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Improving Postpartum Health in Babies and Mothers

December 8, 2015

Drexel’s College of Nursing and Health Professions can add another notch to its belt when it comes to programs that boast a 100% pass rate on a professional licensure exam. The first cohort of students from the Human Lactation Consultant program graduated this spring, and this fall, all successfully passed the International Board of Lactation Consultant Examiners (IBLCE) exam. Now, as newly minted International Board Certified Lactation Consultants (IBCLCs), they’re ready to put their skills to good use.
Beckie Walker ‘15, Lisa Dell ‘15 and Brooke Azevedo are the first alumni to graduate from the Human Lactation Consultant program, but they plan to put their certifications to use in different capacities. For Walker and Dell, IBCLC certification was an impressive addition to their bachelor of science in nursing degrees which were awarded in June 2015. For Azevedo, a non-matriculated student with an education background, enrollment in Drexel’s program included a bit more risk – but ultimately enabled her to follow her passion of helping families raise healthy children. 
“My background was in elementary education,” said Azevedo, “but about three months after breastfeeding my first son, I received help from an IBCLC. I became really interested in the benefits of breastfeeding and overcoming obstacles, and over the next year I started helping friends more and more with issues they faced while breastfeeding.”
Azevedo is representative of a growing community of mothers, educators, hospitals and public health advocates who seek to promote the myriad benefits of breastfeeding and to provide assistance to mothers that may be struggling postpartum.  Breastfeeding advocates have slowly gained momentum over the last 60 years as the body of research in its favor continues to grow.
Rachelle Lessen, MS, RD, IBCLC, adjunct professor in the Nutrition Sciences department and co-creator of Drexel’s Human Lactation Consultant program, knows first-hand that the benefits of breastfeeding are real.  A Registered Dietician since 1994 and IBCLC since 1996, Lessen has been helping families at the Children’s Hospital of Philadelphia overcome obstacles like failure to thrive and food allergies for over two decades. Her experience with this subject is extensive to say the least.
“In addition to more and more evidence regarding the risks of infant formula – like increased risk of SIDS, ear infections and hospitalization for infants, and depression in mothers, the positive statements of support from major groups like the American Academy of Pediatrics show there are efforts at the national level to increase breastfeeding support,” said Lessen.  Endorsements from organizations that have political clout, coupled with a growing body of evidence, have resulted in a trickle-down effect that will positively impact families and their children.
One of the most significant ways the trickle-down effect has manifested itself is a push to make hospitals more baby friendly. Beth Leonberg, MS, assistant clinical professor, director of the didactic program in dietetics and chair of the Human Lactation Consultant program, believes this designation will be fervently sought after by many hospitals and health care networks in the coming years.
“Hospitals are trying to get the baby friendly designation which means they’re not offering formula within a certain number of days postpartum, and they’re not sending parents home with discharge packs of formula,” said Leonberg. “One of the things we think undermines the breastfeeding preface is that when you give a mom these packs, it’s so easy to give up.”
Lessen and the City of Philadelphia agree.
“The Baby Friendly Hospital Initiative is expanding to more and more hospitals each year as more evidence from the CDC shows how birth practices influence breastfeeding success,” said Lessen. “Free formula distribution from the birth hospital has been banned in Philadelphia-area hospitals due to strong evidence that formula given for free reduces exclusivity and duration of breastfeeding and results in higher risk of acute and chronic disease in both mother and baby.”
While cities like Philadelphia are setting the precedent by banning formula and emphasizing breastfeeding, the transition hasn’t been easy. 
“In the 50s and 60s, instant formula was introduced as the new, better thing,” said Leonberg. “There’s no question that standard formula is a good thing since it’s designed to mimic breast milk as much as possible, but there’s also no way that, scientifically, you can be just as healthy feeding with formula as you can with breast milk. There’s no way to defend that claim.”
So what’s changed since the mid-20th century that tipped the scale in favor of breastfeeding?
“Generational habits perpetuate themselves until the body of evidence about the benefits of breastfeeding gets so large it can’t be ignored,” said Leonberg. The political landscape has also shifted in favor of breastfeeding, with legislation like the Affordable Care Act that earmarks specific benefits for new mothers.
“The Accordable Care Act has provisions for women’s health services that include breastfeeding supplies and counseling by a trained provider without cost sharing,” said Lessen. “Laws have been enacted to protect the right to breastfeed in public, and women are becoming more comfortable breastfeeding whenever they are with their babies.”
Given the favorable political landscape, businesses also have an opportunity to enhance their bottom-line and usher in a new era of parent-friendly practices. “The HRSA Business Case for Breastfeeding demonstrated how employers can benefit by supporting breastfeeding in the workplace, thus making it possible for women to breastfeed even after they return to work,” said Lessen. Leonberg agrees, stating that healthier babies and mothers can result in less missed work days due to illness.
Despite state and national support for breastfeeding, and legislation that supports it, there are still some barriers to accessing International Board Certified Lactation Consultants (IBCLCs). “Insurance coverage is spotty and many insurance companies have unlawful restrictions on coverage,” said Lessen. “It’s difficult but not impossible to get insurance to pay for IBCLC services.”
There’s also a significant lack of supply when it comes to educating and training professionals that want to become IBCLCs. This is why Drexel stepped in and became one of only five programs recognized by the IBLCE as a Pathway 2 lactation program. In Drexel’s program, students complete 90 hours of didactic coursework followed by 300 hours of supervised practice prior to obtaining certification. 
Andrea Judge, MPH, IBCLC, adjunct instructor in the Nutrition Sciences department, brings students into the field to learn the basics of breastfeeding first-hand. Experience is accrued at Pennsylvania Hospital, Hahnemann Hospital, and WIC locations throughout Philadelphia and South Jersey.
“Our students get to work alongside lactation consultants and/or peer counselors as they work with prenatal and postpartum mothers,” said Judge. “They assist with teaching mothers the importance of skin to skin contact and frequent feedings. They work to ensure the mothers are comfortable with latching and positioning the babies for feeds, and know what feeding cues look like. If a mother is having discomfort or the baby is not feeding well, the students get the opportunity to educate the mother on how to make adjustments.” Throughout the 300 hours of supervised practice, Drexel students are honing the skills needed to support mothers throughout their breastfeeding experience. 
“Completing the supervised practice really brought everything full circle and was a great way to gain exposure to real-life breastfeeding issues,” said Azevedo, who is sorting through multiple job offers now that she has her certification. “The most beneficial part of the program was the professors. There is no other place in the US where you can get this kind of support in a similar program – the professors really are the ‘Dream Team.’ ”