Making Breastfeeding Work: Support is Key

Breastfeeding is the physiologically normal way to feed a baby. It’s natural, it’s how babies expect to be fed, and women have been doing it for millennia, but that doesn’t mean it’s always easy. Like lots of things in life that are worth doing, sometimes it’s hard and sometimes it’s a skill that must be learned over a period of weeks and months. The one thing that is usually vital for making breastfeeding work is the support of partners, family, medical professionals, community, media, government, voluntary supporters,  and sometimes skilled support from IBCLCs (International Board Certified Lactation Consultants) working within the HSE and/or in private practice.

 

According to Iactation consultant Margaret Hynes, IBCLC, the big fall off in breastfeeding rates between hospital discharge and 6 months is because women aren’t prepared enough for the reality of being a new mother and learning how to breastfeed, a new skill that many may not have grown up with in their families and communities. Hynes says “Parenting is time consuming and demanding. It makes it so much easier if parents have the correct support. I think seeking the best support before giving birth and education about the common realities of breastfeeding helps women succeed in their breastfeeding goals. My advice to women planning to breastfeed would be to attend a breastfeeding preparation workshop.” When Margaret worked at UMHL (University Maternity Hospital Limerick), she did an audit of mothers attending the hospital breastfeeding preparation workshop and found that women attending were 4 times more likely to be breastfeeding at 3 months than women who didn’t attend.

 

Limerick mum Freda Mac Seoin breastfed her first baby, born 9 years ago, for just over 4 months but regrets not feeding him for longer due to a lack of support and information. So when she had her second baby in 2017 she started going to the Friends of Breastfeeding (FoBF) support group in Drombanna when he was one week old.  She says “The advice, knowledge and support I got from this group led me to continue feeding through pregnancy and feeding my now 7 week old and 2 year old. This is something I would never have dreamed of before attending this group. It was the mothers attending the group that were breastfeeding toddlers and tandem-feeding that normalized it for me. Knowing you had somewhere to go to be around other mamas in the same boat as you, that was a great help when I was struggling at times. Also, the chocolate biscuit cake made by one of the volunteers at the group has healing properties!”

 

Evita English and baby Denis at the breastfeeding group in UMHL

Limerick is well served by breastfeeding support groups. Voluntary organisations Cuidiu, La Leche League and Friends of Breastfeeding all run weekly or monthly groups where parents can avail of face-to-face breastfeeding support, a listening ear and friendship. Cuidiu and La Leche League also provide telephone counselling for mums who encounter breastfeeding problems or would like information.

 

The HSE also offers an “Ask the Expert” service, where parents can email or live chat with an IBCLC.  This is a free service and can be accessed at https://www2.hse.ie/services/ask-our-breastfeeding-expert/.

 

 

Another very popular breastfeeding support group in Limerick is the weekly group at UMHL. Breastfeeding mum Stacey Mesces says “I went to the  group when my baby was 4 weeks old as I had lots of pain in one of my nipples when feeding. I was so well looked after in there and got some amazing advice. I ended up breastfeeding my baby for 22 months. I definitely needed the support, advice and reassurance at that time and was delighted with the service. It’s absolutely invaluable for breastfeeding mums.”

 

 

With support from hospital staff, family and voluntary groups, most mums are able to get breastfeeding established. However, some will need a little bit more help and may choose to engage the services of a lactation consultant working in private practice. Johanna Riley Cusack, IBCLC began supporting mums as a La Leche League Leader in 1999, and has been in private practice in the Limerick area since 2014. She says, “If there were a “Top 3” tips I would give, they would be:

 

  1. To learn all you can before your baby is born by going to workshops, mums’ groups, and talking with friends and family who are positive about breastfeeding.
  2. To reach out for help early. There are no silly questions.
  3. There is usually a breastfeeding solution to a breastfeeding problem and that with time, practice, and solid support difficulties can be overcome.

The Association of Lactation Consultants of Ireland website www.alcireland.ie provides a full listing of lactation consultants working in private practice.

 

Evita’s Story

Evita English is a Limerick mum of five.

“My eldest son Michael was born at 36 weeks and as a young mother I was determined to breastfeed my baby.  However, I found it was a little trickier than I expected.  Michael spent some time in the Neonatal Unit where I was lucky enough to receive the support from the hospital lactation consultants.  I was pumping for him while he was in the Neonatal unit and two days before he came home, with the help of the team, I was able to latch him on and we had a wonderful breastfeeding journey.

 

When I had my twins seven years later at 35 weeks they were brought to the Neonatal Unit.  I started pumping immediately for them as they were so tiny.  My little girl Lillianna came home from the hospital after 4 weeks on expressed milk while her brother Martin needed a little longer in the Unit as he was slower to feed.  Again, with the help of a lactation consultant, I was able to latch him on and he just thrived feed by feed.  He came home a few days later and we never had any problems with feeding.  I continued to feed the twins for 2 years.

 

My fourth child was born at 37 weeks by emergency c-section.  I pumped for him immediately and as soon as he was off the Cpap, I was able to latch him on and we had the most amazing breastfeeding journey of just over 3 years.

 

When I gave birth to my fifth child Denis I just assumed that I would just latch him on and everything would be fine. But it was quite a challenging journey as Denis had a tongue tie. However, thanks to having the tongue tie released, support from the hospital staff, support from Cuidiu and help from a lactation consultant in private practice who visited me at home, I am still feeding Denis who is now 2 years and 5 months old and is such a happy, healthy confident little chap.

 

The lactation consultant who came to my home was like an angel sent from above.  She showed me the best way to latch my baby and I fed him pain free for the first time.  It was wonderful.  Having her come to me was easily the best decision I made as it was the right help at the right time.

 

Looking back at my breastfeeding journeys each one was so different and the last was the most challenging.  I have met the most amazing friends through my breastfeeding journeys and I ended up training as a Cuidiu breastfeeding counsellor myself.  Without the help I received in the first few weeks from the Breastfeeding clinic and the Lactation Consultants in the hospital that helped me in the neonatal unit I would not have gotten out the door!  Help and support is needed from day one and I am lucky enough to have been fully supported in University Hospital Limerick.

 

by Caoimhe Whelan IBCLC

 

 

 

ALCI Scholarship & Poster Competitions

Congratulations to the winners of the ALCI Scholarships this year.

Veronica Quadu, Breda Lambe and Anna O’Donoghue.

 

Congratulations to the winners of the ALCI Poster Competition.

Research Category

Author(s) Name(s):     Denise McGuinness1 and Lorraine O’ Hagan2

Credentials:     RGN RM MSc IBCLC RNT 1 RNP2

Organisation:  University College Dublin1 / National Maternity Hospital1 2

Title of Poster Presentation:” Latch On” : A protocol for a multi-centre, randomised controlled trial of perinatal support to improve breastfeeding outcomes in women with overweight and obesity

 

Non Research Category

Author(s) Name(s):      Eimear Ryan and Regina Keogh

Credentials:     Paediatric Dietitian and IBCLC. RN and IBCLC

Organisation: CHI at Crumlin

Title: Impact of a QIP on staff knowledge and expertise on breastmilk feeding in a paediatric hospital setting: sustained improvements three years later.

 

 

 

ILCA Conference 2019

Write up of the 2019 International Lactation Consultants

Conference by ALCI President Sue Jameson.

 

Attending ILCA 2019 was the usual mix of the very familiar and the very new, both in terms of content, and of attendees.  As a Partner Organisation our role  is to promote our country and it’s activities whenever we get the opportunity. It is also to encourage membership of ILCA to our members. Ger Cahill ( who is currently an ILCA Board Member) and I did this with gusto!  Socialising with many friends old and now – making new contacts with women from Aruba – a tiny island community in the Caribbean.

 

While ILCA has great aspirations to be a fully internationally representative organisation, the flavour is distinctly American. Conferences are by and large held in America, there is little in the way of translated materials and English is the conference language. The theme this year was ‘Engage’ and it was the aspiration of the conference planners to fulfill these objectives:

 

  • Apply skill development and global networking among lactation specialists in an inclusive environment
  • Recommend research related to human lactation and encourage its integration in clinical practice
  • Integrate greater development of cultural humility among lactation specialists
  • Use ethical, evidence-based practice that protects the well-being of breastfeeding/chestfeeding/lactating families in diverse contexts
  • Practice breastfeeding/chestfeeding as the biological norm for feeding and nurturing infants and young children
  • Provide equitable access to lactation, skilled lactation care, and the IBCLC® profession
  • Provide support of families’ informed decisions regarding lactation
  • Outline lactation-supportive practices in health care, social service, and community settings

 

The now familiar acknowledgement of the ancestral lands of the native peoples of  the area started us on our way for the four days and the Cherokee welcome was given by Mechell in her peoples’ language.

 

Our first event was the Partners’ lunch.  This was a great way for all the organisations to meet and greet, welcome the newcomers and hear what is happening across the globe.  Each table has a rep from the ILCA Board who could help to introduce members and give us all an opportunity to share. This was very successful and Mudiwah Kadeshe, the current president went out of her way to make us all feel welcome and included.

 

The first thing that strikes you is the scale of everything.  We were in a hotel with 47 floors, fully air conditioned throughout to such a degree that it was chilly at times!  Looking up from the atrium floor was a dizzying sight.  Looking down from the 47th floor was mesmerising as people scurried around like ants far below. To give a sense of scale, there were three other huge functions happening at the same time as ILCA and we never saw many of them except for the Philippino Nurses Organisation who were delighted to speak with us. An Indian wedding in the level below us went on for 24 hrs.

 

I was sharing with Daiva Snuikaite my colleague from Lithuania who was representing The European Lactation Consultants Association, ELACTA. Each partner organisation was allocated a table to represent their country.  Sadly, only ourselves, Lithuania, Australia, Mexico and Peru, had anything other than a few flyers placed on their table. We shared space with the group representing women in the Military which gave lots of opportunity to chat about the unique challenges facing them as parents.

 

 

 

 

So to the conference itself.  The range and quality of speakers on the issue of diversity and equity was impressive. There are a couple of Plenary Sessions each day where all the attendees come together to hear a presentation.  At the other sessions there are many concurrent topics on offer and it is often difficult to choose where to go.  I was lucky enough to be able to volunteer as a welcome and introduction person for three of these presentations. Two were very well known to us here at home, Cathy Watson Genna and Liz Brooks.  The other session I chose to introduce was Jan Tedder, BSN, IBCLC; and Elsa Quintana, BA, BCJ, IBCLC, RLC, CLE talking about one of my favourite topics – infant development and promotion of parenting skills.

 

The day starts early with the first sessions kicking off at 8.30am. There are regular breaks where attendees are encouraged to visit the trade stands. These ranged from the sublime to the ridiculous.

 

Another strange offering was a device like a plastic tube to place under the breast to give the correct angle to the nipple – why on earth???  There was every variety of pump and gadget imaginable plus all sorts of add ons to regular pumps.  Milk storage devices, timers, and of course education opportunities – GOLD, iLactation, Sage publications, LER online, health- elearning, Bartlett & Jones to name but a few. Worth having repeated visits to the trade stands as they all had delicious choccies and other goodies to be sampled while chatting to the stall holders.

 

So let’s look at some of the sessions.  The theme for the conference was ‘Engage’ so the focus was on engaging with communities and ethnic groups who traditionally may not have had access to the skilled timely help that breastfeeding so often requires.

 

The main Plenary speakers covered the issues of  racism and exclusion,  supporting breastfeeding parents in times of crisis, diversity and legal matters pertaining to custody and care.

 

Achieving Health Equity in Breastfeeding: Naming and Addressing Racism and Other Systems of Structured Inequity  was presented by Dr Camara Jones MD, MPH, PhD . Dr Jones

 

Motivations for Entering the Lactation Profession: Perspectives from People of Color (Ifeyinwa Asiodu). As a researcher, registered nurse, and lactation consultant, her research is focused on the intersection of race, systemic and structural barriers, life course perspective, and increasing access to human milk and breastfeeding support.

 

What is the Role for IBCLCs in Emergencies? (Aunchalee Palmquist, Lourdes Santaballa)

Aunchalee Palmquist is an Assistant Professor at the University of North Carolina. She is a medical anthropologist and International Board Certified Lactation Consultant.

Dr. Palmquist’s interdisciplinary work bridges critical biocultural anthropology and global public health. She conducts community-based participatory research and uses both ethnographic methods and mixed-methods approaches. Her work is informed by human rights frameworks and a reproductive justice lens.

Dr. Palmquist is the lead Lactation and Infant Feeding in Emergencies (L.I.F.E.) Initiative and the Humanitarian Maternal and Child Health Program. She serves on the WHO/UNICEF Global Breastfeeding Collective, the Emergency Nutrition Network IFE Core Group, the CORE group Humanitarian-Development Task Force, and the United States Breastfeeding Committee. Dr. Palmquist has previously served as an International Lactation Consultants Association liaison to the United Nations.

Lourdes Santaballa is a community activist and organizer, with a background in domestic violence, affordable housing, and economic equity advocacy. A La Leche League leader from 2009-2017 and IBCLC since 2011, she was the founder of the lactation program at sePARE, providing coordinated services to low income families, leading it to receive the ILCA Care Award and received the Wilson-Clay Hoover Award for Research. Lourdes is currently completing her master’s degree in clinical nutrition. In October 2017, following Hurricanes Irma and Maria, Lourdes founded Alimentación Segura Infantil or ASI, an Infant and Young Child feeding program focused on increasing breastfeeding, leadership and training in marginalized communities in Puerto Rico.

 

 

 

Getting Breastfeeding Right from the Start: Enhancing Maternal and Newborn Competence

Catherine Watson Genna as we know,  is particularly interested in dyads with medical challenges to breastfeeding. In addition to mentoring lactation interns, she uses her clinical photos and videos in presentations to healthcare professionals on assisting breastfeeding babies with anatomical, genetic or neurological problems. Catherine currently participates in research, investigating biomechanics of the lactating nipple and aspects of sucking and swallowing in breastfeeding infants. Again no stranger to us Cathy has visited and spoken in Ireland on many occasions.

 

A Case for Normalizing First-Hour Hand Expression for All Mothers: Selective Studies Supportive of a Mother-Centric, Volume-Centric Approach to Improving Breastfeeding Outcomes 

Jane Morton has had a long, fulfilling career as a general paediatrician. She has also had a long-standing interest in breastfeeding, from understanding its clinical benefits to practical solutions for mothers having difficulty in providing breastmilk to their infants. Over the years, she has conducted research on human milk and breastfeeding and has designed and implemented systems and policies to help breastfeeding mothers. She produced award winning videos on this topic, including “Breastfeeding: A Guide to Getting Started”, “A Preemie Needs His Mother: Breastfeeding a Premature Baby”, “Making Enough Milk, the Key to Successful Breastfeeding” and “A Mother’s Touch, Breastfeeding in the First Hour”. She designed an educational website for expectant mothers for the goal of preventing common breastfeeding problems, www.firstdroplets.com. It is well worth looking at this site as it contains many nuggets useful to all of us.

 

 

Breastfeeding Policy and Advocacy 

Laurence Grummer-Strawn is the coordinator of infant and young child feeding at the World Health Organization. He is an epidemiologist who has published over 150 scientific publications. He is recognized internationally for his work on breastfeeding policy, and development of the WHO Growth Charts. Dr. Grummer-Strawn was the scientific editor of the US Surgeon General’s Call to Action on Breastfeeding. At WHO, Dr. Grummer-Strawn leads the Baby Friendly Hospital Initiative, the Code of Marketing of Breast-milk Substitutes, and the Global Breastfeeding Collective.

 

Litigation and Lactation: Protecting Breastfeeding in Legal Proceedings (Divorce, Immigration, Custody)

Liz Brooks is well known to us here in Ireland, having spoken at ALCI in the past. She is a lawyer/litigator and private practice lactation consultant who offers a lively explanation of the overlap between clinical lactation support, ethics, and the law. Breastfeeding helpers (like IBCLCs) can struggle with ethical, moral, and legal conundrums in their everyday work settings. With plain language and humour, Liz explains how everyone can work ethically and legally, and offers pragmatic tips for immediate use in daily practice. Great to hear Liz again as she is always worth an hour of anybody’s time – and of course the free gifts and chocolates!

 

Speakers covered a diverse range of topics during concurrent sessions including those shown below. The dilemma is always what to go to.

  • Adelante!: A Community-Based Approach to Improve Child Health in a Latinx Community (Paulina Erices, MS, IBCLC, RLC)
  • Breastfeeding Without Nursing: Reducing the Prejudice Against Exclusive Pumping (Fiona Jardine, MA (Cantab), LLM, MLS, ALC)
  • Breastfeeding Rates, Self-efficacy, and Satisfaction in Low-income Mothers (Wilaiporn Rojjanasrirat, PhD, RN, IBCLC)
  • Clinical Skills Session: Using Role Play to Identify Strategies to Provide Cultural Responsiveness and Sensitivity in Lactation Care (Stacy Davis BA, IBCLC, CLEC)
  • Clinical Infant and Young Child Feeding in Emergencies: Skills for the Lactation Consultant (Lourdes Santaballa BA, IBCLC, IYCFS, Aunchalee Palmquist, PhD, MA, IBCLC, & Angela Malloy, MAT, CLC, IBCLC)
  • When Knowledge is Not Power: Considering the Appalachian-American Cultural Power Code (Joni Gray, Ed.D, M.A., B.A., CLC, CLS)

 

I tried to choose to attend sessions that were relevant to the Irish context so while looking at specific communities in USA and other locations with no similarities to ourselves was interesting, it was generally not transferrable.

 

Meeting potential speakers is another reason to attend events, to see them in action! Meeting the big names in the Lactation field is always an honour and to be able to spend time with them chatting and sharing information is magic.

 

The big question I am always asked on returning from big events is often ‘ well, did you learn anything new?  The answer is always an emphatic yes – as learning comes in many forms.  It may be a tit bit of practical skill shared over a lunch table or a new way of looking at a familiar situation. There is always room to  learn and it is a sad day when someone feels they have nothing left to learn, even from the very familiar.

 

Conferences are about so much more than learning.  They are an experience for both mind and body. Cultural exchanges, shared anecdotes and case histories form the bulk of our social chatter around meal times and of course there is the opportunity to see the sights of other cities and experience different cultures. I thank the members of ALCI for giving me this opportunity.

 

Sue Jameson

 

 

 

 

 

MAINN Talk On BFHI by Anna Byrom Reviewed By Liz O’Sullivan

Anna Byrom of the University of Central Lancashire, a Lecturer in Midwifery, gave the first keynote talk on Day 3 of the conference, for which she received a standing ovation. She described some results from her PhD, an ethnographic study that she has been working on for the last 9 years. For her PhD, Anna explored the cultural impact of implementing the Baby Friendly Hospital Initiative (BFHI) in a maternity unit in the North-West of England. Her focus was on the impacts on staff but also the perceptions and views of families, given that the surrounding areas had a high prevalence of formula feeding. Given that she has been doing her PhD part-time, she was also able to observe changes in practice with the change in guidance in the UK that was introduced in 2012, which encouraged staff to focus on person-centred care.

Anna outlined key themes that she developed from her ethnographic data. The first she described was the environment and, in this case, it was likened to a fast-food restaurant as there was often pressure to free up beds and process women and babies through the system. The maternity unit was described as being very fast-paced, and the postnatal ward was described as being the last stop on a conveyor belt. Because the postnatal ward was so busy, women often shut themselves off and pulled the curtains around their beds. This meant that breastfeeding was not often visible on the wards. In addition, women often stopped breastfeeding when they had visitors, further decreasing the visibility of breastfeeding.

In spite of the fast pace and the background prevalence of formula feeding in the community, the Baby Friendly ideals were ingrained in the practice of the staff at this maternity unit. Anna constantly witnessed examples of infant-feeding education being prioritised and staff ensuring that they fit it into their day. Staff said that they just don’t even think about it anymore, it is simply an integral part of their job. The staff took time to help mothers with feeding and simply sitting with mothers as they fed their babies—as opposed to sitting over them—was highlighted as a particularly supportive activity.

The fact that the Baby Friendly ideals were ingrained in the practice of the midwifery staff was the dominant message from this talk and it was reflected again in the Q&A session. Anna was asked her experience of how the delivery of care changed in times when the unit was better funded compared to times when it was not. She felt that mothers and babies received better care when the unit was better staffed; however, even when the unit was short-staffed, the midwives still did their best to provide care related to breastfeeding, though they often felt/wished that they could do more. The most salient take-home message, for me, was that when breastfeeding is viewed as important by healthcare providers, they will do what they can to provide whatever support and care they can. It is not just the case of having a policy like BFHI in place that is important, the staff have to buy in to the policy and believe in the value of it.

 

Liz O’Sullivan October 2019.

Liz received a bursary of €100 from ALCI to attend the Nutrition and Nurture in Infancy and Childhood: Bio-cultural Perspectives MAINN Conference.

LCinPP Talk On Bottle Feeding by Susan Howard IBCLC reviewed by Pauline McLoughlin

The LC in PP in Conference Philadelphia this year was my first international conference to attend in all things breastfeeding; the “Breastars” were in attendance! Some attending the sessions, others giving sessions … and not to forget to mention my lovely Irish colleagues who made the whole experience very worthwhile and fun. Thanks to ALCI for a bursary to attend this conference.

The programme was full and intense, and my wits needed to be on full alert to take all the information in and process it. Given that it was all things lactation I was surprised to see on the programme a session entitled “Bottle Battles, Practical Tips for the Bottle Refusing Baby”, facilitated by Susan Howard IBCLC. Bottle battles at a conference for lactation consultants!? Following an informal chat amongst my colleagues I discovered that some IBCLCs do not as a rule help with bottle feeding problems, even with EBM. In the US where the maternity leave is relatively short many breastfeeding mothers have no other option but to bottle feed EBM as they return to work and want their babies to get breastmilk. I understand that US IBCLCs are more likely to work with bottle feeding dyads. As it turns out I had a call from a mother who was bottle feeding her baby and wanted help just before I left for America. She asked me tentatively if I took appointments from mothers who bottle feed. I asked her to fill me in. She described a 4-month long journey of frustration and failure (her words). She reluctantly finished her breastfeeding journey which was a very emotional for her and started to bottle feed formula to discover to her complete frustration and upset that her problems were not resolving. I felt I could not refuse to offer her help. To be completely honest although this session resonated with me, I thought to myself there was not too much to learn here! When Susan asked her audience to raise their hand those who felt competent and confident to work with bottle refusing babies, I raised my hand without hesitation, flush with the success of my recent consultation!!! OMG when I think of it… morto!!

The session was so well put together, interactive with lots of photos and props. I learned so much that I did not know! Thank you to Susan Howard IBCLC. Anyway, I am here now to share with you all 10 points that I picked up to help with families with “Bottle refusing Babies “

If you work in primary care or on the community, you are likely to have come across babies who play with the teat, chew or chomp the teat but manage to get the milk with the help of a fast flow teat. Or I imagine you have seen babies who appear to have soaking wet Babygro from milk spillage. Or you have encountered parents who have complained to you that it takes ages to feed their baby the bottle. You may find the weight gain is normal but are these babies feeding normally from a bottle? According to Susan, weight gain however should not be the only benchmark for feeding success. In transitioning to bottle feeding a baby should be able to accept a teat into their mouth with no gagging and suck from the teat in an organised manner and with no milk spillage.

First and foremost, in helping overcome the difficulties of transitioning to the bottle Susan would say you need to manage the expectations of the parents; one consult is not necessarily going to solve the problems. She tells families I cannot “make” your baby take the bottle. What we can do as helpers is figure out why there is difficulty with transitioning to a bottle feeding or why the baby is refusing the bottle and then help with a plan.

In figuring out the whys, she looks at the breastfeeding; she observes a breastfeed and watches for leaking, clicking, flow of milk, chewing or active sucking, nibbling, slipping off the breast.

She observes the baby in the same way we all do during a breastfeeding consult, looking for asymmetry, tightness, torticollis, palate shape, cheeks, sensitive gag reflex, hypotonia and hypertonia amongst other observations. All these factors may contribute difficulty transitioning to the bottle and may require other help like bodywork.

 

  1. Mother is in the best position to help their baby transition to the bottle effectively, not their mother or mother in law, child minder or friend. Mothers know their babies and babies trust their mothers.
  2. Hunger is not a great sauce. Babies who are fed and rested will be more regulated and less stressed. If the baby is hungry, they will get stressed, cry more, may have negative associations and develop in extreme cases oral aversions. Hungry babies are not motivated to learn
  3. Wake the baby’s body up: Do body warm-ups, assessing for tension in the neck and shoulders. Move arms up and down and open arms out and bring them together at the chest, talking and engaging the baby. Use lots of eye contact. Do exercises where the opposite body parts meet in the midline … e.g. arm meet the foot of the opposite side at the midline. Wake the baby’s mouth up: Oral massage, tap lips, massage TMJ, and massage palate. All exercises should be quick and playful and be led by the baby’s cues. Praise and encourage and do all of this before a teat has been taken out of the package.
  4. Encourage good baby posture for feeding, upright chest, back supported, hips flexed and positioned so that the baby can make eye contact too.
  5. Practice with empty bottle teat, and yes, no milk in the teat at LEAST AT THE START. Get permission from the baby to accept the teat into their mouth, stimulate or tap their lips with the teat, let them feel it. Touch it lick it praise them as they achieve these goals. Aim for hard palate. Sometimes mimic what you want the baby to do. Keep eye contact and let the baby hear the mother’s voice. Get the sucking skills right and then introduce milk in small amounts.Other ways to help baby suck is “Bait and switch” at the breast on to the empty teat when the baby relaxed and full. When babies are sleeping or drowsy and they “sleep suck” practice lots. Teach parents the visual cues for stress.
  6. Hold the bottle like a pencil, rest fingers on bottle collar and hand resting on chest. Support the jaw as needed. Stabilise the cheeks which helps with vacuum and support the jaw if there is chomping or jaw tremor. Practice when sucking to pull bottle teat slightly out so baby pulls it back into mouth. Discourage parents from bottle hopping or teat swapping.
  7. Success is defined by accepting the bottle into their mouth with a good seal no gagging and an organised suck with no spillage. It is not defined by taking an entire bottle.
  8. Use paced bottle feeding however Susan recommends not taking the teat out of the baby’s mouth in this instance.
  9. Tummy time improves all sucking skills by bringing the jaw and tongue forward. It encourages head/body extension. Roll into tummy time roll out of tummy time.
  10. Progress can and does stall, encourage parents to go back a step and reassure. Need to build into the consultation different stages of success, e.g. first step recognition of the teat, next cuing and opening wide then accepting teat. Following that, good lip seal, no gagging and organised suck. Parents may feel anxious to move quickly as there may be a time pressure for returning to work for example. Short 3 to 5-minute practice sessions 3 to 5 times a day. Pick times when baby is up for “play”.

Finally like all breastfeeding challenges it takes patience and practice and praise or positive feedback.

 

Pauline McLoughlin IBCLC September 2019

Pauline received a bursary of €200 from ALCI to attend LCinPP.