CONF 2018 To Clip or Not to Clip? Clinical Dilemmas Regarding the Release of Posterior Tongue Tie and their Implications for Infant Feeding1 credit offered Recorded On: 07/20/2018
A case for clipping, a case for waiting: Difficult decisions in clinic Background: As far as anterior tongue tie is concerned, there is a vast body of knowledge that has been validated. As for posterior tongue tie, the scientific evidence is lacking. Medical diagnoses are not part of the scope of practice of Lactation Consultants. Hence, there is a lot of confusion among professionals (both Drs and Lactation Consultants), resulting in over diagnosis and over treatment. Nonetheless, there is a lot of pressure on Lactation Consultants not to miss this diagnosis of tongue tie. Objective: To present a unique perspective of an experienced Lactation Consultant who is also experienced in diagnosing and treating various types of tongue ties. Methods: Clinical cases of babies with posterior tongue ties will be shown, including clinical photos. The presentation will focus on the clinical dilemmas regarding releasing posterior tongue ties and their implications for breastfeeding. Clinical Data and Statistics will be presented. Results: Exclusive breastfeeding was achieved in clinical cases with posterior tongue ties that where not released. Follow-ups will be shown. Conclusions: In some cases of posterior tongue ties, good breastfeeding counseling can make the action of releasing the tongue redundant.
CONF 2018 Safe and Sustainable Implementation of BFHI's Ten Steps to Successful Breastfeeding: EMPower Breastfeeding and the New EMPower Training Initiative1 credit offered Recorded On: 07/20/2018
Background: There has been a rapid increase in the number of maternity care facilities practicing the evidence-based care outlined in the Ten Steps to Successful Breastfeeding (Ten Steps). Contributing to this increase are the state recognition programs for hospitals working on these best-practices, and the federally-funded projects helping facilities with technical assistance and training. With any rapid change effort, sustainability and safety are of utmost importance. With this in mind, the newly-funded EMPower Breastfeeding Training Initiative (EMPower BTI) focuses on safe implementation of the clinical practices contained within the Ten Steps. Aim/Purpose: This presentation will share the results and lessons learned from the EMPower Breastfeeding Initiative (EMPower), including cohort data on Baby-Friendly designation progress, breastfeeding rates and other clinical measures on front-line practices. (EMPower closes in April of 2018). In addition, the transition to EMPower BTI will be discussed as it relates to safe implementation of evidence-based maternity care practices supporting breastfeeding. (EMPower BTI begins September 2017, with recruitment in early 2018). Narrative: The Baby-friendly Hospital Initiative (BFHI) has proven effective at improving maternity care practices and increasing breastfeeding rates. Recent changes in the global BFHI guidelines have reconsidered and repackaged the Ten Steps and may signal a need for adapting ongoing efforts in the US. Conclusion: Federally-funded efforts contribute to safe and sustainable uptake of the Ten Steps. Note: A revised abstract including detailed results/conclusion will be submitted for consideration in the JHL publication of abstracts after the federal grant has closed in April.
CONF 2018 WHO Guidelines on Protection, Promotion, and Support of Breastfeeding: Current Updates and Guidance for Facilities Providing Birth and Newborn Services2 credits offered Recorded On: 07/20/2018
In 2017 the WHO and UNICEF released 2 new guidelines related to the Baby-Friendly Hospital Initiative (BFHI). The First Document: Titled “Protection, promotion, and support of breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2017,” proposed Revised Operational Guidance for the BFHI. The second document, is the updated scientific evidence for the 10 Steps, which is cited as reference #34 in the first document. This second document, which is similarly titled “Protection, promotion, and support of breastfeeding in facilities providing maternity and newborn services,” went through WHO’s Scientific Guideline Development process and is not open for public comment. You can access this second document here. This workshop will review the contents of the two documents and provide an update on the direction of the BFHI for the US.
CONF 2018 Deconstructing Fake Equity: Lessons Learned From a Dominant Culture Institution2 credits offered Recorded On: 07/20/2018
Background: Intersectional health inequities, racism, implicit and explicit bias, and oppression are critical issues affecting our field. Working to address these issues has often led to divisiveness and ineffective action. We recognize that individuals are in different places in their journey to understanding and addressing inequities in the field of lactation. This session will be led by an academic institution partnering with an organization that focuses on communities of color. Aims: We aim to provide a safe space for conversation around dismantling systemic oppression and fostering healing relationships in the field. Topics to be covered in this workshop will include: understanding historical trauma in the US and globally, oppressive language and actions, cultural humility and appropriateness versus cultural competence, equality versus equity, improving listening skills, what it means to be an ally, deconstructing fake equity, and trust building. Narrative: Participants will have the opportunity to voice opinions and self-reflect on their experiences in this work. The institution will share lessons learned from applying an equity lens in “First Food” work from the perspective of the dominant culture and a privileged institution. The grassroots organization will share experiences as a grassroots organization that lifts people of color and advocates for the rights of the oppressed. Conclusion: Through discourse and discussion in this workshop, we will encourage expanding ones equity lens, achieving the growth that is essential for beginning the healing process in our field. This workshop will strengthen the participants’ ability to engage with community leaders for meaningful collaboration.
CONF 2018 Gender and Queer Communities 101: Building a Foundation for Culturally Humble and Inclusive Care1 credit offered Recorded On: 07/19/2018
This session is an introduction to LGBTQIA+ identities and communities. We will define key terms and concepts including sex, gender, intersex, gender expression, transgender, transsexual, gender identity, and intersectionality. The basic do’s and don’ts of respectful language and writing will be covered. We will also consider the question of how LGBTQIA+ communities relate to and intersect with other marginalized communities, inclusive of international contexts. Awareness of this essential background information will help lactation professionals in providing culturally competent and inclusive care for LGBTQIA+ patients and clients.
CONF 2018 Length of Stay and Breastfeeding Status Associated with Type of Milk Supplementation Among Late Preterm Infants in a Mother/Baby Unit: Results of a Retrospective Chart Review1 credit offered Recorded On: 07/19/2018
Background: To assess whether type of milk supplementation provided to breastfeeding late preterm infants (LPIs) is associated with length of stay (LOS) in the hospital or breastfeeding status at discharge. Methods: Retrospective chart review at a tertiary care teaching hospital in the southern United States. Participants were late preterm infants 350/7-36 6/7 weeks gestational age (N=183) admitted to the mother-baby unit between November 1, 2014 and October 31, 2016. The exposure of interest was type of milk supplementation, e.g., expressed human milk (EHM), pasteurized donor human milk (PDHM), and formula.Outcomes measured were LOS and breastfeeding status at discharge. Generalized Poisson regression models were used to compare LOS by type of milk supplementation. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals for associations with breastfeeding status at discharge. Results: The LOS for breastfed infants supplemented with EHM and/or PDHM did not differ significantly from exclusively breastfed infants who received no supplement. Exclusively formula fed infants had a longer LOS of 3.2 days compared to 2.6 days for exclusively breastfed infants (p=0.001). Breastfed infants receiving any formula supplementation were 16% less likely to continue breastfeeding until day of discharge compared to breastfed infants receiving human milk supplementation (RR 0.84, 95% CI 0.77-0.92).Conclusion: The high prevalence of supplementation among breastfeeding LPIs underscores the potential impact of type of milk supplementation on LOS and breastfeeding outcomes. Our findings suggest that human milk supplementation discourages transition to formula feeding before hospital discharge without increasing LOS.
CONF 2018 Using the Hazelbaker Assessment Tool for Lingual Frenulum Function: Guidance for Clinical Settings1 credit offered Recorded On: 07/19/2018
Dr. Hazelbaker is responsible for developing some and formalizing and codifying all of the diagnostic criteria for tongue-tie in infants. These diagnostic criteria were then combined to form a screening tool for the condition known as the Assessment Tool for Lingual Frenulum Function©™ (ATLFF©™). Her research on assessment and screening for tongue-tie has set a worldwide standard and forms the basis for many of the other proposed and yet-to-be researched assessment processes. The ATLFF©™ remains the only valid and reliable tongue-tie screening and assessment tool for infants under 6 months of age regardless of feeding method. In this presentation, Dr. Hazelbaker uses multiple video segments to illustrate the proper use of the ATLFF©™. Participants come away with a better understanding of the ATLFF©™ and its application in clinical settings.
CONF 2018 Lactation Support in Disasters and Emergencies: Integrating Life Course, Psychosocial, and Human Rights Perspectives1 credit offered Recorded On: 07/19/2018
In emergencies, women and children are among the most vulnerable to multiple forms of violence and exploitation as well as illness and death. Displacement resulting from natural disasters and complex humanitarian crises has a profound impact on health during the perinatal period, with significant consequences that reverberate across the life course. The literature reveals that emergencies disproportionately affect women’s and girls’ access to medical, social, cultural, and familial support systems. Barriers to perinatal and psychosocial care are associated with increased rates of morbidity and mortality among mothers/birthing parents and infants. Poorly coordinated and inappropriate emergency response (e.g., mass formula distribution), exacerbate the negative impact of emergencies on maternal-child perinatal health. In this presentation, the significance of skilled lactation support in emergencies will be discussed in the context of the reproductive health continuum. Special emphasis will be placed on the integration of psychosocial and lactation support in complex humanitarian settings.
CONF 2018 The Return of Breastsleeping: Humankind’s Oldest and Most Successful Sleep and Feeding Arrangement1 credit offered Recorded On: 07/19/2018
To introduce and justify a new conceptual epidemiological category, breastsleeping, that makes distinctions physiologically and behaviorally between the breastfeeding-bedsharing mother-baby dyad and the bottle or formula-fed bed-sharing dyad. We argue that breastsleeping is an evolved integrated system in which maternal sleep, infant sleep, and breastfeeding patterns can be explained. We argue that breastsleeping behavior deserves to be recognized as legitimate and acceptably safe for bedsharing when practiced (as its definition suggests) in the absence of all known hazardous factors. This argument reflects the full application of evidence based medicine, unlike the AAP's recommendation against bedsharing under any circumstances which violates the most important evidence based medicine requirement like respecting patient values, and generating hypothesis for testing epidemiological findings before moving to sweeping public health recommendations. Parental biology including hormonal profiles of mothers and fathers and characteristic reflexes of the human infant are used to explain the powerful underlying motives and emotions felt by infants and parents alike that explain why breastsleeping will not be eradicated.
CONF 2018 SIDS and Colic: Do They Share the Same Breathing Control System Origin?1 credit offered Recorded On: 07/19/2018
We here present a new set of hypotheses proposing that inconsolable crying and sudden infant death syndrome (SIDS), seemingly remarkably different outcomes may stem from the same human biological vulnerability characteristic not identified in other species. A model stresses the development over the 2-7 month of life of shared control of breathing made possible by the gradual integration of learned, volatile control of breathing underlying vocalizations (based on higher cortex nuclei) with involuntary or tidal breathing (based on chemoreceptor or brainstem nuclei), a system of respiratory control required for language, specifically speech breathing. It is proposed that because of this adaption infants could be subject to two different neurological glitches: SIDS reflects a missed signal as when infants transition between REM and NREM sleep while dreaming. That is, during REM sleep infants willfully participate in their breathing but during transitions either into REM or out of it the signal from one to the other control system is inadequate or missed altogether. As regards to colic, it is proposed that infants can initiate a cry and the voluntary breath required to sustain it but cannot stop it as both voice and breath become locked together with both systems excitatory neurons firing at the same time. Upon realizing that it cannot stop crying, in fear, the infant does more or what it is trying to reverse, to cry.