1 – Promoting Closeness and Presence – Family-centered care – Supporting mental health

2 – Milk production and breastfeeding

3 – Healthy transition to home – continuity of lactation care

1 – 1. Identify 3 practices to teach mothers and parents of preterm infants which reflect family-centered care.

2 – Describe 3 sensory experience techniques to enhance milk expression and improve the experience of expressing milk for mothers and parents of preterm infants.

3 – Name 3 ways that lactation care providers can contribute to a developmentally supportive transition from the NICU to home for preterm dyads.

What comes to mind when you think about the experience of having a preterm baby in the NICU? The NICU experience is often summed up as “stressful” by parents and health care providers alike, yet there are huge opportunities for fostering connection between parents and their babies, including, but not limited to, providing expressed milk for the baby.The experiences of mothers and parents are connected to the developmental trajectory of preterm infants. As lactation care providers, we can use our expertise in counseling and facilitating bonding to educate the parents of preterm infants about how important they are to their baby at a time when they often feel pushed aside while others care for the baby. By offering them the information they need to participate in their baby’s care, we can better prepare them for the transition from NICU to home and to being primary caregivers for babies who thrive on connection and attachment.

Learning Objectives:

1.The learner will be able to identify three key pieces of information needed to assess milk production in a lactating person.

2. The learner will be able to describe three practices which support normal/optimal milk production.

3. The learner will be able to explain two interventions which can positively impact milk production without the use of tools or devices, including appropriate referrals to other resources.

Fortification of expressed human milk presents a conundrum: if human milk is optimal, why would we need to improve it? The concept of fortification has become fraught with misinformation, including misunderstanding of its purpose and application, especially outside of the hospital setting. Families across the U.S. are being advised to “fortify” their milk in ways that are not consistent with any research or formal guidelines, and they are not being given support to do so safely or to understand when they can stop doing so. In order to fulfill their clinical responsibilities, lactation care providers need clarity on when fortification would meet an infant’s needs, what we know and don’t know for sure about fortification, and how best to assist families in communicating with their medical providers and healthcare team about fortification. 

Knowledge Gap 

The practice of fortifying human milk has become muddled with various methodologies, some of which are not evidence-based and others unsafe. Lactation care providers often question the recommendation to fortify human milk due to questions of safety, research proving benefit, potential harms to infant, potential impacts to maternal/parental breastfeeding self-efficacy and confidence, and more.  

Objectives 

By the end of this webinar, participants should be able to: 

1. Define the term “fortification” with regard to expressed human milk
2. Identify three lactation scenarios in which feeding fortified human milk may be recommended by members of the healthcare team
3. Name three areas of concern with regard to human milk fortification which might impact lactation management and care plans

Mindset Shifts & Clinical Techniques for Supporting the Late Preterm Dyad

When parents are not appropriately educated or prepared regarding the unique needs of their late preterm infant, or Early Bird, the situation often deteriorates for them by week one or two weeks after birth, resulting in a baby who’s not thriving and/or a parent who’s not thriving, plus all the emotions of “what am I doing wrong?” – This can be avoided, and late preterm dyads can be better protected with an optimization plan for lactation in this population. This presentation will:

Explain what’s different about the Early Bird

Confirm that it’s not the parent’s “fault”

Get a clear vision of what parent wants to happen now and long-term

Explain what changes they can make to their routine to resolve problems and start thriving, get on a path to their own feeding objectives

Reaffirm that this is indeed extra effort and that it is because of the Late Preterm birth, not because of mistakes or permanent problems (baby doesn’t like breastfeeding, baby is lazy, etc.)

Reset timelines – things will likely be better by the original due date, extra milk expression efforts & alternate feeding devices can be temporary if they prefer

Validate and reassure regarding their efforts to date; build confidence in their capacity to meet their goals by building their competence

Many things parents will need to hear and consider for their Early Bird are therapeutic activities – they sound like things people might choose for healthy term babies but for Early Birds they have more significant effects (negative and positive)

Lactation in the context of a late preterm birth requires a large mindset shift – but it doesn’t have to be permanent! Early Bird interventions are generally temporary and can be discontinued when feeding matures.

Learning Outcomes

By the end of the session, the learner will be able to

Name 3 characteristics of late preterm newborns which affect their capacity to chest/breastfeed effectively

Identify 3 breastfeeding techniques which can positively impact chest/breastfeeding and milk production in the late preterm dyad

Explain 3 ways to support the lactating parent of a late preterm infant to optimize the infant’s early nutrition and outcomes