‘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 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.