IBCLC Detailed Content Outline: Development and Nutrition Focused CERPs - Section I
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When a Baby Dies: Providing Care and Support
Dr Vicki Culling is the Director and principal trainer for Vicki Culling Associates. Vicki is a bereaved parent and has been actively involved in Sands (an organisation that supports families when a baby or child dies) for over fifteen years. The stillbirth of her first daughter led her to utilise her skills, in supporting bereaved parents and families and educating health professionals with in-person workshops and online learning. Vicki was a founding member of the NZ national Perinatal and Maternal Mortality Review Committee (PMMRC) set up in 2005 and charged with collecting data on perinatal and maternal mortality and morbidity in NZ. Vicki is a current member of the NZ Ministry of Health’s Maternal Fetal Medicine Governance Board and vice-Chair of the National Perinatal Pathology Clinical Governance Committee. She also works as a lay reviewer for the Medical Council of NZ and the Dental Council of NZ. She lives in Wellington with her husband Kevan and daughter Phoebe.
In this presentation, we will explore grief and baby loss from a first-world, Western perspective. We will reflect on how our attitudes to grief have formed and look at the differences between traditional and contemporary approaches to grief and the tension that lies between them. We will also discuss some of the different ways that baby loss is discussed societally – looking particularly at platitudes, euphemisms and the tendency to minimize a baby’s death. We’ll finish with an exploration of our own approach to supporting bereaved families - our philosophy of care. At the end of this presentation, participants will have an array of concepts to help reflect on the care they give to parents and families who have experienced the tragedy of neonatal death.
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Where Should We Dig? Not All Gold Is Buried Under the Tongue
Carol has been a therapeutic bodyworker in Portland, Oregon for over 26 years. She is a retired home birth midwife. She specializes in infant and maternal Craniosacral Therapy.
Carol is convinced that if women are appropriately supported in growing, birthing and nurturing their babies, their lives will improve. When women's lives improve their children's health improves. Healthy children grow up to be healthier adults who create healthier communities and a saner, more peaceful world. Carol believes that when things are out of balance even the smallest intervention can bring about great healing. Our need for it is so great.
Carol is passionate about using her CST skills to gently make space in maternal bodies so babies can assume ideal positions for gestation and birth. She is currently developing specialized prenatal yoga classes to support and enhance the maternal bodywork techniques she practices and teaches.
Topic: Where Should We Dig? Not All Gold Is Buried Under the Tongue - [View Abstract]
Carol will explain how the sources of tongue and oral dysfunction aren’t always in the mouth. Sometimes the gold is buried elsewhere. She will discuss torques and twists in the body that extend into the floor of the mouth and express themselves as a lack of tongue mobility. She will discuss how fetal lie and restricted fetal mobility cause babies to grow in ways that negatively impact their breastfeeding. These things may masquerade as and/or exacerbate tongue mobility issues disguised as short frenula. Carol will also explain the CST treatment approach for these babies.
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Why Are We Still Hurting Babies: Provider And Parent-led Interventions For The Treatment And Prevention Of Procedural Pain
Dr. Marsha Campbell-Yeo, a neonatal nurse practitioner and clinician scientist, is a Full Professor at the School of Nursing, Faculty of Health, Dalhousie University and holds cross appointments in the Department of Pediatrics, and Psychology and Neuroscience. Her Canada Foundation of Innovation funded research lab, MOM-LINC (Mechanisms, Outcome and Mobilization of Maternally-Led Interventions to Improve Newborn Care) is located at the IWK Health Centre. She primarily holds grants examining interventions to improve outcomes of medically at-risk newborns specifically related to pain, stress, and neurodevelopment as well as novel knowledge synthesis and dissemination methods, and digital e-heath interventions aimed at enhancing parental engagement.
She has been recognized for her contributions to the field via numerous awards. She has received an Honorary Doctorate from the Faculty of Medicine and Science from Orebro University, Sweden, and invited as a member of the Royal Society of Canada's College of New Scholars, Artists and Scientists, the recipient of the Inaugural Dalhousie University President's Award for research excellence, was named one of 150 Nurses championing innovation in health for Canada by the Canadian Nurses Association to mark the 150th anniversary of Confederation, a Canadian Institute of Health Research New Investigator Awardee, the Canadian Pain Society 2015 Early Career Awardee, and a Career Development Awardee of the Canadian Child Health Clinician Scientist Program. She is President-Elect of the Pain in Childhood Special Interest Group of the International Association for the Study of Pain, an Executive member of the Council of International Neonatal Nurses, and the Inaugural Chair of the Canadian Premature Babies Foundation Scientific Advisory Committee. Follow her on Twitter @DrMCampbellYeo
Topic: Why Are We Still Hurting Babies: Provider And Parent-led Interventions For The Treatment And Prevention Of Procedural Pain - [View Abstract]
After decades of healthcare providers not recognizing newborn infants’ capacity to feel pain and the associated adverse outcomes, we now know that current evidence suggests that repeated procedural pain contributes to long-term changes in stress regulation and brain development in vulnerable preterm infants, after accounting for associated clinical confounders. Many medications are often not effective for the most commonly performed painful procedures, and their repeated and frequent use may have potential short and long-term adverse effects. Recent research has thus focused on finding non-pharmacological interventions or sweet tasting solutions as a substitute to pharmacologic treatments, or as a means to reduce the drug-doses needed for optimal analgesia associated with procedural pain. Several of these interventions involve parents, e.g., skin-to-skin care, breastfeeding, or facilitated tucking. Despite this knowledge, clinicians often struggle with incorporating these strategies into everyday practice. Moreover, most parents and many providers remain unaware of the powerful benefits of integrating parents as active participants in newborn pain management. This presenatation will cover interventions to address the treatment and prevention of procedural pain.
Working With Families Feeding Beyond 12 Months: Offering Support With Confidence
Emma became a breastfeeding counsellor with the UK's Association of Breastfeeding Mothers in 2007. She has been an IBCLC since 2011 and volunteers at two groups in Haringey in North London. She is on the board of trustees for the Human Milk Foundation - a charity committed to improving access to donor human milk. She has written several books including ‘You’ve Got it in You: a positive guide to breastfeeding’ for new parents and ‘The Breast Book’ for pre-teens and teens. Her book, “Breastfeeding past the first six months and beyond: a guide for professionals and parents” was published by Jessica Kingsley Publishers and followed in February 2024 by ‘Supporting the transition from breastfeeding: a guide to weaning for professionals, supporters and parents’. She devotes a portion of her private practice to supporting parents who continue to breastfeed beyond infancy, including during the weaning process. In 2022, Emma received the Lactation Consultations of Great Britain award for outstanding contribution to breastfeeding. You can find her at www.emmapickettbreastfeedingsupport.com and on instagram as @emmapickettibclc. Her podcast "Makes Milk with Emma Pickett" launched in September 2023.
Topic: Working With Families Feeding Beyond 12 Months: Offering Support With Confidence - [View Abstract]
This session focuses on supporting parents who are breastfeeding/chestfeeding beyond 12 months. Many of us live in countries where breastfeeding beyond 12 months is not the norm. When it does happen, it may not happen openly. Parents are often feeling increasingly isolated and may be dealing with lack of support from family and friends. There can be further challenges such as new issues with positioning and attachment, conversations with employers and health professionals, dealing with family break-up and thinking about new pregnancies. Parents continuing to feed older children may not always feel able to reach out to local breastfeeding support services that often focus on the newborn period. You will be encouraged to reflect on your personal approach to supporting feeding older children and whether you have any unconscious or conscious bias that may affect your work. The session will give you confidence to discuss the value of continuing to breastfeed with families and colleagues and be able to offer a variety of support.
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“The Little Engine That Could”: Breastfeeding Journeys of Very Premature Babies on Home Tube Feeds
Karen Lasby leads a specialized nursing team in post-discharge follow-up of extremely premature infants and their families in Alberta, Canada. She has presented locally, nationally, and internationally on the topics of premature babies, neonatal oral feeding, and NICU-to-home transition, including the 2019 and 2022 GOLD Neonatal Conferences. She has been the co-investigator in several research studies examining outcomes for very low birth weight infants and has published articles on maternal work in the NICU, neonatal transition, and gastroesophageal reflux. An educator for nearly thirty years, Karen has taught, written instructional material, and produced online neonatal nursing courses. Formerly the president of the Canadian Association of Neonatal Nurses, she served on this national board for twelve years, and on the board of the Council for International Neonatal Nurses for three years. Karen’s work has been recognized by the Canadian Institute of Child Health and College and Association of Registered Nurses of Alberta. Karen is the co-author for the parent book, "Preemie Care: A guide to navigate the first year with your premature baby".
Noriko Woods is a member of a specialized nursing team in post-discharge follow-up of extremely premature infants and their families in Alberta, Canada. She started her Level 4 NICU RN career in Kanagawa, Japan, trained and worked for 5 years before moving to Canada. She worked 5 years as a Level 4 NICU RN in Calgary Alberta before she started her current position at Postpartum Community Health Services, as a public health nurse. She became passionate about breastfeeding with her own experience with her first child in 2009 and obtained the IBCLC in 2011. She has been working with early postpartum mothers and babies to reach their breastfeeding goals as a Lactation Consultant in her community. She is passionate about supporting families to achieve positive feeding experience with a bottle and at breasts. She has been participating with various committees such as Calgary NICU LC group to revise the breastfeeding guidebook for NICU parents, Calgary Breastfeeding Matters Group annual conference committee, GOLD Neonatal Professional Advisory Committee.
Long NICU stays, invasive oral procedures, chronic lung disease, and gastrointestinal complications can contribute to a complex oral feeding journey for premature infants. Frequently, the NICU journey prioritizes bottle feeding over breast feeding. Breastmilk supply and transfer are challenging for mothers and infants born very premature. At the time of NICU discharge, most very premature infants remain fragile oral feeders with weak breast-feeding and bottle-feeding skills, and some require tube feeding support. Community-based breastfeeding support is often lacking, and breastmilk intake and direct breastfeeding diminish beyond discharge. The authors will highlight four remarkable case studies of very premature newborns who were discharged home on nasogastric tube feeding. All four babies had a complex oral feeding journey in the NICU with minimal opportunity to develop breastfeeding skills. Parent comments will be shared, including barriers and facilitators for breastfeeding. Take away messages will focus on helpful strategies to support families taking home a fragile feeder and progressing toward positive, enjoyable oral feedings and more importantly, weaning from tube support and advancing breastfeeding.
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“Zooming Ahead”; Post-NICU Discharge Very-Low-Birth-Weight Infant Follow-up Program Goes Virtual
Karen has worn a number of hats in her nursing career but always comes back to her passion for premature babies. Her background includes NICU nurse, transport nurse and NICU educator, rural nursing, staff development, pediatrics, pediatric intensive care, and community health. For over 20 years Karen has lead Calgary’s specialized “Neonatal Transition Team”, which she will talk about today. Karen has presented locally, nationally, and internationally and has also been co-investigator in several research and quality improvement studies examining outcomes for very low birth weight infants. For nearly 30 years, Karen taught, wrote instructional material, and produced on-line courses for nurses to earn a certificate in neonatal nursing through Mount Royal University. Karen is a past-president of the Canadian Association of Neonatal Nurses and served on this national board for 12 years, and on the international board of the Council for International Neonatal Nurses for 3 years. In 2019, Along with co-author, Tammy Sherrow, Karen published the book “Preemie Care: A guide to navigating the first year with your premature baby”.
Topic: Home Sweet Home? Realities and Remedies - [View Abstract]
Topic: “Zooming Ahead”; Post-NICU Discharge Very-Low-Birth-Weight Infant Follow-up Program Goes Virtual - [View Abstract]
Many preterm infants remain vulnerable following discharge from the neonatal intensive care unit (NICU). Health challenges persist beyond the NICU including respiratory illness, breastfeeding progression, bottle feeding incoordination, behavior and development issues, impaired growth, infrequent stooling, and gastroesophageal reflux. Preterm infants are up to two times more likely than full term infants to be hospitalized in the first year of life. Parents are challenged to transition their premature baby home and to keep them home!
Community-based, specialized follow-up services following NICU discharge have a powerful impact. The Neonatal Transition Team in Calgary, Alberta, Canada provides post-NICU follow-up for very-low-birth-weight infants and their families. The team consists of community health registered nurses with advanced skill in premature infant outcomes, feeding and neurodevelopmental assessment, and a consultation partnership with nutritional and feeding specialists. While home visits have been the backbone of this service, the team questioned the feasibility and acceptance of virtual care and completed a three month quality improvement pilot. This virtual care pilot demonstrated optimization of health-care resources by providing safe, high-quality care at a reduced operational cost. The pilot was instrumental in the team’s management during the SARS-COVID-19 pandemic. Virtual care has been fully operationalized into the service delivery model and expanded to serve other newborns with feeding or growth challenges.
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