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?

Back-to-school birth story

It's funny how life works. The year after high school I was a Rotary exchange student in Sweden, and Tralee was another exchange student in my district (she was from another part of the U.S.). We saw each other at various Rotary camps and weekends; she was always wickedly funny and kept all of us students laughing with her stories and (mis)adventures. Our common bonds were forged over a love of Swedish candy and the trials and tribulations of exchange student life.

After we came back to the U.S. Tralee and I kept in occasional touch and even managed to visit a couple times despite being on opposite coasts. The funny thing is that somehow over the past decade we have both independently come to a place where we are very involved in birth/breastfeeding - me through public health and doula work, and Tralee through her experience of becoming a mother and educating herself extensively. I saw her earlier this year when she was pregnant with her second and planning a home birth, and she's now posted her birth story. I love this quote:

To me birth is natural, not painful...yeah a little discomfort but every contraction was helping me, every moment was me experiencing me. I looked forward to each new phase, like a runner trains for a marathon...after so much prep and training you think ”yeah come on, bring it...bring on that hill, I can do this."

Congratulations to the Knapp family! I can't wait to see you guys again.

As for me, I'm back at school, getting ready for classes to start next week...including my lactation consultant course! I am excited and also a little nervous. More posts coming soon!

Posting hiatus & who else had a home birth

My posting is slow for the moment - I'm back in my hometown, visiting with family and friends, and taking a (too-short) vacation before school starts again. I can't believe in one week I'll be starting classes...this summer has flown by.

In the meantime, a friend tipped me to the fact that singer Goapele had a home birth and is encouraging her Twitter friends to support the MAMA campaign: "Having a natural home birth was one of my most empowering experiences. Please support midwives."

Nice!

Here comes my aunt and cousins...off to the lake to swim and beat the heat!

You want my mommy to feed me where?

Ha! This video says it all:



(H/t to Bellies and Babies.)

Gimme an I! B! C! L! C! IBCLC!

I have held off getting too excited (OK, I've gotten plenty excited, I've just held off posting) about the possibility of taking a course next year to become an International Board Certified Lactation Consultant (IBCLC). Now it looks like it will happen and I am so excited!

I’m especially happy to post about it knowing many of you will “get” my excitement. It’s hard to convey to non-birth/breastfeeding people what a big deal this is – both the credential in general, and to me personally. If there’s one thing I love as much as attending births it’s working with breastfeeding dyads (although I haven’t gotten to do it in a long time). I’ve thought about going for the IBCLC before, but counted it out (at least for the time being) for a variety of reasons. The chance to get it as part of my MPH is stunning and amazing.

It will be a one-year course under Pathway 2 - one full day of training and clinical rounds each week at the hospital, plus weekly hours in other settings (La Leche meetings, WIC, etc.), plus readings and assignments. If all goes as planned I will finish my MPH in May and sit for the IBCLC exam in July. While I’m not really sure where I will go with it after graduation, it would be great if, combined with my MPH, it ups my chances of getting a job working with breastfeeding/perinatal issues. I also wouldn’t complain if I was “just” an LC somewhere for a while!

I have more posts coming, about my thoughts about lactation consulting as a profession, negotiating concerns around medicalization of breastfeeding, etc. But right now I'll just take a deep breath and look forward what promises to be a very busy school year.

Jennifer Block on who's winning the home birth debate

New article from Jennifer Block on Who's Winning the Home Birth Debate. It's a step beyond the usual "Hey, home birth might be safe" or "Some people say home birth is safe" articles and into "If research has shown that home birth is safe, why is there still so much opposition?" She writes:

if the only research that will satisfy those with authority and power is research that is unfeasible, the controversy will never be resolved. There could be 20 more large, observational studies that come to the same conclusion as those that already exist, but they still wouldn't be randomized controlled trials. The home birth advocates would continue to say "The research proves it's safe!" and the American medical establishment would continue to say "The research isn't good enough!"

And, as she points out, evidence of homebirth dangers will continue to be produced via anecdote and rounds of "birth telephone".

If anything, I could have done with this article being a lot longer. I liked that she acknowledged the presence of the (in)famous Dr. Amy and Dr. Amy's "debate" site, and I'd like to see her really dig into the statistical discussion, the evidence base, and the depth and breadth of the barriers to translating evidence into practice. Perhaps you'd like to write another book, Jennifer Block?

In the meantime, props to Babble. At a wedding a few weeks ago, I ran into someone I know who works there and I told her I really liked Jennifer Block's response to Hanna Rosin, which they ran. Next time I see her I'll have to add my thanks for this. I hope they keep up the Jennifer Block connection, or at least keep running articles in this vein.

Cesarean vs. VBAC

Via The Unnecesarean, who says "Alexandra Orchard is my personal hero":

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

While there are a lot of things I loved about this video (the honest portrayal of cesarean surgery, for one), the letter is what really blows me away. I would love it if more women who are disappointed with their care providers and hospitals openly expressed that disappointment. Nothing is going to change without better communication and who better to speak than someone speaking from immediate personal experience? It's hard for doulas to push that too much with individual clients, but it is inspiring when women and their families take the lead.