Most recent news stories

UK Study on Infant Temperament May Simply Reflect Poor Breastfeeding Support

January 12, 2012

A study out of Cambridge UK by de Lauzon-Guilain et al found that exclusively breastfed infants in the county of Cambridgeshire were rated by their mothers to laugh less, cry more, and be more irritable than their formula-fed or mixed-fed counterparts. These results have puzzled and surprised many who do research in breastfeeding.

These surprising results, however, do not take into account one important factor that might be confounding their data— the mothers and infants are from a part of the UK where there are no Baby-Friendly hospitals and where maternity care practices around breastfeeding are suboptimal. Previous research has consistently shown that if mothers and babies are not getting off to a good start, mothers stop breastfeeding much sooner. Poor hospital practices are shown to associated with multiple breastfeeding difficulties, including suboptimal suckling.

Thus, it difficult to say if these infants are more distressed because of something inherent in breastfeeding itself, or simply because they were trying to breastfeed under difficult circumstances. Some observations in the study seem to indicate that it was the breastfeeding difficulties that may explain the results.

For example, the exclusively breastfed babies cried more. Crying is a late sign of hunger, and normally infants should be offered the breast well before they reach the crying stage. If the infant is having difficulties satisfying his needs, one would expect that he would score worse on just about every aspect of temperament. Additionally, if mothers are distressed because breastfeeding is not going well, they may perceive their infants to be more distressed.

“All we can really conclude from this study is that breastfed infants who were born in hospitals without evidence-based practices around infant feeding are more distressed than formula fed infants,” says Dr. Melissa Bartick, Chair of the Massachusetts Breastfeeding Coalition. “This is precisely the result one might expect from families trying it initiate breastfeeding in difficult circumstances.”

In order to see if there is something about breastfeeding itself that affects temperament, the study would have to be repeated in a setting where there are optimal maternity care practices around infant feeding. “In my experience, in developing countries where breastfeeding is the norm, it’s unusual to see a baby cry,” noted Bartick.

UMass Memorial cuts lactation staff

November 11, 2011

Worcester, MA– UMass Memorial Medical is elminating all of its nurse-IBCLCs, effective Dec 1, in favor of fewer IBCLCs and more lesser-trained personnel. For more details, please read the original letter sent by the Massachusetts Breastfeeding Coalition to UMass Memorial Medical or read the text of the letter below.

November 10, 2011

Mr. John O’Brien
President and CEO
UMass Memorial Health Care (System Administration)
Biotech One, 365 Plantation Street
Worcester, MA 01605

Dear Mr. O’Brien,

It has come to our attention that UMass Memorial has eliminated all of its RN-Lactation Consultant positions, and plans to outsource its inpatient lactation consultants with lesser-trained staff provided by an outside company, Lactation Services, LLC. We understand that most of these new personnel carry only the credential of Certified Lactation Counselor (CLC), and are not International Board Certified Lactation Consultants (IBCLCs). Further, it is our understanding that none of these personnel are RNs. We understand from CME/Invacare that you will have 56 hours a week of an IBCLC (1.4 FTE), half of which is dedicated to the NICU, and there will be CLCs to provide other post-partum help. CME/Invacare tells us that “any mother who requires a lactation consult is referred to the IBCLC.”

We appreciate the need to cut costs in these difficult economic times. However, there are multiple reasons why this decision is not in the best interest of UMass Memorial or its patients:

1. IBCLCs and CLCs do not have equivalent training and experience. IBCLCs require many times the training hours that the CLC requires. In addition, the IBCLC credential also requires hundreds of hours of hands-on training, whereas the CLC training is limited to a single 5 day course.
2. The Association of Women’s Health and Neonatal Nurses (AWHONN) and the US Lactation Consultant Association (USLCA) have issued staffing guidelines for inpatient lactation consultants, both of which are limited to those with the IBCLC credential.
3. For UMass Memorial, the above staffing recommendation would be 1.9 full-time equivalent IBCLCs per every 1,000 births. This would total 5.4 FTE IBCLCs for UMass Memorial, assuming about 3,700 births. Thus, the planned a 1.4 FTE IBCLC will fall far short of what is necessary to serve your number of patients.
4. The Department of Public Health perinatal regulations state that any mother who requires “advanced lactation care” must be seen by an IBCLC or someone with “equivalent training and experience.” As noted above, the CLCs cannot provide advanced lactation care, and there are not enough IBCLCs planned who can fulfill this role.
5. The Centers for Disease Control and Prevention and the Surgeon General both recognize the IBCLC as the standard of care for qualified lactation consultation.
6. Lactation consultants are currently not licensed in any state, so hiring non-RN lactation consultants would mean there is no government oversight or consumer protection for these individuals providing clinical care at your hospital.
7. It is standard of care for hospitals to provide RN-IBCLCs, especially those of equivalent size as UMass Memorial, with a level 3 nursery. Whoever will fulfill the role in the NICU should have experience and training in caring for critically ill preterm infants. By assigning this care to non-licensed personnel without a nursing background is risky for the infant, the mother, and for your institution.

Patients at UMass Memorial deserve evidence-based maternity care practices that follow acceptable national standards of care. Thank you for your consideration.

Sincerely,

Melissa C. Bartick, MD, MSc
President, Massachusetts Breastfeeding Coalition

cc: Nancy Brennan, Manager of Maternity Services, UMass Memorial Medical Center
Karin Downs, Massachusetts Department of Public Health
Anne Dematteis, Massachusetts Department of Public Health

CDC Announces New Effort to Boost Number of Baby-Friendly Hospitals

October 13, 2011

Atlanta– The Centers for Disease Control and Prevention has awarded nearly $6 million over three years to the National Initiative for Children’s Healthcare Quality to help hospitals nationwide make quality improvements to maternity care to better support mothers and babies to be able to breastfeed. The goal of the project is to accelerate the number of U.S. Baby-Friendly hospitals. Read more in the news release.

IOM recommends lactation counseling and equipment be covered as part of preventative care

July 21, 2011

Washington-On July 19, the Institute of Medicine (IOM) released a new report recommending eight preventive health services for women. The Protection and Affordable Care Act of 2010 (ACA) removes cost-sharing requirement for specified preventative services—eliminating out-of-pocket costs that often put such measures out of reach for moderate- and lower-income women. The US Department of Health and Human Services (HHS) charged the IOM with reviewing what critical gaps exist in women’s preventative health services and providing recommendations. HHS is expected to respond to these recommendations by the end of August. The IOM is a private, not-for-profit organization founded under the congressional charter of the US National Academy of Sciences.

The IOM recommends that HHS require health insurance plans cover the following eight preventive services for women with no cost sharing:

1. screening for gestational diabetes
2. human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
3. counseling on sexually transmitted infections
4. counseling and screening for HIV
5. contraceptive methods and counseling to prevent unintended pregnancies
6. lactation counseling and equipment to promote breast-feeding
7. screening and counseling to detect and prevent interpersonal and domestic violence
8. yearly well-woman preventive care visits to obtain recommended preventive services

The lactation provision, like the other seven provisions, had to meet IOM committee’s guidelines to include preventative services that are not included in existing guidelines. These guidelines included convincing evidence that the service is effective in women and has been identified as a federal priority in women’s preventative services.

The text of IOM’s recommendation regarding lactation services that should be provided without cost-sharing: “Comprehensive lactation support and counseling and costs of renting breastfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.)”

“This is a huge step forward for women,” said Dr. Melissa Bartick, chair of the Massachusetts Breastfeeding Coalition. “If adopted, it will go a long way toward ending disparities among breastfeeding rates in the US.”

A summary of the IOM report, Clinical Preventive Services for Women: Closing the Gaps is here; the full report is here on pages 95-102.

Mass. makes progress!

June 6, 2011

In the last two weeks, Massachusetts got its third Baby-Friendly facility and the Mothers’ Milk Bank of New England, based in Newtonville, pasteurized its first donor milk.

On May 25, staff at Tobey Hospital in Wareham were notified that they were awarded the Baby-Friendly designation. A community hospital with about 500 births per year, Tobey is located in Southeastern Massachusetts, a region that has historically had the state’s lowest breastfeeding rates. Nurse manager Mary Ellen Boisvert highlighted the hospital’s efforts to foster skin-to-skin contact with mothers during cesarean births at the third Massachusetts Mother-Baby Summit in April.

On June 3, the Mother’s Milk Bank of New England pasteurized its first donor milk. Founded in 2006, the MMBNE had been distributing processed milk their sister milk bank in Ohio, while working toward building the infrastructure to process its own milk. Last week’s effort culminates years of hard work by executive director Naomi Bar Yam, PhD, medical director Kathleen Marinelli, MD, and a group of dedicated staff and advisors. MMBNE is a member of the Human Milk Banking Association of North America, which currently has 11 member milk banks and 5 developing milk banks. Prior to MMBNE, there had not been a milk bank in the Northeast region since 2001.