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It would be difficult to think of a year when being an International Board Certified Lactation Consultant® (IBCLC®) has been so challenging—or so important. In 2021, birthing and lactating families all over the world have faced unprecedented hurdles as they’ve brought their babies into the world amid the COVID-19 pandemic. They have needed the help […]

Journal of Human Lactation, Ahead of Print.
BackgroundThe Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed.Research Aims(1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months.MethodsThis study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants’ records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding.ResultsReported adherence to 10-Steps policies ranged from 10%–85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months.ConclusionMaternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding.

Journal of Human Lactation, Ahead of Print.

Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-...

The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes an...

The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (1...

Journal of Human Lactation, Ahead of Print.
BackgroundThere is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations.Research AimsTo (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region.MethodWe used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012–2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines.ResultsAnnual emissions for milk formula products ranged from 3.95–4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq.ConclusionsPolicies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are “Triple Duty Actions” that help improve dietary quality and population health and improve the sustainability of the global food system.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundMother’s milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal–infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population.Research AimsTo determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother’s milk and (2) recorded number and volume of pumped mothers’ milk bottles, between two models of lactation care in a referral neonatal intensive care unit.MethodsThis retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017–March, 2018; May, 2018–April, 2019). The reactive care model (n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model (n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests.ResultsA proactive lactation approach was associated with an increase in the receipt of any mother’s milk from 74.3% to 80.2% (p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 (SD 788) to 6620 (SD 1314) bottles (p < .01).ConclusionsIn this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother’s milk provision for a high-risk population.

Journal of Human Lactation, Ahead of Print.
BackgroundLittle is known about breastfeeding initiation and duration in the context of postpartum marijuana use and safety beliefs.Research Aims(1) To describe characteristics of women who used marijuana postpartum; (2) to evaluate the relationship between postpartum marijuana use and breastfeeding behaviors; and 3) to assess, among women who used marijuana postpartum, how safety perceptions are associated with breastfeeding behaviors.MethodsData from the cross-sectional Pregnancy Risk Assessment Monitoring System, a United States national governmental survey, 2017, were analyzed for participants with infants aged ≥ 12 weeks (seven states, unweighted N = 4604). Chi-square tests were used to compare characteristics and counseling for postpartum marijuana use. For participants with postpartum use, adjusted prevalence ratios (aPR) were calculated to evaluate relationships between safety perceptions and breastfeeding initiation and duration.ResultsOverall, 5.5% (95% CI [4.6, 6.6]) of participants reported postpartum marijuana use; among these women, 47.2% (CI [37.6, 56.9]) were breastfeeding at the time of the survey. Overall, 25.7% of participants indicated that they had been advised, by their prenatal care provider, against marijuana use while breastfeeding. Breastfeeding initiation or duration did not differ by postpartum marijuana use. Among participants with postpartum use, those who perceived marijuana was safe for breastfeeding women to use were more likely to have breastfed (aPR = 1.22, CI [1.04, 1.43]) and have a breastfeeding duration > 12 weeks (aPR = 1.57, CI [1.08, 2.27]) compared to those who perceived it to be unsafe.ConclusionsUnderstanding maternal safety beliefs and provider education about the latest evidence and guidance related to postpartum marijuana use may improve clinical care.

Journal of Human Lactation, Ahead of Print.
IntroductionDuring the Coronavirus Disease 2019 global pandemic, maternal and newborn wellbeing has received much attention. Detailed reports of infected women breastfeeding their infants are uncommon. Due to incomplete information available, full data about those infants’ outcomes are lacking, and evidence of infectivity through breastfeeding has not been documented.Main IssueHere, we report about a mother who breastfed her infant until she was confirmed with the SARS-Cov-2 infection. After follow-up, we have confirmed that the infant, who was breastfed by the infected mother, was not infected.MethodsA 33-year-old woman gave birth to a full-term male infant on November 8, 2019. Since birth, she had been exclusively breastfeeding the baby until she was confirmed with the SARS-Cov-2 infection on February 8, 2020. She was hospitalized, isolated from her baby, and stopped breastfeeding. Even though she remained asymptomatic, her milk was expressed using a breast pump and discarded. The mother’s milk sample was collected on February 9, 2020, and the result of the nucleic acid test for COVID-19 was negative. Her infant was asymptomatic and remained virus negative. Her laboratory findings and chest Computed Tomography imaging was normal. She was treated according to the national protocol with aerosolized interferon α2β, lopinavir/ritonavir and ribavirin. Her serum SARS-CoV-2 specific antibodies(IgG and IgM) tested positive when discharged. She returned to breastfeeding after discharge.ConclusionOur findings suggest that breastfeeding may be less of a risk than anticipated. Additional research is needed to explore this possibility.

Journal of Human Lactation, Ahead of Print.
BackgroundBreast hypoplasia is one reason for insufficient milk supply. Case reports use wide intra-mammary width and certain breast appearances as markers of breast hypoplasia. However, the reliability of these variables has not been determined.Research aimsTo test the (i) interrater and intrarater reliability of intra-mammary width measurement and interrater reliability of categorizing women’s breasts into breast types, and (ii) feasibility and acceptability of study procedures for the participants.MethodsThis was a prospective, longitudinal, non-experimental design with survey and observational components of a convenience sample of early postpartum women (N = 31). Interrater and intrarater reliability were measured using intraclass correlation coefficient for agreement for intra-mammary width measurements. Interrater reliability was measured using weighted kappa for agreement for categorizing breast type. Feasibility and acceptability of study procedures were collected 1 month later.ResultsExcellent intrarater and interrater reliability for the intra-mammary width measurement (ICC = 0.99, 95% CI [0.99, 0.997] and ICC = 0.88, 95% CI [0.74, 0.94], respectively) and fair interrater reliability for breast type categorization (k = 0.35, 95% CI [−0.05, 0.75]) with high level of agreement between raters (97%) were achieved. Proportions of participants agreeing to breast photography and acceptability of study procedures were 68% (21/31) and 100% (28/28) respectively.ConclusionThe excellent reliability for the intra-mammary width measurement means it provides a useful measure for future research. Since the “fair” reliability of categorizing breast type was due to lack of breast shape range in our sample, future research could assess the breasts of women with different medical profiles.

Journal of Human Lactation, Ahead of Print.

Early in the COVID-19 pandemic, a troubling trend emerged—as hospitals struggled to understand the new risk, birthing parents and their infants were routinely being separated. Parents were told not to breastfeed or chestfeed, or counseled to only feed expressed milk. Babies were spending the first days of their lives unable to be in contact with […]

Journal of Human Lactation, Ahead of Print.
BackgroundExclusive breastfeeding has a wide range of benefits for maternal health. However, the benefit of exclusive breastfeeding for maternal mental health needs to be further explored.Research AimTo determine the moderating role of exclusive breastfeeding at 3 months on the association between prenatal and postpartum depression.MethodsThis study had a prospective, longitudinal, and comparative design with two groups and three assessment waves. The sample comprised 334 participants (70 depressed and 264 non-depressed) recruited at public health services in northern Portugal. Participants completed a measure of depression symptoms between the second and the third trimester of pregnancy and between 3 and 6 months, and a measure of breastfeeding status at 3 months.ResultsExclusive breastfeeding at 3 months moderated the association between prenatal and postpartum depression. Participants with prenatal depression who were exclusively breastfeeding at 3 months showed fewer symptoms of depression and lower rates of depression between 3 and 6 months postpartum, compared to participants with prenatal depression who were not exclusively breastfeeding. Participants without prenatal depression who were exclusively breastfeeding at 3 months showed similar depression symptoms and similar rates of depression between 3 and 6 months postpartum, compared to participants without prenatal depression who were not exclusively breastfeeding.ConclusionExclusive breastfeeding has a potential protective influence on postpartum depression among women with prenatal depression. Public health policies targeting women with prenatal depression should be implemented and include practices to promote and support exclusive breastfeeding in order to enhance women’s exclusive breastfeeding and mental health.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundThe continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding.Research aimTo compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care.MethodsChinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups.ResultsSignificant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05).ConclusionsA prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

By Melissa Bartick, MD, MS, FABM This week, the results of the COVID Mothers Study were published in Breastfeeding Medicine, providing more evidence that it may be safe to keep mothers and newborns together and, importantly, that separating them causes significant harm.  Indeed, as the authors point out, the “significantly low rate of [neonatal] hospitalization […]

Show your pride in transforming world health through skilled lactation care. Educate your community by changing your Facebook Profile Frame to celebrate IBCLC Day! This day – celebrated in 2021 on 3 March – is an opportunity to honor how IBCLCs transform world health by providing skilled lactation care. (Find other ways to celebrate IBCLC […]

In the early days of the COVID-19 pandemic, one issue quickly rose to the surface for birthing families and their providers. Considering the new risks, could parents and their infants safely remain together? It was a scary time for birthing parents and those who support them, as stories of painful separation abounded from areas around […]