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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Well no, after ducklings hatch from their shells, they usually don’t eat for the first 24 hours, and then they start on small pieces of food and sips of water.  But as we see from this charming video of a mother cat turned mother to ducklings and kittens, unusual things can happen.

That oxytocin circulating right after birth is certainly powerful for bonding for both mothers and their off-spring.  Those newly hatched ducklings arrived just at the peak of the mother cat’s post-partum oxytocin surge.  Lucky for them, she took them “under her wing”, kept them warm and even offered them the only food she had, mother’s (cats) milk.  Oxytocin lives up to its nickname, “the mother love hormone”!

Successful reproduction in mammals demands that mothers become attached to and nourish their offspring immediately after birth. It is also important that non-lactating females do not manifest such nurturing behavior. The same events that affect the uterus and mammary gland at the time of birth also affect the brain. During parturition, there is an increase in concentration of oxytocin in cerebrospinal fluid, and oxytocin acting within the brain plays a major role in establishing maternal behavior.

It may be best to view oxytocin as a major facilitator of parturition and maternal behavior rather than a necessary component of these processes.  

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Legislation to mandate exclusive breastfeeding?!?  Yes, in the United Arab Emirates.  A new law has been passed mandating women to breastfeed their babies for 2 years, and if they are unable a wet nurse will be provided for them.

The BBC published an online discussion of many leaders around the world about this topic., click on the icon next to the picture.

Of course there are supporters on each side,

  • women should not be coerced to do anything with their bodies that they do not choose to do, including breastfeed
  • those who feel that it is such an important health issue, it should be mandated.  There certainly is enough research to back this up.

I agree with both sides.  Law is probably not the best way to promote maternal infant bonding and make women want to breastfeed.

Unfortunately, the discussion left out the important aspect that the birth process plays on initiation of breastfeeding.  Numerous research studies show the impact of immediate skin-to-skin.  Skin-to-skin contact can unlock the new mothers’ desire to nurture her baby and to breastfeed.  Mothers who hold their newborns skin-to-skin after birth have increased maternal behaviors and show more confidence in caring for their babies.  Women, with uninterrupted access to their babies, WANT to be with them and they find separation distressing.  This closeness fosters a good start to breastfeeding and we see that these mothers have a better breastmilk supply and breastfeed for longer duration.  They are more committed to solving any difficulties along the way. 

Skin-to-skin holding at the time of birth helps the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress.  Being skin-to-skin with mother protects the newborn from the negative effects of separation, supports optimal brain development and facilitates attachment.

Let’s start by making the birth process ideal for all mothers and for infants and see what that does for improving breastfeeding initiation and duration rates.


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I recently listen to a TED talk from Diana Nyak About her swim from Cuba to Key West at age 64. On her 5th attempt to swim the channel she succeeded after 54 grueling hours. 

For those of us who have been working in the lactation consultant field it can feel no less grueling.  Not as dangerous to be sure, but just as challenging.

Her challenges:   Jelly fish with vicious stings

Our challenges:    Unsupportive coworkers who can undermine our efforts

Her challenges:    Sharks

Her challenges:    Hypothermia

Our challenges:  Working alone with no support from colleagues

Our challenges:   The formula industry

Her challenges:    Exhaustion

Our challenges:  Years of struggle to make even the smallest policy change

Her challenges:    Navigation

Our challenges:  What is the best strategy to make change or educate co-workers?

Her challenges:    Food and drink 

Our challenges:  Recharging with suggestions from coworkers or conference attendance.

The prize for her.   Walking up on the beach in Key West

For us it might be finally becoming certified as an IBCLC, or helping a mom with a particularly difficult situation or bringing your hospital through the Baby Friendly Hospital designation process

Don't give up when the difficult seems impossible. 

Find a way

By the way, if you are not plugged into the TED talks, you will find them fascinating




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Time to plan for what your intentions are for 2014.  What are your dreams?  You have been thinking about it for a long time - Is it finally time to step up and become an IBCLC?  Is it time to look for that ideal Lactation Consultant job?   A job that will challenge you or a job that will give you experience in an aspect of lactation consulting that you haven’t tried yet.  Maybe it is time to return to school for your RN or advanced degree credential.  Maybe you are ready to hang out your own shingle and start a private practice.

We all need to move forward.  They say, “if you are not moving forward, you are moving backward”.  It is easy to do the same thing day after day, in a groove that is comfortable to you.  Let’s move out of our comfort zone this year and move forward.

They also say put your intentions “out there” and they will be realized.  So put your goals out there by telling friends and family, write a note to put on your mirror or make a picture of yourself in your new work setting.  Join an organization or online community that will help you get closer to your dreams through volunteering or helping you to build skills.  Get involved in your local ILCA chapter or US Breastfeeding Coalition Directory.  Meet the movers and shakers in your area.  Just see what happens in 2014!

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As I look back on an almost 30 year career as a lactation consultant, I have witnessed a huge amount of change for the support of breastfeeding. It is heartening to see support from every corner; the federal, state and local governments, professional organizations, workplaces, and the Affordable Care Act. Even new mothers are better informed and more are choosing to breastfeed. But we still have a ways to go before we reach optimal breastfeeding nationwide.

There are pockets where breastfeeding rates are low and exclusive breastfeeding rates are even lower. Historically, areas that have the lowest rates are the US southeastern states. Also areas where African American, Hispanics and Native Americans live, rates are low.

Lactation Education Resources trains about 350 students to take the IBLCE certification exam each year. But we realize that often the areas that need it most do not have access to a certified lactation consultant. This year we have given four scholarships for our Enriched Lactation Consultant Training Program to individuals who indicated they intend to work in underserved areas once certified.

The winners of this year’s scholarships are:

  • Gloria Bauta, Miami, FL who will be providing low-cost lactation services to area mothers at MilkWorks

  • Jill Olds of Monroeville, PA who will be providing lactation services through her WIC clinic

  • Charlene Parrish of Whiteriver, AZ will be on the Fort Apache Indian Reservation, Whiteriver, AZ

  • Chanel Porchia of Brooklyn, NY will continue to offer infant feeding classes and free/low cost lactation services in her area.

Best wishes to these four winners who will be part of the next generation of Lactation Consultants.

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