Category Archives: News

Infant Mental Health with Dr Sue Jennings reviewed by Roisin O’Byrne

I am currently working as a public health nurse in County Louth. A large part of my role involves supporting breastfeeding mothers and infants. I see mums and babies when they are discharged from maternity/midwifery care. Children are also seen at the four core developmental checks that are offered to all children in Ireland. These checks are an opportunity to provide education and support to parents of young children. I attended the ALCI Conference in October 2021. I found the two talks by Marie Meagher and Rosarii O’Donnell Connorton on Infant Mental Health (IMH) very interesting and they inspired me to seek further training in this area.

 

I attend a two part online training event with Dr Sue Jennings on the 27th and 28th of November. Dr Sue Jennings is a pioneer of Dramatherapy and Playtherapy in the United Kingdom. She has written a number of books on these subjects. The first day of the course focused on neuro-dramatic play and we participated in a number of exercises that can be used with parents to help reduce anxiety in the pre and postnatal period. These exercises will be very helpful in practice especially with mothers and parents in the community.  As a group we talked about different antenatal techniques that can help reduce anxiety, these included yoga, and breathing exercises and in depth antenatal education.  There can be an assumption from health care professionals that women know how to breastfeed and care for a new-born and we explored how important it is to ensure that all mothers have access to proper antenatal/postnatal education and support. Adult anxiety can affect children so it is important that we understand our own mental health so we can then in turn understand and support our infants’ mental health. We discussed the concepts of nurture and nesting and how these are important for both infants and parents when forming attachments with each other in the first years of life. We discussed the different techniques parents can use during the nesting phase these include rocking, stroking and holding. In the nurture phase it is important for infants to feel safe and for parents to understand the different transitions that happen in the first years of life.

 

On the second day of the course the group discussed how to talk to mothers using respectful terminology. Different ways of speaking to mothers were outlined, with a focus on sensitivity and creating the right environment to discuss mental health. We also discussed intergenerational trauma and how that can impact mothers’ and infants’ mental health. Another topic that was discussed was birth trauma. We looked at different techniques that can help mothers who experience this type of trauma. These included skin to skin contact, nurturing, debriefing and how to discuss this topic with an older child. Dr Sue explained the different types of play that children engage in and I found this very interesting. For example, dramatic play can include interactive play with a parent and also how a baby imitates their parent’s expressions in the new-born period.

I believe I gained a lot from Dr Sue’s course that can be used in my practice. The different exercises that we did helped me to gain a deeper understanding of my own mental health and how positive support can be so beneficial to parents and children. Being able to have discussions with different professionals around their own experiences with infants’/parents’ mental health was also very valuable. I believe I have achieved a deeper appreciation of the importance of supporting parents and infants’ mental health in the community.

 

Roisin O’Byrne, December 2021.

Roisin received a bursary of €100 from ALCI to attend Infant Mental Health with Dr Sue Jennings.

Returning to Normal Physiological Birth – Hormones & Birth Kerstin Uvnas Moberg reviewed by Niamh Cassidy

Oxytocin. The love hormone, the contraction hormone, the milk ejection hormone. As lactation consultants this is the basic and necessary information, but what else is there to know about oxytocin that may help our practice?

 

Kerstin Uvnäs Moberg, author of several books about oxytocin and its importance and positive impact on different processes in the body, gave a two-hour lecture on the topic at the “Returning to Normal Physiological Birth. Growing the Practice of Normal Birth and Midwifery Led Care in Ireland” conference organised by midwives from Portiuncula Hospital.

 

Among other fascinating facts Moberg took us through the impact of labour and birth practices on oxytocin. During labour, oxytocin is released into both the blood and brain, Oxytocin has many positive effects in the mother’s brain during labour, and prepares her for motherhood. Oxytocin reduces anxiety, stress and pain in labour and switches on brain pleasure and reward centres, making the new mother relaxed, and happy as she meets her baby for the first time.

 

Oxytocin is activated by stimulation of sensory nerves. During labour this stimulation occurs when the baby’s head presses against the cervix. Epidural anaesthesia removes sensation ‘from the waist down’ for most people. Removing that sensation through epidural oxytocin plasma levels drop and labour contractions can slow down or even stop. The largest oxytocin peak experienced is during the last moments of birth as the baby passes through the vagina to be born. Women and birthing people who have epidural anaesthesia have a much-reduced peak; this obviously includes mothers whose babies are born by caesarean section. These babies also do less rooting. To offset this reduction in oxytocin as much as possible the ‘treatment’ is to increase interactions and skin to skin with mother and baby, not to separate as its often the case after surgical birth. Dyads may also need additional breastfeeding support as babies may not cue to be fed as often as needed.

 

Skin to skin contact after birth produces oxytocin in both mothers and babies. We know oxytocin as the ‘love’ hormone, one that makes parents and babies feel nice and loved up. However, its impact reaches far beyond this. Oxytocin acts on the dopamine receptors in the brain, activating our reward systems. Both parents and babies experience this and the more often and more regular the reward centre is activated the greater the long term impact. Oxytocin has capacity to shape human social behaviour and to enhance intricate social activities including pair bonding, while usually associated with couples the behaviours could also be applied to parent baby relationships. I found myself wondering is this an even greater reason to encourage skin to skin with fathers and non-gestational parents? If the other parent has regular skin-to-skin the baby will associate them with feeling good and happy and is more likely to accept them regularly as a comfort giving caregiver.

 

Oxytocin also has the ability to influence behavioural responses to social stimuli by increasing the prominence of social cues. Babies are highly salient to their mothers and the more opportunities for oxytocin release in both baby and parent the more attuned to each other they become. Oxytocin improves the detection and classification of positive social and emotional stimuli but not for negative stimuli and can blur negative memories and reduce stress in both infants and caregivers.

 

The positive effects of oxytocin are wide and varied with ongoing research into its impact on dopamine receptors and on social communication. I found the presentation fascinating and I feel there is a lot more amazing information on oxytocin to come as research expands into this area.

 

Niamh Cassidy, December 2021.

Niamh received a bursary of €100 from ALCI to attend the Returning to Normal Physiological Birth – Hormones & Birth Kerstin Uvnas Moberg webinar.

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.

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.