The aim of this review was to assess the impact of an NHS specialist breastfeeding clinic staffed by International Board Certified Lactation Consultants, and to identify whether it improves breastfeeding outcomes and duration. This retrospective clinical review evaluated data from consultations at the Merton Specialist Breastfeeding Clinic. The data from each consultation forms the basis of the analysis. In the majority of cases (76%; n=56), the clinician findings differed from the mother's presenting concerns. This highlights the importance of specialist care to correctly identify issues and underlying causes. The majority (83%) of infants in this cohort were receiving some mother's own milk beyond 6 months. Women who faced complex breastfeeding challenges reached their breastfeeding goals with the support of specialist lactation care.

Introduction A woman was able to relactate 7 years after breastfeeding her children. She donated her expressed milk to her friends, a same-sex male couple, who had a child through surrogacy in the United States. She lived in London and shipped her milk to Hong Kong, where they lived. The infant thrived on the donated expressed milk received during the first 3 months of his life. Main issue This case is unusual because the woman was not breastfeeding at the time, which would have made expressing easier, and she was not adopting. She consulted a National Childbirth Trust Breastfeeding Counsellor and an International Board Certified Lactation Consultant® who helped her explore non-puerperal relactation protocols. Management Her plan started 6 months before the birth and included the use of domperidone, frequent expressing by hand and with a hospital-grade pump. A breastfeeding specialist physician made suggestions on the dosage of domperidone. She donated a total of 35.06 L. She had the full support of her partner and family. Conclusion Non-puerperal induced lactation and relactation offer ways to make human milk accessible to all infants, particularly those from LGBTQ+ families in which no parent is lactating, as was the case with the same-sex male couple participating in this study. It is essential to disseminate the knowledge and skills needed to support non-puerperal induced lactation and relactation among all healthcare professionals involved.

Background This case presents a mother’s feeding experience of an infant born with a complete unilateral cleft lip and palate from birth until both were repaired. She fed him directly at the breast with assistance, controlling the delivery of the mother’s own milk. The infant received only his mother’s own milk, no bottles, and the excess expressed milk was donated to a milk bank. Main issue The Cleft Team supported the mother’s wish to breastfeed but expressed realism that cleft lip and palate infants could not create suction. Success had never been observed in the unit. Instead, the team suggested expressing to deliver as much of the mother’s own milk. The mother had previously breastfed her three children and was keen on finding innovative ways to breastfeed. Management Several techniques were trialed with the help of an International Board Certified Lactation Consultant. The most sustainable and successful was the use of a nipple shield applied to the maternal nipple areola complex to cover the lip palate. Underneath, a nasogastric tube connected to a syringe delivered the mother’s own milk. Exclusive expressing protected maternal supply, the infant’s nutrition and growth were monitored carefully and this technique reinforced mother–infant bonding. Conclusion Feeding with the modifications was challenging at times. However, maternal satisfaction was high because the mother had achieved her goal of breastfeeding without assistance post cheiloplasty and palatoplasty. This case adds to the limited body of research about feeding infants with cleft lips and palates directly at the breast.

BackgroundEvery encounter in lactation care should aim to set the ground for an emerging human connection between the lactation consultant (LC) and the breastfeeding mother. Cultivating connection is as important as adequate clinical competencies and effective communication skills.MethodsThe article proposes a hermeneutics of care that articulates elements that enhance the understanding between the LC and the circumstances and realities of the breastfeeding dyad in the context of diagnosis, management, and healing. These elements can be best described by Martin Buber's (2013) I–Thou approach, which we use to enter into a relationship.ResultsWhen the LC has the courage and humility to convey her full presence for that mother and her circumstances, connection has been primed. The quality and depth of the LC– breastfeeding mother relationship, in turn, enhances diagnosis and healing options, particularly in chronic cases.ConclusionsThe “alchemy of connection” opens the ground for a relation of mutual trust between the LC and the mother and her world, which supports better breastfeeding care.