Leading Lactation Insights - May 2023

16th Annual Global Breastfeeding and Lactation Symposium Series – Americas 

Advancing Lactation Science to Improve Care: Bridging Lactation Science to Everyday Breastfeeding Care 

Maria Lennon, MSN, CNM, IBCLC

Medela has a proud history of hosting an annual Global Breastfeeding and Lactation Symposium, a forum where internationally renowned researchers in the field of lactation provide insights into their latest research and clinical practices. The 2023 Symposium takes this to a new level and was presented in the United States for the first time. Two other Symposia will be held around the world this year -  one in China in May and one in Europe in June.

One of Medela’s primary goals is to partner with world-renowned researchers, institutions, and clinical organizations in order to gain a deep understanding of breast milk composition and the process of lactation. To help achieve this goal, these Symposia have been developed to provide a unique platform where healthcare professionals can learn about the latest research as well as connect with colleagues to exchange knowledge and discuss innovative best practices. 

The first of the three Symposia was an invitation-only event and was held in Chicago on April 20-21, 2023.  Attendees were a select group of key opinion leaders in the fields of neonatology, breastfeeding, lactation and human milk, health policy and data tracking. Following is a small sampling of the experience.

Day One opened with a Welcome from Angela Lang, DNP-CNS, CNL, RN, IBCLC, C-EFM, Director of Medical Affairs and Lactation Science for Medela. Annette Brüls, CEO of Medela, gave attendees an inspiring message in her opening remarks and an overview of Medela’s global mission and the commitment to people, the planet, and to society.

Included Research Sessions on Translating Science into Clinical Practice,

Lactation as a Biological System: The Dynamics of Human Milk Composition – Professor Lars Bode, Ph.D., The University of California San Diego 

Dr. Bode, Director of the Mother-Milk-Infant Center of Research Excellence (MOMI CORE), spoke about the investigation of human milk as it functions in the mother-milk-infant triad, and the importance of Human Milk Oligosaccharides (HMOs) in predicting improved health outcomes.

Lactation as a Biological System: The Importance of Dose – Professor Donna Geddes DMU, PostGrad Dip (Sci), Ph.D. The University of Western Australia

Dr. Geddes continued the conversation of the mother-milk -infant triad and the exploration of the many factors that impact the composition of human milk – milk expression, delivery, storage, thawing, warming, etc. and looking at biomarkers of milk production as a diagnostic tool. There is a critical need for more 24-hour studies to develop normative reference ranges to inform clinical guidelines.

A Call to Action: Improving Human Milk & Breastfeeding Outcomes by Prioritizing Effective Initiation of Lactation – Professor Diane Spatz, PhD, RN-BC, FAAN, The University of Pennsylvania

A passionate speaker, Dr. Spatz translates research into clinical practice. She emphasized the importance of discussing the science of lactation during the prenatal period to ensure a truly informed decision. Risk assessment is critical as is the need to manage the patient’s individual situation in order to maximize milk supply. There is a critical window of opportunity and early breastfeeding/milk expression protects the milk supply and helps mitigate risk factors. Nurses are the “first lines of defense” in helping initiate the milk supply. Early, frequent pumping (8x/24 hrs.) is essential in yielding a long-term sustained milk supply. 

Initiation of Lactation: Prophylactic Lactation Support as Standard of Care for Mothers of NICU Infants – Dr. Rebecca Hoban, MD, MPH, Staff Neonatologist and Director of Breastfeeding Medicine at The Hospital for Sick Children, Toronto, Canada

Secretory activation (formerly known as Lactogenesis II) should occur within 72 hours after birth and early pumping is necessary to program the breasts to initiate milk supply. Point of Care Testing (POCT) for biomarkers of secretory activation is being developed to predict who may have problems coming to volume. Frequent stimulation and milk removal is important management of initiating lactation in the early days. Mothers double pumping with the electric pump produced significantly more milk than those using hand expression only. It’s important for mothers to pump at least once during the night and to wait no longer than 5 hours between pumping sessions.   Again, bedside nurses are critical to success because parent contact and support are essential. NICUs should employ dedicated lactation consultants as all mothers in the NICU are high-risk for milk supply problems and need personalized care and support. Late Preterm/Near Term infants also need extra care and mothers may need to pump after breastfeeding in order to get the prolactin surge necessary to meet their lactation goals. 

The afternoon wrapped up with a Panel Discussion on the Value of Colostrum with panelists, Jessica Brumley, CNM, Ph.D. Director of Division of Midwifery at the University of South Florida, Tampa, FL., Drs. Donna Geddes and Diane Spatz.

The discussion opened up with The Power of Colostrum, how it is closely related to amniotic fluid and is a transitional fluid from intrauterine to extrauterine life. Colostrum is not meant to be nutrition, but an immunologic substance important to both term and preterm infants. Colostrum contains components that help heal the gut, protect from NEC, and is used as oral care for preterm and surgical infants. Parents need to be taught in the prenatal period that colostrum has a very special purpose, is present in a very small amount for specific biological reasons; it is not the same as formula in composition or volume and it was never meant to be. Conference attendees were very involved in the conversation and shared many personal stories and best practices. 

Day 2: The second day of the conference was opened by Jeff Castillo, Executive Vice President of the Americas, Medela and was a day full of sharing and conversation with panel discussions on:

Hospital to Home Life Continuum – Panelists, Dr. Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM, Tayo Mbande, Birth and Postpartum Doula, Co-Owner of Chicago Birthworks Collective, Jess Sember, MSN, RN, IBCLC, CPLC, CCE, SBD, Clinical Education Manager for Medela.

These dynamic panelists discussed the importance of supporting birthing parents all along the continuum of pregnancy, birth and breastfeeding and prioritizing the concept of maternal wellness   As a pediatrician, Dr. Thomas spoke about the importance of health professionals preparing and supporting parents for breastfeeding throughout infant and toddlerhood and for parenting in general. Ms. Mbande, a Birth and Postpartum Doula, teaches parents the role of a doula and she focuses on helping Black families in the hospital and after they go home. They discussed the importance of creating a community of support and helping mothers achieve their own personal goals.  Again, the audience was very responsive, actively participated in the discussion and shared suggestions for supporting mothers in this vulnerable time.

Maternal Wellbeing and Mental Health – Lacey Pezley, Ph.D., RDN, CD (DONA), LE, Professor Donna Geddes, DMU, PostGrad Dip (Sci), Ph.D. and moderated by Leon Mitoulas, Ph.D., Global Director of Medical Research for Medela.

This panel discussion began with talking about research into what was happening with women and breastfeeding while being isolated during the pandemic. Mothers described increased anxiety and lack of support which led to increased stress and earlier weaning. They also felt that telehealth calls were not very helpful, as it was difficult to diagnose problems online.  The panel and attendees discussed social media influences, especially as it relates to expectations of milk overproduction which has led to problems of oversupply. It was agreed that there is not enough mental health assistance in hospitals. Some members of the audience shared that they have psychologists in their NICUs and how supporting maternal mental health is being incorporated as the norm in maternal healthcare. 

A highlight of the Symposium was the Networking Tables during lunch. Conference attendees chose the lunch table discussion that interested them the most. They conversed with Conference speakers, researchers, attendees/key opinion leaders from all over the US, and Medela representatives from all over the world. 

Lunch tables included discussions on topics such as Prenatal Breastfeeding Education, Breastfeeding research, Birth Equity, Antenatal Risk Factors, Late Preterm Infant and Breastfeeding, Mother’s Own Milk – Initiation and Discharge Quality Improvement Measures, Peer-to-Peer Support, Breastfeeding Research - Antenatal Milk Expression, Supplementation with Donor Milk in the Nursery

Wrapping up Day 2 was an electrifying Panel Discussion March of Dimes: Breastfeeding Access for All consisting of a dynamic panel of local Chicago speakers: Karie E. Stewart, MPH, CNM, APRN-FPA, Dr. Dakisha Lewis, MD., FACOG, Shanice Williams, MPH, CLC, Tayo Mbande, Birth and Postpartum Doula, Co-Owner of Chicago Birthworks Collective, Janine Valarie Logan, CNM, CLS. Moderated by Patrice Hatcher, MBA, BSN, RNC-NIC Manager of Clinical Education for Medela.

This distinctive panel of local women introduced themselves and the work they are doing with families in underserved areas of Chicago. The love they all had for their local communities was evident in their excitement and passion as they shared their unique roles in caring for the healthcare needs of birthing and breastfeeding women. 

Ms. Hatcher reviewed the recent data that Black women in the US continue to have lower breastfeeding rates. A discussion followed on how the healthcare community can help empower women and support the belief that they can be successful in breastfeeding. More resources are necessary for prenatal care, birth and breastfeeding, and the larger maternal healthcare community needs to create these resources for Black mothers and direct patients to where they can get culturally sensitive and safe care. 

Lively discussions continued and covered topics, such as including family members in care and teaching, especially fathers, building community partnerships and the importance of IBCLCs mentoring students of color so they can become certified. The discussion ended with the charge that if access for all is important, then we all must participate in advocacy so positive change on a larger scale can occur.