Wednesday, September 23, 2009

IBCLC training update

This semester, it is busy. As usual, there are a million things I have sitting around waiting to be linked to. I haven't even talked about the Today show home birth ridiculousness yet! (But when so many other people have done it so well, now it seems repetitive).

Today is Wednesday, which is my lactation consultant observation day at the hospital, which is one of the things that is making me so busy: I'm there all day, and by the time I get home I am zapped and don't get a lot of schoolwork done (OK, any schoolwork done). If it wasn't for that I'd have the whole day free to do all the other things I have to do, which then get shoved into the precious open time in the rest of the week. But would I trade my LC observation days for more free time? Of course not. So, I am figuring out the semester as I go along. And I thought I would shake off my Wednesday evening sluggishness long enough to update a little on my LC observation so far:

The hospital I'm observing at is the same place I work as a volunteer doula, and in general I have found them to be a fairly mother- and baby-friendly hospital (they are actually working on getting their baby-friendly certification). The nurses and the pediatricians I have seen so far are very supportive of breastfeeding, even if they aren't always fully informed.

Lactation services is, unfortunately (maybe fortunately for me) not adequately staffed and in this era of budget cuts, unlikely to be increased any time soon. The LCs I work with are on their feet every minute of their workday, and usually can't even see everyone they're supposed to. Today the LC I worked with was supposed to see something like 11 patients, and made it to 6 - and that includes going to see all of those 6 multiple times - for some of them, we went to every feeding they did during the day. If you can't see everyone, this leads to some tough choices - prioritize the mom with inverted nipples, sleepy baby, and poor family support? Or see she doesn't seem that motivated, and think you should spend your time on someone who has a greater chance of succeeding? Much as these are unpleasant choices that shouldn't have to be made, they are real.

I say that the fact it's not adequately staffed is fortunate for me, only because I get to see so much in a day. There is zero downtime, unless you count when the LC dashes to the computer to chart, and I sit next to her trying to remember what I saw and record it in my observation notebook. I am getting to see so much - just a wide range of situations, anatomies, and medical conditions. I haven't done any days in the NICU yet, but I am really looking forward to my first experiences working with preterm babies & their moms.

One thing I've noticed is that my observation days seem to run in themes. For example, last week I was with an LC who was seeing a lot of outpatients, where overfeeding was the theme. This week, we were seeing all inpatients (most less than 24 hours) and the theme was sleepiness and breast refusal. I started to get a little leery as I saw the LC put on nipple shield after nipple shield. Was this her solution to everything? Then she told me, "I usually use one a week." She said she has been seeing more and more sleepy, fussy babies in the past few weeks and is getting concerned about it. Her concern is that they have apparently changed either the epidural dose and/or the medication; this being a typical American hospital, nearly everyone has had an epidural, and if it's seriously affecting the feeding behavior of the babies it's a big problem. I still don't know how I feel about the nipple shields for every problem she applied (heh) them to, but I am curious to know what she learns about the epidural meds.

In terms of the LCs I'm observing, I am learning a lot from observing different practice styles and different approaches. I try hard to check my judgment when I see something I don't want to emulate. It's so easy as an observer to think "I wouldn't do that" or "I wouldn't use that word the family probably doesn't understand" but I know how extremely hard it is to do in practice. And seeing how extremely rushed the LCs are, I can't entertain too many fantasies of long, empowering chats once my turn comes to do the consults. (Another good reason to find some LCs to shadow who are able to have a slower pace, for balance.) Still, I am trying to stay sensitive to places where I see overmedicalization, or creating dependence on the "expert". I am glad our class and professor give us space to discuss those issues.

So far, I love my LC observation days - I love working with families, having a new challenge every 20 minutes, keeping busy, and learning. And I love all those cute little babies! I know not every doula/midwife/other perinatal professional goes into the field from loving babies - sometimes they just love to work with women and don't find babies that interesting. But I have always loved babies, and I really love these tiny little newborns. It's amazing how they are simultaneously so dependent and helpless, and yet so capable. I haven't seen any true self-latching, but when a baby is hungry but not latching, the LCs will encourage the mom to put the baby upright between her breasts, skin-to-skin. The baby will right away start bobbing its head and throwing itself to the side, then move down her breast, and root for the nipple. And when they're done nursing, they'll just relax into a little pink ball on her skin and fall into the deepest sleep. It never fails to make me go "Awwww." So that's my mission these days: more empowered babies!


Enjoy Birth said...

Interesting that the LC thinks that a change in the epidural dosage or medication is the cause of the sleepy babies. Is she going to follow up on this? Would love to hear what she finds out.

Rebecca said...

I am curious as well! She was plannng to investigate so I will update if I hear anything.

Anne said...

Sorry to post this here - but I didn't find any general "Contact Me" link or private email. I'm very curious about the experience of IBCLC training, and am considering it myself, so I was wondering if I could pick your brain a bit on that. I hope that's not terribly presumptuous!

I'm also having a challenging time with a BFAR client (from my recent post), and was wondering what if anything you'd covered on that at this point. In your copious spare time, ya know.

NO obligation and certainly no rush!

Anne (Dou-la-la)

Rebecca said...

Anne, I would love to talk to you more about this! We haven't covered much on BFAR yet but if you're interested in talking about it, I'd be very interested to hear about it and see if there's any resources or research I can point you to. I've been thinking lately that I need some contact info on my page, so thanks for giving me that nudge. Feel free to e-mail me,!