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Lamaze Celebrates International Board Certified Lactation Consultants & IBCLC Day with a Fun Quiz

March 5th, 2014 by avatar
© ILCA

© ILCA

Today- Wednesday, March 5th, 2014 is IBCLC Day.  Board certified lactation consultants go through a rigorous training and exam process to become certified.  After certification, they are qualified to help women to feed and nourish their babies and support feeding issues that may occur in the mother-baby dyad.  The International Board of Lactation Consultant Examiners (IBLCE) is the organization that administers the exam worldwide and approves certificants, along with managing the recertification process.  They also maintain a registry that lists all the certified lactation consultants.  The International Lactation Association (ILCA) is the worldwide professional organization for International Board Certified Lactation Consultants (IBCLCs) and other professionals who support breastfeeding.  ILCA’s website maintains a directory of working IBCLCs so that mothers and professionals can locate an IBCLC in their area.

IBCLCs work in a variety of settings and with a diverse population of women and their babies.  They may also work in other capacities; as a physician, childbirth educator, doula, midwife, nurse or other professional along with their lactation consultant skills.

On Science & Sensibility today, we have a quick and fun quiz to test your knowledge of what an International Board Certified Lactation Consultant might do to help mothers and babies and also highlight some of their skills.   By taking the quiz, you can learn more about what an IBCLC does and how they can be a resource for a wide variety of mothers and babies.


Will you join me in recognizing the IBCLCs that work with your patients, your students and your clients with a brief thank you and shout out for all they do to support healthy mothers and babies?  Every childbirth educator or other birth professional surely has a few favorite lactation consultants who have gone the extra mile for your clients and patients?  Why not send them an ecard to honor the work they do?  Select the perfect ecard here and let the men and women working as IBCLCs know how much you appreciate their efforts.  Join Science & Sensibility and Lamaze International in thanking an IBCLC! And let us know how you did on the IBCLC quiz in the comments section.

Disclaimer:

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Babies, Breastfeeding, Childbirth Education , , , , , , , ,

2014 Confluence – DONA & Lamaze International Want You to Submit an Abstract!

January 3rd, 2014 by avatar

confluence header

You are invited to submit an abstract for the 2014 Confluence – Lamaze & DONA flowing together for safe, healthy, birth and beyond happening in Kansas City, Missouri on September 18-21, 2014.  Abstract submissions are being accepted until January 29th and I know that Science & Sensibility readers are some of the most interesting, engaged and knowledgeable professionals on topics related to pregnancy, birth and postpartum topics that exist anywhere.

confluence definitionThis unique joint conference is breaking new ground in bringing together two long-time leaders in the childbirth professions, DONA International and Lamaze International so that members of both organizations can share learning opportunities, ideas, networking occasions, and collaboration and learn from each other and other experts. Won’t you consider submitting an abstract?

Conference objectives are to:

  • Incorporate the use of technology and innovation in order to meet the needs of childbearing families.
  • Discuss how evidence-based research and best practice guidelines may be incorporated into practice, used to advocate for safe and healthy birth, promote professional collaborations, and support quality initiatives.
  • Implement innovative techniques that support the physical, emotional, cultural and educational needs of childbearing families.
  • Describe current research initiatives and approaches to perinatal care that may impact safe and healthy birth, postpartum, breastfeeding and early parenting.

Abstracts are being solicited that speak to one or more of the following areas:

  • Using Technology and Innovation to Reach Childbearing Women: The Listening to Mothers III Survey indicates that childbearing women are highly connected to social media and widely receive information about childbirth, postpartum, and parenting through social media platforms. How can childbirth professionals connect electronically with new or potential clients and integrate technology into education, support and advocacy? How can we best connect to families with diverse needs? These sessions may consist of case studies, technology tool demos and best practices, or marketing tips for the independent provider, educator and doula.
  • Evidence Based Teaching and Practice: The use of evidence based information is at the heart of childbirth education and labor and postpartum support. Recently developed quality initiatives and professional guidelines can be used to advocate for safe and healthy birth, breastfeeding support, VBAC, parent-infant attachment, and other topics important to parents and to those who provide childbirth support. How can evidence-based practices be combined with awareness and sensitivity to the range of cultural and religious traditions and preferences to promote safe and satisfying births? These sessions will provide information about how to incorporate evidence-based information into support, education, quality initiatives and advocacy efforts.
  • Supporting the Needs of Childbirth Professionals: Doulas, childbirth educators, nurses, midwives, and others are continually searching for creative ways to understand and meet the physical, emotional, religious, cultural and educational needs and preferences of childbearing families. Topics that sometimes generate strong political, cultural and social opinions (for example circumcision, vaccination, and co-sleeping) may be addressed. Presenters will share innovative techniques for supporting and sharing information with pregnant and parenting families. In these sessions the attendees will act as the learning audience and presenters will share with peers unique learning tips and support techniques.
  • New and Emerging Research in the Field of Childbearing: These sessions are for the presentation of new research, practice guidelines and collaborative efforts (published in the last three to five years) that are relevant to childbearing families and those who serve those families. Topics may range from holistic approaches to perinatal care, nutritional recommendations, effects of stress and toxic environmental exposures on pregnancy, the life course approach to healthy birth, preconception health and other subjects. These abstracts may be submitted for a live session or a poster presentation.

The deadline for abstract submission is January 29th, 2014 and I am confident that many of you have expertise, knowledge and skills that need to be shared with this gathering of professionals. What a great opportunity for you to present on your passion and for all the birth professionals; childbirth educators, doulas, lactation consultants, midwives, physicians, l&d nurses, counselors, authors and more to learn from YOU! Receive a generous honorarium and conference discount if your abstract is accepted.

Please consider sharing your wisdom!  Start working on your confluence abstract now.  You can find more information on submitting an abstract and access to the the online abstract submission tool here.  See you in Kansas City!  Let us know in the comments section if you are planning to submit!  I look forward to all of your great ideas!

2014 Confluence, Babies, Breastfeeding, Childbirth Education, Conference Calendar, Conference Schedule, Continuing Education, Uncategorized , , , , , , , ,

Research Review: Are There Any Benefits to Performing an Early Frenotomy on Newborns?

December 10th, 2013 by avatar

By Elias Kass, ND, LM, CPM

Breastfeeding is often considered the next big challenge after childbirth. New mothers and babies work together to establish a successful breastfeeding relationship. Sometimes, there are complications that can make things harder than they should be.  Tongue tie is one of the circumstances that can interfere with getting the breastfeeding relationship off to a good start. Please welcome Dr. Elias Kass, to Science & Sensibility as he reviews a recent study on early frenotomy (tongue tie clipping) in newborns and shares his thoughts on the study results. – Sharon Muza, Community Manager

With tongue tie seemingly on the rise, it’s always nice to see new literature approach the issue. “Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie” (Emond et al) compares releasing the tongue tie (frenotomy) immediately versus waiting and providing standard breastfeeding support.

What is tongue tie?

Tongue tie describes the presence of a frenulum that restricts the tongue’s ability to reach out and grasp the breast for successful breastfeeding.

Anterior tongue tie Image Source: Melissa Cole, IBCLC, RLC

Anterior tongue tie
Image Source: Melissa Cole, IBCLC, RLC

The most profound anterior tongue tie is one that connects the tip of the tongue to the edge of the gum. These babies have a V- or heart-shaped tongue when they cry, cannot extend their tongue at all, cannot follow a finger tracing along their bottom gum, and cannot generally latch well. Tongue ties can occur all along the spectrum of the tongue and the floor of the mouth, and some are hidden under the surface layer of skin, which we call “posterior tongue tie.”

The role of the tongue in breastfeeding

The tongue is incredibly important in breastfeeding. The baby must reach out with his tongue and grasp the breast. The tongue forms the primary seal, preventing milk loss and air intake. The movement is intrinsic to the tongue. Rather than sawing the tongue in and out, the muscular impulse starts at the tip of the tongue and moves inward, moving milk from the breast into the mouth. The middle of the tongue acts to form the milk into a ball, and the back of the tongue is responsible for coordinating swallowing, raising the larynx so that milk is directed down the esophagus and not down the trachea into the lungs.

What happens when a baby is tongue tied?

Tongue tie interferes with this intricate coordination in many ways. Some babies cannot extend their tongue. Those babies will have difficulty finding and attaching to the breast, but they may be able to nurse if the nipple is placed in their mouth just right. These babies come off the breast easily and become frustrated because they cannot adjust the position of the nipple in the mouth. The babies who are so tied they cannot extend their tongue over their bottom gum will reflexively clamp their gums. To the nursing parent, this pressure can feel like biting, and can damage nipples incredibly quickly, causing cracking, bleeding, pain, and because the skin is now broken, infection. 

Some babies can extend their tongue against the “rubber band” of the tongue tie, but their tongues “snap back” frequently. This can feel like a sawing against the underside of the nipple, and that friction can also damage nipples. These babies tire easily, because their feeding is made more difficult by the resistance of the rubber band. Snap back can sound like clicking. Clicking can also be caused by loss of suction from the underside of the breast. The tongue should stay mostly in the middle of the mouth when breastfeeding, with the jaw opening to create suction in the middle and back of the mouth. If, when baby opens her jaw, the tongue is tied to the bottom of the mouth, her tongue will snap away from the breast, losing suction.

Some babies can extend but not cup their tongues. These babies generally mash the nipple against the roof of the mouth, causing flattened, ridged nipples. Others thrust their tongue against the nipple instead of reaching under it, which leaves the nipple looking like a lipstick applicator.

What is a frenotomy?

Frenotomy refers to the procedure where this tongue tie is released (or in some places, “revised”). Though not all providers perform this procedure, providers from many different specialties have been known to offer it: pediatricians, family practice doctors, ear nose and throat specialists, dentists, and some midwives. For most, it is a simple, in-office procedure.

What did this study look at?

The researchers determined which babies were tongue tied based on the Hazelbaker Assessment Tool for Lingual Frenulum Function and the LATCH score (Latch, Audible swallowing, nipple Type, Comfort, Hold ). Those who had mild-moderate tongue tie according to the Hazelbaker score, as well as a LATCH score less than 8 out of 10 were eligible for the study. Those babies with severe tongue tie according to the Hazelbaker score were not randomized, and were instead offered immediate frenotomy; their outcomes were not considered as part of the study. Some parents of babies who otherwise qualified for the study refused to be randomized because they felt strongly about receiving frenotomy upon diagnosis.

When considering whether to intervene for tongue tie, it’s important to consider appearance as well as functionality. Some tongue ties are not readily visible but interfere greatly with functionality. Some tongue ties appear dramatic, but breastfeeding is not affected. (There are other long-term considerations, like speech and oral health, in deciding whether or not to release a tongue tie that is not affecting breastfeeding.) The Hazelbaker score is a good way to evaluate functionality because it takes into account whether baby can extend her tongue, cup it into the appropriate shape, moved it appropriately, and maintain suction, as well as the severity in appearance. The Hazelbaker score has good inter-scorer correlation, meaning that different professionals using the tool will arrive at the same conclusion (whether or not the baby should have a frenotomy) nearly 90% of the time. Using a consistent tool can help the individual provider get a better sense of who needs the procedure, but it can also help us as readers to know whether the study population was appropriate, and whether the study’s conclusions can inform our own practice.

V-shaped tongue Image Source: Osama Moshet, MD, FAAP

V-shaped tongue
Image Source: Osama Moshet, MD, FAAP

The LATCH score is a very broad evaluation of how breastfeeding is going, and despite its name, only barely addresses latch itself. Using such a general assessment in conjunction with the Hazelbaker score may have helped the researchers isolate the babies who were both tongue tied and having difficulties breastfeeding, as opposed to those who were tongue tied but doing okay.

In measuring outcomes, they used these two measures again, and added several more measures concerning breastfeeding behavior of newborns, breastfeeding self-efficacy (how confident mom felt in her ability to feed her baby, as well as an observer’s evaluation of breastfeeding effectiveness), and pain.

Conclusion

The primary outcome was LATCH score at 5 days. Secondary outcomes were LATCH score at 8 weeks, and the other measures listed above at 5 days and 8 weeks. The Hazelbaker score was another “outcome of interest” at 5 days, as was infant weight at 8 weeks. At 5 days, parents could choose to have frenotomy regardless of whether they had been randomized to the control arm or the intervention arm.

The researchers concluded “Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy. The majority in the comparison arm opted for the intervention after 5 days.”

Discussion

Though the study is structured fairly soundly, it doesn’t really answer its own question of whether frenotomy helps improve breastfeeding, largely because of the outcomes they chose to study. The LATCH score is not an indication of tongue functionality, success of frenotomy, or long-term breastfeeding success. Five days is also probably too soon to pass final judgement on whether the frenotomy helped; babies and nipples are still healing. The study also excluded those with severe tongue tie, and it’s safe to assume these babies would have significant improvement when their tongue ties were corrected.

Mothers did feel significantly more effective in their feeding when their babies had received frenotomy (which is correlated with duration of breastfeeding), and more of those who didn’t receive frenotomy were feeding by bottle. It’s unclear whether this bottle feeding was because of the pain associated with breastfeeding or because of inadequate milk transfer or nutrition, but it’s possible that some of those parents have been helped by immediate frenotomy. Indeed, some of the mothers who had been randomized to the control group requested early frenotomy because their feeding was so painful. There were statistically significant improvements in the Hazelbaker score, representing improvement in both appearance and functionality.

Very thick  submucosal/posterior tongue tie. {link url="http://www.bayareabreastfeeding.net"}Bay Area Breastfeeding & Education, LLC{/link} Image Source: Bay Area Breastfeeding & Education, LLC

Very thick submucosal/posterior tongue tie.
Image Source: Bay Area Breastfeeding & Education, LLC www.bayareabreastfeeding.net

Many features of this study mirror how I treat tongue tie in my practice. Almost all babies are referred by lactation consultants or their own pediatricians because they are having difficulty breastfeeding, or because their tongue ties are so profound that we can anticipate speech and oral health problems if it’s not corrected. I use both the Hazelbaker score and the scoring tool in the appendix of RL Martinelli’s “Lingual frenulum protocol with scores for infants” to capture the infant’s feeding history, anatomy, and functionality on both the gloved finger and at the breast. These scores help support a systematic approach to these infants, and helps communicate back to their referring provider what I’m looking for when I decide whether or not to recommend frenotomy. Though most babies referred do need frenotomy, some need other kinds of support instead, and some just need reassurance around normal feeding patterns.

The article didn’t go into much detail about the aftercare. Aftercare is a crucial variable in improving breastfeeding and maximizing success of the procedure. Seattle area practices who perform significant numbers of frenotomy have collaborated to create a list of exercises we ask parents to do with their babies 5 times daily for a week to keep the area open, reduce reattachment, and help baby learn to maximize their new freedom of movement. We also generally recommend craniosacral therapy to help release tight muscles and retrain movement patterns. Many families have incorporated other feeding tools or accessories into their regimens, whether that’s nipple shields, bottles, supplemental nursing systems, or formula. With frenotomy, most will be able to start to move away from those tools, and need continued support from a lactation consultant to relearn how to nurse at the breast. Though most mothers feel that baby nurses differently immediately, some babies take longer to change their approach, and some do not benefit at all.

Releasing tongue ties is a very satisfying part of my practice. I love when breastfeeding parents nurse immediately after the procedure and their faces light up because for the first time it doesn’t hurt to feed. These parents have been working very, very hard to breastfeed, and I feel strongly that this procedure removes a significant obstacle. The more I work with breastfeeding families, the more in awe I am of the complexity of breastfeeding, and importance of excellent breastfeeding support.

Childbirth  and breastfeeding educators should be sharing that painful breastfeeding sessions are not normal and should be evaluated by a lactation consultant.  Educators should provide resources for qualified LCs in their communities to families in need.  For those that work with breastfeeding dyads, what are you seeing in terms of tongue tie and treatment success? Please share your experiences.- SM

References

Ballard, J. L., Auer, C. E., & Khoury, J. C. (2002). Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.Pediatrics, 110(5), e63-e63.

Emond, A., Ingram, J., Johnson, D., Blair, P., Whitelaw, A., Copeland, M., & Sutcliffe, A. (2013). Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie. Archives of Disease in Childhood-Fetal and Neonatal Edition, fetalneonatal-2013.

Martinelli RL de C, Marchesan IQ, Berretin-Felix G. Lingual frenulum protocol with scores for infants. Int J Orofacial Myology. 2012;38:104–112.

About Dr. Elias Kass

elias kass head shot

Elias Kass, ND, LM, CPM

Elias Kass, ND, LM, CPM, is a naturopathic physician and licensed midwife practicing as part of One Sky Family Medicine in Seattle, Washington. He provides integrative family primary care for children and their parents, including prenatal, birth and pediatric care. He loves working with babies! Practice information and Dr Kass’s contact info is available at One Sky Family Medicine.

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Insta-gram or Insta-gasp? The Ethics of Sharing on Social Media for Birth Professionals

October 24th, 2013 by avatar

Attorney and Lactation Consultant Liz Brooks, President of the International Lactation Consultant Association, takes a look at the issues that childbirth professionals might want to consider before sharing information on a social media platform like Facebook, Twitter, Instagram, Pinterest or others.  Do you follow the HIPAA guidelines, even if you are not bound to do so?  What has been your experience?  Please share your thoughts and experiences in our comments section. – Sharon Muza, Science & Sensibility Community Manager.

By Liz Brooks, JD IBCLC FILCA

Is it ever ethical for a healthcare provider (HCP) to post a photograph or video of a patient on a website or Facebook page? My first reaction is “Heck No!,” but the question deserves a deeper look, especially since social media platforms serve as a predominant means of communication, marketing and information-sharing. It is the way we can speak to today’s mothers, and it is the way they insist on reaching us. 

Privacy and confidentiality are hallmarks of the traditional healthcare professions. I am an International Board Certified Lactation Consultant (IBCLC), and right there, in my ethical code (called the IBLCE Code of Professional Conduct for IBCLCs, or CPC), it says at Principle 3 “Preserve the confidentiality of clients.” Further, I am required under the CPC (a mandatory practice-guiding document) to “Refrain from photographing, recording or taping (audio or video) a mother or her child for any purpose unless the mother has given advance written consent on her behalf and that of her child.” 2011 IBLCE CPC, 3.2. Translation: If I want to take a picture of a mother for any reason at all (to document healing of a damaged nipple, perhaps), even if I drop it into a patient folder only I will ever see, and which I lock away in a file cabinet, I had better get the mother’s written consent first. 

But what about a doula or childbirth educator? Are doulas or educators considered “healthcare providers” in the way a doctor, nurse, midwife or IBCLC would be? Or are they removed from the rules in healthcare?

The Childbirth and Postpartum Professional Association (CAPPA) describes the doula as an important informational and emotional link between the pregnant/laboring woman and her healthcare providers … a part of the birth team. DONA International, another doula organization, describes the role as “a knowledgeable, experienced companion who stays with [the mother] through labor, birth and beyond.”

This is what else we learn from CAPPA and DONA International: It is clear that privacy of the mother is paramount. Any person who is certified through CAPPA is expected to follow a Code of Conduct that is quite plain in its requirement to protect privacy: “CAPPA certified professionals will not divulge confidential information received in a professional capacity from their clients, nor compromise clients’ confidentiality either directly or through the use of internet media such as Facebook or blogs.” (Page 1, Bullet 4, CAPPA Code of Conduct.) The Code of Ethics from DONA International echoes this requirement: “Confidentiality and Privacy. The doula should respect the privacy of clients and hold in confidence all information obtained in the course of professional service.” (DONA Int’l Code of Ethics Birth Doula, 2008.)

Childbirth educators are held to a similar standard. Lamaze International, which offers an international certification for those who are working with pregnant women and their families, has a Code of Ethics for its Certified Childbirth Educators. That Code indicates “Childbirth educators should respect clients’ right to privacy. Childbirth educators should not solicit private information from clients unless it is essential to providing services. Once a client shares private information with the childbirth educator standards of confidentiality apply.” (Standard 1.07, 2006 Code of Ethics, Lamaze International.)

So it seems that healthcare providers, childbirth educators and doulas alike should NOT be posting pictures of their clients/patients on the Internet. So why are we seeing so many of them?

Because if the mother agrees to have her picture or personal information shared, her informed consent changes everything. The notion of protecting privacy is that the patient or client ought to be in control of whatever information gets shared with the outside world. Anyone who has attended a conference, and benefited from education that included clinical photographs, knows that some clients/patients are willing to allow their images to be seen by others. They may require conditions of use (i.e. do not show the face), but they willingly agree.

“So all I have to do is just ask the mother?” you wonder. Well … not so fast. Some other considerations may (dare I say it?) cloud the picture:

  1. Some healthcare providers, hospitals or birth facilities may have rules of their own affecting whether or not images may be taken, by you or even the family. You will need understandings and consent up front, often signed on forms as proof, before you can whip out the smart phone. 
  2. If the doula or childbirth educator has a professional, business relationship with other healthcare providers, or healthcare facilities, she may well be considered a “business associate” for purposes of the privacy-protecting sections of the Health Insurance Portability and Accountability Act (HIPAA), and its first cousin in enforcement, the Health Information Technology for Economic and Clinical Health Act (HITECH). Under HIPAA/HITECH “business associates” who have ANY kind of access to patient information (like: name and address) are held to the same standard for privacy as the healthcare provider. And if there are breaches of privacy, both the business associate AND the HCP are held liable. Enforcement actions recently have included actions against small practices, including the levying of some hefty fines. The person working with the family, who has a professional relationship with a covered entity under HIPAA, should be certain that her own business associate agreement is up-to-date and signed. It is important that she respect the requirements set by her (probably skittish) business partner, before she seeks the mother’s consent.
  3. Make sure you and the mother are very clear in your understanding of what her “consent” really means. Many a mother has been disappointed that her great and wonderful news announcing her baby came from someone else first … even if the plan all along was to have everyone share the great news once mom revealed it.

Discuss all the possibilities with the patient/client. Who can publicly discuss the pregnancy/birth/sonogram? Who can take and post pictures? What and who can be included in the pictures (faces, body parts, location-identifying background all matter). Who can text? Who can tweet? Is a link back to a website or Facebook page by the mother required? When can all of this take place?

As a savvy advocate for the mother, you may want to suggest that she have these same discussions with her own circle of family and friends. While they will not be held to the legal and ethical standards required of a doula or HCP, the disappointment will be no less acute for the mother if the glorious news of her pregnancy or birth is spilled by a friend, first. 

As doulas, childbirth educators, IBCLCs and HCPs who work in maternal-child health, we are privileged to be willingly called into the intensely personal and life-changing events that pregnancy, birth and early parenting represent. Our need to respect the wishes, dignity and privacy of the family are not diminished because modern technology makes news-sharing so easy.

About Liz Brooks

Liz Brooks, JD, IBCLC, FILCA, is a lawyer (since 1983) and earned her International Board Certified Lactation Consultant credential in 1997 after several years as a lay breastfeeding counselor.  Before she left the practice of law, Liz worked as a criminal prosecutor, a lobbyist and a litigator, with a focus on ethics and administrative law.  That expertise followed her to lactation:  She wrote the 2013 book, “Legal and Ethical Issues for the IBCLC,” and was lead author for one ethics chapter in each of three other books.

Liz is on the ILCA Board of Directors (President 2012-2014).  She was designated Fellow of the International Lactation Consultant Association (FILCA) in 2008. She currently is the United States Lactation Consultant Association Alternate to the United States Breastfeeding Committee and is an Elected Representative on their Board of Directors (2012-14).  Liz can be reached through her website.

 

 

Babies, Breastfeeding, Childbirth Education, Guest Posts, informed Consent, Legal Issues , , , , , , , , , , , , , , , ,

Purchased Breastmilk Overflowing with Bacteria? The Facts Behind the Sensationalistic Headlines.

October 22nd, 2013 by avatar

 By Suzanne Barston

Suzanne Barston, author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t and blogger on topics related to infant feeding discusses the new study that examines bacterial levels found in breastmilk purchased online.  Did you bother to look beyond the headlines to see what the research showed.  How will you respond to clients, patients and students who ask you what you think and wonder how safe it is to feed their babies purchased or donor milk?  Suzanne points us toward some great information and takes a level-headed look at what this study actually tells us.  To learn more about Suzanne, please read Walker Karraa’s interview with Suzanne for Science & Sensibility here.- Sharon Muza, Science & Sensibility Community Manager.

© http://bit.ly/Hc2W86

As someone who supports formula feeding parents, I’m used to sensationalized media coverage of studies that confuses real risk with relative risk. It’s taught me to look at research with a critical eye, rather than accepting what the reporters (or even the study authors, at times) claim is absolute truth. 

This week’s splashy headlines involved breastmilk, not formula, but the end result has been quite familiar: frightened parents, frustrated advocates, and confused bloggers. Everyone’s talking about a new study published this week in Pediatrics, which according to its authors “documents the potential for human milk shared via the Internet to cause infectious disease by estimating the extent of microbial contamination among samples purchased via a leading Internet Web site.” Some took the findings of this study – the discovery that most of the obtained samples contained pathogenic bacteria – to be proof that milk donation is a risky business. Others insinuated that this was a social problem; that puritanical/paternalistic attitudes towards breastfeeding and feminine bodily fluids cast unwarranted suspicion on milk sharing, and provoked a dire dismissal of relative risk (after all, formula is subject to bacterial contamination as well).

The “absolute truth”, I believe, is floating somewhere in the middle. As Alison Stuebe, MD, points out on her Academy of Breastfeeding Medicine blog, this study was limited by its methodology. The breastmilk samples were obtained through an online site where milk was not “shared” but rather sold per ounce. In order to maintain anonymity, the researchers only corresponded with donors via email, and cut off communication if the seller asked too many questions. Stuebe explains:

 “It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions. The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler. Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination…”

The other important factor to consider is that we can’t know if any babies would’ve necessarily become ill after ingesting this milk; all we can be sure of is that milk transported across the country from anonymous encounters online has a good chance of containing nasty bacteria. This was an in vitro study of a biological substance – not a study that involved actual cases of sickness caused by contaminated breastmilk.

And that is what is so beautiful about it. This was an in vitro study of a biological substance. It looked at breastmilk unemotionally, separate from the individual producing the milk or receiving it. No babies were harmed or even affected by this research. We don’t need to have a defensive reaction to the results, any more than a formula feeding mother needs to have a defensive reaction about a formula recall due to bugs in the powder. 

Food preparation, storage and safety don’t need to be a personal or political issue. I doubt the local grocer feels offended when spinach gets recalled, but she probably feels concerned. Unlike guilt or shame, concern is a healthy emotion, because it allows for a solution to be found. That’s why this study should be viewed as useful information rather than an indictment on milk sharing as a practice. From it, we can learn that more stringent practices are needed to ensure safety – parents can be informed that there are some risks involved in anonymous online purchase of human breastmilk.

The real difficulty, here, is that the issue of breastfeeding balances tenuously between the medical, the personal, and the political. It may be hard to make peace with the fact that obtaining breastmilk might need to become a sterile, regulated activity, prone to corporate involvement (because anytime money is involved we run that risk, especially when it comes to infant feeding), when breastfeeding is such an intimate, personal act. Ironically, the only other solution offered in response to this study is to make milk sharing more personal – that we urge parents to get to know donors, discuss how the milk will be pumped, stored, and transported, and share locally whenever possible. This certainly might cut down on the risks, but the fact remains that unless the donor is a close friend or relative, you are still asking parents to implicitly trust someone they don’t know very well. 

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Rather than angrily striking out at this research, or accepting it as the final word on milk sharing safety, we could simply use it to ask more questions. How, exactly, should milk be pumped, stored, and transported? There’s been some interesting research on how the freezing process affects the antioxidant and vitamin content of expressed breastmilk, for example – should babies fed expressed, donated milk only be given vitamin supplements? How does this affect infant health in the long term? What about ensuring that foremilk and hindmilk are balanced, by giving donating moms guidance on the best pumping practices? Does the milk of a mom nursing a toddler provide the best nutrition for a newborn, or should donations partnerships be based on age?

Lastly, rather than assuming other modes of milk sharing are safer (even if we intuitively believe that they are), can we study samples obtained from other types of donation arrangements, to put parents’ minds at rest? Do women who pump and store their own milk need to be concerned about bacterial contamination? (The lead author of the study, Dr. Sarah Keim, actually did offer some concrete suggestions to Medical News Today on improving the safety of pumped milk – things like sanitizing all containers and pump parts and freezing or refrigerating the milk within 6 hours.)

We cannot be scared of research, and we can’t get angry at it. But we can get angry at a media that grabs sensational headlines and runs so fast with them that we can’t catch up; we can be scared of an atmosphere that makes moms feel that their choices are limited to the lesser of two evils if they are unable to breastfeed. It’s our job, as advocates and care providers, to ensure that women aren’t given false ideas about risk in either direction, so that their “informed choices” can truly be informed.

Suzanne Barston is a maternal health advocate and freelance writer specializing in parenting, women’s interest, and science/health topics. She is the author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t and blogs as her alter ego, the “Fearless Formula Feeder”. She’s currently at work on an initiative to improve the perinatal experiences of women by addressing infant feeding intention and outcomes in an evidence-based, holistic manner.

 

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