Amy Spangler

Designing a University-Based Lactation Course

A university-based lactation course was developed to provide lactation education to health care providers, with the goal of improving their knowledge, attitude, and skills in assisting American women to breastfeed. This is a key strategy for achieving the Healthy People 2010 objectives, and it addresses the identified need for education among health care professionals. The university as well as an enthusiastic lactation community provided multidisciplinary clinical experiences and classroom lectures to prepare public health students, nurses, midwives, and nurse practitioners to encourage and assist women in breastfeeding. It is hoped that the success of this class and the experiences of the instructors will motivate other lactation consultants to develop similar educational strategies.

There's a Fungus Among Us!

Candida infections can be extremely persistent and often are a source of considerable frustration for parents and professionals. Appropriate management of the initial infection is critical. Too often the treatment is inadequate or carried out for too short a period. A fungus is an amazing organism, deceptive in its simplicity, tenacious in its adaptability. Management of candidiasis challenges the lactation consultant to provide not only assessment and intervention but reassurance and reassessment in order to preserve the breastfeeding relationship.

Lactation education in the 21st century: a retrospective.

Accord ing to Web ster’s New Unabridged Uni ver sal Dic tion ary, a pro fes sion is “a voca tion or occu pa tion requir ing advanced train ing in some lib eral art or sci ence and usu ally involv ing men tal rather than man ual work.” While today, lac ta tion con sult ants read ily acknowl edge the need for advanced train ing, con sid er able con tro versy exists regard ing the acqui si tion of advanced train ing, spe cifi cally col legeand universitybased edu ca tion. The con tro versy is com pli cated by the fact that cur rently there is a pau city of acces si ble and com pre hen sive edu ca tional pro grams. Dur ing much of the world’s his tory, the prac tice of medi cine was car ried on by itin er ant crafts men. Infor ma tion was trans mit ted orally from gen era tion to gen era tion. It was not until the 9th cen tury that the first medi cal school was founded by four phy si cians in Sal erno, Italy. Dur ing the 17th cen tury, stan dards and require ments for medi cal edu ca tion var ied greatly, and degrees could be pur chased after only a few weeks of study. By the end of the 17th cen tury, den tistry was prac ticed by any one who could acquire the skills, and apothe car ies had formed their own soci ety and were per mit ted to prac tice medi cine with out a license. Until the 19th cen tury, licen sure was sel dom required, and pub lic accep tance deter mined whether some one could prac tice medi cine. As recent as 1910, only 1 of the 155 medi cal schools in Can ada and the United States pro vided an accept able medi cal edu ca tion, accord ing to a report by Abra ham Flex ner, Medi cal Edu ca tion in the United States and Can ada. Evo lu tion is a slow and tedi ous process. Fre quently, an iden ti fied pub lic health need is the impe tus for the evo lu tion of a new pro fes sion. Dur ing the 20th cen tury, the preva lence of breast feed ing declined in many parts of the world sub se quent to the intro duc tion of mod ern tech nolo gies and con tem po rary life styles. Because breast feed ing is a learned art and skill, it often bene fits from the assis tance and sup port of another expe ri enced and skilled indi vid ual. How ever, in cul tures where the inter gen era tional trans fer of infor ma tion and skill was weak ened or inter rupted, breast feed ing rates declined. In the early 1980s, La Leche League Inter na tional (LLLI) rec og nized the need for health care pro fes sion als with exper tise in breast feed ing man age ment and sup port and joined with other inter ested par ties to develop stan dards for this new pro fes sion. The LLLI Lac ta tion Con sult ant Depart ment was formed in 1982 and, in 1985, estab lished the Inter na tional Board of Lac ta tion Con sult ant Exam in ers (IBLCE). IBLCE pro vides pub lic pro tec tion through the admini stra tion of an exami na tion designed to evalu ate the com pe tency of indi vidu als who wish to enter the field of lac ta tion con sult ing. Can di dates must meet the exami na tion require ments, which include aca demic prepa ra tion and clini cal prac tice. Suc cess ful can di dates are awarded the cre den tial, Inter na tional Board Cer ti fied Lac ta tion Con sult ant (IBCLC). The Inter na tional Lac ta tion Con sult ant Asso cia tion (ILCA), was formed in 1985 by mem bers of the first group of can di dates to be exam ined and cer ti fied as IBCLCs. As the pro fes sional organi za tion for lac ta tion con sult ants, ILCA pro vides lead er ship, edu ca tion, and advo cacy; facili tates research; and coop er ates with national and inter na tional organi za tions in pro mot ing pro fes sional excel lence in lac ta tion man age ment. In 1995, ILCA pub lished the Stan dards of Prac tice for Lac ta tion Con sult ants. This docu ment, revised in 1999, defines the prac tice parame ters for lac ta tion con sult ants. Devel op ment of stan dards pro motes con sis tency of prac tice by encour ag ing a com mon sys tem atic approach. Hav ing for mal ized stan dards allows for the devel op ment of poli cies, pro to cols, edu ca tional pro grams, and qual ity improve ment efforts that will

Belly Models as Teaching Tools: What Is Their Utility?:

Marble/ball models are often used to represent newborn stomach capacity; however, their accuracy has not been determined. The objective of this review was to analyze data on newborn stomach capacity and determine whether marble/ball models serve as accurate representations. A literature search yielded limited data, most emanating from the early 1900s. Data suggest that anatomic capacity of the newborn stomach varies with the birth weight of the infant. Physiologic capacity bears no relation to anatomic capacity of the newborn stomach but is a measure of the ability of the mother to produce milk and the newborn to ingest milk. Given the wide range of feeding volumes on days 1 and 3 and the reported 8-fold increase in average feeding volume during the same time period, it is best to acknowledge that feeding volumes like anatomic stomach capacity vary widely and do not lend well to visual representation by marble/ball models. J Hum Lact. 24(2):199-205. Los modelos Bolas/Canicas (Marble/balls) se usan con frecuencia para representar la capacidad estomacal del recién nacido, pero su precisión no se ha determinado. El objetivo de esta revisión fue de analizar datos sobre la capacidad estomacal del recién nacido y determinar si los modelos marble/ball son representaciones precisas. Una revisión de la literatura mostró datos muy limitados, la mayoría de principios de los 1900s. Los datos sugieren que la capacidad anatómica del estomago del recién nacido varia con el peso al nacer del bebe. La capacidad fisiológica no tiene relación con la capacidad anatómica del estomago del recién nacido, pero es la medida de la habilidad de la madre de producir leche y la ingesta del recién nacido. Dado el gran margen de los volúmenes de alimentación en el día 1 y 3 y el aumento de 8 veces reportado en el promedio del volumen de alimentación durante el mismo periodo, es mejor reconocer los volúmenes de alimentación como la capacidad anatómica que varía en un gran margen y no confiarse a la representación visual de los modelos marble/ball.