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“The pregnancy was uneventful and until this morning she had always felt the baby move.  Today was different; the baby was quiet, very quiet.  By lunchtime she noted she had not felt the baby move all morning.  A visit to her doctor’s office revealed that at thirty-eight weeks’ gestation the baby’s heartbeat could not be found.  She was immediately sent to the hospital’s birthing center.  While this mother was experiencing a fog of emotions, her labor was induced.  Ten hours later, she gave birth to a beautiful daughter: eight-pounds three-ounces, perfectly formed, yet stillborn” (shared by a bereaved family).  

There is no universally accepted definition of fetal age to define stillbirth.  It varies from twenty to twenty-eight weeks of gestation.  “The reported incidence of stillbirth varies significantly between studies from different countries and depending on the definitions used, but generally ranges from 3.1 to 6.2/1000 births or 1 in 160 deliveries” (Tavares Da Silva et al., 2016). Pregnancy loss even as early as the beginning of the second trimester can result in an unexpected lactation occurrence.

As we come to a close of 2022 there is a lot to reflect on in the world. The past few years have given us all an opportunity to reflect on our practices and how we provide services. They have also highlighted many challenging areas yet given us the opportunity to realise our ability to be flexible, think outside the box, and to provide hope.

Lactation, breastfeeding, chestfeeding, bodyfeeding are all inclusive to supporting a world with hope and acceptance. All of us that work in this field have at one stage or another thought that what we do can change the world, and it can. As lactation professionals, we have the ability to share knowledge with others and to guide our colleagues, communities and our governments in a direction that will benefit all.  

As we come to the close of 2023, we have a lot to reflect on in the field of human lactation and infant feeding. The world is quite unsettled and the simple instinctive behaviour of breastfeeding, chestfeeding and bodyfeeding is also impacted. Yet this simple act is something that can save lives. We continue to see around the world, devastation due to conflict and natural disaster. Industry uses these situations to promote themselves and their products. It is essential that the knowledge of lactation and support is based on best practice and without industry influence.

When you dream something is possible and work really hard in collaboration with colleagues, sometimes those dreams become reality!  It has been a very busy and exciting past few months for Health e-Learning-IIHL and the years’ prior have been even more of an adventure.  Sometimes the paths cross at the right time and this was the case for what has developed into the International Institute of Human Lactation Inc., (Health e-Learning-IIHL) collaborating with the Université du Québec à Trois-Rivières (UQTR).

The journey started many years ago yet began to blossom about 4 years ago with a small team Louise Dumas, MSN, PhD, Chantal Doucet DC, DICCP,MSc, and myself, Carole Dobrich, B.Sc, RN. IBCLC.  

We all had a similar goal to improve lactation through interdisciplinary education. We believed that lactation support needed a village which included all health disciplines.  We wanted to develop an advanced lactation program designed for health care professionals from a variety of backgrounds, with each bringing their own strengths to the learning process. It took a few years as we assessed, evaluated and planned what was possible. We asked international experts to evaluate the content validity, relevance, and feasibility of our proposed interdisciplinary graduate program in advanced lactation and they responded.

A Year to Remember

The year 2020 will go down in history as one we all will remember for so many reasons.

For Health e-Learning-IIHL, we started the year by participating in the first Breastfeeding Advocacy Australia WHO Code training and Infant and Young Child Feeding in Emergencies (IYCFE) workshop on Coochiemudlo Island with colleagues from around the world.

We also attended the annual New Zealand Lactation Consultants Association conference in Auckland, New Zealand and met up with many wonderful colleagues and friends. We had a full calendar year booked and we had looked forward to catching up with colleagues and students at WPHNA (Brisbane, Australia), ELACTA (Milan, Italy), AQC (Quebec, Canada), ILCA (Houston, USA), IBC (Chennai, India), and LCANZ (Melbourne, Australia).

Then in March 2020, it seemed that the whole world stopped! Flights were cancelled, international border crossings were closed, conferences were cancelled or became virtual, due to the global COVID 19 pandemic. The world as we knew it changed and for many has not returned to anything resembling normal. The pandemic has impacted the world, including all supporting infant and young child feeding.

Oooh, the mere mention of “exam” sends a shiver down my spine!

I always find it difficult to know where to start when it comes to studying or the IBLCE exam. I have sat the exam a few times now, and each time my preparation has been a little different.

When I sat the exam the first time, I did an IBCLC course that was all by written course work: multi-choice question and short answer items that we had to post (yes, post!) back to the course assessors. I can only imagine the workload of those course assessors, and am very appreciative of all the time and generous guidance that they offered! Back then the use of email and the internet for online articles was not what it is now (yes, it was the time of the dinosaurs!). In order to prepare for the exam I had to buy text books…expensive textbooks! Thankfully I was preparing to sit the exam with a few of my work colleagues, so we shared that expense and established out own study group.

As a novice, I think the study group was invaluable: it allowed us to share information that we had found and also to urge each other on when we lost sight of the end goal. We often would meet at our local Australian Breastfeeding Association branch office because they had a fabulous library of texts and articles, dedicated solely to lactation – it was our Aladdin’s cave! My friends and I would try to meet there once a week to study and share stories (oh, and sharing yummy food, some recipes and lots of laughter as well!). My friends were what helped me through the exam that first time.

The Trudi Szallasi Scholarship provided me the opportunity to be more knowledgeable, supported and professional when set to the IBCLC examination and got certified. It empowered me to manage and lead the Breastfeeding Support Association, the only breastfeeding formal body in my country, Jordan. It also scaled up my skills as well as my knowledge through the courses that I had received at the Health e-Learning website.

Loss of an infant is one of the most difficult experiences families can live through. As health care professionals, not being able to provide a clear reason for the death is also a significant burden. The American Academy of Pediatrics (AAP) 2016 updated document on safe sleep indicates that “approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome, ill-defined deaths and accidental suffocation and strangulation in bed” (Moon). Sudden unexpected infant death (SUID) describes death occurring during infancy that may or may not be explainable. This can include suffocation, entrapment, infections, disease, trauma and sudden infant death syndrome (SIDS).

The year 2017 has been a bit of a roller coaster for breastfeeding and human lactation. There have been some very difficult challenges faced related to Infant and Young Child Feeding in Emergencies (IYCFE), in particular, hurricanes, floods, fires, and displacement of refugees. International Board Certified Lactation Consultants (IBCLCs) and breastfeeding peer counselors have been there volunteering and supporting families. Education is an essential part of best practice in these situations. IBCLCs are specialised in the field of infant feeding and when it comes to emergencies we need to use our skills to communicate and share our knowledge so all babies are safely fed.

There has been a lot of discussion on social media and in the news recently about “feeding babies”. This discussion has included the questions of whether exclusive breastfeeding is safe and whether all babies should be supplemented in the first week after birth. Despite well documented research to support exclusive breastfeeding, some ill-supported commentaries cited to questionable exclusive breastfeeding research and asserted pre-lacteal feeds have only ceased since the introduction of the Baby Friendly Hospital Initiative. Further still, some publications have accused breastfeeding advocates of forcing breastfeeding onto families, causing mothers to feel guilty, leading to post-partum depression. Most recently an article appeared recalling how an IBCLC gave the mother “permission” to wean her baby.