Lactation Management Training: From Novice to Expert

Lactation Education Resources Blog

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Angela Love-Zaranka has been involved in lactation education for many years, and has an insider’s take on the IBCLC exam: in the past, she helped write the exam for IBLCE. Here, she shares some thoughts about studying for some of the challenging parts of the exam, and how you can plan your studying now to avoid stress later! Check back at LER blog all month for more study tips.
Find and study images you don’t usually see in training
Start by making sure you are studying images you might not have seen in your training. If you are training in a community-based setting, search out hospital-based images, like a baby in the NICU. If you are hospital-based, you are more likely to be familiar with the early stages of the nursing relationship and could benefit from images of older nurslings. Not familiar with two year olds that breastfeed? A toddler latch does not look the same as a newborn latch!
Get creative with finding practice images
The Breastfeeding Atlas is a great place to start, and will be a great reference for your practice. Ask your colleagues who can connect you with images from their practices. It’s also very helpful being on social media, looking at pictures people are willing to share. Engage in the conversations people are having about those images, and practice your clinical thinking skills. The LER online Facebook group is a great place to find those images and discussions.
Plus of course there’s practice images in the LER exam prep course!
Spend extra time on “ages and stages” images
Many people struggle with the “ages and stages,” which require the test taker to identify a baby’s age based on a photo. It’s helpful to look at pictures of babies in general - scroll through Instagram feeds, flip through old photo albums. Look at pictures of babies, see what they are doing, and see how closely you can estimate the baby’s age. For example, if a baby is holding a cup, ask yourself: at what age do babies usually hold a cup? At what age would you see crawling, cruising, or walking? Then check your guess and see how close you got. The more you practice this one, the more confident you’ll get.
Be prepared for less-than-optimal photo quality
When you’re looking at the images on the test, sometimes the images are grainy or the lighting is poor. Don’t let it throw you off! Why the less-than-studio quality photos? Because it isn’t possible to plan a photoshoot for an image like “mastitis in a person with a dark complexion.” Instead, the exam relies on the lactation community to provide clinical photos, and we’re not professional photographers working in perfect conditions! That being said, the examiners have determined that a lactation consultant should be able to answer the question based on the image and the rest of the question.
You’ve got this!
Remember to think like a lactation consultant. If you hold other credentials or training, be sure to set that aside when answering exam questions. Focus on the training you received in clinical skills. Think back to the patients you’ve already worked with, and bring your best assessment of the situation. You are ready to step into this role - and we’re here to support you!
Angela Love-Zaranka, IBCLC, RLC, is LER’s Program Director. In the past, she has volunteered with IBLCE as a question writer for the IBCLC exam.
Feel Prepared to soar through your IBLCE Exam. LER offers two exam prep courses designed to help you study efficiently and effectively.
Enroll Now
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https://womensmentalhealth.org/posts/baby-friendly-mom-unfriendly/ 

This article is full of conjecture as opposed evidence, to get people's attention. To use inflammatory statements like "nursing staff typically refuse exhausted mothers to take care of their babies" and "rigid and rule bound" elicits a negative response to the evidence-informed practices of the international baby friendly designation. Baby friendly is not just about breastfeeding. It is about helping the newborn transition to extra uterine life in the most physiologic appropriate way. ALL babies. Skin to skin, rooming in, listening to the baby, are the what these practices reinforce. For example, rooming in has been the standard of care in military medicine for over 15 years and it is what parents expect. Educating staff members and providing them the skills to support all families is a piece of the process.

This article puts the emphasis on the comfort of the mother, not newborn and his adjustment to life outside the womb. During this critical time in the newborn's life, shouldn't the emphasis be on the baby's needs for care by the most familiar person to him for transition to the new world? Adults can understand, rationalize and make adjustments to their sleep patterns, knowing it is a challenge but temporary. The baby cannot.

Part of the onus of responsibility is upon the obstetric providers to educate mothers during their pregnancy about what to expect in the immediate post-partum phase in the hours and days after delivery. Evidence shows that rooming in allows for MORE sleep by the mother baby dyad. Appropriate education about normal newborn circadian rhythms being OPPOSITE of the mother's in the early days can help them to understand that their baby should wake frequently at night. It's healthy and normal. Understanding the second and third night of life as ones which will entail a wakeful baby and to encourage the mother to plan ahead for this eventuality, will help them to be prepared. Appropriate anticipatory guidance, especially for the families with a history of anxiety and depression, will help them to be proactive in their own self-care and to plan ahead. 24-72 hours after birth, the family needs these skills to help them welcome the new member(s) to their family. Providing them with the supportive environment during this transition and the education they need to care for their baby 24/7, will empower them to do what is best for them and their family AFTER discharge.

It takes a team to support and educate everyone in adapting to their new roles as a family. To blame the baby friendly practices as being mother ‘un-friendly’, doesn't allow for the opportunity for the parent to embrace their new role in a supportive environment. Continuing paternalistic hospital practices from the 1950's, in light of new evidence from around the globe, is a disservice to our families who expect and deserve more. Quoting Dr. Maya Angelou, "I did then what I knew how to do. Now that I know better, I do better". Implementing every aspect of baby-friendly practices helps hospitals to be friendly to all families.

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Singing to your baby, or even just listening to soothing music, can make milk miracles!  Researchers have found that listening to music while pumping can increase the amount of breastmilk pumped as well as the fat and caloric content.  (Keith 2012).  Ak (2015) found that in addition to increased pumped milk volume, music decreased the stress levels of NICU mothers who showed decreased serum cortisol levels.

In the earliest study, Feher (1989) found that the milk production of mothers increased 63% after 1 week of listening to a relation and guided imagery audiotape.  And the mothers of the smallest preemies increased milk production by 121%.

Recordings of mothers singing to their NICU infants showed better adjustment and bonding scores.  Mothers felt strongly that the recordings helped them cope with the NICU stay and infants were discharged 2 days earlier than controls (Cevasco 2008).  Nilsson (2009) found that music increased serum oxytocin levels and decreased stress in surgical patients (This study was not conducted in a NICU setting).

 

 

Resources for mothers of NICU infants:

 

Created by Stephen Feher

       https://www.dropbox.com/s/weyg6uw68u7plnm/Breastfeeding%20for%20Premie%20Infants.m4a?dl=0

Hypnosis for Pumping and Increasing breastmilk Robin Frees IBCLC, Newborn Concepts

       http://www.newbornconcepts.com/products.html#pumping_cd

 

References

 

Ak J, Lakshmanagowda PB, G C M P, Goturu J. Impact of music therapy on breast milk secretion in mothers of premature newborns. J Clin Diagn Res. 2015.  Apr;9(4):CC04-6. doi: 10.7860/JCDR/2015/11642.5776. Epub 2015 Apr 1. PubMed PMID:26023551; PubMed Central PMCID: PMC4437063.

Cevasco AM. The effects of mothers' singing on full-term and preterm infants and maternal emotional responses. J Music Ther. 2008 Fall;45(3):273-306. PubMed.  PMID: 18959452.

Feher SD, Berger LR, Johnson JD, Wilde JB. Increasing breast milk production for premature infants with a relaxation/imagery audiotape. Pediatrics. 1989.  Jan;83(1):57-60. PubMed PMID: 2642620.

Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9. doi: 10.1097/ANC.0b013e31824d9842. PubMed PMID: 22469966.

Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomized control trial. J Clin Nurs. 2009.  Aug;18(15):2153-61. doi: 10.1111/j.1365-2702.2008.02718.x. PubMed PMID: 19583647.

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The Core Curriculum for Lactation Consultant Practice, Third Edition, is now out of print and limited supplies of the existing copies are all that is available until the new edition is released in mid 2018.  If you wish a copy to use for studying for the IBLCE exam, or for your reference, purchase it quickly before supplies run out.

The publisher  Jones and Bartlett  $124
 http://www.jblearning.com/catalog/Details.aspx?isbn13=9780763798796

Amazon via the LER virtual bookstore $73
https://www.amazon.com/Core-Curriculum-Lactation-Consultant-Practice/dp/0763798797/ref=as_sl_pc_tf_til?tag=lactaeducares-20&linkCode=w00&linkId=6c676a1909a26ccdf7bfba6d1f5b69e6&creativeASIN=0763798797

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We need your Feedback! How did you do on the various topics? If we know the weak spots, we can improve coverage of these areas. 

Please provide feedback with this form:

https://lactationtraining.formstack.com/forms/iblce_exam_report_form

 

Thank you for your participation.

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