This morning I attended the El Camino Grand Rounds where Dr. Jane Morton, breastfeeding expert and pediatrician, spoke about best practices for supporting exclusive and long-term breastfeeding among newly delivered mothers. I am posting a few slides from her talk I found to be particularly interesting. Her talk was passionate, and evidence based. I enjoyed it very much.

This first slide emphasizes the need to start expressing colostrum within the first hour after birth. Instead of fixating on getting the correct latch, Dr. Morton communicated that the emphasis should be on expressing colostrum in a frequent, effective manner (hand expression) to encourage a mom’s milk production. Since milk production is directly linked with a woman’s decision to continue or cease breastfeeding, it is in the dyad’s best interest to avoid problems of supply by starting to express colostrum immediately after birth.

This slide is particularly interesting to me because it shows a mobile photo-therapy device (used on baby for jaundice management) that still enables skin-to-skin with mom. The baby is not taken away to a separate bed, so breastfeeding can still occur immediately after birth. 

This slide made me think a lot about the limitations of lactation support in most hospitals. I remembered my own hospital birth experience in Ventura, California: a lactation consultant came in for precisely five minutes to show me proper latch, expression and pumping. Following that five minute visit I never saw her again. I ended up hiring a private postpartum doula to help me through the hurdles of my first few weeks of nursing. Lucky for me, I had the money to hire this support. I can say with confidence that I would have given up without her help. The cracked and bleeding nipples was hard to take while I healed from a level four episiotomy.

The following are challenges Jane mentioned in her talk, and my “How Might We” statements:

1.)The potential lack of “comfort zone” of nurses when it comes to touching mothers and teaching them hand expression techniques and hands-on-pumping techniques. How might we train nurses to feel confident in dispensing breastfeeding support (not only pumps) instead of leaving it mainly to lactation consultants?

2.)The potential lack of resources in most hospitals to help women 24/7 during the first three days after birth when it’s most important. I subsequently
thought about the hugely successful peer counseling program that WIC has been piloting in New Mexico. How might moms of similar socio-economic backgrounds be paired with new mothers in their hospital rooms to help teach them proper techniques and offer peer-to-peer encouragement (taking some of the pressure off hospital staff)?

3.) Cultural barriers to breastfeeding and how we can recognize and educate these moms (I think peer-to-peer teaching here might be more effective than clinician teaching). For example, African-American moms have the most premature births in the US, but are the least likely to breastfeed. Although I agree that information about best practices regarding breastfeeding needs to be consistent from all healthcare providers, how might we re-frame this information differently for communities with specific known barriers and address their unique concerns?