Lactation Management Training: From Novice to Expert

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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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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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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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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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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.  http://www.ilca.org/i4a/pages/index.cfm?pageid=3896 using the application found here http://www.ilca.org/files/education_and_research/Clinical_Instruction_Directory/Clinical_Instruction_Directory_Application.pdf

If you are not sure how to be a mentor, ILCA offers several modules on mentorship:  http://modules.ilca.org/index.php?p=view_catalog

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.

Tagged in: IBCLC
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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!

References:

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

http://www.ilca.org/files/USLCA/Resources/Publications/IBCLC_Staffing_Recommendations_July_2010.pdf.  Accessed July 2014.

https://manual.jointcommission.org/releases/TJC2013A/PerinatalCare.html.  Accessed July 2014.

https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps.  Accessed July 2014.

Tagged in: IBCLC IBLCE
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