About Linn Benton Breastfeeding Coalition

Wednesday, December 6, 2017

How to Apply for Lactation Consultant Licensure in Oregon

"2017 House Bill 2503 created a program and license for lactation consultants. The program was placed under the authority of the Health Licensing Office. Administrative rules for lactation consultant licensing, license renewal and continuing education were developed with a rules advisory committee.

Licenses will be issued beginning Jan. 2, 2018. Rules take effect on Dec. 1, 2017; and applicants can submit their applications beginning on Dec. 1."

As of December 1, 2017, IBCLCs in Oregon can apply for state licensure as lactation consultants. These are the steps to follow to become licensed:

2. Fill in the form and attach payment and 2 forms of ID.

3. Mail or fax to:
Oregon Health Authority
Health Licensing Office - Lactation Consultant Program
1430 Tandem Ave. NE, Suite 180
Salem, OR 97301-2192

Fax: 503-370-9004

4. Request IBCLC Certification Verification Authorization by downloading this form: https://iblce.org/wp-content/uploads/2017/11/ibclc-certification-verification-form.pdf

5. Fill in your name and IBCLC ID number. The recipient to put in the middle of the form is:
Name: Sarah Bye
Title: Licensing Qualifications Specialist
Organization: Oregon Health Authority - Health Licensing Office
Email Address: sarah.e.bye@state.or.us

Then sign and date the form and fax it to the number on the bottom of the form: 703-560-7332

Licenses will be issued beginning January 2, 2018.

Good luck everyone!

Thursday, November 9, 2017

Can Breastfeeding Prevent Type II Diabetes Mellitus?

I recently listened to an Academy of Breastfeeding Medicine podcast where Anne Eglash, MD and Karen Bodnar, MD discuss a fascinating study looking at the connection between lactation intensity and duration, and the likelihood that a woman who has experienced Gestational Diabetes Mellitus (GDM) will go on to develop Type 2 Diabetes Mellitus (DM). You can find the podcast here: https://themilkmob.org/podcasts/gut-inflammation-unpasteurized-breastmilk-risk-type-2-diabetes/
Their discussion of this topic begins at 18:20 of the podcast. You can find the study they are referring to here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193135/

The authors in the study report information already demonstrated by previous research including that 5-9% of pregnant women in the US develop GDM, and these women have a 7 times higher risk of developing DM than women who did not have GDM. Lactation improves glucose and lipid metabolism as well as insulin sensitivity. These have favorable metabolic effects that persist after weaning.

The authors wanted to confirm this connection that has often been assumed by looking to see if women who breastfed more exclusively and for longer would be less likely to develop DM within the 2 years after giving birth. They enrolled over 1000 pregnant women with GDM from 2008-2011. All the women were receiving care at a Kaiser Permanente clinic and hospital. After delivery they asked the women to keep track of how much they were breastfeeding, and if giving formula, how many ounces daily. They also did glucose tolerance testing on the mothers to look for DM.

They found that women who breastfed for at least 6-9 weeks had at 36-57% risk reduction for developing DM in the first 2 years after delivery when compared with women who did not breastfeed for that long. This result was independent of obesity and gestational glucose tolerance.

The authors hypothesize that the reduced risk of DM for mothers with GDM who breastfeed may be because of pancreatic β cells. These cells in the pancreas can compensate for insulin resistance. The hormone prolactin increases the mass and function of these cells during pregnancy, and there is some evidence from studies with mice that these effects continue into lactation. So prolactin may be causing an increase in the number, function and activity of pancreatic cells, helping the body to be able to produce more insulin.

Towards the end of the podcast, Drs Eglash and Bodnar discuss how more and more research is coming out demonstrating the crucial role insulin plays in lactation. They also talk about their experience with differences between women with Type I DM and Type II DM and lactation. The say that women with Type I DM tend to produce plenty of breastmilk, and this is probably because the insulin in their blood is not bound to proteins the way it is in women with Type II. They finish up by saying we have a lot more to learn about insulin and its role in lactation, and that they are very excited to learn about how prolactin affects the pancreas.

I found the podcast and the study fascinating because we all work with so many women with GDM. At WIC we are often working with pregnant mothers as they are finding out that they have GDM, and as they are making the decision of whether or not to breastfeed. Most mothers cite health reasons for the baby when saying they choose to breastfeed. Many research studies are beginning to show that mothers too benefit greatly from breastfeeding, with reduced risk of breast cancer, ovarian cancer, and osteoporosis. We are now seeing that breastfeeding reduces the risk of metabolic syndrome and also DM. This study showed reduced risk when mothers breastfed to 6-9 weeks, and they were only followed for two years. It would be exciting to see a study where mothers breastfed even longer, and were followed for 10+ years. Would a longer duration of breastfeeding have a longer term protective effect? I suspect so.

We can encourage mothers that while breastfeeding is the optimal food for their babies and the connection and bonding during breastfeeding are a wonderful part of the mother-baby relationship, breastfeeding has many health benefits for mothers as well. Benefits that will likely affect their health in a positive way decades into the future!

Thursday, April 20, 2017

Licensure for Lactation Consultants in Oregon

The state of Oregon is one of many states working to write and pass a bill that would license lactation consultants in the state. Rhode Island and Georgia have already passed bills creating licensure for IBCLCs and at least 36 states are working on it. See here for a map. To see the bill Oregon is working on and its progress, please visit the Oregon State Legislature Oregon Legislative Information page.

Why do IBCLCs need to be licensed?

Many professions require licensure in order to practice. Some of the most obvious and familiar include physicians, physician assistants, nurses and nurse practitioners, midwives, speech pathologists, physical therapists, occupational therapists, lawyers, dentists, teachers, accountants, veterinarians, pharmacists, psychologists, engineers and architects. Licensure is intended to ensure the public that a person is competent to practice in that profession. An individual who is licensed is known to have a certain minimum level of education and experience, and must satisfy ongoing requirements including continuing education to assure knowledge and skills. The goal of licensure for any profession, and in particular for lactation consultants, is to provide public safety. Many studies (see here) have shown improved breastfeeding outcomes with the use of IBCLCs as an intervention.

According to the United States Lactation Consultant Association (USLCA) USLCA’s Issue Paper on Need for Licensure of Lactation Consultants,”The U.S. Surgeon General’s Call to Action to Support Breastfeeding recognizes International Board Certified Lactation Consultants® (IBCLC®) as the only health care professionals certified in lactation care and recommends their licensure. An IBCLC is an allied healthcare provider and a member of the maternal-child healthcare team with specialized skills in clinical lactation care and management. The IBCLC credential is the preeminent certification for the provision of clinical lactation care and services. While many training courses provide a certificate of completion, only the IBCLC credential denotes certification in lactation consultation. The IBCLC works in a variety of settings including hospitals, clinics, physician’s offices, public health, human milk banks, and private practice. Research has documented improved breastfeeding outcomes when mothers and infants receive the services of an IBCLC.”

How does licensure ensure public safety?

Licensure protects consumers because it prevents unqualified individuals from practicing and helps patients distinguish from among the variety of different levels of lactation support. Many people receive training and offer breastfeeding support. There are La Leche League leaders, breastfeeding peer counselors, and a variety of individuals who have taken breastfeeding support courses at different levels and may be called certified lactation educators (CLE), certified lactation counselors (CLC), advanced lactation counselors (ALC) and others depending on the course and the organization offering the course. These breastfeeding supporters provide extremely valuable education, support, mentorship and  breastfeeding problem solving with mothers and babies.

At the highest level are International Board Certified Lactation Consultants (IBCLCs) who require the most education, supervised hours, and most comprehensive exam for certification. Many breastfeeding supporters offer wonderful advice and support for basic breastfeeding questions and common concerns, but for more difficult or complicated breastfeeding problems or situations, an IBCLC is the best choice. For a comparison of the education and background required for many of the different lactation supporters, please see this document: https://massbreastfeeding.org/landscape/

At the moment there is no protection of the name “lactation consultant” and anyone may legally refer to themselves as a lactation consultant, whether they are an IBCLC, one of the other qualifications mentioned, or even someone with no training at all in breastfeeding. Most breastfeeding supporters at various levels are open with parents about their background and ability, but there are some who dishonestly call themselves lactation consultants, or lead parents to believe they have a qualification or background that they don’t have.

Health insurance companies generally only reimburse for services rendered by licensed providers. This provides a level of protection for both the patients and the insurance companies. Patients can assume that if their insurance covers a certain provider, that the provider is competent to practice and will provide high quality care. The insurance company knows that the licensed provider will be practicing in an evidence based and up-to-date way and will be working efficiently.

Aren’t many lactation consultants licensed as nurses or dieticians? Why do they need additional licensure?

Many lactation consultants are licensed as nurses or other health care providers including physicians, midwives, registered dieticians, occupational therapists and speech language pathologists. According to a recent survey by USLCA, 49% of lactation consultants are nurses. Among the 51% who are not are some professionals licensed in another way, but many are not. These IBCLCs are currently unable to bill insurance and because of this either work in settings where insurance is not billed (such as WIC) or work in private practice and parents must pay out-of-pocket for their services.

Some states (including Oregon) are proposing licensure bills that would exempt other licensed providers from IBCLC licensure on the basis that the additional cost and additional education requirements for licensure in the state would be a hardship to these lactation consultants and to their employers. However, many lactation consultants who are already licensed as nurses and other providers will likely choose to become licensed anyways to support their chosen profession and because they want to show themselves as accountable to the public.

If lactation consultants are licensed, they can bill insurance for each contact and mothers are more likely to seek lactation support for their breastfeeding problems if it is covered by their insurance. Lactation consultants are likely to be able to see more mothers as a result, increasing access for all families to lactation care.

Some lactation consultants, particularly those who work for WIC, cannot bill for their services because of how WIC is funded, even if they become licensed. Some states (Rhode Island, Georgia and Oregon’s proposed bill) are allowing exemptions to licensure for these lactation consultants because they believe the cost of licensure may be a hardship for these lactation consultants, but as with nurses, many of them will choose to become licensed anyways because they believe, along with the USLCA that: “the small economic sacrifice does not change the ethical duty of health care providers to be answerable to the public.”

What next?

All families deserve skilled, appropriate breastfeeding support, no matter where they live, or how young or old their baby. Each state needs to work to create licensure for IBCLCs for public safety reasons, to make lactation care more accessible and equitable, and to put the lactation consultant profession on par with other healthcare professions. Lactation consultants can and should be held to the same ethical and professional standards as other healthcare providers. Lactation consultants help improve breastfeeding outcomes, and breastfeeding duration is directly linked with improved health outcomes for infants and mothers. Creating licensure for IBCLCs is the next step in the movement to improve access to equitable lactation care throughout the United States, and to help each mother reach her breastfeeding goals.

Thursday, February 2, 2017

What Supplies Do You Really Need to Breastfeed?

For many pregnant women, pregnancy is a time of planning and dreaming about what it will be like once baby arrives. In the US many women have baby showers and receive gifts of clothes and supplies for the new baby. Pregnancy and baby magazines are full of advertisements of all of the cute clothes, toys, furniture and gadgets that promise to make life with baby easier. But what do you really need to have ready before your baby arrives? And what supplies will you really need to breastfeed?

“The newborn has but three demands: warmth in the arms of its mother, food from her breast, and security in the knowledge of her presence— breastfeeding satisfies all three.”

La Leche League used this quote by Dr. Dick-Read for many years and it is as true today as it was in the 1950s when he first said it.

Babies need their mothers, and especially at first, they don’t need much more. But there are some things that are convenient to have with a new baby, especially in our society. We certainly don’t need everything the magazines want to sell us, so what are the essentials?

  • Diapers
  • Wet wipes
  • Cotton onesies or footie pyjamas
  • Hat
  • Baby blankets
  • Towels

Not much! Then there are a few more things that are not absolutely essential, but very useful:

  • Sling or other style of baby carrier
  • Carseat (if you will be taking your baby in a car at all you need this!)
  • Nursing bras

Some things you most likely already have:
  • Washcloths
  • Pillows
  • A backpack or other bag to use for a diaper bag

These are things many women find handy:
  • Breast pads (not all women need these…)
  • Bouncy chair for baby
  • Breastfeeding pillow

There are quite a few things I didn’t mention that might be surprising. What about a stroller? What about a crib? What about a special chair for nursing?

Women and babies in cultures all around the world survive and thrive without these things, and in fact cribs and other separate sleep surfaces may be detrimental to the breastfeeding relationship. Dr. James McKenna has studied breastfeeding and sleep for many years and has coined the term, “breastsleeping” to describe what he believes is a fundamental aspect of the breastfeeding relationship. He describes how mothers who bedshare with their babies breastfeed two to three times as often during the night as mothers who sleep on separate surfaces, and how this encourages optimal milk supply and longer term breastfeeding. You can learn more about safe bedsharing in Sweet Sleep, a book recently published by La Leche League.

You can learn more about breastsleeping from this article by Dr. James McKenna: http://onlinelibrary.wiley.com/doi/10.1111/apa.13161/full

The list of things that are absolutely necessary to take care of a baby is actually very short! Many of the items you will need are very inexpensive or can be bought used. All you really need for baby is some diapers and a few clothes and blankets. And all you need for breastfeeding is you and your baby.

Thursday, November 3, 2016

Hand Expression: Timeless Wisdom and Modern Tool

Breastfeeding is a natural process and most mothers who want to breastfeed can produce enough milk and successfully nourish their babies at the breast. Hand expression is a tool women have been using for thousands of years to assist with various needs and challenges that can arise during breastfeeding.

Why should I learn how to hand express?

During the early days and weeks of breastfeeding many women experience uncomfortable fullness in their breasts or engorgement as their body shifts from producing colostrum to mature milk. This fullness is caused partly by the increased amount of milk in the breasts, and also by fluids shifting in the body after delivery. Women who received large volumes of IV fluids during and after delivery are likely to experience swelling in their breasts as their bodies regulate and get rid of these extra fluids.

Sometimes this swelling in the breasts can make latching difficult for the baby and removing milk difficult for the mother. Hand expression is more effective than pumping during these early days because the early milk is thicker and more viscous than mature milk. Pumping can cause the swelling to become worse because it draws the swelling down the breast towards the nipples. Hand expression is a more gentle and easy way to remove milk, decrease swelling and make latching easier.

Hand expression is also helpful for mothers who are pumping because particularly at the end of a pumping session the milk is more viscous and hand expression can be a more effective way to remove it. This video from the Stanford Newborn Nursery shows how to combine pumping and hand expression to increase milk supply: https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

Hand expression is an especially important skill for all mothers to be familiar with because it can be used in emergencies to maintain milk supply in case mother and baby are ever separated due to an emergency and access to a pump or electricity to run the pump is not available.

How can I learn to hand express?

There are many methods of hand expression that have been taught throughout the years and throughout the world. Each woman’s body is unique and each woman will have to discover how to remove milk from her own breasts. The only really important thing is to find the way that works best for you. This video produced by Breastfeeding Medicine of Northeast Ohio demonstrates one way to massage the breasts and hand express:

The Basics of Breast Massage and Hand Expression from Maya Bolman on Vimeo.

When should I learn to hand express?

Some mothers begin hand expressing before their babies are born if they want to build up a supply of colostrum to feed to the baby in case of hypoglycemia or other reasons that might require supplementation.

Usually hand expressing before delivery is not necessary. You may want to try it to familiarize yourself with your breasts, but too much breast stimulation can cause premature contractions and labor so be sure to ask your doctor first, particularly if you are at risk of delivering early.

Many mothers begin hand expression after their baby is born. This video by the Stanford Newborn Nursery shows how hand expression, combined with spoon feeding small amounts of colostrum to the baby can increase mothers’ milk supply and give babies the the benefit of extra calories:

How can I learn more?

Check out these resources if you would like to learn even more about hand expression:

A La Leche League article about engorgement - http://www.llli.org/faq/engorgement.html

A La Leche League information sheet with instructions on how to hand express - http://www.llli.org/docs/0000000000000001WAB/WAB_Tear_sheet_Toolkit/06_hand_expression.pdf

Sunday, May 15, 2016

Circadian Rhythms and Breastfeeding

Most mothers and families are familiar with the tiredness that comes with parenting a newborn. Often the baby will sleep for long periods during the day, only to wake up frequently at night. This apparent day-night reversal is exhausting and can be frustrating for both parents who (unless they do shift work) are used to being alert and active during the day and sleeping deeply and for long periods at night.

I recently attended a session in the Gold Lactation Online Conference entitled, “Breast Milk and Sleep: Circadian Rhythms in Human Milk.” It was a fascinating session because in it, Briana Tilman, IBCLC, LLL Leader and first year medical school student, describes how our circadian rhythms work, what drives them, and what can disrupt them. She explains how babies are born without most of the hormonal systems necessary for circadian rhythms functioning, and how it takes time for them to develop. She then gives information and calls for further research, and gives ideas families can use based on a basic understanding of their infant’s circadian rhythms that may help everyone get more and better sleep with a young baby in the family. I will briefly explain and discuss what I thought were the most interesting and helpful parts of her talk.

Circadian rhythms are cycles that our bodies repeat. Briana gave the example of a swing going back and forth to illustrate the concept. Some of the rhythms in our bodies are on short periods, like a swing on a short chain that goes back and forth quickly. These are called ultradian cycles. These are rhythms that take shorter than a day and include things like heart rate and appetite. Our bodies have circadian cycles that are longer and take a 24 hour day to complete. Examples of these include our sleep-wake cycles and our basal body temperature which varies over the course of the day. There are also longer cycles called infradian cycles which take much longer than a day. An example of this in the human body is menstrual cycles.

When describing how our sleep-wake cycles work, Briana explained in great detail how many biological factors in our bodies cycle throughout a 24 hour day. Our hormones including melatonin, cortisol, epinephrine, thyroid, and insulin all contribute to this cycling which controls not only our sleep-wake cycles, but also our cognitive performance as well as many biological processes.

She went on to explain how these processes need a nudge from outside influences to stay on track. She described an experiment where people were put in an environment with no light for an extended period of time and their bodies began to cycle on a 24.5 hour day, rather than 24 hours. The outside influences that keep our bodies’ circadian rhythms on track are called “Zeitgeber,” German for “time-giver.” Light from the sun and the darkness when it sets, exercise, noise, social interactions, and perhaps, she suggests, breastmilk, are all Zeitgeber, things that keep our circadian rhythms cycling with the 24 hour day.

There are also things that can interfere with our circadian rhythms including things like shift work, jet lag, lithium, alcohol, antidepressant drugs, age and perhaps even some kinds of food. In particular artificial light at night influences the part of our brain that produces melatonin and causes it to slow production. Briana explained that red lights (such as astronomers, pilots, sailors and others who want to preserve their night vision) do not activate that part of the brain and may be a helpful way to minimize the disruption to circadian rhythms for people, like breastfeeding mothers of young babies, who must be awake periodically during the night.

When our circadian rhythms are disrupted for long periods our health can suffer. Depression, mental illness and perhaps even ADHD can be caused by disrupted circadian rhythms. Many studies have found that people who do shift work on a regular basis often suffer negative health consequences including cancer, hypertension, cardiovascular disease, rheumatoid arthritis, diabetes and metabolic syndrome.

While still in the womb, infants experience day-night cycles, as well as the influence of their mother’s melatonin and other hormones. Once babies are born, they don’t produce the hormones needed to direct their own circadian rhythms for approximately the first 3 months of life. Then gradually their bodies begin to produce their own melatonin and cortisol cycles, as well as other biological rhythms.

So now that we know that young babies don’t have their own circadian rhythms, what can we learn from this information to help us make nights easier for families with young babies?

Briana Tilman described in great detail how the hormones such as melatonin and the proteins that are the building blocks of other hormones are present in breastmilk in varying levels throughout the day and night. This suggests that breastmilk helps influence babies’ sleep-wake cycles and helps bring them into their mother’s circadian rhythm. Skin-to-skin contact has also been shown to improve infant’s sleep-wake cycles and bring them more in line with their mother’s.

She also suggests that mothers who are mostly or exclusively expressing breastmilk for their infants may want to label their milk with the time of day it was expressed (at least morning, afternoon or night) and then give the breastmilk at the same time of day it was expressed.

Briana also noted that infant formula doesn’t contain any melatonin and mothers who are exclusively formula feeding may want to consider asking their pediatricians about supplementing with melatonin.

Another thing families can try that can’t hurt and might help everyone get more sleep is to use red light bulbs, rather than regular light bulbs, when getting up to tend to an infant at night. The red light is less likely to cause the parents’ melatonin production to be disrupted, and may also keep the atmosphere of the room more calm and sleepy.

As mothers who have been there know, the early months with a baby are difficult and physically exhausting, but they are also over very quickly. Along with the recommendations above, patience, support from family and friends, and knowing that before long your baby will be off to kindergarten can help mothers and families navigate nights with a newborn.

- Jessica Barton MA, IBCLC

Friday, August 7, 2015

LLL Willamette Valley Live Love Latch

Happy Breastfeeding Month!

Join LLL for Live, Love, Latch--a celebration of breastfeeding support. We'll be hosting a potluck starting at 5 pm on Thursday August 20th before our regular LLL meeting at the Multicultural Literacy Center 128 SW 9th St, Corvallis. All are welcome!  Hope to see you there!  For more information please see LLL of Corvallis' website or join us the Facebook group.  You can also see and join the Facebook event here.