Lactation Management Training: From Novice to Expert

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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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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 - https://www.youtube.com/watch?v=Me9yrREXOj4. 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

http://altarum.org/health-policy-blog/hospital-support-for-breastfeeding-on-the-cusp-of-big-changes-time-to-step-it-up

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

http://www.dailyherald.com/article/20141027/entlife/141029161/

Local hospitals strive to offer a balance of maternity options

http://www.dailyherald.com/article/20141027/entlife/141029160/

UNM Hospital receives prestigious “Baby-Friendly” designation

http://hscnews.unm.edu/news/unm-hospital-receives-prestigious-baby-friendly-designation110414

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

http://www.slate.com/articles/double_x/doublex/2014/10/baby_friendly_hospitals_promoting_breast_feeding_at_the_expense_of_the_new.html

 In the article published in Slate, the journalist quotes a study that says formula use promotes breastfeeding by relieving maternal stress.  http://www.ncbi.nlm.nih.gov/pubmed/23669513

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  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472256/pdf/fcimb-02-00094.pdf

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

http://www.ncbi.nlm.nih.gov/pubmed/21593648

 Maternal factors pre- and during delivery contribute to gut microbiota shaping in newborns.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417649/pdf/fcimb-02-00093.pdf

 Human gut microbiota: onset and shaping through life stages and perturbations.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505007/

 The long-term health effects of neonatal microbial flora

http://www.ncbi.nlm.nih.gov/pubmed/19398905

 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…..

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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.

Habit

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!  ;-)

 

 

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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/why-ibclc/falc using the application found here http://www.ilca.org/benefits-heading/joinilca

If you are not sure how to be a mentor, LER offers a online lesson on mentorship:  https://www.lactationtraining.com/our-courses/internship/become-a-clinical-mentor

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!

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