Monday, November 2, 2009

IBCLC training update

Last week one of the LCs at the hospital was out sick, and I ended up not really being able to shadow and going home early. It reinforced to me how much I enjoy my LC shadowing and miss it when I don't get to do it!

But I did spend some time, while waiting around, thinking about how I want to structure my LC training. Our course gives us a basic framework, but as it's the first year of the course and there has been some instructor upheaval, a fair amount is on us to organize. And I do feel the need to make sure I am exposed to a the whole range of LC practice; we get to see interesting cases at the hospital, but it's a little catch-as-catch-can and I feel it's important to seek out exposure to problems I might not encounter there. In addition, going once a week I miss the continuity and follow-up process. One of the LCs at the hospital (who, like us, came from a non-nursing background) showed us a "blueprint" notebook she used to organize and document her learning and training. It seemed so useful for making sure all the pertinent issues are covered; I'm thinking about getting one myself. Anyone have thoughts/other suggestions on helpful ways to make sure you're covering what you need to in IBCLC observation?

So far I haven't been putting in the suggested extra hours each week outside the hospital, at LLL meetings or other venues. I started the semester overwhelmed by my class load, assistantship, and extracurricular commitments, but now that things have stabilized a little it would be good to get the outside observation going. I am also laying big plans for next semester, when I will only be taking my LC course, one online course, and writing my master's paper (additional info on master's paper to come, but hopefully I will be working with a local Centering Pregnancy program!) That's when I really want to set up a schedule shadowing outside (non-hospital-based) LCs, attending breastfeeding support groups, and generally maximizing my exposure to lots of different breastfeeding concerns/situations. Once graduation rolls around (May) I will have two months left until the certification exam, and I am hoping to pack more observation and experience into that time...along with studying. Lots and lots of studying.

The week before last I had my first "hands on" experience. The LC had me go in and do the assessment and assistance with the mom, while she observed. Fortunately it was a sweet mom who was so excited about her new baby and about breastfeeding, and just needed a little reassurance and teaching. I forgot a couple of teaching items (I need a checklist), but fortunately the LC was right there to fill in those gaps. I corrected a couple things about the latch (lower lip tucked in, jaw not down well) and the LC agreed with me and we got the baby latched on and eating great.

I was feeling good until we went to the next room. The LC stepped out to get something while I helped the mom latch on one side. She seemed to feel OK and baby seemed to be sucking fine. When the LC came back, she helped the baby latch on very deeply to the other side. "Oh, wow, this latch feels so much better!" the mom said. So I think I missed seeing a shallow latch on the first side, and it felt discouraging to have missed something that simple, something I generally feel very confident about assessing in my doula role. Looking back, I think I was not assertive enough about getting in there and checking. The women I'm working with know I'm a student, and it makes me nervous about being too hands-on and taking over the LC role too early, especially if my preceptor isn't right there. I need to either step back until I get that confidence, or call up some of that confidence and use it! Anyway, hoping for more hands-on experience this week... and a confidence boost.

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