In 2005, when Sonia Semenic, RN, PhD, become one of Quebec’s first international board-certified lactation consultants, she had to travel to Washington for training and to Ontario to write her certification exams. Since then, her program of research has focused largely on breastfeeding promotion and support, health policy decision-making, and knowledge translation in nursing.
Human breastmilk contains hundreds of nutritional and bioactive substances that promote the healthy development of the infant’s microbiome as well as its brain and immune system. The benefits of breastfeeding include reduced incidence of respiratory, gastro-intestinal, ear and urinary tract infections, reduced risk of chronic diseases and sudden infant death syndrome and improved cranial development. As well, close mother-infant contact contributes to the infant’s cognitive, social and emotional development.
Given the overwhelming evidence that breastfeeding contributes to optimal infant health and development, the World Health Organization (WHO) recommends that unless otherwise medically indicated, babies should be breastfed exclusively for the first six months and continue breastfeeding for up to two years or beyond. Being dogmatic about breastfeeding, however, or demonizing women who choose not to breastfeed is counterproductive. “The key is to provide education to help parents make their own informed decisions and to offer practical support for mothers who encounter difficulty breastfeeding,” explains Professor Semenic. Common difficulties include the perception that they do not have enough milk to satisfy their babies’ hunger, lack of skilled support once mothers are home from the hospital, and workplaces that are not “breastfeeding friendly.”
Interprofessional teaching and collaboration on the part of obstetricians, pediatricians and dietitians are critically important in helping breastfeeding mothers to meet their goals. In this regard, Professor Semenic has shared her expertise with students at McGill University’s School of Human Nutrition. “The students expressed their amazement at the benefits of breastfeeding for infant and maternal health and well-being.”
A common complaint, especially from first-time mothers, is that they were never told how difficult breastfeeding can be. To close this gap, Professor Semenic and her research partners are promoting standardized training for healthcare professionals. “All professionals who work with families in the perinatal period have a role to play in supporting breastfeeding mothers,” she says.
Professor Semenic’s keen interest in breastfeeding was sparked when she worked as an obstetrics nurse in the post-partum unit at the Jewish General Hospital (JGH). “In the late 1980s breastfeeding rates in Quebec were the lowest in Canada. Most babies were given formula supplementation in the hospital,” she recalls.
Subsequently, as a Clinical Nurse Specialist at the JGH from 1990-2000 and at the Royal Victoria Hospital from 2000-2005, Professor Semenic was responsible for training and implementing evidence-based breastfeeding policies and practices. She focused on the adoption of the WHO’s “Ten Steps to Successful Breastfeeding”, including practices such as mother-infant rooming in, encouragement of early and frequent feeds, and enabling skin-to-skin contact between mothers and their babies immediately after birth.
Determined to do more to contribute to improved nursing practice related to breastfeeding, Professor Semenic earned her PhD in nursing and postdoc in community health nursing, joining the faculty at ISoN in 2007. She also obtained certification by the Quebec Ministry of Health as an external assessor for Quebec’s Baby-Friendly Hospital Initiative Accreditation Program.
Professor Semenic was part of a group of researchers that created the Baby Friendly Hospital Initiative for Neonatal Units (Neo-BFHI), which provide standardized recommendations for supporting breastfeeding among ill or preterm infants. The Neo-BHFI program includes a self-appraisal tool, translated into 15 languages to allow neonatal intensive care units to monitor their compliance with best practices. “Breastmilk is critically important for preterm infants,” she asserts.
In the span of 30 years, Quebec went from being the province with the lowest breastfeeding rates in Canada to being the first one to develop a ministerial-level policy to increase these rates. Today, while the vast majority of Quebec mothers initiate breastfeeding, less than 55% continue any breastfeeding beyond 6 months. “Nurses provide important information and skilled support, but these days, mothers often stay in the hospital for only 24 hours after delivery,” she notes. “If they don’t get the support they may need once they are home, they are less likely to continue breastfeeding.”