Human Milk Magazine / Issue 2, 2015 by Medela for Professionals US

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

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

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.

table of contents

min

in this issue

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

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

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

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.

cover story

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

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

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.

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

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.”

cover story

But the lactation consultant was only in Monday through Friday, during the day. 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.” 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

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 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. 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. 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

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. 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.

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. 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).

Centers for Disease Control and Prevention. Premature Birth. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm. Accessed March 10. 2015

practically speaking

Let’s Talk:

4 Steps

To a Successful

Breastfeeding Conversation

Early Intervention

Confidence

Education The Right Technology

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

practically speaking

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 breas even

Days 2-7: Lactation has been initiated

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

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

Successful Breastfeeding

min

Personal Use Pump as Needed

Pump Dependent

In this mother-infant relationship, the • Health issues separate mom and baby baby is healthy and able to breastfeed, • Infant is unable to breastfeed while the mother is able to initiate breastfeeding with no significant issues. If mom needs to return to work, a personal-use pump will be valuable to encourage her to continue providing breastmilk for her infant.

Breastfeeding Breastfeeding is best for baby and mom when possible. min

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 can help build milk supply

Use of a Symphony pump with Initiation Technology can help initiate milk supply

Supp the n

Using help breas even

Pump Dependent Hospital Grade Pump and Personal Use Pump Use of a Symphony pump

can helpissues build milk supply Unfortunately, health or other circumstances sometimes prevent Initiation Help mother and baby from being able Hospital Grade Pump and to breastfeed. It could be a situation Personal Usebaby Pump Supp Mother and are unable to After initiation occurs, the pump where the infant is should pretermcontinue and in the dependent mother of car breastfeed due to separation or health pumping 8 orhealth more times to meeti such as mom premature birth and In issues this situation, and/or baby NICU or has issuesdaily preventing build her milk supply cleft palate Using experience obstacles to successful the ability to breastfeed. A hospitalContinued pumping using a Expre The first pumping session should breastfeeding. Sometimes mom needs grade breastpump such as the Medela Symphony pump with 2-Phase can h occur as soon as possible after birth; help initiating milk supply, and this Expression with Technology can™help breas at the latest her within 6 hours and Symphony Preemie+ Initiation moms achieve the full benefit of even continue 8 or more times daily ™ is the perfect opportunity to introduce Technology can helpTechnology mom initiate starting with Initiation a professional-grade breastpump, such her breastmilk supply. The Preemie+ as the Medela Symphony® Breastpump. pattern was specifically designed for Medela’s 2-Phase Milestones Expression® initiation of lactation. Meier et al tested Success Success Milestones S technology has3 been shown this pattern foundbirth thatweight the “pattern Baby has or more yellowto achieve Baby hasand regained at At in 24 hours daymilk 4 latest by days 10-14 ba fasterstools milk ejection andafter faster flow.* morethe effectively removed colostrum 3 consecutive pumping sessions, Typically moms produce around an Ba Later,achieving mom can20introduce 5 and helped mL each1 a personalaverage mothers of 750 mL‘come by dayto 14volume’ ga use pump into her routine in order to gro quicker compared with a standard maintain her milk supply or to continue breast pump suction pattern.”4 After pumping breastmilk when she must be is achieved, the Symphony For more information oninitiation Medela hospital grade and persona apart from her baby. Breastpump can continue to help please visit medelabreastfeedingus.com or call 800-435-83 mom build and maintain her breastmilk volume for the duration of her infant’s 1 Meier,P.P., Engstrom,J.L., Janes,J.E., Jegier,B.J., Loera,F. Breast pump suction patterns hospital&stay. And upon taking her babythat mimic th greater milk output in less time spent pumping for breast pump-dependent mothers with premature infa home from the hospital, a personal 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 ofuse breastfeeds content of breastmilk pump and canfathelp a mother feel throughout the day. min

4 Prime,D.K., Garbin,C.P., Hartmann,P.E., & Kent,J.C. Simultaneous Breast Expression in Breastfeeding W Breast Expression. Breastfeed Med 7, 442-447 (2012). *When pumping at maximum comfort vacuum ™ 5 Neville,M.C. et al. Studies in human lactation: milk volumes in lactating women during the onset of lacta 1375-1386 (1988). 6 Kent,J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfe

Medela, Symphony 2-Phase Expression, Pump in Style a Medela Holding AG. Preemie+ and From Hospital to Hom

practically speaking

confident and capable in continued breastfeeding efforts.

The Right Technology

To Support Breastfeeding, From Hospital to Home™

Where To Go From Here You may be wondering, “What happened to that mother? How did Krista and her baby fare in the end?” We’re happy to report that education and the right techology turned her situation around. She was able to readily supply her premature son with the best nutrition possible, thanks to Medela Symphony Preemie+ with Initiation Technology. Today her son is home and doing well. Learn more about her success story in this issue, on page 4. As a healthcare professional, you care deeply about your patients. You strive to help them achieve best possible health outcomes. In your unique role you have the ability to affect two patients at once: mothers and their infants. By employing early intervention, support to increase confidence, sharing education tools and using the best pump with the right techology for the situation, you can influence breastfeeding outcomes with even greater results. That’s a conversation worth having!

Initiate

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

Which Mom?

Successful Breastfeeding • Mom has no problems with initiation • Infant gets to breast ideally within first hour

Mothers can build upon their initiation and establish their milk production using Medela's 2-Phase Expression Technology.

Milk Supply

Breastmilk is best for baby and mom

min

If mom and baby are separated during this time, the use of a Personal Use Pump can help build supply

Mothers can maintain their milk supply to meet their baby's needs. Daily milk intake remains consistent from months 2-6.6

min

Use of a Personal Use Pump can help maintain supply, especially when mom goes back to work

Baby effectively feeds at breast within the first hour

Mom and baby acclimate to their breastfeeding relationship

Supply is established and meeting needs of the baby

Breastfeeding baby latches at breast every 2 to 3 hours

A Personal Use Pump can help during this important period of building supply, if there are periods of separation

Using a Personal Use Pump can help mom continue to provide breastmilk and maintain production, even when she can’t be there

At first colostrum is produced Milk supply is initiated days 2-5 on average 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

References: 1. Kingston, Dennis , C. L. & Sword, 2007. Exploring breastfeeding self-efficacy. Journal of Perinatal & Neonatal Nursing, 21(3), 207-215. Doi: 10.1097/01.JPN. 0000285810. 13527. A7 2. Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) 2015 Position Statement 3. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics. 2008 Oct;122(Suppl 2):S69–S76. 4. 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).

Which Stage?

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

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 education@medela.com 13

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?

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 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

news you can use

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

• 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 education@medela.com.

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

community outreach

Introducing:

moms babies

communities about...

our environment

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 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.

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.

community outreach

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

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.

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.

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

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 communications@medela.com.

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.

nicu perspectives

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

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 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

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 “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.

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

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

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.

outcomes

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.

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 education@medela.com

Upcoming Live Education Programs Human Milk in the NICU Presented by:

Location:

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

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 lisa.wren@medela.com

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

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

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✁ 23

Medela, Inc., 1101 Corporate Drive, McHenry, IL 60050 Phone: (800) 435-8316 or (815) 363-1166 Fax: (800) 995-7867 Email: customer.service@medela.com www.medela.com Medela, Every Drop Counts, Symphony and 2-Phase Expression are trademarks of Medela Holding AG. Human Milk (magazine), Preemie+, Initiation Technology, Guardian Warmer, Maximum Comfort Vacuum and Hospital to Home are trademarks of Medela, Inc. 1548179A 0615 ÂŠ 2015 Medela, Inc.