Episode 9 - An Introduction to The First 100 Hours
Hi and welcome to a very special edition of this California Breastfeeding Summit/ Lactation Training Lab Podcast mix. I’m coming to you this morning because this week is the California Breastfeeding Summit and right now I am recording both a podcast episode and there will be a video that attendees of the Summit can see as well! Please excuse my headset and everything. It’s really hard for me to record without it so I know it looks a little funky but that’s me.
I’m Christine, I am an IBCLC, I live in Bakersfield, CA, and I have attended most of the California Breastfeeding Summits that have happened over the past 11 years. I’m so excited because this week is really such an important week every single year for me and for hundreds - literally hundreds - of other people in CA who provide lactation care, for birth workers, and for people who supervise those people, for people who are decision makers for those of us who work in that space. It’s a really important time that normally we come together and of course this year we are not together, so the summit is virtual this year. A lot of us were reminiscing yesterday in the meet and greet that last year’s summit was, for many of us, the last live, in-person lactation event that we attended before the pandemic closed us down. It’s a little bittersweet, but it’s also great to be able to see everybody and talk to everybody, reconnect with everybody in the state just like every year when we come back together.
As you know, as part of the Lactation Training Lab Podcast one of the things that we talk about a lot is advocacy. I think that my trajectory of advocacy would not be the same without what I have learned, what I have observed and what I have been able to experience through the CA Breastfeeding Summit. I came on here today because I wanted to talk a little bit about the things that I do and offer. One of the special things that I am offering right now is for summit attendees is a coupon code for the First 100 Hours Masterclass. I wanted to spend just a little bit of time talking about what that is, how it can help you, help your staff.
If that’s where you are in your career and - there’s so much about it, I mean I could go on forever and ever - but I’m going to make this a brief video for those of you who can see it. Those of you who are listening to the audio through the podcast, don’t worry, you can hear me. I’m not going to show anything other than some pretty stuff that you would be able to see, but it’s nothing that you’re going to be missing out on just because you can’t see this video. One moment while I get this started and then I am going to turn off this video and get this slideshow going.
Now we’re looking at the logo for the Lactation Training Lab, which is an organization that I created. It’s a business, so it’s a for-profit organization that I created as an umbrella to be able to provide training, resources, connections, mindset shifts - the types of things that I feel like people really need in order to make progress in their career and in order to move forward. This work that we do as lactation care providers isn’t just about courses and certifications. It’s really about what we learn along the way and how we treat people. As we work to become better counsellors, as we work to expand our world view, a lot of things come into focus that are not necessarily things that you can cover in a training or a course right from the beginning, but we do need to organize and be intentional about how we approach those things as we move forward.
That is the real purpose of the Lactation Training Lab: to have a space where training and resources can be brought forward to be shared and help everyone feel like they have the opportunity to become a better lactation care provider. There are multiple offerings through the Lactation Training Lab, and many of them are free. I offer a lot of free downloadable guides and resources that anybody can download from my website. I also, of course, have this podcast, which is a free resource where people can learn and get information and hear about my opinions and my perspectives. (Whether they agree or disagree-and you’re welcome to do that! I do welcome feedback!)
I offer some paid opportunities as well. One of those opportunities is the First 100 Hours Masterclass, which we will talk about here. I appreciate the opportunity to share this information with you. I promise to make it brief and here’s a little quick bio! This is me, I am an IBCLC, a childbirth educator, I live and practice in Bakersfield, which is the unceded land of the indigneous Yokuts tribe. I’d like to acknowledge that because I feel that it is a very important part of what we do and how we move forward in the right way with our work and with the way that we live and reside on lands that were never actually given to us, that we took.
I operate the Lactation Training Lab, as well as being the Director of Baby Café Bakersfield, which was the first licensed Baby Café in California (and very soon will not be the only.) I can’t talk more about that at the moment but if you have questions and feedback about Baby Café - if you are interested please get in touch. I am the regional coordinator for Baby Café USA in California, so if you have questions or are wondering how to start a licensed Baby Café yourself, please do contact me, I’d love to hear from you!
This really speaks to this slide here speaks to why I started the First 100 Hours. What it says here on the slide (for those of you who can’t see it), my journey to become an IBCLC started when I attended a hospitalbased breastfeeding support group when my babies were young. The IBCLC who led the group lit a spark for me that has burned ever since. I have a passion for finding strategies to create supported lactation experiences for families, and I do still see families and babies every week. I am still working in practice and I have a private practice as well as working through Baby Café so I am definitely in the lactation world here. Then I also found that I have a real passion for helping lactation care providers find their own ways and use strategies to feel like they’re doing a good job, feeling confident, feeling organized about the work that they do. I understand because I’ve been in it.
It’s just one of these fields, things get really confusing, sometimes we spend more time trying to talk to people about why breastfeeding is important than we have time left to explain to them how to do it. There’s just so much that we have to know and do and sometimes I feel like lactation care providers on the whole are really passionate people who spend a lot of their off time seeking support, resources so that they don’t burn out, so that things can get easier for us and that’s what I focus on a lot now these days: finding these strategies and resources and creating things that are not there. I don’t reinvent wheels, I like to promote people’s wheels that they have already invented. I like to create something, and the First 100 Hours is one of those things. As I was working in the hospital, the first ten years of my career in lactation - well, not the first ten years, but really early on working in a hospital - my hospital-based experiences were very eye-opening. The hospital where I worked first as well as the second hospital that I worked were both on the journey to Baby Friendly when I was there. Building to Baby Friendly journey from day one all the way through designation - I’ve seen this from the inside out.
One of the things that came forward for me was that there are so many things that we learn as part of that process that are far beyond the clinical parts. As a lactation team that was supporting the rest of the hospital staff to adopt and implement Baby-Friendly practices, sometimes things would get really bulky and confusing, and I had an experience with a family that led me to create this strategy, which is completely intertwined in everything that we know and everything that works for a Baby-Friendly strategy.
When I was working with this family - basically, I’ll summarize this story really quickly - I was working with a person who was barely beyond 48 hours postpartum who had preterm twins in the NICU, and she was receiving ultimatums from a neonatologist that if she didn’t bring him some milk, he was going to give her babies formula. And there’s a lot more, there are a lot of layers to this story but I can tell you this. I can tell you this was a person who was pumping completely within the protocols that she had been given, she had been started with a pump immediately after the babies were birthed, she was doing everything that she had been taught, everything that needed to happen, she was following all of the protocols, 100% compliant and she was also 100% healthy. And when I had this encounter with her, the anger and the resentment and the fury and the frustration really made me sit down the next down and think, “What did we do wrong here? What is happening that she received all this great information, great support to get started, to make sure everything was working really well, how did this blow up? How did this fire start?”
What I started to realize was that we had things a little bit too complicated for not just the parents, not just the staff, but even for the physicians who are there. We really had things really bound up, and those things also were bound up in cultural beliefs and perceptions about how lactation actually works, and I really wanted to go back to the beginning and start from scratch. That’s what the First 100 Hours truly is. It’s a very simplified way to ensure that we’re focusing on the right things during that early postpartum time.
Focusing, simplifying, clarifying, that’s what we’re doing through the First 100 Hours strategy. Even when there’s a big birth story with lots of things happening, a long medical history, a complex social structure for the family, the fundamental importance of the optimal practices around early initiation of lactation does not change. We still have to focus on the same things. We still have to be looking at keeping babies skin to skin, latching frequently, hand expressing when babies won’t latch, teaching hand expression to everyone so that they have that skill and can control what’s happening with their body. And you know, going back to how complicated things have become, what I knew deep down is that a fact of early lactation care requires the ability to remain focused, so what you can affect in the moment is really a function of your critical clinical skills. It really has to do with what you are able to implement in the moment and not looking forward too much when you’re helping, but looking forward enough to make sure that families are set up with the next set of steps that they’re going to need.
We are so often told by parents and families in my work, many families who see me tell me that they were not taught this, that they were not taught that, that nobody showed them how to hand express milk or maybe they should try pumping if they were worried about their baby, but nobody really taught them how to do that so they’re sort of winging it. There’s a lot of ethical questions for me around the concept of sending families home with babies who are dependent on formula - because formula is commodity, it costs money to get that and if we’re not giving them a guarantee that they’re going to be able to access it for as long as they need it, then how are we sending them home dependent on that rather than sending them home with the skills to feed their own babies? I mean, that’s really food security - it’s being able to feed your baby from your body. Creating dependence on formula - which is unfortunately what we see from the data - if we’ve got all these numbers of babies being sent home from the hospital having already had formula within the first 48 hours of birth, that does not make any sense. That does not square well. It does not make sense that most babies would need formula during that time frame when they’re born in hospitals.
There had to be something missing - and it really is those critical clinical skills, helping staff and everybody around to understand that it really is that simple. It really is about making sure that we’re teaching latch, that we’re positioning babies right, that we’re teaching hand expression and then watching and getting feedback from parents, that we are teaching things about how to manage and prevent engorgement. Without those critical skills, parents are going home into a world of they-don’t-know-what. They don’t even know what to expect and they certainly aren’t going to know how to handle it.
We know how important it is to help people initiate lactation well and thoroughly from the beginning. We’ve known this for a long time and there’s tons of evidence, we don’t even really have to think about that part of it. This is really an implementation strategy for the Baby-Friendly practices. That’s kind of the way that I think about it. [This is not in any way affiliated with Baby Friendly. I do want to make sure that I make that disclaimer, there’s nothing about this that is connected to that, but I want you to know that if you’re on a Baby Friendly journey, if you’re working to follow that model, this is completely going to fit into what you do.]
We just want to think about using our capacity to help to focus on the right things during the first 100 hours of the baby’s life so that we can help get things set up for the next part, and really, that’s all it’s about. The basic, fundamental purpose of the First 100 Hours concept is that within those first 100 hours, we can reasonably expect, according to the science, for a birth and lactating parent to go through a specific trajectory of how milk is being produced. We can look at that and say this is what we expect to happen, this is the average, to leave behind the concept of “oh you get milk on the third day, your milk comes in on the third day,” leaving behind confusing things like that and really thinking about how many hours has it been since the baby has been born.
That was part of the story that led me to develop this. Because those babies were born on Thursday night and when I was talking to this mother, it was Saturday afternoon, so we were right around hitting 48 hours cause when they were born. When I say Thursday night, I mean 5:00, and it was around 3:00 in the afternoon, so we’re talking 48 hours. But everybody was saying that day to her, “you should have milk, it’s the third day, what’s wrong here?” What does the third day - that has nothing to do with it, that doesn’t make any sense to me, it has never made any sense to me that we count things that way. We just count by hours. Everything else we do we count by hours. Everything else that we do in the medical profession and wellness, we count scientifically, we don’t do things like “it’s the third day.” We measure things specifically. That’s a really important part. We know that from the science, from the research that for most people, the increase of milk production begins around 30-40 hours postpartum, so we can extrapolate that even though many people have birth interventions that might cause delays. Those delays are going to happen beyond 48 hours, but we also know, those of us who have worked in hospitals, that for most people, by 96 hours, there is more copious milk production. So we can reasonably say that within the first 100 hours, most people are going to have copious milk production. That’s the core of the First 100 Hours.
It’s about what needs to be happening within the first 100 hours to prevent poor outcomes and then being able to use that exact same framework as a screening strategy when we see families whose babies have come past the first 100 hours, especially during the first month or so of life. If we have this screening process that we use to find out what happened during the first 100 hours, where are the gaps, what was missed, what do we need to fill in here, and have the opportunity to be able to fill those things in during those first early weeks of milk production and of babies establishing how they feed when they are at the body.
It’s really a great way of being able to look through a very specific lens that stays very focused in the beginning and then allows us to look backwards to see what else needs to be done once we’ve passed that very critical first few days of life.
In summary, the last thing I really want to say about it is that this strategy has a lot of potential to really change how lactation staffs are created and supported in hospital settings because if it’s incorporated into an initial 45-hour training course, then it’s already in there for anybody who comes out of a course like that with a title of lactation education specialist, a lactation counsellor, a lactation educator. Being somebody who has taken a 45-hour course which includes this strategy, they are ready to go. These are people who have already been trained in how lactation works in general, plus exactly what to do in a hospital setting, in an immediate post-birth setting to help with the initiation of early lactation. These are people with this training who can absolutely be put to work in hospitals. There is no reason that hospitals are not utilizing these trained folks for this type of work. An IBCLC of course is qualified to do that work, but if your hospital has one IBCLC, how is that one person going to do it all? Let’s expand, let’s make sure that our staff is big enough to be able to support exactly what our patient population needs. There’s the ability for your IBCLC to be the specialist, to be the consultant who sees the really complex cases, who is seeing preterm parents who are beyond this time frame, who are seeing an issue with milk production, to see people who have had babies but who have medical conditions, to see people with actual risk factors for low milk production.
That’s really the potential for this, is to be able to A) get a lot of people who have training to work, let’s get them to work/paid employment/compensated while they are on the road (if that’s what they intend to pursue) to be IBCLCs. And at the same time, let’s let IBCLCs do what they are trained to do, which is to see higher risk populations. This is a way that hospitals can really truly utilize people and the training that they have in an appropriate way.
If we’re talking about people who need this training on top of other training, great, that’s a great way to do it, this type of training really is there for everybody. It’s for people who intend to work in hospitals and people who intend to work outside because if you work in a community clinic, if you work in a place where people are going to show up with their 4-day old baby, their 10-day old baby, their 21-day old baby who potentially has a problem, who you are going to weigh and find out isn’t gaining weight, or who are going to come in and tell you that they are exclusively pumping but it’s not working, they’re having pain, they’re not able to produce all the milk that their baby needs, these are the types of situations where especially when you’re seeing them during that first month, you really do need to know what happened during the first 100 hours, you really do need to be able to do that type of screening. And that’s what the First 100 Hours Masterclass does - it really provides so much more information.
More summaries are available on my website. You can visit lactationtraininglab.com. It’s also under my name - you can visit christinestaricka.com, and you download free resources about many different things.
You can get more information about the First 100 Hours Masterclass, and you can certainly contact me through my website. Reach out to me on social media, come see my virtual booth if you’re at the CA Breastfeeding Summit, come visit me virtually at the virtual booth, I would love to meet you and talk to you about how the First 100 Hours Masterclass can help you, how it can help your staff or your colleagues! I would really love to talk to you about it! I created it because I wanted people to know about it and so that’s why I’m talking about it today!
I thank you for this opportunity to share with you and I look forward to your feedback. Everybody who is at the summit, please enjoy yourselves, it’s such a great time of the year. I’ll be back with more as the week goes on, so thanks for being here and I appreciate you. I hope that if you don’t already, that you’ll subscribe to the LTL podcast. It’s available on all podcast apps and it’s also available right on my website if you prefer to listen to it that way. Transcripts are currently being made available for those who don’t care to listen but who prefer to read the transcript. I will see you soon, have a great day, thanks for being here, bye for now!
Listen to Episode 9 here!