Why We Need Lactation Consultants

Lactation Consultants are an integral part of neonatal and infant care. Please take a minute to read these two perspectives on the crucial work done by laction consultants--one by a nurse, and one by a breastfeeding educator.

The Need for Lactation Consultants: A Nurse's Perspective

Breastfeeding is a learned skill for both mother and baby. Breastfeeding is the Gold Standard for infant feeding; the preferred infant feeding choice. Breastfeeding protects the health and strengthens the bond between mother and child, thereby contributing to the overall health and well-being of our society.

• Many new mothers have grown up seeing babies fed with bottles. Many new mothers have never seen a
  woman breastfeed her child.
• Today, birth and the first few days of motherhood rarely occur in the company of loved ones who are
  skilled in the art of breastfeeding.
• Many new mothers have done little preparation for breastfeeding.
• The majority of new babies born in Austin and their mothers are effected by medications and long hours
  of irregular, pitocin-induced labor.
• At least a third of new babies born in Austin are delivered by C-section or with instrumentation.
  This makes for bruised heads, extra energy used for organizaton and adjustment to the extrauterine
  environment, and tummies full of amniotic fluid. These things complicate a baby's first feedings
  
• All new mothers who birth and recover in an Austin hospital are in an environment and participating in a
  process that actively encourages them to give up control and turn themselves over into the hands of the
  "professionals". Every aspect of labor, delivery, and postpartum is accompanied by guidance or
  restrictions, and is led by a healthcare specialist.
  
• Many new mothers have few or no sources of informal support or information for breastfeeding.
  Breastfeeding is a learned process.
  
• For all these reasons, many new mothers require active, intensive professional support with
  breastfeeding.

Why We Need Hospital Based Lactation Consultants

• Nurses are not the logical source of delivery of all breastfeeding support.
• Nurses have very limited training in breastfeeding support. Nurses are not trained in lactation physiology.
  Nurses are not educated or fluent about the bioactive components of human milk. Most have only a very
  basic understanding that "breast is best". It seems like rhetoric to many of them because they have not
  been extensively trained about why "breast is best".
  
• Much of the information that nurses and physicians receive about breastfeeding is from in-service
  trainings from formula companies. To many, in spite of the research to the contrary, breast milk and
  formula seem equivalent in practice. Free formula is omnipresent and readily available in the hospital
  environment. Formula often seems a whole lot easier than assisting a mother to breastfeeding.
  
• Many Labor & Delivery and Mother/Baby nurses do not have children of their own. Many who do have
  never breastfed a child. Breastfeeding seems like a choice, not an issue of public health.
  
• Some nurses are motivated to support breastfeeding and have individually sought and obtained the
  knowledge, skills and experience to do so. However, they are greatly constrained by working conditions.
  
• A Mother/Baby unit is rarely fully staffed.
  
• Nursing work must follow a schedule. Nurses must meet many deadlines-meds, exams, discharges,
  meals, etc… Infant feeding opportunities happen on demand, not on schedule.
  
• Ideally, nurses should be adequately trained and motivated to support normal breastfeeding. Nurses do an
  amazing job to deliver comprehensive, thorough patient care. Many skip meals and bathroom breaks, and
  literally run between rooms to deliver good care to their clients. When couplets need intensive assistance
  (even if they are otherwise normal and healthy), extra help is needed from a Board Certified Lactation
  Consultant. An IBCLC, with her unique and comprehensive knowledge and skill set, can often help a
  mother and her infant to avoid breastfeeding interventions (supplementation, nipple shield, etc)?nipple
  confusion?low weight gain, breast infection &/or early weaning

written by an RN, MSN who is currently employed by the Seton network, and has asked to remain anonymous.

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The Need for Lactation Consultants: A Breastfeeding Educator's Perspective

Why Our Community Needs Comprehensive Breastfeeding Support Services in Hospitals

What is a lactation consultant?

International Board Certified Lactation Consultants (IBCLC)--in other words, trained and certified breastfeeding specialists--help mothers breastfeed their babies in normal and in challenging situations. A lactation consultant is a specialist who has passed the IBCLC examination.

Lactation Consultants' training is extensive. The IBCLC exam focuses on lactation and also encompasses disciplines such as anatomy and physiology, nutrition and biochemistry, immunology and infectious disease, pathology, pharmacology and toxicology, psychology, sociology, anthropology, growth parameters and developmental milestones, research, ethical and legal issues, breastfeeding equipment and technology, techniques, and public health and advocacy. The standards are set at a university level of difficulty, and one must meet specific eligibility criteria before being approved to sit for the certification exam.

There are thousands of International Board Certified Lactation Consultants around the world working in a variety of settings such as hospitals, WIC clinics, public health, physician's offices, private practice, health clinics, and so on. IBCLCs come from a variety of backgrounds - there are those that are health professionals, and those that have degrees in child development, psychology, anthropology, social work, speech, occupational or physical therapy. Other IBCLCs some to the profession simply because they are committed to breastfeeding and have a strong desire to help other mothers and infants.

Isn't Breastfeeding Natural? Why Do We Need a Specialist?

Breastfeeding is natural, but it is a learned skill for both mother and baby.

Women have been helping other women breastfeed for millennia. Most often, it has been in an informal woman to woman setting. These skills were passed on through the generations. However, today, many women, physicians, and nurses who provide for new mothers and babies have grown up surrounded by images of bottle feeding and know little or nothing about the practical aspects of breastfeeding.

Education to be a nurse or a physician, even an pediatrician, contains surprisingly little information about breastfeeding, and even less about the practical aspects of helping mothers to breastfeed.
One pediatrician in the Seton network, in a powerful though unintended indictment of her training, told about the birth of her first child. 'I was fresh out of med school-what did I know about breastfeeding?'

Why are hospital-based lactation consultants important?

Many women, if breastfeeding is not going well after the first 2 to 5 days after birth, will give up breastfeeding. Support, encouragement, and education the first few days after birth is crucial.

Human milk is the normal food for human babies, and no formula has been developed that even comes close to breastmilk. Most women are able to breastfeed successfully with early, competent intervention if it is needed.

The benefits of breastfeeding for infants are well-established. Breastfeeding also confers a number of advantages for mother's short and long term health.

Breastfeeding is considered a choice for individual families to make, but it is actually a public health issue. Breastfed individuals are healthier, more effectively avoiding viruses, infectious diseases, as well as chronic debilitative conditions like obesity and diabetes, in infancy, childhood, and adulthood. Breastfed individuals save billions of dollars every year in healthcare costs every year. Breastfeeding also saves costs to the social service system, as it is a reliable food source that does not require tax dollars to provide to needy citizens.

At least a third of babies born in Austin are delivered with forceps, vacuum extractors, or by C-section. These interventions cause bruised heads, 'disorganized' babies unable to do their normal physiological newborn activities like sucking, and extra energy expended by babies to adjust to extrauterine environment. Even with a normal birth, most babies and their mothers are affected by medications taken during labor.

In the first few days after a baby is born, it is common to need the expertise and knowledge of a lactation consultant. Lactation consultants assist with: latching a baby on properly so that baby is effectively getting milk and not hurting mom, with sucking problems many babies have initially, and to assess normal feeding patterns of babies.

Probably the most important thing hospital-based lactation consultants do is to iron out minor (but distressing, for new mothers) difficulties and reassure mothers so that they can develop trust and confidence in breastfeeding.

Lactation consultants are also crucial in situations where babies are having ongoing problems breastfeeding for whatever reason, as they are trained in diagnosing the problems and in ways of solving them. It is common for lactation consultants to spend hours at a patient's bedside. No other healthcare professional that a woman sees during her 24 to 72 hour postpartum hospital stay has the time to do this, even if they do have the training-which most do not.

Why can't the nurses do this?

Nurses are overwhelmed with performing their minimally required duties. Maternity units are chronically understaffed and nurses have a high patient load that makes any more than basic information sharing virtually impossible. Nurses do not have the time to provide the kind of care that a lactation consultant give, even if they want to.

Nurses' work must follow a schedule. They must meet many deadlines-medications, exams, discharges, meals, extensive documentation. Nurses do an awesome job of delivering thorough patient care. Many skip meals and bathroom breaks and literally run to deliver good care to their patients.

Not all nurses have an interest in furthering their education about breastfeeding to the extent of being able to replace breastfeeding support specialists (see above, for the kind of training lactation specialists do!). Not all nurses are interested in assisting women in the hands-on way that is often required, for the time period that this assistance is often necessary.

Not all nurses are fluent about the bioactive components of breastmilk, and often the basic understanding that 'breast is best' sounds like rhetoric. To many, in spite of research to the contrary, breast milk and formula seem equivalent in practice, and formula seems a whole lot easier.

Having lactation consultants available in the hospitals 24 hours a day, 7 days a week, contributes in statistically significant, measurable ways to the well-being of individual babies and mothers, as well as to our public health. The wise approach would be to expand breastfeeding support services, not reduce them.

Laura Smith, BFE

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