Tag Archives: Breastfeeding

Book Review – Breastfeeding Take Two

Thank you to Claire Bulfin, IBCLC for this review of ‘Breastfeeding Take Two’ by Stephanie Casemore.

I like this book. I would recommend to a mother who was disappointed with her breastfeeding journey the first time and is preparing to breastfeed a second baby. This book would also be a great library book for a breastfeeding support group.


‘Breastfeeding Take Two’ contains several honest and real stories from mothers who had challenging breastfeeding experiences, and explores the emotions that these experiences brought up for them, eg one mother is quoted as saying “I was angry and defensive and was ashamed to be seen giving him a bottle.” The book explores how women can work throught these kinds of emotions, come to understand what failed them first time (eg lack of information, support, or confidence) and how to move forward, heal from the loss of their breastfeeding experience, start afresh and ‘take two.’


The author includes well researched references and has a put a lot of work into making this a good reference book as well as personal. She delves into why breastfeeding fails for some and is successful for others. Our chapter explores how society and culture shape how we perceive breastfeeding and how we learn about it (or don’t learn about it!).


Advice regarding breastfeeding issues such as increasing milk supply is well referenced and fact based.


I enjoyed reading the mother’s stories and will definitely recommend it to mothers.



Book Review – ‘Breastfeeding Uncovered’ by Dr. Amy Brown

Breastfeeding Uncovered by Amy Brown

Reviewed for ALCI  by Dr Genevieve Becker, IBCLC   Jan 2018


Published by Pinter & Martin, UK 2016. 318 pages excluding references. Approximate price €15.


“We need a new approach to feeding babies” states Amy Brown. She then explains that the approach needs to recognise and get rid of barriers that mothers face, to portray breastfeeding as just normal and not news or debate, and not leave responsibility for breastfeeding to the mothers themselves, motivated individual health workers or volunteer supporters. “Breastfeeding is society’s responsibility.”


Dr Brown explores the evidence of the effects on breastfeeding decisions and carrying out those decisions, and how all of us – society – can act to change these effects. In the introduction she lays out 18 steps. I particularly like Step 15: “Educate the public to stop being idiots, or at least do no harm”. Throughout the book there is a conversational tone so it seems like a friend chatting with you. Numbers and statistics, such as risks of not breastfeeding, are explained with easy to follow analogies as well as answers to commonly raised questions about research evidence provided.


Dr Brown includes responses from mothers from her own research experience which helps to keep the focus on the situations and practicalities that affect real mothers and babies and why these are issues beyond the individual mothers. Responsive feeding and baby care and “normal” (frequency of feeding, sleep, closeness, birth practices, and psycho-social interactions) are well covered and what are the effects on breastfeeding, and the barriers and knowledge gaps related to these practices being better supported. Motherhood, body image, mental health and individual personalities are also included as are fathers, health professionals, media, marketing, economics and politics.


It is easy enough to read, however, I found I wanted to make notes and mark key sections like a textbook so maybe not beach-side reading. The book is also well researched with a 23 page appendix of the chapter-by-chapter references for all the evidence that she discusses using both historical and very recent studies. Some readers might prefer the references were nearer where they occurred in the text, though others may prefer the smoother layout unbroken by citations. I suggest an overall read first and then a more detailed read that also considers the references.


The book is UK-focused though very applicable to Ireland. If you found previous books such as Breastfeeding Matters by Maureen Minchin and Politics of Breastfeeding by Gabrielle Palmer enlightening and motivating, then this book is also for your bookshelf. The difference is Dr Brown gives clear practical points and clear arguments towards what all of society can do to change the situation to be more supportive of breastfeeding as the societal norm. There are many pithy phrases that could be quoted in presentations and media articles (with credit to Dr Brown of course).


I recommend all ALCI members read it and that they encourage other health professionals, students, media workers, politicians, and those who know it all and pontificate on their opinions, to also read this book. Her website has even more to explore http://breastfeedinguncovered.co.uk


Report on the Results of the DAME Study

This report, by ALCI member Denise McGuinness IBCLC and Clinical Midwife Specialist (Lactation) at The National Maternity Hospital, Holles Street, is from the International Lactation Consultants Association Conference in Toronto, in July 2017. Denise was offered a small bursary by ALCI to attend this conference.



Presentation: The Diabetes and Antenatal Milk Expressing (DAME) Study. Anita Moorehead

The Diabetes and Antenatal Milk Expressing (DAME) study is a randomised controlled trial carried out by a team of researchers in Australia. The findings from this study were presented by Anita Moorhead (Registered Midwife) to the International Lactation Consultants Association (ILCA) Conference in Toronto, Canada in July 2017. The study was part of Anita Moorhead’s PhD.


The study is particularly interesting as type 2 diabetes and gestational diabetes are increasing globally. It is recognised that women with diabetes in pregnancy are at increased risk of not breastfeeding exclusively. This group of new born infants are at increased risk of hypoglycaemia and admission to a neonatal unit. Infant formula is more likely to be offered to these babies if there is no available colostrum. Babies are also at increased risk of separation from their mothers due to admission to the NICU. The study aim was to determine if antenatal expression of colostrum was a safe practice for women with diabetes in pregnancy.


The study was a multicentre, randomised control trial which involved six hospitals in Victoria, Australia. A total of 6565 women were assessed for eligibility, however, only 2593 women were subsequently eligible to participate in the study. Interestingly, 3972 women were excluded from the study, the majority due to obstetric risk (n= 1004).


Inclusion criteria were as follows: Pregnant women wishing to breastfeed with pre-existing or gestational diabetes, between 34 to 37 weeks gestation, single pregnancy and baby with a cephalic presentation.


Exclusion criteria included the following: any history of antepartum haemorrhage or placenta praevia, a previous classical caesarean scar or more than one lower segment caesarean section, any indication of compromise to the baby in utero, growth restriction, larger baby, polyhydramnios, foetal anomaly to include maternal obstetric or medical issues.


Method- Women with diabetes in pregnancy were randomised to either expressing colostrum twice per day for no more than 10 minutes, from 36 weeks gestation or standard care by the obstetric and diabetes team. A total of 777 women with diabetes were recruited with 635 women randomised to each group as follows: 319 women were allocated to the antenatal hand expression group and 317 women were allocated to standard obstetric and diabetic care. The majority of women had gestational diabetes, were expecting their first baby with half the women reported as obese or overweight.

Women included in the study were provided with written and verbal instruction in relation to the technique of hand expression, collection in a syringe, freezing and storage. The colostrum was labelled with the hospital medical identification label and transported frozen, where it was placed in a dedicated hospital freezer following arrival at the hospital for birth.



  1. The majority of women, 134 (42%) expressed >/= to 20 times, 80 (25%) women expressed 6-19 times and interestingly, 19 (6%) had not expressed following randomisation to the research study. It was recognised that early feeding volumes expressed were small. The average volume of colostrum expressed was 5.5 mls.
  2. The number of infants admitted to the neonatal intensive care unit did not differ between randomised groups. The three main reasons for admission to the NICU were as follows: hypoglycaemia, suspected infection and respiratory distress. In the antenatal expressing group the most serious adverse event for babies was respiratory distress (<1%) of 317 infants.
  3. The mean gestational age at birth was also comparable.
  4. There was an increase in exclusive breastfeeding in- hospital with this cohort of babies. This avoided formula milk among this group of babies during the early feeding stage, which the authors suggest may have long term implications for future development of diabetes in these infants.


The DAME study was the first randomised controlled trial to test the practice of antenatal hand expression of colostrum. The authors concluded that there was no harm in advising women with diabetes in pregnancy at low risk of complications to hand express colostrum from 36 weeks gestation. However, they issue a note of caution that the study results should not be extrapolated to high risk populations.


The following paper supported the accuracy of the information provided at the conference.

Forster, D.A., Moorehead, A.M., Jacobs, S.E., Davis, P.G., Walker, S.P., McEgan, K.M., Opie, G.F., Donath, S.M., Gold, L., McNamara, C., Aylward, A., East, C., Ford, R., Amir, L. (2017) Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing (DAME)): a multicentre, unblended, randomised controlled trial. The Lancet. 389, pp.2204-2213.

Supporting Couples and Families during Pregnancy after Loss

write up by Aine McCarthy, IBCLC, Midwife. BScNS, MSc


This ALCI 2017 Conference Presentation was given by Margaret Murphy, Doctoral Candidate, MSc, BSc, PGDip in Teaching and Learning, RM, RGN, IBCLC


Margaret’s presentation titled “Pregnancy After Loss: The Role of the IBCLC in Supporting Couples and Families” struck a chord on both a personal and professional level with a captivated and emotional audience. This sensitive subject is largely hidden, and requires further open discussion and the silence surrounding this area needs to be unravelled.


The IBCLC’s role is in supporting families who have experienced infant loss is predominantly one of providing support.  According to Margaret, 1 in 4 pregnancies worldwide will end in loss. In Ireland, that means 15,000 miscarriages per year. 1 in 238 pregnancies will end in stillbirth and 1 in 340 will end in neonatal death. Pregnancy loss affects half of all pregnancies over 40 years of age.


Ireland sits in the middle of the curve in relation to pregnancy loss, and rates vary favourably within the global context. However, these stats may be skewed as we do not routinely offer screening for life limiting conditions, termination and perinatal centre care or post-mortem is not routinely offered in comparison to our counterparts who routinely offer these to all women attending maternity centres. Interestingly there is no internationally agreed definition, leading to huge variation of what constitutes pregnancy loss.


In the Irish context the legislative definition of pregnancy loss includes a child born weighing 500 grammes or more or having a gestational age of 24 weeks showing no sign of life. For the purpose of understanding the statistics perspective, perinatal mortality refers to the death of babies in the weeks before or four weeks after birth. Perinatal mortality includes stillbirths (babies born with no signs of life after 24 weeks of pregnancy or weighing at least 500 grammes) and the deaths of babies within 28 days of being born (National Perinatal Epidemiology Centre, 2013).


Causes of pregnancy loss include antepartum conditions, placental conditions, infection, growth restriction, hormonal problems, chromosomal abnormalities, and immune system responses.


Respectful Bereavement

Margaret spoke about how we collectively need to break the silence. The general population do not know that fully formed babies can die, and there is a general assumption that once babies are viable  that pregnancy loss cannot occur.There is not enough research on health care messages in relation to pregnancy loss.


According to Margaret, respectful bereavement care means acknowledging parenthood, facilitating attachment between the baby and family and supporting the grieving process and various ways of grieving. So it is important for staff to be educated on pregnancy loss so that they can provide suitable bereavement support.


Suitable bereavement support means


  • Helping a family to welcome baby into the world and into the family
  • Addressing the baby as a person; name the baby (use the baby’s name consistently), acknowledge the baby’s individual characteristics, and note parental features/sibling resemblance.
  • Acknowledging Parenthood; address parents as mother and father or mummy and daddy…include siblings. Studies support the inclusion of toddlers and outlines that they can cope with meeting the baby and helps in their bereavement and understanding of the process.
  • Providing respectful care to the baby and parents.
  • Acknowledging the trauma that the parents are experiencing.
  • Modelling respectful behaviour.
  • Giving time.
  • Promoting bonding and meaningful experiences and memory making visits.
  • Some parents enjoy skin to skin contact so it is important to be mindful of the baby’s skin cooling as the baby temperature cools this may alarm or upset parents. (Cuddle cots/cooling blankets) – https://www.irishtimes.com/life-and-style/health-family/parenting/cooling-cuddle-cot-allows-extra-time-with-stillborn-babies-1.2634818
  • Supporting families to create mementos eg photos and prints.
  • Ensuring rigorous medical care and investigations.


In supporting the grieving process, it is vitally important to let parents share their story over and over again, and to listen and be present without feeling the need to give advice. Hold space for these families, listen, be respectful and avoid rushing them into a grievance process.


“Grief is not on a timeline.”



Healthcare professionals should also be mindful of the language they use with bereaved families. eg

“I’m sorry that your baby has died and I don’t know what to say   but  I want you to know that I’m thinking of you…” or

“I see that you are grieving…I’m so sorry…”


And platitudes should be avoided eg   “God needed an angel.”




To conclude, the session finished with a few tears shed, a graphic illustration and a depiction of a Japanese bowl and the art of kintsugi, whereby the Japanese repair broken pottery with gold.  This kind of repair makes the bowls more valuable. Similarly, the grief parents feel after loss will be forever part of them, but makes them who they are and gives them qualities of strength and compassion that they carry through their lives.


“Grief is something that alters you at a cellular level. You never get over it, but you learn to live with it.”





Reference and Resource Links



















ALCI Attends Reception at Áras an Uachtaráin

14543707_1309582015721571_4877222370649048807_o-2In September, ALCI were thrilled to be part of a special reception in Áras an Uachtaráin in celebration of National Breastfeeding Week.

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







(Photo on right with thanks to Maxwell Photography)



Addressing a room filled with happy mothers and babies, Sabina spoke about her own experiences as a breastfeeding mother and emphasised the importance of breastfeeding to life long health. Sabina remarked that it was wonderful to see IBCLCs represented at the event, adding that there was a big need for more Lactation Consultants.






Nicola O’Byrne, ALCI President gave a short speech about ALCI and IBCLCs in Ireland. She stressed the importance of role models such as Mary Robinson and Sabina Higgins. Nicola also expressed her building hope that attitudes towards breastfeeding in Ireland are changing.  Ciara Butler, Vice-President, Meabh-Ann McNamara, Past President and Eimear O’Connor, ALCI secretary also accompanied Nicola to the reception at the Aras.





(Photo on right with thanks to Maxwell Photography)

ALCI Conference Hailed A Great Success

The recent Annual Conference of the Association of Lactation Consultants in Ireland was opened  by Frances Fitzgerald, T.D., and Minister for Children & Youth Affairs, pictured here with  (from left to right) ALCI President Margaret Murphy IBCLC, Keynote Speaker Barbara Wilson Clay, IBCLC, Minister Frances Fitzgerald and ALCI Vice President Meabh Anne McNamara IBCLC.

ALCI Conference Hailed A Great Success

In her opening address Minister Fitzgerald thanked the International Board Certified Lactation Consultants (IBCLCs) community for the work they do in supporting breastfeeding in Ireland. She highlighted the valuable contribution Lactation Consultants make to the health of the nation’s children. She cited in particular the emerging evidence from the Growing Up in Ireland Survey and the benefits of breastfeeding in combating childhood obesity. She encouraged IBCLCs (as strategic, key stakeholders) to become involved in government policy development, particularly in formulating the Early Childhood Strategy.


With 10 plenary presentations and 3 workshops, over 2 days, plus research posters, networking, new product information and much more, the ALCI Annual Conference proved to be the premier event for health workers involved in assisting and promoting breastfeeding in Ireland.


See Barbara Wilson Clay and ALCI President Margaret Murphy speaking on Ireland AM 3rd Oct 2013.

 Twitter: #2013ALCI

Register before Friday Sept 20th to SAVE €20 at the Annual ALCI Conference

Creating Realistic Breastfeeding Expectations”

Annual Conference of the Association of Lactation Consultants in Ireland.

Friday 4th and Saturday 5th October 2013 in the Green Isle Hotel, Clondalkin, Dublin 22.




Workshops are filling fast – register NOW to get your first choices


Special rate B& B in the hotel with triple rooms for an even better deal.


Conference is about networking too. After the sessions on Friday enjoy a chat in the special interest groups:


CMS-Lactation, IBCLCs in Private Practice, Primary Care, Paediatric, Education and others, or spend some time in the leisure centre.


Sign up for adinnertable to continue networking .



Then attend the free Friday social evening: Comedienne Rose Henderson (pictured here on the right) on mothers and breastfeeding plus Fit to Bust talent, silly games and plenty of time to meet new colleagues and catch up with old friends.


With 10 plenary presentations and 3 workshops over 2 days plus research posters, networking, new product information and much more, the ALCI Annual Conference is the premier event for health workers involved in assisting breastfeeding in Ireland.


Register NOW and don’t miss out
Click here for a Booking Form, and further information is available from info@alcireland.ie or text 089 441 6497

“Creating Realistic Breastfeeding Expectations”

Annual Conference of the Association of Lactation Consultants in Ireland


Friday 4th and Saturday 5th October 2013


Green Isle Hotel, Clondalkin, Dublin 22


The use of appropriate language for promoting and supporting breastfeeding and creating realistic breastfeeding expectations for both parents and health workers are the focus for the upcoming Annual ALCI Conference. 


With 10 plenary presentations and 3 workshops, over 2 days, plus research posters, networking, new product information and much more, the ALCI Annual Conference is the premier event for health workers involved in assisting breastfeeding in Ireland.


– The Conference will be opened by Ms Frances Fitzgerald, Minister for Children & Youth Affairs.


– Barbara Wilson Clay, IBCLC, world renowned presenter, will speak on Guilt and Infant Feeding Choices; How Language Affects Expectations; Assessing Lactation Acuity: big problem or little problem?; Why is the Baby Sleepy?; and Why No Milk?


– Siobhan Hourigan, National Breastfeeding Coordinator and Mary O’Connor, IBCLC, will discuss Community breastfeeding initiatives for change and the introduction of a pilot community support programme in Kerry.


– Aileen Doyle, IBCLC and Mary O’Rourke will present findings from their recent research studies on practice related issues with breastfeeding in Ireland.


– Workshops on Saturday 5th October include topics such as the private IBCLC interacting with other health service providers (Nicola O Byrne, IBCLC); ending free formula in hospital (Dr. Genevieve Becker, IBCLC); choosing and using breast pumps (Ger Cahill, IBCLC); and assessing a feed/taking a history (facilitator to be confirmed), and Mary Mahon, IBCLC will facilitate a workshop on achieving and sustaining change in practice.


Conference participants are invited to submit research and practice posters for display, discussion and publication in the conference abstract book and awards.


The conference is approved for 12.25 (L & E) IBLCE CERPs and 5.5 Nursing and Midwifery Board of Ireland (An Bord Altranais agus Cnáimhseachais) CEUs (Category 1, Course Groupings 4 and 9). INDI CPD Approval has been sought.


Handouts, lunch and refreshments are included in the registration fee.


Early Bird rate (before Friday September 13th 2013) is €100 for members (for both days) or €60 (for one day) and €140 and €100 for non-members. There is a discount rate available for full-time students in relevant professions.