Faculty Disclosure
• As a lactation consultant in private practice, I charge one fee for the
consult, whatever supplies are used. I have no retail operations.
• I work in private practice (doing home visits), in a large hospital with
a Level III NICU (rounding on all postpartum breastfeeding families),
and at a non-profit community-based breastfeeding clinic with a
sliding-scale
sliding
scale fee
fee.
• I have written a book, and one chapter in each of three other books,
about legal and ethical issues for the IBCLC.
• I am the Secretary of the United States Breastfeeding Committee
(Aug 2012-14), and a consultant member of the Go-To-WIC Task
Force (Nat’l WIC Assn)
• All content of this presentation is my own, and my appearance is
not paid by any commercial entity.
• .
Looking at Latch:
Offering Hands-Free Help
Abington Memorial Hospital
Staying Abreast Conference
Abington, PA • October 16, 2014
Presentation by
Elizabeth C. Brooks, JD, IBCLC, FILCA
[email protected]
(c) ECB JD IBCLC FILCA Sept 2014
Objectives (45 minutes)
D. W. Winnicott
• Define differences between biological nurturing
and skin-to-skin contact, and describe how
each promotes breastfeeding
• Describe two advantages to mother, and two
advantages to baby
baby, for using a laid
laid-back
back (for
mom) and prone (for baby) position while
breastfeeding.
• Identify two ways that laid-back positions save
hospital administrators costs in providing
maternal-child health care
(c) ECB JD IBCLC FILCA Sept 2014
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D. W. Winnicott
• Psychologist; published 1960’s on
emotional development of human
• Mother needs to feel secure and loved
and accepted in order to impart these
qualities to her infant
• Did he say it? “There is no such thing
as the baby; there is the baby and
someone else.”
Image: http://psicoterapiamarinaalmeida.blogspot.com/2010/07/winnicott-e-melanieklein-encontros-e.html
(c) ECB JD IBCLC FILCA Sept 2014
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Touch is important
We know he said:
“The fact is that doctors and nurses have to
recognize that they are experts in one
direction only. In regard to such a thing
as the beginning of an emotional
relationship between the mother and the
baby (of which the establishment of
breast-feeding is a part), the ordinary
mother is not only the expert; she is
actually the only one who can know how
to act for that particular baby.”The Family and
Harry Harlow, Ph.D.
University of Wisconsin
late 1950’s
Individual Development, p. 24,1965
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
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Image:
http://images.google.com/hosted/life/l?q=Harlow+research+source:life&prev=/images
%3Fq%3DHarlow%2Bresearch%2Bsource:life%26hl%3Den%26biw%3D1362%26bih
%3D534%26tbm%3Disch&imgurl=1b75067737b8c304
1
When introduced to the
group …
1 hour a day feeding on wire mother OR cloth mother
17-19 hours a day
onJDcloth
(c) ECB
IBCLC mother
FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014
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• We were not surprised to discover that
contact comfort was an important basic
affectional or love variable, but we did not
expect it to overshadow so completely
the variable of nursing; indeed, the
disparity is so great as to suggest that the
primary function of nursing as an
affectional variable is that of insuring
frequent and intimate body contact of the
infant with the mother – Harry Harlow
(c) ECB JD IBCLC FILCA Sept 2014
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Luby J L et al. PNAS [Proceedings
of the National Academy of
Sciences] 2012;109:2854-2859
(c) ECB JD IBCLC FILCA Sept 2014
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Hippocampus volume by preschool depression severity and maternal support.
Building Baby Brains
• As the authors put it:
"The finding that early parenting support, a modifiable
psychosocial factor, is directly related to healthy
development of a key brain region known to impact
cognitive functioning and emotion regulation opens an
exciting opportunity to impact the development of
children in a powerful and positive fashion."
• As I put it:
BFg is a slam-dunk means of providing early maternal
nurturance ... which builds baby brains.
Luby J L et al. PNAS 2012;109:2854-2859
(c) ECB JD IBCLC FILCA Sept 2014
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©2012 by National Academy of Sciences
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
2
Traditional prenatal/postpartum BF teaching
• Rules!
• Rules require specialists – IBCLCs!
“Basic Care: Feeding and Nutrition”
(c) ECB JD IBCLC FILCA Sept 2014
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Positions and Holds
• Sit upright
• Lots of holds and
pillows needed to keep
baby there
• How many things are
“wrong” here?
“Baby has been very hungry lately, so
we've topped her off with a little bit of
formula a couple of times.”
(c) ECB JD IBCLC FILCA Sept 2014
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(c) ECB JD IBCLC FILCA Sept 2014
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Gadgets and pumps
Touching
breasts
htt //
http://www.ecrater.com/p/4278398/antique-english-breast-pump-pacific
t
/ /4278398/ ti
li h b
t
ifi
(c) ECB JD IBCLC FILCA Sept 2014
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http://www.poshmums.com/images/Medela_symphony_in_use_000.jpg
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
3
Touching babies
Touching
babies
(c) ECB JD IBCLC FILCA Sept 2014
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Mothers dislike inconsistent
teaching
So what about the mothers?
• Tolerate but dislike breast touching
• UNLESS they feel you gave “sensitive
individualized care”
Image courtesy of Mike
Hughey, MD, Brookside
Associates, C. 2005
(c) ECB JD IBCLC FILCA Sept 2014
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Mothers feel helpless, clueless
and disempowered
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
http://www.flickr.com/photos/tofslie/223138192/
(c) ECB JD IBCLC FILCA Sept 2014
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“Can’t you come home with me?”
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4
Skin-to-skin: a revolution!
Life saving
• Also called kangaroo
care or kangaroo mother
care (KMC)
• Not just for NICU!
25
(c) ECB JD IBCLC FILCA Sept 2014
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http://www.flickr.com/photos/ajoch/144554862/
The Magical Hour
Skin-to-skin
•
•
•
•
•
•
http://www.magicalhour.com/aboutus.html
Regulates B temps
Regulates B sugars
Regulates B oxygenation
Reduces stress and crying
Promotes early BF
Associated with longer BF exclusivity and
duration
(c) ECB JD IBCLC FILCA Sept 2014
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Breast Crawl Video: Quiet, Alert, Centering
breastcrawl.org/video.shtml
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
29
• 9 observable stages when skin-to-skin > birth
• Birth cry
• Relaxation
• Awakening (arm, foot, shoulder thrusts)
• Activity (mouthing, sucking, salivating)
• Rest (at any point)
• Crawling (toward breast)
• Familiarization (licking nipple; hands massage)
• Suckling (bingo!)
• Sleep
(c) ECB JD IBCLC FILCA Sept 2014
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Breast Crawl Video: Orofacial
breastcrawl.org/video.shtml
(c) ECB JD IBCLC FILCA Sept 2014
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5
Breast Crawl Video:
breastcrawl.org/video.shtml
(c) ECB JD IBCLC FILCA Sept 2014
Breast Crawl Video: Olfactory
breastcrawl.org/video.shtml
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Breast Crawl: Lower Limbs/Stepping Reflex
breastcrawl.org/video.shtml
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014
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Breast Crawl Video: Self-latched
breastcrawl.org/video.shtml
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Skin-to-skin vs.
Laid-back
breastfeeding
(c) ECB JD IBCLC FILCA Sept 2014
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Baby-Led Mother-Assisted
• Christina Smillie MD IBCLC
• Different or the same?
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
35
(c) ECB JD IBCLC FILCA Sept 2014
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Underlying notion
Biological Nurturing
• Suzanne Colson RM PhD
• Research into baby and mother reflexes,
triggered by the simple act of laying back
(c) ECB JD IBCLC FILCA Sept 2014
• Innate survival skills: get to and latch onto breast
• Colson: Primitive Neonatal Reflexes (PNRs)
• Important component of Biological Nurturing (BN)
37
(c) ECB JD IBCLC FILCA Sept 2014
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Baby’s use of hands/body
• Catherine Watson Genna
• Baby’s hands move and adjust the breast
• Tina Smillie: babies bob, peck, flex arms
and legs, squirm, push toward breast
• But
B t only
l iin alert
l th
hungry b
babies
bi ((or
mildly sleepy) babies
• Not when frantically crying or deep
sleep babies
(c) ECB JD IBCLC FILCA Sept 2014
http://www.flickr.com/photos/spudnik06/208130664/
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(c) ECB JD IBCLC FILCA Sept 2014
Competent though
immature babies
Biology vs. Culture
• Seemingly random,
uncoordinated movements
by baby are in fact very
intentional
Western
• Tina Smillie: “Western
culture has not prepared
either mothers or
professionals to expect
such infant competence.”
(SSS, p. 80)
http://www.old-picture.com/american-legacy/005/Logan-Child-Mrs-With.htm
(c) ECB JD IBCLC FILCA Sept 2014
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• Nils Bergman
• Babies have innate ability to
BF BUT need uninterrupted
presence of mother
(c) ECB JD IBCLC FILCA Sept 2014
http://www.flickr.com/photos/41460120@N04/4618176851/in/photostream/
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
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http://www.flickr.com/photos/dharmasphere/3095407969/
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Competent though immature
babies
Brain development
and wiring (Bergman)
• Nils Bergman
• Hospital practices
not supported by
research can
affect behavioral
development in
babies, evidenced
by BF problems
(c) ECB JD IBCLC FILCA Sept 2014
• “Cells that fire together,
wire together”
• “Use it or lose it”
43
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Hippocampus volume by preschool depression severity and maternal support.
Gravity works!
• Movements that are
counterproductive
when the baby is on
back suddenly
p
become VERY helpful
when the baby is
placed prone
Luby J L et al. PNAS 2012;109:2854-2859
(c) ECB JD IBCLC FILCA Sept 2014
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©2012 by National Academy of Sciences
Why Do Babies Like it?
47
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
Why Do Moms
Like It?
48
(c) ECB JD IBCLC FILCA Sept 2014
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If you have to do it a LOT
it had better be comfortable
And flexible and adaptable
• BN: Mother is
comfortable;
her upper and
lower back,
neck,, shoulders
are all
supported by
the
chair/couch/bed
(c) ECB JD IBCLC FILCA Sept 2014
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What is it called?
•
•
•
•
•
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Clinical Suggestions (Colson)
Reclined
Prone
Australian
Laid-back (Smillie)
Biological Nurturing
(Colson)
(c) ECB JD IBCLC FILCA Sept 2014
• Compare to bolt upright typist
positions.
• But it is not the ONLY position
• Is particularly helpful in early
learning days
• Explain BN to mother
• Her back touches the
chair/couch “like
when you watch TV”
• Her comfort is
paramount
• No one “correct”
position
•
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Clinical Suggestions (Colson)
(c) ECB JD IBCLC FILCA Sept 2014
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Clinical Suggestions (Colson)
• Comfort for mom often = good and
comfortable latch
• Explain Mom’s
BODY supports B,
not arms or pillows
(no boppies!)
• Pillows may
support Mom’s
arms and head
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
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(c) ECB JD IBCLC FILCA Sept 2014
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Clinical Suggestions
(Colson)
Clinical Suggestions (Colson)
• Baby is placed on Mom so Baby’s body
brushes up against her curves and torso
(c) ECB JD IBCLC FILCA Sept 2014
http://www.flickr.com/photos/archangeldeb/3219674677/
• Baby often uses reflexes to
push into a position similar
to the one in womb
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Clinical Suggestions (Colson)
• For latch refusal/sore nipples
• Place B in BN nurturing position while in sleep state
• B in light sleep or rousing will often latch without a fight
Who wants us to do this?
• Surgeon General!
Vice Admiral Regina M. Benjamin, MD, MBA
• “Everybody can help make
breastfeeding easier”
(c) ECB JD IBCLC FILCA Sept 2014
http://www.flickr.com/photos/seandreilinger/296491284/
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Who wants us to do this?
• Mothers
• Sore nipples = early
cessation
• Laid back = less sore
nipples
• BFg babies = greater
maternal confidence
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
(c) ECB JD IBCLC FILCA Sept 2014
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Who wants us to do this?
• Our bosses!
• Happier patients,
better outcomes,
less staff
frustration
• Fewer
readmissions
• Better Press
Ganey scores!
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Who wants us to do this?
• We do!
• Saves time in teaching
• We see more moms
• How many of us are at recommended
staffing
t ffi ratios?
ti ?
• ↑ mother confidence; ↑ BF
• ↑ mother happiness in hospital
• ↑ BF exclusivity and durations
• Easy skill to teach other HCPs: this isn’t
brain surgery; it’s just BF
(c) ECB JD IBCLC FILCA Sept 2014
“Let’s unwrap the
baby so you can
snuggle, while we
talk about what’s
g
g on”
going
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(c) ECB JD IBCLC FILCA Sept 2014
Who wants us to do this?
Summary
• Babies need to be touched and held
• Mothers need to touch and hold them
• The dyad uses biological reflexes and
behaviors designed to promote survival
• A lot
l t off “teaching”
“t
hi ” iisn’t’t required
i d
• “Laid back” makes it easy and comfortable
for the dyad to do a lot of holding and
breastfeeding
• Lovely way to get BFg off to a great start in
early days
Babies!
(c) ECB JD IBCLC FILCA Sept 2014
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(c) ECB JD IBCLC FILCA Sept 2014
Thank you!
Are We There Yet?
• Define differences between biological
nurturing and skin-to-skin contact, and
describe how each promotes
breastfeeding
mother, and
• Describe two advantages to mother
two advantages to baby, for using a laidback (for mom) and prone (for baby)
position while breastfeeding.
• Identify two ways that laid-back positions
save hospital administrators costs in
providing maternal-child health care
(c) ECB JD IBCLC FILCA Sept 2014
(c) ECB JD IBCLC FILCA Sept 2014 For
individual use of Abington BFg Conf
attendee only
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Works Consulted: See separate
handout
Questions? Comments?
Corrections?
Liz Brooks,
Brooks JD,
JD IBCLC,
IBCLC FILCA
[email protected]
Twitter: @
@LizBrooksIBCLC
LizBrooksIBCLC
FB: www.facebook.com/LizBrooksIBCLC
www.LizBrooksIBCLC.com
www.lactspeak.com/speakers/lizbrooks
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