In the early morning hours of July 12, 2011, I boarded an American Airlines plane to embark on my first ILCA conference in the spectacular city of San Diego. Thanks to good fortune, I was the proud and most appreciative recipient of the WPLCA conference scholarship monies which definitely helped make this dream trip a reality.

Upon my arrival in San Diego I shared the hotel shuttle bus with several other enthusiastic LCs and thus began the networking extravaganza. Since the workshops on Wednesday were full, I used the day to unwind and tour the beautiful city of San Diego, the Harbor, Old Town and Balboa Park. There I met two lactation consultants from Georgia who befriended me and allowed me to join them for the day. Little did I know that later that week we would travel together again; this time by train, up the Pacific coast line to Hollywood to conclude our whirlwind conference excursion!

The vendor show opened in grand splendor with (non-alcoholic-darn) champagne and delectable desserts. In addition to the many vendor booths was a potpourri of lactation icons to meet and talk with including: Cathy Carothers (what a delight!), Dr. Jack Newman, Kitty Franz and Dr. Jane Morton. In many ways it was like the “Lactation Hall of Fame”! 

Before the conference I recalled hearing about the traditional “parade of flags” which opens the conference. There was no way to prepare for this event which instilled in me a sense of pride as I viewed the amazing scope of this “international” organization. This year there were almost 3,000 lactation professionals in attendance.

The main conference convened in grand style as Katherine (Kat) Shealy, MPH, IBCLC, Public Health Breastfeeding Specialist for the CDC, presented an invigorating, passionate and entertaining summary of legislation which has positively impacted breastfeeding management over the past decade. Kat traced the actions beginning with the HHS Blueprint for Action on Breastfeeding in 2000 to the recent 2011 Surgeon General’s Call to Action to Support Breastfeeding as measures which should encourage and motivate breastfeeding advocates that there is “light at the end of the tunnel”. Finally we have data and thus power to persuade those in power positions about the advantages of becoming “baby friendly”. She encouraged everyone to reference the Surgeon General’s “blue book” as a very useful tool to move breastfeeding in the right direction both in hospitals and in communities. Kat breathed fresh life into a sometimes “dry” topic.

Throughout the conference there was frequent emphasis on the very real need for lactation professionals to become skilled and keep updated on the breastfeeding-related information overload available on the internet. Parents today look to the internet for information and answers to their questions. Unfortunately, there is much “opinion” rather than evidence- based fact readily available. Parents need to be guided by educated lactation professionals to identify reputable, evidence-based sources of web information and to realize that the information obtained there should not be their “end point” for information and problem solving. Like it or not, social media sites and mobile technology are here to stay and the wise lactation professional will learn about and embrace these tools if they are to survive in the future.

I was honored to represent WPLCA at the chapters meeting! The chapter representatives had the opportunity to share their local chapter’s accomplishments so I was delighted to relay the educational opportunities offered by WPLCA and our sponsorship of the Egyptian lactation consultant as a member of ILCA.

There was a wide variety of topics covered at this conference and several of the sessions I chose to attend focused on human milk feedings in the NICU environment. This was an appropriate topic choice for me since we serve a large NICU population at West Penn Hospital. Nancy Wight, MD, IBCLC, Neonatologist, presented a fascinating discussion of the many opportunities and challenges for use of human milk in the NICU. She discussed the current “quality chasm” in perinatal care which is evident in the inability to translate evidence based research into practice. This is widely observed in the inconsistent support of and use of human milk in NICUs across the country. Dr. Wight discussed the critical exposure periods for preterm infants to receive human milk and ways to change practice to improve compliance. For example, studies show that daily swabbing the mouth of a vulnerable infant with the mother’s colostrum, results in infants being advanced to and tolerating oral feedings 10 days earlier. Interestingly, Dr. Wight also discussed the problems in measuring the effects of human milk in the NICU because of inconsistent definitions of human milk feedings. The Vermont-Oxford data collection at the time of discharge, for example, records any amount of breast milk the infant received during their hospital stay. When reviewing the data, that means that for some infants, it may be exclusive breast milk and for others it could be one breast milk feeding.

Dr. Jane Morton from Stanford University spoke extensively about her impressive findings regarding milk volumes obtained by hand expression and hands-on pumping as compared to milk volumes obtained by pumping alone. Dr. Morton conducted an excellent workshop on the “headaches” in breastfeeding management of later preterm infants (aka-“The Great Pretenders”;). Her strategy to successfully provide breast milk to this group of infants is to first focus on aggressively but appropriately providing calories. The next priority should be breast milk stimulation, using pumping and hand expression. Dr. Morton has written extensively about the use of hand expression and hands-on pumping. The third priority is that lactation professionals should focus on the attachment process. This paradigm is the reverse of how we approach healthy, term infants. Discharge planning should start from day one and the lactation consultant should work with the parents to develop a comprehensive but easy to follow feeding plan to insure continued breast milk intake.

A recurrent theme in many of the presentations was that of ethical dilemmas. Jennifer Peddleston, BScPharm, IBCLC from Canada discussed at length the professional documents which guide our professional practice. She also reviewed various ethics theories and their application in our professional practice. In another session, Ms. Peddleston dissected the International Code of Marketing of Breast milk Substitutes and code violations which are challenging breastfeeding promotion and support today. On a practical level she challenged the LCs in attendance to hold their institutions accountable for practices such as providing free formula samples, failure to educate parents of the risks of formula and the failure to exclude formula feeding information from the prenatal class curriculum.

This is only a sampling of the abundance of information presented at the sessions at this year’s conference. Equally valuable and enjoyable was the time spent “networking” with colleagues from across the globe. I must admit that initially I was a little anxious attending a conference across the country and knowing no one. My concerns quickly disappeared as I began to interface and interact with many warm, wonderful colleagues. I feel blessed and fortunate to have had the opportunity to attend this conference and I am thankful for the assistance from our local chapter! Like other “first time” experiences, my trip to San Diego for my first ILCA conference will forever hold wonderful memories for me.


Sandra M. Porco, RN, BSN, LCCE, IBCLC
Manager, Maternal Child Support Services
The Western Pennsylvania Hospital

The Midwife Center’s team of five state-licensed nurse-midwives provides pregnancy and birthing care for women and families and well-woman gynecological care from puberty through menopause. TMC’s well-woman care is designed along the “preconception model” to ensure healthier pregnancies in the future. Each of TMC’s midwives is a Certified Nurse-Midwife (CNM), a registered nurse with additional education as a midwife, and licensed by the Pennsylvania Board of Medicine.

The Midwife Center’s unique home-like and safe environment welcomes women and families from all backgrounds. Its high quality and personalized care along with its innovative programs, such as its walk-in “With Woman Fridays” program, have had a significant impact on reducing health disparities for women by addressing the obstacles that discourage some women from seeking quality care. The Midwife Center clients, as midwife clients do nationally, consistently experience fewer c-sections, low-birth weight babies, induced labors, and premature births as compared to the national average. The Midwife Center statistics for women on Medical Assistance (about 20% of its clientele) are consistent with its total clientele and national birth center statistics.

HISTORY AND MISSION OF THE MIDWIFE CENTER

Since 1982 The Midwife Center for Birth & Women's Health has provided exceptional women's health care to thousands of women living in the tri-state area. The Center has welcomed more than 4,000 babies into the world. The Midwife Center’s mission is to provide exceptional woman-centered pregnancy, birth, and well-woman care in southwestern Pennsylvania’s only independent birth center. This approach emphasizes client and family education and prevention-oriented care, and distinguishes The Midwife Center as a respected women's health care provider in the region.

For much of its 27-year history, The Midwife Center (TMC) has operated as part of a larger parent hospital, recently as part of Allegheny General Hospital. In early 2000, Allegheny General announced a restructuring plan that eliminated several non-core operations, including TMC. The Center’s staff, clients, and community members immediately organized to build a new, independent, non-profit birth center. As a result of this community and foundation support, The Midwife Center purchased and renovated a new facility that was opened and granted state licensure and national accreditation as a birth center in 2003. In March 2009, The Midwife Center celebrated the 500th baby born at the new center. We are currently backed up by UPMC Mercy and are enjoying our relationship with their OB Department.

At the birth center, state licensed nurse-midwives provide full pregnancy and birthing care, well-woman gynecological care and educational classes for women from puberty through menopause. The midwives care for women in labor and attend births at the birth center, as at Mercy Hospital where the midwives have admitting and discharge privileges. TMC staff calls upon medical specialists when necessary, including 24-hour physician back-up.

TMC has a demonstrated commitment and proven track record to serving women who do not have adequate healthcare services. In order to meet this commitment, TMC created its Women’s Health Fund in 2005 to support outreach and care to women who are under and uninsured, and as a result, the percentage of women who receive pregnancy and birthing services at TMC who are under and uninsured has increased to 20%. These women have consistently experienced the same excellent outcomes as women who have private insurance in the practice. The Women’s Health Fund has also provided continued support for TMC’s innovative With Woman Fridays that provides a variety of high quality and personalized healthcare and support services to women vulnerable to poor health outcomes during walk-in hours every Friday. The goal of With Woman Fridays is to increase better health outcomes for women who experience barriers to good healthcare.

Women and families come from over a 60-mile radius of the Center, including urban, suburban and rural areas, as well as from all socio-economic, racial, ethnic and religious backgrounds to experience and benefit from the personalized services and programs of The Midwife Center.

Furthermore, a 1991 study conducted by the American College of Nurse Midwives demonstrates why The Midwife Center is uniquely situated to help increase breastfeeding rates in lower-income communities. It concluded that “CNMs make a substantial contribution to the care of women of all backgrounds, and in particular to women and infants from a variety of underserved and vulnerable groups—such as the poor, adolescents, minority ethnic groups, women of immigrant status, and/or those living in medically underserved areas.” TMC has a demonstrated commitment to women from these backgrounds that is illustrated with the Center’s outcome statistics for births that continue to surpass national statistics for all of its clients, regardless of financial and personal background.

WHAT IS SO SPECIAL ABOUT A BIRTH CENTER?

Across the country, midwifery has made a tremendous resurgence. In Pittsburgh, midwives work in a variety of settings, but The Midwife Center for Birth and Women’s Health in the only state licensed and nationally accredited freestanding birth center in the region. Birth in a freestanding center combines excellent medical care and a high level of safety with a unique and satisfying birth experience.

The home-like and family-friendly center houses three birth suites, each with its own large bed, bathroom and jacuzzi. Family members, partners, and children are all encouraged to be active participants in the birth experience. A woman can involve as many or as few people as she chooses to make her birth experience as meaningful as possible.

At a freestanding birth center, midwives are able to provide care that truly adheres to midwifery philosophy. Such care minimizes the need for intervention and contributes to the outstanding safety records of midwives. Midwife Center clients consistently experience better outcome statistics than women and infants nationally. In 2008, 18.9% of women had c-sections, compared to 31.8% nationally. Only 2.1 % of the babies had low birth weights, compared to 8.2% nationally and only 5.3% were born premature, compared to 12.7% nationally.

Additionally we offer 6 weeks of follow up calls to all our first time and at risk moms. This is a generously grant funded service we offer and I am so happy to be selected to fulfill this position. I call all first time moms and those who did not meet their breastfeeding goals with previous children. I also have a list of moms I check in with for general postpartum support and especially those we find at risk or already coping with post partum depression. Starting in September I will have 2 days a week to bring in clients for lactation appointments.

Thank-you to Christine Haas our executive director who supplied the information for this article.

In all of these settings, both before and after the baby was born, I have found that most mothers, fathers and other family members have a mental picture of the new breastfeeding couple. Usually, mom is in a rocking chair, in a beautiful new nursing gown.  She is holding the baby in the cradle hold, leaning over the baby and gazing adoringly into the baby’s eyes.  There is usually no sign of pillows supporting the baby or the mom’s arms.

What we don’t see in this picture is the pain in mom’s eyes and face as she sits on her sore perineum or holds the baby tight against her cesarean incision; the tension in her body as she struggles to hold the baby’s weight; the ache in her back, neck and shoulders from leaning over the baby; and, the pressure she is exerting on the baby’s back or head to keep the baby from rolling too far into or away from the breast.

While the football and side-lying positions change the above dynamics, many new moms find these positions problematic as well.  These are the ones I knew, however, and these were the positions I taught new mothers.

Two years ago, at the ILCA conference, I had the opportunity to hear Suzanne Colson, PhD, MSc, BA, RGN, RM and Honorary Senior Midwifery Lecturer at Canterbury Christ Church University, speak about Biological Nurturing.  Her research, video and discussion of the value of “laid back breastfeeding” totally amazed me.  If you are not very familiar with her work, please do yourself, and the moms and babies you work with, the favor of going to her website, www.biologicalnurturing.com and checking it out.

I returned from that conference as a fervent convert to  the concepts involved in BN. These include the release of neonatal reflexes which help baby to latch and the importance of gravity with the baby in a full frontal position in optimizing the baby’s ability to find the breast and nipple and achieve a deep, asymmetric latch. There is a lot more to BN than these two concepts but they were the main ones I brought home.

In my little office/lactation room at work, there is a small, cushioned recliner for the new mom to use while we do a consult.  I gradually started to suggest to moms that they use the recliner to lie back and get their (usually swollen) feet up.  Most moms were glad to do that but not all were thrilled about the idea of nursing in that position. (Remember the mental picture above?) However, over the last six months or so, I have started really encouraging moms to try it. Most of the moms who have latch problems or sore nipples or problems keeping the baby awake were willing to try this “radical” way of breastfeeding.

So mom takes her shirt off and we fix the recliner so that she is lying at about a 30-45 degree angle. Then we put the undressed baby face down between the breasts and watch what happens.

Most of you have probably watched one of the “self-attachment” videos showing the newly-born baby crawl up the mom’s belly to her breast and start nursing.  During a consult there is a lot to do and a limited time so mom helps the baby to the breast and puts her by the nipple.  The baby then bobs around, lifts his head, does some pushing with her feet and legs and brings his head around in alignment with the nipple.  There is usually a quick, deep latch, face down and then the baby turns her head to the side as he starts to feed.  A pillow is put under the mom’s arm on the side where she is stabilizing the baby.

The look on the mom’s face is priceless.  Two wonderful things have happened.  The first is that she is not sitting on her perineum; she is sitting on her sacrum. So that pain is gone. Her body is relaxed and completely supported.  There is no tension in her neck, shoulders or back. Since the baby can feed this way in a vertical, horizontal or obliquelie, mom does not need to have the baby’s weight on an incision.  Unless she is supporting a very large or pendulous breast, her opposite hand is free.

The second wonderful thing is that the baby, who may have been really struggling with latch, generally gets on with very little trouble.  This is wonderful for both mom and baby.  Most  babies nursing this way have very effective feedings; they are less likely to fall asleep because of poor milk flow.  Moms often say that this was the best feeding the baby had ever had!

The laid-back position (someone needs to find a name for it) has worked really well for the moms I’ve seen in the past six months.  Since most have learned or tried the football or cradle hold, this is the one I usually show them.  Every mom has loved nursing this way and if the babies could talk, I know they would agree.

When you are working with a mom and baby who are struggling, this position can be one more tool in your arsenal.  I primarily see moms and babies in the first week post-partum so I haven’t used this position with older babies.  However, on the Biological Nursing website, there is a wealth of information and pictures which involve new babies and older babies as well.  There is a new DVD and a new book by Suzanne Colson which we will purchase for the WPLCA library.

One unexpected outcome of having moms try this position during a consult is that the area furniture stores should be experiencing a run on recliners!  Mom looks at dad and says,”We need one of these at home”.  And dad usually agrees!  I love watching babies nurse this way and I hope that you will feel encouraged to go the website and start trying this position with the mothers you see as well.