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Thursday, November 14 |
The following sessions are pre-conference sessions that may require an additional fee to attend.
8:00 am – 5:00 pm
What Every Physician Needs to Know Part I
This is a full-day course that aims to fill in the knowledge and clinical skills gaps that many healthcare providers report in their training. The course methods include didactic presentations and audiovisual aids to review the foundation of breastfeeding support, management, and clinical problem-solving. The course will be team-taught by physicians from a variety of specialties, including obstetrics and gynecology, family medicine, pediatrics, and neonatology. Content is based predominantly upon the evidence-based clinical protocols developed and published by the Academy of Breastfeeding Medicine, as well as statements from ACOG, AAFP, and AAP, as well as the Baby-Friendly Hospital Initiative “Ten Steps to Successful Breastfeeding.” This course has been developed and presented to participants in conjunction with the Academy of Breastfeeding Medicine’s Annual International Conference since 2001, with periodic review of content and updates of the evidence and recommendations. The target audience includes physicians, medical students, residents, fellows, and all members of the healthcare team, especially those who have direct interaction with breastfeeding families.
Fee: $195 ABM Members | $295 Non-members | $90 ABM Student Members | $110 Student Non-Members
8:00 am – 3:00 pm
What Every Physician Needs to Know II
This course is designed to build on the foundation presented in WEPNTK 1 and is open to individuals who have already participated in Course I. The format of this course will cover several case study presentations and discussions.
Fee: $195 ABM Members | $295 Non-members | $90 ABM Student Members | $110 Student Non-Members
Presentation Type: In-Person Only
3:00 pm – 5:00 pm
Protocol Writing Workshop
Curious about writing protocols but afraid you don't have what it takes to be an author? You do have what it takes! This workshop will walk you through the steps of developing a protocol, from lit review to writing.
Fee: There is no cost for this optional event. However, pre-registration is required.
Presentation Type: In-Person Only
Friday, November 15 |
The following sessions are included in the registration fee.
8:15 am – 9:15 am
The Historical, Psychosocial, and Cultural Context of Breastfeeding in the African American Community
Camille A. Claire, MD MPH
Several complex factors influence the decision to initiate and continue breastfeeding, including those “external” to women, such as cultural beliefs. The cultural context and environment of decision-making are illuminated through the prism of traditions and historical and cultural events. Black birthing persons may not have spoken to family members about breastfeeding due to the residue of terror, oppression, and gendered dehumanization of enslavement, which overshadowed the emotional bond of parent and child codified in the practice of wet nursing, galvanizing a stunted and complex birthing experience. Conversely, other cultures did not have such negative connotations regarding wet nursing. The ideology and sentiment of breastfeeding have changed throughout history and have evolved within the African American community. This session will review the historical, psychosocial, and cultural context of breastfeeding.
9:25 am – 10:25 am
Breastfeeding Research Hit Parade 2024
Arthur I. Eidelman, MD FAAP FABM
In this session, Dr. Eidelman will review the recent research studies he found most interesting, emphasizing the practical implications of the results for clinical breastfeeding medicine. Dr. Eidelman will define what remains as gaps in the knowledge and the research agenda to address the gaps.
Concurrent Workshops
10:55 am – 12:25 pm
Workshop 1
Building Programs in Breastfeeding & Lactation Medicine in Academic Medical Centers - A workshop to Identify Needs, Strengths, and Plans for Clinical, Educational, Research, and Advocacy Excellence in this Cutting-Edge Field
Casey B. Rosen-Carole, MD; Sheela R. Geraghty, MD MS IBCLC; Emily Beckett, DO; Adrienne E. Hoyt-Austin, DO; Sarah Sobik, MD MPH FAAP NABBLM-C; Katherine R. Standish, MD
Breastfeeding support is provided in a wide range of healthcare settings by individuals with diverse backgrounds and skill sets. Academic medical centers throughout the world provide a unique opportunity to bring together multiple medical specialties focused on clinical, research, education, and advocacy of breastfeeding. This workshop will allow individuals within academic medical centers to learn from those with developed expertise in this arena and to network with one another with the goal of fostering further growth and connections.
Learning Objectives:
- Recognize the successes and challenges of creating a breastfeeding and lactation medicine center within an academic institution, and consider how they can leverage their local strengths to forward their own program(s).
- Develop methods to forward the financial stability of their own breastfeeding and lactation medicine center based on experiences of presenting experts and their own programmatic strengths.
- Develop supportive relationships among participants to continue networking and idea-sharing after the annual ABM meeting.
Workshop 2
Follow the Yellow Brick Road — The Do’s and Don’ts of Opening A Milk Room and Optimizing Human Milk Utilization for Hospitalized Infants
Yuanyi L. Murray, MD; Stephanie L. Altemus Yohe, MS RD LDN IBCLC; and Heather Stephens, DNP ACCNS-N RNC-NIC
The successful operation of a milk room takes collaboration from a multidisciplinary team and careful planning and troubleshooting of pitfalls, some of which can be mitigated while others cannot. Attendees of this workshop will gain insight from the presenter's experience opening a milk room in a rural Level IV NICU, bringing a unique perspective and valuable information for other lactation consultants and physicians working towards improving their workflow in providing human milk for their patients. The workshop activities will also give the participants the foundation for designing the physical space of a milk room and the skills needed to prepare human milk feeds properly.
Learning Objectives:
- Determine the physical space and the number of technicians needed to support a milk room.
- Determine the physical space and the number of technicians needed to support a milk room.
- Recall the parental perspectives of how the milk room and milk room technicians play a role in their baby's care.
Workshop 3
Empathetic Engagement: Amplifying Marginalized Voices through Community-Based Participatory Research (CBPR) for Actionable Insights in Chestfeeding/Breastfeeding Experiences
Francoise Knox-Kazimierczuk, PhD RDN LD CLC
This workshop will address the educational gap in healthcare providers' understanding and implementation of Community-Based Participatory Research (CBPR) principles in breastfeeding medicine. The presenters will emphasize the importance of empathetic engagement and collaborative approaches in researching and mitigating breastfeeding disparities among marginalized populations. By equipping healthcare providers with knowledge and practical strategies for CBPR, the workshop aims to bridge the gap between research and practice, fostering culturally sensitive and community-driven interventions that promote optimal outcomes.
Learning Objectives:
- Identify the foundational principles of Community-Based Participatory Research (CBPR) and its relevance to healthcare providers specializing in lactation.
- Describe the role of empathetic engagement in Community-Based Participatory Research (CBPR) and its potential to amplify marginalized voices in understanding breastfeeding experiences.
- Investigate practical strategies for integrating data collected on breastfeeding experiences among marginalized populations into practice.
Workshop 4
Barriers to Chest/Breastfeeding: Advancing Maternal Health Equity
Nicole Miles, MA CD IBCLC
Attend this workshop to gain greater insights into the educational and structural gaps in in-patient, outpatient, and community settings. The presenter will examine the barriers that chest/breastfeeding poses significant challenges to the health and well-being of Black lactating individuals and their infants. These obstacles encompass racial, societal, structural, and individual factors as well as practitioner-specific and perceived barriers. Addressing these challenges is vital to advancing maternal health equity.
Learning Objectives:
- Identify and understand the various barriers to chest/breastfeeding, including racial, societal, structural, practitioner-specific, and perceived obstacles.
- Explore strategies to overcome these barriers, such as certifying more Black IBCLCs, providing comprehensive support, encouraging workplace lactation programs, and ensuring continuity of care with healthcare providers.
Concurrent Podium Presentations
Each session will include four 20-minute presentations presented consecutively.
1:35 – 2:50 pm
Podium Presentations Group 1
Response of Breast Milk IgA to Supervised Moderate Aerobic Exercise: A Randomized Controlled Trial
Amal AT. El Taweel (ELTAWIL), MD PhD IBCLC FABM
Background:
Breastmilk is well known to be an immunologically reactive system.
It is also well-documented that moderate aerobic exercise boosts the immune system; however, none of the previous studies had studied the effect of supervised moderate aerobic exercise on breast milk immunoglobulin A (IgA).
Methods:
Forty-seven exclusively breastfeeding mothers were randomized into two groups from the first to the fifth month postpartum. The control group followed only counseling on optimum breastfeeding and maternal nutritional practices for 4 weeks (n = 24), while the exercise group followed the same counseling on optimum breastfeeding and maternal nutritional practices. Also, they were enrolled in a regular, thrice weekly, supervised, moderate aerobic exercise program for 4 weeks (n = 23). Maternal anthropometric measures, infant weight, and breast milk IgA were evaluated before and after the program for both groups.
Results:
Comparing both groups after the program revealed statistically non-significant differences in maternal weight and BMI, as well as infant's weight (p>0.05), while there was a statistically significant increase in breast milk IgA (p<0.05) in favor of the exercise group.
Conclusions:
Postnatal moderate aerobic exercise may be associated with favorable effects on exclusively breastfeeding mothers and their infants through increasing breast milk IgA.
Needs Assessment/Presentation Description:
The study explores the impact of moderate exercise on the Ig A content of the breastmilk.
Learning Objectives
- The study aims to investigate the effect of supervised moderate aerobic exercise on breast milk IgA.
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To explore the effect of supervised moderate aerobic exercise on maternal and infant weight.
Breastfeeding Equity for Black Women: A Case Study of Baby-Friendly Hospitals
Kim D. Gadsden-Knowles, DrPH MPH MS
Background:
Evidence shows that the Baby-Friendly Hospital Initiative increases breastfeeding initiation for Black women. However, how Baby-Friendly hospitals use an equity approach to improve breastfeeding rates for Black women is not well understood. This research aims to explore equity-oriented approaches and practices intended to support breastfeeding, uncover barriers and facilitators to breastfeeding equity, and identify opportunities to increase the focus on equity.
Methods:
An exploratory case study using action research and an appreciative inquiry approach was conducted with two Baby-Friendly Hospitals in the Atlanta, GA, metropolitan area. The researcher reviewed publicly available hospital documents, conducted semi-structured interviews with hospital maternity care leaders, providers, and community-based key informants, and facilitated a focus group of Black women. An advisory committee was convened and provided recommendations for practice during one cycle of action research. The researcher used a priori codes based on the predefined conceptual framework and emergent codes from the data and performed quantitative content analysis and thematic analysis using MS Excel and MAXQDA.
Results:
Despite being from the same hospital system, racial equity approaches for one hospital were more equity-oriented, while racial equity approaches for the other hospital were more equality-oriented. While barriers and facilitators were found at all levels of the social-ecological model, most were related to racism and antiracism and included differential access to donor milk by race and practices to address implicit bias. Key themes for enhancing breastfeeding equity that spanned across the continuity of care spectrum were increasing access to culturally matched and respectful prenatal care and providing community-based breastfeeding support post-discharge.
Conclusions:
Changing systems at the organizational level and incorporating policies and practices that mitigate interpersonal, institutional, and structural racism may be beneficial to advancing breastfeeding equity for Black women.
Needs Assessment/Presentation Description:
There is an opportunity to investigate how Baby-Friendly hospitals implement policies and practices alone and with their partners to ensure that Black women have a fair chance to initiate breastfeeding in the hospital and sustain exclusive breastfeeding after discharge. This information can be used to build and expand upon successful efforts to improve breastfeeding rates by addressing structural racism and other factors that affect breastfeeding equity for Black women. An understanding of how equity is considered for Black women and breastfeeding may also inform the approach to other issues that disproportionately affect Black mothers and infants, such as maternal and infant mortality.
Learning Objectives
- Describe equity-oriented approaches and practices that may support breastfeeding equity for Black women at Baby-Friendly hospitals.
- Articulate barriers and facilitators to breastfeeding equity for Black women at Baby-Friendly hospitals.
- Discuss recommendations for Baby-Friendly hospitals to increase their focus on breastfeeding equity.
Influence of Social Determinants of Health on Maternal Breastmilk Composition and Neonatal Growth for Infants Admitted to the Neonatal Intensive Care Unit
Ellen Ribar, MD
Background:
Although maternal breast milk (MBM) is the best source of nutrition for preterm infants, MBM macronutrient composition and energy content can vary widely. How maternal social determinants of health (SDH) impact milk composition has not been studied, but SDH is known to impact birth outcomes and maternal nutrition.
Methods:
This retrospective chart review at a tertiary care children’s hospital in a level IV neonatal intensive care unit included infants < 2200 grams, older than one week of age, receiving MBM, and not meeting predefined growth goals. Infants with cyanotic congenital heart disease and intestinal abnormalities were excluded. An FDA-approved human milk analyzer quantified MBM caloric density and macronutrient content. Data was analyzed using GraphPad Prism with unpaired t-tests or Mann-Whitney tests for non-normally distributed data and linear regressions. P value of < 0.05 was considered statistically significant. Values indicate means ± SD.
Results:
MBM for 36 infants was analyzed, and 15 met the inclusion criteria. Table 1 describes maternal and infant demographic data by insurance status and median income in the billing zip code. Table 2 includes pregnancy complications and neonatal comorbidities. MBM energy and macronutrient content were not correlated with median income. MBM from mothers with private insurance had higher energy content than those with public insurance (84 ± 9 vs. 73 ± 6 kcal/100 ml, P=0.02), higher protein content (1.3 ± 0.2 vs. 1.0 ± 0.3 g/100 ml, P=0.03), and higher fat content (4.8 ± 0.9 vs. 3.8 ± 0.7 g/100 ml, P=0.04). Carbohydrate content was similar. Daily weight gain was similar between groups.
Conclusions:
MBM composition varied by public versus private insurance status, although infant growth was similar and not correlated with billing zip code or median income. This highlights SDH and systemic inequities that may impact MBM composition, indicating an area for further investigation.
Needs Assessment/Presentation Description:
How maternal social determinants of health (SDH) impact milk composition has not been studied, but SDH is known to impact birth outcomes and maternal nutrition. Maternal breast milk (MBM) caloric density and macronutrient content were quantified using an FDA-approved human milk analyzer for infants at a level IV neonatal intensive care unit. This study aims to evaluate how SDH may impact MBM composition.
Learning Objectives
- Describe how social determinants of health may impact maternal breast milk composition for infants admitted to a level IV neonatal intensive care unit.
- Recognize that systemic inequities and social determinants of health impact on maternal breast milk composition is an area for further investigation.
BABE 2: Breastfeeding and Antenatal Breast Milk Expression; Hand Expression versus Pumping RCT
Danielle Liu
Background:
It is well-established that breastfeeding confers health benefits for both mother and baby. However, the rates of exclusive breastfeeding in 2019 in the United States were only 62.6% in the initial postpartum period and 24.9% at 6 months postpartum, leaving room for improvement.
Methods:
A randomized control study was performed with multiparous and nulliparous women enrolled at two clinics in San Bernardino County, CA. Exclusion criteria included prior breastfeeding for 6 months or greater, contraindications to breastfeeding, multiple gestations, and a history of preterm delivery. Participants were randomly assigned to pump (n=51) or hand express (n=49) and were instructed to express breast milk for 20 minutes 3 times daily, starting at 37 weeks gestation. Data was collected from Qualtrics surveys and maternal electronic medical charts.
Results:
There was no significant difference between the two groups in postpartum hospital formula administration (pumping: 23.5%; hand expression: 24.5%, p=0.52). Women in both groups rated the study protocol as “very or extremely helpful” (pumping: 76%; hand expression: 65%, p=0.44). The amounts of antenatal colostrum produced in the two intervention groups did not yield significant differences (pumping mean: 47 cc, range: 0-533.7 cc; hand expression mean: 25.9 cc, range: 0-204.5 cc, p=0.17). Although the difference in mean cervical dilation on admission was notable, it was not statistically significant (pumping: 2.6 cm; hand expression: 3.2 cm, p=0.195).
Conclusions:
Antenatal colostrum expression safely provides women the opportunity to familiarize themselves with breastfeeding and potentially produce colostrum before delivery. As baseline exclusive breastfeeding rates in Loma Linda University Medical Center’s postpartum unit are 48%, both antenatal pumping and hand expression demonstrated improved rates (76.5% and 75.5%, respectively) of exclusive breastfeeding in the initial postpartum period. This study suggests that both pumping and hand expression are similarly helpful and efficacious. Thus, prenatal care providers can consider recommending either intervention to patients.
Needs Assessment/Presentation Description:
This study evaluated the effect of antenatal breast milk expression on exclusive breastfeeding in mothers during the initial postpartum period and compared antenatal breast milk expression with electric pump versus hand expression. The primary outcome was formula use in the first 24-48 hours postpartum in the hospital, and secondary outcomes included women’s quantitative rating for helpfulness of the protocol, amount of colostrum produced antenatally, and mean cervical dilation on admission. Although other studies have explored the benefits of antenatal breast milk expression, research comparing specific methods of antenatal breast milk expression is lacking. This study compared two specific methods of breast milk expression, providing clinicians with data suggesting the similar efficacy and helpfulness of both methods of expression.
Learning Objectives
- Compare the effect of antenatal hand expression versus pumping on exclusive breastfeeding in the first 24-48 hours postpartum.
- Recognize the potential benefits of regular antenatal breast milk expression starting at 37 weeks gestation for first-time mothers and mothers who did not previously breastfeed for at least 6 months.
Podium Presentations Group 2
Breastfeeding in Individuals with Self-Reported Functional Impairments: Secondary Analysis of PRAMS Phase 8
Margarita Berwick, MD
Background:
Individuals with disabilities constitute a large proportion of the general population and experience pregnancy at rates similar to individuals without disabilities. Data regarding breastfeeding rates, practices, and challenges in this population is limited.
Methods:
Secondary data analysis of PRAMS 2016-2022 from states utilizing Disability Questionnaire. Statistical methods included Kruskal-Wallis, chi-square, and descriptive statistics.
Results:
Disability Questionnaire was administered to 47955 individuals. 41.3% self-identified as having at least one mild impairment in one of six functional domains and 16.5 at least two. 34.3 percent self-identified as having a mild impairment, 6.3% as moderate, and 0.7% as severe. Among types of impairment, the memory/cognition/communication category was most common, at 14.6%, followed by sensory (8.5%), mobility (1.2%), and self-care difficulties (0.2%).
A higher percentage of those with impairments decided not to breastfeed prenatally (11.9 vs 8.3 %, p<0.05), and fewer initiated breastfeeding (87.6 vs 88.7 %, p<0.05). A significantly lower percentage were breastfeeding at their postpartum visit (74.4 vs 82.7 %, p<0.05). Differences were more pronounced by severity of impairment: 76.1% of those with moderate and 72.8% with severe impairments initiated breastfeeding compared with 83.4% of those with mild impairments. The lowest percentage of initiation was in those with mobility impairments (79.7%), followed by sensory impairments (81.4 %). The median duration of breastfeeding was 8 weeks in those without impairment, 6 weeks for those with mild or moderate impairments, and 4.5 weeks for those with severe impairments. By impairment type, those with mobility difficulties had a median duration of 8 weeks, those with cognitive and mental difficulties of 7 weeks, and those with sensory impairments of 6 weeks.
Conclusions:
A large percentage of individuals identify as having at least mild impairments in function. Even small impairments are associated with significant differences in breastfeeding initiation and continuation, with notable differences by type and severity of impairments.
Needs Assessment/Presentation Description:
Considering the rising incidence of pregnancy in individuals with disabilities and the proven benefits of breastfeeding for all people, there is an urgent need for quality research on this subject. The objective of the present study was to provide a descriptive data analysis of the incidence and duration of breastfeeding in individuals with and without self-reported functional impairments as listed on Disability Questionnaire in PRAMS Phase 8 and provide further characterization by different impairment severities and types.
Learning Objectives
- Describe the incidence of breastfeeding in individuals with self-identified impairments.
- Identify differences in breastfeeding initiation by type and severity of functional impairments.
- Explore differences in breastfeeding duration in people with and without functional impairments and impairment type and severity.
The LATCH Program In-Person Support Group: Improving Lactation Support During NICU Stay
Sarah A. Harter
Background:
Breastmilk is the best nutrition for term and preterm infants. Approximately 60% of infants <33 weeks gestation at birth receive >50% of their mother's milk after 7 days of age in our unit. To increase the amount of breastmilk feeding, the Lactation Advocacy Through Continuous Help (LATCH) program was initiated in October 2022. The goal is to provide lactation support to parents through weekly check-ins with medical students who are Certified Lactation Counselors (CLCs) and provide camaraderie among NICU mothers. An in-person support group was started in October 2023 to support lactating parents further.
Methods:
All mothers with NICU infants <33 weeks gestation are eligible to participate. Exclusion criteria included drug use or medications contraindicated for breastmilk use for infants. In-person support groups were scheduled twice weekly. A pre-and post-survey was given at each session.
Results:
A total of 79 mothers have enrolled in the LATCH program. Since implementing the in-person support group in October 2023, six mothers have participated in the lactation support sessions. Pre-survey data show that 100% of the moms have described their lactation journey as challenging. In an open-response format, when moms were asked what they hoped to gain from the sessions, we received responses such as help with nursing and how to produce more milk. We asked moms to describe how they were feeling after attending the support session in post-surveys, and 100% of moms said they felt either “supported” or “understood.”
Conclusions:
Expanding the LATCH program to provide in-person support has improved mothers’ confidence and commitment to their lactation journeys. We will continue to tailor our in-person support to the needs of mothers as we trial different options. We expect to see an increase in the rates of infants getting >50% breastmilk in the NICU at our institution.
Needs Assessment/Presentation Description:
Mothers of NICU infants face many challenges, including difficulties with the initiation of lactation, pumping, and support during their infant’s NICU stay. Additionally, the medical school curriculum leaves new physicians unprepared to advise and support breastfeeding women. The LATCH program and in-person support groups provide mothers with lactation support and skills while also addressing the educational gap for medical students.
WELL+ Group Visit: Combining the Trifecta Approach and Group Well-Child Care to Support Postpartum Mental Health and Breastfeeding
Ann Witt, MD FABM IBCLC
Background:
Studies confirm ongoing breastfeeding and mental health support improve breastfeeding duration, yet barriers exist. The Trifecta model combines medical, lactation, and breastfeeding support in one visit. Studies show infant group well-child care (GWCC) improves postpartum depression screening(PPDS) and breastfeeding support. In the fourth trimester, we report on a pediatric practice change to integrate the Trifecta model with GWCC to improve screening and access to breastfeeding and mental health support.
Methods:
A descriptive study of WELL+ Group practice implementation which combines GWCC, lactation consultant (LC), and behavioral health(BH) therapist during a 2-hour group visit with 5-8 dyads. The group included WCC assessment, LC feeding evaluation, PPDS screening, and BH discussion in a group environment. Retrospective chart review reports on group utilization along with pre/post intervention comparison of PPDS and LC visits after one month. Post-group surveys assessed patient feedback.
Results:
Practice change started in September 2023 with a 1-month group visit. In the year before implementation, the practice saw 544 newborns for a one-month WCC, 49% of families completed the EPDS, 98% initiated breastfeeding, and 17% participated in LC visits after one month WCC. In the four months following implementation, 64 out of 254 families (30%) chose to participate in WELL+. Compared to pre-implementation, group participants were more likely to complete PPDS screening (89% vs. 52%,p=0.000) and receive ongoing LC visits following one month(30% vs. 15%,p=0.007). The post-visit survey response rate was 31% (n=17/54), with participants agreeing they were satisfied with their care (94%), received the infant feeding support they needed (88%), and received helpful postpartum mental health information (82%).
Conclusions:
The WELL+ Group model was determined to be a feasible practice change associated with desirable outcomes, including positive parent feedback, improved PPDS, and increased lactation services utilization.
Needs Assessment/Presentation Description:
While breastfeeding initiation has increased, breastfeeding duration continues to fall short of recommended goals. Primary care practices remain instrumental in providing ongoing breastfeeding support. The presentation will report on an innovative practice change to integrate breastfeeding and mental health support in the first trimester to increase the duration of breastfeeding support.
Learning Objectives
- Identify a method of providing ongoing breastfeeding support beyond one month.
- Learn that families value ongoing breastfeeding and mental health support.
- Provide a practice change that improves postpartum depression screening.
The Effect of Reflective Writing and Breastfeeding on Self-Efficacy Scores
Rachel Lorson, BS
Background:
Breastfeeding is known to have a multitude of health benefits, such as a lower risk of diabetes and obesity, as well as better mood and stress reduction in mothers. Similarly, Engaging in reflective writing has been associated with lower scores of depression, anxiety, and stress scales. However, to the authors’ knowledge, no study has yet examined the role that reflective writing may have on new mothers’ self-efficacy.
Methods:
The study was conducted as a randomized control trial, and a reflective writing exercise was administered to intervention participants on postpartum day 1. On day 1 and week 6, all participants completed three questionnaires assessing self-efficacy and growth mindset; exclusive breastfeeding rates were assessed at these times.
Results:
There was a statistically significant increase in self-efficacy survey scores from postpartum day 1 compared to postpartum week 6 for both the intervention and control groups (p < 0.05). The effect was greatest in mothers who were exclusively breastfeeding at week 6 (p < 0.05), and the effect was even greater for those in the intervention group (p < 0.01).
Conclusions:
Self-efficacy scores increased in mothers from postpartum day 1 to week 6. This impact was more pronounced in mothers exclusively breastfeeding at week 6 and, even more so, those who engaged in reflective writing. The findings of this study suggest that mothers’ self-efficacy is malleable in the immediate postpartum period. Further research is needed to elucidate additional methods to bolster new mothers’ self-efficacy.
The postpartum period is a sensitive time for both mother and baby, requiring a unique approach for both research and standardized patient care. We must carefully balance patient interventions and support with respect for the mother’s desires and abilities, working to address outside factors.
Needs Assessment/Presentation Description:
This study investigated a method to boost self-efficacy in new mothers through a reflective writing prompt, encouraging them to reflect on past struggles they had overcome. Though this study featured reflective writing, the general principle has broad applications to how the entire patient care team approaches the first-time mother who is attempting to breastfeed. Preparing new mothers for the breastfeeding process by setting realistic expectations and offering support and encouragement may help promote breastfeeding success. One way to do this is a short conversation reflecting on how past struggles have led to success.
Learning Objectives
- Demonstrate how reflective writing may work to bolster self-efficacy in mothers and why this may improve breastfeeding success.
- Propose additional methods by which the patient care team may improve a mother’s self-efficacy.
- Explain why postpartum is a unique time and how to vary both clinical and educational approaches when working with first-time mothers.
Concurrent Sessions
3:20 – 4:50 pm
Concurrent Session 1
Global Panel 1: ABM Position Statement on Paid Maternity Leave
Maria Enrica ME. Bettinelli, MD IBCLC FABM; Zaharah Sulaiman, MBBS MComm Med PhD IBCLC FILCA; Julie P. Smith, PhD B Ec(hons)/BA Cert IV; Rukhsana Haider
In the position statement on Paid Maternity Leave, The Academy of Breastfeeding Medicine recommends 6 months of paid maternity leave at 100% of pay. This panel comprises authors on that statement from around the world, who all bring a breadth of knowledge and experience to this conversation. The benefits of paid leave to society and the economic value of breastfeeding will be discussed. Dr. Maria Enrica Bettinelli (Italy), Dr. Rukhsana Haider (Bangladesh), Dr. Julie Smith (Australia), and Dr. Zaharah Sulaiman (Malaysia) will also share global perspectives on models of paid leave.
Learning Objectives
- Understand the impact of maternity leave on breastfeeding rates.
- Learn how the economic value of breastfeeding can be measured and calculated.
- Describe how maternal time investments in breastfeeding and infant care contribute to the economy.
- Understand the advocacy potential that ABM members have in this area.
- Describe the enablers and challenges that working women face in maintaining breastfeeding practices.
Concurrent Session 2
3:20 – 4:05 pm
Growing Families, Welcoming Change: Breastfeeding & Lactation Medical Care for LGBTQIA+ and Gender Non-conforming Patients
Casey Rosen-Carole, MD MPH MEd FABM NABBLM-C
LGBTQIA+ and gender non-conforming individuals have existed throughout history and across all regions, yet their experiences are often excluded from discussions of child-rearing. As global communities become more accepting of parents of all genders and sexualities, parenthood is increasingly accessible. And, of course, babies need to be fed! Supporting human lactation means that all should have equal access to human milk and the opportunity to chestfeed or breastfeed if they choose. This lesson will explore the common challenges faced by members of LGBTQIA+ and gender non-conforming communities, as well as affirming and supportive practices. Additionally, we will examine how lactation may be affected by gender-affirming treatments, such as hormones or surgeries. At the end of the lesson, participants will have actionable steps to take to improve their support for LGBTQIA+ and gender non-conforming patients.
Learning Objectives
- Affirm: Become familiar with lactation terminology used in the LGBTQI community.
- Inform: Discuss how lactation changes in the context of medications, surgeries, or fertility treatments.
- Support: Identify tools and resources that may be especially useful for LGBTQI+ and gender non-conforming patients.
4:05 – 4:50 pm
Concurrent Session 3
Maternal Obesity, Milk Feeding Practices and Growth Trajectories in Infancy
Carmen Monthe-Dreze, MD
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months after birth. As the gold standard for infant feeding, breastfeeding is associated with numerous benefits for the dyad, including healthier weight gain trajectories during early childhood. However, previous studies have typically compared breastfed infants with formula‐fed or bottle‐fed (regardless of whether formula or expressed breast milk is in the bottle) infants, and few have attempted to disentangle the effects of feeding mode vs. milk type on infant growth. Furthermore, little is known about the relationship between maternal obesity — one of the strongest determinants of childhood obesity — feeding mode and weight trajectories in infancy. Findings from this study may begin to inform national and institutional maternal leave policies since one of the primary drivers of bottle-feeding introduction is the return to work. Additionally, findings may inform public health strategies for breastfeeding among women with obesity. The audience will be better prepared to provide targeted breastfeeding education to support optimal weight gain in infants.
Learning Objectives
- Identify the impact of rapid weight gain in infancy on childhood health outcomes.
- Discuss how direct breastfeeding vs. breastmilk via bottle may differentially impact weight gain in infancy.
- Discuss how direct breastfeeding vs. breastmilk via bottle may differentially impact weight gain in infancy.
- Recognize the role of maternal obesity in infant feeding.
- Describe how maternal obesity may increase susceptibility to weight gain in infancy.
Saturday, November 16 |
The following sessions are included in the registration fee.
Concurrent Sessions
8:05 – 9:05 am
Concurrent Session 4
Diabetes, PCOS, and Breastfeeding
Kate L. Rassie, MBChB FRACP
The impacts of PCOS and diabetes on breastfeeding are significant yet often overlooked, affecting both maternal and infant health. In this session, endocrinologist and PhD candidate Dr Kate Rassie (Australia) will use a series of clinical cases to outline the physiological mechanisms linking maternal metabolic disease to suboptimal breastfeeding outcomes. She will summarise key themes that emerge from the recent literature and will link pathophysiology to clinical management.
Learning Objectives
- Understand the epidemiology of breastfeeding (rates/ durations) among women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM).
- Outline the maternal metabolic and glycaemic benefits of breastfeeding and the proposed underlying mechanisms, and understand the caution required in interpreting such research.
- Outline the specific lactation difficulties faced by women with GDM and T2DM (e.g., lactogenesis delay) and the underlying physiology.
- Discuss the clinical management of GDM and T2DM in the context of lactation, including antenatal expression and medication/ insulin safety.
- Review the diagnostic features, pathophysiology, and basic management of polycystic ovary syndrome (PCOS) and know where to find evidence-based resources on this condition. Describe the proposed links between PCOS and lactation challenges, outline the proposed underlying
8:05 – 8:35 am
Concurrent Session 5
Exclusive Pumping: How Did We Get Here?
Sheela R. Geraghty
Breast milk extraction without latching a baby to the breast has been made accessible and efficient with the widespread use of the double electric breast pump. “Exclusive pumping” has implications for individuals pumping and infants consuming the pumped milk. There is an overwhelming amount of non-evidenced-based information on the internet that supposedly describes “exclusive pumping.” This overview aims to identify ways that health care personnel can manage “exclusive pumping” in their practice by understanding what evidence has been published.
Learning Objectives
- Define what is “Exclusive Pumping.”
- Describe what “Exclusive Pumping” means for the individual doing the pumping.
- Recognize what “Exclusive Pumping” means for the infant consuming pumped milk.
- Identify ways healthcare personnel can manage “Exclusive Pumping” in their practice.
8:35 – 9:05 am
Concurrent Session 6
Exclusive Breastmilk Pumping in Singapore — What Do We Know So Far?
Wei Wei Pang
Breastfeeding is no longer just about feeding at the breast. Join Dr. Wei Wei Pang as she describes breastfeeding practices and the factors and motivations that drive these practices, like breastmilk pumping, in a high-income Asian country. Find out if it matters to mum’s and child’s health whether a mum feeds her child at the breast or provides breastmilk in a bottle.
Learning Objectives
- Understand breastfeeding practices in Singapore and their associated risk factors.
- Explain the potential effects of exclusive breastmilk pumping on mother and child.
Concurrent Sessions
9:15 – 10:15 am
Concurrent Session 7
What Does the Available Research Say About Oral Galactagogues? Evidence from Cochrane
Siew Cheng S.C. Foong; MD MRCP DipHPE
Traditional galactagogues, primarily plant-based remedies, have been used in many cultures as part of postnatal care, even for women without milk supply problems. Recently, medications have been used off-label in clinical settings for women facing milk supply issues, and traditional galactagogues have also started to be used in non-traditional settings. Do they work? Are they safe? Recent research has aimed to answer these questions. Join us in this interactive and engaging session as we delve into the best available evidence on galactagogues and their role in supporting breastfeeding mothers.
Learning Objectives
- Identify research evidence on galactagogues.
- Provide evidence-based recommendations regarding galactagogues to support mothers facing challenges with breastmilk production.
Concurrent Session 8
Human Milk for Preterm Infants in the Neonatal Intensive Care Unit
Monika Berns, MD
Provision of mothers’ own milk for preterm and critically ill infants is an important goal of care in the NICU. Attend this session to learn about a team-based approach developed to support lactation and breastfeeding. I will focus on initiating milk expression and the value of donor milk from a human milk bank, maintaining milk production, fortification of human milk and the barriers impeding direct breastfeeding. This lecture aims to prepare you to know evidence-based measures to support mothers and families on the way to breastfeed their newborn infant in the NICU and beyond discharge.
Learning Objectives
- Define short- and long-term health benefits of a mother´s own milk provision.
- Solve challenges of mothers of preterm and critically ill infants to initiate lactation.
- Demonstrate practices to support lactation and direct breastfeeding.
- Demonstrate practices to support lactation and direct breastfeeding.
- Identify nutritional requirements to optimize growth and development.
- Develop a multidisciplinary NICU team that supports lactation.
Concurrent Workshops
10:45 am – 12:15 pm
Workshop 5
Development and Interrater Reliability of the Lactation Assessment Care Tool
Allyson Wessells
Families should have evidence-based information regarding their lactation acuity to make informed choices on what level of care and support to pursue for their individual needs. No comprehensive predictive measurement instruments that define lactation acuity have been published by accounting for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Assessment Care Tool (LACT) was developed as a succinct, evidence-based measure of lactation acuity relevant to maternal, infant, and functional factors. The LACT supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of lactation care. It is intended to help identify families at risk for breastfeeding challenges upon hospital discharge and in busy healthcare clinics with a primary goal of facilitating access to the most effective level of care to prevent early breastfeeding cessation. The potential to improve reciprocal referral and collaboration among breastfeeding medicine specialists, other medical providers, and lactation consultants based on acuity may help families avoid delaying care necessary to address breastfeeding challenges, ultimately optimizing health outcomes associated with duration recommendations.
Learning Objectives:
- Define lactation acuity relevant to connecting families with the best level of lactation care to reach their breastfeeding goals.
- Recognize the Lactation Assessment Care Tool (LACT) as a predictive measure of lactation acuity with maternal, infant, and functional factors for difficulty and premature breastfeeding cessation.
- Measure lactation acuity utilizing LACT to facilitate decision-making consistent with the Baby Friendly Hospital Initiative Step 10 goal of coordinating care.
Workshop 6
Bodywork for Babies - Gaining insights into fascia connections to breastfeeding performance
Susan Kratz, OTR CST-D
The osteopathic viewpoint is missing from most traditional training programs. Manual therapies evolved from this philosophy (craniosacral therapy, visceral manipulation, and myofascia release), and been embraced by many medical and allied health professionals, and have yielded ways to treat structures directly rather than behaviorally or with environmental modification. These and other methods have proven safe and direct treatments for the autonomic nervous system behavioral continuum and cranial nerve pathways. In turn, bodywork with precise hand placements facilitates a reduction in protective retraction behaviors as well as management of tongue-tie pre- and post-release management.
Learning Objectives:
- Gain a new appreciation for often neglected anatomical structures involved in feeding, peristalsis, and elimination (hyoid, digestive sphincters, fascia bands, cranial fascia, organ walls).
- Gain observation skills recognizing body asymmetries that adversely pull on the throat, jaw, tongue, esophagus, and visceral organs, impacting the baby’s autonomic behaviors and feeding performance.
- Recognize when cranial nerves to face, jaw, and neck are compressed and the effect upon nutritive and non-nutritive sucking.
Workshop 7
Prenatal Breastfeeding and Lactation Counseling for Individuals with Special Circumstances
Liliana Simon, MD BABBLM-C FABM IBCLC; Anne Eglash, MD BABBLM-C FABM IBCLC
This workshop addresses the need to learn optimal strategies to prepare pregnant individuals who are anticipated to struggle with lactation due to a history of lactation issues in the past or for those who will be navigating a difficult healthcare journey with their newborn. Because healthcare systems are often not sure how to support such individuals, it is important for breastfeeding medicine providers to educate such patients preemptively so that they can strongly advocate for their own needs.
Learning Objectives:
- Identify points of discussion when providing lactation counseling for a pregnant individual with a history of low milk production.
- Describe points of discussion when providing lactation counseling for an individual who is pregnant with a fetus with known critical congenital heart disease.
Workshop 8
Perioperative Lactation program: Barriers and Opportunities
Sarah Dodd; Kaytlin Krutsch
The management and education of lactating patients who need surgery and anesthesia require multidisciplinary coordination, electronic medical record optimization, and accurate patient and provider education and decision support. Developing and implementing a comprehensive program will likely face many barriers unique to each institution type and may be difficult to overcome without a plan. Optimal care of lactating patients is important because it may prevent unnecessary disruptions to the dyad, complications of mastitis, decreased supply, and, ultimately, early weaning.
Learning Objectives:
- Envision a lactating patient's procedural care pathway in the provider's health system, including logistics, education, care, and medications.
- Evaluate and support anesthetic and surgical plans with the goal of compatibility with uninterrupted lactation and robust patient education.
- Incorporate lessons learned at a large academic institution while developing a comprehensive pathway for lactating patients.
1:15 – 2:15 pm
Annual Member Meeting
The Annual Member Meeting is for Members Only and provides updates on ABM initiatives and achievements throughout the year. New Fellows of the Academy will also be inducted during the Annual Member Meeting.
ABM Members Must Be registered to access the meeting.
Concurrent Sessions
2:20 – 3:20 pm
Concurrent Session 9
Why Countries Must Regulate Infant Formula Marketing to Improve Breastfeeding Outcomes: Lessons from the 2023 Lancet Breastfeeding Series
Rafael Perez-Escamilla, PhD; Cecelia Tomori, PhD
This presentation will address key lessons from the 2023 Lancet Breastfeeding Series, which provides a synthesis of the most recent research on the critical importance of breastfeeding, the barriers, and opportunities for creating systems that enable women globally to breastfeed as they desire. The talk will focus on the role of the commercial milk formula (CMF) industry and its far-reaching influence on families, healthcare providers, and policymakers. The lecture will also provide a framework for the CMF industry playbook and specific examples of how this playbook is deployed to shape families’ and health professionals’ views of human infant behavior to generate profit. The talk will conclude with concrete strategies for policies and regulations that must be enacted to end unethical marketing and enable women to realize their breastfeeding goals.
Learning Objectives
- Apply the Lancet 2023 Series framework for understanding the current global infant feeding landscape and barriers to breastfeeding success.
- Identify the elements of the commercial milk formula marketing playbook that undermine breastfeeding, with special attention to the role of health professionals.
- Describe specific examples of how typical human infant behavior is reframed by commercial milk formula marketing to increase profits.
- Identify and take action to help implement strategies and recommendations for enabling equitable policies and regulations that must be enacted to end unethical marketing and enable all women to realize their breastfeeding goals.
Concurrent Session 10
Antenatal Colostrum Expression: Evidence and Considerations for a Handy Technique
April Castillo, MD MPH
This session will provide an in-depth examination of the intervention of antenatal colostrum expression (ACE), including the proven and suspected risks and benefits, the existing research, particularly since the DAMES trial in 2017 established safety, and the proposed mechanisms of effect on secretory activation. Gaps in knowledge and areas for future research will be discussed, and preliminary data from the TEACH Secretory Activation Trial will be discussed, examining changes in the biomarkers during lactogenesis II. Recommendations for advising and educating patients on the topic will be shared.
Learning Objectives
- Understand the evidence base and data limitations regarding the technique of antenatal expression.
- Identify target populations who could benefit most from the technique.
- Clarify the contraindications and know when to advise against the intervention.
- Investigate the relationship between ACE and secretory activation through biomarkers.
- Review best practices for patient recommendations
Concurrent Sessions
3:50 – 4:50 pm
Concurrent Session 11
Clinical Assessment Process for Treating Ankyloglossia (CAPTA) Update
Yvonne LeFort, MD; Nadine Manson, MD; Michal Mansovsky, MD; Rima Strassman, MD
The decision to treat or not treat the breastfeeding infant with ankyloglossia (tongue tie) is not well-served by existing screening tools. Medical doctors who perform frenotomies have criteria and methodologies for evaluation of their own, which assists them in their decision-making. Our goal is to capture these key criteria and collate these elements as a clinical guideline for all who perform frenotomies within the scope of Breastfeeding Medicine. The initial version of CAPTA has been developed by four Breastfeeding Medicine doctors from four countries with input from ABM members who perform frenotomies. A group of Breastfeeding and Lactation Medicine doctors have incorporated CAPTA into their practice when assessing infants with ankyloglossia for possible frenotomy. They were asked to provide follow-up at three points after their clinical decision on whether to treat or not was made using CAPTA. We compared medical doctors' data regarding the decision to conduct a frenotomy and whether the frenotomy was helpful. We will have some early data to present and welcome ABM members at our Annual Meeting to give feedback as this clinical guideline continues to be fully developed.
The next steps will include further recruiting of testers and data analysis. We will also look for ideas on how to best disseminate CAPTA to medical doctors who perform frenotomies, ensuring global accessibility to this innovative clinical guideline.
Learning Objectives
- Clinical Assessment Process for Treating Ankyloglossia (CAPTA) Update.
- Discuss recruitment of testers of the resource and general feedback.
- Describe preliminary data from the testers.
- Describe preliminary data from the testers.
Concurrent Session 12
Dysphoric Milk Ejection Reflex: Clinical Implications
Megan Howard, MD MPH
Dysphoric milk ejection reflex (DMER) is an established clinical phenomenon. However, the data available in the literature is scarce. This session will describe what is known about DMER, including epidemiology and typical clinical presentation. We will discuss the two hypothesized mechanisms behind DMER, along with the limited data supporting each. We will conclude with practical clinical pearls, including evaluation tools and both behavioral and pharmacological tools for management.
Learning Objectives
- Identify Dysphoric Milk Ejection Reflex in a clinical setting based on symptoms and timeline.
- Discuss the two theories behind the pathophysiology of DMER and the strengths and weaknesses of each.
- Provide psychoeducation on Dysphoric Milk Ejection Reflex to a patient, along with recommendations for symptom management.
6:00 – 9:30 pm
Centennial Celebration & Silent Auction Fundraiser
Join us for a memorable evening of community and generosity as we celebrate the centennial birthday of one of our esteemed founding members, Ruth A. Lawrence, at our Centennial Celebration & Silent Auction Fundraiser. Dr. Lawrence celebrated her 100th birthday in August. This special event will not only honor Ruth’s incredible legacy but also raise essential funds to support our organization’s mission and vision. Your contributions will help us continue our vital work in developing clinically-based protocols, position statements, patient handouts, and other educational resources that empower breastfeeding professionals to support the patients and families they serve.
The evening will be filled with excitement, featuring dancing to live music from The Boomerangs, a talented band from Charlottesville, Virginia, that includes our very own Past President, Ann Kellams! The Boomerangs plays your favorite classic rock and acoustic covers of classic rock and other popular songs. Enjoy dinner, exclusive auction items, and the chance to connect with fellow breastfeeding medicine professionals who share your passion for making a difference. By attending, you’ll be part of a night celebrating our past and future as we work together to advance knowledge, improve patient outcomes, and foster a healthier community. We look forward to celebrating with you and making a meaningful impact together!
Fee: $80
Sunday, November 17 |
8:15 – 9:15 am
Global Panel 2: Breastfeeding in Emergencies
Melissa Bartick, MD, MS, MPH; Hiroko Hongo, PhD, Nalan Karabayir, MD, PhD; Deena Zimmerman, MD, IBCLC
Supporting breastfeeding in emergencies is important to child survival and maternal resilience. In emergencies, infants and young children are at risk of morbidity and mortality, which is increased by malnutrition. Breastfeeding reduces the risk of infectious diseases and mortality in emergencies and is the safest way of feeding. Challenges to breastfeeding can be worsened by large donations of commercial milk formula, which is frequently provided to exclusively breastfeeding mothers without restrictions or indications. This panel will discuss these issues and best practices for handling them. In this international panel discussion, attendees will hear from two authors on the ABM Position Statement: Breastfeeding and Emergencies, Dr. Melissa Bartick and Dr. Deena Zimmerman, as well as Dr. Hiroko Hongo on the experience in supporting breastfeeding after the nuclear accident in Fukushima and other emergencies in Japan, and from Dr. Nalan Karabayir on supporting breastfeeding in Turkey after the 2023 earthquake.
Learning Objectives
- Describe why breastfeeding in emergencies is important for child survival
- Recognize the harms of donations of commercial milk formula during emergencies.
- Identify global resources and networks on infant feeding in emergencies.
- Explain the breastfeeding-related problems that occur in disasters.
9:45 – 10:45 am
Founders Lecture
Rethinking the Framework on Global Capacity-building for Skilled Lactation Support
Larry Grummer-Strawn, PhD
Dr. Grummer-Strawn will discuss the need for new approaches in building the abilities of healthcare providers to provide necessary support for mother-baby dyads. Building upon recent and forthcoming WHO publications, he will highlight the importance of shifting from a focus on training courses to competency assessment, emphasizing integration in pre-service curricula, and ending reliance on commercial funding sources. He will discuss the capacity-building implications of improved role delineation in providing routine counselling and support for all mothers and addressing key lactation management problems such as dehydration, poor growth, and insufficient milk.
Learning Objectives
- Describe the advantages of focusing attention on the assessment of breastfeeding support competencies over the provision of training.
- Identify opportunities for integrating breastfeeding education in pre-service medical education.
- Recognize the different skill sets required to generally support breastfeeding mothers and babies with appropriate counseling and advice compared to managing significant lactation problems.
- Advocate for funding of healthcare provider education that is unbiased and free of commercial influence.
11:00 am – 12:00 pm
Mammary Gland Control of Milk Production
Laura Hernandez, PhD
Learning Objectives
The mammary gland provides feedback during lactation on the regulation of milk production. It is critical to understand how the mammary gland affects maternal metabolism and endocrinology, which impacts overall milk production postpartum. Numerous studies in mammalian species will provide foundational information that is critical for the management of milk production in women. Application of knowledge in animals where controlled experiments have occurred to better understand mammary gland physiology are foundational for managing human milk production and providing improved care in women who are breastfeeding.
Learning Objectives
- Define the role of the mammary gland in the control of milk production.
- Understand how factors produced by the mammary gland impact milk production.