Action Step 11: Access to IBCLC's

Photo courtesy of the IBLCE website.

This is our final blog in our World Breastfeeding Month series of articles. Today's action step is so important for nursing mothers. Although community support groups like La Leche League offer an incredible opportunity for mothers to get breastfeeding help, sometimes an IBCLC is really the key to helping a mom overcome a breastfeeding problem.
This information comes from page 48 of the Surgeon General's Call to Action to Support Breastfeeding.



Action 11. Ensure access to services provided by International Board Certified Lactation Consultants.

International Board Certiied Lactation Consultants (IBCLCs) are the only health care professionals certified in lactation care. They have specific clinical expertise and training in the clinical management of complex problems with lactation. Better access to the care provided by IBCLCs can be achieved by accepting them as core members of the health care team and creating opportunities to prepare and train more IBCLCs from racial and ethnic minority groups that are currently not well represented in this profession.

Implementation Strategies 

Include support for lactation as an essential medical service for pregnant women, breastfeeding mothers, and children. Third party payers typically define a standard package of health benefits for women and children. Including standard coverage for IBCLC's as “covered providers” when they perform services within the scope of their certification would ensure that mothers and children have access to these services through insurance maternity benefits. Federally funded health benefit programs, such as Medicaid, the Children’s Health Insurance Programs, Tricare, and the Federal Employee Health Benefit program, could serve as models for such a standard benefit package.

Provide reimbursement for IBCLC's independent of their having other professional certification or licensure. The taxonomy for health care clinicians defines qualifications of clinicians to be reimbursed. One option for reimbursement would be to place certified lactation consultants within the category of “nursing service related providers,” and specifying the nature of care they provide would allow for reimbursement of IBCLC's without requiring that they are also registered nurses. Alternatively, developing state licensure of lactation consultants could help to achieve the same purpose.

Work to increase the number of racial and ethnic minority IBCLCs to better mirror the U.S. population. Racial and ethnic minority communities tend to be underserved by lactation consultants. More students from these communities could be trained in human lactation to increase careers in lactation consultation. Area Health Education Centers could be encouraged to establish community-based training sites in lactation services.

Getting Involved

A Nurturing Moment is actively involved in a program to provide IBCLC's for area doctor's offices. Many pediatric and obstetric practices around the country routinely employ the services of IBCLC's for their patients, and it is our hope that this trend will extend to the Tennessee Valley. One of our long-term goals with our non-profit, The MOM Foundation, is to mentor minority women who would aspire to a career in lactation. At present, however, we are more focused on developing peer counselors in economically disadvantaged areas who will be able to encourage breastfeeding in their own neighborhoods.

Because we have two IBCLC's on staff, we are usually able to see mothers the same day they call for help. We deeply appreciate the many doctors who routinely refer patients to us, and are thankful that they view us as part of the health-care team. We are careful to keep communication open with the referring physician because we recognize the team nature of our efforts to serve moms and babies.

Action Step 14: Employer Support

This is the final week of the US Breastfeeding Committee's 20 Actions in 20 Days Campaign. Today's action step is one that is a high priority for us at A Nurturing Moment - such a high priority, in fact, that we have an entire program designed to help employers in this area!

Today's step comes from pages 50-51 of the Surgeon General's Call to Action to Support  Breastfeeding.


Action 14. Ensure that employers establish and maintain  comprehensive, high-quality lactation support programs for their employees. 

Photo courtesy of Stockfree images

In the United States, a majority of mothers have returned to the workplace by the time their infants are six months old. Continuation of breastfeeding after returning to work is facilitated if the employer offers a lactation support program. The evidence demonstrates that supportive policies and programs at the workplace enable women to continue providing human milk for their infants for signfiicant periods after they return to work. High-quality lactation programs go beyond just providing time and space for breast milk expression, but also provide employees with breastfeeding education, access to lactation consultation, and equipment such as highgrade, electric breast pumps. Currently, only a quarter of U.S. employers provide breastfeeding employees with a place to express breast milk at the workplace.

Implementation Strategies 

Develop resources to help employers comply with federal law that requires employers to provide the time and a place for nursing mothers to express breast milk. As part of the Affordable Care Act enacted in 2010, the Fair Labor Standards Act was amended to require employers to provide reasonable break time and a private place for nursing mothers to express milk while at work. Programs are needed to educate employers about the new law, supply examples of how it can be implemented in a variety of work settings, and provide assistance to businesses that find compliance difficult.

Design and disseminate materials to educate employers about the beneits of providing 
more comprehensive, high-quality support for breastfeeding employees. The Health Resources and Services Administration resource kit, The Business Case for Breastfeeding: Steps for Creating a Breastfeeding Friendly Worksite, is one model of how to promote employer support for breastfeeding employees. Developing Web sites, videos, conference exhibits, and peer-to­-peer marketing strategies could all be useful for expanding the use of lactation programs and implementing effective programs across a variety of work settings. New materials that focus on the unique concerns of non-office work environments and workplaces with few employees should be developed.

Develop and share innovative solutions to the obstacles to breastfeeding that women face when returning to work in non-office settings. While there are numerous examples of creating lactation rooms in office buildings and large stores, many work environments are more challenging for breastfeeding women returning to work. For example, farm workers may find it difficult to access a private place shielded from public view. Service workers who are on the road may not have a regular workplace where they can express milk. Challenges also exist in allowing break time for breast milk expression in businesses where there are few employees to cover during breaks. Many employers have already worked with workplace lactation consultants to develop innovative solutions, such as special trailers, makeshift temporary spaces, or “floater” employees, to enable nursing mothers to take breaks.


Promote comprehensive, high-quality lactation support programs as part of a basic 
employee beneits package. There are cost savings from better retention of experienced workers, higher employee morale, greater loyalty and productivity of employees, reduction in absenteeism and sick leave taken by parents of young children, and lower costs for health care and health insurance. While the percentage of employers having lactation support programs has increased over the past decade, many women still find it difficult to combine breastfeeding with work.

Getting Involved

If you've been around A Nurturing Moment very long, you probably know how committed we are to supporting working mothers. We often consult with moms who are returning to work to help them figure out how they will manage pumping and working. We've worked with mothers in a wide variety of industries and love to help them make continued breastfeeding a success.

Last year we began a special program designed specifically to help employers support their nursing employees - just like the last point of the Surgeon General's call suggests! ANM Workplace Solutions is available to any company in the Tennessee Valley who wants to offer exemplary support. We provide an on-site support group, hospital grade breast pumps, and in-home lactation consultation for employees! If your company isn't offering you this kind of support, then have your HR people get in touch with us! We'd love to help!

Action Step 2: Fathers and Grandmothers

We're continuing our focus on the Surgeon General's Call to Action to Support Breastfeeding.  Today's focus is one that is near and dear to our hearts. I was blessed to have a husband who was very supportive of my breastfeeding efforts, even in the early days when I was struggling. My mother didn't live close by, but she had breastfed me, and was very encouraging as well.

Today's action step focusing on fathers and grandmothers is found on page 39 of the Surgeon General's document.

Action 2. Develop programs to educate fathers and grandmothers about breastfeeding

A woman’s decision to breastfeed is strongly inluenced by the beliefs and attitudes of her family and friends. Unfortunately, family and friends may discourage a mother from breastfeeding if it is not accepted within their culture. Often, when a mother is thinking about how to feed her baby, she values the advice of her partner the most, followed by the advice of her mother, family, and friends. In fact, she often values their advice more than the advice of health care professionals.

Partners are particularly important because their approval means so much to a mother, and her partner is often a mother’s primary source of support. Although fathers want the best for their family, they may become jealous or resentful or get the feeling that they will not be able to bond with their child if their partner chooses to breastfeed. he baby’s grandmothers are also very influential because mothers who have recently given birth rely on them for support and advice. To make breastfeeding successful, mothers need the support and encouragement of all of these people.

Implementation Strategies 

Launch or establish campaigns for breastfeeding education that target a mother’s primary support network, including fathers and grandmothers. Local campaigns can use print, billboard, radio, and television public service announcements that feature members of a specific population for more effective reach.

Offer classes on breastfeeding that are convenient for family members to attend. Educational materials and classes that are directed toward fathers and grandmothers need to be developed to attract and involve this extended support network. To encourage the participation of family and friends, consideration should be given to involving churches, civic organizations, health clubs, community centers, and schools because these venues may be more accessible than health care institutions. Offering classes during a variety of hours and days also may improve participation.

Getting Involved

At A Nurturing Moment we believe in supporting the entire family unit. We encourage fathers to come to our breastfeeding classes and talk to them specifically about their role in supporting a wife who is nursing a baby. 

We also view grandmothers as very important! This document can be printed and given to any grandmother to help her know how she can help her grandchild receive the optimal nutrition provided by breast milk. Grandmothers are always welcome at our Mommy Milk Meet-up group meetings. If you need us to give Grandma some special encouragement, just let us know, and we'll be happy to help! We are looking at beginning a Grandparents Class. Let us know how you think that would go over. We'd love your input!

Action Step 8: Continuity of Care

This is the third in our series of articles based on the the Surgeon General's Call to Action to Support Breastfeeding. The U.S. Breastfeeding Committee has suggested a specific focus for each day of August. Today we're actually looking at the focus from Wednesday.  The text below comes from Pages 45-46 of the Surgeon General's document.

Action 8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community. 

Image from Wikipedia

Upon discharge from their stay in the hospital, many mothers are unable to find and receive skilled breastfeeding support. Mothers often are left on their own to identify resources to help with questions and problems they may have with breastfeeding. Furthermore, hospitals, clinicians in the community, and community organizations typically lack systems to help connect mothers to skilled persons who can offer support for breastfeeding. Ideally, there would be a system to ensure that breastfeeding mothers and their infants would receive skilled support with lactation from informed and available health care teams. Hospitals, primary care clinicians, and community organizations share responsibility for creating such systems.

Implementation Strategies 
Create comprehensive statewide networks for home- or clinic-based follow-up care to be provided to every newborn in the state. Follow-up support for breastfeeding needs to be integrated into home visitation and postpartum care programs. Staff training in breastfeeding management would be fundamental to this care.

Establish partnerships for integrated and continuous follow-up care after discharge from the hospital. Communities often provide a variety of resources to help breastfeeding mothers, including peer support networks, breastfeeding clinics, lactation consultants, and support groups. Health care systems can ensure that their patients are informed about such resources and can facilitate connections to these resources. They can also help to strengthen or create these programs.

Establish and implement policies and programs to ensure that participants in WIC have services in place before discharge from the hospital. Community partners and key stakeholders, such as hospitals, lactation consultants, and other clinicians, can work with WIC to establish continuity of care for WIC participants who breastfeed their infants. In addition, WIC state agencies can collaborate with state hospital associations to identify key barriers to the provision of WIC services within the hospital setting. WIC state agencies and hospitals can partner to establish policies to ensure that WIC participants receive in-hospital
education and support for breastfeeding, including identiication of a WIC peer counselor and scheduling of follow-up support for breastfeeding by WIC staf in the community.

Getting Involved

We try to work as closely as we can with our local hospitals and physicians.  We deliver rental breastpumps to patients in their hospital rooms at Crestwood Hospital. Our Postpartum Support program is a tremendous resource for new mothers who don't have family nearby to help them after baby is born.

Our Bosom Buddies program is specifically designed to help WIC moms by providing them nursing bras. Furthermore, our sliding scale for lactation consultation services in our office ensures that no mother who needs help will ever be refused it due to her inability to pay for an IBCLC.

Action 10: Basic Breastfeeding Support from Health Care Providers

This is the second article in our series about the Surgeon General's Call to Action for Breastfeeding Promotion. Today we're focusing on an action step that we can actually help with significantly.

Action 10. Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians. 

Photo courtesy of the IBLCE   

Midwives, obstetricians, family physicians, nurse practitioners, and pediatricians provide care that supports their patients’ interests and health needs, including breastfeeding. Their full support of breastfeeding may be limited by the use of  practices that unintentionally and unnecessarily interfere with breastfeeding. These practices directly affect mothers’ and babies’ abilities to start and continue breastfeeding.

Implementation Strategies 

Define standards for clinical practice that will ensure continuity of care for pregnant women and mother-baby pairs in the first four weeks of life. The standard of care should include actions that are important for the promotion and support of breastfeeding, including providing prenatal counseling on feeding decisions, setting accountability standards for postpartum follow-up care, monitoring neonatal weight gain, and establishing referral mechanisms for skilled lactation care. Models should be established to integrate assistance with breastfeeding into routine practice settings.

 Conduct analyses and disseminate their findings on the comparative efectiveness of different models for integrating skilled lactation support into settings where midwives, obstetricians, family physicians, nurse practitioners, and pediatricians practice. Skilled lactation support may be provided by trained physicians, by lactation consultants affiliated with a physician practice, through stand-alone clinics, or by referrals. Models of care differ in the degree to which care is provided for all breastfeeding mothers to prevent difficulties and the extent to which care is provided for women already having problems. Identification of best practices and optimal care models is needed.

Getting Involved

We are blessed to live in an area where excellent health-care is available. Many pediatricians are quick to refer mothers to lactation consultants for breastfeeding support. We regularly get calls from their offices requesting consultations for their patients. However, some pediatricians are still quick to suggest that mother's supplement unnecessarily or even stop nursing altogether. Whereas some ob/gyn's are extremely supportive of their breastfeeding patients, others are dismissive at best. 

In many parts of the country lactation consultants are an integral part of the pediatric practice. Therefore, we have designed a program especially for our local doctors to give them the benefit of having a lactation consultant available without having to hire another staff member. Our LC in Your Office program allows even the smallest pediatric or family practice to provide professional breastfeeding support to their patients in the privacy of their office.

Action Step 12: Make Donor Milk Available

From the Human Milk Banking Association of North America

August is National Breastfeeding Month. The United States Breastfeeding Committee has begun a campaign of 20 steps in 20 days to support breastfeeding. These steps are based on the Surgeon General's Call to Action to Support Breastfeeding. We'll be taking a close look at some of these steps over the next few weeks! The information below comes from page 49 of the above document.

Action 12. Identify and address obstacles to greater
availability of safe banked donor milk for fragile infants. 

Growing evidence supports the role of donated human milk in assisting infants with special needs, such as infants in newborn intensive care units who are unable to receive their own mothers’ milk, to achieve the best possible health outcome. In these situations, use of banked donor milk may protect the infant from the risks that might result from not breastfeeding. Unfortunately, demand for donor milk outpaces supply because of logistical challenges related to transportation of donated milk, the lack of clarity in oversight, and the high cost of providing banked human milk. A national strategy is needed to efficiently and effectively address the issues involved in providing banked donor milk to vulnerable infant populations.

Implementation Strategies 

Conduct a systematic review of the current evidence on the safety and efficacy of donor human milk. A systematic review will provide a common understanding of the health outcomes resulting from the use of this milk by analyzing the results of all of the available published research. Additionally, a systematic review will help identify any areas where the evidence is not conclusive and where more research is needed.

Establish evidence-based clinical guidelines for the use of banked donor milk. Necessary components of the guidelines include discussion of the use of donor human milk for a variety of infants, such as those who have a low or very low birth weight, are premature, or have particular medical needs; issues related to collection of and payment for donor milk; and the complex biomedical ethics of prioritizing the distribution of banked donor milk.

Convene a study on federal regulation and support of donor milk banks. Such a study could examine possible models for regulating and funding milk banks. In addition, it should consider
policy options to address concerns about biomedical ethics related to compensation for donating milk and the for-profit sale of banked donor milk. It also could examine models for payment, including WIC or health insurance program benefits that cover the use of banked donor milk. It is important also to consider how human milk banks might be a resource in planning responses to national emergencies.

Getting Involved

At A Nurturing Moment we are passionate about seeing a human milk bank in Alabama. Melissa did her Master's Thesis on Human Milk Banking. Currently the closest milk bank is in Texas. 

However, a bank is being developed in Jackson, MS. They are in the process of raising funds to get started. On October 4 they are having a very special fund-raiser -- A special one-night screening of Donor Milk: The Documentary at the Grandview Cinema in Madison, MS. Following the film there will be a question and answer panel with Amy Vickers - executive director of the North Texas Milk Bank, a couple whose baby received donor milk, mothers who have donated, Jarred King - one of the film's producers and Linda Pittman - executive director of the Mother's Milk Bank of Mississippi. 

One key to having a milk bank in a community is the demand for donor milk by the neonatologists. In the Jackson, Mississippi area, the neonatologists regularly prescribe donor milk for those preemies who desperately need it. Parents have the right to demand that their baby receive donor breastmilk if mom isn't making enough milk for baby.  In the future every state should have at least one milk bank, and many states will have more than one (Texas already has two.) We look forward to the day when Alabama has it's very own Human Milk Bank!

World Breastfeeding Week: Celebrating 20 Years of Breastfeeding Promotion

It has been 20 years since the World Alliance for Breastfeeding Action (WABA) launched the first World Breastfeeding Week campaign. The theme that first year was "Baby Friendly Hospital Initiative." So much has happened in these last 20 years! Let's look at how far we've come.

• The Innocenti Declaration from 1990 has continued to be a guiding force in breastfeeding promotion.
• In 1992 the Healthy Mothers, Healthy Babies Coalition received a grant to move forward with the Baby Friendly Hospital Initiative (BFHI) in the US. Wellstart International in San Diego, CA, developed the assessment tools.
• In 1997 the Healthy Children Project, Inc. accepted responsibility for the initiative and formed Baby-Friendly USA to implement the BFHI in the US.
• In 2002, The World Health Organization (WHO) and UNICEF reaffirmed the Innocenti targets and added additional targets in the Global Strategy for Infant and Young Child Feeding.
• In December of 2011, Regional Medical Center in Anniston became the first Alabama facility to receive the Baby Friendly designation.
• As of May, 2012, 143 hospitals and birth centers in the United States have received this designation.

However, we still have a very long way to go! One of the goals of this year's World Breastfeeding Week is to call attention to the state of policy and programs related to the feeding of infants and young children.

The New York Initiative

Just yesterday there was a lengthy discussion on the WHNT facebook page about the Latch-On NY initiative which encouraging participating hospitals not to give free formula to women and to only distribute formula when medically necessary. A mother who chooses to formula feed will first learn about the benefits of breastfeeding her baby, at least while she's in the hospital. No mother will be denied formula, nor will any baby ever go hungry. The program is voluntary and simply helps hospitals take steps toward becoming Baby Friendly.  What the critics don't understand is that many hospitals are already doing this - there's been no fanfare or political upheaval about it; rather, they have simply implemented evidence-based medicine in their facilities.

Help for Working Moms

An argument that I have seen repeatedly in this discussion is the hardship that returning to work while breastfeeding imposes on women. The US Department of Health and Human Services office on Women's Health put together a promotion called The Business Case for Breastfeeding. It is very true that many women do indeed struggle. That is why it is so important for employers to recognize the important role they play in supporting their breastfeeding employees. Programs like ANM Workplace Solutions help employers provide the level of support necessary, and actually have a positive Return on Investment!

Truth in Advertising for Formula Companies

This week let's celebrate how far we've come, but let's recognize how far we still have to go! Let's help women and doctors alike understand that breastfeeding isn't just a matter of maternal choice. It is a decision that can affect their baby's health. It's time for our government to sign onto the International Code for the Marketing of Breastmilk Substitutes and stop allowing formula companies to mislead the public. 

No Guilt! Lots of Support!

Should mothers who don't breastfeed be made to feel guilty? No, I don't think this is about guilt. But every mother should have the opportunity to know just why breastmilk is so important for her baby. Furthermore, every mother should have the support necessary to breastfeed successfully.