GOLD Lactation Conference News
Author: Dr Virginia Thorley, PhD, IBCLC, FILCA
My presentation at GOLD 14 will raise awareness of breastfeeding as essential, not just an option like magnesium wheels on a car. In car terms it is the engine and chassis and more. Breastfeeding is important, both exclusive breastfeeding for the first six months and with complementary foods after that. (1,2)
In 2004 Chen and Rogan published a paper identifying the number of deaths of United States infants through lack of breastfeeding.(3) Their paper provided evidence that breastfeeding can save lives in the developed world, not just in resource-poor countries. Yet we constantly see a false sense of security among health workers who provide bottles and artificial infant milk, and the community at large, in the belief that artificial is always intrinsically safe in industrial countries. They are oblivious of the possible implications of not breastfeeding. (4)
Infant survival, the lack of which provides a shocking measure, is not the only way breastfeeding saves babies, because food security and protection against infection and other ailments make a huge difference to health and wellbeing in infancy and through life.
Disasters and their aftermaths are fresh in the memories of all of you, wherever you live. You may have been affected. Examples include the massive Typhoon Haiyan in the Philippines hurricane; the earthquake, tsunami and Fukushima nuclear emergency in Japan; cyclones in the Bay of Bengal; Cyclones Larry and Yasi and unrelated serious floods in Australia; devastating bushfires in several Australian states; and hurricanes Katrina and Sandy in the United States.
A resource-rich region can suddenly become devoid of the resources that are taken for granted.(5) Some of the factors that may affect the artificially-fed infant’s food security are:
- Dependence on transport of manufactured infant milks from afar, whether in industrialized or resource-poor settings (disruptable by extreme weather, industrial action and natural disasters)
- Dependence on electricity or other fuel for boiling the water and cleaning equipment (Long power disruptions have been experienced in the US, New Zealand and Australia, even without a natural disaster.)
- Lack of refrigeration
- Dependence on water of questionable quality for reconstituting the ‘formula’ and washing hands and utensils (Any of the above emergencies can affect urban water supply.)
- Lack of support and privacy for the mother who is partly breastfeeding to increase her milk yield, or the mother who is exclusively using formula milk to relactate or access a wet-nurse or donor milk
- Donated formula supplies that undermine breastfeeding so that it soon ceases.(6)
Other emergencies at personal or local level also put infants at risk if they are artificially fed or fed breastmilk exclusively by bottle. My presentation will give examples of these scenarios as well.
Dr. Vrginia Thorely will be presenting her topic at this year's Lactation Conference titled "Breastfeeding can't save lives today – or can it? ". Learn more about Virginia's presentation by clicking here.
(1)World Health Organization/ UNICEF. Global strategy for infant and young child feeding. Geneva: WHO, 2003.
(2)National Health and Medical Research Council. Eat for health: infant feeding guidelines: information for health workers. Canberra: NHMRC, 2012,
(3)Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004; 113: e435-e439.
(4)Spatz DL, Lessen R. Risks of not breastfeeding. Morrisville, NC: International Lactation Consultant Association, 2011.
(5)Gribble KD, Berry NJ. Emergency preparedness for those who care for infants in developed country contexts. International Breastfeeding Journal 2011; 691); 16. doi: 10.1186/1746-4358-6-16
(6) Commission on the Status of Women. Disasters: where does breastfeeding fit in? March 2000. http://www,ilca.org/i4a/pages/index.cfm?pageid=3733 Accessed 13 October 2012.
Breastfeeding Without Birthing
Category: Articles
Author: Alyssa Schnell, MS, IBCLC
Breastfeeding Without Birthing is a personal and a professional story for me. Nine years ago, as my husband and I began our adoption plans, I couldn’t imagine parenting a baby without breastfeeding. Breastfeeding was how I fed, comforted, calmed, and healed my other babies. Breastfeeding was how I would do the same for my next baby, no matter what path she took to arrive in my arms. I began fervently researching information available on adoptive breastfeeding. My resources as a La Leche League Leader were especially helpful. By the time baby Rosa arrived, I had a relationship with a local lactation consultant, was pumping 15 ounces of milk each day, was taking various herbs and medications, had purchased several devices to help with breastfeeding, and had a freezer stocked with my own milk. Despite some additional obstacles (childbirth interventions, not being allowed to breastfeed during her hospital stay, and a tongue-tie/lip-tie), Rosa began feeding exclusively at my breast when she was 2 days old. And we continued that beautiful relationship for several years.
During that time, I began counseling other prospective adoptive and intended (through surrogacy) mothers, first as a La Leche League Leader and later as an International Board Certified Lactation Consultant (IBCLC). My research continued, as my experience working with mothers grew. My personal experience, the experiences of the mothers I worked with, and all the research I did eventually blossomed into a book: Breastfeeding Without Birthing: A Breastfeeding Guide for Mothers Through Adoption, Surrogacy and Other Special Circumstances (2013).
What does it mean to breastfeed without giving birth? I’ve found that it means different things to different mothers. For some mothers, it means putting in a lot of time and effort (and most likely taking medications) to make the most milk possible for their babies. For other mothers, it means making no milk at all, while offering comforting and nurturing at the breast. And for yet many others, it is something in between. As lactation consultants, it is our role to help each mother-to-be to create a breastfeeding plan that suites her values and circumstances, and then to provide the tools for her success.
Some of the essential tools for breastfeeding without birthing include finding community, inducing lactation, latching an older or compromised baby at the breast, and supplementation. Many adoptive, intended, and foster mothers are told breastfeeding is not an option for them; others are told that breastfeeding is possible, but they are not able to find information on how to do it successfully. This needs to change. Every mother who desires to breastfeed should have the information and support to do so, and that includes mothers who did not give birth to their babies.
Alyssa will be presenting her topic at this year's Lactation Conference titled "Breastfeeding Without Birthing: Breastfeeding for Mothers Through Adoption, Surrogacy, or Foster Care". Learn more about Alyssa's presentation by clicking here.
Domperidone and Breastfeeding
Category: Articles
Author: Dr. Frank Nice, RPh, DPA,CPHP
Two drug products available for off label use as galactogogues are domperidone and metoclopramide. Domperidone is not approved as a prescription drug in the United States. Domperidone currently is used worldwide as an anti-nausea agent for adults, children, and women. It is currently available in 60 countries including Canada and Mexico. Domperidone was recently given Orphan Drug designation for the treatment of hypoprolactinemia in breastfeeding by the Food and Drug Administration (FDA) in the United States. The Orphan Drug Act provides incentives for the development of drugs for the treatment of Rare Diseases. Hypoprolactinemia has been designated as a Rare Disease. A scientific rationale for the use of domperidone to treat hypoprolactinemia exists.
Over 60,000 cases of hypoprolactinemia are reported annually in the United States. Infants who do not receive human milk in the United States cost its healthcare system over $13 billion each year and result in over 900 unnecessary infant deaths annually. Domperidone can produce significant increases in prolactin with subsequent increases in milk production. No drug is currently approved for the condition of hypoprolactinemia of lactation in any country. As was stated, domperidone is not approved as a prescription drug in the United States. This is not necessarily due to safety or lack of effectiveness issues, as much as to do with marketing and economic issues
Domperidone can and does increase milk production. It has less side effects than metoclopramide since does not pass the blood-brain barrier. Practical information on domperidone dosing and withdrawal of the drug (both for sufficient milk supply and for insufficient milk supply) has been developed and is available for breastfeeding mothers to apply and use. The usual dosage of domperidone is usually two 10 mg tablets four times a day. It can also be three 10 mg tablets three times a day. Additional dosing regimens exist. Most breastfeeding mothers take the drug for three to eight weeks. Milk supply usually increases in about three to four days but may take up to two to four weeks, or more. A trial for at least four weeks should be used. A mother using domperidone should discuss all possible side effects, drug interactions, and contraindications with her doctor, pharmacist, and lactation consultant. Domperidone can be purchased from reputable pharmacies in Canada and is also is available with a doctor’s prescription from certain compounding pharmacies in the United States.
Dr. Frank Nice will be presenting at this year's GOLD Lactation Online Conference. To learn more about Dr. Frank Nice & his presentation, please click here.