Breastfeeding Medicine Blog

On finding #MyPeopleABM: Physicians share what ABM means to them

Jennifer Caplan, MD, FAAP, IBCLC
North Scottsdale Pediatric Associates, AZ USA
I joined ABM after going to an AAP conference in 2008 with my nursing baby. At the conference, I ended up spending almost the entire time with the Section on Breastfeeding because my baby was not interested in staying with my husband—so I brought her with me. And I felt more comfortable hanging out with the breastfeeding crowd. I ended up riding in an elevator with some of the organizers and one of the women told me I should join ABM.

I had been so energized by the discussions at that conference—learning how to do frenotomies, hearing about the “Ban the Bag” efforts in Massachusetts, finding out about Baby Friendly Hospitals for the first time. So, I joined ABM and attended my first conference in 2009.

Being at an ABM conference is amazing. I’m really not a conference person—networking does not come easily to me, I don’t really like the marketing/advertising hall, but I do love learning about new things. ABM is the only conference I really enjoy going to. I always come away from the conference with at least a dozen new ways to practice and a new energy to spread my knowledge to others. And I love the people I meet at ABM conferences—so many perspectives, so many different ways they express their passion for supporting the mother-baby dyad. After another couple conferences, I had been convinced to become a lactation consultant.

I usually make it to the ABM conference, but even in years where I don’t go, I still get a lot out of my membership. I probably use the protocols more than anything else—always the most up to date, comprehensive source on breastfeeding topics. I enjoy seeing the new research coming out in the journals. And just knowing I’m a part of an amazing group that is a political force for advancing breastfeeding and advocating for women is important to me.


Kristina Lehman, MD, FAAP, ALC
Ohio State University Wexner Medical Center
Internal Medicine and Pediatrics – Hiliard

When I started as a primary care provider (Internal Medicine and Pediatrics) I didn’t have a “focus”. I work at a large academic center so often felt “less than” because I didn’t have a special interest or skill. When I had my first son I knew I would breastfeed but I didn’t know how breastfeeding would build my confidence and help me grow my practice. I have taken the courses to be an Advanced Lactation Consultant, plan to take my IBCLC this year, do lactation specific medical visits, run an elective for medical students at my university, run a support group for our health plan, and participate in a huge online support group for women physicians who want to know more about lactation.

Being a part of the Academy of Breastfeeding Medicine validates my interest and gives me a place to pursue academic excellence by becoming a fellow. The annual meetings give me a chance to meet with people from all over the world who think and practice just like me. The meetings are like coming home and visiting with my people. I prioritize it every year!

 

Amber N. Price, MD
University of Chicago
Comer Children’s Hospital – PL3 pediatric resident

I have been attending ABM conferences since I was a medical student. I vividly remember myself, and a fellow medical student (along with our nursing toddlers) “crashing” a meeting the OB/GYN’s were having. Thinking back, I’m sure they thought, “Who are these girls?” However, everyone was so welcoming and friendly. Throughout the years, I have continued to feel embraced by the conference attendees. I absolutely LOVE the energy, networking, and professional development that take place every year. As a pediatric resident you would think it would be easy to connect with others who have a passion for breastfeeding education and medicine, but surprisingly it can be a challenge. However, when I attend the conferences I am surrounded by others who share my enthusiasm and I leave with a renewed sense of purpose and determination.

I have had so many doors open for me as a result of connections made at the ABM conferences. The size of the conference is perfect. It is small enough to really get a chance to know people, yet large enough to establish vital professional contacts. Also, the fact that ABM supports and encourages physician mothers to bring their nurslings in tow shows how family oriented and progressive the organization is. This means so much, especially for those who have not always received positive feedback with trying to be a breastfeeding mother and physician in the workplace. Personally, this is a must attend conference every year and a priority for my career development. I clear my calendar a year in advance in anticipation of the next conference and always know that it will be a great time!


Melanie Stone, MD FACOG
ObGyn of Lancaster

As an OB-Gyn generalist, I am so glad to have found The Academy of Breastfeeding Medicine. I have now attended two ABM conferences and plan to attend my third in Atlanta this fall. Through the course of my career, I have discovered a passion for Breastfeeding support and activism. Sometimes, this can feel like a lonely position for an OB-Gyn. Even though we are the experts in pregnancy and women’s health, we get shockingly little training about Breastfeeding in residency. We are often seen as part of the problem with Breastfeeding in America. I want to be part of the solution. Breastfeeding Medicine is an exciting discipline because there is so much to learn and so much amazing research happening. It is also a field which incorporates preventative medicine and global health. Advocating for Breastfeeding is fighting the good fight for better health for everyone. Once I expressed an interest in Breastfeeding Medicine, my partners began turning to me with all their questions. ABM membership and conferences help me have the knowledge to be an advocate for my patients and a resource for my colleagues. I am excited to see what we learn and where we go next. I’m not a lonely ObGyn Breastfeeding advocate anymore, I found my people in the ABM.

Holly W. Cummings, MD, MPH
Assistant Professor of Clinical Obstetrics and Gynecology
Perelman School of Medicine at the University of Pennsylvania

During my residency training in OB/Gyn, I received what I thought was an adequate, and even above-average, amount of education about breastfeeding. I placed babies skin to skin immediately after birth, encouraged breastfeeding, and learned about all-purpose nipple ointment from the hospital lactation consultants. I was happy to encourage and support breastfeeding to the best of my abilities and was ready to treat mastitis (antibiotics and encourage continued nursing) and breast abscesses (incision and drainage) on both my in-service exams and in real life, as the occasion rose. But when my own first baby was born, breastfeeding was a challenge I could not have ever previously imagined. The number of potential breastfeeding problems that might occur before a patient can even breastfeeding long enough to develop mastitis is enormous. For me, cracked and bleeding nipples and excessive neonatal weight loss within the first 48 hours led to triple feeds and a nipple shield to allow my breasts to heal for the first few weeks. After struggling with latching for 12 weeks, I turned to exclusive pumping and found a success story of sorts, pumping for 14 months. That was also my first year as an attending physician, and I found my patients were going through similar struggles once their babies arrived and they faced the realities of breastfeeding. I supplemented my standard residency breastfeeding education with my real-world experience and tried to support my patients as best I could.

Thankfully, my second baby didn’t have any latching difficulties, we’ve had a pretty uneventful (in the sense that there haven’t been any problems; there have been many happy events) breastfeeding relationship, and this round of personal experience has supplemented my breastfeeding education further. I continue to support, teach, and treat my patients’ breastfeeding issues, but I still feel the most comfortable medically with the issues I myself have faced. I’m a novice, learning as I go, as I address other lactation challenges with my patients. For instance, I have never had a problem with milk supply, and therefore have no personal experience with galactagogues.

However, this shouldn’t matter. In every other field of medicine, there is no instinct to treat patients based on our personal experiences; in fact, we are explicitly trained not to do this. Why am I relying on my personal experiences to supplement my Breastfeeding Medicine knowledge? It is with this mindset that I attended the Academy of Breastfeeding Medicine conference in 2016, and was introduced to a community of like-minded professionals and a wealth of Breastfeeding Medicine knowledge. I was heartened to meet so many others physicians who treat breastfeeding mothers, across so many specialties, and impressed with the research presented. My basic medical training and personal experiences are now supplemented by evidence, and this has allowed me to improve my skills as a physician. I look forward to future ABM meetings and the evolution of my abilities as a lifelong learner practicing evidence-based Breastfeeding Medicine.


Liz Langthorn, MPH
University of Oklahoma College of Medicine, MS3
ABM is important to me because it is critical to raise the professional training and credibility of physicians supporting lactating parents.

I’m coming to medicine after being a birth doula, working in public health, and serving on a Fetal Infant Mortality Review Board. Through all of these, there is a disconnect between the messaging around breastfeeding, the mission to reduce infant mortality and morbidity, and actual boots on the ground support for lactating parents.

I’m coming to Breastfeeding Medicine after personal experience with the lack of medical training around breastfeeding when my beloved family doctor was not trained to support breastfeeding in the presence of tongue tie. It struck me how badly we need a Breastfeeding Medicine doctor in our area, to support families with babies with ties, support lactating parents undergoing their own medical care, and support lactating physicians to meet their own breastfeeding goals.

I am with the Academy of Breastfeeding Medicine because it helps me communicate to other physicians the advantage a local Breastfeeding Medicine doctor, and how they and their patients will ultimately benefit from the specialization. I attend the ABM conference to stay up to date on research from around the world and to meet others working in the field. I read the ListServ as a form of case-based learning to augment my medical school education. I use the protocols to help families advocate for themselves as they navigate lactation and healthcare decisions. Ultimately, I am grateful for ABM so I am not alone in my journey to support breastfeeding at the highest level of healthcare.


Dr. Erin E Appleton
MD, CCFP, IBCLC
Breastfeeding Medicine Specialist
Lethbridge Breastfeeding Medicine Clinic

What has it meant to be a part of the ABM?

For me, it has meant the world. It has represented t

he end of one time in my career, and the beginning of my passion. It has meant friendships and connections forged. It has meant passion ignited and pushed the winds of change in my practice after each and every meeting. The beginning of my journey toward fellowship, the middle and now steering to the end of the road. Almost there!!!! This next meeting will be the last before reaching my current career goal! And then I feel certain, ABM will help me find my next goal.

Together, we are as one; one singular and uniting purpose: promotion, protection and support of breastfeeding and human lactation. ABM and all its members, you are the foundation for that exact purpose. And I am so very grateful every day for the existence of such a wide reaching and powerful voice.
Thank you!

 

ABM’s 22nd Annual Meeting will ne November 9-12, 2017 in Atlanta.  Submit an Abstract by May 27 and Save the Date!

Compiled by Laurie B. Jones, MD, IBCLC. Dr. Jones is a pediatrician in Arizona and founder of Dr. Milk. You can follow her on Twitter @DoctorDrMILK

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.


Surgeons who pump: #ILookLikeASurgeon

If you follow trends on social media, you have seen the viral tweets and pics from women surgeons who have copied the New Yorker magazine cover showing three women leaning over an operating table.   These posts share two common hashtags:  #ILookLikeASurgeon and #NYerORCoverChallenge.  As an admin for the 7,000+ member Dr. MILK online physician mother breastfeeding support group, I wanted to see this picture taken from the perspective of a multi-tasking surgeon mother who fits in pumping her milk between cases and a very hectic schedule.  I asked our members to try and coordinate OR schedules and pumping schedules to make this happen.  Three superstar OB GYNs from Baylor College of Medicine created this pic while at Texas Children’s Pavilion for Women in Houston, TX.  They don’t literally pump their milk while leaning over an operating table, but this picture represents the duality of surgeon moms who balance patient care needs with meeting the nutritional needs of their infants.  Their stories of breastfeeding/pumping challenges and successes will hopefully encourage mothers of all walks of life to confront and remove barriers to maintaining a milk supply while at work and #normalizePumping.

Here’s what their workday looked like when they managed to take this picture:  One doctor had a delivery and then a c-section while the second had a fetal surgery.  The third surgeon was performing a robotic hysterectomy.  They tried to coordinate the photo between the delivery and c-section but timing wasn’t right, and then just before the fetal surgery the three women rushed into an empty OR to make it happen. 

Surgeon #1:  Beth Davis, MD Assistant professor of obstetrics and gynecology, Texas children’s pavilion for women

I’m spoiled as an attending OB GYN and have recently stopped pumping after reaching my goals.  Clinic days were always hard as I wasn’t granted blocked breaks in my schedule. Surgery days I usually got time between cases to pump, and they were forced to honor that since they can’t start a case without me! Deliveries were harder as babies have their own time line, but I usually had a back-up doctor who could give me a short break if I got desperate. I am also lucky to have my own office space where I could set up my pumping station and wouldn’t be disturbed. I am in awe of women trainees for making it work as residents and fellows. I can’t imagine how hard that would be in their shoes.  I’ve been lucky enough to donate my extra breast milk to eight babies due to my oversupply, including a couple of physician mothers.

Surgeon #2:  Kelly Keuneke Blazek, MD, OB GYN Fellow Minimally Invasive Surgery

Fellowship offers an improved schedule compared to residency, thank goodness.  The days when I get done early and don’t have as many service obligations, it’s nice to go pick up the baby and be able to nurse. During cases, I feel like I always have to think ahead to plan when I can pump next. I hate scrubbing out of cases because I feel guilty.  I pump between cases when possible, but I have found the courage to speak up when I need to leave a case. I work at multiple hospitals around Houston, and at some I use the hospital grade pumps.  I’m constantly forgetting pump parts for all the different pumps on the various days of the week. I’ve been back to work for a little over two months and I feel like I’ve started to get into a work-and-pump routine. I’ve pumped in my car, in bathrooms, on the floor in locker rooms, during lectures, and in the middle of the OB physician lounge. I’m blessed with an oversupply and just donated 300 oz from my freezer this week to a physician mother’s sister. Online physician mother support groups help keep me sane and also keep me awake during all the sleep regression feeds.  I also feel blessed to have never-ending support from people like Kristen and Beth.

It can feel heartbreaking after an exhausting day of operating and pumping to arrive home and find your baby already in bed and to have to sit down with the pump again when all you want to do is be able to is hold him and nurse.  The picture reminds me why I do what I do. It embodies the reality of being a working mom and empowers me because it shows that I can be both a great surgeon and a great mother.

Surgeon #3:  Kristin Clay Chabarria, MD 4th year OB GYN resident at Baylor
In terms of pumping as a resident, I’m fortunate to have faculty that are very supportive. I have scrubbed out of several long gyn-onc cases when the case ran too long during non-essential parts of the surgery. For example, in a combined case with gynecology and general surgery, I scrub out during the general surgery portion. Life gets hectic, especially on days when I’m moving from the OR in the morning to a different clinic in the afternoon, but you make it work! I pump in my car and OR locker rooms frequently. It’s especially been a struggle for me because I have a small storage capacity and thus have to pump every 3-4 or so hours or else my supply dips- but currently 5.5 months and EBF thanks to all the love support and encouragement from the Dr. MILK group! Oh and a little donor milk on tough days from the other ladies pictured here.

These three women in different stages of medical practice face many barriers to reaching their breastfeeding goals, but with the support of their work, family, and online communities they have found determination to fit pumping into their unpredictable and hectic schedules.  They look like surgeons and like moms who are amazing multi-taskers!

Laurie B. Jones, MD, IBCLC, is a pediatrician in Arizona and founder of Dr. Milk. You can follow her on Twitter @DoctorDrMILK

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.


ABM Releases Revised Supplementation Protocol

During a time of abundant research surrounding the long term implications of feeding practices in the neonatal period on maternal and child health, it is of utmost importance that healthcare professionals are guided by the best available evidence regarding infant feeding while caring for breastfeeding dyads. We know that despite the recommendations against routine formula supplementation, this practice is commonplace in hospitals worldwide for a myriad of reasons. In developing ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate (Read the protocol here) newborn physiology and management of breastfeeding mothers were highlighted to impress upon healthcare professionals the delicate balance involved in helping mothers establish exclusive breastfeeding in the early postpartum days. Many mothers set out with the goal of exclusive breastfeeding, but still in many countries, few reach their feeding goals. Studies clearly demonstrate that when healthcare teams have a clear understanding of these topics, provide antenatal education, and implement supportive hospital practices, the need for supplementary feedings in term neonates is rare.

Preventing the need for supplementation altogether should be a common goal for all members of the healthcare team. It has been well established in the literature that exclusive breastfeeding protects mothers and infants from various poor health outcomes, is cost effective, and is the physiologic norm. Thus, the authors of this protocol dedicated substantial time and focus on practices that have been shown to reduce this need, which include many of the ten steps required by the Baby Friendly Hospital Initiative. The revised protocol contains an algorithm for caring for the breastfeeding dyad before and during the birth hospital stay and responding to common concerns.

It is important to recognize true medical indications of supplementary feedings as well as the preferred choice and volumes of supplement, which are appropriately outlined in this protocol, re-emphasizing that, while there is a time and place for formula use, a mother’s own expressed milk or donated human milk in volumes that mimic normal breastfeeding physiology are preferable to breast milk substitutes. The preference for donor human milk over formula use has been suggested by the Academy of Breastfeeding Medicine for years, and is further supported by emerging research on the long term health consequences of the infant microbiome and the role that breast milk substitutes may have on individual health outcomes years down the road.

Educating ourselves as healthcare providers about how best to support mothers in their breastfeeding journey is crucial to their success in meeting their personal feeding goals. This revised clinical protocol highlights supporting evidence and contains information and strategies needed to provide state-of-the-art care and support.