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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

Why Infant Reflux Matters Reviewed by Kathryn Downey PHN IBCLC

Why Infant Reflux Matters is another concise book by Pinter and Martin in the series of why it matters. This publisher has previously presented a range of topics from fertility through to starting solids and all in between. However, this latest title delivers a wealth of information from a renowned Reflux and feeding expert Carol Smyth. Smyth imparts her own experiences as a mother coupled with the in-depth investigations she has pursued in unravelling the modern-day conundrum of infant reflux. In this enlightening read, marrying reflux symptoms together with evidence, she proposes and acknowledges the misinterpretations of normal newborn behaviours and societal expectations which differ tremendously from the needs of our exterogestates.

 

Smyth presents her topic in two parts. Part one is a series of chapters addressing the question what is Reflux. She identifies how so many normal newborn behaviours could indeed be misinterpreted or lead to a series of misinterpretations for parents. Smyth draws on her own experiences as a breastfeeding parent as well as that of her interaction, assessment and support for the many women and infant’s she has supported on their breastfeeding journey. She further explores the cultural diversities of infant care and interpretation of need that is drifting further from accepted societal perceptions of that care. She clearly acknowledges that we as mothers and parents have been persistently fed inaccurate expectations regarding our infant’s behaviour.

 

Smyth delves into Exploring symptoms grouping these into categories covering Feeding Behaviours, Unsettled Behaviours and Medical Issues. Working through these categories Smyth reverts to the imperative and paramount need for a complete feeding assessment with a specialist to truly identify the cause of the symptoms before attributing these to GORD (Gastro Oesophageal Reflux Disease). She further explains concisely what reflux and GORD are and the positives and negatives of the available treatments.

 

She further discusses co-regulation and dysregulation to show us clearly how the infant system actually works. And herein, she offers us all, as practitioners and parents an opportunity to understand how we can switch from merely surviving to thriving during the fourth trimester.

 

This is a very concise and informative book, quick to read and practical to use. It has a logical progression and obvious evidence base. As an IBCLC I would most definitely recommend this book to Health Care Professionals caring for young babies as well as to parents who are struggling with reflux symptoms and looking for answers. A most unputdownable read.

Liz Greene “Breastfeeding the Late Pre-Term Infant (LPTI)” Reviewed by Jenni Ashcroft

Breastfeeding the Late Pre-Term Infant (LPTI) was a presentation at the 2021 ALCI Spring Study Day by Liz Greene RGN, RM, RNT, IBCLC

 

Liz opened by acknowledging that we are seeing more of these late preterm infants (LPTI) due to a rise in the incidence of multiple birth pregnancies and resulting earlier gestation births, which in turn leads to a higher prevalence of feeding difficulties and increase in additional support required.

 

The LPTI is classified as 34+0 -36+6 week gestation, with moderate preterm infants (MPTI) being classified as 32+0 – 33+6 week gestation. Normal weight at 34+0 weeks (female and male respectively) >1.6-1.7kg and at 36+6 (female and male respectively) >2.2kg -2.3kg. This highlights the range of weight, maturation and significant development that is missed during this three-week period in utero.

 

British association of perinatal medicine (BAPNM) acknowledge that LPTI have specific needs that require more attention, and have established a working group for health care professionals; “Management of moderate preterm infants framework for practice” first draft is being prepared.

 

Alongside earlier gestation birth it is important to also acknowledge whether the LPTI was growth restricted in utero. Low birth weight is classified as <2.5kg – if body weight was <2nd centile for gestation the baby is smaller than average – resulting in less body fat and energy reserves which will impact upon oral feeding abilities. For this reason, despite maternal breast milk for LPTI infants being higher in protein and more tailored to increased requirements of the LPTI compared to the term infant, fortification of breast milk is often indicated particularly if growth restriction in utero or if growth has faltered since birth, static weight gain, concerns with length or head circumference etc. Donor milk is valuable for this cohort of infants but important to recognise nutritional limitations, and therefore these infants may require specific preterm infant formula to help meet increased nutritional requirements.

 

Liz highlighted the increasing role of Neonatal dietitians within this setting to improve the care and outcomes these infants and their families are experiencing and the balancing act that is required between volume targets, fluid requirements and growth targets, and establishing oral feeding successfully.

 

Anyone who is helping the mother to feed her late preterm infant should think about what has baby’s story been so far so that care can be individually tailored to infants’ needs – admission criteria for NNU vary between units. We know the LPTI is at increased risk of:

  • Respiratory Distress Syndrome -reduced surfactant
  • Hypothermia -reduced body weight and body fat
  • Hypoglycaemia
  • Jaundice
  • Poor feeding -natural consequence is that baby has less energy available to feed vs challenges
  • Suspected sepsis
  • Increased risk of readmission following discharge

Ignition of BF usually encouraged from 32 weeks, bottle-feeding often from 33-34 weeks gestation. Individual assessment of oral feeding readiness is crucial -importance cannot be overlooked or underestimated particularly if goal of parent is to breastfeed.

 

Benefits of having a tool to undertake individual assessment

  • Safe transition to oral feeding is key by assessing pace of baby’s developmental readiness
  • Reduce problematic feeding issues in the future
  • Working beyond the hospital stay and safeguarding future feeding
  • Minimise feeding issues
  • Focuses on readiness and ability of PTI

PIOFRAS (preterm infant oral feeding readiness assessment scale) and PIBBS (Preterm infant breastfeeding behaviour scale) focused on as specifically look at infant readiness rather than assessing feeding once already established with the aim to not start at pace beyond infant’s ability.

 

PIOFRAS

  • Gestation of baby looked
  • Non-nutritive suck used as starting point for feeding readiness and baby behavioural state -oral and body positions, reflexes etc.
  • Movement of tongue -cupping, movement and sucking strength
  • Babies alertness also looked at
  • Stress signs during non-nutritive sucking -saliva accumulating, nasal nares trembling, colour changes or apnoea, tone changes, hiccupping, crying, refusal etc.
  • Visual or felt observation on finger
  • This tool was envisaged to be undertaken by oral therapists – limitations of staffing and skill set available

 

PIBBS

  • Completed by the mother
  • Advantage -similar to previous tool -rooting, suck, swallow, alertness, time baby actively sucking/swallowing, but also how mother feels baby is feeding

 

How can we support optimal feeding for mother and the late preterm baby?

Well documented that nasogastric tube feeding (NGT) and orogastric tube feeding (OGT) and bottle feeding standard practice with this cohort of infants.

  1. Breastfeed/Hand express (HE) within 1 hour of birth
  • The reason for birth between 34+0 -36+6 gestation may have required operative or assisted birth, oxytocin release could be inhibited by stress related to birth
  • If either mother and/or baby requires medical and midwife/nursing care at birth, support mother to HE and collect colostrum as soon as possible
  • Offering pictures of baby to aid HE of colostrum
  1. Kangaroo care (KC) -want to facilitate as much as possible but realistic challenges i.e., space on NNU, maternal comfort, seating available -recliner i.e., laid back BF, if available they enhance the care available. Restricted growth infants can be difficult to hold. Gentle swaddle/cushions can be important to facilitate
  2. Regular BF/expression and double electric pumping of breast milk -PTI may not have adequate strength suck to stimulate milk removal -therefore breast pump crucial if milk not being removed. Importance of keeping mother updated on infant’s progress if separated and providing photos to support with lactogenesis II

 

Keeping LPTI and mother together (“rooming in”/transitional care) increases:

  • STS/KC
  • BF initiation
  • Lactogenesis II
  • Use of cup/tube feeding as alternate to bottle teats
  • Likelihood of BF continuation

Not all units have transitional care services, not a “place” but tailored support to these mothers and babies, increased workload to staff needs to be recognised

 

Readiness for feeding Signs baby is not ready for feeding
Rhythmic sucking noted during non-nutritive sucking Baby is sleepy – eyes are closed
Baby putting fingers in and around mouth Irregular or spaced-out sucks
Baby is awake and alert Disorganised suck-swallow-breathing
Rooting behaviours Messy feeder
Flexed arms and legs, midline positioning Extended posture and poor tone
Refusal to suck-swallow or complete a feed
Colour change, apnoea

 

 

If we push oral feeding too much -negative future feeding behaviours are likely

 

Cup feeding:

  • Can be commenced from 32 weeks onward
  • Baby is using lips, tongue, jaw, which will help to develop, suck skills
  • Can be messy -that is the norm
  • Increased BF continuation
  • Reduces bottle teat usage
  • Unsure if this increases length of stay in hospital
  • Cup feeding is infant driven -babies can lap milk earlier

 

“At breast” supplementer:

  • Evidence of its success >37+0 weeks gestation
  • Further research is need for LPTI
  • Pre-requisites – readiness to feed, maintain a good latch, organised sucking and swallowing
  • Known challenges – fiddly, cost of tubes, tube blockage or dislodged

 

Finger feeding:

  • Suitable from 32+0 weeks onward
  • Useful if baby has sucking/latching difficulties
  • Breastmilk or alternative in a container level to baby or lower
  • Tube taped to index finger

 

Elevated side lying:

  • Acknowledges developmental stage of baby
  • Recommended in NNU and transitional care settings
  • Mimics cross cradle BF hold and paced feeding therefore easing the transition back to breastfeeding

 

“Prompts” that can lead to negative feeding behaviours

  • Suddenly waking baby and commencing an oral feed
  • Rubbing/moving baby’s jaw to suck-swallow
  • Increasing the milk flow
  • Chin and cheek support
  • “Jiggling” the teat to encourage sucking/swallowing
  • Tilting back baby’s head and neck during suck-swallowing

 

What are the key messages for supporting a mother to breastfeed her LPTI:

– Facilitate STS as often as possible

– HE and use of double electric breast pump in early days/weeks

– Individualised advice and support for mother based on observation of baby’s readiness for oral feeding

– Avoid/minimise separation of mother and baby

– Transitional care

– Tube and cup feeding increase likelihood of BF continuation

 

Jenni Ashcroft April 2021.

Jenni received a bursary of €100 from ALCI to attend the online ALCI Spring Study Day 2021.

New Guidelines for IBCLC Certifying and Recertifying from 2020 and beyond

by Lorraine O’Hagan IBCLC.

 

Here is a spreadsheet of the clinical practice calculator  from the IBLCE site. It is a good example how to document hours.
Here is a presentation made by Lorraine O’Hagan IBCLC at the 2021 ALCI Spring Study Day.
Here is the link to the Recertifying information on the IBLCE website.

Meg Nagle, IBCLC “Supporting Families Through the Tongue Tie Journey” Reviewed by Tara Durkin

Breastfeeding Insight Online Conference (September 1-December 31, 2020, extended to January 31, 2021) on www.breastfeedingconferences.com.au

The Breastfeeding Insight Online Conference this autumn brought together healthcare professionals and academics from many different disciplines and perspectives on aspects of lactation and breast- and chestfeeding that we don’t always get to hear at conferences. All the talks offered food for thought and opportunities for growth in practice. Meg Nagle’s presentation on supporting families through their tongue tie journeys aimed to help rescue discussion around tongue tie from clinical debates among HCPs (e.g. the best way to assess tongue tie) to bring the focus back on the individual mother and baby. Nagle (“The Milk Meg”) stresses the importance of good listening skills, which she notes can take time to develop, and offers some valuable tips and techniques for IBCLCs to keep women and babies and their unique tongue tie journeys at the centre of care. In preparation for her talk, Nagle posed a question on social media inviting parents with experience breastfeeding a baby with tongue tie to tell her what they’d love HCPs to know about their tongue tie journey; it was enriching to hear those parents’ comments and the voices of Nagle’s clients guiding and shaping her talk. I’ll share some of the talk’s key messages.

 

The IBCLC as detective – taking a client’s history as art

Families who come to IBCLCs are often experiencing and exploring a wide array of issues and concerns. In order to really help a mother and baby, Nagle says, it is up to IBCLCs to be like detectives, asking questions to untangle what is going on for the particular dyad, as all mothers and babies are on unique journeys that don’t fit a mould or predetermined list. When taking a mother and baby’s history, asking key questions – and really listening to the answers, trusting the mother’s instinct and tuning into what her goals are – can help put the pieces of the client’s unique jigsaw together and support the mother’s confidence. Nagle suggests asking

  • How does it feel for you?
  • Does your baby effectively and efficiently drain the breast?
  • What are you feeling concerned about?
  • Is your baby settled when feeding?

 

IBCLCs are not magicians

Nagle stresses that lactation supporters need to start from the basis of listening well and trusting women’s intuition – especially when it comes to tongue tie, an area in which a great deal of research still needs to be done. While IBCLCs have their own professional expertise and knowledge based on the best available research, breastfeeding families need to be supported and trusted to find their own way, exploring the suggestions they’re given, and to come back to the LC if things aren’t improving. A referral to another professional such as a craniosacral therapist, speech and language therapist or dentist may be appropriate. At the end of the day, Nagle says, it’s detrimental that professional egos and assumptions about what’s going on don’t get in the way of giving the best possible support and building a mother’s trust in herself as a parent.

 

Consider your questions

Nagle stresses that mothers know how to describe how breastfeeding feels – we just need to ask the questions that prompt them to tell us. For example, how we ask women about pain is important; some mothers might not describe uncomfortable or suboptimal breastfeeding as “painful” so we need to be more specific. Instead of using a 1-10 pain scale, Nagle uses a language-based scale, e.g. “Do you feel a gentle pull that you barely feel, or pain/discomfort?” “Are you feeling a sensation like a chomping or clamping?” and so on.

 

Individualised, empowering care plans

Care plans, Nagle emphasises, have to start with the mother’s goals. Every plan will be different based on her goals and what she sees as her biggest challenges. Secondly, care plans always need to include options and alternatives, including having a tie release and not having a release; it’s important to discuss the known benefits, risks/side effects and alternatives of all the options with the mother. Thirdly, the care plan needs to include a range of positioning and attachment suggestions and alternatives that support the dyad before and after a release, or if the family decides not to release the tie. Skin-to-skin and laidback positions which support self-attachment, the least invasive techniques which activate innate skills, are good to try first. However, these may not work for everyone, or may not work right away. Alternatives such as side-lying, upright positions such as koala on an exercise ball, latching on while moving around and/or using the “flipple” technique may work better for different dyads at different times.

 

Never assume what mothers and babies are capable of

Nagle encourages IBCLCs not to shy away from offering a feeding option because they are worried it will be too much for the mother. She gave the example and showed a photograph of a mother tandem feeding her newborn twins, each using an at-breast supplementer with expressed breastmilk. Give women options, and they can explore, with support, what is right for them.

 

As a longtime Cuidiú breastfeeding counsellor preparing to take the IBCLC exam later this year I appreciated Meg Nagle’s presentation because it illustrated how my experience as a breastfeeding counsellor, and years of practicing active listening (two ears, one mouth, to be used in that proportion) can and should be put to good use in my future practice as a lactation consultant (fingers crossed!).

 

Tara Durkin February 2021.

Tara received a bursary of €50 from ALCI to virtually attend the Breastfeeding Insight Online Conference.

ALCI All Ireland Breastfeeding Spring Study Day 2021

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual breastfeeding Study Day online this year, to enable members to update their knowledge and skills while staying apart to stay safe. (ALCI Spring Study Day 2021 Timetable.) The Study Day will be live on Saturday 13th March and is for ALCI members only. There is a fantastic line up of speakers including keynote speaker Kathleen Kendall-Tackett IBCLC.

 

Kathleen Kendall-Tackett IBCLC is a health psychologist and International Board Certified Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett is Editor-in-Chief of two peer-reviewed journals: ​​Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the APA’s Publications and Communications Board. Dr. Kendall-Tackett specialises in women’s-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2017 President’s Award for Outstanding Service to the Field of Trauma Psychology from the American Psychological Association’s Division of Trauma Psychology. Dr. Kendall-Tackett has authored more than 460 articles or chapters and is author or editor of 38 books. Her most recent books include Depression in New Mothers, 3rd Edition (2017), Women’s Mental Health Across the Lifespan (2017).

 

Other speakers include Nicola O’Byrne IBCLC who will present the topic of Moving On From Tongue Tie Focused Lactation. During this interactive presentation the participants will learn about the history of tongue tie division from an Irish perspective. Nicola will discuss her learning path and how current research has changed practice.

 

Other speakers include Liz Greene IBCLC who will speak about Breastfeeding The Late Pre-Term Infant; as well as Liz O’Sullivan PhD and Aileen Kennedy BA who will address The Irish Experience Of Infant And Young Child Feeding During COVID-19.

 

During the live online study day, participants will be welcome to submit questions and time will be allocated at the end of each session for answers. ALCI anticipate a lively interactive day with a difference, and encourage as many members as possible to join. Following each webinar there will be a live interactive session to generate discussion and promote interaction. The study day will be recorded and made available for a further three days, for ALCI members to review.

 

At a time like no other, ALCI are proud be offering online education to members, while staying apart to stay safe. The Study Day costs € 50 and is for ALCI members only. New memberships are welcome, € 60 for non IBCLCs and € 50 for IBCLCs with membership lasting until January 31st 2022. Email info@alcireland.ie with any queries.

 

ALCI Spring Study Day 2021 Timetable

Why Postnatal Recovery Matters reviewed by Kathryn Downey PHN IBCLC

Pinter and Martin present this concise book in the series of why it matters.  This covers a range of topics from fertility through to starting solids and all in between.  This little book delivers a wealth of information with both fact and anecdotal passages of mother’s own experiences coupled with some lost cultural traditions and those that continue despite mammoth changes in both Eastern and Western societies.

 

Messenger introduces her topic by describing postnatal care as the poor relation of the birthing world.  She identifies how the shift in modern thinking places more value on the newborn child and it’s needs than the needs of the new mother.  Messenger bases her insights on 10 years of interaction while caring for and supporting women on their journey to motherhood.  She identifies that our modern culture has created a system which “perpetuates the myth of the perfect motherhood”.  This she partially attributes to our dependency on social media which leads to a vicious cycle of falseness and inadequacy.  She gives a very honest overview on the lack of postnatal support aimed at the birthing mother.

 

Messenger gives a brief but insightful description of the almost lost traditions of nurturing the postnatal mother and the importance of doing so.  Messenger a Doula with a background in science lays out the very essence of the importance of allowing mothers to recover from pregnancy and birth while re-birthing themselves, as mothers.   Messenger presents the array of postnatal practices of Asian communities where the new mother is nourished, massaged and surrounded with rituals which celebrate, her, in her new role, as a new mother.  A practice which she claims was once celebrated and treasured by all societies.

 

Messenger dedicates a chapter to each of the elements Rest, Food, Social Support and Bodywork among others detailing how to achieve each whether in a nuclear or extended family.  She clearly indicates how the new mother requires and will thrive on hands-on support, but also detailing how new parents can provide these elements for themselves.  Messenger balances this by emphasising that new mother’s need not nor should not try to be all things to all people – being a super mum!  As this just won’t work, encouraging accepting help, be it from family or friends or buying in that help from a skilled helper.

 

Messenger includes special circumstances in the closing chapters of this little book.  These cover situations of single parenthood, admission to NICU and the most dreaded of all scenarios when a baby dies.  She goes on to acknowledge the taboo surrounding baby loss and pregnancy loss and how when this dreaded event occurs the new mother needs support more than ever.  She details the same tenets of support are necessitated – Rest, food, bodywork and social support – how right.

 

In concluding this book Messenger acknowledges how incredibly similar and ubiquitous post partum practices are around the world which are not such a distant tradition as imagined.  Finally, Messenger proposes if “we nurtured new mothers …there is the power to change society as a whole” a long-term cost saving exercise.

 

As a midwife I found this book intriguing, identifying all that we do not do for new mothers as well as all the high expectations we project upon them, the expectations we accept and take for granted.  It highlights our misplaced focus on just the care of the baby in the post partum period.  As a mother this book identifies the mis-placed stereotypical societal attitudes of motherhood-something which we can all help to change.