Friday, August 21, 2009

More thoughts on IBCLC and lactation consulting

My excitement about becoming an IBCLC is mixed with a little apprehension. Given the amount of respect and the number of referrals I’ve given to LCs over the years, I've gotten to thinking about the responsibility of being a good one, the critiques I’ve heard of LCs (both individually and as a profession) over the years, and how I will negotiate that in my own training and eventual practice.

There’s a kind of LC I don’t want to be – the one who marches in grabs, yells, guilts, and blows back out. and I don’t think she exists nearly as often as she’s made out to – as MomTFH points out, they seem to be more creatures of story than of life – but still, I don't want to be one. I also worked in one city where stories circulated about a certain LC who discouraged bottle-feeding/formula supplementation to the point where other LCs were considering reporting her to ILCA. Clearly, I don't want to be her either.

My aspirations for the kind of LC I want to be are the same as for the kind of doula I want to be: meeting women where they're at, helping them determine what their goals and needs are, and going from there. The ultimate goal is a positive breastfeeding relationship for a healthy mom and baby – and if that means less breastmilk and more happiness, so be it.

The piece I really want to build in my own practice is active listening and slooooowing down. I am a "let's fix it now" kind of person. Being a doula, labor forces me to slow down: it can't be rushed, and laboring women definitely can't be hurried into anything ("How about you try moving before the next contraction? Already started? OK, we'll try after the next one...").

Other areas of life don't have those same built-in speed bumps. When doing breastfeeding consults, it's so easy to seize on the first problem you see/hear about, "fix" it, and walk out self-satisfied. I keep thinking back to breastfeeding consults I did in AmeriCorps - they were good experience, but I want to do better in the patience department (vs. Just get the baby to latch, explain how, ask "You understand, right?” and tell her I’ll call tomorrow.) We had no LCs in our health centers (ha! Would that we had money for “extras” like that) but the midwives did some breastfeeding support. I once spent 15 minutes with a mom, "fixed" all her problems, and sent her on her way. Still frustrated, she came back the next day and my supervisor, a wise and experienced midwife, spent 45 minutes just sitting and talking with her. Oh. Right. Listening. Later that year, I watched another experienced midwife do a breastfeeding "consult". I kept twitching internally at all the moments I would have jumped up and jumped in, and she just sat and watched the baby feed...and feed...and feed...and finally she said "You’re doing great, just make sure baby is eating frequently, see you later." When the family left, she said, "They're doing it differently than I would, but they're doing fine. The important thing is to give them confidence." Oh. Right. Empowerment.

And as I said in my comment to MomTFH's post, I think that some LC horror stories might come from a mother’s reluctance to say out loud "I want to quit" while the LC is barreling full steam ahead. I want to be able to make space for those discussions with the women I work with.

I think that "let's fix it now" attitude also contributes to the medicalization concerns I hear around LCs. I recognize and respect concerns many people have about LCs medicalizing and formalizing breastfeeding. My ideal for breastfeeding support is peer-to-peer; in a perfect world, women should have many friends, relatives, and neighbors who are experienced breastfeeding moms and can offer informal support. In a less ideal world, sometimes more formalized support comes in handy - and in special cases, sometimes it will always be necessary.

But just as maternity care providers shouldn't medicalize birth just because they can, neither should LCs over-intervene and technologize breastfeeding just because they have the tools to do it, and not enough time and patience to spend time listening and processing. (My pet peeve is nipple shields being handed out like candy for every problem under the sun, and mothers sent home with the baby, the nipple shield, and no support or follow-up. Grrrr.)

I also don't want to be the "hospital LC" who only knows newborns . In this course, most of our experience will be in the hospital, but we'll also have clinical hours in outside settings. I really want to use that time, and find other opportunities, to build up my knowledge of breastfeeding support past the first few weeks/months. I want to help women through complex and challenging situations – reading through Dou-la-la’s amazing story of overcoming breastfeeding challenges and her thanks to her IBCLC – I thought WOW, that’s what I’m talking about! I want to be there for women who have the determination and just need some support and assistance, and to do that, I have to know my stuff.

In birth plans people are rightly advised to state what they want more than what they DON’T want…let’s see if I can follow my own advice! So I want to be an LC who:
- Listens to and empowers women
- Provides support without judgment
- Uses and promotes evidence-based practices, erring on the side of less technology
- Understands a range of breastfeeding situations and issues, from premature infants through toddlers

I hope and believe that the LCs I'm working with will be good models for all of this. But I also realize I may feel the need more independent work on counseling techniques, reflective listening, etc. Does anyone have suggestions for this?

Also, I know this has been hugely long (I’ve been putting down more and more thoughts ever since I heard I might be able to take this course!) and mostly my own thoughts about lactation support. But if you’ve made it this far, I’d like to hear what has been good and bad about IBCLCs (or other lactation support professionals) that you have worked with in the past? What’s something you wish they knew, or would like to tell me to do/not do?


Anonymous said...

I think you'll be a wonderful, thoughtful LC.

This is one of my favorite about lactation consulting. Good luck!

publichealthdoula said...

Thank you so much for the kind words, and also the link! I think I'm going to print that LC's post out and stick it in my notebook.

StorkStories said...

Wow.. I just adore and LOVE all that you have said here. And thanks to MomsTFH for linking back to my post. Your ideal approach is what I have attempted to consistantly apply in practice. When I was learning, I asked around, gained permission and followed an IBCLC on her shift one day at a nearby hospital. I was floored at her lack of actually listening or talking to the mother! She got some report from nursing staff and went on to do the quick fix approach and not really follow up for any subsequent feedings. Not my style!
Life when on and I became the type of professional I am today thankfully.
I have learned to simplify much of what I do. I also do a reboot "control-alt-delete" for those babies victims of birth interventions adding to lack of breastfeeding. Get them skin to skin, Go back to the beginning- give them time and it really works! I recently learned this and have tried it sucessfully. No gadgets, just some drops of colostrum sometimes and mommie...lots of mommie.
What program are you doing again?? I would be happy to help! Thanks for all you thoughtful approaches!

publichealthdoula said...

StorkStories, thanks! I am doing a Pathway 2 program - a formal course for the education piece, and clinical hours with the IBCLCs at the hospital associated with my university (also some extra hours in the community - WIC, LLL, etc.)
I too have been disappointed to see the style of some LCs I've shadowed. Maybe some of them were just being realistic about the level of support they could offer in their particular settings, but I hoped to see more sitting and talking. I hope I do more sitting and talking!
I would love to e-mail with you more! Is there a way I can PM or e-mail you?