Science & Sensibility

Lamaze International is delighted to be offering a convenient and complimentary breastfeeding webinar for birth professionals on Wednesday, August 15, 2012.  This webinar is being presented by Elizabeth C. Brooks, JD, IBCLC, FILCA.  Ms. Brooks brings the unique perspective of being both a certified lactation consultant and an attorney.

Moms, Babies, Milk and the Law: Legal and Ethical Issues When Teaching Breastfeeding
Date: Wednesday, August 15, 2012
Time:1:00 PM – 2:00 PM EDT

Presented by Elizabeth C. Brooks, JD, IBCLC, FILCA

This presentation will describe the difference between a legal and an ethical responsibility as a health care provider as well as common ethical considerations when teaching breastfeeding in prenatal and postpartum settings.

This activity has been planned for 1 Lamaze Contact Hour, and one Nursing Contact Hour. Attendees may earn contact hours upon purchase and completion of a quiz.

Don’t hesitate! Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/926390753

Sharon Muza Babies, Breastfeeding, Childbirth Education, Continuing Education, Legal Issues, Webinars breastfeeding, Childbirth Education, IBCLC, lactation consultants, legal, Legal Corner, legal issues about maternity care, teaching community breastfeeding classes, tips for the childbirth educator, Webinars

Creative Commons photo by Raphael Goetter

As the mother of two children, both who breastfed well into toddlerhood, and as a childbirth professional, I have spent a lot of time over the years 1) learning how to breastfeed or breastfeeding my children and 2) facilitating “how to breastfeed” conversations with pregnant women and their partners in my Lamaze classes, working as a birth doula with new mothers immediately after birth and in the first postpartum days at home with their newborn as well as regularly training new birth doulas and childbirth educators on how to prepare and work with their clients and students in the early days of the breastfeeding relationship.

I frequently find that new mothers often consider breastfeeding the next potential challenge after they have birthed, and getting it “right” includes avoiding pain, developing a good milk supply and making sure that their baby is getting all the nutrition they need in the vulnerable first days when things are so new and unfamiliar.  Breastfeeding challenges can increase the rockiness of an already emotionally and physically fragile time for the mother-baby dyad.

I have watched teaching methods, techniques and vocabulary change as more is learned about the newborn, their instinctive behaviors and the innate wisdom of the mothers of these new little ones.  Most of us have seen the widely viewed “Breast Crawl” video put out by UNICEF, WHO and WABA, and ooh-ed and ah-ed at the wisdom of the just born baby who self-latches when placed on its mother’s chest.   Suzanne Colson, Rebecca Glover, Christina Smillie and others have shared resources and information that has helped mothers and the professionals that support them get breastfeeding off to the best start possible, by introducing concepts such as baby led and laid back breastfeeding.

It was with great interest that I read Facilitating Autonomous Infant Hand Use During Breastfeeding and learned the important role the newborn’s hands play in helping to shape the breast, areola and nipple to facilitate breastfeeding.  I have always encouraged mothers to undress their newborn to allow for skin to skin when nursing, and sighed when I saw trained professionals encourage mothers to nurse a swaddled newborn.  But, I have to admit, I was guilty of encouraging mothers to “tuck” their baby’s hands out of the way when getting the baby to latch on, concerned that the baby’s hands would prevent a good latch as the baby seemed to want to suck on both the breast and their hand at the same time.

 In the past, the baby’s hand movements while at the breast where considered “uncoordinated,” “purposeless” and “random,” and were thought to interfere with the coordination of the breastfeeding process.  Current research shows that not to be the case at all.

Catherine Watson Genna, BS, IBCLC, RLC and Diklah Barak, BOT, the authors of Facilitating Autonomous Infant Hand Use During Breastfeeding share that babies that hug the breast with their hands are helping to stabilize their neck and shoulder girdle, by pulling together the shoulder blades. Hand movements, by the infant on the breast, increase maternal oxytocin.  It also causes the nipple tissue to become erect, which facilitates latch.  Babies are best able to use their hands “against gravity”, lifting them up, when their hands are in their field of vision.  The hands are used along with the lips and tongue to draw the nipple into the mouth, a behavior that disappears around 3-4 months of age.

The authors observed that infants use their hands to push and pull the breast to shape the breast and provide easier access to the nipple.  Newborns and young infants also use their hands to push the breast away, possibly to get a better visual sense of the location of the nipple.  Genna and Barak also state that an infant may feel the nipple with their hand, and use the hand as a guide to bring their mouth to the nipple.

 Wonderful black and white pictures accompany this article, and useful video clips are included for great visuals of the behaviors described by the authors.  The authors provide information on how to facilitate infant hand use during the breastfeeding session, including step-by-step instructions that can be shared with expectant and new mothers when you are teaching.

 Teaching new mothers that their newborn’s hands are a tool that the baby uses to find and latch on to the nipple, rather than something to be restrained and held out of the way, can help new mothers to appreciate the innate abilities of their newborn to self-latch and breastfeed successfully.  The materials in this article can be incorporated in the curriculum you cover when you discuss breastfeeding, and increase confidence and success for the new mother and encourage the breastfeeding relationship to have the best start possible.

 Please take a few minutes to follow the link and read the article, view the pictures and videos and let me know how you envision using this information in future classes?  Have you changed how you teach breastfeeding as new concepts and information have become available?  Share your tips and success stories with us, so that we all can become more skilled at providing new parents with effective teaching practices that support the breastfeeding relationship.  I look forward to hearing from you.

 Sources

Genna, C.W. & Barak, D.  Facilitating autonomous infant hand use during breastfeeding.  Clin Lact 2010; 1(1):15-20.

http://www.biologicalnurturing.com/

http://breastcrawl.org/index.shtml

http://www.breastfeedingresources.com/

http://www.rebeccaglover.com.au/

Sharon Muza Babies, Breastfeeding, Continuing Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Infant Attachment, New Research, Newborns, Parenting an Infant, Practice Guidelines, Research Barak, breastfeeding, breastfeeding class topics, childbirth education teaching strategies, Colson, first weeks of breastfeeding, Genna, glover, how to breastfeeding, IBCLC, Lamaze Classes, newborns, postpartum, Smillie, teaching community breastfeeding classes, WHO breastfeeding recommendations

A few weeks ago, I was invited to teach a one-time, free, community education class on breastfeeding basics.   As an independent, Lamaze Certified Childbirth Educator in my community, I was happy to oblige—recognizing that low-cost or no-cost community health education classes play an important role in any and all communities.  Being passionate about the dissemination of accessible, evidence-based lactation information, I was more than happy to volunteer the information normally apart of my eight-week childbirth preparation series.

But there was a catch.

My invitation to teach came from a neighbor of mine who owns the local baby supply store in town.  While her secondary reason for offering occasional classes on location, in her store was to further her hard-earned reputation as a one-stop-shopping depot for all things baby—even to the point of providing monthly free classes on varying topics of interest to pregnant, nursing and new mothers during which new and expectant women can mingle and make social connections—her primary purpose was to increase store traffic and, therefore, sales.

A sub-section of Lamaze International’s Code of Ethics for Childbirth Educators speaks to the issue of Conflict of Interest:

1.06 Conflicts of Interest

(a)    Childbirth educators should be alert to and strive to avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. When a real or potential conflict of interest arises, childbirth educators should first disclose the conflict to clients and then take reasonable steps to resolve the issue in a manner that prioritizes the clients’ interests and protects clients’ interests to the greatest extent possible.

How did this invitation to teach (on a volunteer basis) a single class challenge the code of ethics I, as an LCCE, have promised to abide by?  The possibility that my instruction would include subversive or overt recommendations of in-store products the store owner hoped I would incorporate into the two-hour class.

“Feel free to stop on by the store a day or two before the class to see what all we have in stock—that way you’ll know which products to mention when talking about breastfeeding,” my neighbor suggested.  “We’ll probably offer some sort of discount the night of the class for anything purchased that evening.”

Should I have been concerned with the amount of sales generated by my overview on the anatomy, physiology, practice and benefits of breastfeeding?  Of course not.  Would I have been in breach of my promise to uphold Lamaze’s Code of Ethics in regards to Conflict of Interest, had I accepted the invitation to teach this class?  Well, let’s see:

Disclaiming a conflict of interest entails confessing any sort of financial reimbursement given to a conference speaker, health care provider, instructor or administrator (or to his/her family member) that might influence his/her decision to use, recommend or employ a certain product, service or practice of care.  So, by definition, because I was not being paid to teach this class, I would not have technically been in breach of my Lamaze Code of Ethics commitment.

The slippery slope, however, became evident in this business owner’s expectation that the content of my presentation would directly entice class participants to buy certain products, based on my recommendations under the guise of authoritative knowledge.  If, for example, I swore by the functionality of the most expensive breast pump in the store—raving about its ability to support the continuation of breastfeeding over long periods, including mother’s-return-to-work-scenarios, and its status as a “must have” product for all moms with infants, despite the previous ten-minute mini-lecture I’d provided on the supply and demand system of lactation—that could have been perceived by my students as advice on a product they “should” have at home in order to succeed at breastfeeding.

If, however, I mentioned and even showed examples of breastfeeding-related products in conjunction with curriculum content—for example, providing a visual demonstration of how to determine a “good” versus “bad” nursing bra in terms of support, proper fit, lack of underwire structure and easy release of cup latch—would this be considered entering the dangerous waters of Conflict of Interest?  I would argue the answer here is, “No.”

Obviously, receiving a monetary kick-back for each sale made of a particular item, or a percentage of total sales on the night of my class would be a brazen breach of ethics on my part and I’m happy to say such an arrangement was never discussed by business owner nor educator.

I did, in fact, go on to teach the one-time class in question—Conflict of Interest and guilt free, and in the presence of a lovely, invested, intelligent, un-coerced audience!

Ethics can be a tricky thing and, I for one, am thankful for Lamaze International’s clear delineation of the Ethical Standards by which it expects its certified educators, employees and agents to abide.  Wouldn’t it be fantastic to see all professional organizations follow suit?

Posted By:  Kimmelin Hull, PA, LCCE

Kimmelin Hull Uncategorized authoritative knowledge, conflict of interest, Lamaze Code of Ethics, teaching community breastfeeding classes, teaching lamaze classes at commercial locations