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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.

2021 ALCI Conference REVIEWED BY Beena Thomas

I am a Neonatal Nurse, working in a busy NICU of a tertiary referral hospital. In my daily work, I come across many breast-feeding mothers having complex and challenging issues with breast feeding.

I am delighted, to have attended the ALCI conference 2021. All the presentations were very impressive and informative. Among them I was particularly interested in the presentation done by Margaret Hynes regarding ‘Breast feeding following mastectomy-case study’. I would therefore like to review it. In my clinical experience I have limited exposure to cancer patients. Therefore, this presentation allowed me to gain a deeper insight.

 

I learned the fascinating fact that following breast cancer women can breast feed. It is not only a new knowledge to me, but also it gives me an insight into the challenging cases of breast feeding. Margaret’s objective was to increase awareness among health care professionals, that breast feeding is possible for these women. Breast feeding is possible for the woman following breast cancer. What an amazing information! Furthermore, the knowledge of cancer treatment during pregnancy varies in different stages.

 

I acknowledge this presentation truly gives me confidence to support a mother who is going through a similar situation. Moreover, it gives a lot of hope to the mother as well as the health care staff to prepare a care plan for the breast feeding in advance.

 

The topic ‘breast cancer treatment outside pregnancy’ is informative and complex. Total mastectomy and the effect of surgery removes the parenchyma and damages the nerves essential for milk ejection. In my neonatal nursing experience, I happened to experience a lot of pressure to support a mother who is going through serious health issues. The information and knowledge empower me and prepares me to be an active member in the multidisciplinary team in the future.

 

I happened to involve in conversation with mothers who have the family history of cancer and who are reluctant to continue breast feeding after discharge from hospital. The valuable information like breast feeding could prevent pre-menopausal cancer and ovarian cancer and breast feeding is associated with reduced mortality rate in cancer patients. This piece of information is phenomenal and is useful in my clinical field to encourage mothers to breast feed and to continue even after getting discharge from the hospital.

 

As a health care worker is concerned, a woman’s journey to pregnancy during cancer treatment is certainly dreadful. A higher level of motivation and awareness is needed to support the woman during her journey.

 

The lived experience for women’s breast-feeding following breast cancer. Jillian’s remarkable story inspires and gives me paramount of strength to support a mother with a similar background in the future. Interestingly, live experience of those 6 women is an eye opener. Highlighting the lack of counselling and encouragement to breast feeding, cracked nipple, sore painful feeding, and concerned about the volume transferred. I could anticipate similar problems and be mindful of the above-mentioned issues and necessary action plans could be implemented in the future.

 

Lastly, I learned from Margaret about the support systems such as family professional support, private IBCLC, social media and cancer care support. Furthermore, regular breast check breast cancer breast feeding education counselling from multidisciplinary team breast feeding education prior to birth including colostrum harvesting. Referral to breast cancer clinic for unresolved lumps and lactating breast are also recommended.

 

In conclusion, I strongly believe the presentation was a complete success in getting the insight of breast feeding being possible for a woman following cancer. I express my gratitude to all those who worked hard behind this program to make it a success. A special thanks to Margaret for sharing her knowledge and experience which are bound to changes lives.

 

Beena Thomas October 2021. 

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

BFHI UNICEF Neonatal Conference reviewed by Mairead O’Sullivan

Having attended several previous BFHI UNICEF Conference physically I was enthusiastic as ever to attend this virtual conference. As a neonatal nurse IBCLC this conference gives a chance to see what other specialist are doing in their areas both in the UK and abroad working to increase neonatal breastfeeding practices. Working currently in the Irish maternity healthcare system it was way of looking at what we can do as IBCLC’s in Irish neonatal services to develop our practices towards BFHI standards.

 

The Conference was easy to register for through the organisations although registration did close 5 days beforehand so limited lastminute decision to attend. It was indicated at times throughout the conference and in the closing speeches almost 1,000 participants had registered from the event which has to show a hugely positive multi professional interest in healthcare professionals in continuing to develop breastfeeding support in line with BFHI standards specifically in Neonatal Units.

 

With a jam-packed agenda for 9am until 5pm consisting for 13 various speakers there was something for everyone to focus on, for purposes of review I truly found it difficult to pick a specific speaker and could have easily written about all topics covered. I decided as I work in a unit looking to change its structure and develop its breastfeeding support focus, I took particular attention to the following 3 speakers which I will discussion briefly what is each highlighted.

 

Renée Flacking, Professor in Paediatric Nursing, Dalarna University, Sweden “Positive breastfeeding experiences and facilitating factors” This speaker was one of the earlier in the day speakers and spoke passionately about the practices in Swedish neonatal units where rooming in and family centre care is at the paramount NICU/SCBU. Babies nursed all in single rooms where both parents or one parent were encouraged to say with their new-born and be involved in the care from the time of admission to NICU. This practices really encourages BFHI and WHO standards of rooming in, encouraging bonding, skin to skin, breastmilk expression or breastfeeding from the earliest possible stage, on occasions when mum needs specialist care she maybe cared for in a different ward, but partners are then encouraged to stay with new-born. This is something to be looked at in Irish healthcare as some maternity facilities look at upgrading their neonatal units should be aiming to implement. Renée was highly informative about how practices could be developed but also highlighted the comparison to neonatal nurse shortages in the UK to Sweden where they are adequately staff to facilitate this fantastic model of care.

 

Dr Sarah Bates, Consultant Paediatrician & Neonatologist, PERIPrem Operational Clinical Lead (SW England), BAPM & CRG Representative for LNU & SCU (UK), Great Western Hospitals NHS Foundation Trust. Spoke on “Improving survival and outcomes for preterm infants through optimising early maternal breastmilk: A QI toolkit from BAPM.’   Dr Bates spoke very passionately about the work her team have done in implementing the first stage of the BAPM Quality improvement toolkit ‘optimising early maternal breastmilk for preterm infant’ whilst discussing the teams current work in the finalising the next stage of the toolkit, due for release later in 2021. She spoke about how they implemented the plan with a focus on obtaining early maternal breastmilk for preterm infants, recognising that not enough neonatal infants receive breastmilk from the start of their feeding journey. Her quote by Bo Jackson “set your goals high and don’t stop til you get there” really rings out to me the passion of her and her team. The focus on the discussion was to have Maternal Expressed Breastmilk / Colostrum available for preterm babies as soon as possible. The concept of Antenatal harvesting of colostrum was discussed at a much earlier stage than what some recommendations now quote as 36+weeks GA. Sarah’s team speaks about addressing mothers in pending inevitable preterm deliveries an encouraging the establishment of hand expression of antenatal colostrum along with early support once baby(s) are born in establish collection of colostrum and breastmilk. The current 2020 toolkit if fully downloadable and accessible for all to review and having reviewed it after the conference I could see this is in being an extremely beneficial toolkit for all neonatal units in encouraging maternal breastmilk of preterm infants starting from antenatal discussion. I could honestly have listened to Sarah for a lot longer and look forward to hearing about the next stage of the toolkit.

 

Prof Paul Clarke, Consultant Neonatologist/ Honorary Professor, Norfolk and Norwich University Hospitals NHS Foundation Trust & University of East Anglia lecture on ‘Delivery room cuddles for extremely preterm babies and parents . Although this speaker was one of the last of the day his discussion on the concept of offering Cuddles to new-born extreme preterm baby’s immediately after intubation/ stabilisation rang home a lot of thoughts with me. It was an extremely inspiring thought-provoking talk knowing that preterm babies are generally at their most stable immediately after delivery and that this could in fact be the most joyous memory that these parents may be able to have with their new-born or the only cuddle they may have for several weeks and days recognising its importance for maternal wellbeing and aiding in the recovering from the shock associated with preterm delivery. Prof Clarke highlights the idealism of having a well-trained team available in order to facilitate this initial cuddle with no focus on duration of cuddle only that baby is respiratory stable, and parents are allowed that initial chance to bond with their new-born before neonatal admission. Prof Clarke user of service user stories throughout his presentation and conclusion draws reality on the families who thank s to this concept are now benefiting hugely and along in some circumstances their preterm infant may not have lived for long that memory of the initial cuddles lives on forever. A truly inspiring speaker.

 

Mairead O’Sullivan July 2021. 

Mairead received a bursary of €100 from ALCI to attend the online BFHI UNICEF Neonatal Conference.

ALCI All Ireland Breastfeeding Conference 2021

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual Conference online. The Conference will be live on Saturday 2nd October and is open to members and non-members alike. There is a fantastic line up of speakers including keynotes speaker Cathy Watson Genna and Dr. Jenny Thomas. Here is the ALCI Conference 2021 Timetable.

Catherine Watson Genna BS, IBCLC is an International Board Certified Lactation Consultant in private practice in New York City. Certified in 1992, Catherine is particularly interested in helping moms and babies breastfeed when they have medical challenges. She speaks to healthcare professionals around the world on assisting breastfeeding babies with anatomical, genetic or neurological problems. She is the author of Selecting and Using Breastfeeding Tools: Improving Care and Outcomes and Supporting Sucking Skills in Breastfeeding Infants 3rd edition.  Catherine served as associate editor of the journal Clinical Lactation, and researches breastfeeding biomechanics with Columbia and TelAviv Universities.

Dr. Jenny Thomas is a paediatrician and breastfeeding medicine specialist at in Franklin, Wisconsin and is a Clinical Assistant Professor of Community and Family Medicine and Paediatrics at the Medical College of Wisconsin (MCW). She received her MD from MCW in 1993, and her MPH in 2011. She has been an International Board Certified Lactation Consultant (IBCLC) since 2003. She is now serving on the American Academy of Paediatrics (AAP) Section on Breastfeeding Executive Board after spending several years as the Chief of the Chapter Breastfeeding Coordinators. She is the author of “Dr. Jen’s Guide to Breastfeeding.” She is one of only a few physicians internationally to be recognized as a Fellow of the Academy of Breastfeeding Medicine (FABM) for her expertise on breastfeeding. Dr. Thomas’ interests and research have focused on issues related to the use of social media to support breastfeeding mothers.

There will be three case studies on the day with speakers including ALCI Past President Margaret Hynes IBCLC who will address a case study of breastfeeding following a mastectomy, Patricia Marteinsson IBCLC who will address a case study of severe breastmilk overproduction, and ALCI Immediate Past President Sue Jameson IBCLC who will address cleft palate. Other presentations will include a National Update, a session on Reflux with Carol Smyth IBCLC, a session on Therapeutic Ultrasound with Kathryn Downey IBCLC and Mairead McCahill-Riley IBCLC and a session on Infant Mental Health with Marie Meagher Crowley IBCLC and Rosarii O’Donnell. During the live event, participants will be welcome to submit questions and time will be allocated at the end of each session for answers. The Conference will be recorded and made available for a further month for delegates to watch.

The Conference will include a Poster Competition and the announcement of the six winners of the Scholarship Competition. Bursaries are available for ALCI members. ALCI are proud to be offering online education to members, while staying apart to stay safe. The Conference costs € 55 for members and € 85 for non-members. New memberships are welcome with membership lasting until January 31st 2022. Email info@alcireland.ie with any queries. Book here.

ALCI Conference 2021 Timetable