CLCA Newsletter

I am honoured to be taking on the role as Interim President for the CLCA-ACCL.  These are unprecedented times for all of us currently living through and practicing during the world wide health crisis of Covid-19.

We will continue to do our best to support our members as we all deal with the drastic changes to practice, health, and safety concerns for ourselves and our clients/patients, and the need to keep informed as recommendations change from day to day.

Visit our Covid-19 information portal for current resources.

Happy autumn to all our members!

That refreshing autumn wind blows strong and the beautiful kaleidoscope of colour draping over our great nation at this time of year happens to be my personal favourite. In just a few days’ time, many of our members will be meeting to learn and grow in skill and practice in Richmond BC. I am looking forward to seeing each and every one. I will be doing my best to chat with as many of you as possible, please don’t be shy – come introduce yourself and say “Hi”.

New educational opportunities await! The CLCA-ACCL website now hosts a selection of 10 CERPs certified webinars hosted on the GOLD Learning platform.

Log into your CLCA member account, click on the Members Portal and you’ll find all 10 topics available to select from. CLCA membership will allow you to choose 2 webinars that best suit your own learning needs.

Your membership also gives you access in that same Members Portal to the Clinical Lactation Journal. Be sure to Login and upgrade your knowledge base with the latest research in our field.

CLCA continues to strive ever onward in advocacy for the IBCLC in the Canadian landscape. Over the last number of years, our organization has seen wonderful growth in our membership, our pathways of advocacy, education and teamwork. Your continued support through membership and your endorsement to your colleagues means all the difference for this small yet mighty organization. I am in awe of all that a handful of passionate volunteers has been able to accomplish and cannot express my heartfelt gratitude to all those who have supported, recommended and joined in with the good work being done. But we are not done yet!

I am pleased to share with you that we will be launching a new committee at CLCA. Through the planning of this latest conference, an area of need became clear. Our organization needs help from its members to in providing clarity, wisdom and support for the WHO International Code of Marketing of Breastmilk Substitutes.

CLCA strongly stands by its mission, vision and values and upholding the WHO Code is an important part of what CLCA was founded on. In order to support this endeavour, the Board of Directors has moved to create the Ethics and WHO Code Compliance Committee. This committee will be charged with supporting the organization in upholding the WHO Code and offering insight and guidance in matters of the WHO Code as well as related ethical concerns that may arise for the organization. I ask you to consider whether you might donate a small portion of your valuable time to this endeavour during times of event planning and on rare occasion outside of these parameters. To those desiring to support this committee, please email our office with your offer of help.

In the spirit of healthy families & friends this season, and as Dr. Aviva Romm is known to say, to “Hugs over Handshakes”!

See you in a few days!

Bethany Heintz, CLCA President 

Laura Patterson, IBCLC, Ontario

As we all know early support is important to get breastfeeding off on the right foot. For many families seeing an IBCLC out of the hospital or a public health setting is an important step on their journey. Sometimes the cost of this valuable service makes it inaccessible. Many families don’t even know that it is an available service in some areas.

Often companies reimburse employees for some of the health related services that Canadians incur that are not covered by our provincial health care; including but not limited to prescriptions, dental, registered massage therapy, naturopathy and many others. This of course does not apply to part time workers, contract or the self or unemployed.

In Ontario, a group of IBCLCs (including myself) have put together The Committee to Regulate Lactation Consultants. One of our main aims is to see the services of the International Board Certified Lactation Consultant (IBCLC) covered by extended health care programs.

An American study investigating healthcare savings associated with breastfeeding for over one year found that for every 1000 infants that were not breastfed, there were 2033 more visits to the doctor, 212 more days of hospitalization, and 609 more prescriptions filled, when compared with 1000 infants who were exclusively breastfed for at least 3 months (Ball & Wright, 1999). Ball and Wright estimated that if 90% of American families breastfed exclusively for six months, the cost savings would be $13 billion per year and more than 911 deaths would be prevented (1999). This data can be extrapolated to Canada, as Canada is 1/9th the population of the US, we could be looking at a healthcare savings of 1.4 Billion dollars.

Currently Manulife, Great West Life, Sunlife and GreenShield cover the services of an IBCLC. However, it is the employer that buys that coverage who determines what is covered under their plan. Many companies now cover complementary health services such as chiropractic, registered massage therapy and naturopathic medicine. Disease prevention should be a large part of extended health care because healthier employees (and their families) means better employees. Better employees means a healthier bottom line.

At the International Breastfeeding Centre (www.ibconline.ca) in Toronto, we have been offering a receipt to patients to submit to their extended health care. Sometimes companies will cover under a health care spending type expense. Feedback we have gotten tells us some large unions (such as the Elementary Teachers Federation of Ontario, Peel local) will cover the services of an IBCLC. The confusing part is why other locals (the other Greater Toronto Area school boards) do not cover this service.

Please feel free to reach out to the Ontario Committee to Regulate Lactation Consultants if you have information or contact information for any large employer or union, or if any employers have questions.

Ontario Committee to Regulate Lactation Consultants (https://www.facebook.com/OCRLC) ontariocrlc@gmail.com

Ball T, Wright A. Health care costs of formula-feeding in the first year of life. Pediatrics. 1999;103(4):870-6.

Bethany Heintz, IBCLC, Ontario

World Breastfeeding Week is coming! August 1st marks the beginning of the 2019 global celebration and empowerment of breastfeeding/chestfeeding families, the health benefits of breastfeeding/chestfeeding and highlights the important work done by those who support and advocate for these families.

In Canada, we are excited to be able to put breastfeeding in the spotlight TWICE a year - once in August (1st - 7th) as we celebrate with our friends around the globe and again in October (1st -7th) when Canada celebrates National Breastfeeding Week.

Here's How to Get Involved:

Get Committed - The World Alliance for Breastfeeding Action has put together some fabulous digital stickers, slogans, banners, handouts and more - easily available on their website https://worldbreastfeedingweek.org/

Get Social - Join the Conversation on social media with WABA's channels: Facebook, Twitter, YouTube & Instagram and don't forget to use their hashtags #WBW2019 #WABA #EmpowerParents #EnableBreastfeeding #breastfeeding #SDGs #worldbreastfeedingweek2019

Get Involved - Do you know some breastfeeding/chestfeeding families? How about hosting a WBW Advocacy Celebration! Gather friends, family, strangers and more together with a common purpose - to celebrate the empowerment and equality deserved by all those raising their little ones

Get Pledged - WABA is always up for a pledged donation and this week is the perfect time to dedicate yourself to this great cause! Consider a financial donation to this non-profit organization and its great cause - To work together to empower parents and enable breastfeeding, now and for the future!

https://worldbreastfeedingweek.org/pledge-form/

This week, join your colleagues worldwide in celebrating World Breastfeeding Week 2019 beginning Thursday!

A message from GOLD Learning

Now in its 4th year, each year this global event connects 1200+ Healthcare Providers with the latest research and skills by leading ankyloglossia experts. Last year’s symposium was so popular that there is now a whole extra day! This year GOLD Learning is offering two days of exciting learning with 5 speakers each day.

Sept. 16, 2019 | Live Day 1 | Fundamental Skills/Knowledge.
Learn more about assessment, the impact of tongue-tie from birth through adolescence, how to provide lactation care when revision isn’t part of the plan, suck rehabilitation after frenotomy and the big picture of caring for families struggling with a tongue-tied infant.

Sept. 17, 2019 | Live Day 2 | Advanced Skills/Knowledge.
Day two dives deeper with a look at how to identify and treat the compensatory mechanics of suck after revision, the impact of tongue-tie on the myofascial system and primitive reflex integration, tongue-tie and it’s impact on the musculoskeletal and nervous systems, the impact on orofacial myofunctional development and a look at infant frenotomy and pain.

Education Your Way!

• NEW - Select your day! Participants have the option of attending both days or choosing just one.
• At your pace! Attend live or enjoy 8 weeks of viewing time on presentation recordings.
• Participate in Live Chats, Question & Answer sessions and connect through Speaker-Moderated Forums
• Download Handouts to reference in the future.
• Earn CERPs, CMEs & Dietetic CPEUs

Registration: Early Bird Discount Ends August 31, 2019. Early Door Prize when you register by August 15. Additional savings available for groups of 10+.

View Speakers & Topics by visiting: https://www.goldlearning.com/tongue-tie-symposium-2019

Pamela Drynan, RN, BScN, IBCLC, Ontario

In the newest Clinical Lactation journal, Diane C. Powers provides insight on some role differences of the IBCLC profession in her research article “IBCLC Role Differences: Inpatient and Outpatient Practitioners”. The article highlights inpatient and outpatient challenges, painting a picture of what our peers may be experiencing within their work setting. Powers (2019) suggests that IBCLC’s should learn about their peers’ roles in order to recognize and reflect on how our remarks and actions may have an impact on others and the profession as a whole. Powers (2019) quotes “Could there be an elephant in the middle of the room of our profession, causing both sides to get defensive?” As Kathleen Kendall-Tackett states in her 2017 editorial from Volume 8 Issue 2, “We’re on the same side”. Kendall-Tackett (2017) describes that even amongst peers from the same setting, LC’s can bully each other and furthermore, they have been known to cyberbully each other. Topics that have been fuel for the fire include the World Health Organization (WHO) Code and tongue-tie (Kendall-Tackett, 2017). But how could there be this divide within a profession that is only 34 years old?

As I sat here drafting this article, I have been reflecting on my own experience within the lactation and breastfeeding support profession, thinking about how in the years of being a health care professional (HCP), I have had the pleasure of working in the community and also the hospital setting. I am also a nurse, which is a profession known to “eat their own”. It’s not unusual that I hear HCPs remark negatively about another HCP from a different organization on how they cared for a family in regard to infant feeding. And to be honest, I have caught myself in situations thinking “Geez, how come that HCP did that or didn’t do that?” Even thou our community breastfeeding coalition over the past few years has brought numerous community and hospital staff together to learn about best practices for infant feeding support, the divide still exists. Should we have more playdates in order to better understand each other? Does this scenario sound familiar to you? Can you relate to this reflection from your community?

Powers (2019) reported in her article that some IBCLCs from a hospital setting, shared with her at a presentation that they felt “discouraged” and “dejected” by IBCLCs who work in an outpatient setting. Powers provides some insight into some the diverse challenges commonly known to the inpatient setting as follows: multiple care tasks required by the hospital staff, lack of time spent with family, conflicting messages from the other HCPs involved with the family, visitors that overstay their time leaving less time to visit with family, the family only stays 24-48 hours in the hospital, various distractions such as mobiles, parents who feel that they don’t need the support at this time as they “…have it all under control…”, and the variety of medical issues such as hypoglycemia, jaundice, excess weight loss etc. Powers (2019) describes commons scenarios an IBCLC in the outpatient setting may work with and highlights that in the outpatient setting, they often have more time to discuss, educate, and solve problems than their peers in inpatient who have a fraction of the time allotted to care for the family. Some of the medical scenarios seen in the outpatient are also dealt with as an inpatient, but careful consideration must be given to the different organizational structure that shapes the care provided in each setting as well as age of the mother-baby dyad. These differences were highlighted in greater detail in a research dissertation by Aimee R. Eden (2013)

“…research shows that much more than professional background, the organizational structure in which an IBCLC works influences daily practice and determines job responsibilities. IBCLCs working in different contexts have different levels of professional autonomy, different routines, different client populations, and different types of relationships with patients… The organizational or institutional structures and cultures may match or clash with the occupational culture and professional identity of lactation consultants, but in either case, influence both, and therefore influence IBCLC practice. Practice setting determines job duties, how many clients an IBCLC sees each day, the amount of time spent with clients, and access to other health professional.” Pg. 289

As I read through this research paper, I came across a great reminder, that despite where an IBCLC works, they all write the same exam and are required to follow the same standards of practice (Eden, 2013). Reading this research dissertation also inspired me to look at an older article from the Clinical Lactation journal by Tapia & Powers (2011) From Volunteer to Professional, as it humbled me to learn about the struggles some of the frontiers endured as they took the practice from a peer setting to a clinical setting, with their belief “…that we could really make a difference in the lives of breastfeeding women, one mother at a time”. Learning about the history of the IBCLC profession can remind us that just 34 years ago there was no IBCLC profession, and the founders of the IBCLC professionalization had a vision for all persons who had breastfeeding knowledge, skill, and experience to be given an opportunity to be recognized as skillful HCPs within the health care system. The founders endured long and hard journeys to obtain respect from other health care colleagues, and as IBCLCs, we can honour that journey and further expand on the rooted work started over three decades ago, by recognizing the importance of all IBCLCs roles within the health care system (Eden, 2013).

For myself, I look forward to the upcoming CLCA-ACCL 2019 Conference in Richmond, BC to meet fellow IBCLCs who have various professional backgrounds, and in some special way, contribute to supporting the breastfeeding family. This conference supports all professionals from all backgrounds that want to learn more about supporting breastfeeding dyads and families. I look forward to seeing you there and hearing your stories too.

Please check out the CLCA-ACCL conference webpage for updates and information on registration. Also you can follow CLCA Facebook, Twitter, and Instagram for updates.

References:

Eden, Aimee R. (2013). The Professionalization and Practice of Lactation Consulting: Medicalized Knowledge, Humanistic Care. Graduate Thesis and Dissertation. Https://scholarcommons.usf.edu/etd/4477

Kendall-Tackett, K. (2017). Should Lactation Consultants Be Mean? Let’s Bring Civility, Kindness, and Professionalism Back Into Our Discourse. Clinical Lactation, 8(2), 45-47

Powers, D. (2019). IBCLC Role Differences: Inpatient and Outpatient Practitioners. Clinical Lactation, 10(2), 74-80

Tapia, V. & Powers, D. (2011). From Volunteer to Professional: This Journey to Becoming Lactation Consultants. Clinical Lactation, Vol. 20-3

Raha Afshariani , IBCLC , Ontario

In Oman Medical Journal (2014)¹, Raha Afshariani and Pooya Farhadi (2014) explained the effect of Curcumin (the active ingredient in turmeric) on mastitis in lactating mothers.

The pain caused by inflammation of the breast tissue in case of mastitis is quite frustrating for the individual experiencing it. Thus, an important part of the treatment would be to reduce the inflammation, because if not controlled, it can influence a woman’s decision to cease breastfeeding. The main reasons cited for discontinuance of breastfeeding is because of lactation problems; in which mastitis is a significant and common complication. It can contribute to early weaning in the first three weeks. As breastfeeding is considered the most important route of feeding newborn especially in developing countries, early detection and treatment of lactation mastitis is very important. It is implicated that curcumin could potentially serve as an anti-inflammatory agent for controlling skin and soft tissue inflammations even at low doses with topical use. Although a number of studies have investigated the role of curcumin as an anti-inflammatory agent in different diseases, to our knowledge only a few number of studies have evaluated the potential of curcumin in controlling inflammation through skin topical preparations.

In this article, Afshariani and Farhadi (2014) designed a randomized double-blind, placebo controlled clinical trial for assessing anti-inflammatory effects of curcumin in preparations for topical use comparing to placebo in patients with lactation mastitis. After considering the study criteria, the patients were randomly assigned to receive curcumin topical cream, one pump every 8 hours for 3 days (n=32) or topical moisturizer as placebo (n=31). Using an index for severity of breast inflammation, all of the patients had moderate breast inflammation before entering the study. The outcome of treatment was evaluated using the same index at 24, 48 and 72 hours of starting the treatment. After 72-hours of therapy, patients in curcumin groups had significantly lower rate of moderate (p=0.019) and mild (p=0.002) mastitis. Also, patients in curcumin group had significantly lower scores for tension (p<0.001), erythema (p<0.001) and pain (p<0.001), after 72-hours of treatment.

This article demonstrates that topical preparation of curcumin provides favorable effects on pain, erythema and tension of the breast on those suffering from lactation mastitis within 72 hours of administration without side effects. Thus, topical preparation of curcumin could be safely administered to those suffering from lactation mastitis after excluding infectious etiologies.

Reference

1. Retrieved from Oman Medical Journal (2014) Vol. 29, No. 5:330-334 DOI 10.5001/omj.2014.89

Pamela Drynan, RN, BScN, IBCLC , Ontario

Recently, I had the pleasure of speaking with first-time mothers at an organized mommy group within our local community centre. Many of the mothers discussed challenges that they have overcome to reach beyond their initial goal of 6 months of breastfeeding, and now, eight to twelve months in, they are planning their return to the workplace and are worried about sustaining breastfeeding. Most mothers described various mixed emotions and thoughts on how to proceed within the breastfeeding relationship, unsure if they should just wean due to perceived challenges of pumping within their workplace and intimidation of approaching their employers about “extra break time to pump” or “clean places to store milk”. Some disclosed that they have been in contact with their employer who has already given her a hard time about pumping in the workplace and coordinating her schedule (ie: off-site job duties, meetings, training etc). Some plainly stated that the thought of managing breastfeeding in their workplace was just not worth the stress. I came prepared to the session with resources on pumping and storing milk, decreasing the risk of plugged ducts and mastitis, human rights within the workplace in regard to breastfeeding, and various methods of weaning. I planned how I was going to present the material and facilitate “rich discussion”. However, I was not prepared for the anxiety the women expressed and the negative thoughts they had on how they would proceed with breastfeeding within their workplace. I knew it’s our right to breastfeed for as long as we desire. But despite the policies and human rights code to protect breastfeeding families, the discrimination and disempowerment that still exists for women in the workplace was just as real as the struggles women experience at the beginning of their breastfeeding journey such as sore nipples, low milk supply, supplementation, and lack of support, just to name a few.

Multiple research efforts have demonstrated that hospital practices impact breastfeeding. The Baby-Friendly Hospital Initiative (BFHI), that is built around the World Health Organization (WHO) and United Nations International Children’s Emergency Fund’s (UNICEF) 10 Step’s to Successful Breastfeeding, advocates that there is strong evidence to demonstrate a dose-response relationship between the number of steps the hospital adopts and breastfeeding outcomes. In Rouse & Ferrarello’s ³ quality project, results indicated that only one third of the families were still breastfeeding at 3 weeks postpartum (2019) ⁴. In Canada, data reports that nearly 25% of the families at one month postpartum have stopped breastfeeding ¹. Across the nation as well as internationally, policy makers and leaders continue to advocate for improved breastfeeding outcomes. Ladores et al ² discuss in their article, Breastfeeding Women in Academia: Pursuing Tenure Track versus “Mommy” Track, how imperative it is for health care professionals to ensure that we target improving the transition for women back into the workplace while sustaining breastfeeding (2019) ⁴. This article was helpful for me in conceptualizing the difficulties women face as they return to work. Ladores et al ² indicate specific applications for practice as follows: 1) Improved and standardized family leave policies, 2) Improved workplace infrastructure, 3) Flexibility in work schedule and structure, 4) Equal opportunity to advance on the tenure track, 5) Establishment of onsite daycares, 6) Supportive policies clearly communicated and enforced, and 7) Change in attitude and culture (2019) ⁴. Some things to consider for moms pumping in the work place include mothers who have difficulty with mechanically expressing milk due to supply or nipple pain, but also environmental challenges such as lack of private rooms that have a locked door, electrical outlet, comfortable chair, table, and running water, as well as adequate break time to complete pumping session (typical session requires up to 30 minutes). Many employers require employees to attend lengthy meetings or days long conferences, all of which can propose challenges physically for a woman maintaining breastfeeding plus host a variety of stigmas within the workplace. Each place of employment is unique as is every family, however a standardized, collaborated effort to ensure that equal social justice and health outcomes are achieved for all families are an important aspect of advocacy for Lactation Consultants across the globe. Ledores et al ² also indicate that although the article specifies women in academia, they report that these recommendations can be applied to all women in all work settings (2019) ⁴.

I am grateful that Clinical Lactation journal supports the growth and development of the practicing Lactation Consultant to ensure that we can continue to support families at all stages of the breastfeeding journey. Share your journey of professional growth as you read the Clinical Lactation journal on our social media: Facebook, Instagram, Twitter. Log in to the CLCA Members portal here to access the latest Clinical Lactation Journal issue. 

References:

1. Government of Canada: Chapter 6: Breastfeeding: Retrieved on April 23, 2019.

2. Ladores et al: Clinical Lactation, 2019, 10(1).

3. Rouse & Ferrarello: Clinical Lactation, 2019, 10(1).

4. Clinical Lactation Journal (2019) 

Bethany Heintz, RPN, IBCLC, Ontario

Happy New Year!!

With deep gratitude, I welcome back all of our returning CLCA members and offer a very special welcome to our new members who have joined us in 2019.  We are thrilled you're here!

We've kicked off the new year with a bang here at CLCA.  Thanks to you, we are welcoming two new board members to the CLCA team this year - Jandy Beresford, our new Chapters Director and Raha Afshariani, our new Education Director.  Both new Directors currently join us from Ontario, Canada and have already jumped in with both feet at our January board meeting.  I'm excited to witness how their support and enthusiasm for CLCA and our mission will contribute to shaping the future of our organization.

CLCA continues to grow. I am thrilled to see our membership numbers swelling again this year.  This touches my heart as I've watched this organization emerging stronger from its new birth over the last 4 years and my smile has only grown wider.  CLCA takes its commitment to its members seriously and with more members, the organization can do more for you!

Our 2019 conference planning committee is well on their way to bringing you an incredible lineup of speakers, exhibitors, experiences, networking opportunities and hands on workshops you don't want to miss.  With the energy and enthusiasm of this committee, we are seeing the Richmond, BC conference shaping up to be an incredible event packed with opportunities for all attendees.

CLCA wants to celebrate you!  In each newsletter, we are opening the doors for you to tell us about the amazing, life changing work you do.  I invite you to drop us a quick email and tell us about a moment in your own practice, a testimony about a colleague or a highlight story you want to share.  We want to feature YOUR story in the next newsletter!  

May your 2019 be overflowing with peace, abundance and joy, 

Bethany Heintz 

Pamela Drynan, RN, BScN, IBCLC , Ontario

In the recent Clinical Lactation journal, Marsha Walker discusses how social media posts and campaigns have declared exclusive breastfeeding as dangerous and have caused attention deficit disorder, hypoglycemia, hyperbilirubinemia, hypernatremia, dehydration, brain damage, and even death. Although poor breastfeeding outcomes do occur, there are so many ways health care professionals can help these breastfeeding families achieve more healthy outcomes with appropriate breastfeeding management. Walker describes in the article strategies that can improve the clinicians professional practice as an opportunity to help families achieve exclusive breastfeeding safely.

One implication for practice that Walker discusses is normal infant crying vs inconsolable crying, highlighting that inconsolable crying can be a sign that milk transfer is poor and then suggests how clinicians can assess the breastfeeding dyad for adequate milk transfer and support the family to reach their breastfeeding goals. Walker lists the commonalities among mother-reported narratives on social media in this article. Those statements really resonate with common complaints lactation consultants hear from the families they support, and it also highlights that as clinicians, we have a role in debunking the inaccurate representation of exclusive breastfeeding from social media by providing early and comprehensive clinical lactation support. Walker provides research-based information on a variety of topics such as understanding and knowing the signs of milk production and removal, insufficient milk vs delayed lactogenesis II, supplement volumes, hypoglycemia, discharge plans for families to ensure adequate breastfeeding support, and implications for our practice as lactation consultants. This article includes practical resources that Marsha Walker developed on the following topics: “Guidelines for Breastfeeding Your Newborn”, “My Hospital Discharge Checklist”, “Breastfeeding Problems Can Happen”. She also connects her article to the other featured article regarding neonatal weight loss by Watson Genna & Notarangelo (2018) that is in the current Clinical Lactation journal.

To read the featured article visit the Members  Portal here and log on to the Clinical Lactation journal to add to your knowledge and skill library today!

Walker, Marsha, Clinical Lactation, 2018, 9(4), http://dx.doi.org/10.1891/2158-0782.9.4.171