Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade?

BACKGROUND: International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. RESEARCH AIM: To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC's role. METHODS: The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008-2019. Qualitative and quantitative studies were reviewed. RESULTS: Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC's role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. CONCLUSION: In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.

Designing Longitudinal Clinical Studies Involving Lactating Women.

In designing longitudinal lactation research studies, certain factors must be taken into account that are necessary for the generation of meaningful data. Perhaps more like longitudinal childhood research studies in terms of ongoing changes that occur during childhood that challenge study design, longitudinal lactation research studies encompass a period of tremendous change in both the mother and her breastfeeding infant that affect study design, implementation, and analysis. Given this changing dynamic, studies should be designed to accommodate a whole host of factors, such as changes in maternal and infant health; coexisting conditions during the lactation period; the stage of lactation; diurnal variations; the frequency and exclusivity of breastfeeding; maternal diet and any complementary/supplementary foods given to the infant; geography; socioeconomic factors; body mass index; physical activity; and any changes in milk composition that occur across longer periods of lactation. The study of human milk composition itself has lacked rigor and any standardization of methods, and has only recently been revisited with more sophisticated laboratory techniques that have allowed a more meaningful understanding of milk structure and biology, with a greater global approach. In this Research Column, we review some of the issues and challenges in conducting longitudinal lactation research, and provide several references that will aid in the development of meaningful study designs and the interpretation of data.

Facilitating Colostrum Collection by Hospitalized Women in the Early Postpartum Period for Infant Trophic Feeding and Oral Immune Therapy.

Administration of colostrum for early trophic feedings and colostrum oral immune therapy for neonates in the NICU is essential to enhance gut maturation and lower risk of infections. However, it is often difficult for women to collect early colostrum because of its thick viscosity and low volume. Women may be unable to sit upright during pumping sessions because of postsurgical pain, acute or chronic illness, or birth complications and may need assistance. In this article, we describe specific techniques that providers can use to help women to collect colostrum when they are unable to accomplish collection on their own. Helping women collect and administer colostrum to their neonates in the NICU may engage and motivate them to continue to pump and provide breast milk for their hospitalized neonates.

Domperidone for Treatment of Low Milk Supply in Breast Pump-Dependent Mothers of Hospitalized Premature Infants: A Clinical Protocol.

Mothers of hospitalized premature infants who choose to provide breast milk are at increased risk of an inadequate breast milk supply. When nonpharmacologic interventions to increase milk supply fail, clinicians are faced with limited options. There is no current evidence to support the use of herbal galactogogues in this population and a black box warning for metoclopramide for potential serious side effects. Thus, domperidone was the only known, effective option for treatment of low milk supply in this population. With a thorough review of the literature on domperidone and coordination with the obstetrical, neonatal, lactation, and pharmacology teams, a domperidone treatment protocol for mothers of hospitalized premature infants with insufficient milk supply was developed at our institution and is presented in this article. A comprehensive understanding of domperidone for use as a galactogogue with a standard treatment protocol will facilitate safer prescribing practices and minimize potential adverse reactions in mothers and their hospitalized premature infants.

The development of an accurate test weighing technique for preterm and high-risk hospitalized infants.

BACKGROUND: Test weighing, or weighing the infant before and after breastfeeding to assess milk intake, in which weight gain in grams is converted equally to volume of intake in milliliters, is a controversial topic in the literature. This study was initiated to identify variables that impact test weights and to develop an accurate test weighing technique for preterm and high-risk hospitalized infants. METHODS: Test weights were performed on a sample of hospitalized high-risk infants with and without leads who were bottle- or nasogastric-fed. Volume consumed was compared to weight gain to determine whether the developed technique was accurate. RESULTS: In each group, with or without leads, only one measure of actual intake versus test weight result was found outside the confidence limits (95%), and only one measure was found outside the clinically acceptable difference of +/-5 g. Correlation coefficient (r(2)) values of weight gain by test weight to volume of intake were 0.998 for infants without leads and 0.997 for infants with leads. CONCLUSIONS: The data from this study support the use of this test weighing technique as an accurate, objective assessment of the measurement of breastmilk intake after a breastfeeding session, thus allowing medical decisions regarding supplementation to be based on objective data rather than inaccurate clinical indices of the quality of infant feedings at the breast.