Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Research has long shown that breastfeeding provides many concrete health benefits for both mothers and infants that other forms of infant feeding do not. As such, unsurprisingly, breastfeeding has been deemed the preferred infant feeding method by the national and global medical communities and widespread initiatives promoting breastfeeding have followed. However, despite being well-intentioned, messaging around breastfeeding has left some people who cannot or choose to not breastfeed feeling othered and inadequate. While the health benefits of breastfeeding should not be understated, there are other experiences and perspectives that deserve to be in the conversation when thinking about breastfeeding and breastfeeding promotion. This thesis seeks to analyze breastfeeding and breastfeeding promotion from a bioethical perspective, providing an alternative lens through which to think critically about the way breastfeeding recommendations and initiatives are impacting real people. In this thesis, I will discuss the history of breastfeeding in the United States, why breastfeeding has come to be the gold standard of infant feeding, and real-life experiences of breastfeeding. I will also analyze breastfeeding, breastfeeding messaging, and current breastfeeding initiatives through the four principles of bioethics: beneficence, maleficence, autonomy, and justice. Lastly, I will offer my view and recommendations on how to incorporate bioethical perspectives into breastfeeding promotional strategies to create a more effective, inclusive, and supportive breastfeeding culture at the individual, community, and national level. / Urban Bioethics

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers were identified and grouped into the following categories: indirect barriers such as social norms, knowledge, attitudes; direct occupational barriers such as institutional constraints, lack of coordination, and poor service delivery; and direct individual barriers including social support and mother's self-efficacy. A model was developed to illustrate the factors that influence the role enactment of IBCLCs in terms of managing breastfeeding problems. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. However, IBCLCs find creative strategies to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed. Findings provide insight into the management issues of early breastfeeding problems and may lead to future interventions to reduce early weaning, thus increasing the lifelong health benefits of breastfeeding to the infant and mother.

Context: Guidance from health care providers about breastfeeding and lactation is cited as an important factor in breastfeeding decisions, yet clinicians report low levels of knowledge, confidence, and clinical competence in this area. This is due to a lack of standardized, evidence- based education and training in breastfeeding for health care providers, leaving clinicians to rely on personal experience with breastfeeding, or information gathered from a variety of online sources and conferences. This lack of cohesive educational programs and resources results in insufficient training for clinicians to adequately support breastfeeding and lactating families. Objective: Lessons in Lactation Advanced Curriculum (LILAC) is a two-year, fellowship-level breastfeeding and lactation medicine (BFLM) curriculum for post-residency health care providers that provides them with the depth of knowledge and clinical skills necessary to practice breastfeeding and lactation medicine. Target Audience: Maternal health care providers, including physicians, midwives, and nurse practitioners. Description: The LILAC Fellowship has three components: didactic, clinical, and research/QI. The fellowship begins with a week-long contemporaneous session to establish foundationalknowledge in breastfeeding and lactation medicine, followed by 18 monthly modules, built by experts, that cover the Academy of Breastfeeding Medicine (ABM) core competencies in breastfeeding medicine. Fellows complete a research or quality improvement project and obtain 1000 hours of practice in breastfeeding and lactation medicine with clinical oversight of a mentor that is a fellow of the ABM. Evaluation: Kirkpatrick’s four-level evaluation model will be used to evaluate fellowship feasibility, acceptability, and efficacy. Conclusion: The LILAC fellowship was feasible, acceptable, and effective in providing fellows with the knowledge and skills needed to practice breastfeeding and lactation medicine independently. Fellows reported that participation in LILAC positively impacted their patient interactions, helped to increased BFLM consultations, attendance at BFLM conference, and BFLM-related research publications, key factors in growing this nascent field.