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EP07: More Maternal Manifestations

Advanced maternal complexity: applying critical analysis to manage breastfeeding in high‑risk, comorbid and medically complicated situations

This course examines endocrinological and infectious diseases alongside key maternal health issues, focusing on how breastfeeding can be safely supported and sustained through these complex clinical conditions.

Course Learning Outcomes

Critically analyse pituitary dysfunction and its impact on lactation hormones to inform evidence-based assessment and management of milk production disorders.
Critically evaluate infectious disease transmission risk during lactation to develop evidence-based feeding recommendations that safeguard maternal-infant health.
Critically analyse HIV transmission pathways and antiretroviral interventions to evaluate feeding options and risk-reduction strategies in resource-varied contexts.
Critically evaluate medical and metabolic conditions affecting lactation to develop evidence-based risk assessments and individualised breastfeeding management plans.
Critically analyse autoimmune, neurological, and psychological conditions to inform medication safety assessment and tailored lactation support strategies.

IBLCE® Detailed Content Outline

Every module maps directly to the IBLCE® Detailed Content Outline, building your knowledge progressively from foundational science through to clinical application.

This course covers the following IBLCE® DCO items. The applicable Lactation (L), Ethics (E) and Related (R) hours are shown against each heading.

A. Infant

B. Maternal

A. Infant

1. Feeding behaviours at different ages

2. Food intolerances/allergies

3. Infant anatomy and anatomical/oral challenges

4. WHO guidelines for introducing complementary foods

5. Low birth weight and very low birth weight

6. Milk banking - formal and informal

7. Normal infant behaviours

8. Nutritional requirements - including preterm

9. Preterm development, growth, and behaviours (including late preterm)

10. Skin tone, muscle tone, reflexes

11. Term development and growth

12. WHO growth charts with gestational age adjustment

13. Stooling and voiding

B. Maternal

1. Breast development and growth (typical and atypical)

2. Breast surgery

3. Composition of human milk

4. Maternal anatomical challenges

5. Maternal nutritional status

6. Nipple structure and variations

7. Nipple modifications (e.g., piercings, tattoos)

A. Physiology of Lactation

B. Endocrinology

A. Physiology of Lactation

1. Relactation

2. Infertility issues

3. Inducing lactation

4. Pregnancy and breastfeeding - tandem

5. Multiples (e.g., twins, triplets)

B. Endocrinology

1. Hormonal influence of milk production

2. Diabetes

3. Maternal hormonal disorders (e.g., pituitary, thyroid, Polycystic Ovarian Syndrome)

4. Maternal autoimmune disorders

5. Newborn hypoglycemia

A. Infant

B. Maternal

A. Infant

1. Ankyloglossia

2. Cleft lip and palate

3. Congenital anomalies (e.g., gastrointestinal, cardiac)

4. Gastroesophageal Reflux Disease (GERD), reflux

5. Hyperbilirubinemia

6. Infant neurological disabilities

7. Small for Gestational Age (SGA), Large for Gestational Age (LGA)

8. Infant acute disease (e.g., infectious, cardiac, metabolic)

9. Vertically transmitted infections (e.g., HIV, Hepatitis B)

10. Esophageal atresia

11. Inborn error of metabolism

12. Infant cancer

13. Infant GI anomalies

B. Maternal

1. Abscess

2. Milk ejection reflex dysfunction

3. Maternal acute disease (e.g., infectious, cardiac, metabolic)

4. Maternal chronic disease

5. Maternal disability (physical and neurological)

6. Mastitis

7. Milk supply, low or over

8. Nipple and breast conditions

9. Nipple pain and trauma

10. Post-partum hemorrhage

11. Pre-eclampsia / pregnancy induced hypertension

12. Maternal cancer

1. Alcohol

2. Nicotine and tobacco

3. Cannabis

4. Medications (e.g., prescriptions, over-the-counter, diagnostic and therapeutic procedures, aids to labor and delivery)

5. Drugs of abuse

6. Contraception

7. Galactagogues

8. Gel dressings/nipple creams

9. Herbs and supplements

10. Chemotherapy/radiation therapy/radioactive scans

1. Transition to parenthood

2. Birth practices

3. Foods to eat/avoid that influence lactation

4. Employment - beginning or returning to work

5. Family lifestyle

6. Identifying support networks

7. Maternal mental health

8. Maternal psychological/cognitive issues

9. Breastfeeding dyad relationship

10. Safe sleep

11. Weaning

12. Cultural awareness

1. Effective milk transfer (including medically-indicated supplementation)

2. First hour

3. Latching (attaching)

4. Managing supply

5. Milk expression (e.g., pumping, hand expression, leakage)

6. Position of the breastfeeding dyad (hands-off)

7. Refusal of breast, bottle

8. Skin-to-skin (kangaroo care)

A. Equipment and Technology

B. Education and Communication

C. Ethical and Legal Issues

D. Research

E. Public Health and Advocacy

A. Equipment and Technology

1. Feeding devices (e.g., tubes at breast, cups, syringes, teats, paladai)

2. Handling and storage of human milk

3. Nipple devices (e.g., shields, everters)

4. Dummies (pacifiers)

5. Pumps

6. Scales (e.g., accuracy, precision, operation)

7. Communication technology (e.g., virtual visits, translation or interpretation services, websites)

B. Education and Communication

1. Active listening

2. Anticipatory guidance

3. Care plan development and sharing

4. Educating mothers and families

5. Educating professionals, peers, and students

6. Emotional support

7. Empowerment

8. Group support

C. Ethical and Legal Issues

1. Breastfeeding in public

2. Clinical competencies

3. Code of Professional Conduct (CPC)

4. Principles of confidentiality

5. WHO code - advocacy and policy

D. Research

1. Apply evidence-based practice

2. Interpret research results

3. Use research to help develop policies and protocols

4. Design research (including gaining ethical permission)

5. Participate in surveys and data collection

E. Public Health and Advocacy

1. Advocate for Baby-Friendly Hospital Initiative (BFHI)

2. Advocate for compliance with World Health Organization International Code of Marketing of Breast-milk Substitutes (WHO Code)

3. Advocate for mother / infant in healthcare system

4. Develop breastfeeding-related policies

5. Advocate to government / health ministries

6. Breastfeeding in emergency situations (e.g., natural disasters, personal emergencies)

Course Content

Welcome