Could you elaborate on any emerging research or clinical trends you see shaping lactation support in the next 3-5 years

I think we will see emerging research on the infant microbiome and impact on chronic illness (asthma, respiratory conditions, obesity, diabetes). I also think we will see research on infant brain development, maternal health and breastfeeding as well as mental health.
Due to the pump use in the USA, I imagine pumping will also be a focus of research and clinical trends.
I also think the issues with formula contamination and shortage has highlighted disparities in breastfeeding initiation and duration and this will hopefully be reflected in practice.
Clinical trends will also include longer duration of breastfeeding, specifically supporting breastfeeding for the two years and beyond.
Research and clinical trends may also look at early food introduction and breastfeeding.

How do you approach integrating cultural competence into lactation education and support?

Patients align themselves with providers who are from similar cultural backgrounds. We need to increase the number of certified lactation consultants working in hospitals and in the community who represent many different cultures and ethnic groups.
All providers should learn about their patient’s cultural beliefs, values, practices, and how this influences their breastfeeding choices and practices. Providers should ask questions if they are not sure of a specific practice or belief.
Providers should first understand their own cultural biases in order to address implicit bias.
Tailoring information and support to specific cultures is necessary to provide accurate information and dispel myths.
Providing information in multiple languages, using interpreters and culturally appropriate materials is one way to integrate cultural competence.
Address cultural concerns such as prolonged breastfeeding, beliefs about colostrum, respecting modesty, incorporating grandmothers or aunts who are helping the mother.

Can a mother with breast cancer be a danger to a baby who is breastfed?

Neither Dr Komaroff or Dr Robinson work in breast oncology but there are resources you can access that provide evidence based research on care.
https://physicianguidetobreastfeeding.org/lactation-landing/breast-cancer-and-breastfeeding.
Dr Katrina Mitchell is a breast surgeon and lactation consultant who works in southern California caring for a wide range of patients, including patients who have pregnancy associated or postpartum breast cancer. I have attached a link to her website which is for providers. She has many links to guidelines and research that will be helpful in answering questions about breast cancer and breastfeeding.

Can you please tell me where is the law of lactation implemented other than USA?

This is what I can find on lactation protection outside of the USA.
Parental Leave:
Sweden
In Sweden, parents enjoy 480 days of shared leave, with 90 days reserved exclusively for each parent, ensuring both parents have time to bond with their child. The leave is paid at 80% of their wages, encouraging shared caregiving roles while alleviating financial stress​.
Bulgaria
In Bulgaria, mothers are entitled to 410 days of maternity leave paid at 90% of their salary, starting 45 days before their due date. Fathers also have 15 days of paternity leave, and parents can transfer unused leave to one another​.
Chile
In the Global South, Chile offers 30 weeks of maternity leave, with six weeks before birth and 24 weeks post-birth, at full pay. Additionally, fathers receive five days of paternity leave, with options for shared parental leave beyond that period.
Breastfeeding Protections:
USA: Breastfeeding is protected by law in all 50 states, with many having specific laws ensuring mothers’ rights to breastfeed wherever they wish.
Canada: Like the US, public breastfeeding is protected by law, allowing mothers to breastfeed anywhere.
United Kingdom: Public breastfeeding is completely legal and generally well-accepted.
Australia: Protected by law in all states, public breastfeeding is widely accepted.
Scandinavia (Sweden, Norway, Denmark, Finland): Public breastfeeding is broadly accepted and supported in these countries.
New Zealand: Public breastfeeding is protected by law and socially accepted.
Western European countries: Generally, breastfeeding is legally protected and accepted (Germany, France, Italy, Spain, Belgium, etc).
China: Public breastfeeding is generally accepted and socially tolerated, though there are no specific laws banning or permitting it.
Restrictive attitudes:
Some Middle Eastern countries: Public breastfeeding can be deemed inappropriate and prohibited, primarily for religious reasons, especially in Saudi Arabia and the UAE.
Maldives: While not legally banned, public breastfeeding is recommended to be done discreetly due to the dominant influence of Islam.
Southeast Asia: Attitudes toward public breastfeeding vary, with no specific laws in some countries, so it’s advisable to understand local practices and culture to avoid uncomfortable situations.
Eastern Europe: Public breastfeeding attitudes vary, with no strict bans, but in countries like Russia, public breastfeeding can be perceived and accepted differently in urban versus rural areas.

Do you have any new breastfeeding stats for South Africa?

Here are updated stats from the Department of Health, Republic of South Africa.
This video from August 2024 (World Breastfeeding Week August 1-7) discusses breastfeeding in South Africa.

How can I support a mother who wants to breastfeed but is experiencing aggression due to mental health issues?

Perinatal mental health disorders are prevalent in every country. We as providers need to screen our patients for depression and anxiety using validated tools- Edinburgh Postnatal Depression Scale and the GAD- Generalized Anxiety Disorder. If patients are experiencing mental health problems we need to get them support and facilitate treatment. Often times talk therapy is a helpful first step before considering medications to help with a mood or anxiety disorder.
It can be helpful to educate a patient on recognizing their own symptoms and signs of frustration, anger, rage, despair and encourage them to discuss these feelings without shame or judgement.
It is helpful for providers to build a network of counselors, therapists, and mental health professionals who could work with these parents.
It is also important to connect patients with resources- consider PSI, Postpartum Support International as one resource. They offer online support groups.

How do you envisage the role of Community Health Workers in addressing social determinants within communities to support our efforts with families?

Here is a resource from NACCHO (National Association of County and City Health Officials)- it focuses on utilizing local health departments to reach communities.
The Reducing Breastfeeding Disparities through Peer and Professional Support (Breastfeeding Project) is a cooperative agreement with the Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity and Obesity (DNPAO) to increase implementation of evidence-based and innovative breastfeeding programs, practices, and services at the community level in African-American and low-income communities, who are disproportionally affected by structural and social barriers to breastfeeding. The Breastfeeding Project is also intended to increase community capacity to develop and maintain public health partnerships critical to building community support for breastfeeding. The long-term goal of this project is to increase breastfeeding initiation, duration and exclusivity rates within African American and low-income babies.
Parents as Teachers is another organization supporting families and children in the community.

The hospital I primarily serve is non-Hispanic white; however, our population of patients is changing. There are cultures that believe mothers do not have milk until days after birth. They exclusively formula-feed or combination feed. How can this be avoided?

In some cultures, there exists ‘colostrum taboos’ where early milk or colostrum is not safe or suitable for a newborn.
Here is a great article looking at colostrum through the cultural lens.
And here is an article from the American Academy of Pediatrics with suggestions for approaching this topic.
As a hospital based provider you could try partnering with OBs/Midwives to start discussing breastfeeding in the prenatal setting. Maybe you could do a quality improvement project looking to improve early BF rates on your unit. Maybe you can make a handout or video for the postpartum dyad.
It is a challenging issue but providing culturally aware resources and utilizing postnatal care services may be helpful to minimize this trend.

Any implications for adult medical patients and gut health remedies using breast milk?

The implication of using human milk as a remedy is used and recommended in ancient cultures in Europe but in modern medicine further research is still needed to suggest the use of human milk extracts, especially the human milk oligosaccharide as a derivative of human milk and enhance the health bacterial profile (as a prebiotics).

Can mothers milk be used for problems in the gut and how has it to be given? By drinking or directly into the gut?

Human milk is the excellent way to shape the gut microbiota and enhance the gut barriers and form the healthy gut profile picture. Till now all the recommendations is usage by drinking not injections specially in preterm babies and babies with short gut syndrome, post surgery, to enhance the function and protect against small bowel bacterial overgrowth and regulate the motility and restore its normal function.

I want to recommend milk bath, nasal rinse, breast milk lotion in my NICU but I need to go through the medial team/ my peers. Can you share with me your clinical experience with these methods in NICU? Thank you!
I notice, and moms report, that use of BM on the nipple dries out the nipple and leaves a milk crust. Would that still be an effective treatment for nipple trauma? thanks !

Thank you for your lovely feedback. Actually I am currently not working in the NICU plus here in Egypt our babies are very very critical. It is hard to manipulate and not fully control for infection. And as regards the nasal rinse it is under investigation still and needs further research.
But for bath and topical uses generally it is safe when sterile milk is used with babies’ mothers’ or caregivers’ informed consent.

You suggest popsicles of iced breastmilk for soothing teething pain, but I’ve searched online and it seems that this can cause frostbite of the gums. Your comment on this please?
How can breast milk be used for preventing side-effects of chemotherapy?

The frostbite related to length of exposure, popsicles will be used in very short time just few seconds to sooth the pain.
Human milk has probiotics and prebiotics (HMOs) that modulate the gut microbiota so decrease the after-effects of chemotherapy in small intestine microbial dysbiosis.

In that lotion for miracle lotion. Is there a way to substitute beeswax with something? Can I use shea butter also?

Yes, shea butter can be used as a substitute for beeswax in lotions, the differences is that Shea butter is a plant-based fat with a soft texture, similar to beeswax, and can provide similar benefits like moisturizing and creating a barrier on the skin. However, beeswax has a higher melting point and provides a more solid structure compared to shea butter, which is more prone to melting.

Mechanism of Action: Could you elaborate on the proposed mechanisms behind the effectiveness of human milk in these unexpected therapeutic applications?
Clinical Evidence: What level of clinical evidence supports these uses — are they mostly anecdotal, case studies, or are there randomized trials?
Safety and Ethics: How do we ensure safe and ethical sourcing of donor milk when exploring non-traditional uses?
Regulatory Considerations: Are there any regulatory challenges or guidance when using human milk outside of neonatal nutrition?

The clinical evidence by observational and randomized controlled trials.
As regard the safety, it is as safe as diseases and medication that secreted in breast milk. On going trials are coming soon.

Should we, as a developed country be putting HM on umbilical cord sites? Or is this used as a treatment for underdeveloped countries?

Yes we can apply it as topical drops on umbilical cord to speed up the cord separation, it’s safe as the topical usage of fresh expressed mother’s milk. Only the routine topical antimicrobial use is not recommended in high resources countries according to AAP guidelines and recommendations.

What can I do with the mother who asks questions like if she can put a drop of milk inside the baby’s ear?

We need further evaluation by specialized doctor in ENT to exclude any other medical problems first as the fungal infections, middle ear inflammation and effusion can occur and unpleasant sequences.

What was the reference for the diaper cream? I think some components of the breast milk might be lost by adding to hot mixture. Also keeping for 3 months may not be safe. Maybe 48 to 172 hours? Adding scents may not be tolerated by baby.

Heat the beeswax and carrier oil gently until melted, then whisk in the breast milk. Add essential oils and vitamin E oil (optional).
If you pour all of the melted ingredients into the milk at once, the milk will heat up too fast and curdle. So tempering is the best way.
Adding beeswax to a breast milk cream can help extend its shelf life and also contribute to the cream’s texture and benefits. Beeswax acts as a natural preservative and can also help thicken and stabilize the cream.
Some sources suggest that breast milk lotion can be stored in the refrigerator for up to 3 months. Best to use within 4 days of preparation when refrigerated. If frozen, use within 6 months.

Mostly read the slides, it would have been more engaging to interject personal examples on the use of EBM in her practice or to further expand the discussion.

I know I have read the slides as it wasn’t depend on my own practices I just searched for the many uses of human milk as a medicine in history and in modern medicine to collect the data from different researches, but promise in any upcoming presentations I will discuss my own practices especially in my own skills and professionality as pediatrician and IBCLC.

Could you clarify what types of ‘ties’ you were primarily focusing on—are these interpersonal, societal, or metaphorical?
How might understanding the ‘perplexity’ in our relationships help us navigate conflict or decision-making more effectively?
Did you draw on any specific theoretical frameworks when analyzing the complexity of these ties—like attachment theory, network theory, or existential philosophy?

Thank you for your question, though it looks like the questions were AI generated? This talk looked at tight frenulums under the following headings: What are tongue-ties? What’s the big deal? (consequences). Classifications. How to spot it. Alternative breastfeeding positioning to help compensate for a tight tongue. Other causes and To Snip or not. It was not a talk about human relationships, social ties, emotional bonds or the dynamics of social connections.

Have you ever had /seen any issues of over cutting/too deep of laserwork and it really appears to be a deep wound under the tongue?

Thank you for your question. In my area we are lucky in the sense that the practitioners know what they are doing and parents do not complain about over-cutting or cutting too deep. One mother did voice her surprise about how close to the tongue the ENT snipped. Have you read the Clinical Consensus Statement: Ankyloglossia in Children ? (Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 May;162(5):597-611. doi: 10.1177/0194599820915457. Epub 2020 Apr 14. PMID: 32283998), also there are no comparative data on the use of laser versus clipping for frenotomy in babies younger than 6 months. (Thomas J, Bunik M, Holmes A, et al; American Academy of Pediatrics, Section on Breastfeeding, Council on Quality Improvement and Patient Safety, Section on Oral Health, Committee on Fetus & Newborn, Section on Otolaryngology-Head and Neck Surgery. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics. 2024;154(2): e2024067605), although fans argue that laser is more exact and provides better haemostasis than standard frenotomy. (AHRQ Pub. No. 15-EHC011-1-EF May 2015), the truth of the matter is the skill of the practitioner wielding the tool is more important than which tool is used.

How would I locate an IBCLC if I were to need one for my infants?

Thank you for your question. I see you are from the USA? You can use the IBCLC Commission’s Public Registry, but you would need the IBCLCs name. You could also try the United States Lactation Consultant Association’s (USLCA) database to find an IBCLC, but I think they’d need to be a member to be listed. You could check with your local hospitals or clinics. Many hospitals and clinics have IBCLCs on staff or recommend them. You can check with your local healthcare providers or local mothers’ groups or breastfeeding support groups may have recommendations for IBCLCs in your area. Also organizations like La Leche League might have a directory of IBCLCs or be able to provide referrals. Hope you come right!

Other than a physician, what practitioners are allowed to make a formal diagnosis?

Thank you for your question. I don’t know the laws in Canada but here in South Africa, to my knowledge, registered medical doctors, dentists, and all sorts of specialists, physiotherapists, and others like nurse practitioners (under specific circumstances and within their scope of practice), may participate in diagnosis, but not so-called “Allied Health” practitioners. Hope this helps!

Thank you for the wonderful information. How do IBCLC get pediatrician’s on board regarding tongue tie; I still have many peds that tell parents “there is no such thing” or ‘it will improve as the baby ages”.

Thank you for your question and complement. That does seem to be a global issue! To get paediatricians on board regarding tongue ties, you could perhaps focus on evidence-based resources, highlight the benefits of early intervention, and emphasize the importance of a collaborative approach. This includes advocating for comprehensive assessments, educating paediatricians about the potential impact of tongue tie on feeding and speech development, and promoting a nuanced perspective on treatment options. Perhaps point to credible sources from reputable organizations like the American Academy of Pediatrics, Mayo Clinic, KidsHealth, and StatPearls. Share research findings that demonstrate the potential link between tongue tie and difficulties with breastfeeding, feeding, and speech development. Highlight AAP recommendations that encourage a holistic approach to assessment and treatment, rather than a one-size-fits-all solution. Suggest that paediatricians refer parents to lactation consultants, speech therapists, and other specialists for comprehensive assessments and treatment when there are any feeding issues. Emphasize that not all tongue ties require intervention, and that the decision to proceed with a frenotomy should be made on a case-by-case basis, weighing the potential benefits and risks. Share educational videos and podcasts to engage paediatricians and provide a more accessible way to learn about tongue tie. Host webinars and workshops and invite experts to present on the topic and answer questions from paediatricians. By providing credible information, highlighting the benefits of early intervention, and promoting a collaborative approach, you might be able to effectively educate and encourage paediatricians to take a proactive role in the management of tongue tie, ultimately benefiting children and their families. Hope this helps!

The presenter mentioned multiple times about the position of the baby in utero and how it could have an effect on the infant’s mouth. I am interested in knowing a little more about why she thinks that.

Thank you for your question. As mentioned in my talk I am by no means an expert on tethered oral tissues, the talk was the result of my own research to inform myself better as an IBCLC in my own lactation practice and for the Peer Counsellor course I compiled for La Leche League South Africa. I mention the palate can also be high if the baby was prem and didn’t have enough time to smooth out the palate with the tongue(in utero), or perhaps if the baby was breech or perhaps there are some congenital or genetic disorders resulting in a high palate. In any case a high or narrow palate complicates breastfeeding. I first read about the possible connection between a high palate and a tight tongue in Catherine Watson Genna’s book called Supporting Sucking Skills in Breastfeeding Infants. On page 282 the author says: “The hard palate is immobile and plastic and is shaped by tongue movements. The more abnormal the hard palate shape the more likely the tongue movements are to be abnormal. Bony structures are subject to Wolf’s Law, the understanding that bones adapt to the loads placed on them. When muscle power or range is affected, the bones of these muscles are attached to adapt to these abnormal stresses. In the case of the palate, tone issues affecting the tongue have an impact on the hard palate. In utero and swallowing movements work to sculpt the palate but when range of motion, power or sustained rhythms are compromised, the palate may not be lowered and widened to its most effective feeding configurations. A limited or weak tongue can cause palatal adaptation towards a higher, narrower palate.” LLLI on their site says: “The palate is formed in utero by the baby’s tongue pressed against the roof of the mouth. A high palate formed with either a ‘plateau’ or a ‘bubble’ shape can indicate a tongue with restricted movement.” (https://llli.org/news/spy-tongue-tie). Also check out Shondra Mattos’s website. It is chock-full of amazing info related to TT. On her site she says: “Tongue tie is one potential & common cause of a high-arched palate. Restricted tongue mobility, as a result of a short or tight frenulum, may change the shape of a baby’s mouth and lead to a narrow or high palate. Other causes of high palates in babies include congenital disorders, genetics, cranial facial differences, poor tongue function unrelated to ties, premature fusion of the skull bones, excessive pacifier usage, and prolonged intubation with an endotracheal tube.” She mentions palate shape, with regards to width and overall shape, has drastically changed in the past 12,000 years. Additionally, palatal shape varies worldwide, with some ethnicities having a broader palate than others. (https://www.mattoslactation.com/blog/tongue-tie/high-palate-tt). And from a study on Tongue Growth during Prenatal Development: “Our results showed that tongue development affects the development of maxillofacial structures such as the maxilla, mandible, nasal cavity, pharynx, and larynx, either directly or indirectly. Because tongue development is one of the earliest events that progresses through the fetal stage, it can be inferred that the developmental rate of maxillofacial structures should be evaluated with reference to tongue development. In the early embryonic stage, the tongue grows while it fills the pharynx, protrudes upward, and compresses the cranial base. Tongue development precedes that of other maxillofacial structures, and thus, changes in tongue position could be regarded as primary events of maxillofacial growth and development. In addition, because tongue muscles, masticatory muscles, and facial muscles move continually during fetal development, it is likely that the effects of the tongue on other maxillofacial structures continue even after birth. This suggests the tongue is an important organ that plays critical roles in the development of adjacent maxillofacial structures, such as the oral and nasal cavities, pharynx, and maxilla, and that abnormal tongue development might be related to congenital maxillofacial anomalies.” (Hong SJ, Cha BG, Kim YS, Lee SK, Chi JG. Tongue Growth during Prenatal Development in Korean Fetuses and Embryos. J Pathol Transl Med. 2015 Nov;49(6):497-510. doi: 10.4132/jptm.2015.09.17. Epub 2015 Oct 16. PMID: 26471340; PMCID: PMC4696530.) Hope this helps!

This was an excellent talk – thanks so much.
Are there any local or national guidelines in your country to refer to? I work for the health service in Ireland as a lactation consultant in the community.

Thank you for your question and complement. Not in my country, no. As an IBCLC we have the IBLCE Advisory Opinion on Frenulotomy (https://iblce.org/wp-content/uploads/2017/05/advisory-opinion-frenulotomy-english.pdf and from the Clinical Lactation article Tongue-Tie Expert Roundtable: IBCLC Scope of Practice for Tongue-Tie Assessment (https://connect.springerpub.com/highwire_display/entity_view/node/67861/full). I found Clinical Consensus Statement: Ankyloglossia in Children (Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 May;162(5):597-611. doi: 10.1177/0194599820915457. Epub 2020 Apr 14. PMID: 32283998) very insightful. Not sure if this helps?

What are your thoughts on aftercare? Stretches or rubbing? Or nothing. Thanks.

Thank you for your question. As mentioned in the talk, evidence is lacking to support prescribing post-procedural manual manipulation or stretching after a frenotomy, at or near the cut area to open the wound to prevent “reattachment” or contraction of scar tissue. I think prescribing this will depend on the practitioner. Many authors suggest the post-frenotomy stretching exercises are NOT recommended and may cause oral aversion. (O’Connor ME, Gilliland AM, LeFort Y. Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey. Int Breastfeed J. 2022;17(1):39 ● Bhandarkar KP, Dar T, Karia L, Upadhyaya M. Post frenotomy massage for ankyloglossia in infants-does it improve breastfeeding and reduce recurrence? Matern Child Health J. 2022;26(8):1727–1731). Many feel specific oral motor exercises such as resistance training with a finger may be appropriate (Post-Revision Instructions and Pain Relief. United States Lactation Consultant Association Clinical Lactation, 2017, 8(3)), depending on the presentation of symptoms and the baby’s response to the exercises. People trained in body work can help with this. A disorganized suck or weak sucking patterns can also benefit from these exercises and these exercises are often started before the snip. Also see check out Dr Bobby Ghaheri site for aftercare suggestions (https://www.drghaheri.com/aftercare). Hope this helps!

Where do we find a ‘body work’ expert in South Africa?

Thank you for your question ;-). For a bodywork practitioner one can go to this webpage: cranial.org.za or try find a provider at airwayhealth.co.za. Hope this helps!

If the baby latched and maybe the mother feels that the baby is not full what is the problem?

Thank you for the question. I think one would need to have good communication skills to help discern if it is a real or perceived “problem”. As mentioned in the talk, any issues whether it is with the breast, like engorgement or mastitis, or with the nipple, like nipple pain, cracks, blisters, etc, or the mother’s milk supply, or with the baby’s weight, or with the baby’s behaviour; the first thing we can do is to look at the positioning and latch because more often than not it is the cause of the problem. So remember it is not how a tongue looks but how it functions that is important! Next step would be to assess milk supply? What do you think?

How do you navigate the variability in diagnosing tongue ties, especially given the differences between posterior and anterior ties?

This is exactly the difficulty that we all are faced with. No two dyads are the same. This has also been the difficulty with some of the tongue tie assessment tools. And there is subjectivity involved with the practitioners doing the assessments as well, as was highlighted at the start of the presentation. We still have many unanswered questions.

What role do you see for lactation consultants, pediatricians, and speech therapists in creating a cohesive care plan?

This would be the ideal, to have collaboration and include chiropractors, CST, CFT etc. Yet for most families, it all becomes a very costly process. With my own practice when other practitioners are involved, I try my best to provide them with feedback so that we can strengthen collaboration.

In cases where a frenotomy isn’t immediately indicated, what are the most effective positioning or latch modifications you recommend?

There is unfortunately no one-size-fits-all approach. All the strategies in the presentation is an accumulation of tips and tricks learned from dear colleagues, years of reading about latching and positioning, years of observing many breastfeeding dyads and trying different ways to optimise the mother’s relaxation (supporting every part of her body), and then trying to optimise the widest open latch with the baby, getting the baby well supported, tweaking things slowly, checking in with the mother each time a change is made to see if it made any difference. I realise that there are limitations to seeing a presentation. An in-person practical workshop would be much more helpful.

Interesting subject and information, can you please give more about positioning?

I’m so pleased that you were able to attend and watch this presentation. I’m sending through some links with information. I hope you are able to access these.
https://youtu.be/hs7ai466toE?si=98111j1hTpxlaqKo
https://youtu.be/y–syZR0u1E?si=590l4iPWTl7g6yQQ
https://youtu.be/t8F7LAO7B3E
https://youtu.be/l8cItJUTIGw
https://youtu.be/t8F7LAO7B3E
Website: https://www.biologicalnurturing.com/
VIDEO: https://www.biologicalnurturing.com/sample-of-biological-nurturing
In an Italian study (2020), 50% fewer mothers experienced sore and cracked nipples when integrating more biological nurturing components. https://pmc.ncbi.nlm.nih.gov/articles/PMC7132959
Colson’s publication in Electa (2023) explores the concept of neocortical inhibition. What does it mean and why is it important for breastfeeding mothers? See Biological Nurturing: Unthinking Breastfeeding https://www.elacta-magazine.eu/en-gb/neue-seite1
Access Midwifery Matters publications (2022) : Postnatal Scare or Laissez-faire (12) ;
Reading the right way up (48) https://acrobat.adobe.com/id/urn:aaid:sc:EU:51187fc3-2b96-40de-b46f-047b9ad6ea41
Teaching positioning and attachment does not result in better rates of breastfeeding or more maternal satisfaction. Colson (2012) https://www.biologicalnurturing.com/wp-content/uploads/2023/02/Maternal-breastfeeding-positions-Have-we-go-it-right2.pdf

Thank you for the excellent presentation. Can you offer any other resources that can help improve my assessment skills for the posterior tongue tie?

Hello, I am so glad that you found the presentation to be helpful. Dr Alison Hazelbaker offers training in using her assessment tool: https://hazelbakerinstitute.com/hazelbaker-lactation-institute/education-catalog, She also has a book available.
Dr Bobby Ghaheri also offers training https://www.drghaheri.com/online-ce-course
There are several others if you search online. I am just mentioning a few of them. I am not affiliated with any of them, so please don’t consider this an endorsement. I hope you can find one that suits you. I hope you’ve also had a chance to watch my colleague Leana Habeck’s presentation at this conference on tongue ties
https://theinfantfeedingacademy.co.uk/tongue-tie-assessor
https://www.sarahoakleylactation.co.uk/course/tongue-tie-and-infant-feeding

Do tongue-ties change or grow over time?

Usually, the baby’s jaw and other oral structures grow over time. I hope you have had a chance to watch my colleague Leana Habeck’s presentation on tongue ties where she explains things in more detail.

Your presentation was excellent….. I wish I could persuade my colleagues NOT to position in cross cradle!! You don’t reference the work by Suzanne Colson, biological nurturing, I’m wondering why?

I’m so glad that you enjoyed the presentation. Thank you for your feedback. This wasn’t meant to be looking at all aspects of positioning and latch which would have ended up being a much, much longer talk. I was assuming some prior knowledge considering that everyone is in the lactation field and perhaps mistakenly assumed that everyone is familiar with the work of Dr Suzanne Colson, Dr Christina Smillie, Nancy Mohrbacher and others; the gurus in this field upon which we all base our knowledge and work.

Could you briefly walk us through what each letter in CHINS and LATCHES stands for, and how they complement each other in practice?

The presentation provided a detailed overview of CHINS and LATCHES and an explanation of what each of the letters relates to in terms of the principles for supporting effective positioning and attachment. More details and a downloadable leaflet for CHINS and LATCHES can be accessed via the Northumbria University Knowledge Bank. Once on the site, scroll down.
There is a separate site for CHINS and LATCHES. Once on each site, scroll to the section Offerings – here, the relevant leaflet can be downloaded – it is free. We are happy for it to be used in anyway that supports good practice and breastfeeding.

How do you suggest incorporating these memory aides into routine lactation support, especially in busy clinical settings?

Research (Shotton et al. 2024) has shown that CHINS is easy to incorporate into clinical practice because it is simple, logical, easy to remember and recall. A pilot study (Shotton, Elliot et al. 2024) indicated that LATCHES, while more complicated than CHINS, would be useful in practice. Some practitioners use prompts and have incorporated memory aides into flash cards for use in practice. Equally, the downloadable leaflets from the Knowledge Bank could help. These will also allow practitioners to share with other professionals and with mothers.

Have you found one of these tools more effective or easier for new parents to remember and use at home?

CHINS is generally considered easier to use with both practitioners and parents because it is so straightforward. LATCHES is more complex because the theory and process of assessing whether babies are effectively attached to the breast is more detailed. LATCHES may be more suited to practitioners, as it is difficult for a breastfeeding mother to assess all of the principles.<.p>

I would like to use this in my practice in The Netherlands. Is it possible that I translate this method to the Dutch situation? And use it here?

We are happy for the memory aides to be translated and would welcome some feedback on the impact of this in practice.

Do you have a resource or recommendations to help with the physical weaning? To prevent mastitis? Thanks

This answer is going to depend on someone’s history with engorgement, blocked ducts and mastitis and how much a child is feeding prior to weaning. With most gradual parent-led weaning journeys, very little action or vigilance is needed as the body will gradually adjust. The main message is that reducing milk production slowly is the preference. When a mother is very concerned because of a prior history, and a gradual reduction may be confusing to a child, it is an option to ‘drop a feed’ e.g. the bedtime feed, but then express away from the child and gradually reduce the amount expressed over several days. I’m not sure I have a resource that would be universally useful. It’s more about a mother knowing her own body.

Do you have any tips on how we can support parents who want to give a bottle for their baby to wean from the breast? (Bottle refusal)

In cases of bottle refusal, my first message is that trying lots of different brands of bottles is rarely the answer. It’s also important to see acceptance of small quantities as success, rather than aim for large amounts and feel tense and frustrated when the baby isn’t cooperating – tension that will obviously be picked up by the baby. Over 6 months, cups can provide an effective alternative to bottles. A child who is eating well and can use a cup has no need to drink large amounts of milk from a bottle. If parents would prefer to use a bottle, there are lactation consultants who specialise in bottle refusal: Rachel O’Brien in the U.S and Susie Prout in the U.K are two examples.

How do you approach supporting parents who feel guilt or uncertainty about weaning?
Did you observe any cultural or socioeconomic factors that influence how families experience the weaning process?
What are some effective strategies you’ve found for navigating disagreements between co-parents or caregivers during weaning?
How do you recommend balancing evidence-based guidance with respect for each family’s unique values and readiness?

Guilt is a common issue when most parents will start with responsive breastfeeding and struggle to later balance their own needs with their child’s. I think we all recognise that guilt is a theme throughout many aspects of parenting. The British psychologist Philippa Perry has a concept I find helpful: “When the choice is between guilt and resentment, choose guilt.” I think in the context of continuing to breastfeed unhappily, parents imagine that children won’t detect if they are struggling, but children are very astute at picking up on microexpressions and that can leave them feeling more insecure and wanting to feed even more frequently. I ask mothers to reflect on what harm might be caused if they continue to breastfeed when they really no longer want to.
In terms of cultural or socioeconomic factors, there aren’t many generalisations I can make. I do find that occasionally families who live multi-generationally (which in the UK is more likely in some cultures) can leave mothers who want to breastfeed under pressure to wean prematurely. You might imagine that the extra support is always ‘positive’ but in fact, it can mean when there is a lot of shared childcare, mothers are expected to prioritise ending the breastfeeding relationships to make childcare ‘easier’ for others. Sometimes these mothers need extra support to advocate for themselves and their child.
With disagreements between co-parents, I sometimes ask parents to imagine that the child is another member of the zoom call (I’m often doing support remotely). What would the child ask for? What would their dream be? When parents are struggling, this is often because issues are being triggered from their own childhood. While these sorts of conversations go beyond the IBCLC remit, it’s sometimes helpful to ask reflective questions. To be honest, I rarely see disagreements as the breastfeeding parent/ mother is usually given space to decide on her own goals. The disagreements may come prior to that, if there has been pressure to wean before a mother is ready in the belief weaning will fix other problems.
With weaning, we don’t have much evidence-based guidance! It’s always about starting from where the family is and doing lots of listening and reflecting.

I was pleasantly surprised by this presentation. It ticks all the boxes, and is well-balanced, thank you!
While listening, I was just wondering about the use of goatsmilk (instead of cowsmilk or follow-on formula), when weaning a younger baby/child?

In the UK, we often refer to the resources of an organisation called First Steps Nutrition Trust which is an independent organisation providing information on infant milks and young child nutrition. If a child is under 12 months, the recommendation is to use formula milk (which may be goats milk based, or cows milk based). Goats milk could be given as a drink after 12 months. We see no evidence that suggests goats milk is nutritionally preferable to cows milk, nor less allergenic, whether as a formula product or a simple milk.

Mums who enquire about weaning for religious reasons, eg Muslim mothers feel they have to stop breastfeeding as soon as baby turns two because of wrong interpretation of the Quran. What would you suggest?

Thank you for raising this. I’m mindful that as a non-Muslim, it’s difficult for me to appear to contradict someone’s local imam or trusted mentor. However, I will usually simply say something like, “I have worked with several Muslim mothers who have been supported to continue beyond 24 months. There are many groups who feel that the verses support continuing beyond 2 years provided no harm comes to the child or mother and the other family members are supportive. The verse talks of two years being enough, but many do not read that as two years being a maximum restricted amount.” Ideally the mother will feel confident in doing further research and talking to other members of the community. There are lots of useful online discussions. We have articles on aboutislam.net discussing Ibn al-Qayyim talking about breastfeeding even to the end of the third year.

I’ve encountered asking about Tramadol, Pethidine and methadone and morphine
Can you tell me how long should they stop breastfeed after talking the above drugs pls???

That’s a really important question many breastfeeding mothers face. There’s no simple answer for using these medications while breastfeeding, as safety depends on several factors. For Tramadol, standard EU doses usually don’t require pausing breastfeeding, but be cautious with newborns or if other health issues or medications are involved. For Pethidine, Methadone, and Morphine, safety hinges on the maternal dose, the baby’s age (newborns are more sensitive), and any other risk factors. A precise assessment is needed for each drug. While I can’t give a simple ‘yes’ or ‘no,’ resources like e-lactancia, LactMed, and InfantRisk Center can help. Ultimately, it’s best to consult a healthcare professional specializing in maternal-fetal medicine or lactation for personalized advice.

As a CLC how would I find a pharmacist that could help with questions regarding certain medications if it comes up?

Thank you for your question. Finding a pharmacist specializing in lactation can be challenging, as this isn’t universally covered in academic training. Those who do specialize often collaborate with breastfeeding-friendly organizations, so contacting a local La Leche League representative might be a good starting point. You can also search online for “lactation pharmacist” in your area, as many of us who offer these services provide contact information online. In the US, the InfantRisk Center is an excellent resource; you can reach their call center at 1(806) 352-2519 from 8 AM to 3 PM Central Standard Time (US).

What do you see as the most misunderstood aspect of the Code in your area of focus?

I think there are 2 aspects to consider:
• The fact that the Code is about marketing strategies. Many people believe it is about abolition of formula, thereby missing how Code products (formula, bottles and teats) are used to undermine breastfeeding. Within marketing there are ethical tactics and unethical tactics. Code violators use ‘pain points’ to exploit the vulnerability of women and families to undermine breastfeeding.
• Marketing aka advertising of any kind to anyone working with mothers, babies and families, will have an impact and undermine breastfeeding.

How do you suggest communicating the importance of the Code to those outside the profession?

Taking advantage of breastfeeding initiatives such as World Breastfeeding Week (1-7 August) and using that focus to take the message to child care centres, shopping centres (malls), anywhere where there will be mothers and families. Then posting madly on social media!
You could take one small aspect of the Code, or health/economic benefit of breastfeeding and start posting on social media about it, linking it to the global Code.

What are the potential consequences of not adhering to or valuing the Code?

The ultimate outcomes are many and varied. We are already seeing a global decline of breastfeeding rates – digital marketing have played a pivotal role is this outcome. Short- and long-term ill-health are the first consequences for both mother and infant, which is on the way to bankrupting the health banks in world countries. Economically, the drain begins in the homes of people who may already be struggling financially. Sacrifices will be made at a family level to ensure food security for the infant while creating food insecurity for everyone else.

How do you keep the Code relevant and up to date in a fast-changing environment?

Firstly, the WHA updates the Code according to research as it is presented. Interestingly, there have not been any articles that have required a ‘walk-back’ because of new evidence, rather, resolutions have enhanced what was endorsed in 1981!
We all have an opportunity to make the Code relevant by educating our colleagues, hospital executives and the wider community about how breastfeeding is exploited by Code violators.

Were there any real-world examples you found especially compelling in showing the impact of the Code?

Great question, thank you! For me, the absolute impact that digital media and influencers have on women is devastating. Influencers are being paid to promote products, products they themselves have likely used. As a consequence, from this is this ‘cultural conditioning’ whereby if it is good enough for my baby, it’s good enough for your baby. Women are following blindly, and influencers are reaping (significant) rewards while the health and wellbeing of two generations (mother and her infant) are being negatively impacted.

Will the new USA government policies interfere with the WHO code in the USA?

The USA was the last country to voluntarily sign the Code in 1981. Infant and maternal health are largely secondary to commercial interests.
• In the United States, the Code has not been adopted into national law. Infant formula marketing remains largely unregulated, allowing companies to advertise directly to consumers, including through digital platforms. The U.S. government also subsidises formula through programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which accounts for over half of infant formula sales in the country.
• While the USA has not directly enacted policies that interfere with the WHO Code, its longstanding position of non-adoption, coupled with recent policy shifts emphasizing deregulation and limited oversight of digital marketing, may further distance the country from the Code’s principles. This stance not only affects domestic breastfeeding promotion efforts but may also influence global adherence to the Code.
• The USA lacks comprehensive regulations addressing digital marketing of infant formula, potentially allowing for practices that conflict with the Code’s recommendations.

I wonder whether the Code applies to breastmilk substitutes for any time frame? Till one year of age of the baby?

The timeframe is 36 months, after which time the child should absolutely be eating family foods and drinking what the family is drinking.

For how many weeks do you give domperidone?

It varies and can take anywhere from a few weeks to a few months.

Is there a maximum duration of the treatment?

We assess each case individually based on the client’s needs and conditions. Clients are scheduled for regular follow-up appointments throughout the process. I hope this helps clarify things for you.

How much does it cost for induced lactation?

In Malaysia, health services provided at government clinics and hospitals—including our facility—are free of charge. There is only a nominal registration fee of RM1 (approximately USD 0.25). However, the charges are usually much higher in private hospitals/ clinics.

Any failed cases?

Yes, there have been cases where induced lactation was unsuccessful. This typically occurs when clients are unable to follow the recommended stimulation schedule consistently, which is essential for initiating and maintaining milk production.

Was hoping to get more information regarding actual protocols to follow for induced lactation for adoptive parent or relactation for biological parent.

I’m sorry that I was only able to cover the general concept — unfortunately, relactation was not included in the scope of the topic.

Also, wondering if you have any information on inducing lactation for a transgender parent?

Regarding your question on inducing lactation for transgender parents, I have come across a few journal articles addressing this subject. While the data is still limited, it is an area of growing interest and research. These are examples.
• Reisman, T., & Goldstein, Z. (2018). >em>Case report: induced lactation in a transgender woman. Transgender Health, 3(1), 24-26.
• van Amesfoort, J. E., Van Mello, N. M., & van Genugten, R. (2024). Lactation induction in a transgender woman: case report and recommendations for clinical practice. International Breastfeeding Journal, 19(1), 18.

What are the most common misconceptions you encounter about induced lactation?

One of the most common misconceptions we hear from clients is: “I thought I just needed to take some medicine, tablets, or an injection, and then the milk would start flowing.” Many are unaware that consistent breast and nipple stimulation is the key component of the process.

How do you tailor protocols based on different family structures or medical backgrounds?

We begin by taking a detailed medical history and reviewing any previous attempts at lactation, including why they may not have been effective. In Malaysia, for example, the cut-off age for prescribing combined oral contraceptives (containing estrogen) to otherwise healthy women is 40. We also follow a structured set of questions based on our Clinical Practice Guidelines (CPG) to guide treatment options.
In terms of family structure, we assess who is available to support the client throughout the process. If the client is employed, we often provide a letter to their employer explaining the treatment and its requirements to help facilitate support in the workplace.

What role do emotional and psychological support play in the success of induced lactation efforts?

Emotional and psychological support is crucial. The process demands consistency and discipline, especially with regular nipple and breast stimulation. Many clients feel discouraged in the early stages when there is no visible milk. During these times, reassurance and emotional support are vital to help them stay motivated and committed.

Are there any emerging therapies or techniques that show promise in supporting induced lactation?

In our experience, consistency in the stimulation process remains the most important factor. Some clients also report that lactation massage has been beneficial in helping with milk production, though this is anecdotal and varies from person to person.

How can healthcare providers better educate themselves to support non-gestational parents interested in this process?

Healthcare providers should actively seek to educate themselves through relevant reading, training, and participation in workshops focused on induced lactation. Gaining a deeper understanding of the protocols and the unique emotional needs of non-gestational parents is essential for providing empathetic and effective care.

You lost me already in the beginning when you first Mention C section over vaginal birth. How can somebody with a feeling for breastfeeding be more for a C section than a natural birth. C sections are the killer for women and children health worldwide.

Thank you for your comment and for sharing your perspectives. I’m sorry to hear that the way I introduced the topic felt upsetting to you. That was not my intention. I mentioned Caesarean birth first simply as one example, not to promote it over vaginal birth in any way.
What I meant to highlight was that breastfeeding is possible and important no matter how a baby is born—vaginally or via Caesarean. I understand how strongly people feel about birth experiences, and I appreciate your passion for women’s and children’s health.
Feedback like yours helps me reflect and be more mindful of how information is presented. I’ll be more careful in the future about how wording can be interpreted, and I truly value your input.

Tell me more about this perinatal mental health unit in your hospitals. Is that in every hospital?

It is important to point out that we are still awaiting a purpose built mother and baby unit to accommodate persons with perinatal mental health disorders. In lieu of this, their care is being provided at each of the maternity hospital settings which evidence would argue is not the best placed facility for women.
As mentioned in the presentation the foundations of our current national perinatal mental health care stemmed from Ireland’s first National Maternity Strategy in 2016. This informed the development of the Specialist Perinatal Mental Health Services: Model of Care for Ireland in 2017. (We have included a link below for reference). These publications sought to prioritise holistic care for mothers who experienced perinatal mental health disorders and their babies, emphasising their interconnected journey.
• The Model of Care led to the development of a specialist perinatal mental health infrastructure, with a hub-and-spoke model being rolled out to include multi-disciplinary teams in six hubs and perinatal mental health midwives in all 19 maternity services, striving for integrated and stigma-free care. The six hospital groups are the hubs with interconnected smaller spoke maternity providers. Whilst everyone should have access to see a perinatal mental health provider, access is not always timely as posts have not always been filled or only on half time basis.
The key recommendation and perhaps more pertinent to your question was the facilitation of a specific Mother and Baby Unit which unfortunately has not made it out of the planning stage yet. Although this report was established in 2017 the mother and baby units are yet to be developed in Ireland despite significant lobbying by groups like the Women’s Council of Ireland and other mental health charities and groups. The HSE -our national public health provider – has released statements in 2024 indicating that capital investment arrangements will be made available in 2025 for the development of the new national mother and baby unit. This is a long awaited project and we have still yet to hear progress given it is now halfway through the calendar year.
• The report did indicate this as a gold standard of facilitating care and was recommended as a national unit based in St. Vincent’s University Hospital in the capital Dublin, since the Ireland East Hospital Group has the highest number of deliveries nationally and because this location is easily accessible via the M50 and N11w which are major road networks in Ireland.
• This would align with best practice models globally and parallel with our close economic nation of the UK and the model of care available in the UK through the NHS.
Deirdre

As of June 2025, Ireland has established perinatal mental health services across all 19 maternity units nationwide, following a “hub and spoke” model introduced in 2017.
Structure of Perinatal Mental Health Services
6 Specialist Hub Sites: These are located at the Coombe Women & Infants University Hospital, National Maternity Hospital (Holles Street), Rotunda Hospital, Galway University Hospital, Cork University Maternity Hospital, and University Maternity Hospital Limerick. Each hub hosts a multidisciplinary team led by a consultant psychiatrist specialising in perinatal psychiatry
13 Spoke Sites: The remaining maternity units function as spokes, offering perinatal mental health support primarily through midwives and liaison psychiatry teams. These teams are linked to the hubs for guidance, training, and collaborative care.
Inpatient Care: Mother and Baby Units
For a bit of background to their establishment the Irish Health Service Executive (HSE) and the UK’s National Health Service (NHS) have common origins within the British health governance system. Before Ireland gained independence in 1922, the entire island was under British rule, and healthcare was administered under the same structures that later formed the NHS in 1948. After independence, the Republic of Ireland began to diverge from UK systems, but many institutional frameworks, including public health administration, remained similar. This shared legacy, alongside a continued open border with Northern Ireland, means both systems have historically mirrored each other in structure and policy aims, such as universal access and publicly funded care. The Republic of Ireland officially separated its healthcare direction with the establishment of the Department of Health in 1947, just a year before the NHS launched in the UK. However, it wasn’t until the creation of the HSE in 2005 that Ireland formalised a centralised national healthcare system akin in scope to the NHS. Despite differences in funding models and service delivery, the shared border and overlapping historical roots continue to influence collaboration, especially in cross-border care and perinatal services.
The United Kingdom pioneered the development of Mother and Baby Units (MBUs) as part of perinatal mental health care in the mid-20th century. Prior to this, it was standard practice to separate mothers experiencing postpartum psychiatric conditions from their infants, often leading to detrimental effects on both mother and child.
A significant shift occurred in 1948 when Tom Main introduced the concept of joint admissions at the Cassel Hospital in Middlesex, allowing mothers to be hospitalised alongside their babies. This initiative was rooted in psychoanalytic principles emphasizing the importance of the mother-infant bond. Subsequently, in 1959, Banstead Hospital established the UK’s first dedicated psychiatric MBU. Research from this period indicated that mothers admitted with their infants experienced shorter hospital stays and improved recovery outcomes compared to those separated from their babies.
Over the ensuing decades, MBUs became integral to the UK’s perinatal mental health services. By 2018, NHS England had expanded the network to 19 MBUs, ensuring broader access to specialised inpatient care for mothers experiencing severe mental health issues during the perinatal period.
Today, MBUs are recognized as the gold standard for treating severe perinatal mental health conditions, providing comprehensive care that supports both maternal mental health and the crucial early bonding process between mother and child.
Currently, Ireland does not have a dedicated inpatient Mother and Baby Unit (MBU) for mothers experiencing severe perinatal mental health issues. Plans are underway to establish the first such unit at St. Vincent’s University Hospital in Dublin. A feasibility study is being prepared, and the unit is expected to be a key component in enhancing perinatal mental health services
The model of care that is currently being used was established in 2017 and can be read here: https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/specialist-perinatal-mental-health-services-model-of-care-2017.pdf
Elaine

What does ‘in the dark’ represent most in your research or experience — lack of education, support, cultural acknowledgment, or something else?

This is a very meaningful question and the answer is all of the above really. As the term ‘In the dark’ is multifaceted. I would first like to acknowledge this presentation is not representing specific research we have carried out but rather, looking at the empirical evidence available globally in the context our case studies. In my experience, breastfeeding with perinatal mental health disorders or specifically postpartum psychosis can illicit the play on words of ‘In the dark’ an idiom which can also describe a situation where someone or something is kept secret or concealed. Essentially, it also signifies a lack of knowledge or awareness about situations. This can translate to how women feel when they breastfeed with postpartum psychosis, the unknown terrain with regards to supports, confidence in their own abilities and also in establishing and continuing breastfeeding where medications are required. It can also be akin to the dark long hours at night when mothers typically breastfeed a lot and one can be alone with their thoughts and reflective of their emotions and experiences of motherhood and even disordered thinking. It also is a call back to the insomnia theme which a lot of mothers feel when experiencing Post partum psychosis. Often health professionals can feel in ‘in the dark’ with how to safely and effectively medicate women without causing misadventure and the sometimes lack of availability of robust research to support holistic management of PPP.
Deirdre

I love this question. Breastfeeding “in the dark” is a phrase rich with layered meaning, encompassing both the literal and emotional experiences of early motherhood. For many, it evokes the long, silent hours spent feeding a newborn in the stillness of night, physically surrounded by darkness while the rest of the world sleeps. But beyond the absence of light lies a deeper emotional shadow, shaped by isolation, exhaustion and the heavy burden of self-expectation. It can mean breastfeeding while battling intrusive thoughts, fear, dread and sorrow instead of the joy so often expected. For some, “in the dark” reflects a state of complete emotional overwhelm, especially in the context of postpartum psychosis, where reality feels out of reach and control slips away. It can also speak to profound grief — the loss of early weeks with their baby that may be blurred by illness or hospitalisation, where physical or emotional separation disrupts bonding and leaves mothers mourning time they can never reclaim. This darkness is multifaceted and deeply personal, with each mother’s version shaped by her unique story, struggles and the unseen weight she carries in those quiet hours. “In the dark” can also reflect the mind’s protective mechanisms. The human brain, in its effort to shield us from trauma or extreme stress, sometimes withholds memories altogether. As a result, many mothers find themselves unable to recall the details of those earliest days, weeks or even months. When their little ones are older, they remain “in the dark” about significant parts of their early motherhood journey, not because it wasn’t important, but because their brain did what it had to do to survive.
Elaine

How can professionals help illuminate these unseen or unspoken breastfeeding challenges for parents and caregivers?

Education for all health and social professionals to identify PPP would be a first step in how women can be supported. From there, referral to the appropriate services can ensure that they receive timely and holistic care which includes lactation support to establish and continue breastfeeding safely. Recognition of a women’s prior goals and current needs with regards to breastfeeding should be facilitated early in diagnosis and revisited regularly.
Also ensuring that breastfeeding is discussed by all members of the multidisciplinary team with the mother.
Promoting normalisation of breastfeeding practices and encouragement to still engage in the suite of supports available to any breastfeeding mother if they feel able. Eg. Breastfeeding Support Groups, Voluntary group facilities and more visual awareness of the conditions through visual imagery in hospital and primary care settings. Caregivers can also help by facilitating engagement with this process.
Deirdre

While there is growing public recognition of the importance of mental health and the need to protect it, a culture of silence still surrounds the treatment of mental health issues, particularly in the perinatal period. Many parents remain reluctant to speak openly about their struggles due to fears of stigma, judgement, or being separated from their baby. This fear is compounded by the lack of accessible in-patient mother and baby units, which can make seeking help feel even more risky. Mental health support often requires extended and ongoing care, which can seem daunting, especially when parents are unsure of what the process involves. Those who experience the best outcomes are often highly educated, informed, and willing to engage with the available services. But when both parents are “in the dark, unaware of what support exists or how it operates there is a significant barrier to accessing help. Without clear, compassionate information and pathways to care, many will continue to suffer in silence.
Elaine

Were there any stories or themes from families that especially stood out to you during your work on this topic?

Isolation and ‘Being listened to’ were two themes that recurred with all the case studies I have encountered. Isolation mostly as women may have felt unable to engage with the normative postpartum processes. Some because they felt they had no one to turn to or felt distrust with certain health professionals. This ties in with being listened to and for some families they felt that their voices were not heard. Especially in relation to concerned family members. Again this can be attributed to the lack of consistent protocols and systems in health care to support women experiencing perinatal mental health disorders.
Deirdre

A 2022 study involving 1,774 pregnant women in Poland found that those who attended in-person antenatal classes reported significantly lower levels of anxiety and depression compared to those who participated online or did not attend any classes. This suggests that face-to-face interaction may offer unique emotional benefits, possibly due to the supportive environment and direct engagement with facilitators and peers. pubmed.ncbi.nlm.nih.gov/35564465
Another study evaluated a comprehensive perinatal education program for first-time mothers in rural areas. The intervention group showed significant reductions in depressive and anxiety symptoms over six months, along with increased rates of vaginal births. These findings highlight the potential of structured, in-person education to enhance both mental health and birth outcomes. bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-025-07152-8
Elaine

What systems-level changes do you think are needed to bring more visibility and support to these hidden issues?

One consistent theme in the available global research points to the lack of a definitive diagnosis of post partum psychosis. It can often be made as a diagnosis of probability or a mixed diagnosis of perinatal disorder symptoms. This is in part due to the nature and presentation of the disorder. Developing a ‘green top guideline’ for use in diagnosis would benefit early diagnosis and earlier treatment.
Specifically systemic change normalising of the disorder through multimedia campaigns may allow women and families to seek out treatment quicker. Often health professionals can miss early and subtle presentation symptoms. University programmes in health professional education curriculum like Midwifery, Perinatal Physiotherapy, Social Work, Obstetric and Gynaecology could include education of symptom screening at point of care.
Deirdre

In summary, small group antenatal education supports better perinatal mental health by enhancing knowledge, strengthening social support, reducing anxiety, and encouraging help-seeking behaviours—all of which are protective factors against poor mental health outcomes in the perinatal period.
Elaine

In what specific scenarios did you find breastfeeding to be most lifesaving or transformative?
How can public health systems better support breastfeeding during emergencies or in resource-limited settings?
Did you encounter any resistance or misconceptions when advocating for breastfeeding as a first-line intervention?
What role does community education play in reinforcing the idea of breastfeeding as a powerful health tool?

Thank you for these great questions.
Concerning 1:
In my experience breastfeeding can be really transformative when there have been issues around and during pregnancy and birth. Too often women with difficult pregnancies and/or births are told that breastfeeding will be yet another challenge for them. But if breastfeeding was and is a part of their ‘image’ of parenthood, these women and their partner then loose even more. Helping these mothers to breastfeed can help them heal their image of their own body as a mother’s body.
A new study by Wheeler et al confirms this.
Wheeler, A., Sweeting, F., Mayers, A., Brown, A., & Farrington, S. (2025). The Positive Cycle of Breastfeeding—Mental Health Outcomes of Breastfeeding Mothers Following Birth Trauma. Healthcare, 13(6), 672. https://doi.org/10.3390/healthcare13060672
Questions 2, 3 and 4 are closely related.
In western culture breastfeeding has been treated as hard, untrustworthy and taxing for 150 years or so. This means:
At least 3 generations of women are likely to have a less than ideal to downright bad breastfeeding experiences.
Healthcare professionals have learned very little about breastfeeding during their training.
The generations training healthcare professionals personally are very unlikely to have a positive breastfeeding experience and lack knowledge to review that experience.
From that perspective suggesting that breastfeeding could be a first line-intervention is regarded as ridiculous. The misconception is that even suggesting this for women is equal to setting them up for failure, overburdening them and placing the baby at risk.
I think that in order to increase breastfeeding rates and the health of mothers and babies, our next main aim (after emphasising the importance of breastfeeding) needs to be to increase knowledge about the normalcy of breastfeeding. These groups know the horror stories or the sugar coated promotion. We need to show how breastfeeding can be incorporated into normal life. And the groups I’d love to target are:
Healthcare professionals in a broad sweep, including psychologists and psychiatrist for example. Politicians, Educators.

We are sorry but Dr Paricio is unable to answers questions.

How do you balance clinical guidelines with individual growth patterns, especially in breastfed infants who may grow differently?

I think this was more of a problem before we started using the WHO growth standards. Those standards are based on exclusively breastfed infants, so we see less breastfed babies falling off the charts. The WHO growth standards are based on the growth of breastfed infants so the breastfed babies measured on these curves are the norm against which other babies are measured.

What are some common misinterpretations of growth charts you encounter among providers or parents?

I think parents sometimes see the percentiles for growth as a grade, where higher is better. I see that parents and providers think crossing percentiles is always bad, without taking into consideration family or feeding history. We have to be careful as providers to look at the whole picture rather than just the percentile, especially in the early days where fluid shifts can impact weight. We also need to make sure we are not acting on a single data point.

How do cultural norms or parental expectations influence decisions around intervention?

Parents often equate bigger percentiles with health and smaller percentiles with malnutrition. We see supplementation because of this, especially in cultures with histories of food insecurity.

When growth deviations occur, how do you determine whether intervention is truly necessary or if watchful waiting is appropriate?

I talked about some of this in the talk, but it needs to be an evaluation of the whole child with a good feeding history, consideration of family history and birth circumstances, with special focus on the child’s physical exam. Observation of feeding is very important as well.

How important is it to weigh the newborn on the same scale? At my hospital the baby is weighed on a Panda in the delivery room, and then weighed again on the floor at 24 hours on a different scale. There is sometimes a seemingly enormous weight loss.

It’s important. It’s probably not practical in all cases. The difference in scales is one part of evaluating weight loss. There are other things, for example, baby’s output and mode of delivery, that make a difference.

I often see moms in home consultations who are supplementing their babies before 2 weeks of age due to lack or return to birth weight. Supplementing really mucks with their supply and confidence. Why the return to bw prior to 14 days?

The recommendation is 10-14 days, but like all things, needs to be put in context. If a baby loses weight initially, is not back at birth weight at 10-14 days, but is gaining 15-30gm a day, then we would not need to supplement. It’s a guideline not a rule.