2022 Webinar: Turning the Tide for Birth and Breastfeeding

Women birthing in Australia routinely experience the juxtaposition of two paradigms where the concept of safe motherhood is restricted to physical safety at birth, and a holistic paradigm where safe motherhood is much more than the prevention of death and disability.  All women have a right to equitable, dignified and respectful maternity care. Respectful maternity care encompasses respect for a woman’s human rights; disrespectful maternity care diminishes this. Women’s memories of their childbearing experiences stay with them and are shared with other women, contributing to a climate of confidence or doubt around childbearing.  It is important to understand and appreciate how the care provided to childbearing women can either promote optimal health or cause long term physical harm and emotional trauma.  The presentation will explore:
• The Distinctive Importance of the Childbearing Period and the Childbearing Paradigm.
•  How current maternity care practice is impacting on child bearing women and the factors that supported health and wellbeing of women rather than those that cause disease.
•  How human rights are implicated in the childbearing process and affirming their application to childbearing women as basic, inalienable rights. • Propose a model for change - Respectful Maternity Care.

In this presentation, Professor Chamberlain will:

• Briefly outline the key features and causes of complex trauma
• Discuss the impact of trauma, particularly impacting Aboriginal and Torres Strait Islander communities
• Describe the importance of the perinatal period – including pregnancy, birth and breastfeeding, for parents experiencing complex trauma, and the opportunities for recovery
• Share experiences of pregnancy, birth and breastfeeding from parents who were impacted by complex trauma
• Invite reflection on the key principles for supporting breastfeeding among women experiencing complex trauma

IBLCE Content Outline:

0.75 L Cerp (V, VII)

• V Psychology, Sociology & Anthropology
• VII Clinical Skills

Lisa Amir - Mastitis: cases and current research – 1hr (1 L cerp)

Mastitis may be non-infectious (e.g., when the infant sleeps through the night for the first time), but can progress to infection, especially if nipple damage is present and bacteria can enter breast tissue (usually in first eight weeks postpartum). One in five breastfeeding women are diagnosed with mastitis, and the usual organism is Staphylococcus aureus. Breast cellulitis is a type of mastitis and may be caused by a Streptococcus spp infection rather than the typical S aureus. Lisa discusses the results of her research project to understand how general practitioners (GPs) manage mastitis by analysing data from a large GP database and interviewing GPs. 

At the end of this presentation participants will be able to:

-      Understand mastitis is a continuum from inflammation to infection.

-      Be able to demonstrate therapeutic breast massage.

-      Be familiar with recent research describing how mastitis is managed in general practice.

Catherine Bell - The Birth Map: Facilitating communication and informed decision making in maternity services – 1hr (1 R cerp)

Birth plans were introduced to provide a sense of agency to women in an increasingly medicalised maternity care system. They were intended to improve communication between maternity care providers and women. However, in the 40 years since their implementation, they have often been reduced to templates and checklists, which no longer facilitate communication and hence impact on informed decision making.  In addition, the term ‘plan’ has been criticised for its perceived lack of flexibility. This presentation will introduce a new study, which seeks to evaluate aspects of a new woman-centred, structured approach to birth preparation - Birth Cartography.

At the end of this presentation participants will be able to:

-      Have increased insight into the problems faced by women entering our maternity system

-      Understand potential solutions to implement to facilitate better communication

-      Know the difference between a birth plan and a birth map.

Norma Barrett – 0.75hr (0.75 R cerp)

The transition to parenthood (TTP) is widely recognised as a very challenging time for most parents, iImpacting their physical and mental wellbeing. Both mothers and fathers are now known to be susceptible to perinatal depression and anxiety. The average couple also experiences a decline in romantic relationship functioning. There is a dearth of evidence on father experiences of this important life stage. Norma will discuss the findings of her study identifying the experiences of fathers in their journey to becoming parents and during their early parenting years. 

At the end of this presentation participants will be able to:

-      Recognise the implications of inclusion/exclusion of fathers in parent related consultations/support provision from the perspective of fathers. 

-      Recognise the support needs of new fathers and fathers of young children. 

-      Consider how they may maximise father inclusion in parent consultations and support services to maximise family wellbeing.

“Do I have enough milk?” seems to be a constant question among new mothers. What constitutes low milk supply in the breastfeeding mother? What is the difference between true undersupply and perceived undersupply? This presentation will explore some of the issues which can contribute to low supply including iatrogenic factors, IGT, hypoplasia.

• At the end of this presentation participants will be able to:
• have a deeper understanding of causes of undersupply
• know the importance of taking a good medical and birth history.
• be able to make a more effective breast assessment
• have strategies for increasing milk supply, including when galactagogues may or may not be effective.

Dignity is a core concept in human rights, ethics, politics, philosophy and respectful maternity care. Dignity is an inalienable right, based on the inherent human worth of a person. Dignity is the opposite of humiliation and shame. Dignity describes the felt experience of being valued while innate human vulnerability is acknowledged and addressed. Pregnant women are generally in a vulnerable position and how this is managed by maternity care professionals may either increase or decrease such vulnerability.  A woman’s vulnerability becomes clear when her freedom and dignity is compromised.  In maternity care, dignified environments and processes are those in which both the woman’s values and vulnerability are acknowledged and accommodated simultaneously, where she is recognised, empowered, understood, and treated with safety, fairness and accountability.  The acceptability and quality of maternity care services include treating patients with dignity, creating trust and preventing harm.  The most important thing is that maternity services, across Australia provide the best possible care for women and their families. This requires a system that focusses on both experience of care - the interpersonal aspects of care as well as the quality of that care.   We know that for various reasons failures in care do happen and women and their babies are the ones who pay the price.  Australia needs to ensure responsive, sensitive maternity care systems that cater for the individual woman and respect her human rights.  Understanding, embedding and monitoring dignity in maternity care has the potential to make a real difference to women’s experiences of pregnancy and childbirth. The presentation will explore: • Women’s experience of maternity care • Women’s solutions to address the problems •           Propose a model of empowerment for women requiring maternity care. 

Lisa Amir - Reducing the maternal medication barrier to breastfeeding – 0.75hr (0.75 L cerp)

For most maternal medications, the potential for harming the breastfed infant is minimal; only small amounts of medication are transferred into human milk and absorbed by the infant. Most reviews of medications for breastfeeding women conclude that the benefits of medication use during lactation outweigh the risks. Yet, health professionals and families are often unsure about safety of medicines on the breastfed infant, and this is still a barrier for achieving Australia’s breastfeeding goals.

At the end of this presentation participants will be able to:

-      Understand the basic pharmaco-physiology of medications in lactation.

-      Know where to access evidence-based information about medications in lactation.

-      Be able to discuss medication safety in lactation with families.

The COVID-19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS-CoV-2, including quarantine procedures, travel restrictions, border closures, physical distancing and “stay-at-home” orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. Alyce shares the results of her study which aimed to explore women's experiences of receiving maternity care during the COVID-19 pandemic in Australia.

At the end of this presentation participants will:

• Understand Australian women’s experiences of maternity care during the first wave of the COVID-19 pandemic
• Describe how we can draw on lessons learned to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises

Frances Walker - Breast fed babies and food sensitivities: Diet is an option -1hr (1 L cerp)

When breast fed babies seem to be reacting to breast milk, dietary modification can be a powerful tool to manage food sensitivity while successfully enable ongoing breast feeding. In this presentation, Frances explains the process of supporting mothers through this: from identifying triggers, implementing elimination diets and monitoring results to how to safely reintroduce foods/allergens into the diet. Parents are often not aware of dietary options to help manage their baby’s symptoms- providing this treatment modality can often produce excellent results in symptoms while (importantly) avoiding cessation of breast feeding.

At the end of this presentation participants will be able to:

-      Recognise that food allergens and other food components can have their effect via breast milk 

-      Identify red flags for food sensitivity in babies

-      Understand impacts of potential food sensitivity on babies

-      Understand nutritional adequacy around food exclusions especially if a food group is taken out needs to have replacement of lost nutrients, but can be achieved with professional assistance.

Nisha Gill - A Neuro-physiological approach to trauma minimization in the perinatal continuum – 1.5hr (1.5 L cerp)

The high incidence of birth trauma in current times demands that innovative whole-person and whole-family approaches to trauma prevention are imperative to turn around the tide. Applying a neuro-physiological or polyvagal lens to trauma offers an appreciation of our mammalian roots where a sense of safety and attuned connection are foundational to promoting resilience among birthing families.  This presentation highlights the ways in which perinatal professionals can work at the micro level to help mitigate the potential for trauma and support families to shift from surviving to thriving.

At the end of this presentation participants will be able to:

- Understand the neuro-physiological basis for trauma including the concepts of neuroception (detection of safety versus threat), window of tolerance/ resilience range, co-regulation on a primordial level, and the defensive survival states of Fight, Flight, Freeze & Appease.

- Identify five main factors which promote a sense of safety and regulation in the pregnant, birthing or postpartum person & their family.

- List three ways in which the potential for trauma can be reduced specifically during each phase of the perinatal journey:  pregnancy, birth and the postpartum.

Phillip Baker - Breastfeeding, first-food systems and corporate power: Understanding the market and political practices of the transnational baby food industry – 0.75hr (0.75 L cerp)

The global milk formula market has ‘boomed’ in recent decades, raising serious concern for breastfeeding, and child and maternal health. Few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this presentation, the aim is to demonstrate the strategies used by the baby food industry to shape ‘first-food systems’ across its diverse markets, and in doing so, drive milk formula consumption on a global scale. New modalities of public health action are needed to negate the political practices of the industry, and to constrain corporate power over the mother-child feeding dyad.

At the end of this presentation participants will be able to:

-      Understand the market and political practices used by the baby food industry to expand, sustain and protect markets for commercial milk formulas in Australia and globally

Consider new ideas and proposals for countering the power of the baby food industry in order to advance global breastfeeding and the rights of mothers and children to optimal health and nutrition.

Oxytocin: From Birth to Breastfeeding