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Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus westward to Oakland, California. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.

While it’s true that no other area is consistently underperforming as significantly as the South when compared to the CDC’s Breastfeeding Score Card, there is room for improvement in every direction. This is true even on the West coast, where state breastfeeding rates are excellent at a glance. Per the scorecard, California is outpacing the national average in nearly every measure. California has already reached the Healthy People 2020 goals, and is on a trajectory to continue to outpace most states in the coming years. The data highlights some of the many things that are working well in California, such as the high percentage of Baby Friendly Hospitals (which directly correlates to the percentage of babies who receive solely breastmilk during their first two days of life), and childcare regulations that support breastfeeding success in the long run. California gets it right in many ways. However, as much as it is an anomaly, some pockets of California are also plagued by the same obstacles to success that we saw in the deep South and in Appalachia. As we’ve seen, some key factors have a detrimental impact on whether babies get mother’s milk as early, as often, and for as long a duration as is ideal. These factors include race, economic status, and access to quality care. The scorecard shows a significant gap in the number of births to the number of lactation supporters statewide. For example, in terms of free or low cost support, there are only around 2 certified lactation counselors and less than one La Leche League leader per 1,000 live births. Both of these figures are lagging compared to national averages.

So what support is there for parents who need help breastfeeding but may not be in a position to hire an IBCLC? One such solution has been working well in Alameda County, and specifically East Oakland. We caught up with the renowned TaNefer Camara, to discuss her community support group, The Lactation Café (TLC).

California scored well on the last BFing ScoreCard. How does East Oakland compare?

Overall California's breastfeeding rates are impressive and in some areas exceed national averages. In East Oakland, breastfeeding rates do not reflect state averages. East Oakland is an area that is still very much segregated by ethnic and socioeconomic lines. Some areas - particularly the community where The Lactation Cafe is held - are largely Black and Hispanic. While there has been an increase in breastfeeding initiation and duration rates over the past 5 years in Alameda county, there remains pockets of community that could benefit from additional support. Many of the families are receiving the message that breastfeeding is important but they fall short of breastfeeding goals due to work conditions, lack of familial support, medical reasons or misinformation.

Can you tell us a little about the group’s inception and how it has grown/evolved since it began?

The Lactation Cafe began as a pilot program sponsored by First 5 Alameda County. We started off with maybe 4 participants and grew to serve 10-15 moms each group. We collaborated with local health programs, hospitals and clinics to engage new families. The next phase will focus on sustainability and community capacity building. We hope to develop group participants into leaders who will lead and facilitate future groups.

How is the community better off due to your presence?

The Lactation Cafe has been a safe place for families to receive concrete support in times of need, gain knowledge of child development, build social connections and get the support they need to meet their breastfeeding goals. Moms who attend TLC and other groups in our community are able to share what they learn with other mothers, they become advocates for themselves, their children and their community members and they support one another.

Could something like the The Lactation Cafe be duplicated elsewhere?

Absolutely! TLC can be duplicated. We used the Strengthening Families framework as our guide and in alignment with our breastfeeding curriculum. The key to a successful group is outreach, engagement and community partnership. Oh, and good food. Whole some food and nutrition was a major part of our group.

Wherever there are breastfeeding disparities, local activists like TaNefer Camara, Tiana Pyles, Jada Wright-Nichols and Ngozi Walker-Tibbs are rising up to meet the need. Their work is changing the landscape of breastfeeding throughout the United States in real and impactful ways. As a student or professional lactation supporter, you too, have an opportunity to make an impact and to reach communities that have a greater need or unique barriers. We’ll highlight one more group in the North to round out our four cities tour next month and to bring this series to a close. The conversation will continue in various ways as LER works to prepare the next generation of lactation supporters to be informed and equipped resources to all breastfeeding families.

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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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“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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"My name is Maria. When I had my child 26 years ago, I had a little experience about breastfeeding since I was living in Cuba. When I came to the U.S in 2001, I was hired a year after, I'm start knowing how beneficial in breastfeeding a baby beyond a year, I felt regret that I couldn't do it. My reward was my daughter who I educated her while she was pregnant with her first baby. After knowing all the great benefits, she was determine to breastfeed and yeah she did for 19 mo. My grand baby has very strong immune system, smart and a bright girl. That's the reason that motivated me to dream to became Lactation Consultant and also be able to help my community."

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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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Posted by on in General

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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