HOT TOPICS IN BREASTFEEDING

HEALTHY BABIES LOUISVILLE BABY BLITZ MAY 10, 2017 DISCLOSURE AND OBJECTIVES

• I HAVE NOTHING TO DISCLOSE • OBJECTIVES • DESCRIBE THE EFFECTS OF BREASTFEEDING THROUGHOUT THE LIFESPAN • PROMOTE BREASTFEEDING IN THE PRESENCE OF THE USE OF ILLICIT SUBSTANCES, LEGAL DRUGS AND NICOTINE • INCORPORATE MULTICULTURAL COMPETENCY IN THE PROMOTION OF BREASTFEEDING • LEARN TECHNIQUES TO SUPPORT BREASTFEEDING MOTHERS IN THE HOSPITAL SETTING AND AFTER DISCHARGE ALL MAMMALS BREASTFEED!! THE DEBATE IS OVER

• BREASTFEEDING AND HUMAN MILK ARE THE NORMATIVE STANDARDS FOR INFANT FEEDING AND NUTRITION. GIVEN THE DOCUMENTED SHORT- AND LONG-TERM MEDICAL AND NEURODEVELOPMENTAL ADVANTAGES OF BREASTFEEDING, INFANT NUTRITION SHOULD BE CONSIDERED A PUBLIC HEALTH ISSUE AND NOT ONLY A LIFESTYLE CHOICE. • AMERICAN ACADEMY OF PEDIATRICS BREASTFEEDING POLICY STATEMENT, 2012

Willandi.wordpress.com FORMULA IS MADE FROM COW’S MILK BENEFITS OF BREASTMILK

• IN THE INFANT • LOWERS SIDS (SUDDEN INFANT DEATH SYNDROME, SUDDEN UNEXPLAINED INFANT DEATH) BY 75% • REDUCED RISK OF COMMON INFECTIONS • DECREASES CHILDHOOD LEUKEMIA • DECREASES DIABETES • REDUCES RISK OF SEVERE INFECTIONS SUCH AS PNEUMONIA AND SEVERE DEHYDRATION • BRAIN, HEART, INTESTINES DEVELOP DIFFERENTLY • EVEN MORE BENEFITS TO PREMATURE INFANTS

• AMERICAN ACADEMY OF PEDIATRICS BREASTFEEDING POLICY STATEMENT, 2012 BENEFITS OF BREASTMILK

• IN THE MOTHER • HELPS WITH RECOVERY FROM CHILDBIRTH • ENHANCES MOTHER/BABY BONDING • DECREASES RISK OF POSTPARTUM MOOD DISORDERS • REDUCES RISK OF BREAST AND OVARIAN CANCERS • REDUCES RISK OF HYPERTENSION, DIABETES, HEART DISEASE AND STROKE WHEN A MOTHER REACHES OLDER AGE

• AMERICAN ACADEMY OF PEDIATRICS BREASTFEEDING POLICY STATEMENT, 2012 R. Cabrera-Rubio, M. C. Collado, K. Laitinen, S. Salminen, E. Isolauri, A. Mira. The human milk microbiome changes over lactation and is shaped by maternal weight and mode of delivery. American Journal of Clinical Nutrition, 2012; 96 (3): 544 DOI: 10.3945/ajcn.112.037382

BREASTFEEDING AND CIGARETTE SMOKING

• WOMEN WHO CONTINUE TO SMOKE AFTER DELIVERY SHOULD STILL BE ENCOURAGED TO BREASTFEED • INFANT SMOKE EXPOSURE SHOULD BE MINIMIZED • INFANTS WHOSE MOTHERS SMOKE ARE STILL EXPOSED TO CIGARETTE SMOKE, BREASTFEEDING CONFERS EXTRA PROTECTION • HEALTH CARE PROVIDERS SHOULD OFFER ASSISTANCE FOR WOMEN TO QUIT • INFANTS OF SMOKERS HAVE HIGHER RATES OF SIDS, BREASTFEEDING COUNTERACTS THAT HIGH RISK

Doreas, Jose. Maternal Smoking and Infant Feeding: Breastfeeding is better. Matern Child Health J (2007) 11:287-291. ALCOHOL AND BREASTFEEDING

• EFFECTS ON INFANTS NOT STUDIED • MINIMIZE EXPOSURE • DRINK RIGHT AFTER NURSING OR PUMPING AND LIMIT CONSUMPTION TO 1-2 DRINKS • ALCOHOL DIFFUSES OUT OF MILK WITHIN 1-2 HOURS OF CONSUMPTION • “PUMPING AND DUMPING” IS NECESSARY WHEN MORE THAN 1-2 DRINKS ARE CONSUMED • MAY EFFECT MILK EJECTION REFLEX AND INFANT SLEEP PATTERNS Lawrence and Lawrence. Breastfeeding: A Guide for Motherhow.com the Medical Profession. 2016. MARIJUANA AND BREASTFEEDING

• THERE IS A LACK OF DATA AVAILABLE • BABIES EXPOSED TO MARIJUANA WHILE IN UTERO HAVE DEMONSTRATED NEUROBEHAVIORAL EFFECTS • IT IS CURRENTLY RECOMMENDED THAT WOMEN ABSTAIN FROM MARIJUANA USE WHILE BREASTFEEDING • MORE RESEARCH IS NECESSARY Academy of Breastfeeding Medicine Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder. Revised 2015 DRUGS AND BREASTFEEDING

• “DRUGS OF ANY TYPE SHOULD BE AVOIDED IN PREGNANT AND BREASTFEEDING WOMEN, UNLESS PRESCRIBED FOR SPECIFIC MEDICAL CONDITIONS. THE CASUAL USE OF DRUGS- LEGAL, ILLEGAL, ILLICIT, DOSE APPROPRIATE OR NOT- STILL MAY HAVE RAMIFICATIONS FOR THE DEVELOPING FETUS [INFANT] THAT WE HAVE YET TO DETERMINE, AND HENCE, IN GENERAL, DRUGS OF ALL TYPES SHOULD BE AVOIDED UNLESS MEDICALLY NECESSARY.”

• ACADEMY OF BREASTFEEDING MEDICINE CLINICAL PROTOCOL #21: GUIDELINES FOR BREASTFEEDING AND SUBSTANCE USE OR SUBSTANCE USE DISORDER. REVISED 2015 METHADONE AND BUPRENORPHINE

• MOTHERS ON A STABLE DOSE OF METHADONE AND BUPRENORPHINE, REGARDLESS OF DOSE SHOULD BE ENCOURAGED TO BREASTFEED • NEONATAL ABSTINENCE SYNDROME CAN BE LESS SEVERE IN THE BREASTFED INFANT • INFANTS EXPOSED TO METHADONE IN UTERO HAVE NEUROBEHAVIORAL EFFECTS, NO STUDY HAS DETERMINED WHETHER BREASTFEEDING WHILE ON METHADONE IMPROVES OR WORSENS NEUROBEHAVIORAL EFFECTS FROM FETAL EXPOSURE • THIS POPULATION IS AT HIGH RISK OF NOT BREASTFEEDING AND REQUIRES SUPPORT • ACADEMY OF BREASTFEEDING MEDICINE CLINICAL PROTOCOL #21: GUIDELINES FOR BREASTFEEDING AND SUBSTANCE USE OR SUBSTANCE USE DISORDER. REVISED 2015 OTHER OPIOIDS

• CODEINE IS NOT SAFE IN BREASTFEEDING MOTHER • MOTHERS ABUSING OPIOIDS DURING BREASTFEEDING SHOULD BE CHANGED TO BUPRENORPHINE OR METHADONE • SHORT COURSES OF NARCOTICS DURING BREASTFEEDING ARE OK, OBSERVE INFANT FOR EXCESS SLEEPINESS • ACADEMY OF BREASTFEEDING MEDICINE CLINICAL PROTOCOL #21: GUIDELINES FOR BREASTFEEDING AND SUBSTANCE USE OR SUBSTANCE USE DISORDER. REVISED 2015 OTHER DRUGS

• CONTRAINDICATED IN BREASTFEEDING • COCAINE • AMPHETAMINES • HEROIN • PHENCYCLIDINE HYDROCHLORIDE • BENZODIAZEPINES? • LAWRENCE AND LAWRENCE. BREASTFEEDING: A GUIDE FOR THE MEDICAL PROFESSION, 2016.

Pinstake.com EXCELLENT RESOURCE

• ACADEMY OF BREASTFEEDING MEDICINE • WWW.BFMED.ORG • 27 EVIDENCE-BASED PROTOCOLS REGARDING MANAGEMENT OF BREASTFEEDING DYADS OTHER RESOURCES FOR BREASTFEEDING AND MEDICATIONS

CULTURAL CONSIDERATIONS IN BREASTFEEDING

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Pbs.org

Jillstanek.com MUSLIM

• QURAN STATES THAT BREASTFEEDING SHOULD CONTINUE FOR TWO YEARS • IF A CHILD IS BREASTFED BY A FOSTER MOTHER/WET NURSE, THEIR CHILDREN ARE CONSIDERED “MILK SIBLINGS” WHICH IS A SACRED BOND, THOSE CHILDREN CANNOT MARRY • MILK BANKS TABOO, WET NURSE PREFERRED • TAHNEEK IS INFANTS FIRST FOOD-GIVEN BY ELDER, DATE RUBBED ON INFANT’S PALATE • MODEST DRESS FOR WOMEN • BELIEF IN EVIL EYE • WEANING MUTUALLY AGREED ON BY PARENTS • 40 DAYS OF CONFINEMENT POST-DELIVERY • FATHER’S ROLE OF PROTECTOR OF NURSING DYAD • NURSING MOTHER DOES NOT HAVE TO FAST DURING RAMADAN • DR NATASHA SRIRIMAN, ILCA 2016 HISPANIC

• COMMONLY MOTHERS DO BOTH BREASTMILK AND FORMULA, “LOS DOS” • IMMIGRATION • COMMON GALACTOGOGUES: ATOLE (CORN), MALTAS (NON-ALCOHOLIC BEER), TEAS • PEER COUNSELORS DO WELL HERE

• DR. MAYA BUNIK, ILCA 2016 JEWISH

• TALMUD STIPULATES THAT BREASTS WERE CREATED TO NURSE AND NURSE FOR TWO YEARS • WORK OF NEW MOTHER DECREASED AND DIET INCREASED AFTER BIRTH TO PROMOTE BREASTFEEDING • DONOR MILK IS OK • NO PRELACTEAL FEEDS • RELIGIOUS FASTING OPTIONAL BUT PROHIBITED FOR ONE WEEK AFTER BIRTH • DR. DEBRA BOGEN, ILCA 2016 AFRICAN-AMERICAN

• LOWER BREASTFEEDING RATES • SOCIOECONOMICALLY CHALLENGED • ROLE OF SLAVERY • DR. MICHAL YOUNG, ILCA 2016 IN-HOSPITAL SUPPORT

• SURGEON GENERAL’S CALL TO ACTION TO SUPPORT BREASTFEEDING IN 2011 STATED WE SHOULD “ACCELERATE IMPLEMENTATION OF THE BABY-FRIENDLY HOSPITAL INITIATIVE” • BABY-FRIENDLY HOSPITAL AS GOLD-STANDARD FOR BREASTFEEDING CARE • CURRENTLY 418 HOSPITALS/BIRTHING CENTERS IN THE US HAVE BABY-FRIENDLY DESIGNATION (20.5% OF US BIRTHS) • WWW.BABYFRIENDLYUSA.ORG

BABY-FRIENDLY IS WORKING!

CDC breastfeeding report card, 2016 SUPPORTING MOTHERS IN THE HOSPITAL

• BABY-FRIENDLY AS CULTURE CHANGE • TRAINING FOR STAFF • PACIFIERS • THE WHO CODE OF MARKETING OF BREASTMILK SUBSTITUTES • FORMULA PURCHASING • GIFT BAGS • SAFETY AND BABY-FRIENDLY • 24 HOUR ROOMING-IN SUPPORTING MOTHERS WHEN THEY GO HOME

• HOSPITAL SUPPORT GROUPS • WIC PEER COUNSELORS • LA LECHE LEAGUE • LOCAL BABY STORES

• LACTATION CONSULTANTS WIC QUESTIONS?