Acquiring new knowledge about breastfeeding and lactation is an ongoing professional responsibility for all who work with new families. Marsha’s presentations endeavor to provide evidence-based practice guidelines, hands-on suggestions for remediation of breastfeeding problems, and insight into making changes at the institutional level. Professional offerings span a wide range of subjects including clinical, advocacy, systems changes, and breastfeeding as a public health issue. Whether it is a hospital in-service, WIC workshop, regional perinatal program, or large professional association conference, all material is tailored to the needs of the target audience.
Marsha is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently the chair of the board of directors of the Massachusetts Breastfeeding Coalition, and sits on the board of directors of Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association and the Executive Director of the National Alliance for Breastfeeding Advocacy.
Insufficient milk (real or perceived) is a major reason for formula supplementation and the abandonment of breastfeeding. Much of this issue can be attributed to mismanagement of early breastfeeding or a slow start due to multiple factors such as birth interventions, maternal diabetes and/or obesity, breast anomalies, and infants factors that preclude appropriate milk transfer. Interventions depend on the etiology of the cause and range from simply more breastfeeding all the way to milk expression and the use of galactagogues. There are however some situations where none of the traditional interventions work to resolve the problem. Is there something else going on in cases where our usual tricks don’t work? New research has identified two areas of concern–genetic and environmental. This presentation will go beyond the common etiology and interventions and look more deeply into genetic and environmental contributors to low milk supply.
Nipple shields have been used for hundreds of years by mothers to capture leaking milk or manage sore nipples. More recently they have been used as a tool to achieve latch and milk transfer in infants having difficulty with these tasks. Controversy surrounds the use of this tool as there are both pros and cons regarding their use and desired and undesired outcomes. The newborn mouth is a sensitive area with specialized cells tasked with oral tactile recognition. Nipple shields can provide a platform for easier latch and milk transfer in situations of low oral vacuum, upper airway alterations, oral anomalies, and a host of other conditions. However, a rigid nipple shield has the potential to be recognized as a decoy or substitute for the soft pliable breast, can mask the olfactory orientation to the breast, and can act as a super stimulus during a critical period of time when breast recognition is taking place. This presentation will explore the concepts of imprinting, super stimulus, critical periods of time, the development of a conscious mouth image, alterations of the suck central pattern generator, as well as the small amount of research on the use of nipple shields and their effect on breastfeeding.
The field of lactation is constantly changing with new research, skills, equipment, policies, and data constantly being added to our knowledge base. A look at Pub Med at the National Library of Medicine shows the online availability of more than 39,000 articles when the term “breastfeeding” is searched. Keeping up with the volume of new publications can be daunting. This presentation will discuss the top ten newest items in lactation and breastfeeding research as a means of updating clinicians in what’s the newest in the field. Some of it may be surprising!
Ambiguity exists regarding the term “nipple confusion.” Various definitions have been put forth to describe an infant’s difficulty with latching or feeding at breast following exposure to artificial nipples. Conflicting recommendations may further cloud the topic, as the World Health Organization recommends that no artificial nipples be given to neonates while the American Academy of Pediatrics recommends the use of pacifiers as a method to prevent sudden infant death. Sucking at the breast requires a different mouth conformation than does sucking on an artificial nipple. Once exposed to an artificial nipple, some neonates experience a preference for the artificial nipple, refusing the breast or demonstrating difficulty in attachment to the maternal breast. This presentation will explore definitions and evidence for and against this phenomenon, discuss whether nipple confusion is a cause or result of breastfeeding difficulties, examine the differences between the properties of the human nipple/areola and the artificial nipple, discuss the concept of imprinting, and strategize interventions that may provide remedies for infants with latching and feeding difficulties following expose to artificial nipples.
Delayed lactogenesis II can be the source of much anxiety and frustration along with early formula supplementation and eventual early abandonment of breastfeeding. A number of risk factors influence the delay in milk coming in that include cesarean delivery, primiparity, obesity, preterm delivery, retained placenta, polycystic ovarian syndrome, prenatal SSRIs, and diabetes. Assessment and interventions for both clinicians and mothers will be discussed.
Returning to employment following childbirth and continuing to breastfeed present significant challenges to new mothers. This presentation explores the legislative and employer environment for breastfeeding employees as well as discusses how to best help mothers prepare for the return to work. Specific breastfeeding plans for the return to work based on the age of the infant will be presented as well as tips for addressing common problems.
Nipple and/or breast pain can be a breastfeeding deal-breaker. If breastfeeding is not supposed to hurt, then why do so many mothers experience pain while breastfeeding? Is it maternal anatomy, faulty physiology, infant sucking alterations or anamolies? This presentation will look at nipple anatomy, the changes nipples experience during pregnancy, precursors and causes of nipple pain, and the magic number of 7 millimeters. Can 7mm serve as a screening tool for potential breastfeeding problems? If nipple pain is bad, then what about breast pain? An exploration of breast pain looks at the contributors to an unwelcome lactation guest.
The pressure for breastfeeding mothers to supplement with formula has escalated with the recent publication of a paper claiming that formula supplementation in the hospital increases breastfeeding duration and the simultaneous appearance of a new formula specifically labeled for breastfeeding supplementation. This hardly seems a coincidence! This presentation is designed to deconstruct claims that formula increases breastfeeding duration, examine the new formula, and explore the potential hazards and side effects of early formula supplementation.
The International Code of Marketing of Breastmilk Substitutes (The Code) has gained increased visibility relative to the ethical practice of health care providers and the health care system. More hospitals are engaged in the Baby Friendly process whose foundation rests on the Code. Continuing education offerings from breastfeeding coalitions and organizations are trying to adhere to the principles of the Code, as are individual lactation consultants and other health care professionals. Manufacturers and distributors of products covered under the Code are constantly changing their marketing of products, making it difficult to know who is Code compliant and who isn’t. How can we keep up with all of this? And by the way, what does the Code really say about some of the scenarios we are faced with today? How do we adhere to both the letter and the principles of the Code? Who can help with the sticky questions? This presentation will take a look at the Code, validate its continued importance (no, it’s not out of date!), and help make it relevant to current clinical practice.
Have we gone too far with pumping? Do we really need a breast pump in every postpartum hospital room? Is it a toy or does it really work? What’s with all these pumps? More and more mothers are using breast pumps for a variety of reasons. This presentation looks at the why of pumps, pump history, how pumps work, how to select the best pump for the situation, pumping scenarios, creation of pumping protocols, and how to integrate hand expression into the pumping regimine. We will also explore problems with pumps and pumping, safety issues of pumps, and the use of previouly used pumps.
Supplementation of the breastfed infant has been steadily increasing over the years, reducing the rate of exclusive breastfeeding and increasing the likelihood of premature weaning. This presentation explores the reasons for necessary and unnecessary supplementation, as well as when, why and how to supplement if necessary.
Most mothers giving birth experience a myriad of interventions. Many of these affect breastfeeding and the infant’s acquisition of early feeding skills. This presentation discusses many interventions from labor medications and IVs to separation and crying and their affect on the breastfeeding dyad. Suggestions to remediate problems associated with birth interventions are presented.
Overweight and obesity are at epidemic proportions. Both conditions complicate pregnancy, childbirth, and lactation. This presentation looks at the evidence for the protective effects of breastfeeding upon the development of overweight and obesity, especially in infancy and childhood. Also covered is how obesity affects lactation and the possible complications to breastfeeding that overweight and obesity present. Interventions for remediating these problems are offered.
Diabetes (Type 1, Type 2, and Gestational) are all increasing among the general population and especially in childbearing women and their children – much of it as a result of the increasing rates of overweight and obesity. This offering discusses each type of diabetes as it relates to breastfeeding or the lack of breastfeeding and looks at the potential complications to breastfeeding that diabetes can present. Recommendations for diabetic breastfeeding mothers are presented.
In 2007, all US birthing facilities received a survey from the CDC asking questions regarding maternity care feeding practices and policies related to breastfeeding. In 2008, the CDC sent facility-specific scores to responding hospitals assigning them a score based on how close they came to evidence-based best practices. This talk covers how to use your facility’s score as a tool to create a more supportive environemnt for breastfeeding families.
This offering reviews the vulnerabilities of the late preterm infant (34-37 weeks) and offers specific guidelines for breastfeeding these babies and protecting the mother’s milk supply.