Friday, November 28, 2008

UNICEF BFI Conference Day Two

I won't go into all the details like I did the other day, [I wrote that before I wrote this all out, so that turned out to be a lie] but I'll still share a bit about Day Two, as it was just as good, if not better, than Day One. Again, I'm going by memory, so let's see, what was first...

Oh yes. First was an as yet unpublished study by Mary Renfrew, professor at University of York, on best breastfeeding practice in neonatal units. Because the paper is coming out next year, she asked that any journalists not share her findings publicly, and while I'm not a journalist, I'll still respect that, but basically, it was an extremely informative study trying to determine the best practices for breastfeeding preterm babies. Immediately following her was Elizabeth Jones from North Straffordshire Hospital explaining the differences between preterm babies and full term babies and how breastfeeding must be treated in an entirely separate context for this group of vulnerable babies and how these 'best practices' should be implemented in hospitals. Again, it was very informative, and I really enjoyed both speakers. I can't remember which one said this, but one of them pointed out that they view breast milk in a preterm baby as a medical treatment, not a social choice, because no matter what the formula companies say, the two things a preterm baby needs for development and protection, which are long chain fatty acids and IgG [an immunoglobulin], cannot be added to formula adequately because a preterm baby will simply excrete these things without being able to use them (because they have yet to produce pancreatic lipases)*, whereas they are pre-digested in human breast milk. The other thing from these two lectures that I was most startled by is the fact that one study showed that the average yield of a breast pump is only 4% of a mother's available milk! There's some good news for those mums who look at their milk output in a pump and worry they don't have enough milk! But the reason this was pointed out was more to show caregivers how difficult it is for mother's of preterm babies to persevere with breastfeeding if it is all by pump and to encourage HPs to give the utmost support to these women.

There was then a lecture by UNICEF on how they are prepared to help hospitals achieve Baby Friendly status, and following that there were two talks about The Baby Cafe and the Little Angels peer support projects. Both were interesting and inspiring, though for those of us peer supporters in the area we are in, which has staggeringly low breastfeeding rates, we were more inspired by the Little Angels story, as they started from nothing too!

After lunch was perhaps my favourite lecture of the day. Dr Martin Ward Platt from the Royal Victoria Infirmary discussed neonatal hypoglycaemia evidence and recommendations for practice. It was incredible. I don't think he shared any 'new' information, just information we didn't know! He basically explained how the first few hours of ANY baby's life is the WORST time to check blood glucose levels because EVERY baby experiences a severe plummet in glucose as soon as they are detached from the placenta; the level is so low that in any normal adult, we would be absolutely comatose. He explained why then healthy, full term babies seem so alert and conscious despite this massive drop in glucose. Basically (I'll probably totally butcher this, but hopefully you'll get the picture), the stress of birth causes the baby's body to (getting out notes now) breakdown protein, which produces lactate, which the brain actually prefers to glucose. So in those first few hours where the stress of birth is still present and there is usually no maternal lactation for feeding**, the baby is fully sustained by lactate. Eventually, the stress of birth wears off and the liver begins using its store of glucose until the mother's milk comes in. When the liver stores of glycogen run out, protein breakdown slows and then hormonal control takes over to breakdown the baby's store of fat to produce ketones (which aren't the evil thing we are all conditioned to believe they are), which fuels the baby on until the mother's milk comes in***. Therefore, in 'high-risk' babies, it is important to withhold glucose testing for several hours (even past 4) to allow the body to regulate. Testing for glucose too early (in any baby) just means the care giver is likely to give formula or glucose supplements, and many babies will be treated unnecessarily. I love the way he stated it - Reaching for formula resolves no one's stress levels except the person reaching for the formula. He also talked about how much more important it is to check the baby's level of consciousness as a better indication of hypoglycaemia than anything else (if the baby is alert and responsive, he is most likely just fine, but if he is floppy and unresponsive, by all means, check the glucose), which he restated over and over. Anyway, there was a lot more to it than just that, but as I'm not a doctor or midwife, that's the part I found most interesting and useful to know.

The last lecture of the day was a presentation on a new website called healthtalkonline, which is set up for women to have a place to go for evidence-based information but also for support from other women who have been through similar experiences. It's actually surprisingly good (at least the breastfeeding part is, as that's the part the researcher showed us at the conference), so I recommend having a browse. You can watch video interviews of all kinds of different women discussing their experiences.

In the end, I thought the conference was wonderful, and I'm so thankful I was able to attend. I learned so much and wish everyone in the health profession who deal with women and breastfeeding could've been there! Next year's conference is in South England... we're already talking about saving up for it! (But then, my 10 year class reunion is in 2010 in America, and I think I'd rather save up for that...)

*As it has been pointed out in my comments below, there is a very small percentage of women (somewhere between 1%-3%, are the stats I have found) who are unable to produce milk, or enough milk. This is multiplied in women who have preterm babies, particularly before 36 weeks, whose breast tissues and mammary glands have not had ample time to fully develop. If lactation cannot be sustained, donor breast milk ought to be the next option for these vulnerable babies.

**An audience member asked him what he thought about colostrum, as newborns who are breastfeeding do receive colostrum, but he said there isn't enough study on colostrum to add it to his findings, and that colostrum should be studied more extensively.

***If a mother's milk does not arrive within a couple of days, the baby once again goes into stress, and the protein breakdown begins again, producing lactate and fueling the brain that way until the milk comes in, which is why again the baby still seems so alert, although perhaps a bit peeved, even after several days with no proper milk.

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