Waikato DHB lactation consultants help new
Debbie Graham and Alys Brown from Waikato District Health Board’s lactation consultant services are busier than ever. They talk about the rewards of the job, and some of the issues they face.(pictures available on request)
IN A SMALL, whitewashed room of Waikato Hospital, it’s a happy scene.
A new mother rests on her bed in Ward 52 – the postnatal ward – reading a magazine.
A content baby, tiny and wrapped in a white woollen blanket, sleeps in a bassinet beside her.
Vanessa MacCarthy, a mother of four from Te Awamutu, is feeling particularly chuffed. Looking down at her newborn daughter Brianna, just three-days-old, she is proud of her wee girl.
It’s the first daughter for MacCarthy and her husband Wayne, and Brianna’s three older brothers can’t wait to meet her.
However, MacCarthy is also feeling proud for another reason.
This morning, with the help of Waikato District Health Board (DHB) lactation consultant Alys Brown, she was finally able to get little Brianna to latch on and begin breastfeeding.
“To be successful is a sweet achievement,” says MacCarthy, smiling happily. “To get her latching and see her swallow, you have that sense of satisfaction.”
MacCarthy says breastfeeding has never been easy for her. “I’d struggled with all of them; getting them to latch has always been a challenge.”
Unable to breastfeed her first two children, MacCarthy got the hang of it with her third (“I wish I’d persevered with the others”) but it was back to square one with her fourth.
“For me Alys’ help was imperative,” says MacCarthy. “I absolutely need that support from someone who is an expert, someone who can show you what to do and gives you the confidence that you can do it.”
Breastfeeding may be natural, but it’s not always easy.
Waikato DHB lactation consultants Alys Brown and Debbie Graham provide an invaluable service, helping Waikato mums master the art of breastfeeding their babies.
Based at Waikato Hospital, part of the Women’s Health team, their lactation consultant services mostly focus on mothers with newborns up to six weeks old.
They also run weekly outpatient clinics in Hamilton, alternating between Plunket on Richmond St and Te Kohao Health on Dey St, assisting mothers and babies up to 3-months-old who are having difficulties breastfeeding.
Their midwife, general practitioner, Plunket nurse or other Well Child provider can refer women to the lactation clinic, and Brown and Graham say they are busier than ever.
Issues can be as diverse as latching, mastitis, blocked milk ducts, sore or damaged nipples, milk supply issues (too much milk, or too little), tongue ties, positioning, and babies who are slow to gain weight.
During a consultation they spend time with each woman, listening to her story and take notes. They observe the baby feeding and offer solutions, writing a breastfeeding plan for each mother.
Breastfeeding is a learned skill and mother and baby sometimes need to practice to get it right. It is not unusual for some women to find it takes several weeks, or longer, for breastfeeding to become easier.
The most common issue they see in the newborn postnatal ward is mothers with babies struggling to latch on. “There is any number of reasons for that, but it can often relate to the birth and medications,” says Graham
Women who have had caesarean sections may need assistance with positioning.
With premature babies, especially those in the Newborn Intensive Care Unit (NICU), there may be problems with getting the mother’s milk supply established, and helping with expressing.
Waikato Hospital staff call them for assistance with older babies too, offering advice if a sick or injured breastfeeding mother or breastfed infant is admitted elsewhere in the hospital.
Graham and Brown both hold an international qualification (the International Board Certified Lactation Consultant certificate – IBCLC) which means they have specialised skills in breastfeeding management and care.
Graham, a trained midwife, has been a lactation consultant since 2002, and is also a breastfeeding educator. She is also mother to three children, Fraser, 20, Meredith, 18, and Chelsea, 14.
She has always been a proponent of breastfeeding support and education, and became involved with La Leche League as a young mother. She is still actively involved with educating La Leche League leaders.
As a midwife, she realised there was a need to provide professional health services helping mothers with lactation issues, and decided to specialise in the area.
A large part of Graham’s job is educating other health professionals about breastfeeding.
Brown has been a midwife for 10 years and has worked as a lactation consultant for two years. Her mother, Judy Ngakuru, was also a midwife and lactation consultant, and her sister is too.
Brown is the mother of five children (Alvin, 14; BJ, 12; Liahona, 10; Jasmine, 8; and Hyrum, 7), a role, which she says, has given her valuable hands-on experience. “I have breastfed five babies, up to the age of 3 each,” she says.
There are good reasons that Brown and Graham – and government and health agencies – encourage mothers to breastfeed.
“Breast milk is the perfect nutrition for baby,” says Brown.
The Ministry of Health (MOH) and the World Health Organisation (WHO) support exclusive breastfeeding of babies until 6-months-old, and then ongoing with the introduction of complementary foods (solids) up until 1-year-old (MOH) or 2-years-old and beyond (WHO).
Studies show that babies who are exclusively breastfed may have increased immunity to illness, and are less likely to get sick. Human breast milk contains antibacterial properties and immunities can be passed on from a mother to her child.
For babies who are breastfed, there is a reduced risk of sudden infant death, allergies, eczema, asthma, reflux, and some childhood cancers. Breast milk provides a baby with excellent nutrition, lowering its risk of heart disease, obesity and diabetes later in life.
Breastfeeding also provides a special bonding opportunity between mother and child.
“It’s what a baby expects when it’s born: to breastfeed,” says Graham. “They are programmed in their hindbrain to seek the breast and latch, that’s why skin-to-skin (contact immediately after birth) is so important. It’s the natural thing for your baby to do.”
They support both breastfeeding and non-breastfeeding mums, including those wanting to return to work. “We encourage them to include breastfeeding as part of that process,” says Graham.
They also support mums who have stopped breastfeeding, but want to start again. Amazingly, they have helped adoptive mothers produce their own breast milk to breastfeed adopted babies. “It can be done,” says Graham.
THE MESSAGE seems to be reaching women, but are breastfeeding mums keeping it up until the recommended six-month mark?
Many start off well. “More mums are trying to breastfeed, they understand they need to give babies the best start in life,” says Brown.
When asked, some 98 per cent of New Zealand woman say they have the expectation that they will breastfeed their newborns.
“At Waikato Hospital the discharge rate for women exclusively breastfeeding is very good,” adds Graham.
Some 80 to 84 per cent of women are breastfeeding exclusively at the time of discharge from Waikato Hospital, and a further eight to 13 per cent are partially breastfeeding (which means they may be supplementing with formula or expressed breast milk via a bottle).
However, statistics show that by three and six months, the number of mums breastfeeding has dropped.
According to Waikato DHB rates for the year ending December 2010, six weeks after their baby’s birth only about two thirds of new mums (68 per cent) are breastfeeding; by three months it’s just over half (56 per cent) and by six months just over one quarter (28 per cent) continue to breastfeed.
When the level of care drops off, perhaps during the transition period between when midwife care ends (at 6 weeks) and Well Child providers take over (with gaps between the 3-month, 5-month and 9-month visits), may be when some woman are giving up breastfeeding.
On their own, finding and accessing support may be an issue for some mothers, and many would benefit if extra funding were directed towards lactation support services.
“There aren’t enough services for (breastfeeding) women in the community,” Graham admits. “An increase in the availability and number of services would definitely enhance (a new mother’s ability to continue) breastfeeding.”
Adds Brown: “Mothers don’t always know where to turn for help.”
Assistance from lactation consultants and groups such as La Leche league are invaluable for those who want to continue breastfeeding.
A pilot programme is currently being developed in the Waikato to help establish mum-to-mum peer support networks within Maori and Pacific Island communities with South Waikato Pacific Islands Community Services (SWPICS) in Tokoroa, Te Kohao Health and K’aute Pacific Services in Hamilton, Ngā Miro Health in Ngaruawahia and Taumarunui Community Kokiri Trust in Taumarunui.
The initiative will see women in those communities supplied with breastfeeding information and resources, so that they can pass that on and support new mothers within the community.
For World Breast Feeding Week, which ran from August 1 to 7, Brown and Graham joined forces with Waikato DHB’s Healthy Eating Healthy Action (HEHA) project manager breastfeeding promotion, Jo Cottrell, with a series of educational seminars for staff.
Brown says she loves her job, which enables her to help women with another step on their way into motherhood.
“For me it’s about seeing a woman latch her baby after not being able to,” says Brown. “It’s that ‘a-ha’ moment... I learn so much from women every day.”
Adds Graham: “It is stressful for women who can’t (breastfeed). It takes a while sometimes to get it right. It’s so worth it to keep persevering.”
mother-to-mother breastfeeding support and advice see La
Leche League New Zealand: www.lalecheleague.org.nz
• Other breastfeeding websites include www.moh.govt.nz/breastfeeding and the Labour Department’s breastfeeding in the workplace site, www.ers.dol.govtnz