Looking for breastfeeding help can cause even more frustrations. Well meaning grandparents may be passing on outdated information. Friends may share what worked for them while your body and your baby might require a different approach. The “breastfeeding nurse” may have no specific education in breastfeeding at all, or could be a fabulous resource, but how do you know the difference?
Certified childbirth educators, doulas, lactation educators and La Leche League leaders generally have a good basic education in breastfeeding. They will probably cover what a typical nursing relationship looks like in classes and can answer the common questions like, “why does my baby’s poop look like it has seeds in it?” (That’s the casein—the curds in “curds and whey”—that your baby isn’t processing just yet, and it’s totally normal to see it in the early weeks). These birth professionals generally know their limits and will refer out anything that is beyond their scope of practice.
When you’ve determined you are having a more serious problem though, who do you see? The gold standard is an International Board Certified Lactation Consultant (IBCLC). An IBCLC acquires several years of education specifically in human lactation. They are required to have a background in health sciences, including biology, anatomy, infant and child development, counseling skills and other related topics; complete at least 90 hours of continuing education in lactation; and complete many hours of supervised clinical practice before they can apply to sit for the board exam. After passing through this application process and passing the exam, they become an IBCLC. Many people spend 3-4 years on this process in addition to any college degrees they might have. IBCLCs are required to recertify every 5 years by continuing education or by exam. In short, a person who holds an IBCLC can be expected to have extensive lactation experience. If you are not sure whether or not you are working with an IBCLC, you can check the registry here.
Once you hire an IBCLC, you may be wondering what to expect in an appointment. This will vary a bit depending on your situation, but it is important to remember that both mom and baby are patients when working with an IBCLC and sometimes the root of the problem may be caused by something seemingly unrelated. Your appointment should include reviewing what your primary concerns are and what your breastfeeding goals are. There should be a fairly thorough medical history taken on both you and the baby. Some of these questions will be obviously necessary, like the weight history of the baby. Some may seem more intrusive, like asking for a full list of medications you take, and discussing your menstrual history or any difficulties conceiving. These things seem unrelated but can often yield clues to solving things like low milk supply. Depending on the situation, the IBCLC will also examine your breasts and the baby’s mouth. She should ask permission before touching you or your baby. She may offer or ask to hold the baby and talk to him or her a bit. During this time she is looking for clues and red flags in how the baby holds his or her body and moves around that may be affecting latch or ability to transfer milk well. An oral exam will include assessing for tongue and lip ties and palate abnormalities along with tongue mobility and then discussing these issues with you. While some IBCLCs feel these evaluations should be done on every baby, I feel like it is important to keep my fingers out of baby’s mouth unless there is cause for concern, but I am always keeping a close eye on how baby is moving his or her tongue while we “talk” and during rooting and latching.
If mother is in pain or baby’s weight gain is below normal limits, the IBCLC should observe a breastfeeding session.There are a few ways to approach this task. I choose to have mothers do what they have already been doing and we adjust from there. I strive for a hands off approach, where I talk mom through adjustments rather than physically moving her or the baby. Since I will not be in the home all the time, I think it’s important for parents to learn how to adjust the latch on their own. When latch looks good to me, I ask mom how it feels to her. A latch that “looks good” is not good if mom is hurting. When mom and baby are both comfortable and baby is transferring milk well (while I discuss the signs, I am looking to assess this), I will often bring in dad or grandma or aunt to see what I’m seeing so they can help mom remember what to look for when I am not around. We will try nursing on the second side and I encourage mom and her support person to fix the latch on their own this time before I offer more pointers. A good IBCLC will be encouraging you towards self-confidence and self-reliance. While I am available to my clients for months after I first see them, it is important to me that they build confidence in their own abilities, not reliance on me.
The other topics discussed in an appointment can vary greatly, but will probably include information about how to tell your baby is getting enough milk, the safety of medications while breastfeeding, normal newborn behavior, and general information about transitioning to life with a new baby. The IBCLC will help develop a plan of action that will help you along toward your goals. This may include a specific set of directions to follow each day, suggestions for blood work to request, regular weight checks, and/or just a general guideline to follow. This action plan should be evidence based and the IBCLC should be clear if any of her suggestions are more anecdotally based. She should also be sure you understand why each suggestion is being made.
The IBCLC will probably give you some tips about working through certain milestones many babies go through on a predictable schedule. She should make sure the plan of action is doable for mom’s specific situation. This involves reading a mom’s emotional state, listening empathetically to what her challenges are and discussing point blank if mom feels the plan is feasible or not. Be honest with your IBCLC. If you are already completely overwhelmed, do not let someone tell you that you have to nurse 12 times a day, pump 12 times a day and supplement in order to be successful. It is rare that there is only one solution to a problem and a good IBCLC should be able to adjust your plan to fit your family. A summary of your visit and the plan that was agreed on should be provided in writing.
After the appointment, there should also be follow-up. I generally stay in touch with my clients primarily by email. This gives them a written record of our conversation that they can refer back to at anytime. I choose to include follow-up in the initial fee I charge because I feel it encourages moms to contact me early if things aren’t going well. It is always easier to intervene earlier on. In general, I will contact my clients 2-3 days after I see them to check in and see how they are doing and make sure the plan we agreed on is working for them, or make adjustments where necessary. I continue following up on this schedule until things settle down and mom is feeling confident. If mom has requested it, I will provide a written report of our visit(s) and conversations that she can provide to her or the baby’s doctor.
An IBCLC can be a key member of your healthcare team. They are the specialists in lactation that can help address a wide range of breastfeeding issues.
~Kimberly Hill, IBCLC
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