A mother comes to you with a one-week-old infant born at 37 weeks gestation.  She states she wants to breastfeed, but perceives she does not have enough milk and her infant does not want to latch.  Do you know how to help this woman who wants to breastfeed?  You may not have this exact scenario, but issues related to breastfeeding may be on the rise.  According to Centers or Disease Control and Prevention (CDC) 2012 Breastfeeding Report Card, breastfeed initiations and 6 month and 12 month durations increased by 2%.  From 2008 to 2009, breastfeeding increased from 74.6% to 76.9%.  Although, there is an increase in breastfeeding in the US, we can do better than this.  The following table is the 2020 Health People objective under the Maternal, Infant, and Child Health section:

How as Registered Dietitians (RD), Dietetic Technician, Registered (DTR), or other healthcare professional be able to assist the community in reaching the 2020 Healthy People objectives related to breastfeeding?  The following are some resources that may assist your counseling with mothers and families during pregnancy, delivery, and human lactation.

• Kellymom is an evidence-based research website made by Kelly Bonyata who is an International Board Certified Lactation Counselor (IBCLC).  IBCLC is the highest level of competency related to breastfeeding management.  Bonyata’s website offers information related to infant nutrition, infant development, and lactation.  Kellymom also has a Facebook that offers updates on articles, pictures, and statements related to promoting, protecting, and supporting breastfeeding.

• Women, Infant, and Children (WIC) is an excellent resource for professionals, especially for families who meet the requirements.  Employees of WIC talk about breastfeeding everyday.

• CDC recommends to use the World Health Organization (WHO) growth charts for infants from birth until 24 months of age.  After 2 years-of-age, it is recommended to use the CDC growth charts.

• The Academy of Breastfeeding Medicine clinical protocols offers professionals guidelines related to exclusively nursing.  Topics include: hypoglycemia, discharge from the hospital, mastitis, supplementation, breastfeeding management, hospital policies, milk storage, and more.  The best part of all these resources, is that it is FREE for the public.

• Thomas W. Hale, Ph.D is a clinical pharmacologist and the author of Medications and Mother’s Milk.  Hale’s book is an excellent resource to determine the risk of medication use while a mother is pregnant or breastfeeding.

• American Academy of Pediatrics has a breastfeeding initiatives section that offers breastfeeding updates in the US.

• The Certified Lactation Counselor is a United States certification in lactation management and is offered by Healthy Children’s Center of Breastfeeding.  The CLC certification indicates a person has competencies in lactation skills, knowledge, and attitudes.  CLCs have the ability to assess latching and feeding process during breastfeeding, offer interventions to manage breastfeeding, and counsel mothers.  CLCs can assist moms in maternity units, neonatal intensive care units, outpatient lactation clinics, WIC programs, maternity and child health services, parenting centers, and offices of physicians and midwives. DTR/RDs receive 45 CPEU through CDR for completing the training.

• IBCLC is the highest level of certification related to breastfeeding management.  IBCLCs provide expert lactation and breastfeeding care, assist with staff training breastfeeding policies within the healthcare system.  In addition, IBCLCs increase community-based breastfeeding support, reduce societal barriers related to breastfeeding, and assist with expanding legislation, regulations, and polices related to breastfeeding.  The knowledge an IBCLC possesses is extensive requiring pre-requiste education in health sciences, clinical experience in assisting with breastfeeding families, and education related to human lactation and breastfeeding followed by completing a certified examination.  The following link will lead you to the competencies of a IBCLC professional.
  

• The Womanly Art of Breastfeeding written by the La Leche League (LLL) is a great resource for to-be mothers.  “Is Breastfeeding right for me?” begins the book followed by community resources mothers may use to increase breastfeeding success.  The best part of this book is that it offers FREE toolkits to professionals and families.  The tool-kits I used the most while I was working for WIC were pace-bottle feedings, laid-back nursing and other techniques, and breast milk handling.

• It is now a federal mandated for employers to offer nursing breaks under the Patient Protection and Affordable Care Act (“PPACA”), which took effect when the PPACA was signed into law on March 23, 2010 (P.L. 111-148).  This law amended Section 7 of the Fair Labor Standards Act.  The United States Department of Labor offers a PDF version of the federal law. The United States Breastfeeding Committee and womenshealth.gov offers more information related to breastfeeding in the workplace.  One example is the business case, which is used to discuss with employers the importance for mothers to express milk in the workplace.

• “Real moms, real breastfeeding.”  This is what I think about when I think of the LLL.  The volunteers who are there are moms who are experienced with breastfeeding.  Chicago offers a list of sites that you may refer mothers to for further assistance.

• Is your hospital certified as “Baby-Friendly?”  UNICEF has 10 steps to assist hospitals in becoming a certified “Baby-Friendly” hospital.  If you are in the community, you may want to create relationships with the hospitals near you and suggest or assist with completing the certification.

The above information are just some of many resources to assist families who want to breastfeed.  The expectation of an RD/DTR is not to know everything, but be resourceful and guide clients in the right direction.  Your patients will see you as a savior, especially the mom with her one-week old born at 37-weeks gestation!!!  So go out there and make breastfeeding a wonderful experience because breast is always best!