The ICEA Board has worked hard to make certain all of our workshops and conferences bring you value. To continue these efforts, we are very excited to bring you the following news:
International Childbirth Education Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation.
ANCC recognizes organizations which demonstrate excellence in the ability to deliver continuing nursing education (CNE) with Primary Accreditation. We are excited to be a part of their Primary Accreditation Program because it contributes to improving healthcare outcomes. To learn more about ANCC, please visit their website.
What does this mean for you?
To sum it up, continuing nursing education (CNE) will now be awarded with every ICEA workshop and conference. The number of CNE credits will vary for each event, and the number of credits awarded will be noted with event registration. CNE credits can be used towards American Nursing Association certification or recertification.
If you have any questions about ICEA becoming an accredited CNE provider with ANCC, please email email@example.com.
ANCC accreditation requires renewal every two years. To oversee this extensive process, ICEA is seeking a Registered Nurse with a Masters or higher level education to be the ANCC Lead Nurse Planner. Experience with ANCC is preferred. This is a part-time, salaried position.
Job responsibilities include, but are not limited to:
Orienting nurse planners
Providing direction and guidance to individuals planning
Coordinating and evaluating CNE activities
Participating in the ANCC CNE Committee
Ensuring all programs approved meet the ANCC standards
To better serve you, and to set an industry standard that will demonstrate the hard work you have accomplished in becoming certified with ICEA, we have updated your credentials!
We are setting an industry standard so clients, employers, and colleagues are able to easily recognize your dedication to family-centered maternity care.
CHILDBIRTH EDUCATOR: ICCE
Common credentials used for Childbirth Educator in the past include: CBE, CCE, CCBE, and PCBE. Moving forward, the official credential for a Childbirth Educator certified with ICEA is ICCE (ICEA Certified Childbirth Educator).
BIRTH DOULA: ICBD
In the past, credentials that have been used to note a person is certified with ICEA as a Birth Doula include CD and ICD. Now, the industry standard is ICBD (ICEA Certified Birth Doula).
POSTPARTUM DOULA: ICPD
Previously, ICEA certified Postpartum Doulas have used credentials such as CPD and CPPD. Officially, the credential for Postpartum Doulas is now ICPD (ICEA Certified Postpartum Doula).
Please use ICCE, ICBD, and/or ICPD on all resumes, CVs, websites, email signatures, or anywhere you want to showcase your commitment to ICEA, our mission, and your efforts to create a nurtured world through professionals trained in family-centered maternity and newborn care.
If you’re uncomfortable with the change, then you can continue to use an old credential. However, please note the credentials listed above are the new official industry standard, and this what ICEA will use moving forward.
We encourage you to send an email to firstname.lastname@example.org or call +1.919.674.4183 if you have any questions about this change.
Do you have a few hours a month to volunteer for your profession? Would you like to help others all over the world support family-centered maternity and newborn care? Do you enjoy the camaraderie of working together with a great team, developing new skills, and promoting freedom of decision making based on knowledge of alternatives?
If you answered yes to these questions, then consider joining the ICEA Board of Directors!
ICEA is currently seeking volunteers for the following positions on the Board of Directors:
Director of Lactation
Director of Public Policy and Communications
Director of Marketing
Director at Large
Nomination forms for board of director and committee positions are due by 11 June 2018. Please visit our website for more information and to fill out a form. If you have any questions about these positions, please email email@example.com.
by Cynthia Billiar BSN, RN, IBCLC, ANLC, ICD, ICCE
If the CDC came out today and reported they had found a medication that would decrease sudden infant death syndrome (SIDS) by 73%, people would be flocking to the pharmacy in droves, demanding they receive this life saving drug, yet we have known for years that breastfeeding decreases SIDS. According to the research article, Breastfeeding and the Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis, exclusively breastfed infants have a reduced likelihood of SIDS by 73%. There is new research that suggest that at least 2 months of breastfeeding cuts the risk of SIDS in half, and to receive this protection breastfeeding does not have to be exclusive, (Thompson et al., 2017). With this new finding, I wonder, will we see an increase in breastfeeding initiation? It is still recommended by the American Academy of Pediatrics to breastfeed exclusively for the first 6 months and then begin adding solid foods and continue breastfeeding for a year and beyond; this increases the protection against SIDS along with all the other benefits of breastfeeding. Some moms may feel overwhelmed by the recommendation of exclusive breastfeeding for 6 months and might decide breastfeeding is not something they can do. Nonexclusive breastfeeding for 2 months could be a more realistic goal for these mothers.
What causes SIDS is still unknown but with each new clue that is found in research we gain another piece of this complex puzzle. A recent study suggests that genetics could play a role in the risk of SIDS. This study identified a rare genetic variant in some of the infants who died from SIDS that directly alters the respiratory and laryngeal function. This study is the first to link a genetic cause of weakened muscles for breathing with SIDS, (Mannikko R, 2018). In the March ICEA blog, I wrote about epigenetics and breastfeeding. The more we study epigenetics, the more we understand why so many things happen. What if we find with more research there is definitely a genetic factor related to SIDS? Is it possible that even nonexclusive breastfeeding in the first 2 months of life could be the epigenetic key that turns those genetic tags off for the risk of SIDS?
There is still lots of research that needs to be done before we know for sure what causes SIDS. But what we know so far is that just some breastfeeding can decrease the risk of SIDS along with the other preventions, such as back to sleep, no fluff in baby’s bed, and not over heating the baby. We can help save lives by teaching mothers about the importance of breastfeeding in the first hour of life and the need to do at least some breastfeeding for the first 2 months of life.
Hauck, F. R., Thompson, J. M., Tanabe, K. O., Moon, R. Y., & Vennemann, M. M. (2011, March 14). Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis. American Academy of Pediatrics, 128(1). https://doi.org/10.1542/peds.2010-3000
Thompson, J., Tanabe, K., Moon, R. Y., Mitchell, E. A., McGarvey, C., Tappin, D., … Hauck, F. R. (2017, October 30). Duration of breastfeeding and the risk of sids: an individual participant data meta-analysis. American Academy of Pediatrics,https://doi.org/10.1542/peds.2017-1324
Many, probably most new mothers, are looking for information and answers to their questions on the internet. The internet is often the first source they turn to when wondering how often a baby nurses or what the red lump in their breast could be.
But are the answers they find correct? Is the information going to be helpful or could it be incorrect or even possibly cause harm?
I decided to do some investigating, looking into some frequently used sources of breastfeeding support on the internet. I was saddened to find so much “misguided” or downright false information.
Here are some examples of misinformation on the internet:
Advice: Numerous references still recommend adherence to a scheduled feeding pattern rather than cue feeding, or baby led feeding. Many state that babies should never go more than 2-3 hours without feeding. Also, some recommend not letting a baby sleep more than three to four hours, often encouraging mothers to set an alarm clock to prevent the infant from “over-sleeping.” Thinking of the number of feedings each 24 hours rather than the strict interpretation of “every X hours” supports a more physiologic pattern of feedings, especially in the first days and weeks.
Advice: Many resources still refer to fore milk and hind milk- especially the myth that the foremilk is mostly water or protein and that the rich fats only come at the end of the feeding in the hindmilk. Mothers are told that the first part of the feeding provides the foremilk and the high fat, “dessert” hind milk comes at the end of the feeding. This often comes with the advice to breastfeed for a specified amount of time which might require a mother “forcing” an infant to continue nursing after they were satisfied, full and have come off the breast contentedly.
Reality: We have known for a long time that mothers of very effective feeders have letdowns early in the feeding, with higher fat content in the foremilk. Some milk has higher fat content mid-feeding and some later in the feeding. Giving advice to mothers based on the idea that the milk fat only comes forward at the “end” of the feeding is not evidence-based. Mothers instead need to understand their infant’s satiety (feeling full and satisfied) cues, not allowing arbitrary time frames to determine the length of each feeding. Recommending the newborn or infant continue nursing for at least 10 minutes (or 15 minutes) or to remove a nursing infant from the breast after “X” minutes ignores the fact that infants have varying needs. Breastfeeding infants are not little machines we can wind up and set for a specific amount of time! Another misguided bit of advice is that the infant will “just use the mother for a pacifier”. Babies do love to be at the breast, it is comforting, soothing and pacifying, part of the nurturing needed to promote the best infant health. I found one reference that recommended new mothers to nurse for 15 minutes after the letdown (which letdown? Mothers have several letdowns throughout the feeding). If the newborn won’t nurse for that specific amount of time it will result in frustration for both mother and baby!
Advice: Breastfed babies need to burp after each breast or at the end of the feeding.
Reality: Some breastfed infants may need to burp, some not at all. Some new parents will pat or rub and if no burp is produced an aggressive burping will ensue, all to satisfy the unsubstantiated old wives tale that all babies must burp. A gentle rubbing or patting is enough to produce a burp if needed but aggressive burping is not warranted.
Advice: For proper latch the baby must have their mouth covering the entire areola.
Reality: This one is may be the funniest. Most of you have probably seen those women with large areolas that can easily measure 5-6 inches in diameter. Even a large newborn with the widest gape physically possible could not entirely cover these areolas- but they certainly can still have an effective latch. For proper latch look for a wide open mouth, lips flanged outward on the breast, full round cheeks, an symmetric latch (the infant looks “off-center” with the mouth further down on the areola and more areola visible above the top lip) and active swallowing).
Advice: There are still those who tell mothers there are prescribed positions for the first days. It also varies between advisors, but there seems to be a “must” position for best latch and maximum comfort. Some prescribe the cradle hold, others side lying, reclining or it might be the clutch or “football hold”.
Reality: Each mother and baby are unique and quickly find the position that is best for them. There is no one magic position that is best for all new nursing couplets. Some positions might be more effective if there are problems or special circumstances, but as a general rule mothers need the freedom to choose the position that is most comfortable for her and her baby.
Advice: You should feel a tingling sensation when you have “the” letdown.
Reality: Some moms may feel a mild tingling or pressure with a letdown, but certainly not all mothers. By continuing this myth many mothers fear their infant may not be getting the milk they need because they don’t “feel” the letdown. This may also perpetuate the myth of having only one letdown rather that the reality of having many letdowns during each feeding.
Advice: One of the most common myths is about the foods mothers can’t eat while breastfeeding. Here is a list of foods that have been linked with causing an increased risk for infant gas or colic when breastfeeding.
These include: artificial sweeteners, broccoli, cabbage, cauliflower, Brussels sprouts, dairy, garlic, onions, peanut butter, fruits with a laxative effect such as cherries and prunes, any and all “spicy” foods, citrus fruits and their juices, chocolate, and common allergens such as soy, peanuts, dairy, wheat, corn and eggs.
You might also find recommendations on how many extra calories are needed to provide nourishing milk. The advice ranges from 500 to 1500 “extra” calories needed daily.
Reality: Most mothers need not alter their diet from pregnancy as their infant has been exposed to the tastes and aromas of their normal diets. The idea that certain foods are “gas-forming” come from the misguided idea that if it affects the mother in a certain way, it will affect the baby in the same way. Nutrients are carried by the bloodstream to the alveolar cells (milk making cells) in the breast where milk is produced and transported by the ducts, through the nipples to the infant. As foods are being digested in the mother’s intestines, the digestive process releases “gas”. Only the nutrients (not gas bubbles) are carried through the blood stream to the breasts to make milk. Mothers all over the world, some in cultures whose traditional foods are very spicy, nurse without infant symptoms. It is even worse that the foods often forbidden are nutritious vegetables and fruits, based on old wives tales and myths. In some cases where colic symptoms persist, especially when there is a family history of cow’s milk allergies, it may be helpful to avoid or restrict the intake of cow’s milk.
Although most maternal and infant advocates recommend an increase of 300-400 calories per day to assure optimum maternal and infant health, there are and still continue to be situations where women exist on far less than optimal diets and still produce the quantity and quality of milk needed to sustain infant growth and development.
Advice: Oatmeal cookies will increase your milk supply.
Reality: There is no evidence to support the use of oatmeal in any form to increase milk production. There does not seem to be any evidence of harm in consuming oatmeal, so it probably won’t hurt but the chances are slim it will be a miracle cure for low milk supply. If there are actual or perceived concerns of low production a lactation care provider should asses the maternal and infant history and observe a feeding for possible problems and provide appropriate interventions or referrals. There are many foods that are traditionally prescribed for new mothers to support their ability to produce milk, most of which are not evidence-based galactagogues (substances thought to increase milk production), but are culturally important traditions of new motherhood,
Advice: It is normal to have sore nipples for the first week of breastfeeding, sometimes it might be 10 days or advice may be that soreness will resolve after 2 weeks.
Reality: This one makes me sad as it can easily lead to a mother weaning early because she just cannot tolerate the pain. Breastfeeding should not hurt. Women experience pain in different ways with very different pain tolerances. So, what is pain? Some women may not be able to tolerate a tenderness while others with severely damaged nipples have only mild complaints. Either way, if the mother is experiencing any discomfort it is wise to seek help. Lactation care providers can assess the latch and other possible causes of soreness and may provide interventions to reduce pain and encourage nipple healing or refer to other specialties for treatment. Moms should not have to suffer for any specific period of time before seeking help and support.
Holmes AV. Establishing successful breastfeeding in the newborn period. Pediatr Clin North Am 2013;60:147–168.
UNICEF Breastfeeding Initiatives Exchange. The Baby Friendly Hospital Initiative. http://www.unicef.org/programme/ breastfeeding/baby.htm (accessed October 31, 2013).
American Academy of Family Physicians. Family Physicians Supporting Breastfeeding, Position Paper. http://www.aafp.org/ about/policies/all/breastfeeding-support.html (accessed October 31, 2013).
Mekuria G, Edris M. Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: A cross-sectional study. Int Breastfeed J 2015;10:1.
Appendix A Task Force Ratings. Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force, 2nd ed. Available at http://www.ncbi.nlm.nih.gov/ books/NBK15430/ (accessed November 2, 2015).
Boni Katz and I had the privilege of attending the United Nations Commission on the Status of Women, March 14 – 16 and representing ICEA. This was a huge opportunity afforded us by IMBCO (International MotherBaby Childbirth Organization) through sharing of their passes and we were extremely grateful. The theme for 2018 was “Achieving Gender Equality and the Empowerment of Rural Women and Girls.” We were excited about the theme as this fits in with one of ICEA’s core values: Practicing a culture of collaboration based on the knowledge that mindful engagement with diverse groups advances positive, family-centered maternity care.
Prior to attending, Boni poured herself over the schedule to help lay out a plan that would allow us to attend as many sessions, representing other countries as possible. As we attended sessions representing countries like India, Nepal, Zambia, Arab, Merico, Tunisia Egypt, Turkey and the U.S., we learned about the challenges that face rural women around the world. We learned they do not have the resources for the basic needs let alone education and health care. Many of those sharing about the challenges in these countries shared what they are doing to meet these challenges and how other organizations could help. This is when ideas began forming of how ICEA could be a part of supporting rural childbearing women across the world!
We also had the opportunity to network with unique people representing a variety of organizations. These included International Mother Baby Childbirth Organization, Every Mother Counts, Circle of Health International, Zonta International and American Association of University Women, and Big Ocean – Women for Faith, Family, Motherhood. Our conversations left us excited about the possibilities of partnering with these and other organizations to provide education that supports family-centered maternity and newborn care. This has motivated us to share not only with the Board but with the entire membership of ICEA so that all can see the great needs that exist…and help to meet those needs.
ICEA has already been a part of educating others for certifications in CBE, Birth Doula, and Postpartum Doula in China, Taiwan, Costa Rica, Guatemala, and South Africa. We are looking at how we can take these programs to other countries and continue to help support family-centered maternity and newborn care.
Flourishing for ICEA,
Debra Tolson, RN, BSN, ICCE, IBCLC, CPST ICEA President
by Kathleen Kendall-Tackett, PhD, IBCLC, RLC, FAPA
We are at a critical junction in the U.S. in our conversations about race and ethnicity. People are being shot by police, and others rise up to protest those shooting. We grieve those losses and hope that changes in our system will result. In the face of these violent events, is breastfeeding even relevant? The short answer is Yes. Breastfeeding can’t stop racism and discrimination, nor can it stop trauma and adversity, but it can protect new mothers from their effects. To understand why breastfeeding helps, I’ll use discrimination as an example. What happens physiologically when people are discriminated against? We happen to have some good science on this.
The Biology of Discrimination
A fascinating book called Social Pain summarizes many studies, and describes the neurobiology of social exclusion (Dickerson, 2011; Eisenberger, 2011). The basic premise is this: we are designed to be in relationships with others. It’s important for our survival. When we are not–when we are excluded–our stress response is triggered, including the inflammatory response system. These are our survival mechanisms. Social exclusion activates the same part of our brains as physical pain—the anterior cingulate cortex (ACC). The ACC is the same part that is activated for other mammals in the separation-distress response. The response to social exclusion is a hard-wired for all mammals, including human beings.
The act of discrimination says to the recipient, “You are not one of us. You are not part of our group.” These behaviors can be in the form threats of overt violence, or they can be in the form of microagressions. Some people dismiss microaggressions, saying that people are “too sensitive.” Sometimes, that can be the case. There could be misunderstandings. But what we need to keep in mind is how it affects the people who experience them. These often careless utterances still have a physiological effect on the person who hears them. Microaggressions tell people that they are being excluded from the group, and that is why it is important to be aware of them.
So what happens when people experience discrimination on an ongoing basis? You get a chronic activation of the stress response system, which increases chronic inflammation and disturbed sleep. Many researchers have studied this effect. One study asked a series of questions, such as “you get poorer service in restaurants or stores,” or “people think you are not smart.” The more of these questions that people said yes to, the higher their levels of inflammation (Lewis, Aiello, Leurgans, Kelly, & Barnes, 2010).
Inflammation and disturbed sleep are physiological time bombs and increase rates of heart disease, diabetes, and BMI >30—in other words, the exact pattern you see in many of our minority populations (Suarez & Goforth, 2010). The obesity statistics are particularly relevant. Consistently, what you see across countries, that marginalized populations tend to have higher BMIs. The more marginalized they are, the higher the percentage of people with a BMI >30. In the U.S. and UK, women of African descent have the highest rates. But other groups, such as American Indians and people from Southeast Asia, tend to also have a higher percentage of people with BMIs >30 than Whites. In the UK, Irish are split out as a separate group from British Whites. Interestingly, a similar pattern of higher BMIs emerges. Given the long history of marginalization of Irish people, this effect is consistent with other research. You also see a similar pattern for people who have lower-incomes (Goodman, McEwen, Huang, Dolan, & Adler, 2005).
The Critical Role of Breastfeeding
Exclusive breastfeeding acts as a powerful counter to these physiological effects (Groer & Kendall-Tackett, 2011). It is one of the mechanisms that downregulates, or turns off, the stress response. Baby at the breast actually lowers two important stress hormones in the short term: ACTH and cortisol. Further, when the researchers tried to stress the mothers in their study, they couldn’t because of the lovely little cloud floating around them (Heinrichs et al., 2001). In other words, it was a short-term lessening of the stress response. When mothers experience that day after day, it lowers lifetime risk of the Number One killers of women in the U.S.–heart disease and diabetes—in a study of 139,000 women with a mean age of 63 (Schwartz et al., 2009).
There is an important caveat to these findings: in most of these studies, exclusive breastfeeding lowered risk, partial breastfeeding did not. In our study of 6,410 new mothers, we found that exclusive breastfeeding improved mothers’ sleep, lowered their risk of depression, and had a dramatic effect on self-reported anxiety and anger (Kendall-Tackett, Cong, & Hale, 2011). This was even true when women had a history of sexual assault, which puts them at high risk for both sleep problems and depression. There was still an effect of the sexual assault, but it was significantly lower (Kendall-Tackett, Cong, & Hale, 2013).
I was honestly surprised that we found no significant difference between partial breastfeeding and exclusive formula-feeding. I thought we would see a dose-response effect: the more they breastfed, the better the response. Instead, we found a threshold effect: that exclusive breastfeeding is a very different physiological experience than partial breastfeeding. It is one more reason to continue to support exclusive breastfeeding wherever possible.
How Shall We Then Treat?
As individuals, and as a culture, we must continue to eliminate discrimination. One way for you to do that locally is to foster trust, and then have open discussions with the population you serve. How do they describe themselves? Is there any terminology that they find offensive? A Jewish friend once told me that the term “Nipple Nazi” was high offensive to her and asked that I not ever use it. I hate that expression too, so I was happy to comply with her request. Other terms may seem more benign to you, and you don’t understand why they are problems. The best strategy is to ask.
As a woman with a disability, I’ve been on the receiving end of many microaggressions. For example, I have a hard time with stairs, so a conference organizer once volunteered to “carry” me up the stairs—a very demeaning way to speak to me. I’m sure she was trying to help and had no idea how offensive that was. It took me a long time before I started speaking up, and it was only after I was actually injured at a conference because the organizers ignored my requests.
Sometimes these conversations can be uncomfortable and really tense. I’ve seen some ugly ones that were not at all productive. So it’s important to set some ground rules about communicating respectfully, even if frustrated. And you’ll probably make some mistakes along the way. But having these conversations will deepen your relationships within the community, and will make you even more effective in helping the women you serve.
In summary, breastfeeding can be a radical act that helps women who experience discrimination take back their health. American Indian lactation consultant and social worker, Camie Goldhammer, describes breastfeeding as “food sovereignty,” a powerful way to take back your culture. You can help women overcome the physical effects of discrimination, one woman at a time. By doing so, these women can become powerful agents for change the broader culture.
Thanks for all you do for mothers and babies. You make a radical difference.
Dickerson, S. S. (2011). Physiological responses to experiences of social pain. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of social loss and exclusion (pp. 79-94). Washington, DC: American Psychological Association
Eisenberger, N. I. (2011). The neural basis of social pain: Findings and implications. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of loss and exclusions (pp. 53-78). Washington, DC: American Psychological Association.
Goodman, E., McEwen, B. S., Huang, B., Dolan, L. M., & Adler, N. E. (2005). Social inequalities in biomarkers of cardiovascular risk in adolescence. Psychosomatic Medicine, 67, 9-15.
Groer, M. W., & Kendall-Tackett, K. A. (2011). How breastfeeding protects women’s health throughout the lifespan: The psychoneuroimmunology of human lactation. Amarillo, TX: Hale Publishing.
Heinrichs, M., Meinlschmidt, G., Neumann, I., Wagner, S., Kirschbaum, C., Ehlert, U., & Hellhammer, D. H. (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism, 86, 4798-4804.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8 (1), 16-22.
Lewis, T. T., Aiello, A. E., Leurgans, S., Kelly, J., & Barnes, L. L. (2010). Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain, Behavior & Immunity, 24(3), 438-443.
Schwartz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., & Cauley, J. A. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology, 113(5), 974-982.
Suarez, E. C., & Goforth, H. (2010). Sleep and inflammation: A potential link to chronic diseases. In K. A. Kendall-Tackett (Ed.), The psychoneuroimmunology of chronic disease (pp. 53-75). Washington, DC: American Psychological Association.