastfeeding outcomes, and differences in exposure and outcomes based on patient and provider characteristics. Twenty-one quantitative, qualitative and mixed methods articles met inclusion criteria. A higher reported adherence to best practices was associated with greater odds of breastfeeding; some practices demonstrated greater effects overall or for specific groups. Higher exposures to best practices and higher breastfeeding rates were found for non-Hispanic white patients, and those with more education, private insurance and who live in urban areas. Disparities in support and outcomes were related to patients' race/ethnicity, language, weight and age. Qualitative findings reflected missed care concepts, such as internal processes related to habits and group norms, relevant to breastfeeding support. Review findings also include an adapted Missed Care Model specific to breastfeeding support, which can inform future research related to providers' internal processes that may influence breastfeeding or equitable breastfeeding care. Missed care can be influenced by a variety of factors, including providers' internal values and beliefs. Study findings suggest the existence of inequities in breastfeeding care and underscore the need to address and eliminate breastfeeding disparities. This study addressed how patient exposure to best practices in breastfeeding support relates to breastfeeding outcomes and whether exposure and outcomes differ by patient or provider characteristics, connecting this to the Missed Care in Breastfeeding Support Model. The main findings were that higher reported exposure to best practices in breastfeeding support related to improved breastfeeding outcomes; inequities exist in exposure to best practices; and patients and providers identify the importance of providers' internal processes in the delivery of breastfeeding support, which aligns with the Missed Care in Breastfeeding Support Model. Study findings will have the potential to impact how nurses, lactation consultants and other providers who deliver breastfeeding support in the postpartum hospital setting. The authors adhered to relevant 2020 PRISMA reporting guidelines. No patient or public contribution.

Поддержка грудного вскармливания в акушерских стационарах

Aim. To evaluate the implementation of the modern breastfeeding support principles into the practice of the maternity hospitals in Moscow. Design. Observational cohort study. Materials and methods. The study was conducted on the basis of two maternity hospitals in Moscow. With the help of a questionnaire specially developed by us, an anonymous survey of maternity patients was conducted at the time of discharge. A total of 614 mothers were interviewed from October 2020 to July 2021. Results. In general, the clinical practice of breastfeeding support in the maternity hospitals has demonstrated its stability and compliance with the criteria recommended by WHO for monitoring the main clinical practices. The rate of exclusive breastfeeding at the time of discharge from the hospital was 83.9%. The majority of mothers were satisfied with the breastfeeding support provided to them (90.9%). Mothers highly appreciated the work of lactation consultants introduced into the staffing of hospitals. Nevertheless, shortcomings were also identified in the implemented practice of breastfeeding support that requires improvement. Conclusion. The introduction of modern practice of breastfeeding support in maternity hospitals contributes to an increase in the level of breastfeeding among maternity hospitals, including exclusively breastfeeding from birth. To achieve the sustainability of this practice, it is necessary administration support, training of the medical staff, including lactation consultants, and monitoring of the breastfeeding practice. Keywords: breastfeeding, maternity hospitals, “Ten steps of breastfeeding support”.

Pain Management during Pregnancy and Lactation

Pregnancy and lactation are important stages in a woman’s existence, and pain management becomes a difficult problem at some point. The well-being of each mother and the growing fetus or breastfeeding toddler must be cautiously considered when selecting appropriate pain management techniques. This abstract evaluates modern knowledge and guidelines for pain control during pregnancy and lactation, focusing on the dangers and advantages of numerous pharmacological and nonpharmacological interventions. During pregnancy, women usually experience physiological changes that may exacerbate their current pain conditions or result in new ones. The use of certain pain medications, especially non-steroidal anti-inflammatory capsules (NSAIDs) and opioids has been linked to potentially destructive effects on fetal development. Consequently, healthcare providers often choose non-pharmacological interventions, including physical therapy, acupuncture, and relaxation techniques, as first-line remedies. Furthermore, a thorough evaluation of the risk-to-benefit ratio is essential when considering the use of any medication throughout pregnancy, and a session with a healthcare expert is important. During the lactation period, the ability to transfer medication through breast milk to infants raises issues regarding the protection of medications used for pain management. Healthcare companies have to remember the drug’s pharmacokinetics, its potential effect on the little one’s health, and the mother’s potential to care for the infant while on medicine. Opioid use at some point during breastfeeding is a concern because of the hazards of sedation, respiratory despair, and withdrawal signs inside the infant. In comparison, a few medicines are considered, especially those that are safe throughout lactation, and alternative non-pharmacological interventions have to be explored where possible. An interdisciplinary approach involving obstetricians, anesthesiologists, pediatricians, and lactation consultants is essential for developing comprehensive pain control plans during pregnancy and lactation. Alternatively, pain relief for the mother is critical to ensuring her well-being and a successful bond with the little one. Concurrently, minimizing any capacity risk to the fetus or breastfeeding infants is of maximum significance. Moreover, affected person education and shared selection-making play a critical role in supporting ladies to make informed choices about pain management strategies that stabilize their pain alleviation wishes and the safety of their unborn or breastfeeding child.

Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study.

While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health-funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation's equity-centered model. Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations.

The Conception and Birth of the Lactation Consultant Profession (1977-1983): An Interview With Chele Marmet (Part I).

In 2015, Miriam Labbok, MD, MPH, entrusted Chele Marmet with the task of writing a chapter on the early history of the lactation consultant profession for the public health textbook she was preparing about lactation, saying, "I invited you to author it because you conceptualized and pioneered the profession, and there is nobody else I could ask who could do it justice," (M. Labbok, personal communication, June 28, 2015). Chele Marmet envisioned the allied health field of lactation consulting, complete with international educational standards, professional organizations, and a scope of practice. She was an active contributing founder of the International Lactation Consultant Association, developed hundreds of test questions for the early International Board of Lactation Consultant Examiners (IBCLE), and co-founded the first academic (BA and MA) lactation education program, The Lactation Institute, to name only a few of her many innovations and contributions to the field of lactation we know today-a field that has grown exponentially globally since those early days in the 1970s when Chele began creating our profession. Her academic background in speech and hearing gave her the orientation to delve into infants' oral-motor function. Additional education and experience followed as her passion for helping breastfeeding families grew. This is the first part of her interview; the second part will follow in the next JHL issue. Fortunately, Chele is working on her memoir, which will detail topics we could only briefly discuss in this interview. It was my honor to interview Chele Marmet.Joan E. Dodgson.

The role of nursing in breastfeeding in hospitalized neonates

Introduction: In this research, the issue of the role of nursing in breastfeeding in hospitalized neonates is addressed. Breastfeeding plays a fundamental role in the health and development of hospitalized neonates, and adequate support from nursing staff is essential to promote and facilitate this practice. Objective: To explore the experiences and perceptions of mothers, fathers and nursing staff in relation to breastfeeding in hospitalized neonates, as well as to evaluate the correlation between a good latch of the neonate and the production of breast milk. Methodology: Through a mixed methodological approach that combines qualitative and quantitative methods, to obtain a complete and holistic understanding of this important issue to improve neonatal care. Through in-depth interviews, focus groups, and structured questionnaires, the experiences and perceptions of mothers, fathers, and nursing staff were explored, as well as the correlation between newborn latch-on and breast milk production. Data analysis revealed that the instruments used in this study showed good reliability, with Cronbach's coefficients higher than 0.8. Results: They showed common challenges in breastfeeding, such as the lack of information and emotional support. A significant correlation was found between a good latch of the newborn and a higher production of breast milk. Conclusion: The training of nursing staff and the implementation of support strategies, such as the use of lactation consultants, were identified as key elements to improve breastfeeding care in the hospital setting. These findings support the importance of the role of nursing in the promotion and support of breastfeeding in hospitalized neonates.

BREAST MILK BANKS – THE WAY TO GLOBAL BREASTFEEDING SUPPORT IN UKRAINE AND THE WORLD

Breast milk is the standard of infant nutrition, recognized worldwide as the optimal fi rst source of food, and breastfeedingis the ideal way to feed children, meeting all their needs. Breast milk is especially valuable for premature infants, who require specialized medical care from the fi rst seconds of life and for a long time, and for sick newborns born at term. Preterm or sick preterm infants are most vulnerable to perinatal illness, have a high probability of dying and, most importantly, are at the greatest risk of not receiving the life-saving benefi ts of breast milk. In today’s world, the World Health Organization and the American Academy of Pediatrics recommend the use of donor human milk as the fi rst alternative for feeding preterm infants of any gestational age, including very preterm infants (&lt;32 weeks gestation) or very low birth weight infants (&lt;1500 g), when human milk is not available. Studies have shown that breastfeeding, even partial breastfeeding, reduces the risk of necrotizing enterocolitis and late neonatal sepsis, retinopathy of prematurity, and sudden infant death, improves cognitive outcomes in preterm infants, and helps establish optimal functioning of the digestive system and enteric digestive processes. In many countries around the world, targeted support for breastfeeding in neonatal intensive care units, including enteral feeding of sick and premature infants, is provided by donor human breast milk that is concentrated and stored in an established and functioning network of breast milk banks.A breast milk bank is an institution whose purpose is to collect breast milk from mothers who produce more than theirinfants need, and to process and store breast milk for the feeding of infants who, for medical or other reasons, cannot receive it temporarily or for a long period. International associations of breast milk banks have been established throughout the world to promote the activities of banks and to establish international cooperation among breast milk banks.The European Milk Banks Association (EMBA) was offi cially launched on October 15, 2010. There are currently 282 activebanks in 31 European countries and 18 banks in the process of becoming active. The Southern African Milk Banks Association (HMBASA) was established in 2009. HMBASA coordinates the activities of the network of milk banks throughout the country. The North American Milk Banks Association (HMBANA) was founded in 1985 and brings together 30 non-profi t breast milk banks in the United States and Canada. There is a positive trend in the establishment of new breast milk banks in all countries of the world. There are currently about 500 in 37 countries. Brazil is the world leader in breast milk banks, with 222 breast milk banks and 217 milk collection centers. The first donor breast milk bank in Ukraine was established in 2019 in Kyiv at the Perinatal Center, where about 80 % of all premature babies in the city are born. In December 2022, when the country was at war, a high-tech breast milk bank was opened at the Lviv Regional Clinical Perinatal Center. This is the second bank of donated breast milk successfully operating in Ukraine on the basis of perinatal centers.The operation of the breast milk bank at the Lviv Oblast Clinical Perinatal Center is one of the many modern high-tech areasof the healthcare facility. The breast milk bank is equipped with all the necessary equipment, which meets the highest modern world standards. Active daily teamwork of obstetricians, neonatologists, lactation consultants and mothers has allowed the bank to attract 32 donors of breast milk and collect more than 380 liters of donor milk since its opening. The fi rst batch of donor milk was received on January 12, 2023.Promoting the creation of a network of mother’s milk banks in Ukraine at the state level will help to make a signifi cantcontribution to the preservation of the full healthy development of newborns and infants in our country, which has becomeespecially important in the current military situation in Ukraine.