Over the last hundred years there have been huge advances in medical care for pregnancy and childbirth such as: assisted reproductive technologies, blood tests for hormone levels, ultrasound assessments of pregnancy and neonatal intensive care units. However, we are not seeing similar advances to treat issues relating to lactation.

We medically support pregnancy and childbirth but we don’t offer the same process for lactation, which of course completes the reproductive cycle.

Melinda Boss

Mother breastfeeding. Photo by Rainer Wolfsberger, courtesy of Family Larsson-Rosenquist Foundation

Support for lactation

Mothers experiencing difficulty with breastfeeding who wish to sustain lactation need to seek advice from their family doctor. However, family doctors report that they haven’t received the education for the knowledge and skills expected of them in this area.

It’s not about interfering with normal function; this is about helping when something is going wrong and using the medical care framework that we use for other organs of the human body.

Melinda Boss

Unlike other organs of the human body, medical care plans for lactation rely almost entirely on experience rather than medical guidelines. Conflicting advice is one of the most common factors that impact on a mother’s confidence in her ability to breastfeed and sustain lactation.

Currently, the only global tests for function are the World Health Organization infant weight charts. However, these tests do not consider the human lactating breast as an organ that requires two humans in its normal function. The mother, in sustaining milk synthesis and the infant, in the frequent and effective removal of milk. Is the mother producing enough milk? Or, perhaps the baby is having difficulty removing the milk.

The cost of human milk production

The World Health Organization recommends that infants should be exclusively breastfed up to six months of age. According to the 2010 Australian National Infant Feeding Survey by the time infants are five months old, only 15.4% are exclusively breastfed. 38% of respondents cited ‘previously unsuccessful experience’ as their reason for not breast feeding.

Infants are born with an underdeveloped immune system. Breastmilk contains antibodies from the mother which aid in reducing the risk of conditions such as: respiratory tract infections, ear infections, gastrointestinal illness and necrotizing enterocolitis. The Australian National Breastfeeding Strategy: 2017 and beyond has reported that early weaning from breastmilk is associated with significant hospitalisation costs, for these conditions; estimated at around $60-$120 million pa.

It’s such an emotive thing for us women because those of us who choose to breastfeed often have difficulty. It also impacts our economy in terms of poorer health outcomes.

Melinda Boss

Aside from its nutritional value, lactation also has economic value. In Australia, approximately 60% of potential human milk production is lost due to premature weaning from breastfeeding. This represents an economic loss of over $4 billion in Australia each year.

Novel lactation care platforms

Led by Senior Research Fellow Melinda Boss, the UWA LactaResearch Group developed two platforms: LactaPedia and LactaMap, to assist doctors in the care of patients who wish to sustain lactation but are experiencing difficulty.

The research has been mainly supported by the Family Larsson-Rosenquist Foundation (FLRF), an independent, charitable organisation based in Switzerland dedicated to promoting and supporting breastfeeding and human milk. The Rotary Club of Southern Districts also provided support for LactaMap.

LactaResearch Group aims to:

Support effective lactation through the translation of research to practice via:

• Provision of evidence-informed information to doctors
• Development of a global standard of terms in lactation

LactaMap

The LactaResearch Group have been developing LactaMap since 2010. LactaMap launched internationally on 26th March 2019. An APP version is also planned for release later in 2019.

Unlike other medical guidelines, LactaMap is an online lactation care support system designed for use by doctors at the point of care, to support mothers and infants experiencing difficulty with lactation.

My passion is in what we can do to improve this area of health for women who choose to breastfeed.

Melinda Boss

For doctors, an understanding of what is normal in terms of lactation is important so that dysfunction can be recognised and treated.

LactaMap starts with addressing four key questions:

• Is there pain/discomfort for the mother or infant during lactation?
• Are there concerns regarding milk synthesis and/or the infant’s ability to remove milk?
• Does the infant have any diagnosed medical conditions and require strategies to support breastfeeding?
• Does the mother have any diagnosed medical conditions and require strategies to support breastfeeding?

With the information base, doctors can then easily navigate through the platform to develop a personal care plan for the patient. The platform currently contains 112 clinical practice guidelines, the LactaPedia glossary and 21 take-home information sheets that can be printed/emailed and provided to patients at the consultation.

In addition to its content, LactaMap itself is research-based. The UWA LactaResearch Group conduct studies to test the acceptability and functionality of the website when used by doctors, and as well gain input from mothers. The LactaResearch Group continually update and research current literature to ensure it is kept relevant.

LactaPedia

LactaPedia

The LactaResearch Group recognised that reaching a common understanding of terminology is fundamentally important for the prevention of conflicting advice and in developing patient care plans, including LactaMap. For example, what is the definition of a breastfeed? Is it: the infant removing milk from one breast; is it one sitting; and what if the infant feeds from more than one breast in a sitting?

We started defining terminology so that when a doctor diagnoses a patient, everybody’s talking about the same thing.

Melinda Boss

LactaPedia is the first internationally collaborative glossary of lactation terminology for use mainly by science and medicine.

The online tool was developed in 2018 by Senior Research Fellow Melinda Boss and Emeritus Professor Peter Hartmann and was launched on 1st August, 2018. It was included in the evidence-based reference book by the Family Larsson Rosenquist Foundation: Breastfeeding and Breast Milk — from Biochemistry to Impact which is available worldwide.

Whilst aimed at science and medical professionals, LactaPedia is open to the public and invites user input. The collection of over 560 lactation-related terms included in LactaPedia has been collated with the aim of becoming endorsed as a globally accepted standard of human lactation terminology. The terms have been reviewed by five internationally recognised experts in the field.

A gold standard in Lactation care

LactaMap: A novel approach to lactation care

There has already been support for LactaPedia to be endorsed as a global gold standard to define terms for normal human lactation. Senior Research Fellow Melinda Boss attends international conferences to progress discussions towards international endorsement.

The LactaResearch Group have also been recognised as contributors to the Draft Australian National Breastfeeding Strategy “2018 and beyond” which identifies evidence-based guidelines as a key input. The strategy is due for release in in 2019.

The future of lactation care

Version 1 of LactaMap is designed for use by doctors; however future versions will be available to other health professionals such as: nurses, lactation consultants and pharmacists. Once the site is mature, the LactaResearch Group will introduce LactaMap to medical schools and tertiary institutions for case-based learning.

A choice to sustain lactation

In the short term, lactation helps to regulate an infant’s respiration, heart rate, acid-base balance and sleep-wake patterns. It helps with an infant’s eye development and oral and speech development. It also has long term benefits.

Non-communicable diseases such as obesity, cardiovascular disease, cancers and diabetes are on the increase. All of those are reduced with lactation for both mums and babies.

Melinda Boss

Mother and her child. Photo by Rainer Wolfsberger, courtesy of Family Larsson-Rosenquist Foundation

Doctors using LactaMap and LactaPedia will be able to provide families who choose to breastfeed with evidence-informed care plans around lactation as well as reassurance of what is ‘normal’.

For example, the composition of human milk doesn’t lend itself to long periods of feeling full. This means babies feed frequently, including during the night. Having the ability to see a family doctor and know that this is normal can build confidence and work toward alleviating some of the pressure felt by many families.

Impact in action anecdote

Providing evidence-informed information to mums can be helpful. Melinda conducted a pilot study carrying out some objective tests with two breastfeeding mums. One of the mums was having difficulty with feeding and felt encouraged after receiving the results that her milk had a relatively high calorie content. “I have been given motivation to continue. I was thinking of weaning Aiden (real name not supplied) because I know he’s only getting small amounts when he breastfeeds.”