Presenting at the ILCA 2023 In-person Conference in Las Vegas: 

 A Personal Account

By Caoimhe Whelan

 

Have you ever wondered how people end up presenting at large or international conferences such as the ILCA Conference? Well wonder no more because in this article I’m going to explain how it all works and what my own experience of speaking at the ILCA conference was like.

 

Over the last year or two I have become much more aware of comments from new mothers about information on infant feeding, parenting, infant sleep and newborn behaviour that they are seeing on Instagram. Some of the information comes from trusted sources and is sound and evidence-based based. However, much of it is not helpful, not evidence-based and in fact could be classed as misinformation and/or predatory marketing. The problem with this misinformation and predatory marketing is that it has the potential to negatively impact on a woman’s experience of becoming a mother and her self-confidence, and can lower her sense of breastfeeding self-efficacy. In my private practice work, I have certainly noticed higher levels of anxiety among client in recent years, and often when we explore the causes, we can trace it back to Instagram or other social media platforms. I started to take a closer look at the kind of content on Instagram that my clients and other mothers and parents were potentially being exposed to. As I did so, an idea started to take shape in my head of a presentation that would analyse this content in detail, and consider its’ impact on new parents. I also started to consider the content that IBCLCs and lactation professionals were posting on Instagram and the things that we need to be mindful of, such as the IBCLC Commission Code of Professional Conduct, Scope of Practice and the World Health Organisation Code on the Marketing of Breastmilk Substitutes. All the while I was contemplating my own thoughts and feelings about Instagram and social media. So, with a head full of ideas for a presentation around the topic of Instagram use by new parents and IBCLCs, I started to draw a big mind map on a blank A3 sheet of paper – see here fig1.

I always find mind-mapping to be a really helpful way to untangle my thoughts and get some clarity, or shape, to a particular idea that’s swirling round my head. Once I did the mind map for this topic, I felt confident that I had the bare bones of an interesting (at least to me!) conference presentation. It would be a presentation of two halves; the first looking at the kind of misinformation, predatory marketing and momfluencer content that new parents are seeing on Instagram, and the second half would explore ethical, legal and privacy-related concerns for IBCLC when posting on Instagram.

 

Around the time that I was mind mapping this topic, I happened to notice a call for abstracts for the ILCA 2023 Conference in Las Vegas. I already had given some thought to attending the conference in person, so I decided I may as well send in an abstract. I did it all through the ILCA website online application process whereby you provide information about yourself, a presentation abstract, key learning objectives of the presentation and at least five recent citations to support your application. I know that not everyone may be familiar with the concept of writing an abstract, but basically it is a paragraph of around 200 words that outlines the main ideas that you are going to explore in your presentation and a rationale for why this topic is important. It should be clear and concise and pique the interest of the reader.

 

This is the abstract I included in my application:

Instagram and the IBCLC – Ethics, Privacy, Misinformation and Maternal Mental Health

Parents are increasingly turning to Instagram for information on aspects of parenting such as feeding, sleeping and baby behaviour. Globally, the use of Instagram has more than doubled in the past five years, with the platform on track to reach 2.5 billion users by the third quarter of 2023. The kind of content that parents may see on the platform includes posts from commercial entities, influencers who are gifted products or paid to promote products, other parents, and professionals (including IBCLCs) who work with parents antenatally and postpartum and who ‘share’ information pertaining to their area of expertise. There are many positives for both parents and professionals in using Instagram, however, the platform also presents a number of ethical issues relating to the type of information that is shared, privacy issues and the practice of ‘sharenting’, ie the documenting of children’s lives on Instagram. Additionally, a small number of recent studies have explored how Instagram can affect mother’s mental health, body image and degree of perceived self-efficacy.

 

This presentation will explore issues around Instagram use for IBCLCs, in particular, ethical concerns related to the type of content they share, consent, the law and sharenting. These issues will be considered in the context of the IBLCE’s Code of Professional Conduct and the World Health Organisation code on the marketing of breastmilk substitutes. The presentation will also look at the type of information new parents are being exposed to on Instagram, and how this information might be shaping their views on aspects of parenting such as breastfeeding, pumping, newborn behaviour, safe sleep practices and tongue tie. Another aspect of Instagram use by new parents that will be considered is how it can affect mental health and parents’ perceived self-efficacy.

 

I submitted the application around the beginning of February (the closing date for applications was 15^th February) and received confirmation around two months later on 5^th April that my abstract had been accepted for an online presentation at the conference. I was thrilled to have been accepted but also a bit daunted as it meant I actually had to get cracking and start putting the presentation together. I had until the beginning of July to submit a competed PowerPoint presentation for review by ILCA.

 

The first thing I did was start reading books and research papers and anything else I could find on topics which I felt were relevant to my presentation, such as the phenomenon that is Instagram, motherhood in the social media age, maternal mental health, privacy, sharenting and predatory marketing. In the space of a month I read around 8 books (see image here fig2 ) and did some fairly in-depth research of parent-facing content on Instagram and of recent studies on motherhood, breastfeeding and social media. I’ve included the references from my presentation at the bottom of this article, just to give you an idea of how much reading and research I did. I suppose I felt that because it was an international conference I had to do everything I could to knock it out of the park. Or at least try! To keep track of all that I was reading and useful nuggets of information or quotes I came across, I created a table in a Word document with three columns: ‘Theme’, ‘Quote’ and ‘Source’ – that way I had everything in one place and could use the document as a basis for my PowerPoint presentation.

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fig2 above

 

I spend a solid two months putting the 87-slide PowerPoint presentation together. I was very determined that it would look attractive and be engaging, because one of my pet peeves is poor quality PowerPoint slides eg. things like font that is too small to read, too much text, and boring or visually unappealing content. I commissioned artist Lauren Rebbeck (who created images to represent the research I did on women’s experiences of breastfeeding with Primary Low Milk Supply) to create some images for me ( see image fig3 and fig4).

fig3 above

fig4 above

 

 

I did a practice run of the presentation – a sort of a first draft – in mid-May to a few volunteers (thank you Mairead Murphy, Maria O’Sullivan, Ciara Butler and Heidi Hembry) who gave me some very useful feedback and lots of encouragement. And after that I kept working on it, and refining it until I had to submit it in July. Once ILCA had accepted my final PowerPoint draft, I recorded the presentation on Zoom and sent it to the conference organisers. I did not particularly enjoy recording the presentation on Zoom – I wasn’t in my comfort zone. But, shortly after I did the recording, ILCA got in touch to offer me the opportunity to present live in Las Vegas instead (apparently someone else had had to cancel). I immediately said yes, as by this stage I had already made plans to attend the conference in person.

 

I have to admit, I did experience quite a bit of anxiety and imposter syndrome in the run up to the trip to Las Vegas. Would I be good enough? Who do I think I am thinking I can present at an international conference? Will anyone even want to hear what I have to say? I just kept working on silencing that inner anxiety, and reminding myself that my voice and my insights were as valid as anyone else’s.

 

On the day, it was grand. I had done the work and done as much as I possibly could have to prepare, so I knew what I was talking about, and that gave me confidence. I also had my fanclub of one, Lorraine O’Hagan, in the audience waving her Irish flag! I only said sh*t once (when my mic fell off) and there were loads of questions from attendees at the end, which I took to be a good sign. I’m glad I did it. It was a big thing for me and I definitely feel more confident about doing future presentations, and also just more confident in myself – it’s that thing of setting yourself a challenge and having the determination and bloody-mindedness to follow it through, despite the moments when you feel afraid and anxious.

 

Just a couple of things to note about speaking at ILCA:

ILCA does not pay its’ speakers (whether they speak online or in-person), and neither does it pay expenses to speakers. However, ILCA does offer speakers a 25% discount on the conference fee. Given that the in-person conference fee is $850, it is still a very expensive conference to attend, even with a 25% discount. In my case, I had decided to travel to the conference irrespective of whether I would be getting any remuneration or expenses for my talk. I am aware of the privilege of being able to afford to attend the conference. Delivering the presentation online is an affordable option for speakers, but the fact remains that you are not paid anything for your time.

I found the ILCA staff very good to deal – always professional, pleasant and clear in their communications to me. The process for submitting an abstract and subsequently being accepted to present is a very streamlined and systematic one. The key dates are given to you at the outset, such as when you need to submit your learning objectives or your PowerPoint slides, so that helps with planning.

 

Do you have a presentation in you? Could you present at the ALCI Conference? ILCA? iLactation? Gold Lactation? LCGB? ELACTA? If you have an idea that you think could be developed into a conference presentation, start writing things down or mind mapping. And see where that takes you. Everyone has some unique experience, knowledge or perspective to offer.

 

If you would like some guidance on writing a conference abstract, please feel free to email me at caoimhew@gmail.com.

References:

Agarwal, P., 2021. (M)otherhood On the choices of being a woman. Cannongate Books.

Aston, M., Price, S., Hunter, A., Sim, M., Etowa, J., Monaghan, J. & Paynter, M. 2021, “Second Opinions: Negotiating Agency in Online Mothering Forums”, Canadian journal of nursing research, vol. 53, no. 4, pp. 327-339.

Auxier, B., Anderson, M., Perrin, A. and Turner, E., 2020. Parents’ attitudes–and experiences–related to digital technology.

Azad, MB, Nickel, NC, Bode, L, et al. Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities. Matern Child Nutr. 2021; 17:e13109. https://doi.org/10.1111/mcn.13109

Baker, B. & Yang, I. 2018, “Social media as social support in pregnancy and the postpartum”, Sexual & reproductive healthcare, vol. 17, pp. 31-34.

Black, R., McLaughlin, M., & Giles, M. (2020). Women’s experience of social media breastfeeding support and its impact on extended breastfeeding success: A social cognitive perspective. British Journal of Health Psychology, 25(3), 754-771. https://doi.org/10.1111/bjhp.12451)

Braghieri, L., Levy, R. & Makarin, A. 2022, “Social Media and Mental Health”, The American economic review, vol. 112, no. 11, pp. 3660-3693.

Brooks, E.C., 2013. Legal and ethical issues for the IBCLC. Jones & Bartlett Publishers.

Bryson, H., Perlen, S., Price, A., Mensah, F., Gold, L., Dakin, P. & Goldfeld, S. 2021, “Patterns of maternal depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum in an Australian cohort experiencing adversity”, Archives of women’s mental health, vol. 24, no. 6, pp. 987-997.

Burke-Garcia, A., Kreps, G.L. & Wright, K.B. 2018, “Perceptions about disseminating health information among mommy bloggers: Quantitative study”, JMIR research protocols, vol. 20, no. 4, pp. e116-e116.

Chin, S., Carlin, R., Mathews, A. & Moon, R. 2021, “Infant safe sleep practices as portrayed on instagram: Observational study”, JMIR pediatrics and parenting, vol. 4, no. 4, pp. e27297-e27297.

Coyne, S.M., McDaniel, B.T. & Stockdale, L.A. 2017, ““Do you dare to compare?” Associations between maternal social comparisons on social networking sites and parenting, mental health, and romantic relationship outcomes”, Computers in human behavior, vol. 70, pp. 335-340.

Esfandiari, M. & Yao, J. 2022, “Sharenting as a double-edged sword: evidence from Iran”, Information, communication & society, vol. ahead-of-print, no. ahead-of-print, pp. 1-19.

Franco-Lares, B., Lara-Mejía, V., Lozada-Tequeanes, A.L., Villanueva-Vázquez, C. and Hernandez-Cordero, S., 2023. Legislation on marketing of breast-milk substitutes in digital and social media: a scoping review. BMJ Global Health, 8(3), p.e011150.

Friedman M. (2018). Insta-judgement: Irony, authenticity and life writing in mothers’ use of Instagram. Interactions: Studies in Communication & Culture, 9(2), 169–181.

Frier, S. 2020. No Filter: How Instagram transformed business, celebrity and culture. Penguin Random House, UK.

Germic, E. R., Eckert, S. and Vultee, F. (2021) ‘The Impact of Instagram Mommy Blogger Content on the Perceived Self-Efficacy of Mothers’, Social media + society, 7(3), pp. 205630512110416.

Gingnell, M., Bannbers, E., Moes, H., Engman, J., Sylvén, S., Skalkidou, A., Kask, K., Wikström, J. & Sundström-Poromaa, I. 2015, “Emotion reactivity is increased 4-6 weeks postpartum in healthy women: A longitudinal fMRI study”, PloS one, vol. 10, no. 6, pp. e0128964-e0128964.

Grond, S.E., Kallies, G. and McCormick, M.E., 2021. Parental and provider perspectives on social media about ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 146, p.110741.

Haley, C.O., Gross, T.T., Story, C.R., McElderry, C.G. and Stone, K.W., Social Media Usage as a Form of Breastfeeding Support Among Black Mothers: A Scoping Review of the Literature. Journal of midwifery & women’s health.

Haugen, F. 2023. The Power of One: Blowing the Whistle on Facebook. Little, Brown and Company.

Hennessy, M. et al. (2020) ‘“They Just Need to Come Down a Little Bit to your Level”: A Qualitative Study of Parents’ Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours’, International journal of environmental research and public health, 17(10), pp. 3605.

IBLCE (2022). Advisory Opinion on Professionalism in the Social Media Age. Available at https://iblce.org/wp-content/uploads/2022/08/2022_August_17_Updated_Advisory-Opinion-Social-Media-Professionalism-and-Online-Communities.pdf [Accessed 29 April 2023].

Keats Citron, D., 2022. The Fight for Privacy: protecting dignity, identity, and love in the digital age. Penguin Random House.

Kirkpatrick, C.E. & Lee, S. 2022, “Comparisons to picture-perfect motherhood: How Instagram’s idealized portrayals of motherhood affect new mothers’ well-being”, Computers in human behavior, vol. 137.

Levy, M., 2023. Don’t Forget to Scream: unspoken truths about motherhood. Phoenix Books.

Marcon, A.R., Bieber, M. & Azad, M.B. 2019, “Protecting, promoting, and supporting breastfeeding on Instagram”, Maternal and child nutrition, vol. 15, no. 1, pp. e12658-n/a.

Moujaes, M. and Verrier, D. (2021) ‘Instagram use, InstaMums, and anxiety in mothers of young children’, Journal of media psychology, 33(2), pp. 72-81.

NBC News (2023). How one teen is urging legislators in Washington state to help protect kids from being exploited on vlogs. Available at: How one teen is urging legislators in Washington state to help protect kids from being exploited on vlogs (nbcnews.com). (Accessed 15 May 2023)

Plunkett, L., 2019. Sharenthood: Why we should think before we talk about our kids online (strong ideas). The MIT Press.

Politico (2023). France aims to protect kids from parents oversharing pics online. Available at France aims to protect kids from parents oversharing pics online – POLITICO. (Accessed 15 May 2023).

The Privacy Whisperer (2022) ‘Your Child’s Privacy is Worth More than Likes’ Available at https://www.theprivacywhisperer.com/p/your-childs-privacy-is-worth-more. [Accessed 14 April 2023]

Richards, N., 2022. Why Privacy Matters. Oxford University Press.

Seals-Allers, K., 2017. The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding. St. Martin’s Press.

Skelton, K.R., Evans, R., LaChenaye, J., Amsbary, J., Wingate, M. and Talbott, L., 2018. Exploring social media group use among breastfeeding mothers: Qualitative analysis. JMIR pediatrics and parenting, 1(2), p.e11344.

Stickel,  S., Eickhoff, S.B., Habel, U., Stickeler, E., Goecke, T.W., Lang, J. & Chechko, N. 2021, “Endocrine stress response in pregnancy and 12 weeks postpartum – Exploring risk factors for postpartum depression”, Psychoneuroendocrinology, vol. 125, pp. 105122-105122.

Yeung, A., Ng, E. and Abi-Jaoude, E., 2022. TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), pp.899-906.

Zappas, M.P., Becker, K. & Walton-Moss, B. 2021, “Postpartum Anxiety”, Journal for nurse practitioners, vol. 17, no. 1, pp. 60-64.

World Vision Cambodia, 2022, “Under [social media] influence digital marketing of breastmilk substitutes in Cambodia”

 

Complied by: Caoimhe Whelan

Dated: 1^st September, 2023. 

Caoimhe did not receive a bursary from ALCI for this report.

ALCI Council would like to thank you for this report.

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ILCA 2023 Conference Presentation –Building Policy Coalitions:

A Case Study of Reframing Breastfeeding Around ‘First Food Security’ in Australia 

Presenters: Naomi Hull and Libby Salmon

Report complied by: Caoimhe Whelan

 

One of my favourite live presentations at the ILCA 2023 Conference in Las Vegas was one by two Australian presenters, Naomi Hull and Libby Salmon, which explored the idea of reframing breastfeeding in the context of ‘First Food Security’ in Australia. Naomi is an IBCLC and volunteer peer counsellor with the Australian Breastfeeding Association (ABA), and has a background in infant feeding policy, research and health promotion. She is also the Australian coordinator for the World Breastfeeding Trends Initiative Assessment (WBTi-Aus). Libby is a PhD candidate at the Australian National University researching the issue of food security for infants and young children as workforce participation by mothers and markets for human milk expand, and supplies of infant formula face unprecedented global demand. Libby is also a volunteer peer counsellor with the ABA and is involved with WBTi-Aus.

 

The presentation took place after lunch on the second day of the conference, and despite the combined effect of jetlag and a post-lunch energy-slump, Naomi and Libby held my interest, kept me awake, and provided me with many interesting insights into breastfeeding policy in Australia and the notion of reframing breastfeeding as a first food security issue.

 

Naomi started the presentation by providing us with some context. She provided statistics on breastfeeding in Australia – an initiation rate of 96%, exclusive breastfeeding rate of 15% at 5 months, and 20% of babies still breastfeeding at 12 months. However, these figures are from 2010 and Naomi informed us that Australia currently has no national breastfeeding strategy, no national coordinating committee, no targets and no up-to-date data. Naomi went on to describe some of the consequences of a lack of funding and national breastfeeding policy, such as a lack of emergency planning and preparedness for infant and young child feeding in the event of bushfires. Australia experienced bushfires in 2019 and floods in 2022 and some families found themselves in situations where they were seeking shelter, with no access to facilities to prepare infant formula or access family-centred support. Large amounts of formula were donated in an uncoordinated fashion, but often it went out of date before it was used, or was for infants over twelve months of age.

 

Naomi went on to explore why health systems fail breastfeeding and fail families like those affected by natural disasters in Australia. She focused on Australia’s interests in commercial milk formula (CMF) and how the powerful infant feeding lobby has managed to influence policies on formula marketing, export and manufacture. Much like the Irish government, the Australian government subsidises the CMF industry and in doing do, “puts babies before bottom lines”.  However, there are many non-governmental organisations in Australia who have joined forces to form a coalition that aims to counter the influence on government and policy by the CMF industry. This coalition includes the ABA, WBTi-Aus, the Public Health Association of Australia, the Australian College of Midwives, Lactation Consultants of Australia and New Zealand, and academic institutions. The main goal of coming together as a coalition is to get the members to consider the collective knowledge and skills they can use to help shape breastfeeding policy and planning in Australia, and in effect to have members ‘singing off the same hymn sheet’. Naomi concluded her part of the presentation by encouraging all those in attendance to consider who their local coalition members might be (eg here in Ireland we have ALCI, Cuidiu, La Leche League, academics, researchers etc), and how they might be better able to work together to influence policy and fund research that will result in achieving our breastfeeding targets or as she put it, our “breastfeeding utopia”.

 

Libby presented for the second half of the session and started off by defining the term ‘first food security’ as “when all people at all times have physical, social and economic access to sufficient, safe and nutritious food…” (Food and Agriculture Organisation, 1996). When framed in this context, breastmilk becomes a critical universally available first food for infants and young children, and a “sustainable, localised food system”. However, this breastmilk food chain is vulnerable to disruption if it is not protected, promoted and supported, and grounded in women’s and children’s rights to breastfeed. Libby described some of the situations and contexts which can threaten the security of breast milk as a first food; infant formula marketing, and structural failures such as lack of paid maternity leave and sociocultural factors. One point she made really resonated strongly with me, that of the ‘breastfeeding paradox’ – that the poorest households are the least likely to breastfeed. This is particularly true here in Ireland and has been previously highlighted by the ESRI Growing up in Ireland study.

 

So, how can the concept of first food security be used as an advocacy tool for breastfeeding? Libby outlined a number of ways in which this can be done, first and foremost by reframing the protection of breastfeeding first food security from optional to critical. She also suggested that breastfeeding is discussed in policy forums other than that of maternal health, such as disaster planning and farming, and that focusing on the first food security messaging has the potential to disrupt CMF marketing messages. Breastfeeding is not just a women’s health issue. Infant feeding is not just about a choice that parents make. Breastfeeding has to be considered in the context of climate change, structural barriers, rights, and food security and must be regarded as a solution. In an Irish context then, we should be looking at which population groups or demographic areas are vulnerable, and what needs to happen (policy changes, initiatives etc) to provide them with the supports they need to reduce those vulnerabilities.

 

Libby described efforts that a coalition of organisations including the ABA, Infant and Young Child Feeding in Emergencies (IYCF-E) and Food Systems Policy (Deakin University) put into creating a submission to an Australian Government inquiry on food security that was initiated in 2022. The submission defined breastfeeding women as “primary producers” and highlighted the value of breastfeeding to the economy. It also stressed the importance of paid parental leave in protecting breastfeeding, the resilience of breastfeeding as a food source during emergencies and the importance of breastfeeding in mitigating the effects of climate change. The submission was initially rejected by the inquiry and it was only after sustained lobbying of members of parliament and the government agriculture committee that the submission was finally accepted.

 

To conclude her presentation, Libby outlined recommendations for how breastfeeding organisations in other countries should advocate for first food security. The first step is to define first food security in emergency and everyday contexts, the second is to identify coalition members, the third is to identify a clear message/asks and political opportunities,  and the fourth is to develop a strategy that will allow for opposition, engage coalitions and get breastfeeding on the right agendas.

 

Both Australia and Ireland have big dairy farming and CMF manufacturing industries. So, there may be a lot of key learnings from our colleagues in Australia on how they reframed breastfeeding as a first food security issue and managed to push back against the power of CMF industry marketing and lobbying. Is there anything we need to be doing differently in Ireland to ensure that breastfeeding is being taken seriously, not just as a women’s health issue, but as something that is critical to ensure first food security and mitigate against the effects of climate change? Do we need to build an Irish Breastfeeding Coalition?!

 

 

Report complied by: Caoimhe Whelan

Dated: 1^st September, 2023. 

Caoimhe received a bursary of €300 from ALCI to attend the ILCA Conference, which was held in Las Vegas.

ALCI Council would like to thank you for this report.

 

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To view in more detail, click here: Claire Allcutt’s Report – June ’23

Unravelling the Mysterious Milk Ejection Reflex

By Sue Jameson IBCLC, FILCA

It was brilliant to be back at a face to face conference in the UK last month. LCGB our sister organization had invited a selection of speakers covering many integrated topics over the weekend. The theme was ‘ From Science to Practice’.

 

Someone well known to us in ALCI, Lisa Marasco MA, IBCLC, FILCA uncovered the mysteries of the milk ejection reflex on Day 1 and engaged us all on Day 2 to look at Unsolved mysteries of the Mammary Gland.  I am going to attempt to give you an outline of Lisa’s complex talk on Unravelling the Mysterious Milk Ejection Reflex.

 

Anyone working with lactation folks have seen a variety of situations where the milk ejection reflex is slower than we would wish, faster than the mother would wish and in some cases, absent to a great extent.

 

Lisa provided a detailed description of the physiology of Milk Ejection, citing the work of Kerstin Uvnas Moberg from her book Oxytocin – the biological guide to motherhood, and many other references, which I can make available to anyone interested in reading more on this complex subject.

 

So what does suckling do? It induces the release of local peptides which in turn relaxes the opening of the milk ducts and blood vessels in the skin overlying the mammary glands – the familiar ‘red flush’ we are accustomed to seeing on a breastfeeding persons chest area. Oxytocin is released into the circulation and causes the contraction of myoepithelial cells. This in turn triggers activity in the brain which downregulates the sympathetic nervous system. This means a lowering of fear and anxiety in the parent which further downregulates the Sympathetic Nervous System. All the actions above increase the skin temperature and cause the Milk Ejection Reflex to activate.  There are so many actions and reactions involved in milk ejection that it is easy to see how the system can be influenced at so many different stages during the process. As IBCLCs we need our best sleuthing skills to get to the bottom of issues faced by our clients when it comes to problems with milk ejection.

 

So why does MER not always work reliably?    The three main areas of investigation are :

1. Physiological – subdivided into hormonal/metabolic and Mechanical reasons.

Hormonal/Metabolic	Mechanical
High BMI	Poor quality of suckling stimulation
Hypertension/pre-eclampsia	Unusual nipple & ductal anatomy
Thyroid dysfunction	Nerve subluxations
Diabetes	Breast nerve damage from surgery or accident
	Spinal cord injury

 

2. Pharmacological

Smoking/nicotine

Alcohol

Morphine

Tocolytics ?

Magnesium ?

Oxytocin in Labour ?

3. Psychological – subdivided into Pain or noxious stimuli and psychosocial

 

Pain or Noxious stimuli	Psychosocial
Postpartum pain	Chronic stress
Latch pain	Anxiety/PTSD
Vasospasms	Adverse early experiences (ACE)
Breast/nipple trauma	Depression
Biting	Race & poverty
Partner abuse	Grief & loss
	Negative or chaotic environment

 

 

So what do we know? That milk production  and milk yield are not the same. Parents perception of supply is based solely on yield in many cases.

Oxytocin is essential to milk production as well as delivery.

The vagus nerve – cranial nerve X often called the wandering nerve operates outside the spinal nerve. Stimulation of this nerve by stroking (in rats) gives immediate increase in oxytocin

Alveoli don’t contract all at the same time – the fuller they are, the more sensitive to oxytocin.

There are a range of sensations felt during MER which can vary from barely felt to painful.

The closer the mammary tissue is to the nipple, the diameter of the ducts, milk density & viscosity, elasticity of tissue and infant suck all play a role.

Oxytocin release can be longer or shorter bursts and can vary in number, with the first couple yielding the most milk.

Exposure to stress during nursing resulted in significantly fewer oxytocin peaks

Genetic make up plus early life experience affect oxytocin function.

 

So how does labour and birth impact on Oxytocin and MER?

It would appear that oxytocin given in labour is related to natural levels on Day 2. The more Oxytocin given in labour, the lover the  level of natural oxytocin on Day 2. It is temporary and may interfere with feedback mechanisms. Jonas 2009

Epidural administration is also linked to a higher risk of disturbing the oxytocin mechanism.

Active management of Stage 3 of labour also implicated in reduced duration of breastfeeding (Brown A & Jordan S (2014)

Problems with C Section.  Stress activation in emergency situations. With elective no priming of oxytocin system and slower initiation of breastfeeding. Wang Y (2019)

 

So how can we help?

Get our best investigative heads on and look for source of inhibition.

Work towards creating an environment of safety, relaxation & confidence

Help parents to reduce anxiety by avoiding data collecting and help them to focus on being present, responding to their baby in the here and now.

Teach stress reducing techniques and above all re-inforce successes and positive thoughts. It is possible to press the re-set button and improve positive conditioning of the let down reflex.

Using  relaxation therapy, hypnotherapy, acupuncture, acupressure, reflexology, breast massage, warmth, baby wearing, skin 2 skin, breast compression, and massage  can all help to improve MER and oxytocin response.

There is also a place for herbal and other pharmaceutical remedies known as oxytocics.

Lisa also reckoned it was time to revisit the use of nasal sprays. She shared a selection of RCTs (Randomised Control Trials) which clearly demonstrated a place for pharmaceuticals in this arena.

 

Sue Jameson, May 2023. 

Sue received a bursary of €200 from ALCI to attend the LCBG Conference in the UK.

To ALCI members,

As you are aware, one of the many benefits of becoming an ALCI member is having the opportunity to apply for a Bursary to attend a breastfeeding related event.

 

Click on the link with the latest ALCI Bursary application form, to be used: ALCI’s Bursary Application – updated 30.01.2023

 

Thank you,

ALCI Council

 

To view this new’s letter in higher quality,  Click Here

ALCI’s Poster Call, is open

 

Click below to read the full report in a pdf.

The 12th ELACTA Conference Breastfeeding and Lactation DMCG

Denise received a bursary from ALCI to prepare this report.