LCW 2022: Midwives
Lactation Celebration Week: Day 2
Today I’m going to talk to all the midwives out there. Thank you for your work to support our expecting families!
“Midwives have a powerful influence on a person’s decision to chest feed and on the success of their feeding experience.
Quality midwifery care improves survival of the infant and birth parent, health and well-being throughout the antenatal, birth, and postnatal periods.”
Midwives play a unique role in healthcare. They can have different credentials and have slightly different scopes of practice but, in general, they do similar work: gynecological care, birthing care from conception through the postpartum period, and often pediatric care up to 6 weeks. There is a wide age range of people they work with and, therefore, many points throughout someone’s life when they may discuss lactation.
Because of their family focused model of care, young children are often brought along to prenatal and postpartum appointments. Kids may also be present during the birth of a loved one and midwives are perfectly situated to normalize labor, birth, and lactation at an age appropriate level.
WABA has a few suggestions of how midwives can use their role in the warm chain to step up and support and advocate for lactating families:
Discuss lactation with youth in reproductive health education
While it may not germinate right away, planting the seed of infant nutrition in a young person’s mind is critical. In time, and with nurturing, continuing to educate, and normalizing human biology (lactation), the seeds will sprout.
It takes all members of the warm chain to help the seed flourish.
As a parent, lactation consultant, and community member, I take youth lactation education very seriously. Children are our future and if we want to change the future, we need to help our kids learn.
Inform expecting families about the benefits and management of exclusively providing human milk
Most people know there are well-researched, evidence-based reasons to give a baby human milk, however, most of those people are never taught how to manage latching, milk production, growth spurts, introducing solids, nursing strikes, or weaning.
Referring families to a prenatal lactation class is necessary for any family expecting a baby, even if they are planning on exclusively formula feeding
Yes, I just said that…but there’s context.
Everyone should understand how babies work. Prenatal lactation classes, while they include lots of info related to milk production and management, also talk about expected infant feeding behavior. This behavior is the same, no matter what the baby is drinking. All families need to understand normal, biological baby behavior.
There are some classes that are very pushy with the “breast is best” narrative. For formula feeding families, find a class that’s informative but not pushy. Interview the instructors for classes and see if they teach a class that would be right for your clients.
A private class or prenatal lactation appointment may be best for families who are planning to exclusively bottle feed
Additionally, if a family is planning on exclusive bottle feeding, an appointment with an IBCLC can teach them about functional bottle feeding so they know when bottle feeding isn’t going well. Just because a baby can swallow liquid doesn’t mean they are doing well.
A prenatal lactation class also gives families a resource to connect with prior to the birth of their child. If families already have a trusted lactation person in their mind, they’re much more likely to call before a feeding crisis hits.
Enable families to achieve their ideal birth experience
Doulas. Doulas are magic. Work with doulas. Doulas work hard to support and advocate for families to have the birth they always imagined. They are an essential stepping stone to preventing birth trauma.
If you don’t have a network of doulas you recommend to all clients, no matter their birth method, start making phone calls
The Community Doula Alliance is a local (Oregon) organization that can help families find a doula
Student doulas can be a less expensive option for families who may not have the funds for a private doula
A traumatic birth experience negatively impacts parent/infant bonding, disrupts lactation, and can lead to postpartum depression or psychosis
Who are the postpartum mental health practitioners you can refer families to in the case of a traumatic birth or experience?
What are their wait times? A great therapist who has a 4 month wait list isn’t going to be able to help your client now.
Support the Golden Hour after birth
Ensure skin to skin (S2S) contact between the parent and baby for AT LEAST one solid hour and ideally until the baby has finished their first feed.
Actually, ideally the baby would be skin to skin with the birth parent or a close relative for the first 1000 minutes.
Want some super scientific research on S2S? Nerd out to Dr. Nils Bergman, an expert on the subject, and promoter of 1000 minutes of skin to skin contact.
The first (couple) hours after birth will never happen again. The Golden Hour is sacred. Protect it.
APGARS can be observed while S2S. Weights can wait. Meds can wait. Baths can wait.
Want some super scientific but easy to read info? Check out the World Health Organization’s article on skin to skin contact.
WHO recommends 90 min of uninterrupted skin to skin contact immediately after birth
Provide lactation counseling for all families and refer to an IBCLC if complications arise
Watch a feed. Ask specific questions about feeding, baby behavior, milk management, diaper counts, etc.
New parents (and any of us, really) don’t know what they don’t know. Asking targeted questions can help you identify the hidden red flags that indicate a referral is needed.
Targeted questions also help parents remember stuff they learned prenatally. Brains turn to mush after a baby is born and much of the info is forgotten…they may just need a little memory refresher!
Listen to parents. What lactation or baby behavior concerns do they have? Answer and counsel appropriately but if you don’t know the answer, refer to someone who does.
Trust parents. They are the expert on their baby.
Concerns about baby behavior (sleep, poop, fussiness, cradle cap, hiccups…), particularly in the first month, are often related to feeding issues
And refer to support groups!
Decline gifts, samples, sponsorships or displays of infant formula, bottles, or teats from companies
I know we all love free stuff but taking free stuff and giving it to clients or having it where clients see it is an endorsement of the company which undermines lactation.
If you have not heard of the World Health Organization’s International Code of Marketing of Breast-milk Substitutes (AKA “the Code”), A) I’m not surprised and B) read it
I was a labor & delivery and postpartum nurse in a busy OB unit with a Level III NICU for 6 years before I started my journey to becoming an IBCLC and only in my IBCLC coursework did I hear about the code. I’d be more surprised if you had heard of the Code.
By taking gifts, samples, sponsorships, or continuing education funded by formula/bottle/pump companies, you are showing the companies that their marketing is worth the $480 million/year spent on advertising (in the USA…and that just the formula companies)
This doesn’t mean you can’t use formula in your clinic; it means you can’t advertise the formula you have in your clinic.
Decline the samples, pens, mugs, rulers for measuring head circumference, scale paper, parent centered lactation education pamphlets, free lunch…
Pay for the formula. You will be much more mindful about formula usage in your clinic.
Formula should be given to families exactly how you would give out medication samples.
No free table of meds
Not every baby is eligible
Try a variety of other non-medication related methods (LACTATION SUPPORT) first
Tell event organizers that you are boycotting their webinar or conference because they are sponsored by * insert major formula company *.
This also goes for bottle and pump companies
I have seen keynote speakers be fired by conference organizers for being funded by a well-known pump company. Enough IBCLCs spoke up about the conflict of interest and the person was asked not to present. IBCLCs mean business when it comes to the Code!
WHO put out a report earlier this year called “How the Marketing of Formula Milk Influences our Decisions on Infant Feeding.” Here’s a short summary of the report written by WHO.
*Upholding the Code will come up in several of the posts this week because formula/bottle companies market everywhere. Apologies if this info gets redundant but I’ll try to give some links/resources specific to the warm chain link we’re talking about.
Empower parents with strategies to help them combine pumping and work
Ask parents what their plan is for childcare and infant feeding if they will be separated from their baby for work
Location, number of hours away, number of days per week
The type of childcare setting a family uses may dictate the specifics of how their baby is fed.
Daycare workers must follow strict food handling guidelines while a family member or nanny at home can use normal guidelines for milk storage and feeding.
Refer to a lactation consultant for every pumping parent to get properly fitted for flanges
Pumping sessions are more productive
Better for maintaining milk supply
Less chance of nipple damage (sort of like wearing properly fitting shoes…no one wants the wrong size)
99% of my clients need a smaller flange than what comes in the box
Encourage parents to tell their employer what they need when they return to work
This should be discussed prenatally, as some jobs require creative thinking to procure a private pumping area
Make sure parents know there are laws (nationwide; here’s Oregon's) protecting their right to pump at work
If you’re a midwife, what’s something you do for every family to support lactation? Where did you first learn about the Code? How do you incorporate lactation in reproductive health education for young people?
Parents, share a story about how your midwife supported you!