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Laktation & Stillen LactationLaktation & Breastfeeding & Stillen ZeitschriftMagazine der of theEuropäischen European LactationLaktationsberaterinnen Consultants Alliance Allianz • www.elacta.eu • ISSNISSN 1614-807x1614-807x COVER STORY PRACTICAL KNOW HOW PRACTICAL KNOW HOW Breastfeeding After Cosmetic Infant Hand Movements During Do Mothers Really Have The Choice th Breast Surgery – page 15 Breast Seeking – page 6 To Breastfeed? – page 10 3 • 2017 30 Volume Foto: Field exchange 48 2 EDITORIAL EDITORIAL Dear members, dear colleagues, dear readers, IMPRINT summer has gone, it has started raining, the wind is blow- Company Information: ELACTA European Lactation ing and leaves are falling from trees. In this ELACTA mag- Consultants Alliance azine you will find some nice issues to read about, even by www.elacta.eu authors from overseas. About situations that will come up Email: [email protected] ZVR-Nr.: 708420941 unexpectedly and are sometimes unwanted. Our profession is really important, also after hospitalization. Convince your ELACTA president: Karin Tiktak, IBCLC colleagues and other health care providers about the impor- [email protected] tant role you play as an IBCLC. Editorial and project Actually the ELACTA board is writing this editorial from coordination: Opatija in Croatia. It is a beautiful place where one of our Eva Bogensperger-Hezel, IBCLC board members lives and does her job as an IBCLC in her pri- Email: [email protected] vate practice. We have board meetings on Friday and Saturday Team: from 9 am to 5 pm. During this enjoyable time together, we Andrea Hemmelmayr, IBCLC Elke Cramer, Ärztin, IBCLC bridge the differences we experience in lactational care. Be- Kathrin Meier, IBCLC ing the president of this important association makes me feel Bärbel Waldura, IBCLC grateful and responible. Beside a laugh and a tear, we work Zsuzsa Bauer, Dr. phil Gudrun von der Ohe, Ärztin, very hard and efficiently to reach the goals we have given our- IBCLC selves. One goal we have reached is opening the registration Translations: th st of the 10 ELACTA congress in Rotterdam on 1 September. Annika Cramer, Martina Hezel, Please find your way to the website, to catch up with the latest Elizabeth Hormann, IBCLC news on this upcoming event. You are invited to register ear- Photos: © as mentioned on the ly for this conference on the amazing steamship Rotterdam. photos; Coverphoto: © Catherine German translation will be provided. Watson Genna Last but not least it is my pleasure to thank our editorial Layout: Christoph Rossmeissl team for this magazine! They have managed again to make a Published quaterly at the end professional and interesting issue! Have fun reading! of March, June, September and December Warm regards, Deadline: 15 January, 15 April, 15 July, 15 October Karin Tiktak With its articles, Lactation and Breastfeeding wants to President ELACTA go beyond expert information about breastfeeding and also stimulate discussion. Therefore, we welcome your views. Please send Letters to the Editor to the following email address: [email protected] The articles published in Lactation and Breastfeeding do not necessarily reflect the opinions of the editors or of ELACTA. Rather, they are the author’s own personal views www.elacta.eu Lactation & Breastfeeding 3 • 2017 CONTENTS 3 Photo: © Catherine Watson Genna Photos: © Gina Weissman 2 EDITORIAL 4 LETTERS TO THE EDITOR Jaundice Therapy: Discussion About Breastmilk Icterus And The Supplementary Feed Of Formula 6 PRACTICAL KNOW HOW Infant Hand Movements During Breast Seeking Do Mothers Really Have The Choice Photo: © Kzenon/fotolia To Breastfeed? 13 HANDOUT Sudden Weaning –Actively Structuring a Difficult Situation 15 COVER STORY Breastfeeding After Cosmetic Breast Surgery 21 PRACTICAL KNOW HOW Dental Treatment During Breastfeeding Cerps International May 24th-28th 2017 Salzburg Austria 27 ELACTA NEWS Impressions of CERPS International Photo: © Andrea Hemmelmayr 2017 in Salzburg 4 LETTERS TO THE EDITOR Jaundice Therapy: Discussion About Breastmilk Icterus And The Supplementary Feed Of Formula Dear editorial team, Letter to the editor in regard to breast-fed babies have higher bilirubin the article “Hyperbilirubinaemia“ values than children fed on formula today I am writing to you because I want by Petra Schwaiger and Anke probably depends on a stronger en- to express my praise and thanks for your Prothmann, terohepathic circulation of the bibliru- magazine and in particular for your suc- Lactation and breastfeeding 2/2017 bin due to the ß-glukuronidase in the cessful and competent latest issue of L & S. bowels of the breast-fed child, which is Again you have succeeded in getting me to he subtitle of the article deals with inhibited by the protein components in read your magazine with enthusiasm even T prevention, breastfeeding manage- the formula. Reasons like the increased after having had 20 years of experience as ment and a new family-friendly thera- intake of maternal hormones that com- an IBCLC myself. What I found extremely py approach. In these days of an early petitively inhibit the Glukuronyltrans- fascinating was the article “A different way discharge of mothers and babies after ferase in the child´s liver or other in- of breastfeeding“. It sounds very consist- birth it is outstanding if the photother- hibitors of the Glukuronyltransferase, ent, logical and very much hands-on ori- apy as described by the authors would such as an elevated fat-content in the entated and encourages me in my efforts be offered more frequently and would breastmilk, an increased concentration to use none or at least as little lactation be paid for by both statutory and pri- of free fatty acids, a strikingly divergent equipment as possible because I often ex- vate health insurances in the future. composition of specific fatty acids in perience it as cumbersome and disturbing This is cheaper and also less stress- the breast milk as well as an increased and only rarely helpful for the breastfeed- ful than being sent to hospital again activity of the lipoprotein lipase and ing relationship. I also find the controver- where rooming-in is rarely possible. the stimulable lipase which is stimulat- sial discussion in the articles about the Apart from the minimization of the ed by the bile acid have been excluded use of nipple shields really interesting and enterehopathic circulation, photother- so far. helpful. It is amazing how you deal with apy the therapeutic strategy of choice Nonetheless it is argued that ac- the topic neither taking extreme points whereby the separation of mother and cording to AWMF guidelines feeding of view nor being one-sided. Although I, baby is described as the most severe formula is considered to be an optional myself, really never use nipple-shields as a side-effect in the AWMF guideline. therapy in order to break the enteroh- lactation consultant I am often confronted The importance of a successful epathic circle. This is not expicitly de- with them if mothers get in touch with me. breastfeeding management from the scribed as a therapy for icterus prolon- Thank you so much for the good job you do very beginning is illustrated very im- gatus. Generally speaking the possiblity and for this wonderful scientific magazine. pressingly. Newborns that suffer from of making good use of it exists. Yet the an elevated bilirubin value, are tired side effects should not be neglected; in Gabi Hörandner, IBCLC whereby it is unclear if they are breast- this case it would be a negative effect Schörfling, Austria fed insufficiently due to their tiredness on the microbiom of the child´s intes- or if they are tired due to their bilirubin tines with longterm effects. It is es- value. sential to exclude other reasons as the What counts is that by nursing the authors cite from the AWMF guideline. baby frequently/feeding mother´s milk With the help of good breastfeeding and a higher defecation frequency the management and photo therapy with- enterohepathic circulation is mini- out separating mother and child, feed- mised. ing formula can be marginalised. What is yet irritating is the para- graph on the so-called “breastmilk icter- Gudrun von der Ohe, us“, which is rather known as „Icterus physician and IBCLC, prolongatus“. This phenomenon that [email protected] www.elacta.eu Lactation & Breastfeeding 3 • 2017 LETTERS TO THE EDITOR 5 Jaundice Therapy: Discussion About Breastmilk Icterus And The Supplementary Feed Of Formula Hyperbilirubinemia – additional with certain risk factors such as a neo- of the breastfeeding this is a a much less comment natal jaundice automatically receive a intrusive measure that leaves the breast- better basic medical care because thus feeding relation intact and minimises he article was written on the the effort of additional necessary medi- the stress for mother and child. T grounds of our experiences with ba- cal treatment can be reduced. Successful Generally, all the professional groups bies that suffer from elevated bilirubin breastfeeeding without disruption can that get in touch with mother and baby values and the resulting problems and be more easily achieved for more moth- during the early stage of developing their strains for both parents and infants as er-child pairs. relationship or mother-child-relation- well as for the nursing staff. It is our aim Criteria and recommendations for ship, should work together very effec- to make our contribution in the fields of prevention and therapy of Hyperbiliru- tively and closely. prevention and successful breastfeeding binemia of the newborn can be found in From my point of view it is also es- management and thus to contribute to the AWMF guideline (2015) and in the sential that the professional exchange the relief of the strain for all parties in- ABM protocol 22 (2010). about different approaches in treatment volved. In case the bilirubin value remain el- does not disregard the experience-reality evated throughout weeks in the further of those people who do practical work To prevent irritations a further ex- course, some paediatricians often wish for newborns and their mothers under planation will be given: to confirm their diagnosis “ breastmilk difficult working conditions every day.
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