ABA Seminar: Breastfeeding: Science to Practice
Dr Amy Brown

Dr Amy Brown is an Associate Professor in the Department of Public Health, Policy and Social Sciences at Swansea University in the UK. Her research explores psychological, cultural and societal barriers to breastfeeding, with an emphasis on understanding how we can better support women to breastfeed and subsequently raise breastfeeding rates. Her primary focus is how we can shift our perception of breastfeeding as an individual mothering issue, to a wider public health problem, with consideration to how we can make societal changes to protect and encourage breastfeeding. 

Dr Brown has published over 50 papers exploring the barriers women face in feeding their baby during the first year. In 2016 she published her first book ‘Breastfeeding Uncovered: Who really decides how we feed our babies’, followed by her second ‘Why Starting Solids Matters’ in 2017.  She is a regular Huffington Post blogger, aiming to change the way we think about breastfeeding, mothering and caring for our babies.

What really matters when introducing solid foods? Timing, experience and responsiveness

How, when and why to introduce solid foods can feel overwhelming for new parents. Anxiety over which foods are ‘right’, whether their baby is ready or not and how much to give them can be high. Extra questions around whether you should give finger foods only, spoon-feed or a mixture of both can complicate the issue. Advice can be confusing – who do you trust, how do you know what they are saying is up to date, and what or who is influencing their words? If you are a health professional supporting parents the same concerns can arise.

This talk will examine the evidence for the what, when, how and why behind introducing solids to babies. It will explore what we know is important about this period, how this can be applied across different situations and unpack the different layers of influence upon advice around giving babies solid foods. It will pay specific attention to the evidence surrounding baby-led weaning as a method of introducing solids and consider how its underlying principles encourage a positive experience. The role of industry, sponsorship and generational advice will be central to this talk. 

What can we do to support mothers who don’t meet their breastfeeding goals – how guilt, anxiety and anger can turn to trauma.

Promoting breastfeeding as protective of both maternal and infant health is a central role for governments, health professionals and breastfeeding advocates. Talking about breastfeeding difficulties and why ingrained barriers must be tackled is essential to ensuring the situation changes for future mothers. However, sometimes it feels as if we are caught in a vicious cycle; we must talk about breastfeeding as our rates are low and many women wish they had breastfed for longer, yet discussing these issues is often criticized as causing pain.

This talk will present findings from a large research study which explored the experiences of over 3000 women who could not breastfeed for as long as they wanted. It will present their lasting emotions from their experience and their ideas for how we could promote breastfeeding in ways that cause them the least pain. The concept of negative breastfeeding emotions displaying as psychological trauma for a sub group of women will be discussed.  

Della Forster
Presenting in Melbourne Only

Della is a Professor of Midwifery and has a joint appointment between the Judith Lumley Centre at La Trobe University, and the Royal Women’s Hospital. Her research includes work on breastfeeding, maternity models of care and perinatal mental health. She lead the DAME randomised controlled trial recently published in the Lancet, as well as the RUBY trial of telephone peer support to increase breastfeeding at six months.

Della Forster & Anita Moorhead – Diabetes and Antenatal Milk Expressing (DAME): A Multi-center Randomised Controlled Trial

The DAME randomised controlled trial (RCT) investigated the safety and efficacy of the increasingly widespread practice of advocating breastmilk expression during pregnancy (for women with diabetes in pregnancy). This presentation will present the primary and key secondary study outcomes. 

Associate Prof Katie Hinde

Katie Hinde, Associate Professor, School of Human Evolution and Social Change, Center for Evolution and Medicine, Arizona State University. 

As Director of the Comparative Lactation Lab, she investigates the mother-infant dyad and the role of milk for organizing infant development. In addition to her cross-cultural work among human populations, Hinde has studied rodents, cows, and other animal species. She has established descriptive and explanatory mechanisms of milk synthesis in the rhesus macaque, the primary non-human biomedical model, and demonstrated how maternal life history, infant sex, and cultural ecology influence milk. She earned a BA in anthropology from the University of Washington in 1999, a PhD in Anthropology from UCLA in 2008.

From 2009-2011 she trained as a post-doc in neuroscience at the California National Primate Research Center, UC Davis and began her faculty career as an Assistant Professor in Human Evolutionary Biology, Harvard University 2011-2015. Author of dozens of essays and academic articles, Hinde situates her work at the intersection of the life sciences and social sciences to improve human health and well-being. Hinde co-edited “Building Babies: Primate Developmental Trajectories in Proximate and Ultimate Perspective” released by Springer in 2013, is an associate editor and writer for SPLASH! Milk Science Update.

She showcases research on mother’s milk, breastfeeding, and lactation for the general public, clinicians, and researchers at her blog “Mammals Suck… Milk!”

Mothers Milk and Baby Behavior.

Mother’s milk is more than a food full of essential nutrients and more than a medicine packed with protective immune-factors. Mother’s milk contains signals- hormones of maternal origin- that influence infant metabolism, neurobiology, and behavior. A growing body of evidence has demonstrated that hormones from the mother, ingested through milk, bind to receptors within the young. Once these “maternal-origin” hormones bind, they seemingly trigger hormonal signaling cascades as would the young’s own hormones. Some hormonal pathways underlie our behavioral tendencies- our individual predilection toward impulsivity, aggression, shyness, extroversion, etc.

The phenomenon of individual behavioral tendencies is variably known as temperament or personality. Glucocorticoids in mother’s milk have been associated with offspring temperament, behavior and cognition in rodents and monkeys. Among monkeys, glucocorticoids in mother’s milk, predict better cognitive performance and, independent of available milk energy, predicted a more nervous, less confident temperament in both sons and daughters. Recent research among human infants show important consistencies with the experimental animal research. Higher cortisol concentrations in milk were associated with greater infant weight gain across time.

Taken collectively, emerging results suggest that mothers with fewer somatic resources may be “programming” through cortisol signaling, behaviorally cautious offspring that prioritize growth. Glucocorticoids ingested through milk may importantly contribute to the assimilation of available milk energy, development of temperament, and orchestrate, in part, the allocation of maternal milk energy between growth and behavior.

How the Biological “Recipe” of Milk Differs for Sons and Daughters.

Mammalian females pay high energetic costs for reproduction, the greatest of which is imposed by lactation. The synthesis of milk requires, in part, the mobilization of bodily reserves to nourish developing young.

Studies from across mammal species from rodents to wallabies to monkeys to seals to humans, have revealed that milk synthesized for sons and daughters may differ in volume as well as nutrient, mineral, and hormonal concentrations. Biologists have proposed numerous explanations to predict how mothers will differentially invest in sons and daughters. Increasingly the evidence suggests that mother's milk is tailored to the developmental priorities and trajectories of offspring. When those priorities and trajectories may differ between sons and daughters, so does the milk the mother synthesizes.

Here we will explore the state of knowledge about sex-differentiated milk synthesis across mammals studied to date, how to interpret these findings, and how this information may motivate and guide maternal decisions to initiate and sustain breastfeeding.

Monica Hogan

Monica Hogan is currently registered as a Nurse, Midwife and International Board Certified Lactation Consultant. She has also been an inaugural board member of LCANZ and is currently on the board of ASTLiT. Having worked in a variety of settings and models of care in both Australia and the UK, Monica brings her passion for education and interest in tongue-tie to assist in helping families achieve their breastfeeding goals.   

Following the Tongue Tie Journey

Randomised controlled trials have shown short-term improvement in breastfeeding outcomes post Tongue Tie (TT) division however there is a need for longer term studies following up mothers and babies post division. At Canberra Hospital, we have been dividing TT’s for over a decade in a standardised manner. As part of our ongoing research and quality initiative, we have followed a group of babies who have had a TT division from 2013-2014. Our follow-up time periods have been 1-3 weeks, 3-5 months, 8-10 months and 34-38 months. In my presentation, I will discuss the journey post TT division and compare these findings where applicable to other studies. 

Anita Moorhead
Presenting in Sydney and Brisbane Only

Anita Moorhead RN, RM, IBCLC, CertNeonatPaed & CertHlthSerMan, PhD Candidate. Anita is a Clinical Midwife Consultant (Lactation), Royal Women’s Hospital, Melbourne and Trial Coordinator for the DAME (Diabetes and Antenatal Milk Expressing Trial), Judith Lumley Centre, La Trobe University and is PhD candidate at La Trobe University. 

Anita has worked in the fields of midwifery, neonatal paediatrics, early parenting, lactation services and nursing management. She has collaborated on a number of breastfeeding papers, hospital and state based clinical guidelines and breastfeeding reports. She has been a BFHI assessor and educator.

Della Forster & Anita Moorhead – Diabetes and Antenatal Milk Expressing (DAME): A Multi-center Randomised Controlled Trial

The DAME randomised controlled trial (RCT) investigated the safety and efficacy of the increasingly widespread practice of advocating breastmilk expression during pregnancy (for women with diabetes in pregnancy). This presentation will present the primary and key secondary study outcomes.