magazine

humanmagazine
milk
every drop counts
Issue 2 | 2015
Real Stories of
Breastfeeding
™
®
The Right Technology
Education
min
Confidence
Early Intervention
Cover Story
A Tale of Two Moms
Practically
Speaking
Let’s Talk: 4 Steps
to a Successful
Breastfeeding
Conversation
Outcomes
Striving for Excellence in
Hospital Lactation Care
editorial
table of contents
min
From Hospital to Home
™
Welcome to another issue of Human
Milk Magazine. This month we’re taking
a closer look at stories of breastfeeding,
which can differ substantially based on
birth experience, infant health, and even
education opportunities for mothers.
With this diversity of influences affecting
a breastfeeding journey, how can
professionals guide mothers to successful
outcomes? We turned to a variety
of resources in order to address this
question.
First, we spoke with two mothers who
had very different birth stories. Each
faced her own challenges when it came
to providing breastmilk. In “A Tale of
Two Moms: Supporting Breastfeeding in
the Hospital,” you will meet them both.
Krista, the mother of a premature infant,
explains her precarious experience trying
to provide much-needed breastmilk
for her son. Her story describes the
difficulties of a mother who must face the
frightening reality of her infant’s tenuous
health combined with struggles to pump
breastmilk. You will also meet Monica,
who was fortunate to have a healthy, fullterm infant. She felt confident in her ability
to breastfeed, but the reality was much
different than her expectations. In this
article she explains why reality differed,
and how she overcame the obstacles
in her way. I hope the stories of these
two women will inspire you in your own
practice, whether as a lactation, neonatal
or women’s health professional.
Diving deeper into the hows and whys
of successful breastfeeding, “Let’s Talk:
4 Steps to a Successful Breastfeeding
2
Conversation” explains four topics
clinicians should be familiar with to help
mothers avoid reality road blocks. One
of these is confidence, and that applies
to confidence in volume too. In fact, one
of the top three reasons mothers stop
breastfeeding within the first month is the
belief they are not producing enough milk.
You can help moms avoid this pitfall by
broaching the topic up front in a direct
conversation. Learn more in this article
about how confidence and three other
topics impact breastfeeding and pumping
mothers’ success.
From there we looked at the reality of
how moms learn about breastfeeding.
In today’s fast-paced digital age,
education materials must evolve to not
only meet the needs of the student,
but also their preferred method of
interacting with learning material. With
these considerations in mind, we
created Medela Breastfeeding University.
Breastfeeding University is an ideal
complement to your existing education
materials for breastfeeding and pumping
mothers. Read all about it in “Digital
Education for Today’s Mom: Medela
Breastfeeding University is in Session.”
Our Neonatal Perspectives section takes
a closer look at neonatal intensive care
units and their passion for human milk.
Why the love affair with “liquid gold?”
Because clinicians know the reality that
human milk is like medicine for these
fragile infants. With multiple positive
health impacts, breastmilk is a valuable
resource for any infant, especially those
who are at risk. In “3 Reasons Why NICUs
Are Passionate About Human Milk,” three
crucial human milk health benefits are
explained.
Also in this issue, we share our latest
project, Medela Cares. At Medela,
we take our community, mothers,
professionals and even the environment
into careful consideration with each new
initiative. We are proud to embark on this
Medela Cares journey which enfolds all of
our outreach efforts, such as the Medela
Recycles program, our partnership with
Ronald McDonald House Charities®,
Medela Breastfeeding University, and
the March of Dimes®. These efforts are
an extension of our commitment to the
Medela Breastfeeding Destiny Statement:
Medela’s Breastfeeding Division exists to
enhance mother and baby health through
the life-giving benefits of breastmilk.
Medela is proud to support professionals
in many areas of the hospital. We are
dedicated to you as well as to the
mothers and infants in your care. I hope
the information and stories in this issue
are a compliment to your existing tools
for patient success and perhaps offer
interesting new insight to share with the
patients you care for.
Kind Regards,
Kind regards,
Carolin Archibald
President, Medela, Inc.
in this issue
4
10
cover story . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
A Tale of Two Moms: Supporting Breastfeeding in the Hospital
Meet new moms Krista and Monica, and learn more about their
breastfeeding journey.
practically speaking . . . . . . . . . . . . . . . . . . . . . 10
Let’s Talk: 4 Steps to a Successful Breastfeeding Conversation
Let’s talk about Early Intervention, Confidence, Education and The
Right Technology.
news you can use. . . . . . . . . . . . . . . . . . . . . . . 14
Digital Education for Mom: Breastfeeding University is Now in Session
16
18
Medela meets the digital needs of today’s mom with Breastfeeding
University.
community support and outreach . . . . . . . . . . . . . . 16
Medela Cares
Learn more about the ways Medela is giving back to moms, babies,
communities and our environment.
neonatal perspectives. . . . . . . . . . . . . . . . . . . . 18
min
3 Reasons Why NICUs are Passionate About Human Milk
Human Milk provides many positive impacts in the NICU. Find
out more about three reasons that Human Milk promotes better
outcomes.
outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Striving for Excellence in Hospital Lactaction Care: How to Address
Critical Windows of Opportunity for Term and Preterm Situations
In this article we re-cap this full day educational event.
education. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Classes and events, Human Milk Monthly Webinars
Breastshield Sizing Tool
23
3
cover story
cover story
A Tale of Two Moms:
Supporting Breastfeeding
in the Hospital
Krista Rogulic is a seasoned breastfeeding mom. Her first two children started nursing right away
in the hospital, so Krista imagined she would have a similar breastfeeding experience with her
third child, a little boy with a Christmas 2014 due date.
Monica Blanchette is a registered nurse. When she and her husband, Ryan, found out they were
expecting their first baby, breastfeeding was a certainty in her mind. And having seen her sister
and sister-in-law breastfeed with ease, Monica was sure her own breastfeeding experience would
be “super easy.”
While their visions of their breastfeeding journeys didn’t turn out the way they expected, Krista’s
and Monica’s stories provide inspiration and lessons learned.
Krista’s Breastfeeding Tale
A registered nurse and former master
fitness trainer with eight years in the
U.S. Army, Krista Rogulic knows that
good nutrition is a key component of
health and physical fitness. And Krista
also knows the benefits of breastmilk as
the best nutrition for babies.
Krista and her fiancé, Matt, found
out she was pregnant in the midst
of planning their September 2014
wedding. Surprised but thrilled, they
continued with their preparations, and
on September 19, they exchanged
vows in front of family and friends.
But, at the reception, they had an
unexpected “wedding crasher”. Their
son wanted to be a part of the special
4
day, and he wasn’t giving them any
choice.
Krista was rushed to the hospital, and
an examination showed she was 10
centimeters dilated. Blake Daniel made
his unexpected appearance at 11:45
p.m. that evening, at 26 weeks and 6
days. A micro-preemie at 2 lbs, Blake
was immediately transported to a Level
III Neonatal Intensive Care Unit (NICU).
At 3:45 a.m., the very-newly wed Krista
and Matt officially met their son.
Not long after that, Krista started
wondering when the nursing staff would
ask her about breastfeeding. “My older
children started nursing right away. This
was a little different scenario,” recalled
Krista. No one said anything, so she
asked the nurse about pumping. “The
nurse said, ‘Oh yeah,’ and brought me
a pump.”
Matt set up the pump and Krista was
able to collect colostrum for Blake. She
continued pumping at intervals, but
it wasn’t comfortable and she didn’t
have much production—which was
very different from her past pumping
experiences. Later, while Matt took a
shower, a nurse tried to help Krista.
“She turned the pump up all the way.
My nipple actually tore and bled. I was
in severe pain,” said Krista.
The next day, Krista was discharged
from the hospital and went immediately
to the NICU to see Blake and bring
the milk she had pumped to be fed
enterally to him. Krista continued to
pump during her NICU visits...and the
pain and lack of production continued,
as well. The NICU nurses assured her
that this was normal and she was fine,
telling her that the pumps were great
technology.
At the reception, they had an
unexpected “Wedding Crasher”...
“I spent 2 to 3 hours pumping. My
nipples were extremely sore. I was in
pain and bleeding,” she said. Krista’s
instincts and experience told her this
was not normal. She spoke to the
lactation consultant on staff, who
also told her that everything was OK.
The pump they gave Krista had two
settings, so the lactation consultant
merely turned it to the lower setting,
and encouraged her to keep pumping.
At that point, a tired, scared, sore and
emotional Krista took matters into her
own hands and contacted a friend,
who works for Medela. “We had seen
each other over the summer. She
congratulated me on my pregnancy
and told me if I needed anything to call
her,” remembered Krista. “I never would
have imagined needing her the way
I did.” Krista soon received a Medela
Symphony® Breastpump Preemie+™
with Initiation Technology™, which is
specially designed to help mothers
of premature infants establish a milk
supply to provide their own breastmilk
to their babies.
“It was an amazing difference,” recalled
Krista with a smile. “It was more
comfortable. There was not as much
pressure. And it’s the quietest pump!”
Krista brought her Medela pump to her
NICU visits with Blake. Several times,
the nurses and other mothers asked
what type of pump she was using.
They were impressed with how quiet it
was – something that is greatly valued
in NICUs, where loud sounds can be
jarring to tender and under-developed
babies. The ease of use – one dial
versus two on other brands – was
also a plus. Even better, Krista’s milk
production soared. “It was a blessing
that we got the Symphony pump,” said
Krista.
Today, Blake is home and thriving.
Krista is still breastfeeding for seven
months, and continues to pump as
well. It was her resolve and tenacity that
allowed her to provide her son with the
continued ❱
5
cover story
cover story
medicine-like benefits of her breastmilk.
“This is the best nutrition for Blake, and
key for his growth and development,”
she said.
Krista is like many moms who don’t
expect their babies to be born
premature. But she is dedicated to
sharing her experience with the hope
that it will help other moms and babies,
and the clinicians who care for them,
begin a positive human milk experience
in the NICU.
“We are so thankful that we had
Medela as part of our journey,” said
Krista. “Our pump, and other Medela
products, helped Blake and me to have
a successful breastfeeding experience.”
Blake Daniel Rogulic
Monica’s Breastfeeding Tale
“I always knew I’d breastfeed my
children.” Monica Blanchette certainly
had the training and role models to
help support her in this decision. A
registered nurse, whose mother and
sisters also are nurses, Monica was
sure she’d be able to easily initiate and
sustain breastfeeding with her baby.
That, however, was not the case.
On Mother’s Day 2014, one day prior
to her due date, Monica gave birth to
a healthy baby girl, Isabelle. It was an
easy delivery, and Monica immediately
set out to nurse her newborn.
During her pregnancy, Monica attended
childbirth classes, but breastfeeding
was not covered in the curriculum. No
specific breastfeeding classes were
offered either. Monica and her husband,
Ryan, relocated while she was pregnant
so he could take a job with Medela
in McHenry, IL. While both her former
6
But the lactation consultant was only in
Monday through Friday, during the day.
and her new OB/GYNs knew of her
decision to breastfeed and encouraged
her, neither provided any information or
education. Monica was not concerned.
“I knew I’d be able to provide breastmilk
for my baby,” she recalled.
expecting,” said Monica. “I was
expecting to be able to breastfeed her,
and it was all very difficult to deal with.
I broke down crying. I couldn’t feed my
baby the way I thought I was supposed
to.”
But when she tried to initiate nursing
in the hospital, Monica could not
get Isabelle to latch. The lactation
consultant on staff visited her twice.
She assessed both Monica and
Isabelle, and assured Monica there
were no anatomical issues with either
the baby’s mouth or Monica’s breasts
that might cause challenges. Both
times, she was able to assist Monica,
and Isabelle nursed successfully.
Her sister comforted her, telling her that
she, too, had issues early on. “She said
‘The beginning is always the hardest,
but you’ll both get the hang of it,’”
remembered Monica.
While she kept trying to nurse her baby,
Monica also initiated pumping so that
she could provide breastmilk to her
newborn daughter. She knew, however,
that she didn’t want to solely pump. “It
wasn’t how I wanted to feed Isabelle.
I didn’t want to have to take a pump
everywhere. I wanted to breastfeed her,”
said Monica. “I was not ready to quit.”
Monica was an easy, uncomplicated
patient, so the labor and delivery unit
nurses generally only visited her once
a shift—which meant that she was
navigating breastfeeding largely on her
own. Some of the nurses tried to help
her, but none successfully. When she
asked for help late one night, one nurse
even told her, “Oh, I don’t do that. I’ll
put in a call for the lactation consultant.”
At home, Ryan took the lead looking for
community resources. He found her a
breastfeeding support group, led by a
local lactation consultant. All the other
mothers in attendance had established
breastfeeding and participated in the
group for moral support and to socialize,
so the consultant was able to focus
on Monica and Isabelle. Quickly, she
established a latch, and Isabelle once
However, when Monica tried on her
own, she could not get her newborn to
latch. “The only times I could breastfeed
was when the lactation consultant
was there. That was not what I was
again nursed well. “I was distraught,”
remembered Monica, “I kept saying to
myself, ‘Why can’t I get this to work? I
know it can work. Why can’t I do it with
just me and her?’”
Monica, Ryan and Isabelle Blanchette
“... I was able to breastfeed Isabelle
in a way I felt was ideal.”
Ryan began asking for advice from his
Medela colleagues and researching
products. He brought home Medela
nipple shields for Monica to try. These
soft, silicone shields overdramatize the
shape of the nipple, making it easier
for newborns to latch. They also help
moms with overactive let-downs or
with flat, inverted and sore nipples.
“They worked beautifully,” said Monica.
Isabelle latched immediately and
consistently, and Monica wondered why
no one else had previously mentioned
the idea of using nipple shields. “Those
nipple shields were golden,” she said
with a laugh.
continued ❱
7
cover story
cover story
to provide significantly greater milk
output in fewer minutes pumping. In
fact, a study published in the Journal of
Perinatology showed that the addition
of a unique pumping pattern can help
mothers of premature infants pump
nearly 67 percent more breastmilk over
the first seven days after birth than
mothers who did not use the pattern.
Nipple shields can help with
latching difficulties.
Monica continued to use the shields
for a few weeks. After that, her own
nipples adapted to breastfeeding an
infant, and Isabelle was latching in an
easy, natural way. The shields were no
longer necessary. “By the time she was
one month old, I was able to breastfeed
Isabelle in a way I felt was ideal.”
Insights for Clinicians
While breastfeeding is the most natural
way to feed a baby, many new mothers
experience challenges providing
breastmilk to their infants, and need
help with tips, tools and techniques.
Whether the baby is a healthy, full-term
infant who struggles with a latch, or a
preemie being enterally fed, the tales
of these two moms offer important
insights for clinicians, who often are
part of the start of many breastfeeding
journeys.
Don’t wait for mom to initiate a
breastfeeding dialogue with you.
Be proactive and ask if she plans to
breastfeed – and then be prepared
to help her get started. In particular,
mothers of premature infants should be
encouraged to breastfeed or pump, if
possible. Every year, approximately
450,000 (one in nine)1 babies are
born prematurely in the U.S. and
require NICU support. Research has
demonstrated that for most babies –
particularly premature babies – human
milk is easier to digest than formula and
helps vulnerable stomachs to mature.
Because their immune systems are
immature, premature babies also face
a greater risk of infections, such as
necrotizing enterocolitis, an intestinal
disease associated with a high mortality
rate in the NICU. Human milk contains
hormones, antibodies and other
protective factors that help babies
fight infection and become stronger.
Since 2005, the American Academy of
Pediatrics has had a policy statement
calling for hospitals and physicians to
recommend human milk for premature
and other high risk infants. For those
infants unable to directly breastfeed,
expressed mother’s own milk or
pasteurized donor human milk should
be provided.
Labor and delivery unit nurses
often serve as important ad hoc
breastfeeding support. While many
hospitals offer lactation consultants, the
hours of service may not align with the
timing when moms need help. Ensuring
all nurses know the fundamentals of
breastfeeding, such as how to help
baby latch, is one important way to
provide around-the-clock breastfeeding
support for new mothers.
Learn how to operate the breastpumps.
In Monica’s case, her husband was able
to assist. But for Krista, not having the
initial support she needed led to injury
and severe pain.
Offer breastfeeding classes as part of
your suite of prenatal programming.
If you are unable to offer a dedicated
class, ensure breastfeeding is part of
the curriculum in your birth preparation
classes.
Find the breastfeeding resources
near you and provide those to all new
mothers in their discharge packet.
Make sure new parents are aware that,
through the Affordable Care Act, most
insurance providers cover visits with a
lactation consultant and a breastpump.
Pain while pumping is not normal
or “fine.” If a mother is experiencing
discomfort, check the pump to ensure
it is functioning correctly. Turning up
a pump does not necessarily ensure
greater milk production for a new mom.
The maximum comfortable vacuum
level is ideal for most effective milk
removal.
Both Krista and Monica ultimately
were successful in achieving their
breastfeeding goals. Along the way,
however, they both experienced
frustrating and painful challenges that
could have been managed – and
even avoided – with the right support
from the members of their clinical
care teams. It has been said that
breastfeeding takes two, and both mom
and baby need to be supported. But in
reality, successful breastfeeding involves
many more people – and clinicians can
make an enormous positive difference
in the breastfeeding stories of women
like Krista and Monica.
New from Medela...
One way to ensure pumping is as comfortable
and efficient as possible is with a correctly
fitted breastshield.
You can help moms determine which size is
right for her with Medela’s “Choosing Your
PersonalFit™ Breastshield Size” guidelines
on page 23.
Please visit www.medela.com for a printable
PDF of this great tool.
Enteral Feeding:
A Pathway to Provide the Medicine of Breastmilk
One in nine babies in the United States is born
prematurely. Premature babies, born before 37
completed weeks’ gestation, are at risk for both
moderate and severe health problems. Enteral
feeding is often a primary way human milk, which
acts much like medicine to premature babies, can
be provided to babies in neonatal intensive care units
(NICUs). Medela’s feeding solutions for NICUs include
the Medela Enteral Feeding System — one of the
few complete enteral systems on the market today,
offering an enteral feeding end-to-end product line
made to exacting safety standards for the improved
outcomes of neonatal patients. Other products
include a line of feeding tubes and syringes, and two
waterless milk warmer options. These warmers are
the Medela Waterless Milk Warmer and the Guardian
Warmer™, which warms an enteral feed as it is
delivered (instead of in advance).
Not all pumps are the same. A
standard, hospital-grade double electric
pump is not always the best solution
for mothers of premature infants. The
Symphony Preemie+ Breastpump’s
unique burst/pause pattern is clinically
shown to help mothers of premature
infants initiate milk flow, as it mimics
baby’s first sucking pattern after birth.
The combination of the two programs
in Symphony Preemie+ Breastpump
allows mothers of premature infants
1
8
Do not discharge a mother who is
having trouble establishing a successful
breastfeeding relationship with her
newborn without a plan of next-step
support and a list of resources.
Centers for Disease Control and Prevention. Premature Birth. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm. Accessed March 10. 2015
9
practically speaking
practically speaking
Let’s Talk:
4 Steps
To a Successful
Breastfeeding
Conversation
Early Intervention
Confidence
Education
The Right
Technology
10
Imagine, for a moment, the experience
of a new mother with a premature infant.
Already dealing with the trauma and
fear that comes with having a child in
intensive care, she must now accept
that she cannot hold and breastfeed
her baby as she had planned. Instead,
she is faced with using a breastpump
accompanied by a user’s manual.
She has never been introduced to
a breastpump before and is not
immediately comfortable with the idea,
much less the use of, such a device.
Krista Rogulic is such a mother.
When her son was born at 28 weeks
on September 19, 2014, he was
not the healthy Christmas baby she
was expecting. At only two pounds
and thirteen inches, her son was
incredibly tiny and so very fragile. He
was immediately whisked away to the
NICU. After her initial recovery, she was
handed a generic brand breastpump
with instructions to turn it to the highest
setting for use. Unfortunately she had
not received early education on the use
of pumps, and lactation experts were
not readily available during her hospital
experience. Days later, successful milk
initiation had not been achieved. Painful
injuries caused by the improper pump
setting challenged her ability to continue.
She began to question whether she was
capable of producing breastmilk for her
son at all.
As a clinical professional, what would
you have done differently to improve
Krista’s experience, not only to ease her
pain and fear, but also to deliver ideal
human milk nutrition to her son, who
was struggling to survive in neonatal
intensive care? Early familiarity and
education would have helped her in
the long run, which in turn would have
impacted her level of confidence, and
ultimately her success. Perhaps a new
outlook is needed. What if you could
change the conversation right now…
and the outcomes?
breastfeeding.” Concluding their
studies in regard to a woman’s ability
to successfully breastfeed with any
longevity, they feel that self-efficacy
is directly related to an increased
duration of breastfeeding.1 By helping
Early Intervention
women
become more comfortable
Early
Intervention
Introducing pregnant women to
the benefits of a breastpump early
in the conversation helps mitigate
Confidence
many issues. Some women feel
too embarrassed to ask questions
about something so personal, and
perhaps foreign to their experience.
Education
Others expect breastfeeding will be a
natural, easy activity, not realizing that
breastfeeding can be challenging. Your
early intervention can change all that.
with breastfeeding and breastpump
use, clinicians can actually encourage
women to feel more comfortable with
Confidence
breastfeeding overall and for a longer
time. Or, if women find themselves in
a situation where exclusive pumping is
necessary, it will be one less hurdle to
overcome, allowing them to move into
Education
the role of provider with less confusion
and fear of failure.
The Right Technology
In their recent updated position
The
Right Pump
statement, AWHONN (Association
Early intervention is also critical for new
of Women’s Health, Obstetric and
mothers struggling with breastmilk
Neonatal Nurses) maintained that
initiation and volume building. One
“the benefits of ensuring exclusive
of the three most frequent reasons
human milk feeding through the use
mothers stop trying to breastfeed in
of
breastfeeding
supplies, when
Early
Intervention
the first month relates to a perception
necessary, far outweigh any risks.”2
of production: “I didn’t have enough
While acknowledging breastfeeding
milk.”3 Your anticipatory and open
is best, leaders in women’s and infant
communication about breastfeeding
Confidence
health
know that any effort to provide
and breastfeeding tools can mean the
Early Intervention
Early
Intervention
human milk to both preterm and full
difference between a mother who gives
term infants is valuable indeed.
up, or the mother who continues on.
Confidence
Education
Confidence
A clear path to education is important
Confidence is necessary for successful
for a woman during her initial plan to
breastfeeding and pumping. As a
breastfeed and also as a breastfeeding
knowledgeable professional, your
mother.
Given the
physical changes her
The Right
Technology
information sharing and helpful
Education
Education
body will undergo during prenatal and
encouragement can have a positive
impact on a mom’s self-confidence and postnatal periods, continuing resources
will be valuable in encouraging
ability perceptions.
a woman to be comfortable and
The
Right
Technology
Right Pump
Related
to perception
and confidence, The
confident with her decision. In addition
Kingston et al call out self-efficacy in
to your own coaching, mothers would
their research, defining the context
benefit from resources they can access
as “a woman’s perceived ability to
24 hours a day. Medela is proud to offer
successfully master a task such as
such supportive education to mothers
through a variety of materials, and most
recently with Breastfeeding University.
Breastfeeding University is a tencourse online program designed to
prepare expectant and new mothers
for the experience of breastfeeding.
Each class is about ten to twelve
minutes of education. Medela created
Breastfeeding University out of a clearly
defined need: Women were looking for
additional resources to support their
breastfeeding journey. Yet another
goal was to empower women with the
morale to be comfortable with honest
conversations with their healthcare
provider about any questions or
difficulties they continued to face.
Immediately following the launch of
Early Intervention
Breastfeeding
University, success was
verified: Moms who participated in
Breastfeeding University classes were
surveyed after their experience. Over
Confidence
97% said they felt more confident
Early
Intervention
asking for breastfeeding help in the
hospital as a result of participating in
the courses. Learn more about our
Breastfeeding
EducationUniversity courses in
Confidence
this issue of Human Milk Magazine, on
page 22.
The Right Technology
Education
Early
Confi
Educ
The R
Breastpumps are tools designed to
meet the needs of a mother, but also
take into account the needs of an infant
as well. Ensuring moms are using the
The
Right Pump
correct pump with the Right Technology
is important for breastfeeding success.
Consider these three scenarios,
and how each impacts the need for
breastpump support:
See pages 12 & 13 for tools to
help choose the right technology
for mom.
continued ❱
11
At first colostrum is produced
practically speaking
Milk supply is initiated days 2-5
on average
during this important period of
building supply, if there are periods
of separation
help mom continue to provide
breastmilk and maintain production,
even when she can’t be there
Days 2-7: Lactation has been initiated
confident and capable in continued
breastfeeding efforts.
The Right Technology
To Support Breastfeeding, From Hospital to Home™
Where To Go From Here
Initiation Help
min
min
• Mom or baby breastfeeding challenges
• Mom needs help initiating milk supply
Use of a Symphony
pump with Initiation
Technology can help
initiate milk supply
The baby becomes more effective at
breastfeeding over the first month
helping to build milk supply
A Symphony pump with Initiation
Technology can be used to
complement the baby's feeds at
the breast in order to initiate milk
supply
Continued pumping using a
Symphony pump with 2-Phase
Expression Technology can help
moms achieve the full benefit of
starting with Initiation Technology
min
Personal Use Pump as Needed
Pump Dependent
In this mother-infant relationship, the
• Health issues separate mom and baby
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min
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min
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4 Prime,D.K., Garbin,C.P., Hartmann,P.E., & Kent,J.C. Simultaneous Breast Expression in Breastfeeding Women Is More
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5 Neville,M.C. et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 48,
1375-1386 (1988).
6 Kent,J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 8, 401-407 (2013).
12
1548165A 0415 ©2015 Medela, Inc.
Medela, Symphony 2-Phase Expression, Pump in Style and Freestyle are registered trademarks of
Medela Holding AG. Preemie+ and From Hospital to Home are trademarks of Medela, Inc.
Build
Breastmilk Production
Maintain
Breastmilk Supply
Days 1–7
Breastmilk Supply
Days 8–30
Months 2–12
Initiating milk production is imperative to
building and maintaining a good supply.
Initiation Technology closely mimics
the pattern that term infants use in
the first few days after birth. Using
this technology, mothers achieved
67% more milk by day 7.1
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first hour
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within the first hour
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breastfeeding relationship
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needs of the baby
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at breast every 2 to 3 hours
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during this important period of
building supply, if there are periods
of separation
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is achieved, the Symphony
For more information oninitiation
Medela
hospital grade and personal use References:
pumps,
1. Kingston, Dennis , C. L. & Sword, 2007. Exploring
apart from her baby.
Breastpump can continue to help
breastfeeding
Journal of Perinatal & Neonatal
please visit medelabreastfeedingus.com or call 800-435-8316. Nursing, 21(3),self-efficacy.
207-215. Doi: 10.1097/01.JPN. 0000285810.
mom build and maintain her breastmilk
13527. A7
2. Association of Women’s Health, Obstetric and Neonatal
volume for the duration of her infant’s
Nurses (AWHONN) 2015 Position Statement
3. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why moth1 Meier,P.P., Engstrom,J.L., Janes,J.E., Jegier,B.J.,
Loera,F.
Breast
pump
suction
patterns
breastfeeding:
hospital&stay.
And
upon
taking
her
babythat mimic the human infant
ers stopduring
breastfeeding:
mothers’ self-reported reasons for
greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol
32,
103-110
stopping
during
the first(2012).
year. Pediatrics. 2008 Oct;122(Suppl
home
from
the
hospital,
a
personal
2):S69–S76.
2 Kent,J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008).
4. Meier,P.P., Engstrom,J.L., Janes,J.E., Jegier,B.J., &
3 Kent,J.C. et al. Volume and frequency ofuse
breastfeeds
content
of breastmilk
e387-e395
pump and
canfathelp
a mother
feel throughout the day. Pediatrics 117,
Loera,F.
Breast pump(2006).
suction patterns that mimic the human
Initiation Help
2
Use of a Personal Use
Use of a Symphony
pump can help
build milk supply
Baby did not feed effectively
within 6 hours of birth or
fed less than 8 times daily
Successful Breastfeeding
min
practically speaking
Days 2-7: Lactation has been initiated
Initiation Help
• Mom or baby breastfeeding challenges
• Mom needs help initiating milk supply
Pump Dependent
• Health issues separate mom and baby
• Infant is unable to breastfeed
Breastfeeding
Breastfeeding is best for baby
and mom when possible.
2-Phase Expression® Technology
Helps mothers achieve more milk in
less time, and to maintain milk
supply.3 18% more milk when
double pumping with 2-Phase
Expression Technology.4
Hospital Grade Pump
Symphony®
with Initiation Technology™1
min
Personal Use Pumps
Pump in Style®Advanced or
Freestyle® (not pictured)
Use of a Symphony
pump with Initiation
Technology can help
initiate milk supply
Use of a Symphony
pump can help
build milk supply
Baby did not feed effectively
within 6 hours of birth or
fed less than 8 times daily
The baby becomes more effective at
breastfeeding over the first month
helping to build milk supply
A Symphony pump with Initiation
Technology can be used to
complement the baby's feeds at
the breast in order to initiate milk
supply
Continued pumping using a
Symphony pump with 2-Phase
Expression Technology can help
moms achieve the full benefit of
starting with Initiation Technology
Use of a Symphony
pump with Initiation
Technology can help
initiate milk supply
Use of a Symphony pump
can help build milk supply
Mother and baby are unable to
breastfeed due to separation or health
issues such as premature birth and
cleft palate
After initiation occurs, the pump
dependent mother should continue
pumping 8 or more times daily to
build her milk supply
The first pumping session should
occur as soon as possible after birth;
at the latest within 6 hours and
continue 8 or more times daily
Continued pumping using a
Symphony pump with 2-Phase
Expression Technology can help
moms achieve the full benefit of
starting with Initiation Technology
min
Use of a Personal Use
Pump can help maintain supply, especially
when mom goes back
to work
Supply is established and meeting
the needs of the baby
Using a Personal Use Pump can
help mom continue to provide
breastmilk and maintain production
even when she can’t be there
Use of a Symphony pump
can help maintain milk
supply
Supply is established through continuity
of care for this critical population and
meeting the needs of the baby
Using a Symphony pump with 2-Phase
Expression Technology
can help mom continue to provide
breastmilk and maintain production
even when she can’t be there
Success Milestones
Success Milestones
Success Milestones
Baby has 3 or more yellow
stools in 24 hours after day 4
Baby has regained birth weight at
the latest by days 10-14
At the end of the first year, half of
baby’s calories come from breastmilk
3 consecutive pumping sessions,
achieving 20 mL each1
Typically moms produce around an
average of 750 mL by day 145
Baby demonstrates consistent weight
gain according to WHO breastfeeding
growth charts
For more information on Medela hospital grade and personal use pumps,
please visit medelabreastfeedingus.com or call 800-435-8316.
1 Meier,P.P., Engstrom,J.L., Janes,J.E., Jegier,B.J., & Loera,F. Breast pump suction patterns that mimic the human infant during breastfeeding:
greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol 32, 103-110 (2012).
2 Kent,J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008).
3 Kent,J.C. et al. Volume and frequency of breastfeeds and fat content of breastmilk throughout the day. Pediatrics 117, e387-e395 (2006).
4 Prime,D.K., Garbin,C.P., Hartmann,P.E., & Kent,J.C. Simultaneous Breast Expression in Breastfeeding Women Is More Efficacious than Sequential
Breast Expression. Breastfeed Med 7, 442-447 (2012).
5 Neville,M.C. et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 48,
1375-1386 (1988).
6 Kent,J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 8, 401-407 (2013).
1548165A 0415 ©2015 Medela, Inc.
Medela, Symphony 2-Phase Expression, Pump in Style and Freestyle are registered trademarks of
Medela Holding AG. Preemie+ and From Hospital to Home are trademarks of Medela, Inc.
For a digital copy of this tool contact [email protected]
13
news you can use
news you can use
Digital Education for Today’s Mom:
Medela Breastfeeding University
Is Now in Session
Women in all stages of pregnancy
and early motherhood are looking for
supportive breastfeeding education,
and as a clinical professional you are
in a special position to offer it. But how
can you know which tools will be most
effective? How do today’s women
prefer to “consume” their educational
content?
h
in Spanis
Available nglish
and E
Consider the nature of today’s averageaged breastfeeding information
consumer, who is estimated to be
about 27 years old. They are living in
a digital age and prefer videos over
most other external formats of learning.
They also prefer to take in “snacksized” snippets of information, because
time and attention spans are more
challenged by virtual stimuli than they
used to be. We live in an information
era where a constant stream of digital
connectedness is simply the norm.
This demographic also highly values
access to information anywhere,
anytime. That means resources must
be available by desktop computer,
tablets, and smart phones if they are to
be successful.
Breastfeeding
A class designed to prepare you for breastfeeding your baby
Class One
Making the Decision on
How to Feed Your Baby
Class Two
The Breastfeeding Lifestyle:
Can Breastfeeding Fit Into Into My Lifestyle?
Class Five
The Baby Arrives:
Get Breastfeeding Off to a
Strong Start in the Hospital
Class Eight
Special Situations:
Continuing to Provide Breastmilk if You and
Your Baby Are Separated From Each Other After Birth
Class Six
Life With a Breastfed Baby:
The First Two Weeks
Class Nine
Combining Work or
School While Breastfeeding
Class Three
Preparation for
Breastfeeding
Class Four
How Breastfeeding
Works
Class Seven
Overcoming Possible
Breastfeeding Difficulties
Class Ten
Breastfeeding Continues:
Life with a Breastfed Baby
Medela has taken these facts into
consideration and created a new tool
optimized with informative video to
share with pregnant and breastfeeding
mothers. This tool is Medela
Breastfeeding University.
Medela Breastfeeding University is a
ten-course online program of video
tutorials for pregnant and breastfeeding
women who are looking for additional
resources to support their breastfeeding
journey. Each video was designed to fit
into busy schedules with “snackable”
content shared within a short time
frame. Our goal was to offer researchbased information to support the
benefits of breastfeeding in a friendly,
encouraging way – all within a format
that is easily accessed by a computer,
tablet or smart phone.
Shortly after launching Breastfeeding
University on the Medela website,
we encouraged participants to
answer survey questions about their
experience. We wanted to verify the
value of these courses and if the
short video formats worked for these
busy women. The response was
overwhelmingly positive!
Out of 1,154 responses from women
who completed Breastfeeding
University:
• 95% said they learned new
information
• 97% now felt better about asking for
breastfeeding support in the hospital
• 77% said Medela Breastfeeding
University helped them meet their
breastfeeding goals
14
• 88% would recommend Medela
Breastfeeding University to a friend
expecting a baby
Class One
Making the Decision on How to Feed
Your Baby
As if that wasn’t enough to grab your
interest, we have another amazing
reason to share Medela Breastfeeding
University with your expectant and new
mothers. Medela will donate 100%
of Medela Breastfeeding University
registration fees to the Ronald
McDonald House Charities®. We strive
to give back to our communities, and
through a partnership with Ronald
McDonald House Charities we are
able to provide support, education,
breastfeeding tools and so much
more. You can learn more about our
partnership with Ronald McDonald
House Charities on page 16 where
we open up about our Medela Cares
community support program.
Class Two
The Breastfeeding Lifestyle: Can
Breastfeeding Fit Into My Lifestyle?
Meeting breastfeeding education
needs in today’s demanding digital
environment is a challenge, but armed
with the knowledge of how your
patients value information presentation
is helpful and half the battle. Medela
Breastfeeding University was created
as a tool for professionals just like you
to meet these information preferences
and support your patients in their
breastfeeding journey.
View a special Introduction to Medela
Breastfeeding University video at http://
www.medelabreastfeedingus.com/
breastfeeding-university-preview.
If you have questions about Medela
Breastfeeding University, email your
queries to [email protected].
Class Three
Preparation for Breastfeeding
Class Four
How Breastfeeding Works
Class Five
The Baby Arrives: Get Breastfeeding
Off to a Strong Start in the Hospital
Class Six
Life With a Breastfed Baby: The First
Two Weeks
Class Seven
Overcoming Possible Breastfeeding
Difficulties
Class Eight
Special Situations: Continuing to
Provide Breastmilk if You and Your
Baby Are Separated From Each
Other After Birth
Class Nine
Combining Work or School While
Breastfeeding
Class Ten
Breastfeeding Continues: Life with a
Breastfed Baby
New courses are being added
throughout the year!
Visit www.medelaeducation.com
15
community outreach
community outreach
Introducing:
moms
babies
communities
about...
our environment
Continuity of Care Program benefiting
Ronald McDonald House Charities®
Nearly 40% of families served by the Ronald McDonald House Charities® (RMHC®) have an infant in the
NICU. To support the continuity of care between the hospital and the house, Medela will donate multiuse Symphony® Breastpumps with Preemie+™ technology and breastfeeding supplies to five RMHC®
houses around the United States in 2015, bringing more breastmilk to the babies who need it most.
The Continuity of Care Program and Medela Recycles share the same goal — to provide moms with the
same high-quality equipment they use at the hospital during their stay at a Ronald McDonald House®.
The mission of Ronald McDonald House Charities (RMHC) is to create, find and support programs that
directly improve the health and wellbeing of children.
To learn more about Ronald McDonald House Charities visit rmhc.org
And we know you do too! Medela Cares is a continuation of Medela’s long history of caring for moms, babies,
communities and our environment. These are the cornerstones that guide Medela Cares; and an extension
of our commitment to the Medela Breastfeeding Destiny Statement. We believe, through corporate social
responsibility and partners that share our vision the truest spirit of the Medela brand comes to life.
Medela Cares focuses on two areas: 1) Helping mothers continue their breastmilk feeding journey when they
return to work; and 2) Supporting mothers with infants in the NICU as they begin their breastmilk feeding
journey. To learn more about the programs and partners associated with Medela Cares, visit
www.medelacares.org. In this issue, we invite you to learn more about the recent ways we are giving back….
Medela Breastfeeding University
Medela’s Breastfeeding University
is an online program consisting of
10 classes designed to prepare
new and expectant mothers for the
experience of breastfeeding. The best
part is that not only are moms learning
valuable breastfeeding skills, 100% of
Breastfeeding
the proceeds are donated Ronald
McDonald House Charities®. Learn
more about Medela’s Breastfeeding
University at medelabreastfeedingus.
com/breastfeeding-university.
A class designed to prepare you for breastfeeding your baby
Class One
Making the Decision on
How to Feed Your Baby
Class Two
The Breastfeeding Lifestyle:
Can Breastfeeding Fit Into Into My Lifestyle?
Class Three
Preparation for
Breastfeeding
Class Four
How Breastfeeding
Works
Class Five
The Baby Arrives:
Get Breastfeeding Off to a
Strong Start in the Hospital
Class Six
Life With a Breastfed Baby:
The First Two Weeks
Class Seven
Overcoming Possible
Breastfeeding Difficulties
Class Eight
Special Situations:
Continuing to Provide Breastmilk if You and
Your Baby Are Separated From Each Other After Birth
Class Nine
Combining Work or
School While Breastfeeding
Class Ten
Breastfeeding Continues:
Life with a Breastfed Baby
Medela Recycles benefiting Ronald McDonald House Charities®
Medela Recycles focuses on helping moms who have finished
their breastfeeding journey help another mom start hers. Each
personal-use electric Medela breastpump we receive through
the program supports the donation of new hospital-grade
Medela Symphony® Preemie+™ Breastpumps and breastfeeding
supplies to the Ronald McDonald House Charities® (RMHC®).
The goal is to provide moms with the same high-quality
equipment they use at the hospital during their stay at a Ronald
McDonald House®. All while keeping breastpumps out of the
landfill and giving moms an inspirational reason to recycle.
Medela hopes to recycle 12,000 Medela breastpumps through
this initiative to support its commitment to reducing solid waste
and helping protect the environment. To learn more about
Medela Recycles, visit www.MedelaRecycles.com. As of
June 1st, 2015 - 2,451 breastpumps have been accepted for
recycling and 4,100 are pending.
16
Ronald McDonald House Charities, RMHC, Ronald McDonald House, Ronald McDonald Family Room, and Ronald McDonald Care Mobile are all registered trademarks of McDonald’s Corporation or its affiliates
and are used with permission.
The McHenry Medela Team
March of Dimes® March for Babies®
Medela believes in the March of Dimes® mission to help
moms have full-term pregnancies and research the problems
that threaten the health of babies. To support March of Dimes
and their efforts, Medela participated in two local March for
Babies® chapter walks. Together we donated $12,235 to the
March of Dimes.
Melissa Gonzales, Vice President of
Medela Sales and Channel Management, with the
McHenry County March of Dimes Ambassador family.
On Sunday, April 26th 2015, Medela participated in both
the March for Babies Orange County Walk in Newport
Beach, CA and the March for Babies McHenry County
Walk in Woodstock, IL. More than 100 participants from the
Medela family participated in the walks.
If you have questions about Medela Cares or any of these
programs, please email [email protected].
March of Dimes is a registered trademark of the March of Dimes Foundation. March for Babies is a registered trademark of the March of Dimes Foundation.
17
nicu perspectives
nicu perspectives
on a financial scale, with estimates of medical NEC costing a
hospital $74,004 and surgical NEC costing $198,040.2 The
good news is that human milk has a positive effect on the
health of preterm infants’ intestines.
Meinzen-Derr et al discovered that increasing amounts of
human milk for extremely low birth weight infants in the first
two weeks was related to survival time in which the infant
was free from NEC.3 Johns Hopkins found in their studies
that if mothers were not producing enough milk on their own,
supplementing with donor milk for the feeds seemed to offer
the same NEC-preventing benefits. Combining with formula
did not.4
Neonatal Perspectives
Professional Perceptions and Team Communications
| 3 Reasons Why NICUs Are Passionate About Human Milk |
Human milk is the ideal source of nutrition for preterm infants, with a wealth of benefits to contribute
to overall health and outcomes, and earning the descriptor “liquid gold.” What’s not to love about
the positive impacts of human milk in the NICU? While it’s hard to pick only three reasons out of the
many, here are three reasons human milk generates such passion in neonatal intensive care,
all three of which promote better outcomes for the at-risk patient population:
It reduces intestinal permeability
One of the many reasons strict neonatal intensive care
measures are necessary for the preterm infant is the higher
risk of environmental pathogens. An example of these risks
is the immature gastrointestinal system. The problem with an
immature GI system is related to the nascent and susceptible
junctions between cells of intestinal mucosa. These junctions
close over time with maturity of the gastrointestinal system,
but while they are immature, they are at risk.
Taylor et al tested the impact of human milk on these
junctions by measuring the lactulose to mannitol ratio
(L/M ratio) in subjects’ urine. Why? The lactose molecule will
only pass through intestinal walls if the junctions between
cells of intestinal muscosa are open. If the junctions have
matured and closed (meaning now have reduced exposure
to environmental pathogens) then the L/M ratio would be
reduced.1
18
They found that infants receiving human milk showed
positively impacted L/M ratios: they were significantly lower.
In addition, infants who received greater than 75% human
milk feeds demonstrated a 3.8-fold lower composite median
L/M ratio (and decreased intestinal permeability).1 This leads
to the conclusion that human milk allows the junctions to
mature and thus prevent environmental pathogen access.
The authors stated, “Preterm infant intestinal permeability
was significantly decreased for those receiving human milk
versus formula in a dose-related manner in the first postnatal
month.”1
“An earlier study by the same team showed that babies who
get their own mother’s milk fortified with the standard cow
milk protein are more prone to NEC than babies given a
combination of their mothers’ milk fortified with human donor
milk.”4
They noted that the infants who received the human milk
also tolerated feeds better. This in turn eliminated the
continued need for supplemental IV nutrition (after an
average of 27 days).4 The overall impact of human milk on
the gut seems impressive in its scope and continued studies
reinforce its value.
It cuts the risk of sepsis
Imagine decreasing the odds of sepsis by 20% in a very
low birth weight infant. It’s not hypothetical; it’s science.
The science of human milk. Rush University Medical Center
researchers discovered that every 10 milliliters of human
milk per kilogram a VLBW infant received in the first 28 days
of life actually did just that. That was great news for patient
outcomes.
As an added bonus, the financial investment to accomplish it
was merited. Dr. Aloka L. Patel, who led the Rush University
research, said of their findings, “The substantial NICU
hospital cost savings associated with increased dosages of
human milk are likely to offset the maternal and institutional
costs of providing and feeding human milk, such as breast
pump rental, lactation care providers and milk storage.”6,7
“A daily dose of 25 to 49.99 milliliters of human milk per
kilogram cut NICU costs by more than $20,000, while
50 milliliters per kilogram per day lowered NICU costs by
nearly $32,000.”6,7
Late-onset sepsis is also a common occurrence in VLBW
infants, at about a 22% incidence rate.6,7 Its impact is severe,
leading to potential neurological disabilities, longer lengths
of stay and of course, higher costs. If human milk could
minimize that number it would have even more far reaching
impacts for patient outcomes in the NICU and its financial
impact to heathcare. Continuing research shows promising
benefits related to minimizing sepsis risk based on an
exclusive human milk diet.
These are just three ways at-risk infants in the NICU benefit
from human milk. The actual list of benefits stretches even
further, but there is not enough room here to address them
all! Studies have generally revealed that a diet of human milk
for at-risk infants leads to decreased length of stay, improved
patient outcomes and reduced expense. No wonder human
milk incites such devotion from healthcare practitioners. It
seems human milk is literally one of the best special-delivery
year-round valentines of all for these infants. And that’s
something we can all love.
It lowers the risk of NEC
Necrosis of the bowel tissue is something no clinician ever
wants to see. Necrotizing enterocolitis (NEC) is a disorder
known for its devastating impact on a preterm infant, leading
to serious and life-threatening complications. Out of the
unfortunate infants who develop NEC, about 40% of them
will not survive.4 These complications also impact a hospital
References:
1 Taylor SN, Basile LA, Ebeling M, Wagner CL. Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula. Breastfeeding Medicine, 2009; 4(1): 11-5.
2 Ganapathy V1, Hay JW, Kim JH. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeeding Medicine. 2012
Feb;7(1):29-37. doi: 10.1089/bfm.2011.0002. Epub 2011 Jun 30.
3 Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocoloitis or death. Journal of Perinatology, 2009; 29(1): 5762.
4. Formula-Fed Preemies at Higher Risk for Dangerous GI Condition, Than Babies Who Get Donor Milk. http://www.hopkinschildrens.org/Human-Donor-Milk-Lower-Risk-for-Premature-Babies.aspx
5. Maureen W Groer, Angel A Luciano, Larry J Dishaw, Terri L Ashmeade2, Elizabeth Miller and Jack A Gilbert. Development of the preterm infant gut microbiome: a research priority. Microbiome 2014, 2:38 doi:10.1186/2049-2618-2-38
6. A L Patel, T J Johnson, J L Engstrom, L F Fogg, B J Jegier, H R Bigger, P P Meier. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. Journal of Perinatology, 2013;
DOI: 10.1038/jp.2013.2
7. Breast milk reduces risk of sepsis and intensive care costs in very-low-birth-weight infants. http://www.sciencedaily.com/releases/2013/02/130206162129.htm
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outcomes
outcomes
Striving for Excellence in Hospital Lactation Care:
How to Address Critical Windows of Opportunity
for Term and Preterm Situations
A March 2015 Medela Education Event
Presented by Paula Sisk, PhD, RD, IBCLC and Jean Rhodes, PhD, CNM, IBCLC
Paula Sisk, PhD, RD,
IBCLC
Jean Rhodes, PhD,
CNM, IBCLC
On March 20th, Acelleron Medical Products sponsored
a full-day Medela conference organized by Kathy Silvio in
Natick, Massachusetts. Attendees included nurses, lactation
consultants and other healthcare providers from New
England.
Jean Rhodes opened the program with a presentation
entitled “Ways of Knowing: What We Know and Don’t
Know about Breastfeeding,” which reviewed the history of
scientific knowledge in health sciences as well as patterns
of knowledge development unique to nurses and women.
Also discussed were different types of scientific evidence,
from expert opinions and descriptive research to randomized
control trials and meta-analyses. Although the topic sounds
rather dry and esoteric, the participants responded well
to discussion of the rarely acknowledged perspective that
nurses and other caregivers can bring to clinical research,
particularly research related to lactation.
Next, Rhodes presented an overview of Colson’s research
on primitive neonatal reflexes and “Biological Nurturing,” a
method of breastfeeding that challenges traditional notions
about effective positioning. Infants are born with suck,
swallow, breathe and rooting reflexes to enable them to
feed. Clinicians have known for many years infants have
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other reflexes at birth, such as finger and toe grasping,
head bobbing and step-in-place behaviors, but little
was understood about their purpose. Colson’s research
completes the puzzle: “Biological Nurturing” positioning (also
known as laid-back breastfeeding) allows infants to become
active participants in feeding, using their innate reflexes to
crawl to the breast, locate mom’s nipple, latch and nurse
successfully. Ideal positioning to activate infant feedingrelated reflexes is mother reclining — slightly upright with
knees bent — receiving her infant tummy to tummy. Certainly
this is not the only position for nursing but it can be very
helpful when mothers are inexperienced, tentative or have
sore nipples or infants are having difficulty latching.
Paula Sisk’s first presentation titled “Establishing Lactation
during Maternal-Infant Separation” began with an overview
of the physiology of lactation. Physiological changes begin
in puberty, increase dramatically during the first trimester
of pregnancy, and continue until parturition. If delivery
occurs prematurely, breast development may be halted and
lactation delayed. New evidence also suggests that maternal
metabolic health may contribute to delays in lactation. Initial
hormonal control of lactation transitions to local control
during the first week postpartum and is a vulnerable time
in which effective equipment and frequent milk expression
are critical for establishing an abundant milk supply. In
preparation for discharge from the hospital, mothers need
assistance with obtaining an effective breast pump, supplies
for storing and transporting milk, and education on handson pumping techniques. Mothers also need anticipatory
guidance regarding milk volume targets and stress
management. Utilization of breastfeeding peer counselors
and frequent skin to skin holding can help mothers manage
frequent milk expression and stress during mother-infant
separation.
Crosscradle hold
Football hold
Rhodes’ next discussed associations between lactation and
reduced risks of obesity in children as well as decreased
cardio-vascular and metabolic diseases in women. Since
the 1990’s obesity has increased, year by year, in an almost
exponential fashion. Research suggests breastfeeding plays
a role in reducing obesity in breastfed children, although
studies vary as to the extent of the breastfeeding effect. The
impact of breastfeeding on obesity is likely to be multiple
factorial including behavioral, nutritional and epigenetic
explanations. Additionally, women’s health scientists are
discovering long-term benefits of lactation for the mother,
conceptualizing lactation as the natural (and thus, intended)
end to the reproductive cycle of childbearing. Many theories
suggest hormonal changes of lactation, especially those
related to oxytocin, provide protection against systemic
inflammation and pathologic metabolic programming.
and household responsibilities, support from their infant’s
father, knowledge of the benefits of maternal milk and
anticipation of breastfeeding.
Sisk reviewed results of a qualitative research study on
experiences of pump dependent women in which mothers
identified barriers to and supports for milk expression. Pump
dependent women are often dealing with pregnancy related
illnesses as well as stress and anxiety associated with
delivering a sick or premature infant. Mothers reported that
these physical and emotional stressors frequently interfered
with their ability to learn and focus on milk expression. They
also reported that lacking privacy in the hospital, procuring
effective equipment for use at home, being separated from
their infant, traveling a distance to the hospital, experiencing
boredom with pumping, completing family and work
responsibilities and updating family and friends on their
infant’s health were barriers to frequent milk expression.
Mothers reported that supports for frequent milk expression
were a high quality breastpump, assistance with childcare
In the last presentation of the day, Sisk discussed the
process for transitioning to at-breast feedings. She reviewed
the differences between rates of breastfeeding at hospital
discharge between the United States and Sweden and the
challenges mothers and infants encounter. These challenges
include immature breastfeeding behaviors and delayed
lactation or low milk supply at the time of infant discharge
from the hospital as well as differences in the mechanics of
breastfeeding as compared to bottle feeding. The benefits of
at-breast feedings for the infant were reviewed and include
physiological stability during feedings, avoidance of nutrient
losses, and better oral development. At-breast feedings can
begin as a natural response to infant feeding cues during
skin to skin holding and can progress to nutritive suckling as
the infant matures and gains experience. The cross-cradle
and football holds are especially helpful to the premature
infant who lacks the strength and maturity of the full term
infant. Expert opinion guidelines on transitioning to exclusive
at-breast feedings include establishing “breastfeeding”
times in which the infant is allowed to nurse on demand
and the mother uses the breast pump after 2-3 feedings.
Increasing at-breast feedings are based upon infant weight
gain and milk transfer that can be measured with a highly
accurate infant scale. Suggestions for weaning off lactation
aids, i.e. a nipple shield, infant scale and the electric pump
are also based on weight gain and infant maturity. Weekly
weight monitoring and knowledgeable lactation support
are invaluable in the transition to at-breast feedings after
maternal-infant separation.
21
✁
classes and events
Prepare Mothers for Breastfeeding Success with
Medela’s Professional Education Programs
Medela offers education programs and resources that can
help prepare new mothers for successful breastfeeding
experiences. Live and online programs are available for you
and your staff.
Medela’s extensive research program initiates and supports
clinical research by the world’s leading lactation scientists
and clinical specialists. This research allows the Medela
Education Team to bring you the latest research on breast
milk science. Visit www.MedelaEducation.com to review
the complete list of courses offered online or live near your
location. To schedule a program, call 1-800-638-3284 or
email [email protected]
Upcoming Live Education Programs
Human Milk in the NICU
Presented by:
Diane Spatz PhD, RN-BC, FAAN
Event Details
Date:
Friday, June 19, 2015
Program: 8:00 am – 4:00 pm
Registration and continental breakfast
from 7:30 am – 8:00 am
Lunch included
Location:
Children’s Mercy Hospital Main Campus
Main Auditorium
2401 Gillham Rd
Kansas City, MO 64108
Registration Fee:
$125.00
Learn More & Register:http://www.MedelaEducation.com
Continuing Education Credits:6.5 Nursing Contact Hours
6.5 Dietitian Category II CPE
Questions:Lisa Wren
[email protected]
human
milk
monthly webinars
Learn more about
Breastfeeding
University
on pages 14 and 15.
Education to Support
Breastfeeding Success
Human Milk Magazine
Online Course Special!
1000 off
$
22
each course
The Medela Education Team is now offering a webinar series: Human
Milk Monthly. You can sign up to get the latest in breastfeeding research
and clinical information conveniently and timely. Human Milk Monthly Live
Webinars will cover a variety of topics relevant from NICU to well-baby.
$10 Off Promo Code:
For more information
visit www.medelaeducation.com
Use as many times as you wish by
September 30, 2015
with Promo Code
HMMNJ4YTG
23
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