MOTIONS Concept Review Committee Marie Beam and Heidy Guzman, co-Chairs March 23, 2020
Proposed changes to Concepts and Concept Explanations are noted in blue.
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#1 MOTION: Revise “Mothering through Breastfeeding” Concept Explanation
Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby. (Apr 94)
Proposed Concept Explanation: Breastfeeding, defined as the baby nursing directly at the mother’s breast, provides a complete way of meeting a baby’s primary needs, which include touch, comfort, warmth and protection, as well as food. Every time a mother puts baby to breast, all of these needs are satisfied. The intimate interaction between the pair deepens as the breastfeeding relationship continues, creating a reciprocal framework which both increases the mother’s capacity to understand the baby and enhances the baby’s responses.(1) Prolactin, often referred to as the “mothering hormone,” is produced in response to the baby’s suckling and further encourages sensitivity to the baby’s needs. The hormone oxytocin assists in milk ejection and enhances trust, nurturing, relaxation, bonding/attachment and healing. In the act of nursing skin-to-skin, the baby’s saliva communicates with the mother’s breast and body to customize the milk’s properties to meet the baby’s current immunological needs and optimize the baby’s microbiome.(2,3) The physical mother-baby connection is integral to maternal sensitivity to the baby, even during sleep.(4,5,6) Mothering through breastfeeding beautifully and automatically satisfies a baby’s primary needs all at the same time.
(1) La Leche League International, The Womanly Art of Breastfeeding, 2010. (2) Moossavi, S., et al. (2019). "Composition and Variation of the Human Milk Microbiota Are Influenced by Maternal and Early-Life Factors." Cell Host & Microbe 25(2): 324-335.e324. (3) Azad, M. B., et al. (2013). "Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months." Canadian Medical Association Journal. (4) Wiessinger, D., D. West, L.J. Smith and T. Pitman, Sweet Sleep, La Leche League International, 2014. (5) McKenna, J. J. and L. T. Gettler (2015). "There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping."Acta Paediatr. (6) Blair, P. S., et al. (2020). "Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019." Breastfeed Med. (DRAFT Jan 20) ------
Rationale for changes to the Concept Explanation: 1. A definition of “breastfeeding” has been added to clarify that it means the baby is nursing/feeding directly at the mother’s breast. 2. “Acceptance” was deleted because its meaning is unclear; “comfort” and “protection” were added as basic needs. 3. Information about oxytocin was added to recognize that both prolactin and oxytocin play important roles in “mothering through breastfeeding.” 4. Recent research is cited on the evidence that mother’s sensitivity to the baby is enhanced by direct feeding at the breast, an important safety issue when the baby is in bed with the mother. ------Current Concept Explanation: Breastfeeding provides a complete way of meeting a baby’s primary needs, which include touch, acceptance, and warmth, as well as food. Every time a mother puts baby to breast, this whole complex of needs is uniquely and naturally satisfied. The intimate interaction between the pair deepens as the breastfeeding relationship continues, creating a reciprocal framework which both increases the mother’s capacity to understand baby and enhances baby’s responses. Prolactin, often referred to as the “mothering hormone,” is produced in response to the baby’s suckling and further encourages sensitivity to the baby’s needs. Mothering through breastfeeding beautifully and automatically satisfies a baby’s primary needs all at the same time. (rev Mar 19) ======
#2 MOTION: Revise “Childbirth” Concept
Proposed Concept: Initiating breastfeeding is easier for mother and baby when birth takes place in a supportive environment where interventions and drugs are minimized. (DRAFT Nov 2019)
Current Concept: Alert, active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.
Rationale for changes to the Concept and Concept Explanation: “Alert, active participation by the mother in childbirth” was not the norm when this Concept was first articulated decades ago. While it has become standard practice in many places for mothers to remain awake and aware during childbirth, babies and mothers still may have difficulty initiating breastfeeding because of routine interventions. The new Concept wording focuses on factors that have been demonstrated by research to provide optimal circumstances for breastfeeding initiation: having a trusted companion present during childbirth, minimizing interventions and drugs, and preparing for birth and breastfeeding while pregnant. ======
#3 MOTION: Revise “Childbirth” Concept Explanation
Proposed Concept Explanation: Events during labor and childbirth can impact the breastfeeding experience. Improved birth outcomes occur when a companion supportive of the birthing mother’s wishes is present and provides comfort measures that reduce pain, fear and anxiety. Research shows that minimizing interventions and drug use during birth supports the baby’s ability to initiate effective breastfeeding immediately after birth. Although some interventions, such as a cesarean birth, may be lifesaving, it is important to be aware that interventions can significantly affect breastfeeding in the early days. These may affect the baby’s ability to suck, swallow and breathe normally, interfere with immediate skin-to-skin contact, delay the initiation of an adequate milk supply, and impact maternal health and early mothering behaviors.
Understanding the physiological process of labor and childbirth, how childbirth is managed, and how interventions may impact breastfeeding can help in planning for giving birth. Preparation for birth and breastfeeding may include attending a class, reading books, talking with someone knowledgeable on these topics, and/or attending La Leche League meetings. Knowledge can help the birthing mother feel confident and make informed decisions during the birth that can contribute to getting breastfeeding off to a good start.
Bibliography (1) Beck, C. T., & Watson, S. (2008). Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res, 57(4), 228-236. (2) Bohren, M. A., Hofmeyr, G. J., Sakala, C., et al. (2017). Continuous support for women during childbirth. Cochrane Database Syst Rev, 7, Cd003766. (3) Brimdyr, K., Cadwell, K., Widström, A.-M., et al. (2015). The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth, 42(4), 319-328. (4) Pérez-Escamilla, R., et al. (2016). "Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Maternal & Child Nutrition. (5) Smith, L. J., & Kroeger, M. (2010). Impact of birthing practices on breastfeeding (2nd ed.). Sudbury, Mass.: Jones and Bartlett. (6) World Health Organization (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva, World Health Organization: 200. ------Current Concept Explanation: Alert and active participation in childbirth can influence what happens during the birth and can impact the initiation and establishment of breastfeeding afterwards. Minimizing drug use during the birth supports the initiation of breastfeeding and the baby’s ability to nurse effectively immediately after birth. While some interventions, such as birth by cesarean, may be lifesaving, they also can significantly affect nursing in the early days. Having more information about the physiology of childbirth and its relationship to early breastfeeding provides a better idea of what to do in order to minimize the effects of any interventions. (Mar 19) ======
#4 MOTION: Revise “Early and often” Concept
Proposed Concept: Mother and baby need to be together early and often to establish a satisfying breastfeeding relationship and reliable milk production.
Current Concept: Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply. (Apr 94)
Rationale for changes to the Concept: 1. “Satisfying breastfeeding relationship” replaces “satisfying relationship” to clearly define the relationship. 2. “Adequate” was changed to “reliable” to make clear that milk production needs to be both adequate to meet the baby’s needs and also responsive to an increased need for more milk. 3. “Milk supply” was changed to “milk production” to recognize that it is the breasts’ ability to produce milk in response to the baby’s needs that is important, not the amount of milk produced.
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#5 MOTION: Revise “Early and often” Concept Explanation
Proposed Concept Explanation: The term “early and often,” rather than an arbitrary time limit, describes how milk production and the breastfeeding relationship are naturally established. Encouraging immediate and uninterrupted skin-to-skin contact after birth and 24-hour rooming-in helps get breastfeeding off to a good start. Frequent nursing in the first minutes, hours, and days is important for initiating milk production, and feeding the baby on cue helps increase and maintain milk production. The hormones that are released during breastfeeding enhance bonding and attachment between mother and baby, support recovery from birth for both, and promote normal growth and development of the baby.
Special circumstances may impose separation during the early weeks, presenting challenges to the establishment of the breastfeeding relationship. However, with support, persistence, plenty of skin-to-skin contact and frequent removal of milk via milk-expression, the mother-baby bond can be encouraged, reliable milk production can be achieved, and often exclusive breastfeeding can be established.
(1) Widstrom, A. M., Brimdyr, K., Svensson, K., et al. (2019). Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr, 108(7), 1192-1204. (2) World Health Organization. (2018). Implementation Guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-Friendly Hospital Initiative. Geneva:http://www.who.int/nutrition/bfhi/en/ (DRAFT Dec 2019)
Rationale for changes to the Concept Explanation: 1. Skin-to-skin contact and rooming-in were added, as these practices have been demonstrated to help facilitate breastfeeding success. 2. Factors were noted that can help establish the breastfeeding relationship even after a challenging start. ------Current Concept Explanation: The term “early and often,” rather than an arbitrary time limit, describes how the milk supply and breastfeeding relationship are most easily established. Frequent nursing in the first minutes, hours, and days helps bring in and regulate the milk supply more quickly. Milk removal, as related to feeding the baby on cue and not limiting feedings, helps increase the milk supply. As nursing continues, the hormones that are released during breastfeeding help to build connection and love between mother and baby. LLL recognizes that special circumstances can impose separation in the early weeks after birth, presenting challenges to the establishment of the breastfeeding relationship. Keeping mothers and babies together and encouraging nursing from birth reflects an understanding of how important “early and often” is to preventing future milk supply issues. (Apr 94, rev Mar 19) ======
#6 MOTION: Revise “Human Milk” Concept Explanation
Human milk is the natural food for babies, uniquely meeting their changing needs. (Dec 14)
Proposed Concept Explanation: Human milk is a complete food containing all the nutrients in ideal proportion for optimal human growth. It is easily digested and eliminated, and it is the unique and unduplicated food for babies. During direct breastfeeding, the composition of human milk changes to meet the changing needs of the baby.
Human milk provides more than nutrition. Beginning as colostrum, it works with the infant’s developing immune system to provide protection against a wide array of illnesses and allergens, a benefit that extends well beyond infancy. (1) The baby receives optimal immunological benefits, and the baby’s microbiome is optimized, when directly breastfed by the mother.(2, 3, 4) Sucking at the breast promotes normal oral configuration, eye development and hand-eye coordination. Furthermore, the psychological effects of breastfeeding are invaluable: frequent opportunities for touching, holding, and eye contact serve as important stimuli for the child’s development. According to the World Health Organization, the recommended alternatives to direct breastfeeding are, in order of preference, “expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute.”(5)
Human milk is an important factor in the healthy development of babies and young children at all economic levels around the world.
1. Miriam Labbok et al, “Breastfeeding: maintaining an irreplaceable immunological resource,” www.nature.com/reviews/immunology.com July 2004; Goldman et al, “Immunologic components in Human milk during the second year of lactation,” Acta Paediatr Scand 72:461-462, 1983 2. Azad et al, “Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months,” Canadian Medical Association Journal, Feb 11, 2013; 3. Hassiotou et al, “Breastmilk is a Novel Source of Stem Cells with Multilineage Differentiation Potential,” www.StemCells.com, 2012;30:2164-2174 4. Kakulas, Milk Genomics: https://milkgenomics.org/article/even-to-the-brain-yes-breastmilk-stem-cells- do-transfer-to-organs-of-offspring/ 5. Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization UNICEF, 2003. (DRAFT July 2019) ------Rationale for changes to the Concept Explanation: The order of some sentences was changed so that the information about human milk as “food” is in the first paragraph; the second paragraph focuses on the protective and psychological benefits; and the final paragraph is a summarizing statement. As part of the second paragraph, we recommend listing alternatives to emphasize that how a baby receives human milk, and from whom, is important, since there are differences in milk composition depending on whether the milk is delivered to the baby directly from the mother's breast or indirectly supplied to the baby via another means, whether by the mother or by someone else.
This Concept is ONLY about the biochemical and immunological properties of human milk. The baby does NOT receive “optimal immunological benefits” when breastfed by anyone other than the baby’s mother. The use of “mother” in the explanation is evidence-based and biologically and scientifically accurate, and necessary to support the facts of that statement. In other Concepts, there may be opportunities for adding “gender-neutral” words, but not in this Concept Explanation. ------Current Concept Explanation: Human milk is a complete food containing all the nutrients in ideal proportion for optimal human growth. During breastfeeding, the composition of human milk changes to meet the changing needs of the baby. Human milk provides more than nutrition. Beginning as colostrum, it works with the infant’s developing immune system to provide protection against a wide array of illnesses and allergens, a benefit that extends well beyond infancy. Human milk is easily digested and eliminated. Furthermore, the psychological effects of breastfeeding are invaluable: frequent opportunities for touching, holding, and eye contact serve as important stimuli for the child’s development. Human milk is the unique and unduplicated food for babies. It is an important factor in the healthy development of babies and young children at all economic levels around the world. (Apr 94, rev Dec 14, rev Mar 19) ======
#7 MOTION: Revise Preface to PSR Appendix 17
CONCEPT EXPLANATIONS These explanations describes in greater detail our understanding of each concept. The concepts are shown in bold font after the notes below, with the explanation of each following.
NOTES ABOUT OUR USE OF LANGUAGE LLL philosophy encompasses not only breastfeeding, but mothering through breastfeeding. This is an approach that appeals to those who come to us for help, attend our meetings, read our literature and go on to become Leaders. We know that some of them do not identify as mothers; yet when they read The Womanly Art of Breastfeeding, they nevertheless find a philosophical approach that appeals to them and reflects their experiences in its pages. The language that we use is designed to appeal to the Leaders now accredited and to those potential Leaders of the future. (DRAFT, Feb 20) ------Preface currently on the website: CONCEPT EXPLANATIONS This appendix describes in greater detail our understanding of each concept. The concepts are shown in bold font after the notes below, with the explanation of each following. NOTES ABOUT OUR USE OF LANGUAGE We use “mother,” “breastfeeding,” and “father” in this document. La Leche League International (LLLI) recognizes that: ● although the vast majority of people who nurse their babies are mothers, not everyone identifies this way. We encourage those who do not use ”mother” as their personal identification to think of this Policy and Standing Rule in terms of the word they prefer as they read. ● some people do not use the word “breastfeeding” to identify the act of feeding their baby their milk from their bodies. While the word breastfeeding will be used in this document to describe that act, we encourage you to use the word that feels best to you. ● there are a variety of family structures. Not all families include a father; some include a partner, some include other family or friends as support, and some are composed of mother and child or children. Please use the word that works for you and your family. ● there are a number of other terms that can be used when discussing breastfeeding, the person who breastfeeds, and the person who supports them. We hope those who prefer other words will accept our need to use terms acceptable across many cultures and will think of this Policy and Standing Rule in terms of their preferred language as they read.
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