:: PUBLIC SPEAKER
Nikki has been passionate about promoting, protecting and supporting natural birth and breastfeeding since 1975. She is a nurse, an educator, a writer, a researcher, a public speaker, a clinician, a faculty member at Union Institute and University, and Film Reviews Editor for the Journal of Human Lactation. She integrates theory and concepts from four disciplines into her work: Lactation Consultation, Childbirth Education, Craniosacral Therapy and Infant Massage. Other interests include figure skating, Cajun and old-time rhythm guitar, flatfooting and homeschooling her youngest daughter.
Nikki has traveled around North America, from Alaska to Florida and from Maine to California and to Canada, and looks forward to more travel, to anywhere in the world.
Nikki’s talks can be tailored to fit any time slot or audience. Fees are negotiable, and include travel and expenses.
Suggestions and requests for new topics are welcomed!
2010
Once a month
Nikki offers one day of the 18-hour Interdisciplinary Breastfeeding Management Course for the US at the Philadelphia Department of Public Health, 1101 Market Street, Philadelphia, PA.
Call 215-685-5237, ext. 1 or email Nikki.Lee@phila.gov for a schedule and details. This course offers 6.7 nursing contact hours.
Another course offered at the Philadelphia Department of Public Health is an Update to the 18-Hour Breastfeeding Course for people that want to update their knowledge. This course will be offered October 15, 2009 and March 26, 2010 and offers 6.7 nursing contact hours. Call or email Nikki.Lee@phila.gov for details.
Breastfeeding Basics is a 9-week course for anyone working with new mothers and babies in the first two weeks at home. This is the time where breastfeeding can be lost. Graduates of this course will have sung the Nigerian Counseling song, will be given their own breast model and current textbook, will participate in many role plays to practice counseling skills and will learn a lot about breastfeeding. And, we will all have fun!
· Connecting the Dots: Birth and Breastfeeding
When birth is traumatic or technologically driven, breastfeeding can suffer. Breastfeeding helpers often have to ‘pick up the pieces’ after a traumatic birth. This presentation bridges the gap between research and practice about birth and research and practice about breastfeeding. It is as excellent for health care professionals who work with laboring and birthing women as it is for those who are working with breastfeeding women and babies.
· Infant Massage Supports Breastfeeding
Massage works in two directions. The bab66>We who work with mothers and babies often have very difficult working situations. This relaxing and thought-provoking talk is good for any audience as it gives specific ways that we can take a breath, stay calm, and make some changes in our lives without spending a ton of money or taking a month away from our jobs.
Audience participation makes this talk more personal and relevant.
* Issues and Skills in the use of Massage Therapy for the Premature Infant
Exciting new research describes how massage helps infants gain weight and be discharged home more quickly, while their parents learn a a skill that supports bonding and attachment. The massage can be done by NICU staff or by the mother; in either case, the premature infant gains.
* Skin to skin care as part of breastfeeding recovery.
This presentation will demonstrate what can happen during skin-to-skin care when it is used for breastfeeding recovery. Craniosacral therapy and somatoemotional release are part of this work. Mothers and lactation professionals need to be ready for a baby to tell its story as part of breastfeeding recovery.
What is somatoemotional release? How does it work during skin-to-skin care when attachment has gone poorly? This workshop includes videotapes of a babies having an emotional release, some case histories, and suggestions for lactation professionals to use when using skin-to-skin care and remedial co-bathing.
* Craniosacral therapy: another tool in a lactation consultant's toolbox
1. What is craniosacral therapy?
* Anatomy and physiology of the craniosacral system
* Profile of affected infant
· Profile of affected mother
2. Techniques
· Light forces and palpation
· IF THERE IS TIME: some audience partner work
3. Breastfeeding Management Model
· Key concepts: assess lactation course thus far, treat mom, view mom and baby as unit
· Prepare for possibility of SER (somato-emotional release)
· Need time: several hours
4. Case Studies (IF TIME, CAN PRESENT BOTH)
· SS: needed more help with breastfeeding, poor home environment (unsupportive H. and m-I-l), did still points and diaphragm releases on both. Saw LC when baby 8 weeks old.
· TG: 6-hour labor, deep decelerations, emergency c/s, d/c home pumping and bottle-feeding and using nipple shield. Saw LC when baby 2 weeks old.
Latch-On: An International and Historical Perspective
ABSTRACT:
This presentation will take the audience on a tour showing how latch on has been portrayed in art through the centuries and of how it has been taught in texts and videos in the last two decades. Components of latch-on in common and in therapeutic situations (Dancer Hand; a high-arched palate) will be described, using information from international research. Factors that have positive and negative impact on latch will be explored.
OBJECTIVES:
1. The participant will identify how women today see and learn latch-on.
2. The participant will see styles of latch-on displayed in overhead projections of art works from history and in texts from the past two decades.
3. The participant will view the differences and similarities in latch-on teaching from seven countries, shown in videos.
4) The participant will be shown six assessment tools for latch-on.
5) The participant will see two types of therapeutic latch.
WORDS THAT WORK
The workshop participant should, at the end of this presentation, be able:
* To identify two concepts fundamental to this model of telephone counseling
* To list several words, phrases, or attitudes to avoid
* To identify particular interventions for each postpartum day in the first common or normal week of breastfeeding
* To describe the value of the daily phone calls· Mother the mother
· Trust the baby
· Keep them together
2. Words, Attitudes and Phrases to avoid
· Does baby need to eat right away?
· The word "colostrum" as in "I don't have any milk, I just have colostrum. (Sigh)" that many new mothers say.
· Time spent teaching anatomy and physiology
· Daily stooling
3. the Model
· What mother, baby, and breastfeeding helper can say or do on each of the first seven days of the baby's life. A three-column tool.
4. Additional Helpful Strategies
· Assess mother's confidence before she goes a day without a phone call
· Value of anticipatory guidance
* it builds confidence
* it prevents or reduces problems
* it is fun
· Assess the future
Stooling Frequency in the First Week of Life and Weight Gain in the Exclusively Breastfed Infant
Newborn stooling patterns are considered indicators of breastfeeding sufficiency in the first weeks postpartum. There is little in the literature about the stooling frequency of the term, healthy, and exclusively breastfed infant. This paper reports on a study of 20 exclusively breastfed infants whose stooling frequency in the first week of life was recorded. All babies thrived. The daily stooling frequency ranged from zero to one with every feed. There was no correlation with weight gain. As newborn stooling patterns are so variable, other indicators are needed to assess the health status of the newborn. Stooling is but one part of the whole picture of a healthy breastfed baby.
· Is infant stooling a reliable indicator of infant weight gain?
2. Review of Literature
· Stooling patterns
· Feeding patterns
· Hyperbilirubinemia
3. Author's study
· 20 exclusively breastfeeding women asked to keep tract of their infant's stooling.
· Weights collected at infant's birth, hospital discharge, and first pediatric check
· Average daily stooling rate plotted against the average daily weight gain
4. Conclusions:
· Need for more research
· Stooling may not be the sole indicator of breastfeeding adequacy and a thriving infant
SEXUALITY AND LACTATION
There is little published about the impact of lactation upon a woman's sexuality. A lactating woman's libido is reported to be increased or decreased depending upon the source of the data. Motivating factors for a woman's return to coitus postpartum are rarely considered or described.
This presentation presents a review of literature and the results from a bi-modal sample of 25 women who were interviewed by telephone during the first 6 months postpartum. The average time of return to coitus was 8 weeks postpartum. 52% of the sample reported that the reason for the return to coition was to relieve sexual tension in their partner. Other findings were that sexual feelings during suckling are not experienced by most women, and that persistent difficulty with breastfeeding may adversely affect libido and return to coition.
A review of literature shows that birth practices that result in perineal trauma and damage have a negative impact on breastfeeding. Women will not volunteer that they are incontinent of bowel and/or bladder.
Recommendations for clinical lactation practice will include strategies to normalize the woman's experience, provide reassurance, and refer to the appropriate health care professional when necessary.
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Benefits of Breastfeeding and Their Economic Impact
YEARLY HEALTH CARE COST SAVINGS
Estimates are based on the most conservative figures, ex: if breastfeeding is estimated to reduce diarrhea by 51%-71%, then half of what diarrhea costs per year was calculated. It is important to remember that breastfeeding reduces incidence of many diseases for which a cost savings can not yet be estimated.
If 75% of new mothers would breastfeed in the first hour after birth, exclusively for the first 6 months, and partially for the next 1-2 years, the US would save in annual health care costs for:
THE MOTHER
1/ Reduction in medical materials at delivery $3.4 million
2/ Reduction in premenopausal breast cancer $202 million
3/ Reduction in domestic violence $42.5 million
THE BABY
1/ Overall: average savings of $200/year in medical costs per infant per year enrolled in an HMO
C Hoey and J Ware "Letter to the Editor" ABM News and Views Vol 3, No.1 1997
2/ Overall: estimated savings of $459 to $808 per year per family enrolled in four social service programs
CR Tuttle and KG Dewey "Potential cost savings for Medi-Cal, AFDC, Food Stamps, and WIC programs associated with increasing breast-feeding among low-income women in California" J Am Diet Assoc 1996; 96:885-890
3/ Overall: estimated savings of $112 for the first 6 months of life per infant enrolled in Medicaid; pharmacy costs were half the amount of formula-fed infants (infants were breastfed exclusively for at least 3 months).
DL Montgomery amd PL Splett "Economic benefit of breast-feeding infants enrolled in WIC" J Am Diet Assoc 1997; 97:379-385
4/ Overall: a minimum of $11.5 million could be saved per year in Australia if the prevalence of exclusive breastfeeding at three months was increased from 60% to 80% The savings was estimated in the area of only four illnesses (otitis media, IDDM, gastrointestinal illness, and eczema).
D Drane "Breastfeeding and formula feeding: a preliminary economic analysis" Breastfeed Rev 1997; 5:7-15
5/ Reduction in childhood cancer.................................................................................... $10 million
6/ Reduction in childhood diarrhea............................................................................... $100 million
7/ Reduction in ear infections........................................................................................ $500 million
8/ Reduction in tympanoslomies................................................................................... $500 million
9/ Reduction in juvenile onset diabetes......................................................................... $2.6 billion
Conservative Estimate of Total Cost Savings for One Year
$4.2 BILLION
Outline:
1. Introduction:
· The cost of health care in general
· Who is making all the money? And how could they make more?
2. Review of Literature:
For each of the following risks:
Risks of Formujla-feeding to the MOTHER
< increases the risk of women with gestational diabetes developing subsequent diabetes
< increases risk infertility
< increases risk for ovarian and endometrial cancer
< increases risk for osteoporosis
< increases mortality for women with rheumatoid arthritis
< minimizes or reduces postpartum weight loss
< increases the incidence of postpartum hemorrhage
< increases risk of thyroid cancer
Risks of Bottle-feeding to the BABY
< increases risk of allergies and asthma
< increases risk of anemia
< increases risk of appendicitis
< increases risk of certain communicable diseases
< increases risk of death
< increases risk of diarrhea
< increases risk of gastrointestinal disease other than diarrhea
< increases risk of adult heart disease
< increases risk of hospitalization
< increases risk of inguinal hernia
< increases risk of juvenile rheumatoid arthritis
< increases risk of multiple sclerosis
< increases risk of necrotizing enterocolitis
< increases risk of lower respiratory infections
< increases risk of sepsis
< increases risk of sudden infant death syndrome
< increases risk of tonsillectomy
< increases risk of urinary tract infections
These are currently known benefits; more are discovered every year. Breastfeeding is a renewable resource that makes no demands upon the environment, and creates no pollution.
FRIENDLY CHARTING
Charting can be drudgery, yet it is an essential component of professional practice. How can a practitioner keep charting alive, accurate and rewarding? This workshop will define the importance of charting, including legal issues and standards of practice. It is appropriate for the new lactation consultant, and will be a refresher for the experienced lactation professional.
The presentation starts with an actual case history where a LC was called in to give a deposition. The participants are invited to comment on the charting and learn from the mistakes of another. Charting recommendations for LC practice based on the law are described. Various methods of charting and types of breastfeeding assessment tools will be presented. Suggestions will be made to make charting easier and helpful. Several participatory activities will reinforce the presentation, and an exercise in humor will remind the audience of the importance of written language.
1. The participant will define charting
The participant will list 4 purposes of charting
The participant will identify where to find standards and legal requirements about charting
The participant will identify several common pitfalls in charting and how to avoid them
LATCH
d. SAIB
e. NICU form
f. Slow weight gain/Failure to Thrive form
Group exercises
Handouts
A-V equipment needed: Overhead projector/screen
Paper and pencil for participants
Time for workshop: Ideally, 2 hours although it has been done in 1-½ hours
Two true-false questions based on the session objectives:
The legal concerns about charting are set by professional standards and established by Common Law.
True/False?
Some purposes of charting include the determination of benefits and the allocation of resources.
True/False?
(They are both true.)
* A Kinder, Gentler World
Breastfeeding is associated with a reduction in child abandonment and abuse, and maternal depression. How can this be? What fabulous program developed by the World Health Organization and UNICEF can make a difference?
* Babies Tell Their Stories
Nikki specializes in breastfeeding recovery, when babies refuse to latch. Based on principles from craniosacral therapy, this presentation is about the emotional expression from babies that is necessary before they will latch on and feed. Participants will learn about this process, including ways to create an environment where babies can tell their story to their mothers, facilitated by the lactation consultant.
* Making the Connection: Birth and Breastfeeding
This is a full-day presentation for all those working with pregnant and postpartum women. The day has been awarded CERPS (from IBLCE) and CEUs (from CAPPA and ICEA), and is for nurses, midwives, doulas, childbirth educators, physicians, and breastfeeding helpers. The day begins with the fundamentals of milk making and a 3-step counseling strategy for working with pregnant women. Some time is spent learning about the risks of human milk substitutes. A major part of the day is spent learning about delivery and self-attachment, with the end of the day spent discussing issues of the first week postpartum, a critical time for the new dyad.
* Lack of Breastfeeding and its impact on infant metabolic and endocrine function
Learn how the US government is suppressing the truth about infant formula, and of the many reasons that formula use is the first step to obesity and diabetes (both types). This talk is 1 to 1 1/2 hours long.
* Breastfeeding and Abuse
This talk goes into the details of how breastfeeding is protective against documented cases of infant abuse, neglect and abandonment. A maternal history of abuse can have a positive impact on breastfeeding. 1 to 1 1/2 hours
* Medical Supplementation of the Brea stfed Newborn
If a baby needs supplementation, what is the healthiest food to give? How is it best given? This talk is geared to physicians and other health care professionals, and is 1 to 1 1/2 hours long.
* Cultural Competances
Immigrants are an increasing proportion of the childbearing population. This presentation presents several different models of cultural communication, and offers group process exercises using filmed scenarios.
* Promoting relationship while bottle feeding
Bottle-feeding is the major method of infant feeding in the US, yet little is taught to the public and health workers about giving the baby control of the intake or promoting relationship while bottle-feeding. One wonders if the point of bottle feeding is to inject as much fluid into the baby as quickly as possible so babies pass out. Ignorance about bottle-feeding can lead to obesity, and to wastage of precious human milk as infants will spill when they can't keep up with flow. The presentation illustrates the importance of giving the baby control of intake.
