“The pregnancy was uneventful and until this morning she had always felt the baby move.  Today was different; the baby was quiet, very quiet.  By lunchtime she noted she had not felt the baby move all morning.  A visit to her doctor’s office revealed that at thirty-eight weeks’ gestation the baby’s heartbeat could not be found.  She was immediately sent to the hospital’s birthing center.  While this mother was experiencing a fog of emotions, her labor was induced.  Ten hours later, she gave birth to a beautiful daughter: eight-pounds three-ounces, perfectly formed, yet stillborn” (shared by a bereaved family).  

There is no universally accepted definition of fetal age to define stillbirth.  It varies from twenty to twenty-eight weeks of gestation.  “The reported incidence of stillbirth varies significantly between studies from different countries and depending on the definitions used, but generally ranges from 3.1 to 6.2/1000 births or 1 in 160 deliveries” (Tavares Da Silva et al., 2016). Pregnancy loss even as early as the beginning of the second trimester can result in an unexpected lactation occurrence.

The Trudi Szallasi Scholarship provided me the opportunity to be more knowledgeable, supported and professional when set to the IBCLC examination and got certified. It empowered me to manage and lead the Breastfeeding Support Association, the only breastfeeding formal body in my country, Jordan. It also scaled up my skills as well as my knowledge through the courses that I had received at the Health e-Learning website.

Oooh, the mere mention of “exam” sends a shiver down my spine!

I always find it difficult to know where to start when it comes to studying or the IBLCE exam. I have sat the exam a few times now, and each time my preparation has been a little different.

When I sat the exam the first time I did an IBCLC course that was all by written course work: multi-choice question and short answer items that we had to post (yes, post!) back to the course assessors. I can only imagine the workload of those course assessors, and am very appreciative of all the time and generous guidance that they offered! Back then the use of email and the internet for online articles was not what it is now (yes, it was the time of the dinosaurs!). In order to prepare for the exam I had to buy text books…expensive textbooks! Thankfully I was preparing to sit the exam with a few of my work colleagues, so we shared that expense and established out own study group. As a novice, I think the study group was invaluable: it allowed us to share information that we had found and also to urge each other on when we lost sight of the end goal. We often would meet at our local Australian Breastfeeding Association branch office because they had a fabulous library of texts and articles, dedicated solely to lactation – it was our Aladdin’s cave! My friends and I would try to meet there once a week to study and share stories (oh, and sharing yummy food, some recipes and lots of laughter as well!). My friends were what helped me through the exam that first time.

Loss of an infant is one of the most difficult experiences families can live through. As health care professionals, not being able to provide a clear reason for the death is also a significant burden. The American Academy of Pediatrics (AAP) 2016 updated document on safe sleep indicates that “approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome, ill-defined deaths and accidental suffocation and strangulation in bed” (Moon). Sudden unexpected infant death (SUID) describes death occurring during infancy that may or may not be explainable. This can include suffocation, entrapment, infections, disease, trauma and sudden infant death syndrome (SIDS).

The year 2017 has been a bit of a roller coaster for breastfeeding and human lactation. There have been some very difficult challenges faced related to Infant and Young Child Feeding in Emergencies (IYCFE), in particular, hurricanes, floods, fires, and displacement of refugees. International Board Certified Lactation Consultants (IBCLCs) and breastfeeding peer counselors have been there volunteering and supporting families. Education is an essential part of best practice in these situations. IBCLCs are specialised in the field of infant feeding and when it comes to emergencies we need to use our skills to communicate and share our knowledge so all babies are safely fed.

There has been a lot of discussion on social media and in the news recently about “feeding babies”. This discussion has included the questions of whether exclusive breastfeeding is safe and whether all babies should be supplemented in the first week after birth. Despite well documented research to support exclusive breastfeeding, some ill-supported commentaries cited to questionable exclusive breastfeeding research and asserted pre-lacteal feeds have only ceased since the introduction of the Baby Friendly Hospital Initiative. Further still, some publications have accused breastfeeding advocates of forcing breastfeeding onto families, causing mothers to feel guilty, leading to post-partum depression. Most recently an article appeared recalling how an IBCLC gave the mother “permission” to wean her baby.

Infant Feeding in Emergencies: A Global Crisis

By Carole Dobrich, RN, IBCLC

©2016, Carole Dobrich. Original submitted in partial fulfillment of the requirements for the degree of Bachelor of Science Maternal Child Health: Human Lactation, Union Institute & University, Cincinnati, Ohio

Abstract

The crisis of human displacement due to war, environmental emergencies, and natural disasters have become far more frequent in the past few decades. The burden of these catastrophes is not only monetary, it also carries a heavy human cost. The health crisis brought about by the devastation increases the morbidity and mortality rate exponentially. When access to food supplies and safe water are scarce the most vulnerable, newborns, infants, and young children are at greatest risk. Free donations of commercially manufactured Infant Milk (CMIM) and an unsafe water supply, can lead to disaster, and death. Education about breastfeeding, and safe preparation of CMIM is needed for both volunteers, and health care professionals. Breastfeeding and breastmilk provide critical nutrients and immune protection. It is a lifesaving practice in emergency situations.

Giving birth and breastfeeding are physiologically normal human behaviours. Once baby is born and placed skin to skin on its mother’s chest, it will instinctively start to search for the breast and latch on. Sadly that is not how most births go. Many interventions during labour and birth impact both the mother and the infant. Mothers are often discharged home from hospitals with breastfeeding in the process of still being established. Those who are having difficulties with breastfeeding are more likely to stop breastfeeding and not reach their own goals.

201603 article photo smallNeonatal hypoglycemia is one of the most common reasons for infant admission to the Neonatal Intensive Care Unit (NICU). Over the past five to ten years, the long-standing guidelines for hypoglycemia and its treatment have been shown to be flawed and not research based. Threshold values relating to pathologic hypoglycemia have not been consistent, and interventions showed a wide range of disparities.

Breastfeeding, tongue-tie and frenotomy is still a controversial issue. Online, there are many different Facebook parenting groups providing family to family information about tongue and lip-tie. As well, there are professional groups providing support and information to both families and to the multidisciplinary professionals who together support these families. The goal is to provide evidence-based information and encourage further research in this area.