‘Whatever You Do, Don’t Call a Lactation Consultant!’

The little munchkin in the above photo is my first baby, born 19 years ago.

I was a very naive, ill-informed, first-time mother. I was not aware of how my pregnancy, labour, birth and postpartum experiences could impact the establishment and continuation of breastfeeding. I didn’t ask the right questions and the information was not offered to me. We experienced all of the factors listed below.

Induction of labour

Continuous fetal monitoring

IV fluids

Epidural

Episiotomy

Ventouse

Forceps

Separation

Severe breast edema

Retained placental fragments

Postpartum haemorrhage

D & C

Iron deficiency anemia


My baby experienced….

Cephalohematoma

Upper lip Hemangioma

Hyperbilirubinemia

Phototherapy treatment

Separation

I was lucky. My baby and I did actually manage to struggle through the early weeks and our breastfeeding journey ended prematurely due to circumstances not at all associated with our earlier experiences.

Having said that, it would have been so beneficial had someone connected the labour-birth-breastfeeding dots for us.  Knowing what I know now, there were a number of 'red flag' reasons behind our shaky start to breastfeeding. I was given many reasons for the difficulties we experienced and yet there was always only one solution offered - formula supplementation. 

My experience is not at all unique; nineteen years on, I meet mothers on a daily basis who are given many reasons for their breastfeeding difficulties - baby too big/small/tired/lazy/hungry and nipples too big/small/long/flat/inverted etc.

The standard 'answer' is often supplementation with formula and an absence of information on how to preserve breastfeeding.

A few weeks ago, I met a mother who hadn't really felt her milk 'come in’ and whose baby was still losing weight at 12 days postpartum. Over our two hour consultation, I learned that she had a very traumatic birth and that she had been admitted to hospital at 9 days postpartum for retained placental fragments. We discussed the relationship between her experiences and the establishment of breastfeeding and we put a plan in place to improve things, based on her own goals.

During our conversation, this mum revealed that her Public Health Nurse  (PHN) was concerned about the baby’s weight loss. I asked what she had suggested. “Well, she didn’t really say.  She just said that she’d have to refer us to our GP if his weight was still low on Friday. She thought that I looked tired and pale, so she said my husband should give him a bottle of formula while I slept”

The mother had explained her desire to breastfeed this baby, her second son. She’d had a very difficult breastfeeding journey previously and she had hoped that things would be better this time. The mother remarked to her PHN that she’d probably ‘call a Lactation Consultant to give it one last go’. 

Without hesitation, her PHN said “whatever you do, don’t call a Lactation Consultant!”; qualifying her statement with “they’ll have you pumping and I can see you’re already exhausted; she’ll just put more pressure on you”.

Wow! Here we have two professionals who supposedly have the same goal of supporting a breastfeeding dyad but whose approaches and outlooks are at opposite ends of the spectrum.

With much determination and hard work (which did involve expressing to get mother’s milk supply up to where it needed to be),  this particular mother is now exclusively breastfeeding and her baby is gaining weight well.

‘The IBCLC has the duty to provide competent services for mothers and families and will perform a comprehensive maternal, child and feeding assessment related to lactation’ ~ IBLCE

Do NOT contact an International Board Certified Lactation Consultant  (IBCLC) if you do not want him/her to…..

o identify events that occurred antenatally, during the pregnancy, labor and birth process that may adversely affect breastfeeding

o assess the breasts to determine if changes are consistent with adequate function/lactation

o assess maternal physical, mental and psychological states

o assess social supports and possible challenges

o promote continuous skin-to-skin contact of the newborn and mother

o provide education to assist the mother and family to identify newborn feeding cues and behavioural states

o assess oral anatomy and normal neurological responses and reflexes

o assist the mother and child to find comfortable positions for breastfeeding

o identify correct latch/attachment

o assess effective milk transfer

o assess for adequate milk intake of the child

o assess for normal infant behavior and developmental milestones

o provide suggestions as to when and how to stimulate a sleepy baby to feed

o provide evidence-informed information to assist the mother to make informed decisions regarding breastfeeding

o provide education for the mother and her family regarding the use of pacifiers/dummies including the possible risks to lactation

o provide appropriate education for the mother and her family regarding the importance of exclusive breastfeeding to the health of the mother and child and the risk of using breastmilk substitutes (formula)

o provide information and demonstrate to the mother how to perform manual expression of breastmilk

o provide information and strategies to prevent and resolve painful damaged nipples

o provide information and strategies to prevent and resolve engorgement, blocked ducts and mastitis

o provide information and strategies to minimize the risk of Sudden Infant Death Syndrome (SIDS)

o provide information regarding family planning methods including Lactation Amenorrhea Method (LAM) and their impact on lactation

o assist and support the mother and family to identify strategies to cope with peripartum mood disorders (prenatal depression, “baby blues”, postpartum depression, anxiety and psychosis) and access community resources

o provide information regarding introduction to appropriate family foods

o provide information regarding weaning from the breast when appropriate, including care of mother’s breasts and preparation and use of breastmilk substitutes according to World Health Organisation Guidelines for Safe Preparation, Storage and Handling of Powdered Infant Formula

o calculate an infant’s caloric/Kilojoule and volume requirements

o assess the mother’s milk supply and provide information regarding increasing or decreasing milk volume as needed

o assess the breastfeeding child’s growth using World Health Organization adapted growth charts

o provide education to the mother related to normal child behaviors; signs of readiness to feed, and expected feeding patterns

o evaluate potential or existing challenges and factors that may impact on a mother to meet her breastfeeding goals

o assist and support the mother to develop, implement and evaluate an appropriate, acceptable and achievable breastfeeding plan utilizing all resources available

o facilitate breastfeeding for the medically fragile and physically compromised child

o evaluate how each breastfeeding dyad and situation is unique, and their affect on breastfeeding

o provide anticipatory guidance to reduce potential risks to the breastfeeding mother or her child

o assess and provide strategies to initiate and continue breastfeeding when challenging situations exist/occur

o critique and evaluate indications, contraindications and use of techniques, appliances and devices which support breastfeeding or may be harmful to continued breastfeeding including alternative feeding methods

o evaluate, critique and demonstrate the use of techniques and devices which support breastfeeding, understand that some devices may be marketed without evidence to support their usefulness and may be harmful to the continuation of breastfeeding

o evaluate and critique how techniques and devices may be used to ensure initiation and/or continuation of breastfeeding in certain circumstances

o provide evidence-informed information to the mother regarding the use of techniques and devices

o use adult education principles

o select appropriate teaching aids

o provide information on community resources for breastfeeding assistance

o provide evidence-informed information regarding a lactating mother’s use of medications (over-the-counter and prescription), alcohol, tobacco and street drugs, including their potential impact on milk production and child safety

o provide evidence-informed information regarding complementary therapies during lactation and their impact on a mother’s milk production and the effect on her child

o integrate cultural, psychosocial and nutritional aspects related to breastfeeding

o provide support and encouragement to enable mothers to successfully meet their breastfeeding goals

o use effective counseling and communication skills when interacting with clients and other health care providers

o use the principles of family-centered care while maintaining a collaborative, supportive relationship with clients

o support the mother to make evidence-informed decisions for her child and herself

o provide education and information at a level which the mother can easily understand

o evaluate the mother’s understanding of all information and education provided

o assist families with decisions regarding feeding their children by providing evidenceinformed information that is free of any conflicts of interest

o provide follow-up services as required and requested

o make appropriate referrals to other health care providers and community support resources in a timely manner depending on the urgency of the situation

o work collaboratively with the health care team to provide coordinated services to families

The above list is an excerpt from Clinical Competencies for the Practice of International Board Certified Lactation Consultants (IBCLCs), 2012

I yearn for the time when there is true collaboration between all stakeholders involved in breastfeeding support. No one has an monopoly on breastfeeding support and no one person has all the answers. Each and every one of us have a role to play and respect for the breastfeeding dyad and for each other has to be our starting point. 

Joint Statement on the Upcoming Pregnancy & Baby Fairs

We, Amanda Glynn IBCLC (www.lactation.ie), Carol Smyth IBCLC (www.carolsmyth.co.uk) and Nicola O’Byrne IBCLC (www.breastfeedingsupport.ie ) have come together to make the following statement re International Board Certified Lactation Consultants (IBCLCs) attending non-WHO Code compliant baby fairs.

The adoption of and adherence to the International Code of Marketing of Breast-milk Substitutes is a *minimum* requirement and only one of several important actions required in order to protect health practices of infant and young child feeding. (Resolution WHA 34.22) 

Why would a formula company invite a breastfeeding advocate and/or healthcare expert, such as an IBCLC, to attend its Pregnancy and Baby fair?

Having an expert such as an International Board Certified Lactation Consultant associated with a Code violating company, lends credibility to its products and activities. It’s a clever marketing ploy that achieves endorsement by association, whether or not that was the IBCLC’s intended outcome. When an IBCLC has an association with a formula manufacturer, directly or indirectly, we believe that the IBCLC is not meeting his or her responsibilities under the spirit of the Code. It is our contention that lending support to such events not only serves to undermine the professional integrity of the IBCLC credential and profession but also threatens future breastfeeding advocacy efforts. 

Stand holders and presenters at baby fairs are there to increase sales through discounts and complimentary gifts, which in turn builds brand awareness and loyalty. Some of the stand holders and presenters have chosen to further promote this non-Code compliant Pregnancy and Baby fair by offering mothers “free” attendance tickets. It is worth noting that even when a company offers free tickets to an event, the cost of providing those free tickets is simply absorbed by the marketing department of the formula company and added to the price of the products that fall within the scope of the Code. We do realise that the two upcoming Pregnancy and Baby fairs are being run by an event company. However, we believe the main sponsors are funding the bulk of the costs.

Recognising the complexity and susceptibility of the Code as a minimum standards document which is open to interpretation, we further our commitment to upholding the spirit and intention of the Code by declaring that we will not accept, or offer to the public, any inducements (such as free tickets, samples, gifts, material items containing logos etc.) relating to products or entities which fall within the scope of the Code. To strengthen our adherence to the provisions and obligations of the Code and to avoid any conflict of interest, we further declare that we will not offer nor accept any invitation to speak at non-Code compliant events.

Amanda Glynn - www.lactation.ie

Carol Smyth - www.carolsmyth.co.uk

Nicola O’Byrne - www.breastfeedingsupport.ie 

For Further information on WHO Code and IBCLC Code of Professional Conduct please use these links

http://www.unicef.org.uk/.../A-guide-for-health-workers.../

http://iblce.org/.../08/code-of-professional-conduct.pdf

Breastfeeding Platitudes - Why No Parent Wants to Hear Them

A common occurrence, on social media forums in particular, unfolds when a mother posts that she is stuck. She writes that she and her baby are having breastfeeding difficulties. She pours her heart out in every line. The thread quickly lengthens with lots of posters wanting to help. Many offer great information. Some will provide links to supports that the mother can access and others will empathise and offer their own story; how they managed to get over a similar situation.  Admins will do their best to quickly jump to correct any misinformation that hasn’t already been queried. This is social media support at its best. When it works, it works really well.

This level of support and sharing does not happen on all online breastfeeding support forums, however.  Depending on the particular social media forum that a mother is connected to, sometimes she may only receive a few responses to her query. Maybe just one or two; a ‘sad’ face emoticon even. It’s then that the one-liner platitude responses, that appear frequently in all support forums, take on a whole different meaning to a mother who is in distress.

Platitudes such as...

~ Keep Strong

~ Hugs x

~ It’s totally normal

~ At least you did your best

Breastfeeding Platitudes.jgg

When offered in isolation, these overused sayings do very little to validate a mother who is feeling overwhelmed and exhausted. Remember, sometimes these platitudes will be the only responses that a mother reads. Though offered with genuine sympathy, what we say and what we mean may not be what the mother ends up hearing. This is especially true when we're using a method of communication that makes it almost impossible to gauge tone. Imagine yourself as a new mother. Everything is new. Your body looks (and acts) new. Your baby is new. Your feelings are new. Your partner is also trying to get to grips with his or her new role.

The way a mother internalises sayings such as "it's totally normal" may result in her doubting her own self-efficacy and desire to keep going. These phrases are not empowering phrases.  They don’t add to her confidence. They take away from it. The mother sometimes ends up hearing...

~ I haven’t a clue how to help you

~ You’re on your own

~ Nobody likes a whinger

~ For goodness sake, get over it – I did!

~ If this is normal breastfeeding behaviour, I don’t want any part of it

Just because we say something is normal or natural does not automatically normalise the experience for THIS parent.

Of course it can be helpful for parents to know that what they’re experiencing right now, and the behaviours that their baby is displaying, are ‘normal’. However, just because we say something is normal or natural does not automatically normalise the experience for THIS parent.

Before we can even begin to offer support, it’s helpful to remember that when a parent reaches out to us - in pain, with worry or in grief – the first thing we need to do is to really hear them. They have just told us that this is NOT a normal experience for them. Not normal for this mother. For this father. For this baby.  

When we feel heard and understood, we find it easier to accept help and are more open to receiving information. When we say:

~ I believe you

~ I'm here

~ I’m so glad you’ve told me

~ Would you like to tell me more?

~ I really understand

we open the doors of communication. We can truly empathise and be in the moment with that parent. Only then will the recipient (the mother, father, partner) be accepting of further information and explanation. This kind of dialogue helps to NORMALISE the experiences that the mother is struggling with e.g. taking the time to explain common newborn behaviour or common parent emotions and validating her emotions. 

Listen, hear and then respond.