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The Healthy Birth: Dyad or Triad? Exploring Birth and the Microbiome

April 28th, 2015 by avatar

By Anne Estes, PhD, Illustrated by Cara Gibson, PhD

There has been much discussion and burgeoning research on how the mode of birth affects the microbiome of the infant (and later on the adult).  It is becoming clear that how babies are born impacts the type of bacteria that take up residence in and on our bodies. Today, I would like to welcome researcher and writer Anne Estes, PhD, and researcher and illustrator Cara Gibson, PhD to Science & Sensibility.  Anne shares information on the research into a newborn’s (and later on the adult) microbiome and how it can be affected by the location of birth, the type of birth and the interventions that occur during birth.  Learn more about what this new field of research is telling us about the importance of the microbiome. Stay tuned for a future interview by Anne, with some of the research scientists attempting to supplement the microbiome of infants delivered by planned Cesareans. – Sharon Muza, Science & Sensibility Community Manager

Birth plans often change. Neither my husband nor I anticipated the series of interventions with my first daughter’s birth. In the end, though we had the most important outcome – a healthy mom and baby dyad. How did these interventions influence the health of the third, silent, and invisible member of my daughter’s birth that I hadn’t included in her birth plan – her microbiome?

The helpful and harmful bacteria, viruses, and fungi that live in and on every environment, both living and nonliving, are the microbiome of that environment. The bacterial component of the microbiome is best understood to date and will be this post’s focus. An organism’s microbiome influences the development and health of those animals and plants, whereas the microbiome of soil and buildings influence organisms that reside in those non-living environments. Our helpful microbes provide services that range from vitamin synthesis and food degradation to preventing attacks by pathogens. However, in the last few centuries of human-microbe interactions, changes in our birth and medical practices and living conditions may have altered the acquisition of our microbial communities. Our altered microbiomes, especially in the industrialized world, may help explain the increase in allergies, asthma, diabetes, gastrointestinal diseases, and mental disorders, such as depression, anxiety, and autism.

Humans as ecosystems for microbes

To a bacterium, you are a planet made up of several different ecosystems. From the dry, UV-intense “deserts” of your skin to the warm, wet, nutrient-rich “lakes” of your mouth, specific bacteria live in different regions on a person, just as specific vertebrate animals live in different ecosystems on the Earth. As ecosystems of the human environment change during development, pregnancy, or with changing diets, which bacterial species remain or how these microbial species function may shift is slowly becoming understood. How do we first acquire these microbes? Previous posts here and other blogs have done excellent reviews of the human microbiome and birth, so my post will serve to provide updates and pose new questions for consideration.

Fig1_MapLadies6

 

The source of the infant microbiome

The infant microbiome is acquired during birth [1, 2], from first foods [3-5], and the environment [6], and may also be partially colonized in utero [7]. The Fig2_MicrobirthVagvC5microbiome of infants born vaginally most closely represents the microbiome of the mother’s vagina and feces [1], and is rich in beneficial bacteria such as Bifidobacterium longum subsp. infantis and Bacteroidetes [8, 9]. In contrast, the microbiome of infants born via planned Cesarean is more similar to that of the mother’s skin and hospital environment [1]. The microbiomes of planned Cesarean-born infants are more likely to have hospital-acquired pathogens such as Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and pathogenic Es. coli [1] and lack beneficial Bacteroidetes and Bi. longum subsp. infantis [10]. However, when beneficial Bifidobacterium were occasionally present in Cesarean-born infants, pathogenic Es. coli and C. difficile were not found [11] suggesting that one benefit of Bifidobacterium, especially Bi. longum subsp. infantis, may be outcompeting these potential pathogens.

Influence of birth mode on microbiome transmission

Repeatedly, studies in different countries, ethnic groups, ages, and health status have suggested that planned Cesarean-born infants are more likely to have more health issues and a different microbiome, as compared to vaginally born infants [2, 10, 12-14]. These differences in community composition can even be seen in adulthood [15]. A new Canadian study finds that the microbiome of infants born via unplanned Cesarean had increased bacterial richness and diversity, more similar to that of vaginally born infants than planned Cesarean [10]. Unfortunately, this was only a small study where fewer than ten mother-infant pairs were examined. Several variables such as length of time in labor or how far labor progressed, antibiotic use, natural vs. artificial rupture of membranes, and/or other interventions that may influence the microbiome were also not examined [10]. However, it does suggest that the process of labor, perhaps the hormonal or other physiological changes, may influence the microbiome. Additionally, some maternal bacteria may be transmitted when membranes rupture during labor [10]. Are bacteria “eavesdropping” on the chemical changes in the human to prepare themselves for transmission to the baby? Do these maternal hormone changes lead to increased vaginal or gut epithelial sloughing to transmit more or specific bacteria? Certainly, studies with larger sample sizes that can help control for these variables along with experimental studies on model animals are warranted.

Influence of birth place on microbiome transmission

Infants also acquire a proportion of their microbiome from their physical, inanimate surroundings. What proportion of the microbiome and which bacteria are acquired most likely depends on how many and what kinds of bacteria are acquired in utero, through birth method, and first foods. Since Cesarean delivered infants seem to be exposed to a lower density of maternal bacteria than vaginally delivered babies, the former may be more likely to acquire bacteria from their environment. However, this hypothesis has not been examined.

Fig3_Locations4

Just as living organisms are a microbial environment, so are non-living structures such as buildings. Scientists at several universities working together on The Microbiology of the Built Environment Project funded by the Sloan Foundation are comparing the microbes of homes and hospitals. They have found that buildings are quickly colonized by the microbes of the people living in them [16]. Such rapid colonization specific to the individual being housed is even seen in infants in the neonatal intensive care unit (NICU) [17, 18] . One group is surveying the microbiome of a hospital over time, as it is being built and then occupied. Hospital-acquired infections are an increasing concern for all patients, especially newborns. Infants born by Cesarean have an increased rate of MRSA, C. difficile, and other opportunistic pathogens [1]. However, different hospitals and even wards within a hospital might be expected to have disparate levels of pathogens depending on how prevalent the disease is within the hospital patients and staff. Whether freestanding birth centers, operating rooms dedicated to labor-and-delivery only, and mixed-use operating rooms have dissimilar microbiomes has yet to be investigated. Infants born in private homes would be exposed to the same microbiomes of members of the household.

Influence of first foods on microbiome transmission

First foods are a third source of the infant microbiome. Breastfed infants have two “moms:” their human mother and their Milk-Oriented Microbiota (MOM). The MOM are a diverse group of about 200 species of beneficial bacteria transmitted via breast milk and fed by the breast milk sugars. Fig4_MicrobirthBreastvBottle5The average breastfed baby receives between 1 and 10 million bacteria daily from their mother’s milk – quite the bacterial soup [5]! The bacterial diversity and concentrations of specific bacteria change dramatically between colostrum and mature milk with colostrum having over 1,000 different bacterial types [4]. The milk microbiome is a unique assemblage of bacteria, different from human skin, gut, oral, vaginal, and other specific site microbiomes [4]. Although only ten women were followed, it is intriguing that the milk microbiome of women delivering via planned Cesarean at birth, one month, and six months post-birth, was more similar to their gut microbiome than the breast milk of mothers who delivered vaginally [4]. Milk of mothers undergoing unplanned Cesarean and vaginally delivering mothers were most similar [4]. Breast milk also includes the food, or prebiotics, for the developing infant microbiome. Sugars found in breast milk, the human milk oligosaccharides (HMOs), differ in sugar types and concentrations between pre-term and full term birth, vaginally delivering and planned Cesarean births (reviewed in [19]), and even between mothers with different types of “secretor” genes [20]. These HMOs are digested by the microbes, not the infant. Additionally, the changes in sugar types and concentrations seem to influence bacterial diversity, keeping strains of Bifidobacterium longum subsp infantis in highest abundance in the first few months of life [19]. How the presence of different microbes influences the developing infant immune system has yet to be determined.

Formula-fed babies have a more diverse and rich microbiome than breast-fed babies, with lower numbers of Bifidobacterium and higher abundances of Peptostreptococcaceae, which includes C. difficile [10, 21]. Gut bacterial diversity is essential in increasing the ability of adults to digest a wide variety of foods. However, bacterial diversity may be detrimental in the infant stage when the immune system is developing and learning to distinguish between microbes that are friends and those that are foes. Breast milk sugars may mediate the relative abundances of different bacterial species [22]. Through studies like the Milk Bioactives Program at University of California at Davis, more is learned about the interaction between breast milk sugars and specific bacteria that can lead to better probiotic and prebiotic formulas and improve infant health.

Influence of in utero environment on microbiome transmission

Many other factors surrounding birth may influence the infant microbiome. High levels of reported maternal stress and high cortisol concentrations during pregnancy, correlated with lower relative abundances of beneficial Lactobacillus and Bifidobacterium sp. and higher abundances of Proteobacteria, such as Enterobacter and Escherichia. Infants of these highly stressed mothers had increased reports of gastrointestinal symptoms and allergic reactions, though these issues were reported by caregivers, not physicians, which may confound the findings [23]. A separate study found infants whose gestation lengths were less than 38 weeks had microbiome communities that were low in Bifidobacterium and took three to six months to reach a normal Bifidiobacterium-rich community as compared to infants born at 40 or more weeks [9]. Finally, the use of antibiotics during pregnancy [12] may also lead to infant health issues.

Do birth interventions change the microbiome?

The potential “eavesdropping” of bacteria on human hormones during pregnancy and labor lead me to wonder how the use of synthetic hormones such as Pitocin, especially during stalled labor, might influence the microbiome and overall infant health. There are so many variables to the birth process that many of these questions could only be answered with extremely detailed data of tens of thousands of mother-infant-microbiome triads over time. The influence of interventions such as epidurals, frequency of cervical checks, vaginal preparation with betadine, enemas, and other procedures used during labor and delivery also have not been extensively examined. In general, any procedure that “sterilizes” or cleans the vaginal and rectal area would most likely decrease the transmission of the mother’s microbial community. Whether cervical checks introduce skin or environmental microbes to the infant should also be considered. Finally, what effect does postponing baby’s first bath until 24 or 48 hours after birth have on microbial colonization? What role does the vernix have in facilitating the colonization of the infant’s microbiome?

From lab bench to birth room

Antibiotics, Cesarean delivery, and other interventions are valuable and life-saving for many women and infants; however, as they have become more commonly used we have seen an increase in many long-term diseases and disorders. Recent microbiome research suggests that we should consider birth as delivering and nurturing a healthy triad – mom, infant, and microbiome. Currently, studies are being conducted to swab Cesarean delivered infants with vaginal secretions immediately after birth. Should fecal microbiome members also be considered? If hormone surges are important for the microbiome transmission during labor and in breast milk, as the unplanned Cesarean data suggest, how could the natural hormone surges of labor be mimicked for planned Cesarean? When antibiotics are needed for mother or infant, how best can we quickly repopulate the disturbance to the native microbiome?

Humans, and all organisms, are planets with diverse ecosystems. In sequencing of the human genome, we learned that diseases rarely correlated to specific human genes. Most likely instead of focusing on only the human or only the microbes, we should be examining the intersection between human genomics and microbiome structure and function to best understand health and disease of human-microbe ecosystems. Both human genomics and microbiome work are in their infancy (pun intended). Researchers examine correlations to develop testable hypotheses that can be examined in non-human animal models. Yet many of the microbes of interest are currently unable to be cultivated for direct testing or probiotic use. At this time, directly translating research findings to the delivery room is difficult, but I hope that this post will stimulate thought and conversations about the silent, invisible, yet important third member of human birth and life.

References

  1. Dominguez-Bello, M. G., E. K. Costello, M. Contreras, M. Magris, G. Hidalgo, N. Fierer, and R. Knight. 2010. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proceedings of the National Academy of Sciences 107:11971-11975.
  2. Mueller, N. T., E. Bakacs, J. Combellick, Z. Grigoryan, and M. G. Dominguez-Bello. 2015. The infant microbiome development: mom matters. Trends in Molecular Medicine 21:109-117.
  3. Zivkovic, A. M., J. B. German, C. B. Lebrilla, and D. A. Mills. 2011. Human milk glycobiome and its impact on the infant gastrointestinal microbiota. Proceedings of the National Academy of Sciences 108:4653-4658.
  4. Cabrera-Rubio, R., M. C. Collado, K. Laitinen, S. Salminen, E. Isolauri, and A. Mira. 2012. The human milk microbiome changes over lactation and is shaped by maternal weight and mode of delivery. The American Journal of Clinical Nutrition 96:544-551.
  5. Fernández, L., S. Langa, V. Martín, A. Maldonado, E. Jiménez, R. Martín, and J. M. Rodríguez. 2013. The human milk microbiota: Origin and potential roles in health and disease. Pharmacological Research 69:1-10.
  6. Thompson, A. L., A. Monteagudo-Mera, M. B. Cadenas, M. L. Lampl, and M. A. Azcarate-Peril. 2015. Milk- and solid-feeding practices and daycare attendance are associated with differences in bacterial diversity, predominant communities, and metabolic and immune function of the infant gut microbiome. Frontiers in Cellular and Infection Microbiology 5.
  7. Prince, A. L., D. M. Chu, M. D. Seferovic, K. M. Antony, J. Ma, and K. M. Aagaard. 2015. The Perinatal Microbiome and Pregnancy: Moving Beyond the Vaginal Microbiome. Cold Spring Harbor Perspectives in Medicine.
  8. Jost, T., C. Lacroix, C. P. Braegger, and C. Chassard. 2012. New Insights in Gut Microbiota Establishment in Healthy Breast Fed Neonates. PLoS ONE 7:e44595.
  9. Dogra, S., O. Sakwinska, S.-E. Soh, C. Ngom-Bru, W. M. Brück, B. Berger, H. Brüssow, Y. S. Lee, F. Yap, Y.-S. Chong, et al. 2015. Dynamics of Infant Gut Microbiota Are Influenced by Delivery Mode and Gestational Duration and Are Associated with Subsequent Adiposity. mBio 6.
  10. Azad, M. B., T. Konya, H. Maughan, D. S. Guttman, C. J. Field, R. S. Chari, M. R. Sears, A. B. Becker, J. A. Scott, and A. L. Kozyrskyj. 2013. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. Canadian Medical Association Journal 185:385-394.
  11. Musilova, S., V. Rada, E. Vlkova, V. Bunesova, and J. Nevoral. 2015. Colonisation of the gut by bifidobacteria is much more common in vaginal deliveries than Caesarean sections. Acta Paediatrica 104:e184-e186.
  12. Mueller, N. T., R. Whyatt, L. Hoepner, S. Oberfield, M. G. Dominguez-Bello, E. M. Widen, A. Hassoun, F. Perera, and A. Rundle. 2014. Prenatal exposure to antibiotics, cesarean section and risk of childhood obesity. Int J Obes.
  13. Neu, J., and J. Rushing. 2011. Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis. Clinics in perinatology 38:321-331.
  14. van Nimwegen, F. A., J. Penders, E. E. Stobberingh, D. S. Postma, G. H. Koppelman, M. Kerkhof, N. E. Reijmerink, E. Dompeling, P. A. van den Brandt, I. Ferreira, et al. 2011. Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. J Allergy Clin Immunol 128:948-55 e1-3.
  15. Goedert, J. J., X. Hua, G. Yu, and J. Shi. 2014. Diversity and Composition of the Adult Fecal Microbiome Associated with History of Cesarean Birth or Appendectomy: Analysis of the American Gut Project. EBioMedicine 1:167-172.
  16. Lax, S., D. P. Smith, J. Hampton-Marcell, S. M. Owens, K. M. Handley, N. M. Scott, S. M. Gibbons, P. Larsen, B. D. Shogan, S. Weiss, et al. 2014. Longitudinal analysis of microbial interaction between humans and the indoor environment. Science 345:1048-1052.
  17. Brooks, B., B. Firek, C. Miller, I. Sharon, B. Thomas, R. Baker, M. Morowitz, and J. Banfield. 2014. Microbes in the neonatal intensive care unit resemble those found in the gut of premature infants. Microbiome 2:1.
  18. Raveh-Sadka, T., B. C. Thomas, A. Singh, B. Firek, B. Brooks, C. J. Castelle, I. Sharon, R. Baker, M. Good, M. J. Morowitz, et al. 2015. Gut bacteria are rarely shared by co-hospitalized premature infants, regardless of necrotizing enterocolitis development, vol. 4.
  19. Smilowitz, J. T., C. B. Lebrilla, D. A. Mills, J. B. German, and S. L. Freeman. 2014. Breast Milk Oligosaccharides: Structure-Function Relationships in the Neonate. Annual Review of Nutrition 34:143-169.
  20. Lewis, Z., S. Totten, J. Smilowitz, M. Popovic, E. Parker, D. Lemay, M. Van Tassell, M. Miller, Y.-S. Jin, J. German, et al. 2015. Maternal fucosyltransferase 2 status affects the gut bifidobacterial communities of breastfed infants. Microbiome 3:13.
  21. Bezirtzoglou, E., A. Tsiotsias, and G. W. Welling. 2011. Microbiota profile in feces of breast- and formula-fed newborns by using fluorescence in situ hybridization (FISH). Anaerobe 17:478-482.
  22. Guaraldi, F., and G. Salvatori. 2012. Effect of Breast and Formula Feeding on Gut Microbiota Shaping in Newborns. Frontiers in Cellular and Infection Microbiology 2:94.
  23. Zijlmans, M. A. C., K. Korpela, J. M. Riksen-Walraven, W. M. de Vos, and C. de Weerth. 2015. Maternal prenatal stress is associated with the infant intestinal microbiota. Psychoneuroendocrinology 53:233-245.

About Anne Estes

AnneMEstes_headshot 2015Anne M. Estes, PhD is a postdoctoral fellow at the Institute for Genome Sciences in Baltimore, MD. She is interested in how microbes and their host organisms work together throughout host development. Anne blogs about the importance of microbes, especially during pregnancy, birth, first foods, and early childhood at Mostly Microbes.

 

 

About Cara Gibson

cara gibson head shot 2015Cara Gibson, BSc (Hon), MS, PhD was trained as an entomologist (insect scientist) and her interests include ecology, biodiversity, and interactions with microbial symbionts. She has worked as a field ecologist, research scientist, educator, outreach coordinator, and scientific illustrator. Dr. Gibson would like to help bridge the gap between current practices and new research to improve women’s health and birth outcomes. Contact Cara at caramgibson at gmail dot com for illustration inquiries / permissions.

 

 

 

 

Babies, Breastfeeding, Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, New Research, Newborns , , , , , ,

New Webinar for Birth Pros: “Making It Work! – Breastfeeding Tips for the Working Mom”

March 24th, 2015 by avatar
breastfeeding working mother

flickr.com/photos/jennysbradford/4356862824

I often share in childbirth classes that breastfeeding can be the next big challenge after birth.  As a childbirth educator, I weave breastfeeding information throughout my class series. By the time the “breastfeeding” part of the class happens towards the end of the series, the families are eager and ready to learn how to be as prepared as possible to feed their baby, without actually having baby there yet to “practice” with.

I provide additional follow up resources for the families as well, including where to get help locally with breastfeeding issues, what current best practice says on a variety of breastfeeding topics and useful videos like effective hand expression.  Returning to work and breastfeeding is one topic that I feel is important to cover, but often gets short shrift due to lack of time. Families don’t even have their babies in their arms yet, and the “return to work” point still seems very far off, and I have a lot of information to share in a short class time. In some areas, there are specific classes that families can attend that specialize in the “breastfeeding for the working parent” topic, but not many families can locate or take advantage of this type of class.

I would love to be able to support my families long after their childbirth education class is over with information they can use and apply for the working/breastfeeding parent, and that is why I am planning on attending Lamaze International’s free (non-Lamaze members $20) 60 minute webinar “Making It Work! Breastfeeding Tips for the Working Mom” offered on March 26th at 1:00 PM EST.

It is well documented that exclusive breastfeeding rates drop significantly when women return to work or school.  There are many barriers to overcome and prenatal information and support can help families to prepare for the time when babies are being cared for by others and still being breastfed.  This online webinar is appropriate for doulas, childbirth educators, lactation consultants, nursing staff, physicians and midwives.

The webinar is being presented by Patty Nilsen, RN, BSN, BA, IBCLC, ANLC.  Patty is an Outpatient Lactation Consultant for Mount Carmel East, West & St. Ann’s Hospitals in Columbus, Ohio, where she provides daily private outpatient lactation consultation for women experiencing challenges and in need of encouragement with breastfeeding, leads weekly breastfeeding support groups, and answers over 300 breastfeeding helpline calls per month.  Patty has learned many innovative tips for returning to work and breastfeeding from the thousands of mothers she has worked with over the years and is eager to share them in this webinar.

© womenshealth.gov

© womenshealth.gov

The webinar is open to all, and Lamaze International members are able to attend at no cost.  Non-members will pay $20 at registration to participate.  Additionally, this workshop has been approved for continuing nursing education hours which  are accepted by DONA, Lamaze, ICEA and other birth professional organizations. The cost for receiving continuing education hours for Lamaze members is $35 and for non-members is $55, (which includes the cost of the webinar). As mentioned above, Lamaze members attend for free, if they are not enrolled for the contact hours.  Contact hours are awarded after completing the webinar and a post-webinar evaluation. CERPS are pending.

You can register for the webinar (select contact hours or no-contact hours) at this link – and then prepare to join on Thursday at 1:oo PM EST.  After the webinar, come back and share your top takeaways and how you are going to use this information to support families in your area with other Science & Sensibility readers.

Babies, Breastfeeding, Childbirth Education, Lamaze International, Webinars , , , , , , ,

Thanks IBCLCs – For Helping New Families Meet Their Breastfeeding Goals

March 5th, 2015 by avatar

IBCLCDayLogo 2015(2)Yesterday was IBCLC Day – a special day set aside once a year to recognize the hard work and efforts that International Board Certified Lactation Consultants provide all all year long in support of breastfeeding for mothers, babies and really, the entire family.  IBCLC Day is sponsored by the International Lactation Consultant Association, a professional organization for IBCLCs around the world.

Becoming an IBCLC is no easy feat; the requirements to become credentialed are very rigorous and involve many clinical hours and an exhaustive exam.  Continuing education hours and/or retaking the exam are required every 5 years to maintain the credentials.  There are over 27,450 IBCLCs worldwide.

Some IBCLCs are also Lamaze Certified Childbirth Educators.  Both organizations represent the gold standard in their field and it is not surprising that some professionals seek out both qualifications.  When an LCCE is also an IBCLC, their class families can really benefit.  The LCCE is able to weave in a rich knowledge of breastfeeding topics and information throughout the class, as well as share information about common challenges that they see when working as an IBCLC.

creative commons licensed (BY-NC) flickr photo by robysaltori: http://flickr.com/photos/robysaltori/4604876371

CC flickr photo by robysaltori: http://flickr.com/photos/robysaltori/4604876371

A lactation consultant can use their childbirth education skills to hone their communication and help families understand the nuances of feeding their babies when they are delivering breastfeeding information during a consultation.  The two professions can complement each other beautifully.

Of course, the scope of practice of LCCEs and IBCLCs is different, and it is important to recognize the separation and to wear the proper hat when conducting yourself professionally in either capacity.

For official information on how to become an IBCLC, check out the information on the International Board of Lactation Consultant Examiners (IBLCE ) site. If you are considering becoming an IBCLC, there is an Facebook Group just for you, where you can discuss the different pathways, find out more about the requirements and costs, and receive the support of other men and women exploring the IBCLC process and preparing for the exam.

I reached out to some Lamaze Certified Childbirth Educators, who are also IBCLCs, to ask some questions and learn more about experience of wearing both hats.  Teri Shilling, Ann Grauer and Ashley Benz generously shared their thoughts below.

Sharon Muza:  Which credential did you receive first, your IBCLC or your LCCE?

Teri Shilling: I received my LCCE first.

Ann Grauer: I was an LCCE first. I never thought I’d be an IBCLC but one year the policies fit me and I decided to go for it.

Ashley Benz: I became an LCCE first and then an IBCLC. My goal had always been to become a lactation consultant. I knew that it was a long road and I was so interested in getting started working with families that I did a couple of certifications before I was ready to take my IBCLC exam.

SM: How does having both credentials benefit your students and clients?

Teri: So much of my work as an IBCLC is education – by the bedside, on the phone, etc.  Keeping things simple and memorable is key.  The certifications speaks to my professionalism and commitment to continuing education

Ann: I had a CLC before my IBCLC—I’ve always felt that I wanted and needed more information on breastfeeding. I’ve taught breastfeeding classes since the beginning but the information explosion in that one topic is incredible!  I feel very strongly that it serves my childbirth classes well that I have that credential and that being an LCCE serves my breastfeeding clients. I see things from a “facilitator of education” standpoint, rather than a traditional IBCLC standpoint.

Ashley: Because a lot of what a lactation consultant does is teach, I use the skills I’ve gained from teaching Lamaze class in breastfeeding consultations. In Lamaze class, I use my knowledge about breastfeeding and mother-infant bonding.

SM: Does your IBCLC knowledge influence how and what you teach about breastfeeding? 

Teri: Yes, I think it does, but I have been an IBCLC for 20+ years and can’t remember what I taught before.  But being an IBCLC gives me first had experience with the big bumps in the road many women hit during the postpartum time.

Ann: Yes. I’ve actually simplified what I teach. Being an IBCLC, means I now appreciate that parents need simple and honest information that they can incorporate into their parenting.

Ashley: I probably emphasize the need to seek proper help more than other educators. My class focuses on the basics of breastfeeding and assumes I’ve convinced my students to get support for issues that arise.

SM: What would you recommend for other LCCEs who might want to be an IBCLC? What are the challenges?

Teri: Do a community search for where the gaps are in support – is there a breastfeeding coalition in your area? It is important to network.  Find a mentor.  I would say go for it.  More education never hurts.  The challenge is being employed as an IBCLC as a non-nurse.  It helps if you are the entrepreneur type and able to set up a private practice.

Ann: If you’re a non-RN you will have to work incredibly hard. The system is set up to be medically-minded and there is not appreciation/understanding of what non-RNs bring to the table. Which, by the way, is a lot. Rather than focusing on becoming an IBCLC, allow yourself to enjoy the journey of learning and you’ll be there before you know it.

Ashley: The major challenge of the IBCLC path is that it can be very time (and often financially) intensive. I recommend checking out the IBLCE website and see if there is a pathway that you already fit into. If not, make a five-year plan to become an IBCLC.

SM: Where do you think it gets tricky wearing both hats?

Teri: I don’t think it does.  I love being able to be part of the continuum from pregnancy to postpartum.

Ann: I don’t think it does. My confidence is in the mother and baby. I’m just here to help in any role I can.

Ashley: Whenever you have multiple sets of skills, it can be difficult to maintain appropriate business boundaries and communicate those to your students and clients.

Careers as both a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant are fun, challenging and very rewarding.  They are a wonderful compliment to each other and families can benefit from the knowledge that someone who holds both credentials can share when serving in either role.  Are you an LCCE who has considered or would like to become an IBCLC?  Are you already on that path?  Share a bit about your journey in our comments section and let us know.

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

Lamaze International Online Classes for Parents Expands Offerings!

November 11th, 2014 by avatar

Screen Shot 2014-11-10 at 5.16.54 PM

The Lamaze International Strategic Framework 2014-2017 that resulted from in-depth strategic planning meetings held earlier this year with the Board of Director and Lamaze Management resulted in many forward thinking, comprehensive and courageous goals, including plans to “innovate education and expand to the childbearing years” by:

  • reaching more women earlier and more frequently throughout childbearing years,
  • expanding delivery methods for online education (e.g., virtual classes, Facetime consults, and mobile apps), and
  • developing a strategy to broaden outreach at the electronic level and cultivate moms ‘up’ the ladder for more personalized services and training.

As part of fulfilling this mission, Lamaze International is pleased to announce that three online childbirth education classes are developed, online and open for business.  The first class to go live was “Safe and Healthy Birth: Six Simple Steps,” a class designed to help families prepare for birth by presenting six simple practices shown to greatly improve birth outcomes for both mothers and babies. The next two were recently added – VBAC: Informed and Ready and Breastfeeding Basics: From Birth to Back to Work.

The online classes are presented in an interactive, engaging format with unlimited access for parents, so they can complete the class(es) at their own pace. The classes are meant to be used as an important beginning point in a families’ complete prenatal education. They provide vital information, and throughout the online course, families are encouraged to find a comprehensive in person Lamaze class in order receive a thorough preparation for childbirth. Parents are informed that to be fully prepared for labor, birth, breastfeeding, and postpartum, it’s important to attend a good quality childbirth course. There are links to the “Find a Lamaze Class” portion of the parent website.

The online classes can be accessed on a computer (desktop or laptop), tablet or smartphone and learning can take place at a convenient time and place for each individual family.  There are interactive activities and discussion forums to connect with other participating families.  Fun quizzes are spaced throughout the course to help with the retention of information.

Safe and Healthy Birth: Six Simple Steps

Knowledge is power! It’s our goal to help you prepare for one of the most important days of your life – baby’s birthday! This course presents six simple practices that research has shown to greatly improve birth outcomes for both mothers and babies. These practices have been developed by Lamaze International and are based on recommendations by the World Health Organization. Lamaze has simplified the scientific facts into six healthy birth practices to make it easy for you to choose the safest care, understand your options, and steer clear of care practices or unnecessary interventions that may not be the best for you and your baby.

After completing this course, learners will be able to:

  • Discover how the Lamaze Six Healthy Birth Practices can simplify your labor and birth
  • Find out how your care provider and support team can make a difference
  • Learn about common medical interventions
  • Alleviate fears and learn ways to manage pain
  • Build your knowledge and confidence to make informed decisions

Breastfeeding Basics: From Birth to Back to Work

As comforting and healthy as breastfeeding can be, it is not always easy in the first few weeks while recovering from birth. If you find yourself struggling, know that hard work in the early weeks pays off as you and your baby learn to breastfeed. Having realistic expectations about how breastfeeding will go in the early weeks will help you to meet your breastfeeding goals. With the information in this class, you can prepare to get breastfeeding off to a great start and look forward to the many benefits that breastfeeding can provide to you and your baby.

After complete this class, learners will be able to:

  • Recognize the Benefits of Breastfeeding to Mother and Baby
  • Understand how milk supply works
  • Learn about the mechanics of breastfeeding, latch and positioning
  • Recognize good feeding and if baby is getting enough milk
  • Manage nighttime breastfeeding
  • Be prepared for what to do if there is a recommendation to supplement/pump
  • Prepare for returning to work

VBAC: Informed and Ready

This class will help you understand the facts, benefits, and risks of all your delivery options including a vaginal birth after cesarean (VBAC), and set you up for the best chance of success. Prepare yourself and learn how to simplify your labor and birth by participating in this interactive online course.

After completing this class, learners will be able to:

  • Understand the risks and benefits of both VBAC and repeat cesarean birth
  • Recognize the qualities of a VBAC supportive health care provider
  • Identify a strong support team for your  VBAC birth
  • Develop and practice coping and comfort techniques that will help during your VBAC labor
  • Write a VBAC and cesarean birth plan that reflects your informed preferences

International Cesarean Awareness Network (ICAN) has collaborated with Lamaze International to offer all ICAN members a 15% discount on the VBAC class, to help them feel better prepared as they plan for their subsequent birth after a cesarean.  To learn more about ICAN and become a member, in order to take advantage of this discount, follow the link to the “Join ICAN page.”

Additional courses planned include “Labor Pain Management: Techniques for Comfort and Coping” -scheduled to go live next month and an early pregnancy class in the early part of 2015.

Offering online classes serves to increase name recognition of the Lamaze International brand and create demand for in person Lamaze classes offered by LCCEs around the world.  Programs like this position Lamaze as the leader in childbirth education. Additionally, families that do not have Lamaze educators in their community can take advantage of the evidence based information and skills offered in the classes.  Educators can follow the class links above and sample all of the courses in a preview segment.

Breastfeeding, Cesarean Birth, Childbirth Education, Healthy Birth Practices, Lamaze International, Pain Management , , , , , ,

Breastfeeding & Racial Disparities in Infant Mortality: Celebrating Successes & Overcoming Barriers

August 28th, 2014 by avatar
© mochamanual.com

© mochamanual.com

August has been designated as World Breastfeeding Month, and Science & Sensibility was happy to recognize this with a post earlier this month that included a fun quiz to test your knowledge of current breastfeeding information.  Today, we continue on this topic and celebrate Black Breastfeeding Week 2014 with a post from regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA sharing information about the increased breastfeeding rates rates among African American women.  Kathleen also discusses some of the areas where improvements can help this rate to continue to increase. 

Celebrating Successes

Many exciting changes occurred in 2013 in the breastfeeding world. One of the best trends was the increase in breastfeeding rates in the African American community. The CDC indicated that increased breastfeeding rate in African American women narrowed the gap in infant mortality rates.  As the CDC noted:

From 2000 to 2008, breastfeeding initiation increased…from 47.4% to 58.9% among blacks. Breastfeeding duration at 6 months increased from…16.9% to 30.1% among blacks. Breastfeeding duration at 12 months increased from… 6.3% to 12.5% among blacks.

Much of this wonderful increase in breastfeeding rates among African Americans has come from efforts within that community. In 2013, we saw the first Black Breastfeeding Week become part of World Breastfeeding Week in the U.S. Programs, such as A More Excellent Way, Reaching Our Sisters Everywhere (ROSE), and Free to Breastfeed, offer peer-counselor programs for African American women.


We can celebrate these successes. But there is still more to do. Although the rates of infant mortality have dropped, African Americans babies are still twice as likely to die. In addition, although rates of breastfeeding have increased among African Americans, they are still lower than they are other ethnic groups.

For each of the 2000–2008 birth years, breastfeeding initiation and duration prevalences were significantly lower among black infants compared with white and Hispanic infants. However, the gap between black and white breastfeeding initiation narrowed from 24.4 percentage points in 2000 to 16.3 percentage points in 2008.

Barriers to Overcome

In order to continue this wonderful upward trend in breastfeeding rates, we need to acknowledge possible barriers to breastfeeding among African American women. Here are a couple I’ve observed. They are not the only ones, surely. But they are ones I’ve consistently encountered. They will not be quick fixes, but they can be overcome if we recognize them and take appropriate action.

1) Pathways for IBCLCs of Color

In their book, Birth Ambassadors: Doulas and the Re-Emergence of Women-Supported Birth in America, Christine Morton and Elayne Clift highlight a problem in the doula world that also has relevance for the lactation world: most doulas (and IBCLCs) are white, middle-class women. And there is a very practical reason for this. This is the only demographic of women that can afford to become doulas (or IBCLCs). The low pay, or lack of job opportunities for IBCLCs who are not also nurses, means that there are limited opportunities for women without other sources of income to be in this profession. Also, as we limit tracks for peer-counselors to become IBCLCs, we also limit the opportunities for women of color to join our field. I recently met a young African American woman who told me that she would love to become an IBCLC, but couldn’t get the contact hours needed to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.)

2) We need to have some dialogue about how we can bring along the next generation of IBCLCs. We need to recognize the structural barriers that make it difficult for young women of color to enter our field. ILCA has started this dialogue and held its first Lactation Summit in July to begin addressing these issues.

These discussions can start with you. Sherry Payne, in her recent webinar, Welcoming African American Women into Your Practice, recommends that professionals who work in communities of color find their replacement from the communities they serve.  Even if you only mentor one woman to become an IBCLC, you can have a tremendous impact in your community. If we all do the same, we can change the face of our field. (Note, here is a wonderful interview with Sherry as she discusses “Fighting Breastfeeding Disparities with Support.”)

3) Bedsharing and Breastfeeding

 This is an issue that I expect will become more heated over the next couple of years. But it is a reality. As we encourage more women to breastfeed, a higher percentage of women will bedshare. As recent studies have repeatedly found, bedsharing increases breastfeeding duration. This is particularly true for exclusive breastfeeding.

Bedsharing is a particular concern when we are talking about breastfeeding in the African American community. Of all ethnic groups studied, bedsharing is most common in African Americans. It is unrealistic to think that we are going to simultaneously increase breastfeeding rates while decreasing bedsharing rates in this community. The likely scenario is that breastfeeding would falter. It’s interesting that another recent CDC report, Public Health Approaches to Reducing U.S. Infant Mortality, talks quite a bit about safe-sleep messaging, with barely a mention of breastfeeding in decreasing infant mortality.  A more constructive approach might be to talk about being safe while bedsharing. But as long as the message is simply “never bedshare,” there is likely to be little progress, and it could potentially become a barrier to breastfeeding.


Reason to Hope

BBW-Logo-AugustDates3Even with these barriers, and others I haven’t listed, Baby-Friendly Hospitals are having a positive effect. When hospitals have Baby-Friendly policies in place, racial disparities in breastfeeding rates seem to disappear. For example, a study of 32 U.S. Baby-Friendly hospitals revealed breastfeeding initiation rates of 83.8% compared to the national average of 69.5%. In-hospital exclusive breastfeeding rates were 78.4% compared with a national rate of 46.3%. Rates were similar even for hospitals with high proportions of black or low-income patients (Merewood, Mehta, Chamberlain, Phillipp, & Bauchner, 2005). This is a very hopeful sign, especially as more hospitals in the U.S. go Baby-Friendly.

http://kcur.org/post/kc-group-fights-breast-feeding-disparities-education-support

In summary, we have made significant strides in reducing the high rates of infant mortality, particularly among African Americans. I am encouraged by the large interest in this topic and the number of different groups working towards this goal. Keep up the good work. I think we are reaching critical mass.

Additional resource: Office of Women’s Health, U.S. Department of Health & Human Services Breastfeeding Campaign for African American families.

References

Merewood, A., Mehta, S. D., Chamberlain, L. B., Phillipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in U.S. Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116(3), 628-634.

Reprinted with permission from Clinical Lactation, Vol. 5-1. http://dx.doi.org/10.1891/2158-0782.5.1.7

About Kathleen Kendall-Tackett

kendall-tackett 2014-smallKathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist, International Board Certified Lactation Consultant and Fellow of the American Psychologial Association in both the divisions of Health and Trauma Psychology. Dr. Kendall-Tackett is President-Elect of the Division of Trauma Psychology, Editor-in-Chief of Clinical Lactation, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and Owner/Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett has authored more than 310 articles or chapters and is the author or editor of 22 books on women’s health, maternal depression, family violence and breastfeeding. Dr. Kendall-Tackett and Dr. Tom Hale received the 2011 John Kennell and Marshall Klaus Award for Research Excellence from DONA International. You can find more from her at Uppity Science Chick

 

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