LGBTQ+ Competency in Birth and Beyond reviewed by Kirsten Killoran

Did you know that in a 2018 survey, 1 in 2 young adults (18-24 years) did not identify as 100% heterosexual?  (https://yougov.co.uk/topics/lifestyle/articles-reports/2015/08/16/half-young-not-heterosexual). As lactation consultants we are called on to support a diverse range of family types, whether in hospital settings, in the community, or in private practice.  How does your workplace or your practice reflect this diversity… or does it?  That is what we set out to explore with AJ Silver of the Queer Birth Club (https://queerbirthclub.co.uk) : the barriers and challenges faced by LGBTQ+ families in antenatal and postnatal care, how we as lactation consultants and healthcare workers can help our clients/patients to navigate an historically cisgender, patriarchal system, and how we can work to support the cause by becoming meaningful allies.

 

The day began with a run-down of common terms used within the LGBTQ+ community; for example, transgender, cisgender, nonbinary, gay, lesbian, heterosexual, and many more.  While these terms may be useful in box-ticking exercises, it is up to us to listen to our families and respect the pronouns (she/her, they/them, etc) and terminology they wish to use for themselves, and should not make assumptions.

 

Just as we value all our clients and patients equally, so too do we have to respect and value their lived experiences.  Historically (and even to this day) the LGBTQ+ community has been over-medicalised; in particular, the transgender community.  Assumptions about a client’s gender or sexuality can often lead to lack of trust and disengagement with healthcare professionals, as well as mental health issues.  As AJ noted: “The words you use can have lasting effects on families”.

 

Have you considered how your workplace or private practice might appear to an LGBTQ+ family?  As a simple exercise, AJ suggested walking through your system as a potential LGBTQ+ client.  Does your website and social media include images of a diverse range of families, or only mums, dads and babies?  Do your forms and charts use gendered terms like mother/father, or instead do you use birth parent/parent 2?  Are there inherent assumptions that everyone in the family is related by blood, or is there room for donor/surrogate information?

 

While these may seem like small, nit-picky things, representation and inclusion not only matter, but in some cases can be of huge medical importance.  In the afternoon we were presented with several case studies to consider.  In each example, couples and families were subjected to unnecessary procedures, incorrect tests, delays and red tape, simply because they were LGBTQ+ families and the traditional maternity system procedures were not set up to cater for them.

 

Finally, we looked at what we can do to become better allies.  The first is to acknowledge and examine your own biases.  Explore where they come from, and try to learn more about issues you’re not familiar with – ideally from LGBTQ+ sources.  Consider changes to your website, social media and forms/charts to be more inclusive.  Demonstrate your allyship not just during pride month in June (also known as rainbow-washing), but as a natural part of your practice.  Post photos of LGBTQ+ families in “boring”, everyday social media posts, rather than as special “good news” stories. Allyship should be normal and natural, not forced or demonstrative.

 

Ultimately, while we all provide the same caring, compassionate support to our clients regardless of family type, it never hurts to consider a few small changes to show that we do “walk the talk”.  After all, as Marian Wright Edelman once said: “You can’t be what you can’t see”… can LGBTQ+ families see themselves as your clients..?

 

Kirsten Killoran, November 2021.

Kirsten received a bursary of €100 from ALCI to attend  LGBTQ+ Competency in Birth and Beyond.

Part Time Administrator Required

Part Time Administrator (from home)

The National Council of the Association of Lactation Consultants in Ireland are seeking a part time administrator, to work with them, to promote the professional development, advancement, and recognition of International Board Certified Lactation Consultants (IBCLC) for the benefit of breastfeeding infants and children, mothers, families, and the wider community. This role is primarily working from home and does not require breastfeeding education/training. Please email info@alcireland.ie for full job specification or queries.

  • General administrative duties, excellent organisational and IT skills essential
  • 12 +/- hours per week where an increase in weekly hours can be expected for educational events
  • Working from home on a sole trader basis
  • Beginning January 2022

2021 ALCI CONFERENCE REVIEWED BY Iby Chacko

Differentiating Normal New-born Weight Loss from Breastfeeding Failure

 

As a Lactation consultant in a tertiary hospital, I’m always keen to update my knowledge with current research evidence. No doubt, ALCI’s annual conference is the best chance for that. As usual, this year’s conference was also packed with, lots of valuable information along with inspiring stories and case studies. It was exciting to hear from national and international speakers with a wealth of knowledge and experience. Here, I would like to review a lecture given by Catherine Watson Genna on “Differentiating Normal Newborn Weight Loss from Breastfeeding Failure”. I enjoyed this informative lecture and gained lots of evidence-based knowledge to apply into my clinical practice.

Catherine is an inspiring IBCLC, currently working in private practice in New York City. She is the author of many breastfeeding books. She was the Associate Editor for the United States, Journal of Clinical Lactation. Catherine discussed recent data on normal weight changes in exclusively breastfed infants and those at risk for hypernatremic dehydration to help health professionals to determine when infants require further supplementation.

 

Normal weight loss

Catherine started her lecture by giving a short description of normal weight loss. Newborns are expected to lose weight in the first few days after birth as a part of healthy adaptation to extra uterine life and promptly begin gaining as milk production increases (Mulder & Gardner, 2015). Breastfeeding difficulties and also perinatal practices can exaggerate normal weight loss (Mulder, Johnson, & Baker, 2010). Giudicelli, M et al (2021) revealed that excessive intravenous fluids during labor and delivery may lead to increased weight loss in the first 24 hours of life. It is valuable information that newborn care practices like separation from parents, cold stress, restrictive feeding routines, delayed initiation/ mismanagement of breastfeeding also reduce weight gain. She discussed ABM Clinical Protocol #3 (2017) and explained medical indications for supplementation which has given insight into the careful regulation of breast milk substitutes.

 

Hyponatremic Dehydration (HND)

I was curious to hear a precise explanation of hyponatremic dehydration. Sodium (Na+) >145-150 mEq/L can lead to renal injury, intravascular coagulation, cerebrovascular events, and Cerebral edema (if rapid refeeding). Therefore symptoms of dehydration or low breast milk intake should not be disregarded at any age. Signs of dehydration may be subtle in HND as fluid is shifted to the extracellular compartment by osmotic pressure from the elevated sodium. Signs and symptoms such as dry mucous membranes, lethargy, Irritability, inconsolable crying with constant ineffective feeding attempts should be investigated.

 

Evidence based practice

Furthermore, the lecturer illustrated a few recent pieces of research on infant weight loss. She explained the importance of routine use of “24-hour weight” as the reference for newborn weight loss calculation. Deng & McLaren (2018) demonstrated that their overall supplementation rate decreased from 43.6% pre- to 27.4% post-intervention. Research done by DiTomasso, D., & Paiva, A. L. (2018) found that Weight loss > 7% may be a normal phenomenon among breastfeeding newborns. Use of formula significantly increased at 7% weight loss. Thus I learned that it’s vital to rethink weight loss expectations before supplementation. Frequent or daily weighing in the first 5 to 7 days has been also proposed to reduce the risk of HND (Bucher, & Arlettaz, 2009). According to Zia, M et al (2021) intervention is initiated when there is >=5% weight loss in any 24 hours. Lactation consultation, 2 hourly breast feedings, skin-to-skin contact, hand expression of colostrum, and reweighing in 12 hours are recommended and they found fewer nursery admissions for HND after intervention which is a very interesting and informative study.

 

Identifying infants at risk

It was my new knowledge about nomogram charts. These charts help to capture the time dimension and individual variations to identify babies at risk. Several groups have produced nomograms that clinicians can use to help screen newborns. As per studies, mild hypernatremia may be normal and HND can occur regardless of weight loss. Von Dommelen’s nomogram captures infants at high risk for HND and treated it along with the continuation of breastfeeding. From her lecture, I learned that an infant who is remaining below 10% below birth weight after 1 week is at high risk than who is 10% below birth weight at 2 days old.

 

Conclusion

To conclude, I gained a wealth of knowledge from Catherine’s lecture. Research on infant weight changes highlighted the impact and importance of perinatal practices and postpartum breastfeeding management. Understanding the data we have about weight loss, and carefully assessing the breastfeeding dyad, can help prevent hypernatremic dehydration and conversely, unnecessary formula supplementation. I take this opportunity to thank ALCI for organizing such a knowledgeable international guest lecturer and also a huge thank you to Catherine Watson for generously sharing her expertise.

 

Iby Chacko October 2021. 

Iby received a bursary of €100 from ALCI to attend the 2021 ALCI Conference.