Experts-in-Lactation Lectures

Experts-in-Lactation Lectures are recorded presentations on a range of lactation topics by Lactation Professionals from around the world. The easy format lets you watch and listen as though you were in a lecture, then repeat the lecture as many times as you wish during your enrollment period.

All the lectures will award CERPs for Lactation Consultants and you will have access to the recording for one week from the time you enroll.

Each lecture costs USD$25 for one week access

Please note: The lectures use Adobe Flash technology - Apple devices such as the iPad or iPhone do not support Flash and you would not be able to view them using these devices.

XL46: Louise Dumas: Baby-Friendly Initiative: Why Bother?

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Louise Dumas

During this presentation, participants will realize the importance of documented risks of non-breastfeeding for both the mother and infant. They will learn how to properly answer questions posed by pregnant women/mothers about those risks. Participants will also recognize that breastfeeding difficulties commonly encountered in industrialized countries are often due to non-compliance of the basic BFI criteria (WHO / UNICEF). Dr. Dumas will prompt participants’ reflection on their own professional practice by explaining the basics of the Baby Friendly Initiative (WHO / UNICEF) and how certain aspects of the Code (WHO / UNICEF) influence care practices and services.

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XL45: Louise Dumas: Skin-To-Skin For All Mothers And Term Babies At Birth

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Louise Dumas

Dr Dumas presents the differences between kangaroo and skin-to-skin care practices at birth and what is meant by evidence. She then explains the exhaustive evidence that is available for two Baby-friendly Steps: step 4 on skin-to-skin and step 7 on mother- infant togetherness. Presenting how these techniques are realized in Canada and in Sweden, she will prompt participants to reflect on their own clinical practice to ensure a safe transition for both mother and baby at vaginal birth and at caesarean section and also how to explain these important facts to parents.

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Read more: XL45: Louise Dumas: Skin-To-Skin For All Mothers And Term Babies At Birth

XL44: Ewa Andersson: Group-Based Antenatal Care versus Standard Care

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Ewa Andersson

Group-Based Antenatal Care versus Standard Care: Results from qualitative and quantitative studies in Sweden.

Group based antenatal care (GBAC) is a model of antenatal care that has been implemented in Sweden since year 2000. Sparse research has been conducted in Sweden but in the USA, where the model is more common, the research has found that women´s satisfaction with GBAC is higher than with standard individual care (SC).

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XL43: Ewa Andersson: Transition into Fatherhood: A Time of Risk for Mental Illness

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Ewa Andersson

The transition to parenthood is an important life experience which brings along stressful changes regarding different parent roles. Historically, fathers were considered more as providers but since the era 2000, they assume new roles in the lives of their children. Researches have been conducted in many countries to describe this evolution.

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XL42: Cathy Fetherston: Understanding Mastitis, Current knowledge and new perspectives

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Cathy Fetherston

Mastitis remains a cause of significant concern for breastfeeding mothers and health professionals who are tasked with assisting them through this difficult experience. This presentation will examine clinical knowledge and evidence related to the aetiology, pathophysiology and management of mastitis during lactation, whilst also exploring recent research that provides new perspectives based on the normal microbiome observed in milk.

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XL41: Dr Kathleen Kendall-Tackett: A New Paradigm for Depression in New Mothers

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Kathleen Kendall-Tackett

Recent research has revealed a surprising link between inflammation and depression. Although inflammation was first identified as a risk factor for postpartum depression in the late 1990s, researchers have recently learned that it underlies all the other risk factors. All other known causes of depression, such as pain, psychological trauma, lack of social support, or sleep problems, trigger the inflammatory response.
This research tells us why women are vulnerable to depression in the last trimester of pregnancy and postpartum. It also explains the link between depression in pregnancy and preterm birth, and why breastfeeding protects maternal mood because it down-regulates the stress and inflammatory response.

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XL40: Dr Jane Morton. Baby-Friendly Bedside Care of Low and High Risk Infants

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Dr Jane Morton

In this lecture Dr Morton discusses the most important actions to be implemented in the first few days following birthing, that will guarantee successful, continued breastfeeding. She looks at how to apply these principles to the healthy, term baby, then how to adapt them to the special needs of the infant at risk of morbidity and re-admission to hospital. Finally, to achieve this goal, Dr Morton outlines a 5-point "Share the Care" plan that provides a proactive plan of care that will reduce the perennial staff problems of insufficient time, insufficient knowledge and skills, and lack of individual accountability that pervades many hospitals.
This lecture is complete within itself, however XL39: Game-changing Research about Breastmilk Expression provides the background knowledge you will need for success.

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XL39: Dr Jane Morton - Game-changing Research about Breastmilk Expression. Early hand expressing and hands-on pumping.

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Dr Jane Morton

Pump-dependent mothers of preterm infants commonly experience insufficient production. In this lecture Dr Morton presents compelling research demonstrating the combination of two milk removal techniques, hand expression of colostrum and hands-on pumping of mature milk, that increased mean daily milk volume to nearly 1L and maintained production at that level for at least 8 weeks despite pumping less frequently.
This lecture is complete within itself, however XL40: Baby-Friendly Bedside Care for Low and High Risk Infants is supported by the application of these techniques.

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Read more: XL39: Dr Jane Morton - Game-changing Research about Breastmilk Expression. Early hand expressing and hands-on pumping.

XL38: Liz Crowe: Cry Baby - Grief And Loss And The Lactating Mother

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Diane Wiessinger

Loss and grief permeates every part of the life cycle extending to the lactating mother. This talk will dismiss the myth of the ‘stages’ of grief, discuss what is 'normal' grief and give some practical and gentle strategies on how to assist and support women in their grief and loss.

This talk will give important information on the general principles of grief and loss acknowledging that for a new mother grief and loss can co-exist with great joy and happiness.

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Read more: XL38: Liz Crowe: Cry Baby - Grief And Loss And The Lactating Mother

XL37: Janine Stockdale: MAP-ing Women's Motivation And Succeed To Sustaining Breastfeeding

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Diane Wiessinger

When it comes to breastfeeding behaviour, international evidence demonstrates that many women struggle to find the personal motivation to persist in the early weeks; as a result they fail to achieve their breastfeeding goal.

Applying three basic principles of optimally-motivated behaviour (Mastery, Autonomy and Purpose), an illustration from a motivationally designed instructional program “Designer Breastfeeding” demonstrates how health professionals can facilitate women in achieving their personal breastfeeding goal.

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Read more: XL37: Janine Stockdale: MAP-ing Women's Motivation And Succeed To Sustaining Breastfeeding

XL35: Yvette Sheehy: Breastfeeding Premature Infants

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Diane Wiessinger

Exclusive breastfeeding is achievable for most premature babies. An understanding of the physiology of breastmilk production and maintenance of supply, premature infant breastfeeding behaviour, and the unique feeding challenges posed by prematurity are essential to feeding success.

This talk covers unique benefits of breastmilk for premature infants, establishing and maintaining the breastmilk supply, development of effective feeding behaviours and transition to breastfeeding, including problems commonly encountered by premature babies.

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XL34: Edith Kernerman: Mammary Constriction Syndrome And PEC Massage

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Diane Wiessinger

There has been much research on the various causes of nipple and breast pain in the lactating mother. In recent years, evidence has been brought to light to suggest that some of the more common causes of pain, may not actually be involved or as involved as previously thought.

Our research has suggested that much breast and nipple pain is either: referred from traumatised nipples, vasospasm that radiates, or is a result of muscle tension in the pectoralis area - now identified as Mammary Constriction Syndrome.

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Read more: XL34: Edith Kernerman: Mammary Constriction Syndrome And PEC Massage

XL33: Lisa Marasco: Thinking Outside The Box: Alternative therapies for milk supply issues

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Diane Wiessinger

Failure to produce adequate milk supply meant almost certain death, so throughout history a number of strategies were developed to help mothers make plenty of milk. Methods work on the side of stimulating the rate of milk production, or involve the process of milk release.

While certain ideas may sound exotic or challenge the sensibilities of westerners, they may actually be considered mainstream in their originating cultures.This session will discuss several alternative therapies, including what part of lactation they may work upon, what level of evidence exists to support their validity, and when they might be appropriate.

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XL32: Diane Wiessinger: Watch Your Language

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Diane Wiessinger

“Our study found significantly lower illness rates among breastfed infants.” “Breastmilk is the ideal infant food.” “It’s wonderful that you’re still nursing your baby.” “There was a 20 percent lower risk with breastfeeding.” How can any of these statements be counterproductive? Because breastfeeding is our biological norm, and should be the control group in any study of infant feeding. Surprising things happen when we use formula as the study norm instead.

We’ll look at the effect of inaccurately framed research on the media, health care professionals, mothers, and the general public, and discuss who should be promoting breastfeeding and who should protect and support it, and how.

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XL31: Catherine Watson-Genna: Facilitating Infant Competence: Hand Use During Latch

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Most breastfeeding instruction includes strategies to prevent baby’s hands from ‘getting in the way’ during positioning and latch. Careful observation reveals that infants use their hands in predictable ways that help them find, shape, and move the breast to assist attachment.

This presentation focuses on these predictable behaviors and ways to work with them and when necessary modify them to assist breastfeeding dyads. The longer version includes the research base for these observations.

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XL30: Fiona Giles: Breastfeeding for Fun and Pleasure

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Fiona Giles

The majority of advocacy and health promotion efforts to increase breastfeeding in developed countries since the 1980s have emphasized its scientifically verified physical and psychological benefits. The slogan ‘breast is best’ has been successful in terms of awareness, if not application, on a wide scale, even while there are challenges to the relative health benefits and risks of breastmilk and formula.

Knowledge is one of the necessary ingredients in any social change recipe, together with self-efficacy, opportunity, and economic and cultural support; but it has not been sufficient in enabling the initiation and continuance of breastfeeding for most mothers, evidenced by the stagnation of breastfeeding rates in the past 10 years.

This paper considers the ways in which the focus on scientific knowledge, while beneficial, has left a gap in representations of breastfeeding, particularly relating to the potential for breastfeeding to be pleasurable. I argue that we need to promote breastfeeding not only through science but also through reference to experiential and relational advantages. By appealing to mothers through recognition of their maternal sexuality, breastfeeding can be promoted as physically and psychologically pleasurable in addition to (or regardless of) providing health benefits.

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XL28: Nils Bergman: Infant feeding frequency: proposal based on available evidence and neuroscience

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Nils Bergman

Our medical culture behaves as if the brain and the gut are disconnected. The autonomic and enteric nervous systems regulate the gut, and the main sensory inputs are olfactory and tactile, provided in skin-to-skin contact. It is usually assumed that the anatomy and physiology of newborns is immature, but given the right context even the preterm gut behaves competently. In terms of available evidence on feeding frequency, there is none. Feeding frequency is however an inverse function of stomach capacity.

There is evidence on fetal stomach capacity from ultrasound, on newborn gastric aspirates, and some evidence on post-mortem studies. Corroborating these, a study on volumes and pressures is interpreted as supporting a newborn stomach maximum capacity of 20 milliliters.

The proposal therefore is that the feeding frequency should be approximately hourly, but adjusted to the actual sleep cycle with associated enteric cephalic phase which averages one hourly. This has implications for reflux and hypoglycemia, two very common feeding related problems; it may even address early epigenetic programming of obesity. While such frequent feedings may seem too much work, closer scrutiny shows it results in a major time saving.

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XL27: Diana West: Breastfeeding after Cosmetic Breast Surgery

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Diana WestA comprehensive discussion of breast augmentation and reduction surgeries and their impact upon lactation; discussion of incidence, motivations, surgical techniques, implications for lactation, psychological factors, breastfeeding management, and resources.

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XL26: Catherine Watson-Genna: Infant Oral Assessment for Breastfeeding Helpers

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Normal human variation can sometimes be difficult to distinguish from minor anomalies that can impact feeding ability. This presentation uses clinical photographs to illustrate a systematic assessment of infant anatomy for optimal breastfeeding.

Minor oral anomalies that may affect breastfeeding are highlighted, including tongue-tie, mandibular asymmetry due to torticollis, natal teeth, hemangioma, and palatal problems.

Minor conditions are differentiated from those that might put infants at risk for significant feeding difficulties.

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XL25: Lisa Marasco: Playing Detective: Assessing for insufficient milk supply.

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Is the doctor right? Is the mother right? Does anyone have a clue? While some situations are quite straight forward, others can be ambiguous and confusing.

Low milk supply can be a matter of misperception only, or it may be very real. Mother’s milk may have come in well in the beginning only to apparently drop off, or it may simply never have come in well at all. The process of determining if there is a problem and where the problem/s may lie can require the skills of a detective, but are necessary in order to form the best prognosis and strategy for the mother-baby dyad.

This session will follow a process of elimination, including how to go about screening for hormonal causes and enlisting health care provider help.

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Read more: XL25: Lisa Marasco: Playing Detective: Assessing for insufficient milk supply.

XL19: Marsha Walker: Stemming the Tide of Supplementation

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Marsha Walker

Early supplementation of the breastfed infant with infant formula has significant effects on the recipient infant’s gut flora, can provoke sensitivity and allergy to cow’s milk protein and has been identified as an environmental triggering event in the development of diabetes in susceptible families.

In a recent survey in the United States conducted by the Centers for Disease Control and Prevention, 24% of hospitals supplemented more than 50% of their breastfed infants. Supplementation should be undertaken with specific therapeutic goals in mind. However, the vast majority of supplementation in the hospital is done by maternal request based on infant behavior, cultural influences, or due to clinicians’ use of formula to solve breastfeeding problems. Formula supplementation is generally associated with a shorter duration of breastfeeding. Exclusive breastfeeding at hospital discharge is a vanishing entity.

This presentation will explore reasons for supplementation, look at true medical indications for supplementation, discuss what to supplement, when to supplement, how to deliver the supplement, how much supplement to give, and how to stem the flow of supplements in the hospital. Some hospitals have successfully helped staff reduce inappropriate supplementation by placing infant formula in a medication distribution system such as Pyxix. Others require infant formula to be logged out to help identify usage and where additional staff education and skill areas need improvement.

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XL16: Martin Ward-Platt: Neonatal Hypoglycaemia - Evidence and Recommendations

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From over two decades of research, we have a much better understanding of the physiology of blood glucose, and other fuels such as lactate and ketones, in the newborn baby; but we still have few randomised trials to guide us towards the best strategies either for the prevention or the management of hypoglycaemia. Therefore if we are to manage babies properly, we need to base our clinical guidelines on an understanding of the physiology until we have empirical studies to guide us. We need to understand that babies potentially face two successive nutritional crises: the loss of the placenta at birth, and the delayed arrival of breast milk, especially when the mother is primiparous.

Most babies are robust enough to deal with these two difficulties, but we need to identify, and help where necessary, those babies who are not coping successfully, and are becoming fuel deficient. This presentation therefore focuses on normal physiology in the context of term and preterm delivery; the concept of ‘safe’ blood glucose values in relation to alternative fuels; the hormonal control of blood glucose in the newborn; situations of abnormalities of supply and demand for glucose; and some of the influences of intrapartum care on newborn metabolism.

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XL15: Lawrence Gartner: Bilirubin Management and Implications for Breastfeeding

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Although neonatal jaundice is a common occurrence in both breastfed and artificially-fed infants, there are some special relationships between breastfeeding and jaundice in newborns. These will be explored by first examining the question of why and how jaundice or hyperbilirubinemia is a risk for newborns. The brain disorder known as "kernicterus" will be defined. The scenario of a badly managed case which resulted in development of kernicterus will be presented. Bilirubin metabolism will be examined with diagrams to understand how the newborn differs from the older child and adult in the six specific steps of this process: 1) synthesis; 2) transport; 3) hepatic uptake; 4) hepatic conjugation; 5) hepatic excretion; 6) intestinal reabsorption.

The additonal differences in bilirubin metabolism between the breastfed and the artificially-fed infant will then be explored to understand why breastfed infants normally have a prolonged period of jaundice and hyperbilirubinemia and why some breastfed infants have abnormal exaggerations of jaundice and hyperbilirubinemia. The entities of "Breastmilk Jaundice" and "Starvation Jaundice of the Newborn" will be defined. Using guidelines from the American Academy of Pediatrics, the talk will explore how to identify the infant at increased risk for exaggerated neonatal jaundice and how to assure good follow-up of the high risk infant. Methods for optimizing breastfeeding while controlling hyperbilirubinemia will be explored in detail.

The ultimate goal of the talk is to enable the health practitioner to assist in maintaining breastfeeding while protecting the infant from the rare, but very real, risk of developing bilirubin-related brain damage.

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Read more: XL15: Lawrence Gartner: Bilirubin Management and Implications for Breastfeeding