Infant Suck Strength Exam: Introduction of an Accessible Clinical Technique for Measuring Infant Suck at the Breast.

One of the core skills required in lactation support is understanding and correcting ineffective or painful breastfeeding. The behavior being corrected, however, occurs inside the infant's mouth, making it difficult to see and assess. When providing care in the field, we use standardized tools and digital suck exams. In research, instruments have been developed to measure infant suck strength with a pacifier, bottle, or at the breast using ultrasound. The aim of this article is to introduce a simple manual clinical technique to identify areas of weakness in an infant's suck and describe one treatment option that can be used to reduce weakness in the identified area. During the Infant Suck Strength Exam, the lactation support provider places a finger on the breast 2 to 4 cm from the edge of the infant's mouth at the upper and lower lip and then at both corners of the mouth, testing the strength of the suck in each of these four areas. To address any specific areas of weakness, the nursing parent can be taught to apply light skin traction back toward the chest wall at the affected area. This engages the suckling reflex and amplifies the strength of the infant's suck in that particular area. The traction applied should not indent the breast but rather just pull back on the skin. It should be applied with enough strength to challenge the infant without pulling the breast out. This is a teaching tool, and is typically only needed for a few weeks before the infant improves their nursing habits.

Immersive Videos Improve Student Self-Efficacy in Clinical Lactation.

The current study examined the use of immersive technology as a way to improve access to high-quality interpersonal breastfeeding interactions in an undergraduate clinical lactation course. In particular, we investigated the impact of immersive consultation videos and related activities on student self-efficacy, motivational beliefs, and perceived skill level. Results indicate that usability was high, with participants rating videos, interactives, and activities positively. Students did report a significant increase in self-efficacy and their perceived ability to meet the course learning objectives; no significant changes in the level of interest or perceived skill were found. Our results demonstrate that high-quality immersive videos can be an important learning tool for teaching clinical skills when access to direct patient care is limited or absent.

Perspectives From a Career in Breastfeeding Research, Mentorship, and Advocacy: An Interview With Karen Wambach.

Karen Wambach recently retired from a distinguished career in nursing education and breastfeeding research in the United States, practicing her craft during the formative years of the field of lactation consulting. Her research focused on the description of biopsychosocial influences on breastfeeding initiation and duration, as well as interventions for promoting and supporting breastfeeding among vulnerable childbearing populations, for example, adolescent mothers. Her research career trajectory mirrors the development of breastfeeding research more broadly. She began with descriptive studies and theory testing, which included the development of the Breastfeeding Experience Scale quantifying early breastfeeding problems. She then moved on to randomized clinical trials of breastfeeding education/support for adolescent mothers, and finished her funded research using a multi-behavioral, technology-based education and support intervention to promote breastfeeding, healthy lifestyle, and depression prevention in adolescent mothers. As researcher and educator in a clinical science area, she has supported evidence-based practice and translational science through her work as lead editor of many editions of the textbook Breastfeeding and Human Lactation. She is a consummate teacher, having mentored many upcoming researchers during her teaching career, and directed the undergraduate nursing honors program and PhD program at the University of Kansas School of Nursing in the United States. She also believes in serving her profession and has been an active member of American Academy of Nursing, the Midwest Nursing Research Society, the Association of Women's Health, Obstetric, and the Neonatal Nursing and the International Lactation Consultant Association, including serving on JHL's Editorial Review Board for many years. (This conversation was recorded on October 14, 2022 then transcribed and edited for readability. EC = Ellen Chetwynd; KW = Karen Wambach).

Increasing Diversity in the Field of Lactation: An Interview With the Directors of Pathway 2 IBCLC Programs at Historically Black Colleges and Universities.

In this issue's Lactation Newsmakers: Documenting our History, we are featuring two emerging leaders in the field of lactation. Rachel Davis and Janiya Williams are both International Board Certified Lactation Consultants and hold positions as directors for the only two Pathway 2 Lactation Consultant Training Programs in Historically Black Colleges / Universities. Rachel is Program Director for the Lactation Consultant Training Program at Johnson C. Smith University in Charlotte, North Carolina, while Janiya directs the Human Lactation Training Program at North Carolina Agricultural and Technical State University an hour and a half away in Greensboro, North Carolina. While their backgrounds are quite different, both women care passionately about increasing diversity and equity in the field of lactation support, as well as normalizing nursing for Black and brown families transitioning into parenthood. In this interview they speak to relationships they have developed with their students, their students have developed with each other, and the strength of community created within and between their programs. They describe the difficulties their students encounter with institutional racism within the medical system, and the additional preparation they receive to navigate it. Both programs experience high volumes of applicants-almost 350 for the 12 positions at Johnson C. Smith University-demonstrating the significant need for this curriculum in Historically Black Universities/Colleges. The importance of this model in diversifying the field of lactation cannot be underestimated, and the outspoken women doing this work will be influencers in this field for years to come. (RD = Rachel Davis; JW = Janiya Williams; EC = Ellen Chetwynd).

Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure.

OBJECTIVES: Almost 15% of all US births occur in rural hospitals, yet rural hospitals are closing at an alarming rate because of shortages of delivering clinicians, nurses, and anesthesia support. We describe maternity staffing patterns in successful rural hospitals across North Carolina. METHODS: All of the hospitals in the state with ≤200 beds and active maternity units were surveyed. Hospitals were categorized into three sizes: critical access hospitals (CAHs) had ≤25 acute staffed hospital beds, small rural hospitals had ≤100 beds without being defined as CAHs, and intermediate rural hospitals had 101 to 200 beds. Qualitative data were collected at a selection of study hospitals during site visits. Eighteen hospitals were surveyed. Site visits were completed at 8 of the surveyed hospitals. RESULTS: Nurses in CAHs were more likely to float to other units when Labor and Delivery did not have patients and nursing management was more likely to assist on Labor and Delivery when patient census was high. Anesthesia staffing patterns varied but certified nurse anesthetists were highly used. CAHs were almost twice as likely to accept patients choosing a trial of labor after cesarean section (CS) than larger hospitals, but CS rates were similar across all hospital types. Hospitals with only obstetricians as delivering providers had the highest CS rate (32%). The types of hospitals with the lowest CS rates were the hospitals with only family physicians (24%) or high proportions of certified nurse midwives (22%). CONCLUSIONS: Innovative staffing models, including family physicians, nurse midwives, and nurse anesthetists, are critical for the survival of rural hospitals that provide vital maternity services in underserved areas.

Ankyloglossia Identification, Diagnosis, and Frenotomy : A Qualitative Study of Community Referral Pathways.

BACKGROUND: Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards. RESEARCH AIM: The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants). METHODS: We recruited clinicians (N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes. RESULTS: Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians-primarily pediatricians-were omitted from referral pathways. CONCLUSION: Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.

Toward Consistency: Updating Lactation and Breastfeeding Terminology for Population Health Research.

There has, historically, been a lack of consistency in the use and definition of terms and their associated measurement in breastfeeding research. The purpose of this paper is to promote consistency through a taxonomy and lexicon for population-based breastfeeding research with the modern nursing dyad. The taxonomy organizes concepts in categories related to research on feeding human milk to infants, noting the perspective from the provider of human milk (parent or alloparent) and the receiver of human milk (child). The taxonomy includes these categories: psychology, physiology, behavior, and modality. The intensity of behaviors and modalities can be characterized qualitatively or quantitatively. Other terms are introduced or defined for the modern era and measurement standards are posed. These suggestions invite discussion and debate, in an effort to move researchers toward consistent measurement, documentation, and presentation, to build a credible evidence base for breastfeeding and practices related to the provision and consumption of human milk.