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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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"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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After years of ousting breastfeeding moms, calling security and generally harassing women who breastfeed in their stores, Target now has a Breastfeeding Policy that is exemplary.

Breastfeeding Guests may openly breastfeed in our stores or ask where they can go to breastfeed their child.  When this happens, remember these points:

  • Target’s policy supports breastfeeding in any area of our stores, including our fitting rooms, even if others are waiting
  • If you see a woman breastfeeding in our stores, do not approach her
  • If she approaches you and asks for a location to breastfeed, offer the fitting room (do not offer the restroom as an option).
  • If you have any questions, partner with your leader.

OMG, did a LC write this?!

Now the rest of you retailers, follow Target’s lead.  They have hit the target on this one!

Tagged in: breastfeeding
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That’s right! Initiating skin-to-skin and breastfeeding in the OR after a cesarean section is becoming the standard of care in many places.

Step 4 of the Baby-Friendly Hospital Initiative has helped moved this idea forward. Mothers are loving it! And providers are finding that is easy enough to do.

Step 4:  Help mothers initiate breastfeeding within a half-hour of birth
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

We have known for a long time that holding an infant skin-to-skin immediately after birth improves the physiologic stability for both mother and baby and increases maternal bonding behaviors. It is also the optimal start for breastfeeding. 

The nine instinctive stages of newborn behavior, first described by Anne Marie Widstrom, unfold during the first hour after birth while the infant is in skin-to-skin.

  1. Birth cry - This distinctive cry occurs as the infant’s lungs expand.
  2. Relaxation – Mouthing movements begin and the hands are relaxed.
  3. Awakening – The infant moves his head, opens his eyes, and shows some mouth and shoulder activity. This begins at about 3 minutes after birth.
  4. Activity – Mouthing and sucking movements increase as the rooting reflex becomes more obvious.  Eight minutes after birth.
  5. Resting – Periods of resting are interspersed with activity.
  6. Crawling – The infant approaches the breast with crawling and thrusting movements. Begins about 35 minutes after birth.
  7. Familiarization – The infant begins licking and nuzzling the nipple. Begins at 45 minutes after birth and may last for 20 + minutes.
  8. Suckling – The baby self-attaches to the breast and suckles.
  9.  Sleep – Both mother and baby fall asleep. Usually about 1 ½ to 2 hours after birth.

Interruption of skin-to-skin holding can interfere with the normal progression of the infant through these nine stages. He then has to “start-over” delaying his first attempt at breastfeeding.

I highly recommend the article by Philips for a full discussion of the benefits of skin-to-skin and very practical steps to initiate these procedures in the OR**.

 

References:

Burke-Aaronson AC.  Skin-to-skin care and breastfeeding in the perioperative suite.  MCN Am J Matern Child Nurs. 2015 MarchApr;40(2);105-9.

Grassley JS, Jones J.  Implementing skin-to-skin contact in the operating room following cesarean birth.  Worldviews Evid Based Nurs. 2014 Dec;11(6):414-6.

Hung KJ, Berg O.  Early skin-to-skin after cesarean to improve breastfeeding.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24.

** Phillips R.  The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth.  Newborn & Infant Nursing Reviews.  June 2013Volume 13, Issue 2, Pages 67–72

http://www.researchgate.net/publication/257612445_The_Sacred_Hour_Uninterrupted_Skin-to-Skin_Contact_Immediately_After_Birth

Sundin CS, Mazac LB.    Implementing Skin-to-Skin Care in the Operating Room After Cesarean Birth.   MCN Am J Matern Child Nurs. 2015 Jul-Aug;40(4):249-55. 

Widstrom AM,  Aaltomaa-Michalias P, Dahllof A, Lintula M, Nissen E.  Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.  Acta Paediatr 2011.  Jan:100(1): 79-85.

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I have had the privilege of helping mothers and babies for approximately 28 years now. I always share with my Moms that the reason I most likely became an IBCLC is because of the bad experience I had with struggling to breastfeed my first child (now age 30). I was a young mom and although I had read about breastfeeding, I like so many other people believed breastfeeding is a natural thing - you just put the baby at the breast and it sucks. How hard can that be?

As a young mom in the hospital I was trying my best. My nipples were cracked and bleeding and as I was crying and trying to nurse my baby my nurse said, "You are starving that poor baby...give her a bottle.” As a result, we struggled for months with low supply. I was determined no other new mom should ever feel that way!

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For me, becoming an LC was a natural evolution. Growing up I only once saw a woman breastfeeding. Yet, coming of age in the time of Women's Liberation and starting as a Nurse Practitioner in a rural mountain community, it seemed the natural, healthy and right thing to do. I was blessed with two babies who latched on with ease and never gave me a minute's trouble until, when my second child was 17 months old, an abscess and surgery brought an abrupt, sorrowful end to breastfeeding. I had the pleasure of knowing, being assisted by and learning from a fabulous role model - Mary Rose Tully. There is nothing more rewarding than the joy on a Mom's face, and Dad's too, when together we solve a problem, Mom is no longer in pain, their baby eats with gusto and then looks deeply into Mom's eyes.

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In 1985, I was a La Leche League Leader of 11 years and knew that some mothers needed another level of care in addition to what I was providing. The development of IBLCE occurred as I was choosing to re-enter the work force. My life has been so enriched by the mothers I have helped, the support of my peers and the other professionals who accepted my expertise. I hope it will continue to evolve to the original plan: A stand-alone profession such as physical therapy or optometry, which can provide expert care unequaled by any other health care profession.

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I have been watching the Kid President videos on YouTube, haven’t you?  He is the cutest little guy and has some good things to say  https://www.youtube.com/watch?v=l-gQLqv9f4o.

Let’s be awesome.  No matter where we are, not matter what we do. Be awesome.

We all have opportunities, every day, to be awesome to many new moms and babies.  And let’s not forget to be awesome to each other.  Give the people you encounter a reason to dance!

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In February, I had my first child and knew very little about breastfeeding. From the first time I held her, she latched on perfectly. I then became very passionate about making sure every mother and baby had the same opportunity that we had.

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When I had my third baby, I wasn't successful with breast feeding my first two, so I decided not to even attempt it. All over my medical record, "Formula" was written.  As if my son understood, as I was holding him, he turned his head and latched on through the hospital gown and began suckling. I said "OK, if that is what you want to do!" I took one day at a time, like the 12-step program, and breastfed him for 13 months. It was the best experience that only another breastfeeding mother could appreciate. This is where I got my passion. I made a difference in his life but he changed mine forever too. I went on to have a fourth child and she breastfed for a year too.

 

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a maximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

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I remember babysitting my younger cousins every summer when I was in high school.  Every year my aunt would be sitting on the couch breastfeeding the newest baby while I watched the rest of the kids.  It seemed so natural and easy.  She could direct the play and work of the rest of us from her seat.

When I had my own baby my mother, always the practical one, said “that’s what they’re there for”.   And she helped me through those first weeks when the formula discharge bag was sitting there so handy.  So I went on to breastfeed each of my children for several years.

Years later, when I returned to work as a pediatric nurse, I was always assigned to the babies on the unit, especially the breastfeeding babies.  I wasn’t afraid to care for them as many of the younger nurses without children were.   And some I could actually help.  I transferred to the Milk Bank and then my interest in everything to do with lactation, breastmilk and breastfeeding really took off.  I took the IBLCE certification exam in 1985, the first year it was available, and have been working in the field (devotedly) ever since.

Vergie Hughes RN MS IBCLC FILCA

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a maximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

Why I Became a Lactation Consultant

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Those working towards the Baby-Friendly Hospital Initiative often find it is a complex, sometimes harder road, than they anticipated.  Picking some of the easy “low hanging fruit” and getting some early successes can help the staff working on this project move forward with enthusiasm.

Implementing skin-to-skin care (Step 4) as one of the first strategies often does not meet with much resistance, and can yield impressive results in initiation of breastfeeding and patient satisfaction scores.  McKeever found that infants in skin-to-skin care did not become hypothermic, most breastfed within an hour and they continued to successfully breastfeed the second day.  In addition mothers remarked on the bonding effects (McKeever).  Mothers who did not experience immediate skin-to-skin care demonstrated more roughness in their behaviors with their infants, difficulty with latch-on and infants showed a lack of wakefulness during breastfeeding (Dumas).

Easier to implement steps may include Step 3 (inform pregnant women about breastfeeding), and Step 5 (show mothers how to breastfeed), and Step 8 (encourage breastfeeding on demand).  Provide breastfeeding information in childbirth and lactation classes.  Encourage prenatal clinics and offices to recommend breastfeeding to their clients.  Hospital staff is already showing mothers how to position and latch-on babies.  Technique can be improved to be more effective through staff education.  And flexibility in feeding schedules is probably in place, but can be encouraged. So start with these steps, then tackle the more difficult ones: Step 1 (breastfeeding policy), Step 6 (give nothing but breastmilk) and Step 7 (rooming-in) (Semenic).

Most managers implementing Baby-Friendly practices find that a gradual and step-wise approach works best.  Make the most of the “easy to change behaviors” to get some momentum going and the rest will follow, eventually.

NEW GUEST BLOG FEATURE: Why Did I Become a LC?

I know you all have great stories about your experiences being or working toward becoming a lactation consultant. Well now we have created a forum for you to share your stories with others. We invite you to write a meximum 100-word essay on who or what influenced you and what experiences encouraged you to enter the rewarding field of lactation consulting. To submit your essay, click on this link -https://lactationtraining.formstack.com/forms/ler_blog_submission.

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References:

Dumas L, Lepage M, Bystrove K, et al.  The influence of skin to skin contact and rooming-in on early mother-infant interaction: A randomized control trial.  Clin Nurs Res.  August 2013;22(3):310-336.

McKeever J, St Fleur R.  Overcoming barriers to baby-friendly status.  J Hum Lact.  Aug 2012:28(3):312-314.

Semenic S, Childerhose JE, Lauzière J, Groleau D.Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.  J Hum Lact. 2012 Aug;28(3):317-34.

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I’ve participated in the Nestle Boycott for more than 25 years now.  And I have been teaching about the dangers of formula discharge packs in every class I have taught the past 25 years, our lactation consultant training program, our Baby-Friendly Hospital program, in live courses, in online courses.

But those are puny efforts compared to the courage and sacrifices of Syed Aamir Raza Hussain who blew the whistle on artificial baby milk marketing practices in Pakistan.

The new film, “Tigers” exposes the aggressive tactics of companies in promoting the use of infant formula in places where its use is inappropriate.  Where there are no facilities for clean water and the cost of formula is exorbitant compared to the poverty in which new parents are living.  When Syed learned about the consequences of his marketing efforts, he quit his job and went on a campaign, with the help of IBFAN, to stop the use of formula where it can cause malnourishment and diarrhea, even death.

I encourage you to seek out where Tigers will be showing near you and make a point to view it.  http://www.babymilkaction.org/tigers#monitoring  You will wonder why you haven’t been doing more.  Like I have.

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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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