Lactation Management Training: From Novice to Expert

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Vergie Hughes

Vergie Hughes

Vergie Hughes has a long history of experience in Maternal Child Health including labor and delivery, post-partum and pediatrics, and for the past 25 years she has been involved in lactation management. Ms. Hughes has a BSN from Pacific Lutheran University and a MS from Georgetown University. She has been a board certified lactation consultant since 1985. At Georgetown University Hospital, she was the director of the Human Milk Bank. She created and developed the National Capitol Lactation Center and the one week Lactation Consultant Training Program. This course has trained more than 4,000 Lactation Consultants since its inception in 1990.


She has been a private practice lactation consultant and business owner, and operated her own lactation center, Washington’s Families First. Lactation Education Resources On-Line is her website, offering training to professionals and information to parents as well. Ms. Hughes has served on the International Board of Lactation Consultant Examiners and has served on the IBLCE exam writing committee. Her first love is teaching and that is exemplified by the creativity of the courses she has developed. A series of courses “The In-patient Breastfeeding Specialist,” "The Out-patient Breastfeeding Specialist” and “The NICU Breastfeeding Specialist” are all designed to advance the lactation management skills of nurses at the bedside. She regularly teaches skills to labor and delivery nurses and just recently developed the course “Towards Exclusive Breastfeeding.”


Ms. Hughes is the program director and content manager for all of the on-line Lactation Education Resources courses. Ms. Hughes was recently honored with a “lifetime achievement award” as Fellow of the International Lactation Consultant Association (FILCA).

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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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Katie Hinde is studying breast milk’s status as the first superfood, providing babies with invaluable microbes custom-tailored to their individual needs, via an incredible and unlikely dialogue between the mother’s enzymes and the baby’s saliva.  And in studying the marvels of human breast milk she strongly advocates for a society and health care system that will support the breastfeeding goals of all women.

Katie Hinde Associate Professor, Director of the Comparative Lactation Lab in the Center for Evolution and Medicine and the School of Human Evolution and Social Change at Arizona State University. Click the link below to view her TED Talk.

https://www.ted.com/talks/katie_hinde_what_we_don_t_know_about_mother_s_milk

Maybe her March Mammal Madness can be your inspiration for your next World Breastfeeding Week event!  http://mammalssuck.blogspot.com/

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"My son was born with a recessed chin, he was jaundice. I didn't understand why breastfeeding was so painful. He latched the best that he could with his recessed chin. I saw countless Lcs and Dr.s who told me that bf would never work for us. I pumped for 6 months, I continued to latch my son several times a day even though there was little to no milk transfer and endless pain even with a shield. At 6 mo my son started to latch with less pain.. We had thrush twice. We have overcome so much so that my sweet boy would have all the amazing benefits of my milk. We are at a year and still going strong. I aspire to become an LC to provide knowledge, experience and support to breastfeeding mothers. I am so passionate about bf and I want to help guide other mothers through their beautiful journey."

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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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I'm in the process of pursuing IBCLC certification. My third baby struggled from day one. I was baffled- I had the benefit of success and experience on my side! This wasn't supposed to happen! With the patient, gracious help of my favorite IBCLC, we persisted. I learned what it is like to live through undiagnosed medical problems (hello, tongue tie!) and supplementation in the face of severe breastfeeding problems. We surpassed every nursing goal I had by breastfeeding until 23 months! I'm a Registered Dietitian. I believed in breastfeeding before I ever had my babies, but through this experience, I learned that I have a great passion for lactation. I am eager to complete my remaining requirements to join the ranks of IBCLCs!

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Lactoferrin is one of the miraculous substances found in breastmilk which helps the infant kill bacteria and fight infection.  It is the major whey protein in human milk and has its highest concentrations in colostrum.  While it is important for all infants, it is especially important in the prevention of necrotizing enterocolitis (NEC) in preterm infants.   Lactoferrin has an anti-inflammatory action that may mitigate the pro-inflammatory states present in the gut before the onset of NEC.  This highlights the importance of mothers providing early feedings of colostrum and fresh mature milk to prevent necrotizing enterocolitis in their premature infant.

Researchers are experimenting with recombinant lactoferrin use in preterm infants and showing a benefit in reducing NEC.  In recombinant DNA, molecules of DNA are recombined into sequences that would not otherwise be found in the genome.   Recombining DNA is possible because DNA molecules from all organisms share the same chemical structure. They differ only in the nucleotides, the subunits of DNA and RNA, in the gene sequence.

Lactoferrin is present in cow’s milk in lower levels than found in human milk.  And the process of creating formula lowers those levels even further.  So, exogenous sources of lactoferrin must be added to formula if it is to match human levels.  Recombinant human lactoferrin can now be obtained from yeast, transgenic cows, and rice which have structural similarity to endogenous lactoferrin. 

There is already an infant formula manufacturer which is marketing Enspire™ containing lactoferrin in the range found in mature breastmilk.  This formula uses bovine sourced lactoferrin and is being marketed for use in any baby, not necessarily NICU infants.

Why are research dollars being spent on developing a protein that mothers can provide to their own infants?  Why don’t we spend the research dollars refining our techniques on how to best help mothers of premature infants provide their own lactoferrin, provide the best breast pumps, a place to pump, “rooming in” in the NICU and facilitate lots of skin-to-skin holding? In addition, when the mother is supplying her own lactoferrin, she is also colonizing the newborn's GI tract with beneficial bacteria and lowering stress levels in both herself and her infant. 

Liao Y, Jiang R, Lönnerdal B.  Biochemical and molecular impacts of lactoferrin on small intestinal growth and development during early life. Biochem Cell Biol 2012   90: 476–484.

Lönnerdal B, Jiang R, Du X  Bovine lactoferrin can be taken up by the human intestinal lactoferrin receptor and exert bioactivities. J Pediatr Gastroenterol Nutr 2011 53: 606–614.

Satué-Gracia MT, Frankel E, Rangavajhyala N , German JB.  Lactoferrin in Infant Formulas:  Effect on Oxidation.  J. Agric. Food Chem., 2000, 48:10:4984–4990

Sherman MP, Adamkin DH, Niklas V, Radmacher P, Sherman J, Wertheimer F, Petrak K Randomized Controlled Trial of Talactoferrin Oral Solution in Preterm Infants.  J Pediatr. 2016 Aug; 175:68-73.e3

Sherman MP, Sherman J, Arcinue R, Niklas V.  Randomized Control Trial of Human Recombinant Lactoferrin: A Substudy Reveals Effects on the Fecal Microbiome of Very Low Birth Weight Infants.  J Pediatr. 2016 Jun;173 Suppl:S37-42.

Sherman MP, Pritzl CJ, Xia C, Miller MM, Zaghouani H, Hahm B.  Lactoferrin acts as an adjuvant during influenza vaccination of neonatal mice.  Biochem Biophys Res Commun. 2015 Nov 27;467(4):766-70.

Sherman MP, Miller MM, Sherman J, Niklas V.  Lactoferrin and necrotizing enterocolitis.   Curr Opin Pediatr. 2014 Apr;26(2):146-50.

Sherman MP.  Lactoferrin and necrotizing enterocolitis.  Clin Perinatol. 2013 Mar;40(1):79-91.

Sherman MP, Petrak K. .  Lactoferrin-enhanced anoikis: a defense against neonatal necrotizing enterocolitis.  Med Hypotheses. 2005;65(3):478-82.

Sherman MP, Bennett SH, Hwang FF, Yu C.  Neonatal small bowel epithelia: enhancing anti-bacterial defense with lactoferrin and Lactobacillus GG.  Biometals. 2004 Jun;17(3):285-9.b, c

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Lactation Education Resources has exciting plans for enhancing our Lactation Consultant Training Course beginning in January 2017. We will add micro-learning sessions – short 5-15 minute classes on a focused topic available live as well as archived for viewing later. Another welcome addition will be Virtual Teaching Assistants. VTAs will be available to students to discuss topics and answer questions about the lessons or give career advice.


There will be a tuition increase beginning January 2017. The 90-hour Lactation Consultant Training Program will increase to $975 and the other courses will increase proportionately. We have not had an increase in tuition for over 5 years. If you, or a friend, were planning on taking the Enriched Lactation Consultant Course, you might want to sign-up before the price increase. Just a head’s up. ;-)

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We, along with breastfeeding supporters around the world, mourn the passing of Miriam Labbok MD, MPH, IBCLC. Miriam was a friend and supporter at the inception of our Lactation Consultant Training Course at Georgetown University Hospital in 1990.  Those of us who had the good fortune to have worked closely with her in those early years, know of her influence on the breastfeeding world. Those who come to this work in the future will not know her personally, but will also be strengthened by her tireless work in support of breastfeeding.

Dr Labbok had a distinguished career beginning at the University of Pennsylvania and Tulane Medical School. She served as Director of the World Health Organization Collaborating Center of Breastfeeding, and was the Chief of Nutrition and Maternal Health, Division of the Agency of International Development (USAID). She was UNICEF’s Senior Advisor on Infant and Young Child Feeding and Care.

Most recently she was the founder and a professor at the University of North Carolina Gillings School of Global Public Health and Director of the Carolina Global Breastfeeding Institute. She was a favorite speaker at hundreds of breastfeeding conferences and won many achievement awards related to breastfeeding promotion throughout her career.

Dr Labbok’s vision and commitment to protect, support, and promote breastfeeding has had worldwide influence on the health of mothers and infants!

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The attached survey comes from International Board of Lactation Consultant Examiners to investigate the interest in having a new credential available for people working in the lactation field.  This potential credential is intended for those individuals who are not IBCLCs, but are interested in being recognized by the IBLCE for the training they have accomplished (40 – 89 hours).  

This potential credential is not intended as substitute for the IBCLC but as an enhancement to the IBCLC’s practice.  It would be under the auspices of IBLCE who will develop a scope of practice and entry level exam which would complement and mesh with the IBCLC.  To avoid the appearance of competing with the IBCLC, we see great advantage to having this new recognition developed by the same organization that has oversight of the IBCLC credential, the IBLCE.

Those who may be interested in this new credential include:

  • Those seeking work while completing the rest of the requirements for IBLCE certification
  • Those seeking work without the intention of pursuing IBLCE certification in the future

This credential would be equivalent to the Breastfeeding Specialist certificate given by Lactation Education Resources at the present time.  It would be renewable and internationally recognized.

 We hope all of you will take the time to return this brief survey to IBLCE and tell them of your interest and support.  The survey takes less than five minutes to complete and will close on July 29. 

If you are not yet an IBCLC, please take this survey.

 https://www.surveymonkey.com/r/J79YTH5

If you are already an IBCLC, please take this survey

https://www.surveymonkey.com/r/J82VTPQ

Vergie Hughes RN MS IBCLC FILCA
Program Director
Lactation Education Resources
V 443-203-8553
F 410-648-2570
programdirector@lactationtraining.com

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I started Nursing at a very young age and still I have several years to work. My experience includes 30+ years working OB. What a wonderful way to finish my last trimester than helping new Mom's to perfect their God given ability to nourish their babies.

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I was a 22 yr old, first-time parent in 1988. My own mom told me that breastfeeding was "just a fad" --but the price of formula- at SIX dollars a can was too much for my budget.


The only support I got was from one kind nurse. I can still see her eyes smiling above her mask. She had a slight German accent and reminded me of my grandmother.


My first child breastfed for 13 months despite my return to difficult full-time work 8 weeks postpartum. Later, WIC hired me to assist the Deaf and Hard of Hearing community as a peer counselor and eventually to help staff the first Government- funded Breastfeeding clinic in the Southwest.

I became a proud IBCLC in 1999.
My mom is now grandmother to 3 healthy breastfed grandkids and a vociferous proponent of this "fad". :)

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Although we do this work because we love what we do and know it makes a difference in the health of mothers and babies we serve, most of us can’t be volunteers.  We want to provide expert lactation support, while we make our car payments, rent or mortgage, and buy food too. 

Many lactation consultants are employed in hospitals, where salary ranges are similar to those of Registered Nurses.  Others work in physician’s practices, WIC or public health clinics where salaries may be a bit lower.  Others start a private practice.   This is very driven by your local area and salary scales.  It also depends on the availability of lactation consultants in the area.  Are there open jobs or are there very few opportunities?

Those who also have a credential as a registered nurse will find the easiest to find a job in a hospital. Some hospitals require the lactation consultants they hire are also RN's, although non-nurses are sometimes also hired in certain hospitals.  Other employment opportunities may not have the RN requirement.

Many lactation consultants choose to work part time to meet their other obligations at home.  Others may work two part-time jobs in order to find full employment.

These websites can provide some data on salaries across the nation.

http://work.chron.com/lactation-specialist-make-21656.html

http://www1.salary.com/Lactation-Consultant-Salaries.html

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We have taken, as gospel, the guideline of weight loss of greater than 5-7% (7-10% in many circles) as dangerous for newborns and requires supplementation – for years.  Is this an arbitrary line in the sand, or serious research?


What do you mean that the research upon which this guideline is based might be flawed?  That data was incompletely gathered, sample sizes were too small, formula supplemented infants were not excluded or the supplementation was not recorded.  Was the weight loss effect of maternal IV fluids during labor considered?  The recent article in the Journal of Human Lactation Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full Term Breastfed Infants questions the foundation of these guidelines.  And this is not the first time the data supporting the weight loss guidelines has been challenged.  Noel-Weiss did so in 2008.


The consequences of over-diagnosing excessive weight loss are many.  The mother’s own breastmilk could be expressed and used as a supplement but often that is not considered, and the handy bottle of formula is offered.  Volumes are often excessive.  That formula bottle contains virtually unlimited amounts of supplement, compared to the volumes the baby would be consuming at the breast, if breastfeeding was going well. 

 
Then there is the disruption to the gut flora.  And the sensitization to cow’s milk through the porous newborn gut wall.  Even one bottle can make a difference.


The possible physical sequela are a concern, but the most serious problem with incorrectly identifying an infant as losing too much weight is the damage done to the mother’s breastfeeding intention.  “Well, from the start, I didn’t get this right”.  So, what does it matter if I offer a bottle when the baby cries and I am tired, or I when I go for my OB check-up, and then one when my home is full of guests and I might be embarrassed, and then when I go out for a while with friends, and then, and then….  It starts a slippery slope.   When a mother hears that her baby is losing too much weight she not only questions the adequacy of her breastmilk but of her mothering capacity.   

So, who will do the research, the right way, and get reliable guidelines?  We then can prevent the serious complications of hypernatremic dehydration in a few infants and preserve the breastfeeding relationship during the dip in weight before the mother’s milk comes in, in many infants.  Research methods have improved, more researchers are looking at these issues and we owe it to our breastfeeding babies and mothers to get this right.

Thulier D.  Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants.  J Hum Lact. 2016 Feb;32(1):28-34.

Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review.  Open Med. 2008;2(4):e99-e110.

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My first baby, born in 1975, was premature at 34 weeks gestation, cared for in an excellent NICU for its time. There was little communication to parents, no visits into the unit, no contact with baby until discharge, no mention of how you might intend to feed your baby. It was understood that breastfeeding was too hard for premies, and no mention of breastmilk by pumping. After 18 days, I took home a tiny "puker", allergic to most formula tried in the first year. I became an NICU nurse in 1978, began to hear about benefits of breastmilk, was exposed to a two day course on brestfeeding in 1999, that led to my becoming certified. That was only the open door. Lactation affords me opportunity to support breastfeeding, mother the mom, and fulfill my mission to God for this calling.

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I breastfed my first 2 children with ease for almost 9mo each. When I had my third child I got a very serious nipple wound from improperly pumping. Every time I nursed my daughter it would tear open and bleed. I didn't know what to do or how to help myself. I kept thinking that if I just placed her properly on my breast it would heal.I was up day and night, reading, researching and trying to figure out how to help myself but it kept getting worse. I remember calling LLL and asking if someone could come out and help me, they could offer me phone advice but I needed someone to come to me. I was too tired to go out and get help. I did get that help, and went on to nurse my daughter for over a year. I became an IBCLC to help women in their homes, but am still based in the hospital!

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Breastfeeding prevents allergies.  No it doesn’t.  Breastfeeding helps prevent obesity.  No it doesn’t.  Breastfeeding babies have higher IQs later.  No they don’t.   It is dizzying to follow the research reports on the benefits of breastfeeding.  Just when there are several studies showing a certain benefit, there comes along one that demonstrates otherwise.  What in the world is going on? 

I think that “Summarizing the health effects of breastfeeding” gives a good clue to what is going on.   http://onlinelibrary.wiley.com/doi/10.1111/apa.13136/epdf.  The act of breastfeeding is so complex in terms of how long, how much, supplements given, pumped breastmilk, timing of feedings, mother’s supply, feeding method, and so on.  The milk is so complex in terms of daily variations, monthly variations, variations over the course of breastfeeding, genetic variations, and so on.  The family in which the breastfed baby grows up is so complex in terms of maternal nurturance, life style, socio-economic influences, parental education and so on.  The variables in any research study are enormous and although researchers attempt to mitigate those variations in the design of the study, it is virtually impossible to take them all into consideration.   So we get research that is contradictory.  If the new research not outright contradictory, at a minimum, it may draw differing conclusions.

So, just when you feel comfortable making a claim about a facet of the superiority of breastmilk, know that some research will come out that says something different.   Studies that are replicated and come out with similar results are the most reliable.  Be critical when you read research.  Are there variables that were not considered in the study design?  Who funded the study?  Do the results support the conclusion?

Don’t be shaken by the fluctuations in published literature.  Breastfeeding is more art than science.

Tagged in: breastfeeding IBCLC
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“Be the change you wish to see in the world” This statement has been my go to through many times throughout my life, so it seemed only natural that I looked to it when I sat and thought...what do I want to do with my life? What change do I want to see in the world?
It was when I was two months postpartum with my second child that this answer came flooding into my life. My best friend had just had her first child and there she was sitting on the couch with her newborn with the look of defeat plastered all over her face. The same dreaded face that I have come to recognize all too quickly with many of my patients ... Her son would not latch onto the breast. Though I had a few months of breastfeeding under my belt, I lacked the education, verbiage, and overall counseling techniques to get her through this hurdle. I was at a loss as how I could help. I knew that I loved breastfeeding my child more than anything, the look of contentment, sedation, love and purity that came from him each time he fed, I knew that I wanted her to experience that same feeling, especially since she wanted it so badly. Be the change...I decided then that she was my muse to my new found path. I delved right into how I could be the change I wanted to see in this world, where women who chose to breastfeed had the support, guidance, alliance and encouragement they needed to reach their goals. I earned a BS in Maternal and Child Health with a concentration in Human Lactation; from there I earned my IBCLC. I became the change I wanted to see in this world, and now my new mantra to each patient I see has become, "my goal is to help you achieve yours, whether its three days, three months or three years, I will support you”. Never would I have thought that a profession could feed your soul as much as this one does, but each day I am reminded of that enrichment by the sighs of relief after a successful feeding, a mother’s soft gaze into her newborns eyes and the empowerment she feels when our consult ends. I have become what I set out to be!

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At the age of 24, I delivered my twins at 37 weeks. I thought I would "try" breastfeeding like so many moms say they will. Babies were expensive and so was formula. Luck was on my side, I had a wonderful nurse who helped me get off to a great start. After we were home, a public health nurse came weekly to visit and offer assistance. Sometimes she'd just sit in my living room; her presence was enough to give me the confidence I needed to feed my babies. I watched them grow and thrive on my milk. By the time they were 8 months old I knew I wanted to help other women like the nurse that had helped me. Breastfeeding wasn't just feeding, it was a way of parenting. I couldn't imagine things any other way. With the nurses support, I became an LLL Leader & 3 years later an IBCLC.

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Why an LC?
I read everything I could about breastfeeding before the birth of my first child. He would not nurse in the hospital, and I was told I was starving my baby. At one point he was brought to me and spit up formula, despite me having told them he was to be exclusively breastfed. My anger which I was unable to articulate at that time turned to research and study about breastfeeding. I nursed my son for a year. I’ve dedicated my professional career to breastfeeding women and their babies. It is great to see the progress that has been made.

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