There will be a shift in the US Presidency in 2025. Federal programs, regulations, and protections for health insurance and lactation will change.
You feeling some-kinda-way about the imagined changes … for you, and for the families you serve?
Let me gently remind: Simple, basic lactation support is something WE DO for families, as IBCLCs.
Every single international and national public health and healthcare provider organization recommends exclusive breastfeeding for 6 months, to continue for at least two years. Why? It is how we reduce risks to better survive, as human mammals. Healthy babies grow into healthy adults.
Lancet 2016 told us that EVERY RISK of short- and long-term morbidity and mortality, for both Mum and Bub, was improved with human milk use. The more milk, the merrier. Every baby and every mother (the researchers’ term) have better outcomes (less disease and death) the longer lactation was exclusive, and the longer it continued until weaning.
I work as per diem IBCLC at three different BFHI hospitals in Philadelphia. A LOT of unnecessary formula supplementation goes on, using much higher volumes than biologically required. Babies do not need lots of FOOD in the first three days of life. And parents do not make high volumes of colostrum on those first three days, either. Coincidence … or nature?
In-hospital formula feeding (IHFF), to families intending to breast/chestfeed, results in earlier weaning. Look at this lovely open-access article about a well-designed study in MN. Early unnecessary supplementation with commercial milk formula (CMF) means families wean earlier and sooner than their lactating neighbors who got no supplements.
So, as we approach 2025, I encourage you (especially those working bedside at birth centers): Double-down on all the easy-peasy ways to support lactating families, so they are discharged exclusively on human milk. Lots of skin-to-skin. Lots of snuggling and suckling in the first days. This is the best way to set up a baby’s immune system, and establish their healthy gut, and facilitate nerve/brain development, and to cement the bond of love and security that they find in a parent’s arms.
Offer to do a 10-minute in-service for your colleagues, reminding that normal newborn behaviors are not “cured” by over-feeding in the first three days (as parents and HCPs alike presume). CMF companies are very skilled at persuading parents and HCPs alike to think their product will “fix” a baby who is doing nothin’ more than bein’ a baby.
Try to initiate a policy review. I’ll bet dollars-to-donuts that your facility’s suggested supplementation amounts in Days 0-3 are WAY more than any baby really, truly needs.
What about those families that choose to formula-feed? Who had a medically-indicated need for supplements, and extra human milk (from the parent, or a respected donor source) was not readily obtainable? Whose milk supplies are below baby needs, for whatever reason? Of course we will support those families – as we already do, when we use best-IBCLC-practices, ethically-mandated by our profession.
I am suggesting that we DO have a significant “power” in our grasp, as IBCLCs, to set breast/chestfeeding families up to avoid unnecessary supplementation in the first three days. That sets them up to breastfeed for longer duration. And that sets up the baby and the parent for DECADES of improved health outcomes.
Lancet (Ed.). (2016, January 29). Breastfeeding 2016 (2 articles, 2 commentaries, 1 editorial). Lancet. https://www.thelancet.com/series/breastfeeding
Lancet. (2023). Breastfeeding Series 2023 [three papers]. Lancet. https://www.thelancet.com/series/breastfeeding-2023
McCoy, M., & Heggie, P. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146(1), e20192946. https://publications.aap.org/pediatrics/article/146/1/e20192946/77021/In-Hospital-Formula-Feeding-and-Breastfeeding
Nyamagoudar, A., Kannur, N., Chavan, V., & Kulkarni, V. (2024). Retrospective analysis of volumes of manually expressed colostrum among healthy postnatal mothers at a tertiary care referral unit in South India. Not enough milk or not enough patience? BMJ Paediatrics Open, 8, 1-6. https://doi.org/10.1136/bmjpo-2024-002622
Santoro Jr., W., Martinez, F., Ricco, R., & Jorge, S. (2010). Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants. Journal of Pediatrics, 156(1), 29-32
Original post: 7 Nov 2024
———————–
Update 11 Nov 2024. Elsewhere I have been asked why I think lactation support programs are at risk. A few thoughts on that: