Breastfeeding Promotion and Management Speaker

Despite the brevity of the post-birth hospitalization, a large body of evidence confirms that making institutional changes in maternity care practices can significantly increase breastfeeding initiation and duration rates. The Baby-Friendly Hospital Initiative’s (BFHI) Ten Steps to Successful Breastfeeding have long been recognized as the “gold standard” for maternity care practices that promote successful breastfeeding. Initially slow to gain momentum in the US, achieving the Baby-Friendly designation has now become a megatrend among US maternity hospitals. Well over a million births now occur in Baby-Friendly designated facilities, and countless other hospitals are making incremental changes toward implementing supportive infant feeding maternity practices.

This presentation will educate nursing staff, lactation consultants, physicians, mid-level providers, administrators, prenatal educators, and others concerning the “Whys” and “Hows” of implementing the BFHI Ten Steps. Special emphasis will be given to the “anchor” steps of immediate mother-baby skin-to-skin contact and exclusive breastmilk feeding as strong evidence-based interventions to increase breastfeeding duration and exclusivity. In addition, the program will address the importance of preparing expectant mothers for an optimal hospital breastfeeding experience, explain why the Ten Steps benefit all mother-baby pairs regardless of infant feeding preference, and emphasize the essential role of Step 10 in ensuring a seamless transition to post-discharge lactation care. Let Dr. Neifert’s empowering information and contagious enthusiasm inspire your hospital maternity staff to implement the highest standards in infant feeding care.

The first postpartum weeks represent a critical period in establishing successful breastfeeding practices and an abundant milk supply. Early infant feeding challenges and concerns about producing enough milk put a damper on new parenthood and prevent many women from reaching their breastfeeding goals. In contrast, getting breastfeeding right from the start sets the stage for long-term success. Identifying newborns at risk for ineffective breastfeeding and using “lactation technologies” to ensure infant well-being and a plentiful milk supply are key foundations to achieve exclusive and extended breastfeeding.

This presentation will cover the prevention and management of the common reasons that mothers cite for the early discontinuation of breastfeeding. Topics to be discussed include: 1) the stages of lactation, including the initiation stage, coming-to-volume (the stage associated with the greatest risk of suboptimal breastfeeding and early, unplanned weaning), and maintenance stage; 2) infants at-risk for ineffective breastfeeding, including late-preterm and early term babies, jaundiced newborns, and those with latch difficulties; 3) the benefits of early hand expression of colostrum and “hands-on” pumping to promote the establishment of an abundant milk supply for at-risk breastfeeding pairs; 4) ensuring nutritional well-being among infants of mothers with delayed lactogenesis and the successful transition to exclusive breastfeeding; and teaching effective infant latch and signs of milk transfer. In addition, Dr. Neifert will review maternal and infant criteria for post-discharge assessment of the successful onset of breastfeeding and describe the timely intervention for early lactation difficulties to promote infant well-being and the establishment of an abundant milk supply.

Despite a steady increase in breastfeeding initiation rates, a large majority of U.S. infants and mothers do not receive the maximum health benefits associated with exclusive and extended breastfeeding. Many breastfeeding mothers encounter lactation difficulties that prevent them from achieving optimal infant feeding recommendations or their own breastfeeding goals. Furthermore, substantial differences in breastfeeding rates among vulnerable populations contribute to infant and maternal health disparities.

This presentation covers the prevention, recognition, and clinical management of the common maternal and infant breastfeeding concerns that often lead to early weaning. Participants will learn specific prenatal, intrapartum, early follow-up, and ongoing interventions linked with improved exclusive breastfeeding outcomes.

Dr. Neifert will share effective counseling strategies targeting common barriers that undermine exclusive breastfeeding, including: the lack of prenatal preparation; in-hospital elective use of formula supplements; infant latch challenges; failure to establish an abundant milk supply during the critical coming-to-volume stage of lactation; maternal sore nipples; perception of insufficient milk; the practice of los dos; misinterpretation of infant crying; returning to work or school; early introduction of solid foods, and inadequate support. The practical and empowering information presented will equip lactation care providers who work in diverse practice settings to implement evidence-based, clinical strategies that promote exclusive and extended breastfeeding for all mother-baby pairs and reduce disparities.

Infants born at 34, 35 or 36 weeks’ gestation--referred to as “late-preterm” infants--make up 7% of all U.S. births and 70% of all preterm births. Many “slightly early” newborns masquerade as developmentally mature, appearing to need no special care after birth and often being discharged as early as full term babies. Yet, late-preterm infants are physiologically immature and have special health care needs compared to full term infants. They have an increased risk for a variety of neonatal complications including feeding problems, severe jaundice, and excessive weight loss after birth. Smaller, developmentally immature late-preterm infants often have difficulty latching to the breast correctly and breastfeeding effectively at first, due to fewer awake-alert periods, immature oromotor skills, lower muscle tone, and a tendency to tire easily. They require close monitoring and evaluation after birth and extra help establishing breastfeeding. As we come to appreciate that each week of gestation up to 39 weeks is important for a baby to fully develop before delivery, we now recognize that even babies born at 37 and 38 weeks are somewhat immature. Many of these “early term” newborns also need extra help with breastfeeding. LPT and ET infants also are more likely to be readmitted to the hospital in the early weeks of life for medical complications related to poor feeding.

In this session, Dr. Neifert will describe the special breastfeeding challenges among late-preterm and early-term newborns; explain the use of helpful “lactation technologies” to ensure a thriving baby and promote the establishment of a plentiful milk supply; and recommend ways to support mothers of late-preterm infants to successfully transition to exclusive breastfeeding. The extra investment of time and effort to safeguard early breastfeeding among these vulnerable newborns can set the stage for long-term breastfeeding success.

While more than 80% of US mothers begin breastfeeding their newborns, only a quarter of infants are exclusively breastfed for six months, as recommended, and fewer than 40% are receiving any breastmilk by a year of age. Concerns about producing enough milk prevent many women from achieving exclusive breastfeeding recommendations or reaching their own breastfeeding goals. Insufficient milk not only undermines exclusive and extended breastfeeding, it contributes to unacceptable breastfeeding-related morbidities, including neonatal hospitalizations for excessive weight loss, dehydration, jaundice, and hypoglycemia, as well as maternal grief and self-blame. Yet, despite its wide-spread prevalence, the all-too-common complaint of insufficient milk remains poorly understood.

In this presentation, Dr. Neifert will distinguish rare “primary” causes of low milk–such as maternal breast variations/breast surgeries and underlying medical conditions--from common, often remediable, “secondary” reasons for insufficient milk that are linked to suboptimal breastfeeding management. Participants will learn the critical importance of the Initiation and Coming-to-Volume stages of lactation in establishing an abundant milk supply; recognize how variability in breast storage capacity influences optimal feeding and milk expression routines; and understand why a robust milk supply is the single most important factor impacting breastfeeding duration and exclusivity. Learners will be able to identify newborns at-risk for ineffective breastfeeding; prevent morbidities, including hypernatremic dehydration, in underfed newborns; and implement the use of “lactation technologies” to optimize maternal milk production and ensure the nutritional well-being of vulnerable breastfed newborns. The program will include ongoing anticipatory guidance to help breastfeeding mothers maintain an abundant milk supply and describe management strategies to help increase low milk production. Dr. Neifert also will discuss the current controversy surrounding the clinical use of pharmaceutical and herbal galactagogues.

While a large majority of US mothers begin breastfeeding, the current low rates of breastfeeding continuation and exclusivity confirm that most US infants and mothers are not receiving the maximum health benefits associated with full and extended breastfeeding. Despite the enthusiastic promotion of exclusive breastfeeding and the use of inflammatory language to malign infant formula, only a third of US mothers achieve their intended exclusive breastfeeding goal. Meanwhile, multiple surveys consistently identify the two most common reasons mothers cite for stopping breastfeeding as: “I didn’t have enough milk” and “Breastmilk alone did not satisfy my baby.”

Many lactation care providers use “risk-based” breastfeeding promotion strategies, in the absence of evidence that fear is an effective motivator for long-term behavior change, especially among vulnerable populations. The intense pressure to breastfeed and the prevalence of insufficient milk contribute to unacceptable breastfeeding-related infant morbidities, including neonatal hospitalizations for excessive weight loss, dehydration, jaundice, and hypoglycemia, as well as inducing maternal grief and self-blame. This breastfeeding paradox has spurred the Fed is Best Foundation’s mission to highlight the risks of over-enthusiastic promotion of exclusive breastfeeding without adequate healthcare safety nets. Furthermore, the pervasive problem of insufficient milk, coupled with society’s new emphasis on the product, human milk, over the process of breastfeeding, has triggered a dramatic rise in peer-to-peer milk sharing and raises additional ethical concerns, including the lack of health professional guidance in making informed milk sharing decisions and the impact of informal milk sharing on milk donations to donor milk banks that serve the most vulnerable infants.

This session will address contemporary lactation professionals’ multiple ethical concerns surrounding the promotion of exclusive breastfeeding amid the realities of insufficient milk. These issues include the moral responsibility to reject fear-based breastfeeding promotion; identify mother-infant dyads at-risk for inadequate breastfeeding; protect the critical “coming to volume” stage of lactation; implement accessible, affordable lactation services to reduce breastfeeding-related morbidities; provide guidance about informal milk sharing; and provide supportive counseling to help mothers heal their breastfeeding grief

Each year in the U.S., approximately 3,500 infants die suddenly of no immediately obvious cause. Nearly half of all Sudden Unexpected Infant Deaths (SUID) are attributed to Sudden Infant Death Syndrome (SIDS). While SIDS rates have dropped significantly since the Back-to-Sleep Campaign was implemented in 1994, SIDS still remains the leading cause of death for infants aged 1–12 months. Meanwhile, accidental suffocation and strangulation in bed (ASSB) is another subgroup of SUID that has quadrupled in the last two decades. Lactation care professionals who work with expectant and new mothers have the opportunity and ethical responsibility to help reduce preventable sleep-related infant deaths.

This session will review the environmental, biologic, and social risk factors for SIDS and ASSB and briefly discuss the latest recommendations for a safe infant sleeping environment, endorsed by the American Academy of Pediatrics and the national expanded NICHD Safe to Sleep® Campaign. The updated AAP/NICHD recommendations acknowledge that breastfeeding and safe infant sleep are dual aligned public health priorities and strive to find partnership between safe sleep proponents and breastfeeding advocates. Furthermore, breastfeeding and sleeping—the two most daunting challenges parents face--impact one another. Recognizing that parents are the ultimate decision-makers about where and how their babies sleep, the new recommendations highlight the importance of meeting families where they are and having individualized, open, non-judgmental conversations about their infant sleep practices. Participants will learn effective, safe sleep conversation starters and respectful information sharing, including harm reduction strategies for parents who choose to bed share. Diverse health care workers will be empowered to begin incorporating realistic, respectful safe infant sleep discussions as a routine—potentially life-saving--aspect of their breastfeeding counseling of expectant and new mothers.

While nearly 80% of U.S. mothers choose to breastfeed, many encounter lactation difficulties that prevent them from achieving optimal infant feeding recommendations or their own breastfeeding goals. Lactation care providers need to know how to troubleshoot common breastfeeding difficulties that arise during the course of lactation. This presentation covers the prevention, recognition, and clinical management of the common maternal and infant breastfeeding concerns that often lead to early weaning.

Maternal problems to be addressed include: anatomic breast variations; postpartum breast engorgement and delayed lactogenesis; acute and chronic sore nipples, including infection with bacteria and/or candida and Raynaud’s Phenomenon; plugged ducts and mastitis; insufficient milk; and return to work or school. Infant breastfeeding challenges include: breastfeeding-related jaundice; the late-preterm infant and other at-risk newborns; infant latch difficulties; and inadequate infant weight gain. Learners will leave the session empowered and equipped to more confidently troubleshoot common lactation concerns.

This presentation represents a celebration of the incredible progress that has been achieved by countless, tireless “breastfeeding champions” over the past 4½ decades. In 1975, when Dr. Neifert began helping breastfeeding mothers overcome lactation challenges, only 25% of US mothers chose to breastfeed their newborns, and a mere 5% of infants were receiving any breast milk by 6 months of age. Breastfeeding statistics were monitored by Ross Laboratories; the US had no national breastfeeding objectives or initiatives; WIC was viewed primarily as a source of formula for infants in need; hospital maternity practices undermined the successful initiation of breastfeeding; public breastfeeding was not protected; workplace lactation support was non-existent; effective breast pumps were unavailable; non-valid medical contraindications to breastfeeding abounded; lactation management was not taught in medical training; the lactation consultant profession did not yet exist; many neonatologists considered new premature infant formulas to be superior to human milk for hospitalized premature infants; lactation management practices were seldom evidence-based, etc. La Leche League, International was the predominant, vital source of breastfeeding support and education.

While much work still needs to be done to ensure that every mother receives essential support and lactation services to reach her breastfeeding goals, the remarkable progress that has been achieved is astonishing! This presentation provides an opportunity to pause, reflect, and celebrate how much we have jointly accomplished, and to recommit our unstinting efforts to protect, promote, and support breastfeeding.

Our clients’ personal motivation for behavior change can be significantly influenced by the way we talk with them about health decisions. The clinical method of Motivational Interviewing (MI), first described in the early 1980s, now has widespread applicability, including discussions with clients about breastfeeding. MI works by triggering patients’ own motivation to change and comply with recommended treatment. Instead of an uneven power relationship (an expert and a passive client), MI involves active collaboration and joint decision-making; respect for the client’s basic worth; recognition of their individual strengths and efforts; and the client’s right to choose their own path.

This presentation will help diverse health care workers use MI techniques to draw out their clients’ own resources and motivation for change, by connecting with their personal values and goals. One of the guiding principles of MI is to “resist the righting reflex.” Although the helper’s natural urge is to correct their client’s suboptimal choices or behavior, this approach is seldom effective because an ambivalent client’s natural response to persuasion is to argue the other side, causing them to be even more committed to the status quo. Instead, participants will learn how to use core MI interviewing skills—open questions, affirmations, reflective listening, and summarizing of key themes–to encourage clients to voice their own arguments for behavior change.

Virtually every lactation professional and other health care worker knows the feeling – too much to do and too little time or energy to do it all well. This informative, entertaining, and inspiring professional development session will target those dedicated, and often-depleted, lactation care providers who sometimes forget to re-fill their own emotional tanks as they endlessly respond to the compelling needs of nursing dyads. Juggling professional and personal responsibilities can create unrelenting stress that jeopardizes both roles and contributes to job burnout. Worse yet, toxic role overload threatens to create “compassion fatigue” by draining health care workers of a deeply cherished attribute.

Drawing from her own experience of giving birth to five children in seven years, while completing her medical education, Dr. Mom shares hard-earned wisdom gleaned from her personal journey, professional encounters, and prolific reading. In addressing the universal quest of contemporary life – finding a balance – Dr. Mom offers timeless practical life-strategies to equip health care workers to achieve greater balance, promote resilience, and enhance life satisfaction by clarifying governing values, aligning priorities, nurturing core relationships, recognizing faulty thinking, and increasing essential self-care. Her content-rich, immensely funny, piercing, life balance message will resonate with anyone who is eager to re-examine their choices and renew their excitement about their life and their work. Discover how reordering our own harried lives can better equip us to sensitively counsel and support client families at risk for increased levels of stress. Come prepared to laugh and learn – leave rejuvenated and re-energized!

Do you want to improve your relationships, increase your productivity, experience greater meaning and fulfillment, and live at the upper end of your inborn level of happiness? In this lively and informative personal development session, Dr. Mom will review life-changing principles of positive psychology—the scientific study of optimal human functioning–that promote positive emotions, stimulate creative problem-solving, enhance well-being, and build resilience. Participants will learn how to experience authentic happiness by using our unique character strengths and core virtues in as many life arenas as possible, and in service to a noble purpose larger than ourselves. Discover why cultivating an attitude of gratitude is strongly and consistently linked with greater happiness and fulfillment and how complaining and blaming release a cascade of stress chemicals and diminish both complainers and hearers. Understand how positive emotions create a “Happiness Advantage” in the workplace by increasing our energy level, productivity, motivation, and creativity.

Leave the session empowered to begin incorporating happiness-boosting insights, attitudes, and practices into your daily routines to generate positive energy, cultivate your strengths, reduce stress and burnout, and keep you more engaged with life. Let your personal example of happiness, satisfaction, optimism and joy serve as a healthy and effective model for your loved ones, as well as for staff and clients within your sphere of influence.