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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(Addressing the Healthy Beginnings Partnership of Greater Prince William VA & Alexandria VA Breastfeeding Promotion Committee celebration, April 7, 2015)

There is a perspective you achieve having been in the lactation field for most of a career; for me it has been more than 30 years.  I took the IBLCE certification exam the first time it was offered, in 1985.  Back then there were no pre-requisites, just a desire to offer breastfeeding support.  Eat your heart out - those of you who are taking 90 hours of training and hundreds of hours of clinical practice!  But the changes have been good for the profession as there is so much more to know now, and we hit the ground running as a new IBCLC with a much better background.

Thank you to the La Leche League Leaders here who kept the torch burning during the years when breastfeeding rates hit their low point and the medical professionals were seduced by the claims of the artificial baby milk companies.

We have since developed organizations to foster information sharing and program collaboration; The International Lactation Consultant Association (ILCA) and the United States Lactation Association (USLCA) for lactation consultants.  The Academy of Breastfeeding Medicine (ABM), is specifically for physicians.

We have international organizations also working to promote breastfeeding and limit the use of artificial breast milk worldwide.  The World Alliance for Breastfeeding Action (WABA) promotes World Breastfeeding the first week in August each year.   And the International Baby Food Action Network (IBFAN) keeps track of compliance with the World Health Organization Code of Marketing of Breastmilk Substitutes.  The “Code” limits the marketing of artificial baby milk.

The Baby Friendly Initiative has made huge strides in promoting the hospital conditions that promote the successful initiation of breastfeeding.  There are now 250 hospitals designated as Baby Friendly which amounts to about 12% of babies being born in “ideal” breastfeeding circumstances.  So there is certainly work to be done here as more hospitals address their policies and procedures to improve breastfeeding support.

The Office of Women’s Health (part of the Federal Government’s Health and Human Services) has primarily supported employed breastfeeding mothers and encouraged employers to provide facilities and time to enable breast pumping at work.

The Centers for Disease Control (CDC) has developed a “Breastfeeding Report Card” benchmarking policies and procedures in hospitals.  This allows administrators to compare their services and outcomes to other hospitals in their state and the nation.

Back in the day, we used to lament that there was no research on breastfeeding issues.  That has certainly turned around.  Now there is so much lactation related research in so many health science journals, it is hard to keep up.

Breastfeeding Coalitions, sponsored by the United States Breastfeeding Committee and the CDC, are active in all states and sometimes several coalition and workgroups are active in an area.  I congratulate you in your efforts here in Northern Virginia to expand breastfeeding advocacy and support.

Laws ensuring the right of a breastfeeding mother to feed her baby in any public place have been enacted in almost all states.  Congratulations to you for moving this through the Virginia legislature.

So, over the past 30 years, there have been tremendous changes in the breastfeeding landscape that is gratifying to see.  I am sure I have not mentioned all of the groups involved or activities of concerned professionals.  When you have a bad day, you encounter an “uneducated” health professional or a breastfeeding mother who did not receive the support she needed at the time she needed it, just think about all the improvement that has occurred over the past 30 years and keep the faith.  Working together we are making progress!  

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I heard a quote recently that “Breastfeeding is part of mothering, not the point of mothering”.  And I thought back on all of the mothers I have worked with over the years who desperately wanted to breastfeed but were running into problems; some easy to resolve, others seemingly unsurmountable complications.  There have been mothers who endured sore nipples for months, breastfeeding/pumping/cup feeding around the clock, or repeated bouts of thrush or mastitis.  Hero’s? Yes!

I have, at times, given a mother “permission” to supplement or to stop.  Some have gratefully accepted the out, and others have done so with overwhelming guilt and sadness.  Some have hung in there despite the problems.  It seems some mothers have gotten the message that it is imperative to breastfeed.  Exclusively breastfeed; supplement at your baby’s peril.   Breastmilk is magic, to be sure.  However, pushing moms to the edge is not part of mothering, and it is not the point of lactation consulting.  Suggesting alternatives until we come upon the one that fits for this mom and baby is the point of lactation consulting.

We have a breastfeeding dyad here.  Both must benefit physically and emotionally.  What can we each do to prevent the kind of difficulties that get moms into those unsurmountable complications to start with?  And what can we do to resolve them quickly?  That is the point of lactation consulting.

Breastfeeding is a (REWARDING) part of mothering but, not the point of mothering!

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I remember my experience following around Lactation Consultants at Georgetown University Hospital over 20 years ago. Those LC’s made a huge impression on me and I made several decisions about how I would or would not practice from those experiences.

Recently, I started working with Lactation Education Resources and began taking interns. Sometimes I think we see students as a burden, as rounding will take more time and there are always questions to answer etc. But, I have to say our experiences with these interns has been amazing. They are so excited and interested in what we are doing and beam when they have made progress. It made me remember that this his is how I was in the beginning too, and sometimes it’s hard to get that energy back.

These interns really remind us why we do this job of helping breastfeeding couplets. Our interns say thank you to us every single day and also say they have found that niche they have been looking for. They also keep me up on my reading research articles, looking at new products and  going to seminars.  If you want to get your enthusiasm back, support an intern- You won’t be disappointed.

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I know I am contributing to this video going viral - The marketing of infant formula has hit a new mark.  A video that goes viral, everyone sees it. That’s not really advertising, is it? And the maker has a tasteful ad at the end with a link to its FaceBook page.  What could be more welcoming than the FaceBook page for the Sisterhood of Motherhood.  Parent your own way.  Sounds great, doesn’t it? I can ignore the research evidence for breastfeeding if it suits me. I can ignore the recommendations regarding breastfeeding from every organization that has anything to do with maternal-infant health.

The video hits on all of the hot button topics for new families these days: breast or bottle, cloth or disposable diapers, daddy care givers, employed moms, slings or strollers, and attachment parenting.   But when a common crisis unites them all, nothing else matters but the infant’s safety. True…

Now, don’t I feel warm and grateful to this company who says I can parent any way I want to?  But it’s not about me!

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We all know how important skin-to-skin (STS) contact is for a newborn and his mother.  Most hospitals are moving towards immediate skin-to-skin for all newborns (breastfeeding mothers or not) in our delivery rooms!   But what about the operating rooms? 

At a time when families are under the additional anxiety of a surgical delivery, skin-to-skin care increases family togetherness and satisfaction with the birth.  We have known for years that a cesarean delivery delays lactogenesis II and negatively affects breastfeeding duration.  With a cesarean rate of 33% in many areas, this is an issue that affects many families. 

A systematic approach makes this change more acceptable to all involved: nurses, obstetricians, anesthesiologists and lactation consultants.  An organized process of planning, testing a pilot protocol, staff training will reduce the anxiety of all staff.  Involve stakeholders from all disciplines in planning and executing the changes.  An influential champion can provide the leadership to engage staff and create enthusiasm for the process of change.   Finally, implement a preliminary protocol and refine it as needed, then make it policy.

Continual surveillance is needed to assure that the procedural changes are incorporated into practice and maintained and that there is no back-sliding into old habits.  Analyzing the improvement in Quality Assurance measures can reinforce the hard work of the staff.

How this skin-to-skin procedure is implemented will vary from hospital to hospital depending on their facility and their staff.  But Moms, infants and families will benefit as skin-to-skin becomes a normal and routine practice.

Want to explore this further?

Facilitating Skin-to-Skin Contact in the Operating Room After Cesarean Birth.

Stone S, Prater L, Spencer R.  Nurs Womens Health. 2014 Dec;18(6):486-99.

Early skin-to-skin after cesarean to improve breastfeeding.

Hung KJ, Berg O.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24

An interprofessional quality improvement project to implement maternal/infant skin-to-skin contact during cesarean delivery.

Brady K, Bulpitt D, Chiarelli C.  J Obstet Gynecol Neonatal Nurs. 2014 Jul-Aug;43(4):488-96

Skin-to-skin contact after cesarean delivery: an experimental study.

Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P.  Nurs Res. 2010 Mar-Apr;59(2):78-84

Postcesarean Section Skin-to-Skin Contact of Mother and Child.

de Alba-Romero C, Camaño-Gutiérrez I, López-Hernández P, de Castro-Fernández J, Barbero-Casado P, Salcedo-Vázquez ML, Sánchez-López D, Cantero-Arribas P, Moral-Pumarega MT, Pallás-Alonso CR.

J Hum Lact. 2014 May 20;30(3):283-286

Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature.

Stevens J, Schmied V, Burns E, Dahlen H.  Matern Child Nutr. 2014 Oct;10(4):456-73.

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At this time of year, when we are scrambling around to find the perfect present for everyone on our gift list, let’s remember that breastmilk is the gift that lasts for many holiday seasons.

In fact it is a whole pile of gifts for everyone in the family: the baby, mother, and family as well as the community at large.  And these gifts are free!  Now where do you get a gift, that keeps on giving, for free?!

Here is wishing a years’ worth (or more) of breastmilk for every baby, mother, family!

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Hospitals which are attempting to initiate Baby-Friendly practices have received a lot of press recently.   Not always does the reporter get the details right.  Sometimes the headline is negative, but the story is essentially positive. 

But at least people are taking notice of the movement!  Here is just a sampling of what has been published recently.

Hospital Support for Breastfeeding: On the Cusp of Big Changes, Time to Step It Up

'Baby-friendly' hospitals: Moms give new measures mixed reviews

Local hospitals strive to offer a balance of maternity options

UNM Hospital receives prestigious “Baby-Friendly” designation

No Nursery, No Formula, No Pacifier:  Are “baby-friendly” hospitals unfriendly to new mothers?

 In the article published in Slate, the journalist quotes a study that says formula use promotes breastfeeding by relieving maternal stress.

But she neglects to address the main reason why exclusive breastfeeding is so important, the changes in the newborn gut from even limited amounts of formula.  Here are just a few selected research articles related to the importance of gut flora and how it can be impacted by breastmilk or formula.

Effect of breast and formula feeding on gut microbiota shaping in newborns

 Effect of formula composition on the development of infant gut microbiota.

 Maternal factors pre- and during delivery contribute to gut microbiota shaping in newborns.

 Human gut microbiota: onset and shaping through life stages and perturbations.

 The long-term health effects of neonatal microbial flora

 I suspect, as more and more hospitals become Baby-Friendly and institute policies that promote exclusive breastfeeding, the rhetoric will heighten even further.

Congratulations to those over 215 hospitals who have achieved Baby-Friendly Hospital designation.  Lactation Education Resources is proud to have been a part in the educational preparation for designation in many of these hospitals.  There are currently 250+ hospitals using the LER training. 

At present, only 9.4 of the births in the US occur in Baby-Friendly hospitals.  Let’s not stop until we have 100%!!

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Lactation Education Resources has conducted it second annual Scholarship competition and we are pleased to congratulate the winners!

Drum roll here please………….

Shlonda Smith  Augusta GA

“After obtaining my IBCLC, my goal is to help all moms with breastfeeding support with a special emphasis on protection/promotion/support among women of color.  My goal is to continue working with low income women normalizing breastfeeding.”

Angie Natero  Dover, TN

“I am so thankful for this scholarship, and my goal is to use my future certification to become a lactation consultant, which will allow me to hopefully help many moms and babies have the most successful breastfeeding experience as possible.  Angie will be the only IBCLC in her hospital and in her area.”

Josephine Silversmith  Gallup NM

“I am a nurse working at the Indian Health Service Hospital.  I will be better able to help moms with difficult situations.”

Megan Kahlich  Hereford TX

“I would love to normalize breastfeeding among my staff and patients.”  Megan will be the only IBCLC in her hospital.

Tamika Simpson  Moreno Valley CA

“I plan to work with and support pregnant and parenting teens at Planned Parenthood and WIC in Orange and San Bernardino Counties and educate them on the importance of breastfeeding.”

The winners were selected on their commitment to work in breastfeeding support positions in underserved areas as well as their commitment to breastfeeding mothers and babies.  In addition, their previous experience, previous education, how involved they  are already in their community protecting, promoting and supporting breastfeeding, was considered.

Best wishes to these women as they begin the training to become an IBCLC!

Cymbal crash here…..

Tagged in: IBCLC IBLCE scholarships
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You have seen it, a mother who runs into every problem possible as she attempts to begin breastfeeding.  One problem is solved, another one pops up.  How do these lactastrophies happen?

Usually it is related to a series of unwitting and unintentional circumstances during the newborn period in the hospital.

Perhaps it was no skin-to-skin contact immediately after birth

Or no initial feeding during the first hour after birth

Or separation of mom and baby for the initial bath, routine newborn care, or temperature stabilization

It could be a sleepy and sluggish baby due to maternal anesthesia during labor and/or surgical delivery

Maybe it was a lot of intrusions from visitors, cell phones or care providers interrupting the privacy of mom and baby

Maybe it was separation with the baby in the nursery so mom could sleep

Or a bottle of formula due to the infant’s excessive weight loss

Sometimes it is excessive IV fluids during labor causing both pathological engorgement and excessive infant weight loss

Sometimes is it a poor latch that leads to cracked nipples that leads to mastitis

Or a pacifier used to calm a baby when all he really wanted was to be held and fed

Perhaps to mother requests formula feeding due her misperception she has “no milk “ and  then her baby learns to prefer the bottle nipple

Or the mother’s confidence is shattered in her ability to breastfeed by inconsistent or even incorrect advice from her nurse or physician

We can stop this from cascading into a lactastrophe by getting mom and baby together right from the beginning, avoiding separations and the need for supplementation.  If we as a team of health care workers get most of this right, we can help avoid the next problem. 

But if many of these events occur, it is a lactastrophe waiting to happen!

Thank you to Alison Stube MD for coining the term lactastrophe and for inspiring this blog.

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I read recently the article on how difficult it is to get new research into practice.  (Pravikoff DS, Tanner AB, Pierce ST.  Readiness of U.S. nurses for evidence-based practice.  Am J Nurs.  Sep;105(9):40-51; 2005.).  The author says it takes 17 years for research to make an impact on practice.  And that change in maternity settings takes the longest.  Why is that?

I did it that way

For the most part, nurses working in maternity are already mothers.  They have made their choices about feeding and caring for their infants, long before they are confronted by research that perhaps shows that they did not make the best evidence based decision.  Who would want to think that they did not do the best for their own children?  So, the “my kids turned out fine” argument supersedes the research that shows otherwise.


Sometimes it is a matter of habit.  We are learning that habits are neural pathways that have become hard wired in the brain.  They are ways we have done something so often that the thought or the act of doing something different is difficult to change.  It requires real effort.

Take the example of doing the baby bath.  You learned to do the initial baby bath during the first hour or so of life.  You have done it that way for so long that it is “hard wired” into your brain.  That is how the bath is done.  Neural pathways are set and it takes some effort to get the brain impulses to travel over different pathways. 

Maybe it is even hard wired into your institution.  There are policies and procedures that mandate that the first bath be done during the first hour of life.  Even before the family has had a chance to really bond or breastfeed their baby.  Now, that is going to take some effort to change the hard wiring in your institution as well in your practice.

It is possible to change.  We used to think that neural pathways were set by adulthood and the brains physical pathway was permanent.  Modern research has demonstrated that the brain continues to create new neural pathways and alter existing ones in order to adapt to new experiences, learn new information and create new memories.  Here are some suggestions for unlocking the neural pathway rut and changing your thinking.

  1.  Identify the habit
  2. Observe the consequences of the habit
  3. Shift your focus to create a new neural pathway.  The brain is plastic and can change
  4. Use your imagination.  How could it be better?
  5. Interrupt your thought patterns when they arise.  Turn that mental corner towards your new behavior.
  6. Create a plan about what you will do in the future
  7. Transform the obstacles.  Talk to co-workers about the routine of bathing, change the policies and procedures
  8. Connect with others
  9. Make the shift

Diffusion theory

There are some who see a new idea and accept it readily (Innovators).  There are some who see a few people doing things a new way and see the advantages (Early adopters).  The Early Majority will adopt the new idea more slowly, but they will get there. Then there is the group of people who follow along what most people are doing (The Late Majority).  And the final group is the Laggards.  They will adopt the innovation after much resistance and social pressure. 

So the trick is to engage the innovators and the early majority in making the change you want to see.  Then allow them to spread the change throughout the staff.

Fear of the unknown

Changing a practice or policy leads the staff into the unknown.  What could possibly change as a result?  Could there be unintended consequences?  Address concerns that change will bring.  Who would change when they don’t see what the future will bring or that they aren’t sure they know how to do the new task.  Talk about what can go wrong and have a plan for addressing it.   Training will be the key in addressing the unknown and making it a “known”. 

So if you are the change leader, plan how you can best accomplish your change.  Gather your innovators and those in the early majority to assist you in planning and implementing your change.  Address the staff concerns and determine ways to break old habits.  Provide training to address the unknowns and make the change safe.

Good luck!  ;-)



Tagged in: breastfeeding
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The biggest challenge facing many aspiring lactation consultants is where to obtain their clinical hours.  Those who have the easiest path for this are RNs working in maternity, nursery, labor and delivery, or other maternity setting.  They can collect clinical practice hours at work as they focus on Pathway 1.

But for those who are not in this situation, finding an internship setting can be frustrating, discouraging, if not down-right impossible.  I hear from potential IBCLCs on a regular basis about how difficult it is to find a mentor.  This may be the stumbling block for many who throw in the towel at this point and give up on a career in lactation.  What can we all do to help?  We need as many workers in the field as we can find.

Do you want to retire at some point?  Do you want to leave the lactation world in a better place than when you came into it?  Then volunteer to mentor an intern.  Or better yet, seek out a potential IBCLC and offer to assist her through her journey.  List yourself on the ILCA Clinical Instructor map so people can find you. using the application found here

If you are not sure how to be a mentor, LER offers a online lesson on mentorship:

Lactation students look to mentors to provide that real-world component to the “book learning” they have been doing.  Interacting with a variety of mothers, navigating “the system”, problem-solving in difficult situations: these are all skills best learned one-on one.  Remember the old saying “iron sharpens iron”.   Interns keep you sharp.  They ask questions that make you think.  You search the resource books together.

Mentors gain as much from the experience as the intern!  It is so rewarding to see one of your “fledglings” fly off and do good work on her own.

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Our current acting Surgeon General, Boris Lushniak MD MPH, gave a rousing address to the attendees at the United States Breastfeeding Coalition conference held in Arlington, VA on August 4.  His main message?  Let’s go retro!

Dr Lushniak spoke about 3 “retro” actions that he believes will improve the health of the nation:

Walking, Cooking at home and Breastfeeding

Walking: What is retro?  We used to walk everywhere we went: to school, to shop, to visit friends.  Cars were for long trips.  Not anymore.  We tend to get in the car and drive everywhere we need to go.  We might even drive our car from one end of the shopping center to the other if we go to both ends for the stores we want to visit.  We could walk.  Americans need to get out of their cars and walk more.   And we can walk more just for fun and recreation. 

Cooking:  What is retro?  Home cooked meals.  And back in the day they were prepared from local ingredients.  Not anymore.   Americans are relying more and more on fast foods, precooked foods and convenience foods.  These often have been processed so they have minimal nutritional content and fiber.    They also often contain unhealthy amounts of salt, sugar and fat, and they cost more.

Home cooking affords the family the benefit of fresh foods prepared at the time of the meal to preserve the most nutrient value.   It also usually means that the family sits down to eat together.  In a busy family this may be the only time in the day that the family unit is together to talk and share. 

Breastfeeding:  What is retro?  Every baby was breastfed for extended periods of time.  The only alternative was a wet nurse.  Not anymore.  Artificial baby milk is everywhere.  We are coming out of a period when breastfeeding was in severe decline.  Thankfully, that has turned around and national breastfeeding rates are climbing to over 77%.  We know well the benefits to the health of the baby and mother.  There are also benefits to the family and cost savings to the health care system.

So let’s go retro by walking more, cooking more at home and breastfeeding!

Tagged in: breastfeeding
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Let your imagination go wild!  What would the world look like if breastfeeding was ultimately supported?

  • Every mother has breastfeeding education during pregnancy
  • Pregnant women are encouraged to breastfeed by their friends and family and are offered positive stories
  • All health care workers mention breastfeeding in a positive light
  • Every maternity shop promotes breastfeeding bras, tops and night gowns
  • All new mothers chose to breastfeed and plan on it for at least a year
  • Every hospital makes skin-to-skin care the norm after vaginal and cesarean deliveries
  • Rooming-in is standard in all hospitals
  • Formula and pacifiers are not available in hospitals except for true medical need
  • Visitors are limited in hospitals to “immediate family” only
  • Every mother has erect nipples that are easy for latch
  • Every mother’s milk comes-in in 24-48 hours
  • No breastfeeding mother has sore nipples
  • Mothers are able to breastfeed around the clock as long as their baby requests that and are not tired the next day
  • Engorgement is mild and viewed as a good sign that the milk “is-in”
  • Breastfeeding mothers do no need a support group because everyone is supportive
  • All mothers have an abundant milk supply
  • No mother ever leaks, especially when she is in the company of strangers or co-workers
  • Slings and carriers replace “baby buckets”
  • Most employers have day care facilities in-house and encourage mothers to feed 2-3 times per day
  • Other employers offer private breast pumping facilities
  • Every store, restaurant, office, airport and airplane the breastfeeding mother visits, encourages her to stop, relax and feed her baby
  • All babies gain weight at an appropriate rate (WHO standards)
  • Everyone who encounters the breastfeeding mother says “You are still breastfeeding, aren’t you?”
  • Formula manufacturers are in danger of going out of business
  • There is a rainbow over every breastfeeding mother’s residence

And all babies get the benefit of breastfeeding for at least a year

What would you see in Lactopia?

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I just got home from the AWHONN conference in Orlando.  We heard speakers talk about their plans to have an all IBCLC staff on their maternity units.  Now that is an exciting idea and what a great benefit for all of the breastfeeding mothers.   Expert help, at hand, whenever needed!

Other speakers talked about a mix of skills.  Some Breastfeeding Resources Nurses, some IBCLC’s.  But these managers recognized that everyone needs to have beyond the basics of lactation management training.

Recommendations from USLCA (and endorsed by AWHONN) have calculated the following recommendations for IBCLC staff:

Tertiary Care Facility (Based on 20% preterm delivery rate) - 1.9 FTEs/1000 deliveries

Hospital with Level II Neonatal Service - 1.6 FTEs/1000 deliveries

Hospital with Level I Neonatal Service - 1.3 FTEs/1000 deliveries

 The Joint Commission Accreditation Surveys now include Perinatal Core Measures that every hospital over 1,100 deliveries per year must monitor.   Through experience with high preforming hospitals, the Joint Commission believes that hospitals can achieve a 90% exclusive breastfeeding rate.  As more and more hospitals adopt the Baby-Friendly Hospital Initiative, they also are challenged to improve exclusive breastfeeding. 

The role of the hospital IBCLC is not only to provide care to breastfeeding mothers wherever they are in the hospital (maternity, pediatrics, emergency suite, surgical or medical units), but to train, coach and motivate the rest of the nursing and medical staff.  The other key role for the IBCLC is to influence unit policy and procedures.  The best way to improve breastfeeding exclusivity is to have an abundance of staff well trained in lactation support. 

In order to meet the mandates to improve breastfeeding initiation and duration rates, it is imperative that expert lactation support be readily available during the hospital stay.  The best way to achieve this is with an all IBCLC staff!


AWHONN  Guidelines for Professional Registered Nurse Staffing for Perinatal Units.2010.  p.31  Accessed July 2014.  Accessed July 2014.  Accessed July 2014.

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I recently spent 3 days in Omaha Nebraska doing a 3 day Train the Trainer Program for the Lactation Consultant leaders in the hospitals.  It was designed to improve the breastfeeding support in their hospitals and move towards Baby Friendly Hospital status.  This was a group of exceptionally well prepared IBCLCs whose passion for the success of breastfeeding for the mothers and babies was evident.  

The evening after our second day, tornadoes moved through Omaha, with torrential rain, flooding and baseball sized hail causing widespread damage in parts of the city and surrounding areas.  None the less, everyone was present for class the next morning.  It didn’t matter that for one student all of her windows were broken by the hail.  Now that is commitment!

Each of the students in the Train the Trainer class taught two of the modules comprising the 15 hour Baby Friendly Hospital training.  In addition, they each taught an aspect of the skills fair preparing  to lead the 5 hours of hands on clinical experience.

Bravo for the Lactation Consultants in Omaha and the breastfeeding mothers and babies in the Omaha hospitals!

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Those of you who are sitting for the IBLCE exam for the first time this year, the countdown has begun.  There are 76 “study days” left.    So how will you spend your time?  You may think, I don’t have to start yet, there is plenty of time.  Or some of you may be panicked thinking there is so much material and so little time.   Deep breathe. 

And if you have taken the exam previously, but are at your 10 year or 20 year mark and have to re-sit the exam, take heart.  Remember, the exam is an entry level exam and if you have been actively practicing as a lactation consultant, then you have the advantage.  You have passed the exam at least once and you have experience.  Those case study questions will make more sense now.  ;-)

Here are some suggestions:

Start now

Plan a strategy for how you will review all of the material.  Use the IBLCE Exam Blueprint to categorize the topics and plan to study one each week.

You will be more confident during the last week before the exam, if you have reviewed everything and feel in control.

Gather compatriots

Group study is always more fun, so gather some local people who will be studying also.  Plan to meet a few times to go over strategies, practice test questions, and share anxieties.

For those of you who have taken the LER Lactation Consultant Training Program, we have a FaceBook page for the IBLCE Exam 2014.  If you did not get an invitation, email for access.

Make flash cards

Jot down facts that you feel are important and “testable”.   Writing helps you remember, and you can also review them later.

The ones developed by Lactation Education Resources are good for medical/lactation terms.

Study in short bursts

Don’t study for hours on end.  Things begin to fall out of your head after long stretches with the books.   Take a break and get your blood moving again.  Do some stretches, drink something.  Study for a few hours, review what you studied and do something else, or sleep.

Choose a quiet place

Make sure you have a place conducive to study: quiet, good lighting, comfortable, snacks if you like.  Sometimes going to someplace helps, like a library or coffee shop or a friend’s quiet space

Set up a place that is your study nook that has all of your reference books, paper, pens, etc. so you don’t have to waste time searching for study materials each time.

Some people find studying with soft music helps, others find it detracting.  A headphone or earplugs prevent bothering others and keep out distracting noises, even without the music.   If that quiet hum of background noise helps you block out distractions, but a coffee shop is not handy or is too busy, try listening to   You can choose your favorite “noise”.

Negotiate with your family

Plan for study time where everyone agrees to not bother you – for anything.  You will be able to concentrate better knowing you have uninterrupted time ahead of you.

Positive affirmations help

“I can learn this material easily”, “I remember everything I read”,  “This material is interesting to me”,  “I am good at taking tests”, “I recall everything I study”, more….

Feed your brain

Skip the junk food and eat foods known to aid concentration and memory such as fish, nuts, seeds, yogurt and blueberries.   Have lots of water available to sip on.

Have good reference materials

There are several good books useful for studying for the IBLCE Exam. 

  • Your class power point handouts of each lecture
  • Breastfeeding & Human Lactation by Riorden and Wambach

The lactation consultants “bible”

  • The Core Curriculum by ILCA

Excellent, comprehensive book in outline form

  • The Breastfeeding Atlas by Hoover

Great for pictures

If you have, or have access to, other books use them all.  Look up controversial topics up in several references so you have the consensus of the authors.

Practice exams

Take the exam at the end of your lactation consultant Training Program, again.  First time, do it as an open book exam and look up what you need to.  Then time yourself and see if you can do it faster.  Push yourself a little.  The IBLCE exam is not a “speed” test, but practicing with a little pressure makes it more realistic.

If you want additional test questions to practice with, consider signing up for the IBLCE Exam Review program

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Some people you encounter for a day, others you remember for a few months, and others influence you for a lifetime.  I have been blogging recently about “making change” in your own practice and in your institution, “leaning in” to your career, and “finding a way” to accomplish things even though the odds may not be in your favor.  All of those things Barbara did daily in her practice as a lactation consultant, a woman's health nurse practitioner and integrative medicine specialist.   She was always up to date on the latest research, willing to go the extra 10 miles for her patients and had a cheerful word for everyone.

Those of us who worked at Georgetown University Hospital in the Lactation Center and Milk Bank in the 1990’s formed a special bond: Barbara Boston, Silvia Ochs, Karen Rechnitzer,  Maire Hewitt and I.   Though none of us are still working at Georgetown, we have worked together in various configurations at several local hospitals and lactation centers.  Some of us have moved away and come back during the intervening years.  But our group endured.  When Barbara lived in Switzerland or Denver, she always returned to speak at the Lactation Consultant Training Program.

Perhaps many of you reading this remember Barbara and her lectures on sexuality.  Always funny and always right on point with a deep understanding of the impact on the family.  Thank you, Barbara, for all you have given to everyone you have influenced.

Barbara died April 28 after more than a year of cancer treatments.

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Why is change so hard?  Whether it is something as simple as adding a new skill to our “tool box”, or a big project such as Baby Friendly Hospital designation, it can be hard.  It puts us outside of our comfort-zone.  That safe feeling of confidence, security and being free of risk.

For some of us, adapting to change is easy.  It may be uncomfortable for a short time, but basically not a big deal and we move on doing things the “new way”.   We are sometimes called the “innovators, or the early adopters”.   We view a new way of doing things as a challenge and we find it exciting.  We welcome the change.

For others of us, adapting to change is difficult.  And down-right scary.  We find any and every reason not to make change.  We are in the group called the “late adopters or the laggards”.  We dig in our heels and won’t listen to reason. 

There is, of course, the group in the middle who see the majority of people making the change and who will go along with the crowd.

My mother-in-law was a late-adopter.   Microwave ovens have been common place in kitchens since the 1960’s.  She refused to have one.  Even when her adult children bought one for her at Christmas years later, she refused to use it.  It sat in the garage.  “I can’t see any reason for it.  The stove works just fine”.    No way would she explore what benefits it might have for her.

So when change is thrust upon us by our supervisor, or maybe by the management’s decision to become Baby Friendly, how do we handle it?  Embrace it or resist it?  Or maybe wait to see what everyone else thinks first.

Getting un-stuck

  • Know why you are making the change
    • Gather the relevant research and review it.  Discuss it in a committee meeting.  Decide how the research aligns or doesn’t align with your current policies and procedures
    • What could be the upside of making the change?
  • Know how to make the change
    • Let people vent and grieve the loss of the old way
    • Change policies and procedures based on your analysis of the research
    • Get needed resources whether those are people resources or equipment
    • Orient staff to the new policy and procedure
    • Start small – make a small change, then several small changes, then you will have a big change
  • Avoid failure.  Nothing is more discouraging than working on a project just to have it fall apart.
    • Plan carefully to avoid unintended consequences
    • Be ready for set-backs whether in the form of the laggards who give you resistance or the administration who change their support/resources.
  • Making it stick
    • Keep the enthusiasm going with staff meetings, supervisory sessions, posters,
    • Use peer support for those who need coaching
    • Use peer pressure for those who are resisting


Let’s look at the concept of delaying the newborn bath that is usually done soon after delivery.   I have heard nurses say, “We do the bath when the mom is transferred to her post-partum room.  She can’t hold her baby then anyway”.  Or, “Moms don’t want to hold a gooey baby”.  Or, “how could a bath make any difference in initiation of breastfeeding?”

Why should a hospital make the change to delaying the bath?  Search up the research.  Here are a couple of specific articles, but there are many more on the consequences of delaying skin-to-skin contact for mom and baby.  Skin-to-skin is essential for a good start to breastfeeding and it is often delayed or interrupted for the baby bath.

A delayed newborn bath was associated with increased likelihood of breastfeeding initiation and with increased in-hospital breastfeeding rates.

Preer G, Pisegna JM, Cook JT, Henri AM, Philipp BL.  Delaying the bath and in-hospital breastfeeding rates.  Breastfeed Med. 2013 Dec;8(6):485-90.

In this review of the literature, procedures beneficial to initiating breastfeeding such as drying, skin-to-skin contact, delayed cord clamping, and delayed bathing were either omitted or inappropriately sequenced in the time immediately after birth in a significant number of institutions.  Sobel HL, Silvestre MA, Mantaring JB, Oliveros YE, Nyunt-U S.  Immediate newborn care practices delay thermoregulation and breastfeeding initiation.  Acta Paediatr. 2011 Aug;100(8):1127-33.

Does the research support the policy and procedure on the timing of bathing?  If not, what is the best way to modify it.  Delay the bath for two hours or for four hours, wait until the baby wakes up from his first deep sleep, wait until the nurses routine bathing time, wait for 24 hours, or wait until hospital discharge?  A bath demo could be done with the parents in the discharge teaching.  What will work for your hospital?  Maybe little steps would be a good start.  So start with a delay of 2-4 hours.  When that is working well, make it 24 hours or at hospital discharge.  Explain to parents what the policy is and why you bath babies the way you do.  Enlist their support.  The vernex is good for the baby’s skin and can be massaged in.

What could be the upside of changing to delayed bathing?  It saves nurses time, babies don’t have to spend extended periods of time under the radiant warmer warming up after the bath and the bathing procedure can be used as a teaching tool with new parents.

If there are several people who are not embracing this new procedure, let them vent.  Acknowledge that change is difficult and the old way of doing things seemed to be working well.  Help them move past this.

Have your pediatric committee or breastfeeding committee review the policies and procedures based on the research that was reviewed and make the needed revisions.  Communicate the revision to the staff so everyone is aware of the change.

Think about what resources might be needed.  Are there any?  How can in-servicing of the new procedure be done most effectively?  Will you use staff meetings or have a skills station?  Posters?

What unintended consequences may happen?  Do your homework.  Know what pitfalls there could be and plan to avoid them.  Will babies become chilled?  Make sure that babies are dried and placed skin-to-skin immediately after birth.  Are warmed blankets available?  What other unintended consequences might arise?

Involve everyone in evaluating how the new procedures are going.  Make any adjustments that are necessary.   Maybe you can give your laggards a key role in supporting the new procedure.  That just might help them become your strongest innovators.

Keep the ball rolling!  Who are your innovators who can give encouragement and training to the rest of the staff?  Have them lead by example.  And then you can use a little peer pressure to bring around the rest of the staff.

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I have been alternatively aggravated, inspired, confused and exasperated since listening to the TED talk by Sheryl Sandberg, “Lean In”.  I bought her book to understand better her concepts for women in leadership careers.

“Lean in”.  As lactation consultants it seems we do this daily.  We “Lean In” with our clients.  We give attention and we show interest.  We help problem solve and create strategies.  That seems natural.

I think most of us went into lactation consulting thinking that our role would be to help new mothers be successful with breastfeeding.  Our main challenges would be difficult latch-on, flat nipples or helping moms with engorgement or previous breast surgery.

But once we get into our work, we learn that those clinical challenges are what we prepared for in our lactation consultant training.  They are no less difficult for the mother and no less of a challenge for us, but they are usually solvable.

The bigger challenge is managing a career with all of the other responsibilities that working women generally have, juggling children, work hours, partner’s needs and social obligations.  And we all need a little fun and relaxation from time to time.

But the biggest challenge we encounter is influencing change among co-workers in our hospitals, agencies or communities.  No matter where we work, we likely don’t experience optimal support for our skills and expertise.  We may even experience disparaging comments, unrealistic workloads, or out-right resistance.

Let’s “Lean In” to our careers.  What does that mean?   

  • Make suggestions for change
  • Do library research to share with others
  • Speak up even when not asked ;-)
  • Quote reliable authorities, (The Surgeon General, The Centers for Disease Control, the American Academy of Pediatrics, The Joint Commission and others)
  • Volunteer for committees
  • Learn something new, teach something new
  • Do a quality assurance project, survey or a research project
  • Sit at the table and actively engage (as Sheryl would say)
  • Pick an informal mentor for yourself
  • Accept leadership positions in lactation related organizations
  • Mentor (formally or informally) aspiring lactation consultants
  • Grow in your abilities to influence others

I have known many lactation consultants over the years, working in many different settings.  Most did their jobs and went home.  They were good at assisting breastfeeding moms and passionate about the importance of breastfeeding.  They weren’t engaged in moving the breastfeeding agenda forward – whatever that may mean for the setting.  They had a lactation job, but the primary focus was their children and family, not career.  

Lactation Consultants CAN balance their family goals and needs with a career where they “Lean In”, whether working full time or part time.  And the future of breastfeeding support in our country needs these kinds of lactation consultants!

Watch Sheryl Sandberg’s TED talk to get inspired about how you can “Lean In” to your career.

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The Baby Friendly Hospital Conference is an annual event sponsored by the New Mexico Breastfeeding Task Force held in Albuquerque, New Mexico.  The over 150 delegates attending the conference were eager to hear KimMarie Bugg, Jane Morton, Molly Pessell, Kittie Frantz and others as they informed us of current research and helped build enthusiasm for the Baby Friendly Hospital movement. 

As an exhibitor at the conference, we at Lactation Education Resources, were pleased to present our online training to hospitals looking for training resources.  Representatives of interested hospitals were thrilled to hear that online training can be very affordable, is easy to use and streamlines the tracking process.

For hospitals using HealthStream, the program files can be loaded and run on the hospital system.

For further information, please go to or contact Juanita at  A free course trial is available here

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