Breastfeeding 1-2-3

Interview with Dr. Jane Morton, Director of Breastfeeding Medicine at Lucile Packard Children’s Hospital and Clinical Professor at Stanford University School of Medicine

by Angela White, J.D., breastfeeding counselor on March 9th, 2007

I was lucky enough to have the opportunity to conduct a telephone interview with Dr. Jane Morton, Director of Breastfeeding Medicine at Lucile Packard Children’s Hospital and Clinical Professor of Pediatrics at the Stanford University School of Medicine.

When I told her that I was interested in looking at the fact that breastfeeding instruction is lacking in medical schools across the country, she replied:

I couldn’t agree more and the American Academy of Pediatrics also agrees completely. That’s why the American Academy of Pediatrics and the Health Resources and Services Administration’s Maternal and Child Health federal bureau have put together a multi-specialty breastfeeding curriculum that is in its first pilot year at seven pilot sites and seven control sites across the country. The seven pilot sites are Duke University Medical Center, Harbor-UCLA Medical Center, Jacobi Medical Center in New York, Medical University of South Carolina, MetroHealth Medical Center in Ohio and Texas Tech [University Health Sciences Center at Amarillo]. Out of 70 applicants we chose ones that had a good number of residents in both obstetrics and pediatrics and in family practice and also were located in underserved communities. There are over 400 different residents participating.

Dr. Morton went on to describe the unique model breastfeeding curriculum put together by a group of academicians in the field. There are two prongs to the curriculum for the residents: Advocacy – how to support breastfeeding in what you do and say — and Clinical Management. With respect to Clinical Management, Dr. Morton states:

There are three clear things that every single resident needs to be able to teach every single mother: (1) four nutritional parameters, (2) hand expression, and (3) positioning and latch.

She elaborated on the four nutritional parameters: (1) it’s normal for the baby to lose weight in the first few days, (2) the baby should regain that weight within 10 days, (3) the baby only takes in a teaspoon – 5 milliliters – of breast milk at a feed in the first day (about an ounce total), and (4) the baby should have bright yellow mustard-like poop by day 5. The parameters can be summarized easily for tired residents and overwhelmed new mothers as 10-5-5: regain any lost weight in 10 days, take in 5 ml of milk per feed in the first day, and have yellow breast milk poop by day 5.

I found very interesting what Dr. Morton had to say about the second element: hand expression. She firmly believes that most mothers should not need to rent a breast pump when they leave the hospital to get their milk supply up. Instead, they can be taught the art of hand expression, which is free and more gentle than a pump. Hand expression can help relieve engorgement, gently express milk when a mother is in pain or having trouble getting the baby to latch on, and stimulate the breasts to produce more milk. Dr. Morton hinted at new research that suggests that hand expression used in conjunction with pumping in the first three days is much more effective in promoting subsequent milk production than pumping alone. If women were taught to hand express in the first three days after giving birth, their milk production could be boosted significantly and fewer women would experience problems (or unnecessary worries) over low milk supply. Look for that research to be presented at the international conference of the Pediatric Academic Societies in Toronto, Canada in May. Dr. Morton will also help get out the word through a new video entitled “Making Milk.”

Personally I gave up my manual pump and switched to hand expression long ago. It’s simple, sanitary (no equipment to sterilize), and it worked the best to clear the plugged ducts I experienced early on when breastfeeding my first daughter. I’m very encouraged by the thought that women, regardless of their income, could be empowered with the knowledge of how to hand express their milk and boost their milk supply.

Back to the third element of the Clinical Management portion of the curriculum: positioning and latch. The residents are learning how to demonstrate the cross-chest or cross-cradle hold for the baby and the sandwich hold or “C-hold” on the breast to get the most effective latch. The cross-cradle hold allows for a deep latch with the lower jaw and tongue massaging the breast tissue below the nipple and allows the mother to see the baby’s jaw.

These techniques are being taught to residents in the pilot program regardless of each resident’s gender. Dr. Morton reports that the pilot year is being very well received. She says that doctors in the past may have been reluctant to support breastfeeding because they were never trained in it.

They never had a “see one, do one, teach one” in breastfeeding. That is where you watch a procedure, have someone watch you, and teach someone else how to do it. Residents enjoy being able to help at a mother’s bedside. It’s all part of taking breastfeeding out of the closet and making it a norm and making it a comfortable process to ask for help.

The pilot program will be analyzed to compare breastfeeding rates among women helped before the residents received the training and after they started the training, and that data will also be compared to information from the seven control sites. Results should start coming in by the end of summer 2007. The program has already generated a tremendous amount of interest from other schools.

The program sounds fantastic and it’s wonderful progress forward in breastfeeding instruction. I want to thank Dr. Morton for taking the time to speak with me and share her inside knowledge of the model breastfeeding curriculum. You can read more about Dr. Jane Morton at her biography on the Breastfeeding.com site.

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