Meeting the needs to breastfeed

From hospital rooms to University classrooms, faculty and staff are dedicated to helping new mothers breastfeed their babies and supporting them when it doesn’t go as planned.

Meeting the needs to breastfeed click to enlarge Lactation consultant Diane Asbill (right) discusses breastfeeding and other newborn issues with Kaila Mitchell and her baby, Anna, born Aug. 6. (Photo by Max Englund)
Meeting the needs to breastfeed click to enlarge Dr. Alison Stuebe

Studies have long shown that the best start for babies is with breast milk, with the World Health Organization recommending that babies be exclusively breastfed for at least the first six months of their lives and for as long as mutually desirable for mom and baby.

While breastfeeding is an affordable and available option for many mothers, it is a misconception that it always comes naturally, said Diane Asbill, BSN, RN, program coordinator for lactation services at N.C. Women's Hospital at the UNC Medical Center.

Preterm birth, illness, latching problems, pain and a host of other difficulties can get in the way for a new mother trying to feed her newborn. Even those who breastfeed fine at the hospital face roadblocks when they return home: extended families where breastfeeding or pumping is not the norm, limited maternity leave, other responsibilities and the stigma of breastfeeding in public.

"When breastfeeding is hard, it can feel like failure for many of our moms in the hospital and even after they get home," said Asbill. "This is one thing they thought their body was supposed to do on its own."

Carolina demonstrates a campus-wide commitment to healthy mothers and babies through clinical practice, cutting-edge research and both patient and practitioner education. From hospital rooms to University classrooms, faculty and staff are dedicated to helping new mothers provide vital nutrition for their babies – and supporting them when it doesn't go as planned.

A 'baby-friendly' birthplace

In 2012, N.C. Women's Hospital was the third hospital in the state to receive international recognition as a Baby-Friendly birth facility from Baby-Friendly USA, a program of the World Health Organization and the United Nations Children's Fund which recognizes an optimal level of care for breastfeeding mothers and babies.

Lactation services began with a team of two in 2000, and now 14 International Board Certified Lactation Consultants are on staff to serve every nursing baby and mother in the hospital seven days a week and, often, in the middle of the night.

"I don't know of many hospitals with that much night coverage, and it's essential for the continuity of care, " said Asbill. "The night is not when adults are used to being awake, making decisions and competently using new skills."

Nearly 30 years ago, Asbill herself was a neonatal intensive care unit (NICU) nurse at UNC. She knew that breast milk was essential to support the NICU babies in her care – babies who were often born premature or sick. She became a lactation
consultant in 1989.

"Our lactation consultants in the NICU help these moms to pump and store their milk and have a plan for when they get home. We teach them how to transition the baby to breast if the baby is medically and developmentally ready to do that," she said. "Food is important, but it's also their medicine."

This hospital also makes available donor breast milk to all breastfeeding newborns who need early supplementation during their hospital stay.

"The previous thinking was that full-term babies didn't need donor milk. But if your goal was to exclusively breastfeed and something after delivery changed your ability to do that, you won't be able to meet your breastfeeding goals," she said.

Support doesn't stop at discharge. Lactation consultants see all the newborns who come to the UNC pediatric clinic and staff the Lactation Consultant Warmline, a hotline for moms with questions about breastfeeding.

"We hear from moms all the time who tell us that our team was there to give them confidence when they didn't think they could keep going. We have mothers with significant barriers to doing this, and it's gratifying when we know we've helped them."
'A public health imperative'

Catherine Sullivan, MPH, deputy director of the Carolina Global Breastfeeding Institute (CBGI) at the Gillings School of Global Public Health, said the benefits of breastfeeding to maternal and child health make it a public health priority.

"It's a public health imperative to reduce chronic diseases in children and adults, and breastfeeding has been shown to reduce the risk for various conditions," said Sullivan, who oversees training of students seeking to become board certified in lactation in the school's Mary Rose Tully Training Initiative (MRTTI).

"We're not just focused on the baby; we're focused on the mom, too. We know that women who have exclusively breastfed have reduced risk for breast and ovarian cancer and diabetes, and new research is looking at the role breastfeeding plays on heart health," said Sullivan.

This week, MRTTI welcomes their seventh class, their biggest and most diverse yet: 14 students from multiple demographics and backgrounds, combatting misperception about who belongs in the field. Over the years, the initiative has seen enrollment from physicians, nurses, and nutritionists to anthropologists and social workers and has a 100 percent pass rate on the international board exam.

Because the program is housed in an academic center, the course work is rigorous and includes 300 hours of clinical work and 90 hours of classroom time, providing an education that goes well beyond basic breastfeeding.

"North Carolina is fourth in the nation for the total number of board-certified lactation consultants, and our numbers grow every year. We're training leaders in the field of breastfeeding, people who can go out in their communities and advocate for and support entire families and empower health."

Best laid plans

When a new mother has tried everything, and breastfeeding still isn't working out, Dr. Alison Stuebe, a physician and researcher at UNC's Department of Obstetrics and Gynecology in the School of Medicine, calls that a "lactastrophe."

"Sometimes, it doesn't work out no matter how hard you try, and that can be a very stressful time," said Dr. Stuebe, Distinguished Scholar of Infant and Young Child Feeding. She currently focuses much of her research on the effects of postpartum depression on breastfeeding, as well as barriers to breastfeeding such as racial and ethnic disparities, and she manages a clinic of physicians and lactation consultants who work toward new approaches for the management of breastfeeding difficulties.

"Trouble with breastfeeding – whether due to mastitis or milk supply – can lead to a flood of negative experiences for a new mother: the inability to bond with her baby or the judgmental stares and comments of others if she isn't able to nurse," she said. "We see a lot of mothers with postpartum depression."

It's a message that's important to Dr. Stuebe, who nursed three children while building a demanding career: With the right support, moms who struggle with breastfeeding don't necessarily have to give up.

But she had another message for moms, too: If it's not working out, it's OK to move on.

"We should remember that breastfeeding is a part of motherhood, but it's not the only part. If breastfeeding struggles are preventing you from seeing your baby smile or hearing your baby coo, then there may come a time when this is not making sense for you and your baby.

"We'll take away as many barriers as possible so you can give it your best shot – and if it doesn't happen, then we will help you make peace with that and find other ways to bond and connect with your baby."


This story also appeared in The University Gazette

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