The "Essential Education" courses have been designed to meet the needs of hospitals requiring Baby Friendly Staff Education for their hospital or health organisation. Each and every course meets the needs of the participants and the requirements of the WHO/UNICEF's Baby Friendly Hospitals Initiative. These courses are evidence based, high-quality and peer reviewed, ensuring that your staff complete the course with the knowledge they require to successfully work in a Baby Friendly Hospital.
ES01 Breastfeeding Essentials (20 hr Curriculum)
Breastfeeding Essentials is for primary-care staff who are caring for mothers during pregnancy, birthing and for the duration of Breastfeeding. In this course, the participant will learn how to apply each of the 10 Steps to Successful Breastfeeding, or the 7-Point Plan for the Protection, Promotion and Support of Breastfeeding in community settings. The curriculum is based on the WHO/UNICEF 20-hour course that is required for Baby Friendly Hospitals Initiative (BFHI) accreditation. Therefore Breastfeeding Essentials will meet your need for primary-care staff education for your hospital or community Baby Friendly accreditation.
ES04 Breastfeeding Essentials for Ancillary Staff (Short Presentation)
Breastfeeding Essentials for Ancillary Staff is suitable for non-clinical staff who come into contact with mothers and babies, but do not provide them with direct breastfeeding education and support. This course is a short video presentation that outlines the 10 Steps to Successful Breastfeeding and the World Health Organization Code on the Marketing of Breastmilk Substitutes so that the participant will understand the Baby Friendly Hospital Initiative and be able to provide appropriate support to breastfeeding families within the scope of their role.
ES05 Breastfeeding Essentials for Allied Health Professionals (8 hr Curriculum)
Breastfeeding Essentials for Allied Health Professionals has been designed to meet the educational needs of clinical staff who provide secondary or supportive care to mothers and babies. Participants will be introduced to the Baby Friendly Hospital Initiative through a short video presentation, and then progress through the course modules that address relevant elements of the Baby Friendly Hospital Initiative to assist the participant in providing the appropriate level of care within the scope of their role.
ES06 Breastfeeding Essentials for Physicians (4 hr Curriculum)
Breastfeeding Essentials for Physicians is a 4 hour online education course for Physicians who support and care for families during pregnancy, birthing and the duration of Breastfeeding. The in-depth content is presented across ten modules and covers the essential topics for providing best-practice breastfeeding and maternity care. Upon completion the participant will be well prepared for Baby-friendly accreditation.
Following the excitement, and relief, of receiving your Baby Friendly accreditation, you will soon be turning your thoughts to keeping that hard-won plaque. Having a work force that is up-to-date in their knowledge and skills will make it so much easier. We've developed some "Maintaining Education" short courses and lectures from experts in the field that will keep your staff motivated and well-educated on the latest research on breastfeeding, and keep Baby Friendly top of mind. The shorter courses help you to spread the costs over the intervening years, and make learning even more enjoyable for your staff.
MA01 Breastfeeding Policy Orientation (2 hr Curriculum)
Breastfeeding Policy Orientation is a short course for health professionals supporting women during pregnancy, birthing and for the duration of breastfeeding, who work in a Unit that is Baby Friendly accredited or striving for that accreditation. It is perfect for orientating all staff new to your Unit, as well as re-familiarizing staff prior to re-accreditation. The course focuses the participant’s attention on your Unit’s Breastfeeding Policy and how the Baby Friendly 10 Steps to Successful Breastfeeding, or 7-Points in Community Settings, are incorporated into your Policy and the procedures that they will follow. Regular familiarization with the Policy will ensure high standards are maintained and prevent conflicting advice.
CE15 Bilirubin Management and Implications for Breastfeeding (1 hr Curriculum)
by Prof. Lawrence Gartner
Although neonatal jaundice is a common occurrence in both breastfed and artificially-fed infants, there are some special relationships between breastfeeding and jaundice in newborns. These will be explored by first examining the question of why and how jaundice or hyperbilirubinemia is a risk for newborns. The brain disorder known as "kernicterus" will be defined. The scenario of a badly managed case which resulted in development of kernicterus will be presented. Bilirubin metabolism will be examined with diagrams to understand how the newborn differs from the older child and adult in the six specific steps of this process: 1) synthesis; 2) transport; 3) hepatic uptake; 4) hepatic conjugation; 5) hepatic excretion; 6) intestinal reabsorption.
The additional differences in bilirubin metabolism between the breastfed and the artificially-fed infant will then be explored to understand why breastfed infants normally have a prolonged period of jaundice and hyperbilirubinemia and why some breastfed infants have abnormal exaggerations of jaundice and hyperbilirubinemia. The entities of "Breastmilk Jaundice" and "Starvation Jaundice of the Newborn" will be defined. Using guidelines from the American Academy of Pediatrics, the talk will explore how to identify the infant at increased risk for exaggerated neonatal jaundice and how to assure good follow-up of the high risk infant. Methods for optimizing breastfeeding while controlling hyperbilirubinemia will be explored in detail.
The ultimate goal of the talk is to enable the health practitioner to assist in maintaining breastfeeding while protecting the infant from the rare, but very real, risk of developing bilirubin-related brain damage.
Prof Lawrence Gartner specialized in neonatology and pediatric liver disease during his pediatric training. He was Professor of Pediatrics and Director of the Children's Clinical Research Unit at Albert Einstein College of medicine and later, appointed as Professor and Chairman of the Department of Pediatrics at The University of Chicago and Director of Wyler Children's Hospital. The great majority of his basic laboratory and clinical research has been in the area of neonatal jaundice, with particular reference to its relationship to breastfeeding. He is a past-president of the Academy of Breastfeeding Medicine and currently Professor Emeritus, Departments of Pediatrics and Obstetrics/Gynecology at The University of Chicago.
CE16 Neonatal Hypoglycemia – Evidence and Recommendations (1 hr Curriculum)
by Dr. Martin Ward Platt
From over two decades of research, we have a much better understanding of the physiology of blood glucose, and other fuels such as lactate and ketones, in the newborn baby; but we still have few randomised trials to guide us towards the best strategies either for the prevention or the management of hypoglycaemia. Therefore if we are to manage babies properly, we need to base our clinical guidelines on an understanding of the physiology until we have empirical studies to guide us. We need to understand that babies potentially face two successive nutritional crises: the loss of the placenta at birth, and the delayed arrival of breast milk, especially when the mother is primiparous.
Most babies are robust enough to deal with these two difficulties, but we need to identify, and help where necessary, those babies who are not coping successfully, and are becoming fuel deficient. This presentation therefore focuses on normal physiology in the context of term and preterm delivery; the concept of ‘safe’ blood glucose values in relation to alternative fuels; the hormonal control of blood glucose in the newborn; situations of abnormalities of supply and demand for glucose; and some of the influences of intrapartum care on newborn metabolism.
Dr Martin Ward Platt has been a consultant in neonatal medicine in Newcastle upon Tyne since 1990; he is also honorary Reader in Neonatal and Paediatric Medicine at Newcastle University. He has a long standing interest in the developmental physiology and metabolism of the neonate and infant, and has published extensively on clinical aspects of blood glucose control and its disorders.
CE19 Stemming the Tide of Supplementation (1 hr Curriculum)
by Marsha Walker
Supplementation of the breastfed infant has been steadily increasing over the years, reducing the rate of exclusive breastfeeding and increasing the likelihood of premature weaning. This presentation explores the reasons for necessary and unnecessary supplementation, as well as when, why and how to supplement if necessary.
Marsha is a registered nurse and International Board Certified Lactation Consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association and the Executive Director of the National Alliance for Breastfeeding Advocacy.
CE23 Translating Evidence into Practice (1 hr Curriculum)
Dr. Barbara Morrison
WHO/UNICEF recently revised the interpretation of Step 4 of the 10 Steps to Successful Breastfeeding to read "Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed." (BFHI, Section 1, 2009, p. 34). Since as early as 2000, international, national and professional organizations have recommended placing all newborns in skin-to-skin contact (Birth Kangaroo Care, BKC) starting immediately after birth and leaving them there until after the first breastfeeding is completed.
Thus, it is necessary for birth practices to change so BKC with breastfeeding is routine care. However, such a change in care is not easy as it means changing culture within birthing units and changing well-established behaviors and habits of health care providers. The evidence is compelling as to the benefits of both BKC and breastfeeding, now BKC with breastfeeding needs to be translated into practice. Steps to translate BKC with breastfeeding into practice will be presented through examples of implementation projects in the United States, followed by discussion of BKC implementation in other countries.
Dr. Barbara Morrison is a nurse midwife, family nurse practitioner, and assistant professor of nursing. She has been working with and for parents and their newborns for 28 years, assisting with their births and early parenting. Her research interests focus on breastfeeding, kangaroo (skin-to-skin) care for full-term infants, and developing a hospital environment that promotes, protects and supports breastfeeding. Dr. Morrison has a special interest in the neuro-endocrine and neuro-biological effects of kangaroo care that lead to strong social attachments and exclusive breastfeeding.
CE28 Infant Feeding Frequency: Proposal based on available evidence and Neuroscience (1 hr Curriculum)
Dr. Nils Bergman
Our medical culture behaves as if the brain and the gut are disconnected. The autonomic and enteric nervous systems regulate the gut, and the main sensory inputs are olfactory and tactile, provided in skin-to-skin contact. It is usually assumed that the anatomy and physiology of newborns is immature, but given the right context even the preterm gut behaves competently. In terms of available evidence on feeding frequency, there is none. Feeding frequency is however an inverse function of stomach capacity.
There is evidence on fetal stomach capacity from ultrasound, on newborn gastric aspirates, and some evidence on post-mortem studies. Corroborating these, a study on volumes and pressures is interpreted as supporting a newborn stomach maximum capacity of 20 milliliters. The proposal therefore is that the feeding frequency should be approximately hourly, but adjusted to the actual sleep cycle with associated enteric cephalic phase which averages one hourly. This has implications for reflux and hypoglycemia, two very common feeding related problems; it may even address early epigenetic programming of obesity. While such frequent feedings may seem too much work, closer scrutiny shows it results in a major time saving.
Dr Nils Bergman is a paediatrician whose primary professional interest revolves around Kangaroo Mother Care (KMC), and the underlying perinatal and developmental neuroscience. His diverse background explains his broader public health approach to supporting and promoting the global dissemination of maternal-infant skin-to-skin contact. He also researches with the University of Cape Town, developing a brain monitor that will read the autonomic nervous system.
CE32 Watch your Language (1 hr Curriculum)
“Our study found significantly lower illness rates among breastfed infants.” “Breastmilk is the ideal infant food.” “It’s wonderful that you’re still nursing your baby.” “There was a 20 per cent lower risk with breastfeeding.” How can any of these statements be counterproductive? Because breastfeeding is our biological norm, and should be the control group in any study of infant feeding. Surprising things happen when we use formula as the study norm instead. We’ll look at the effect of inaccurately framed research on the media, health care professionals, mothers, and the general public, and discuss who should be promoting breastfeeding and who should protect and support it, and how.
Diane Weissinger has been a La Leche League Leader since 1985 and an IBCLC since 1990. She is in private practice in New York. She has published articles and commentaries on various breastfeeding topics, and is a contributor to Smith’s The Lactation Consultant in Private Practice and Genna’s Supporting Sucking Skills in Breastfeeding Infants. Most recently she has co-written the completely revised eighth edition of La Leche League International’s The Womanly Art of Breastfeeding with Diana West and Teresa Pitman.
CE35 Breastfeeding Premature Infants (1 hr Curriculum)
Exclusive breastfeeding is achievable for most premature babies. An understanding of the physiology of breastmilk production and maintenance of supply, premature infant breastfeeding behaviour, and the unique feeding challenges posed by prematurity are essential to feeding success. This talk covers unique benefits of breastmilk for premature infants, establishing and maintaining the breastmilk supply, development of effective feeding behaviours and transition to breastfeeding, including problems commonly encountered by premature babies.
Yvette Sheehy has worked in Neonatal Intensive Care for over 28 years as a registered nurse and as the Lactation Specialist at the Royal North Shore Hospital Sydney for the last eight years. Her special interests include breastmilk as medicine and transition to breastfeeding for premature infants.
CE36 Breastfeeding the Late Preterm Infant (1 hr Curriculum)
Dr. Kathleen Marinelli
The late preterm infant is defined as being born between 34 weeks and 36 weeks 6 days gestation. The advantages of breastmilk feeding for premature infants are even greater than those for term infants: however, a large body of literature in the past 5 years documents the increased risk of morbidity and even mortality of the late preterm infant often related to feeding problems, especially when there is inadequate support of breastfeeding. This lecture defines the characteristics of the late preterm infant, noting their effect on early postnatal adaptation and outlining ideal clinical management and morbidity prevention.
Dr Kathleen Marinelli is an Associate Professor of Pediatrics at the University of Connecticut School of Medicine, and a neonatologist and director of lactation Support Services at Connecticut Children's Medical Center, CT, USA. Her research interests focus on breastfeeding and the use of human milk in the neonatal intensive care unit, cup-feeding, donor milk and donor milk-banking, and the education of medical professionals.
CE37 Game-changing Research about Breastmilk Expression (1 hr Curriculum)
Dr. Jane Morton
Pump-dependent mothers of preterm infants commonly experience insufficient production. In this lecture Dr Morton presents compelling research demonstrating the combination of two milk removal techniques: hand expression of colostrum, and hands-on pumping of mature milk, that increased mean daily milk volume to nearly 1L and maintained production at that level for at least 8 weeks despite pumping less frequently. This lecture is complete within itself, however CE38: Baby-Friendly Bedside Care for Low and High Risk Infants is supported by the application of these techniques.
Dr Jane Morton was the Director of the Breastfeeding Medicine Program at Stanford University, executive board member of the American Academy of Pediatrics’ Section on Breastfeeding and Fellow of the Academy of Breastfeeding Medicine. Her particular interest is preventing breastfeeding problems by training new mothers, their partners and their providers simple, doable but critical steps from the first day, no matter what the challenges may be.
CE38 Baby Friendly Bedside Care for Low and High Risk Infants (1 hr Curriculum)
Dr. Jane Morton
In this lecture Dr Morton discusses the most important actions to be implemented in the first few days following birthing that will guarantee successful, continued breastfeeding. She looks at how to apply these principles to the healthy, term baby, then how to adapt them to the special needs of the infant at risk of morbidity and re-admission to hospital. Finally, to achieve this goal, Dr Morton outlines a 5-point "Share the Care" plan that provides a proactive plan of care that will reduce the perennial staff problems of insufficient time, insufficient knowledge and skills, and lack of individual accountability that pervades many hospitals. This lecture is complete within itself, however CE37: Game-changing Research about Breast-milk Expression provides the background knowledge you will need for success.
CE39 Group-Based Antenatal care versus Standard Care (1 hr Curriculum)
Group-Based Antenatal Care versus Standard Care: Results from qualitative and quantitative studies in Sweden.
Group based antenatal care (GBAC) is a model of antenatal care that has been implemented in Sweden since year 2000. Sparse research has been conducted in Sweden but in the USA, where the model is more common, the research has found that women's satisfaction with GBAC is higher than with standard individual care (SC). Speaker will present results of four researches conducted in Sweden comparing group-based antenatal care to standard individual midwife care. Findings report few differences in women's expectations about the content of care between GBAC and SC, but women's expectations have changed over the last ten years. Parents who experienced GBAC appreciated the group model. Similar overall satisfaction in both models of antenatal care suggests that GBAC can be introduced without altering women's satisfaction with antenatal care but midwives viewed constraints to implement GBAC. Speaker will explain how both models can fit within Swedish prenatal guidelines.
CE40 Transition into Fatherhood: A Time of Risk for Mental Illness (1 hr Curriculum)
This lesson includes issues about new fathers and the risk of mental illness during transition into parenthood.
The transition to parenthood is an important life experience which brings along stressful changes regarding different parent roles. Historically, fathers were considered more as providers but since the era 2000, they assume new roles in the lives of their children. Researches have been conducted in many countries to describe this evolution. We know nowadays that fathers describe the postnatal period as associated with mixed feelings, feelings of pride and pleasure, and a strong desire to be emotionally available to their children. However, this period is also considered as frustrating for many fathers because they feel less skilled in caring for their infant than their partners. Many studies report depression rate among new fathers which varies according to the type of samples, measures used, and time point chosen. However, depression rate is significantly lower than that for women. Different aspects of positive fathers' involvement, such as emotional investment and warmth or closeness in the relationship, are associated with children's well-being, social competence, cognitive development, and development of the emotional regulation system.
CE41 Skin-to-skin for all mothers and term babies at birth (1 hr Curriculum)
Dr Dumas will present the differences between kangaroo and skin-to-skin care practices at birth and what is meant by evidence. She will then explain the exhaustive evidence that is available for two Baby-friendly Steps: step 4 on skin-to-skin and step 7 on mother-infant togetherness. Presenting how these techniques are realized in Canada and in Sweden, she will prompt participants to reflect on their own clinical practice to ensure a safe transition for both mother and baby at vaginal birth and at caesarean section and also how to explain these important facts to parents.
CE42 Baby-Friendly Initiative: Why Bother? (1 hr Curriculum)
In this presentation, participants will realize the importance of the documented risks of non-breastfeeding for both mother and baby. They will discover how to inform pregnant women and mothers on those risks. Participants will also recognize that most of the women’s difficulties with breastfeeding are often due to the non-respect of bases and criteria of Baby-Friendly Initiative (WHO/UNICEF). Dr Dumas will prompt participants’ reflection on their own practice by explaining the bases of Baby-Friendly Initiative (WHO/UNICEF) and how certain aspects of the Code (WHO/UNICEF) influence practices and services.