Articles

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.

Neonatal 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.

The International Breastfeeding Journal has recently published a series called Economic Aspects of Breastfeeding.  The articles and commentaries in this series provide information for policy makers and others on how breastfeeding can lead to health care and other cost savings. These articles also raise awareness among academics and the wider community, highlighting a new and publicly relevant area of research.

Being pregnant, for most women, is a wonderful, exciting, period.  They have wanted to start a family and this is the beginning of their adventure.  For others, the pregnancy may have been a nice surprise or it may be a difficult, unwanted, experience.  Life experiences are not always what we expect.

Sometimes, women have read numerous pregnancy books and then their pregnancy does not follow what the texts indicate.  This also goes for the birth experience.  One woman may dream of an idealized, beautiful, un-medicated water birth, while another, clearly having made up her mind that she wants a pain free birth, will opt for an epidural.

The article, Implications of Cesarean Delivery for Breastfeeding Outcomes and Strategies to Support Breastfeeding by Kuyper E., Vitta B., and Dewey K., addresses four main issues:

1. Rapidly rising C-section rates in low– to middle–income countries
2. Lower breastfeeding initiation rates following C-section than vaginal births
3. Breastfeeding rates at six months are the same among mothers who initiate breastfeeding irrespective of birth method
4. Overall breastfeeding rates can improve with interventions to improve breastfeeding initiation rates.

Health e-Learning-IIHL also had a wonderful experience this past June attending La Grande Conférence de l’Association québécoise des consultantes en lactation (AQC) (Quebec Lactation Consultant Association Big Conference) in our home town of Montreal. Merci à tous les IBCLC et d'autres professionnels de la santé qui nous ont accueillis. Thank you to all the IBCLCs and other health care professionals that welcomed us. We also chatted with many of our past students who were excited to see the French LP14 up and running as well as learning that we are slowly translating all the BreastEd courses into French which will be excellent for our francophone distance learners.

This month we would like to share with you the updated Academy of Breastfeeding Medicine, Clinical Protocol #1. Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014. All the clinical protocols from the Academy of Breastfeeding Medicine are excellent resources for clinical use. ABM Protocol # 1 was developed to help provide guidance in those first hours/days of life so as to prevent clinically significant hypoglycemia in infants, appropriately monitor blood glucose levels in at-risk term and late-preterm infants, manage documented hypoglycemia in infants, and to establish and preserve maternal milk supply during medically necessary supplementation for hypoglycemia or during separation of mother and baby.

This is an excellent guide to share with colleagues, as provides both guided care plans and treatment plans. The document clarifies general management recommendations for all term infants including early and exclusive breastfeeding as well as skin to skin contact and no routine supplementation for healthy term newborn infants. Here is the summary from the ABM clinical protocol #1.

During my recent visit to Australia, I had the opportunity to meet with Associate Professor, Catherine Fetherston, at Murdoch University, South Street campus in Western Australia. We had a wonderful lunch together and discussed varying subjects about breastfeeding, mastitis, milk banking, milk sharing, and the ethics of co-sleeping in Australia. Cathy recorded last month a wonderful expert lecture called "Understanding Mastitis, Current Knowledge and New Perspectives" and we are offering it as our special this month.

I crossed the country to Melbourne where I met up with Lenore and we had a wonderful evening out with Dr. Lisa Amir and Dr. Anita Bearzatto. Our dinner conversation covered topics of last year’s ILCA conference, candida, induced lactation and tongue tie. We also discussed getting together during our next visit to Melbourne in August for the Australian Breastfeeding Association 50th anniversary Liquid Gold conference.

We would like to give a special thank you to Freddy Angel and Trinity Maas for being so accommodating during our stay in Australia.

This month we would like to share with you an interesting article by Linda J Kvist. As health care professionals working with lactating mothers we need to know how to evaluate and assess for mastitis. We need to know how to help these mothers and when to refer for treatment as about 1/3 of breastfeeding mothers will experience mastitis some time during their breastfeeding experience.

We hope you enjoy reading “Re-examination of old truths: replication of a study to measure the incidence of lactational mastitis in breastfeeding women” published online through the International Breastfeeding Journal.

Health e-Learning had the pleasure of recently exhibiting at the Human Milk Banking Association of North America (HMBANA) 2014 conference in the beautiful city of Victoria, British Colombia, Canada. Thank you to all our present and past students who passed by our booth to say hi, it was so great to meet you all. In Canada there are new Human milk banks opening including in our own city here in Montreal, so we were very excited to hear what the experts had to say about human milk banking.

The conference opened with Dr. Uwe Ewald Neonatologist from Uppsala, Sweden. Imagine a family centred neonatal intensive care unit (NICU) where infants and families remain together 24 hours a day and the parents provide much of the care for their children. Constant skin-to-skin care is a key element of this care. Integrating best practice into the NICU also includes family centred care, Kangaroo Mother Care, breastfeeding, breastmilk feeding and use of donor human milk.

Kerstin Hedberg Nyqvist, RN, PhD also from Uppsala, Sweden introduced us to Baby Friendly Hospital Initiative for neonatal intensive care (Neo-BFHI). There is a preliminary version of the document with evidence, standards and criteria for the steps and guiding principles, on the International Lactation Consultant Association (ILCA) website at http://www.ilca.org/i4a/pages/index.cfm?pageid=4214

We hope you enjoy this article by Arslanoglu et al., Donor Human Milk for Preterm Infants: Current Evidence and Research Directions.