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Silencing The Self by Denise O’Brien reviewed by Tara Durkin

When I received the ALCI 2019 Conference Programme, I was very excited to see Denise O’Brien’s presentation listed, recognising the deep impact the ability to exercise informed decision making around birth has on a woman with implications for her health and well-being into motherhood, and highlighting the importance of listening to women’s voices. The talk did not disappoint. It offered vital insights for all who work with women and families in pregnancy, birth and the postnatal period, and for informing healthcare policy and practice.


Dr Denise O’Brien is a lecturer and assistant professor in the School of Nursing, Midwifery and Health Systems at UCD. Since noticing as a midwifery student in the early 1990s that confident women were saying, “I can’t do it” or “I lost my confidence”, when it came to labour and birth, she has been interested in what happens to a woman’s sense of self when she enters the maternity care system. Dr O’Brien pointed out that until recently maternity service users have not been asked about their experiences, or invited to the table to help shape service provision. This year marks the Irish health services’ first ever national maternity care experience survey (Linda Drummond from HIQA presented to ALCI on this immediately after O’Brien’s talk).


To hear more from women, in particular how they themselves define informed choice, and building on previous Irish research revealing that women have long been asking for improvements in the provision of information to improve their overall birth experiences (O’Hare and Fallon, 2011), O’Brien and co-researchers, Professor Mary Casey and Professor Michelle M Butler designed a fascinating participatory action research study.


The objective of their research was to explore women’s understandings and definitions of informed choice as a concept, during pregnancy and childbirth. In other words, how do women define and internalise their experiences of exercising choice? They also wanted to investigate with women and midwives what supports were necessary to enable informed choice.


The setting for the study was a national referral hospital in Dublin with a normal birth rate of 57% and caesarean rate of 29%, lower than the national average, and a greater diversity of care options (obstetric-led, midwife-led, Domino midwifery services) compared to hospitals nationally. Women were recruited from postnatal wards, the postnatal baby clinic, the community midwives postnatal support group and the breastfeeding support clinics.


O’Brien outlined their study’s three distinct phases:

  1. Interviews with 15 women (11 of whom, O’Brien noted, were breastfeeding) undertaken over a 6-month period.
  2. A series of group meetings (n=7) with 5 women over a 13-month period, using a co-operative inquiry (CI) approach to explore the information and other supports needed to support the concept of choice.
  3. Evaluating the information pack using a CI approach with midwives’ input, as requested by women during the inquiry process, to fully understand the supports and changes necessary to implement informed choice as a cultural norm for women during pregnancy and childbirth. Fathers were invited to be involved in this phase.


O’Brien’s presentation to ALCI honed in on the details of the first – interview – phase, the part of the study that has been published (O’Brien, Denise et al. 2017, Midwifery, Volume 46, 1 – 7). The interviews consisted of 12 open questions asking the women how they would describe informed decision making. Interviews were conducted between three and six months postpartum and lasted 33 minutes to 2 hours long each. The majority of women opted to have the interview in their own home.


In O’Brien’s illuminating analysis of the interviews, she focused on the first-person voice, how each woman spoke about herself. Pulling out the ‘I’ statements from each woman’s narrative, O’Brien created what American psychologist Carol Gilligan (1992) has termed an ‘I Poem’ for each interview.  O’Brien explained how the poems revealed what women said about ‘the self’ and demonstrated how relationships influenced the women’s expressed sense of self. She then pulled each occurrence of ‘they’ when the women spoke about their relationships with maternity care professionals, to form ‘they’ poems. The two poems together illustrate the interplay between women and maternity care professionals as each woman exercised (or tried to exercise) choice during and around her birth, as well as the influence of relationships on a woman’s sense of self.


In defining informed choice, the women held multiple meanings, but there were recurring themes:

  • The provision of up-to-date information and coming to an understanding of that information through in-depth discussions with a maternity care provider of their choice was a prerequisite to making informed choices;
  • The new sense of responsibility to their baby was hugely important;
  • If they knew and trusted their midwife or doctor, the women were happier with their choices.


Other themes that emerged in the interviews included

  1. A sense of uncertainty and a sense of regret: Women were certain when they described their desires and expectations of making informed choices and uncertain when they described their actual experiences of making informed choices. Uncertainties and regrets related to choice and access to pathways and models of care, and the inability to build relationships in the current maternity system. Monica’s ‘I poem’ serves as an illustration:

“I looked for”
“I don’t know”
“I wasn’t able”
“I wished”
“I missed”
“I needed more”

“I realised too late”

“I regretted”

  1. A sense of anxiety and isolation in early pregnancy.
  2. A sense of disappointment in care and support.
  3. Positive and negative feelings of self: 5 women expressed positive feelings of self when they spoke about making informed choices during the birth of their baby, while 10 felt they could not make informed choices and expressed negative feelings of self when they spoke about their experiences.
  4. A sense of conflict between what the doctors and midwives were saying and the women’s intuition.
  5. A sense of empowerment among the 5 women who felt supported to make their own decisions during birth and who expressed positive feelings of self when describing their interactions with their caregivers (midwives). Jo’s ‘They’ and ‘I’ poems highlight this dynamic:

“They told me”           “I knew”

“They trust you”         “I wasn’t worried”
“They make sure”      “I was delighted”
“They are always”      “I was really relaxed”
“They are so”              “I was very in control”

Of all the take-homes from O’Brien’s presentation, the biggest for me was just how vital it is that healthcare professionals and maternity care systems prioritise the relational aspects of informed decision making and work to foster relationships of trust and mutual respect between women and their care providers. This study shows how detrimental this action is to a woman’s post-birth sense of self, her mental health and well-being.


I look forward to seeing the results and information pack that emerge from phases 2 and 3 of this exciting research study!


Tara Durkin November 2019.

Tara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.

The Impact of Child Development on Breastfeeding by Elsa Quintana by Sue Jameson.

This session was presented at the 2020 ILCA Conference by Elsa Quintana BA, BCJ, IBCLC, CLE  and Jan Tedder BSN, FNP, IBCLC, and this review was written by ALCI President Sue Jameson.


Elsa had worked with Jan in New Mexico to improve breastfeeding outcomes by referencing Child Development Milestones.  As this is an area that I have read and presented on, on many occasions I was interested to learn how they had used Jan’s HUG programme to make changes. HUG stands for Help, Understanding and Guidance and from this Jan has developed a Parent Information Sheet that provides anticipatory guidance for what to expect in the early months. She uses the term GPS – Great Parenting  Skills  and the road map analogy is used throughout. This is very good as it follows the theme that breastfeeding and parenting is a journey with many twists and turns and that some of these can be avoided or planned for if one has a map.


Brazletons Touchpoint Theory is used to underpin the programme as it identifies significant events or Touchpoints  (referred to as Leaps in the more familiar Wonder Weeks materials by Frans X. Plooij &  Hetty van de Rijt-Plooij  seen in Europe) which signal change is on the way.


Often surges or leaps  in development cause changes in baby’s eating and sleeping patterns, which are often misunderstood by parents and can cause them considerable distress. The other point to note  is that these developmental surges are predictable. Research has shown that understanding infant behaviour and responding effectively to infant cues contributes  to longer breastfeeding duration (Shloim et al., 2017); promotes positive interactions between parent and child (Nugent et al., 2007); boosts parental confidence, reduces risk of postnatal depression, and positively impacts both attachment of baby to parents and baby’s development (Lester & Sparrow, 2010).


The materials were used to educate health professionals so that they had an increased awareness and confidence in discussing all aspects of normal developmental behaviours with parents and providing anticipatory guidance to them from an increased knowledge base. Over the areas the scores on all aspects were improved see slide showing results.


The HUG programme is available to purchase and training is available for anyone wishing to be a HUG consultant.  Referring to the material, it mirrors what community based support groups in Ireland provide by way of trained breastfeeding helpers and Peer support.


The studies confirm what we know – that is parents do better when they receive timely skilled help and information about infant behaviour to help them understand what’s happening for their little ones. 


It was reassuring to hear from another country that similar programmes make a difference to all population groups and to those in the lower SE groups in particular.  The HUG programme is child centred and optimizes parent responsiveness to their infant’s needs.


Listening to this talk and speaking to the presenters afterwards I noted that it was an approach that any of us working in the voluntary sector would immediately recognise. Working on improving parents’ knowledge of the normal newborn’s behaviour makes breastfeeding a more enjoyable experience as anticipatory guidance provides them with a road map for the journey over the first year.


Further information on HUG here


Sue Jameson, ALCI President, October 2019.

Sue attended the ILCA Conference, representing and funded by ALCI.

Painful Nipples by Kay Hoover reviewed by Jennifer Ashcroft

Kay Hoover, MEd and IBCLC, was the keynote speaker at the recent ACLI conference held in Limerick. Kay’s presentation on the Friday was titled “Painful nipples during breastfeeding” where she addressed the multiple root causes for nipple pain and highlighted the need to not just manage the symptoms.


Kay’s objectives for the presentation were that the delegates could;

  • List 5 causes of nipple pain
  • List 5 dermatological conditions
  • Draw up a care plan for damaged nipples


Kay spoke from her experience that it can be normal for mums to experience approximately 20 seconds of discomfort with the initial latch but that after this mothers should be able to relax and be less tense throughout the duration of the feed. Days 3-5 post-partum are often the peak of nipple pain and that this is expected to subside by days 7-10 however from experience it is seen that a large percentage of mothers have ongoing pain for a significant period of time.


Kay highlighted that we know hormonal changes such as the menstrual cycle causes breast changes and nipple tenderness, so therefore with the post-partum hormonal shift it is not surprising that we see this peak at days 3-5 post-partum in nipple pain. Kay spoke that there is limited research to back up this theory, however from what we understand about hormones and their impact we can better equip mothers in their expectations in these early post-partum days.


Maternal problems that can lead to nipple pain include the following:


  • Long nipples – causing infant to gag or pull off the breast frequently
  • Large nipples (diameter) making it more difficult to achieve a deep latch
  • Inverted nipples – pain in extracting the nipple to feed
  • Skin tags on nipples – potential for repeated trauma each time infant feeds
  • Blebs and blocked ducts
  • Vasospasm (Raynaud’s syndrome) – often seen on the face of then nipple, unusual to be the whole nipple – can cause a burning sensation in both the nipple and breast. Once blood flow restores the pain is expected to settle


Kay stressed the importance of asking the mother “how does that feel for you?” as our interpretation of what would cause pain during a feed may not be significant for the mother experiencing it.


Trauma can cause blanching, alongside a stinging or burning sensation. Amir et al., (2014) found vasospasm was the reason in 22-23% of breastfeeding mothers as a cause of pain.


Blanching can be on part of the nipple with the associated pain – squeezing blood back into the nipple (which often looks like hand expression) reduces the time the mother is in pain as it increases the blood flow to the affected area and is found to work quicker than warm compresses. These mothers are advised to keep warm – hats, sweaters etc. to minimise risk.


Medications that reduce vasoconstriction could be considered for these mothers – fish oil and evening primrose oil are longer term treatments and don’t provide immediate relief.

Oral Nephetamine (30mg slow release OD x 4 weeks or 5mg TDS) has been used with good effect


Injury or trauma – unrelated to breastfeeding

  • The baby with a strong suck – nipple shields as a temporary solution have been used in studies as increased vacuum is cause of pain, however this could cause further pain as the nipple can be pulled through the shield – always important to solve the cause of the pain
  • Incorrect use of a pump at its highest suction – pump should be used at highest “comfortable” setting. Also important to ensure appropriately sized flange and that the nipple is centred in the flange
  • Pre-natal “preparation” – i.e. rolling of nipples to “toughen them”
  • Baby not unlatched properly
  • Long distance runners can have chaffing
  • Incorrect fitting bra/seam or pressure
  • Breast pads sticking to nipple
  • “Spot” on nipple (sebaceous cyst) or varicose vein causing pain near nipple


Dermatological conditions on nipple causing pain

  • Dry skin (irritation)
  • Moisture – causing tissue breakdown
  • Infant food/medication causing maternal eczema due to change in saliva
  • Teething – acidic saliva (nappy rash and nipple pain)
  • Reaction to treatment
  • Poison Ivy of nipple
  • Psoriasis of nipple or breast tissue – some mothers require steroid cream or light treatment, others might not have any problems
  • Bloody discharge from nipple – 3% Breast cancer diagnosis (Paget’s disease)
  • Staph infection or streptococcus infection (could be on one or both breast – get cultures)
  • Herpes simplex (cold sore virus) – baby to mum transfer is ok, but if herpes lesion on mum could be fatal to infant (handwashing, not kissing baby as treatment)
  • Hand foot and mouth from toddler
  • Yeast infection – shooting pain, feels like “shards of glass” burning sensation, some mums cannot hold baby, or describe it hurts to wear clothing (shells can be helpful)


Key question to ask “Is this the normal look of your breasts or nipple?”


Kay then moved on to explain how to draw up a treatment plan for healing damaged nipples.


If nipples are lipstick shaped post feed work on a deeper latch, teach mum how to do suck training with baby, work on positioning to reduce pinching (Kay explained she uses plasters to show placement of hands for shaping breast).


If infant gagging and coming off too soon work on desensitising gag reflect with finger exercises in infant mouth moving back gradually to dampen response.


If mum has large nipples or there is suspected frenulum tie – i.e. nipping from baby address this issue, this may be evident as baby losing milk out of corner of mouth as unable to create seal and vacuum.


Kay explained that with a breast wound and suspected infections or mastitis important to remember that the yellow pus from this wound is not necessarily the infection but the leukocytes starting the healing process and stressed that if a mother is in pain, to use appropriate pain medications whilst breastfeeding to reduce the discomfort. Other strategies to reduce pain –

  • Reduce duration of feed (hand express into babies mouth)
  • Use breast shells
  • Pump exclusively until the damage heals


There are many treatment options and often no consistency with the research

  • Hand express and add Expressed milk to nipple
  • Warm compresses
  • Salt soaks (Epsom salts)
  • Lanolin (purified) – thin coat on face of nipple
  • Gel pads (hydrogel or glycerine gel) have been associated with increased risk of mastitis as source of infection so ensure washing between use, however others have found these to be extremely helpful
  • Cotton, breathable clothing
  • Air drying nipples – avoiding retraction in those with inverted nipples (dimpled nipple ring – Velcro, which holds nipple out whilst allowing it to air dry
  • Warm soap/water destroys the biofilm – soap has a drying effect therefore wash daily if not twice daily
  • Sometimes needs to advise the mum to stop what she has currently been doing – ointments, treatments etc
  • Antifungal preparations to be added topically – nystatin and hydrocortisone cream. Ensure systemically and topically treat to reduce poor outcomes


If believed to be an infection best treatment course is wash with warm soapy water, advise culture from primary care provider and find out source and treat accordingly.


Severe mastitis = might not present with temperatures look at breasts singularly and together – patterns in infection – MRSA, step and Staph


If suspected fungal infection check babies cheeks not tongue, and often the mothers nipple has  a “shiny complexion”


Impetigo – highly contagious – use topical +/- oral treatment, wash regularly and ask if too painful to feed and draw up treatment plan accordingly, some mothers can feed fine and others need to express until healed.


There is some research to suggest silver caps are more effective than breastmilk for nipple damage


Kay finished off by highlighting the importance of not dismissing nipple pain as it was in the top 2 reasons why mothers end breastfeeding before they had planned

  • perceived low supply
  • Sore nipples
  • Baby wouldn’t latch

Jennifer Ashcroft October 2019.

Jennifer received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.

ALCI At The Aras 2019

ALCI Council and members recently represented ALCI as part of a special reception in Áras an Uachtaráin in celebration of National Breastfeeding Week. This year two ALCI members Mairead Murphy IBCLC and Danielle Sullivan IBCLC (and Danielle’s baby) attended along with ALCI Council members Sue Jameson IBCLC, Lorraine O’Hagan IBCLC, Aine  O’Leary IBCLC and Fiona Rea IBCLC.



The reception, which was hosted by Sabina Higgins, included a  ‘Latching on’ morning and involved representatives, mothers and babies from ALCI, Cuidiú, La Leche League, Friends of Breastfeeding and  Association for Improvement in the Maternity Services Ireland (AIMS),






Breastfeeding Multiples by Kay Hoover Reviewed by Barbara Noonan Sexton


Kay Hoover MEd and IBCLC was the keynote speaker at the recent ALCI Conference. Kay’s final session was about breastfeeding multiples.

Kay highlighted that sometimes people can frighten mothers of multiples by saying things like “Better you than me”, “Were you on fertility drugs?” or “Do Twins run in your family?”

Kay would say to these Mothers “You will have double or triple the amount of hugs. ” Focus on positive comments not on the negative ones.

(Photo:  ALCI delegates enjoying the Conference recently.)

Infertility treatments have increased the numbers of multiples from 1991 to 2016 the twinning rate per 1,000 births went from 12% to 19%. In 2016 in Ireland there were 2,363 sets of twins and 79 sets of higher order multiples.


Kay highlighted that there are many Pregnancy, birth and post- partum concerns

  • Kay stated that there is maternal, physical and emotional strain.
  • Increased risk of durgical delivery ( caesarean section ) and pre term labour,
  • Pregnancy induced hypertension increases with each baby
  • Risk of gestational diabetes increases with each baby


There are Risks with Multiples

  • Neo – natal Mortality
  • Birth – defects
  • SIDS
  • Child – abuse
  • Developmental – disabilities


Kay stated that there can be growth restrictions that affect breastfeeding

  • Intrauterine growth restriction and prematurity
  • Increased Incidence of congenital anomalies
  • Infant death is five times higher than for single infants.


Kay highlighted the importance of mothers not being afraid to ask for help from family. In one case, Kay encouraged one mother to ask her parents to stay with her for a month so that while she was breastfeeding the babies, the parents were making the meals and doing the households jobs.


Strategies for breastfeeding is very important

  • Make sure the babies can establish a milk – supply,
  • Pumping if necessary
  • Transitioning premature babies to total breastfeeding
  • Discharge planning
  1. Sometimes one baby comes home before the other,
  2. Frequently one breastfeeds better than the other at the start.


Kay stated that 60% of Twins are born preterm. When a mother pumps by her bedside nears the babies, she usually pumps more times and gets more milk. Donor milk is available in America until the mother has milk.


Kay highlighted practical tips

  • Keeping track of each baby by feeding record using different coloured paper for each baby, Individual differences in the normal range,
  • Ways to tell the babies apart
  1. Clothing
  2. Toe nail polish
  3. Bracelets


Kay also highlighted the importance of mothers getting out of the house

  1. Take one baby and leave one at home
  2. Strollers made for multiples
  3. Elastic waist band so she can go the toilet easier herself,
  4. Start saving weekly for the children
  5. Accept all help offered
  6. Remember it does get easier when the babies get older and the night feeds stop


Barbara Noonan Sexton October 2019.

Barbara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.

Tongue Tie by Alan O’Reilly reviewed by Barbara Noonan Sexton

Dr. Alan O’Reilly MB BCH BAO DCH DRCOG IBCLC facilitated two workshops entitled “Tongue Tie: Lactation Support V Frenotomy” at the recent ALCI Conference.

Dr. Alan O’Reilly is a GP who works in Camden Street in Dublin. He qualified as a Doctor in Galway, In 2013 he trained in assessing and releasing tongue ties. He qualified as an International Board Certified Lactation Consultant (IBCLC) in 2017. Margaret O’Connor IBCLC works alongside him in his Gp surgery in Dublin.


Objections of the Workshop

  • Normal tongue movement and function
  • Symptoms of tongue tie
  • Examination of tTongue tie
  • Lactation Support
  • Tongue Movement during breastfeeding

What is a Tongue Tie

This is a lingual frenulum that causes a restriction in tongue movement. Reduced tongue movement leads to impaired tongue function.


Examination of Tongue Movements

  • Extension: rub chin just below the lower –lip.
  • Lateralisation: run a finger along outside of lower gum from side to side.
  • Elevation: may be noted when infant cries.
  • Suction: allow infant to suck on the clean finger.
  • Grooving: allow the infant to suck finger and assess how well the sides of the tongue holds on to the finger.

Examination of Tongue tie

  • Insertion of Lingual frenulum on

1. Inferior surface of tongue

  1. Floor of mouth
  • Elasticity of Frenulum on elevation
  • Thickness and Fibrosity of Frenulum



Tongue tie and Frenotomy

  • Everybody seems to have a tongue tie.
  • Parents are leaving Lactation Consultations believing a Frenotomy is that sliver bullet that will solve all of their feeding problems.
  • The Focus needs to always be on lactation support and Frenotomy if indicated should be just part of the plan.

Lactation Support: First few days

Baby not Latching on

  • Hand express colostrum
  • Avoid bottle – feeding
  • Consider finger – feeding, spoon or cup feeding
  • Syringe feeding is also a good option
  • Suck training
  • Electronic pump when milk comes in


Single most Important factor in getting baby to latch is an abundant milk supply”   (Jack Newman).


Dr. O’Reilly also stated that treating nipple pain is very important.  He highlighted the importance of working on a deeper latch. Topical steroid may help reduce inflammation and take pain killers if needed. Feed expressed milk to allow nipples time to heal. Ensure to maintain an abundant milk supply.


Nipple shields are also useful if a baby is unable to sustain a latch or has a dysfunctional suck. Nipple shields may transfer more milk with a nipple shield that without. Useful for flat or inverted nipples. The shield is a barrier for inflamed or ulcerated nipples.

A mother protects her milk supply by pumping intermittently. Monitor weight gain. Supplement if required with feeding tools. Use for a short period if possible. Wean slowly if used for an extended  period (over 7 – 10 days).


  • If a baby is not gaining weight, look at history of mother: Breast surgery, PCOS and Hypothyroidism.
  • Improve latch.
  • Ensure mum recognizes effective feeding and swallowing
  • Breast Compression towards end of feed.
  • Consider galactogogues.
  • Consider additional feeds by feeding – tube: further stimulates supply.

There should be a Weight Gain of 155 grams per week. Fluid requirements: 160 mls per Kilo e.g 4 kg baby requires 640 mls per 24 hours, which equates to 80mls per feed.

Useful Handout here.


Barbara Noonan Sexton October 2019.

Barbara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.

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



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 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.