Donna at Banned from Baby Showers writes about her excitement that CenteringPregnancy is coming to her area. (You can read a description of Centering in her post, and learn more about the model at the Centering website.) That reminded me that I just finished the last visit for the Centering group I have been co-faciitating and have been wanting to write a post about the experience.
The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.
She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.
I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.
The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.
At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.
It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")
If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.
And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...
Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!
Monday, July 12, 2010
Thursday, July 8, 2010
Tip of the day
Calculating weight loss of newborns? You can get reaaaally good at doing it on your own: (Birth weight - Current weight) / Birth weight * 100 = % lost. Or you can find a website to do it for you.
The first way can solidify your admittedly weak arithmetic skills. But the second way is so easy!
And that's your tip of the day, and possibly of the week since I have been too busy with work + Fourth of July + life to be posting much. I promise the next installments of my MPH series are in the works!
The first way can solidify your admittedly weak arithmetic skills. But the second way is so easy!
And that's your tip of the day, and possibly of the week since I have been too busy with work + Fourth of July + life to be posting much. I promise the next installments of my MPH series are in the works!
Friday, July 2, 2010
BBC doesn't believe lack of breastfeeding kills babies in developing countries
Morgan Gallagher, breastfeeding advocate in the UK, writes about how she was kicked off an interview on the BBC world service for saying that formula feeding kills babies in Africa.
Here's an excerpt, when the producer tells her she needs to stop criticizing formula:
It consistently blows my mind how the media is able to cast health effects breastfeeding vs. formula feeding as a matter of opinion even when the discussion is happening re: the developed world. It's beyond belief that the BBC World Service would try to apply this already false construct to the developing world, and would throw off a participant for being willing to say that babies die in the developing world because they are not breastfed. Because, you know, she's "biased". I guess I'm "biased" towards breastfeeding too, particularly for children in the developing world. I am also "biased" towards those children getting food aid, vaccines, and clean water, as those also improve survival rates. Oh, wait - those are considered facts. Strange.
Ugh. Working nights is making me cranky, and this is not helping!
Here's an excerpt, when the producer tells her she needs to stop criticizing formula:
...she cut me off and said she understood I was against formula, and pro-breastfeeding, but formula wasn't the issue. I was biased, and they couldn't have that bias on air. I said they had the bias, not me, and this was the World Service, and they had a duty to act globally, and not act as if the whole discussion was taking place in West London. How could they ask a women in KENYA if she would support formula feeding?
It consistently blows my mind how the media is able to cast health effects breastfeeding vs. formula feeding as a matter of opinion even when the discussion is happening re: the developed world. It's beyond belief that the BBC World Service would try to apply this already false construct to the developing world, and would throw off a participant for being willing to say that babies die in the developing world because they are not breastfed. Because, you know, she's "biased". I guess I'm "biased" towards breastfeeding too, particularly for children in the developing world. I am also "biased" towards those children getting food aid, vaccines, and clean water, as those also improve survival rates. Oh, wait - those are considered facts. Strange.
Ugh. Working nights is making me cranky, and this is not helping!
Monday, June 21, 2010
Doulas, what do you give your clients?
Another doula practice question! I'm working on a packet of info for future doula clients. I haven't done this before but it seems like a nice resource to give. I'd like them to have local breastfeeding resources (e.g. support groups), general parenting resources (e.g. organized playgroups, places to get low-cost services/baby needs), and a few info sheets from me - on things like writing the birth plan, thinking about your options in labor, etc. What else is helpful? Doulas, what do you give your clients (if anything)? If you've used a doula, what information did you get, or would have liked to get?
Reply turned post, on birth plans
At Your Cervix has a post up on birth plans from the nurse's point of view:
I encourage you to go over there and read the whole thing, as well as the comments - all pretty interesting.
My reply, which got kind of overlong and so is getting its own revised and expanded post:
Interesting comments!
My (evolving) philosophy on birth plans is that they should be about what you can control, not what you can't. It's not a movie script.
Some birth plans will say "I want to be allowed to push in a variety of positions, and to squat for delivery." Well, you can't control whether you will deliver squatting. Maybe when it comes times to give birth, you're going to be too tired or baby only tolerates you being on your side or you're more comfortable on your hands and knees.
You also can't control whether you'll be "allowed" to push in different positions - or rather, the only way you can control that is by 1) choosing a provider who is open to that and/or 2) actually GETTING in different positions to push, whether or not your provider likes it. Putting on your birth plan doesn't make it so.
And, like you said, there are some things that are under your control without needing to specify them - you can turn the lights low and fill up the bath on your own. If you're concerned that you'll be too intensely in labor to think of things independently, then make sure your support people are ready to be proactive! And if you're not sure if they will be, hire a doula! ;-)
In the end, I think the best way to use a birth plan is for things you know people are fine with you doing, but that are not totally routine so that they might need a reminder. In your sample birth plan you talked about intermittent auscultation, no IV, no separation, no offering pain meds. In advance, you made sure that everyone was on board, and this was just a reminder that these were your preferences.
I will say, I think for some people, it doesn't hurt to put "no students" on there too if that's very important to them. I know as a nurse you might feel confident about recognizing and turning away students, but not all patients do. I talked to a mom recently who had people flood the room for her first birth as baby was about to crown and she was frightened. She thought something was wrong with the baby. When she asked the nurse later, the nurse said it was a group of students. This mom was surprised to hear that she could have declined to have students in the room. I think based on her previous experience, she might be more emphatic about that this time around - if so it would probably help to state it up front.
I have noticed that the longer the birth plan, the greater attempt at control, the more likely that the woman will not get the birth she desires. The increased chance of pitocin, epidural and eventual c-section.
Keep it short and sweet. Many things can be excluded from your birth plan/list. ...
Don't go into great detail about freedom of movement in labor, lights down low, no students, plans to breastfeed, no supplements, etc, etc, etc. Many of those things you can control in labor. Get up and move in labor. Turn the lights down. Use the tub/shower.
I encourage you to go over there and read the whole thing, as well as the comments - all pretty interesting.
My reply, which got kind of overlong and so is getting its own revised and expanded post:
Interesting comments!
My (evolving) philosophy on birth plans is that they should be about what you can control, not what you can't. It's not a movie script.
Some birth plans will say "I want to be allowed to push in a variety of positions, and to squat for delivery." Well, you can't control whether you will deliver squatting. Maybe when it comes times to give birth, you're going to be too tired or baby only tolerates you being on your side or you're more comfortable on your hands and knees.
You also can't control whether you'll be "allowed" to push in different positions - or rather, the only way you can control that is by 1) choosing a provider who is open to that and/or 2) actually GETTING in different positions to push, whether or not your provider likes it. Putting on your birth plan doesn't make it so.
And, like you said, there are some things that are under your control without needing to specify them - you can turn the lights low and fill up the bath on your own. If you're concerned that you'll be too intensely in labor to think of things independently, then make sure your support people are ready to be proactive! And if you're not sure if they will be, hire a doula! ;-)
In the end, I think the best way to use a birth plan is for things you know people are fine with you doing, but that are not totally routine so that they might need a reminder. In your sample birth plan you talked about intermittent auscultation, no IV, no separation, no offering pain meds. In advance, you made sure that everyone was on board, and this was just a reminder that these were your preferences.
I will say, I think for some people, it doesn't hurt to put "no students" on there too if that's very important to them. I know as a nurse you might feel confident about recognizing and turning away students, but not all patients do. I talked to a mom recently who had people flood the room for her first birth as baby was about to crown and she was frightened. She thought something was wrong with the baby. When she asked the nurse later, the nurse said it was a group of students. This mom was surprised to hear that she could have declined to have students in the room. I think based on her previous experience, she might be more emphatic about that this time around - if so it would probably help to state it up front.
Saturday, June 19, 2010
Why do babies get supplemented in the hospital? A story from my first week on nights
While I have told myself I was going to try to pick up the posting rate in June, this week was my first doing night shifts (11 pm - 7 am) on lactation support at the hospital where I've been training to be an LC. I feel pretty comfortable there at this point, but it feels so strange to have my own electronic charting ID and not have to wait for anyone else to log me in - before, we were being supervised by the LCs and so I would chart on their accounts under their supervision.
Obviously, I've been a little anxious about whether the night nurses would be welcoming, whether people would be willing to call me - basically whether I'd have any work at all! While all the staff I've talked to so far have been nothing but happy and excited to have lactation support available, the first night was really quiet. I saw a few people in the first couple of hours, then sat around, and then things picked up from 5 am - 7 am when people started to wake up and call for assistance. I told myself that the census was low, and staff were still getting used to me being there, but I wondered if every night would be so quiet. The big hope was that having someone overnight on lactation would help prevent a lot of the bottles and supplementation that happens at night. Was I going to be able to do that?
The following night answered that question for me. I basically never sat down except to chart. I spent at least an hour with in three different rooms. And my big victory was helping keep a hypoglycemic baby from being unnecessarily supplemented. The cut-off for hypoglycemia in the newborns here is 45. The nurse caught me in the nursery and said she had tested twice, baby was just below the cut-off and heading in the "wrong direction". To the nurse, formula seemed like a medical necessity at this point. She asked if maybe I could do it at the breast. When I came into the room, though, mom was crying - she didn't want to supplement. I offered to handle the situation from there and the nurse said that was fine - she left us to it. The mom told me the baby had been hungry and about to feed, right before the nurse had come in and taken him for the blood sugar testing. I said "Well, if he's hungry, he can nurse and if he nurses well, he won't need any formula."
So, we put the baby to breast - and this baby was, indeed, very hungry and nursing fairly well. Still, I was anxious - I did not want to screw this up, I was going to get all the colostrum into that baby that I could. The nurse had brought a couple of dental syringes for the formula. I took one and popped the stopper out, and asked mom if we could hand express into it from the other side and supplement the baby with expressed colostrum. Mom said OK very readily and wow, she had plenty! I was boggled to think this baby could have ended up with formula with so much colostrum available. The mom's sister was spending the night to help her out and happily assisted with hand expression (with mom's agreement, of course) - it was so nice to see such good family support! Who says other family members can't participate in breastfeeding?
Between nursing and supplementing, by the end of the nursing session I was having to take him off and wake him up repeatedly, and he would fall asleep as soon as he got back to the breast. This kid was full. (But I was not going to let him go to sleep without getting every last drop he could!) Finally, I put him skin-to-skin with mom (also good for blood sugar!) and called the nurse to tell her "went great, no formula needed!" And you know what? The nurse was totally fine with that. She gave the baby a full hour before rechecking his sugars and - yay! - baby was back above the cut-off - "heading in the right direction". The nurse was actually very gracious and helpful about all of this, and I realized after talking with one of the other LCs that it's not a "breastfeeding is bad" mentality at all on the nurses' part - this nurse just wanted to fix the blood sugar, and the formula could be the fix, or my help with breastfeeding could be the fix. Of course, since I'm not always there, it would be nice if this experience helps her have more confidence in the future with putting baby to breast as the first line of treatment. But one step at a time!
After all this drama about avoiding what probably would have been just several milliliters of formula, you may be wondering, what's wrong with just a little supplementation? Just to get the baby's blood sugar up - then they could go on breastfeeding, no problem. And I think it's a fair question. It doesn't seem like a single bottle would do that much harm. And yet we know that babies who are supplemented - even a single bottle - in the early days tend to have shorter durations of both exclusive and any breastfeeding. And is that so surprising? After all, we say to mom "You need to supplement with formula because your baby's blood sugar is low", what is the message we are sending? "Your milk has not been feeding your baby adequately, and it will not feed your baby adequately; we cannot trust that it is there in sufficient amounts and/or that your baby can get enough of it." Any wonder that these moms go on to mistrust their ability to nurse their babies? Additionally, even just a little formula affects baby's gut flora for weeks, changing the balance of beneficial flora that exclusive breastfeeding establishes (for more information on all of this, see this article by Marsha Walker, particularly the section "Some Cautionary Words About Supplementing with Formula").
Does all this mean we should not give formula when medically necessary? Of course not! But as you can see, medical necessity in this situation was somewhat blurry. With no breastfeeding support, it's possible that this baby would have needed to be supplemented with formula. But in the end, it turned out not to be necessary at all. Babies get those bottles of formula not necessarily through malice, but because of staffing issues, longstanding habit, and lack of education and lack of trust in breastfeeding. They get formula without the understanding of the risks of "just a little bit".
What can you do to avoid unnecessary supplementation in the hospital? A few things:
1) Prepare yourself for breastfeeding - read, take a class, attend La Leche League meetings - boost both your knowledge and your confidence.
2) Choose a certified baby-friendly birthplace - this won't eliminate the possibility of unnecessary supplements, but it will greatly decrease them!
3) Make sure breastfeeding is going well - let the staff know you are committed to breastfeeding, ask for a lactation consult, and solicit outside help from La Leche League or a lactation professional if you need to. Yes, those people can come visit you in the hospital!
4) Surround yourself with family and friend support. Maybe the sister-in-law who keeps asking whether the baby is "too hungry" is not the person to spend the night with you!
5) Be ready to advocate for yourself if needed, and have all that knowledge, preparation, and support ready. I saw another mom a few months ago who confronted the same night-time pressure to supplement for hypoglycemia. She insisted that she get a chance to breastfeed first and, lo and behold, that baby's sugar came up too. Self-advocacy is not always easy (and unfortunately not always successful), but it is very important!
So that's my first dispatch from nights! I'm currently in recovery from the crazy schedule-shifting and ready to get back to regular sleep patterns for a few days. Any nurses out there have tips on shifting back and forth? I'm used to doula work where you can't plan it - you just power through and then sleep it off over the next couple of days. Tips for actually planning your night shifts would be greatly appreciated!
Obviously, I've been a little anxious about whether the night nurses would be welcoming, whether people would be willing to call me - basically whether I'd have any work at all! While all the staff I've talked to so far have been nothing but happy and excited to have lactation support available, the first night was really quiet. I saw a few people in the first couple of hours, then sat around, and then things picked up from 5 am - 7 am when people started to wake up and call for assistance. I told myself that the census was low, and staff were still getting used to me being there, but I wondered if every night would be so quiet. The big hope was that having someone overnight on lactation would help prevent a lot of the bottles and supplementation that happens at night. Was I going to be able to do that?
The following night answered that question for me. I basically never sat down except to chart. I spent at least an hour with in three different rooms. And my big victory was helping keep a hypoglycemic baby from being unnecessarily supplemented. The cut-off for hypoglycemia in the newborns here is 45. The nurse caught me in the nursery and said she had tested twice, baby was just below the cut-off and heading in the "wrong direction". To the nurse, formula seemed like a medical necessity at this point. She asked if maybe I could do it at the breast. When I came into the room, though, mom was crying - she didn't want to supplement. I offered to handle the situation from there and the nurse said that was fine - she left us to it. The mom told me the baby had been hungry and about to feed, right before the nurse had come in and taken him for the blood sugar testing. I said "Well, if he's hungry, he can nurse and if he nurses well, he won't need any formula."
So, we put the baby to breast - and this baby was, indeed, very hungry and nursing fairly well. Still, I was anxious - I did not want to screw this up, I was going to get all the colostrum into that baby that I could. The nurse had brought a couple of dental syringes for the formula. I took one and popped the stopper out, and asked mom if we could hand express into it from the other side and supplement the baby with expressed colostrum. Mom said OK very readily and wow, she had plenty! I was boggled to think this baby could have ended up with formula with so much colostrum available. The mom's sister was spending the night to help her out and happily assisted with hand expression (with mom's agreement, of course) - it was so nice to see such good family support! Who says other family members can't participate in breastfeeding?
Between nursing and supplementing, by the end of the nursing session I was having to take him off and wake him up repeatedly, and he would fall asleep as soon as he got back to the breast. This kid was full. (But I was not going to let him go to sleep without getting every last drop he could!) Finally, I put him skin-to-skin with mom (also good for blood sugar!) and called the nurse to tell her "went great, no formula needed!" And you know what? The nurse was totally fine with that. She gave the baby a full hour before rechecking his sugars and - yay! - baby was back above the cut-off - "heading in the right direction". The nurse was actually very gracious and helpful about all of this, and I realized after talking with one of the other LCs that it's not a "breastfeeding is bad" mentality at all on the nurses' part - this nurse just wanted to fix the blood sugar, and the formula could be the fix, or my help with breastfeeding could be the fix. Of course, since I'm not always there, it would be nice if this experience helps her have more confidence in the future with putting baby to breast as the first line of treatment. But one step at a time!
After all this drama about avoiding what probably would have been just several milliliters of formula, you may be wondering, what's wrong with just a little supplementation? Just to get the baby's blood sugar up - then they could go on breastfeeding, no problem. And I think it's a fair question. It doesn't seem like a single bottle would do that much harm. And yet we know that babies who are supplemented - even a single bottle - in the early days tend to have shorter durations of both exclusive and any breastfeeding. And is that so surprising? After all, we say to mom "You need to supplement with formula because your baby's blood sugar is low", what is the message we are sending? "Your milk has not been feeding your baby adequately, and it will not feed your baby adequately; we cannot trust that it is there in sufficient amounts and/or that your baby can get enough of it." Any wonder that these moms go on to mistrust their ability to nurse their babies? Additionally, even just a little formula affects baby's gut flora for weeks, changing the balance of beneficial flora that exclusive breastfeeding establishes (for more information on all of this, see this article by Marsha Walker, particularly the section "Some Cautionary Words About Supplementing with Formula").
Does all this mean we should not give formula when medically necessary? Of course not! But as you can see, medical necessity in this situation was somewhat blurry. With no breastfeeding support, it's possible that this baby would have needed to be supplemented with formula. But in the end, it turned out not to be necessary at all. Babies get those bottles of formula not necessarily through malice, but because of staffing issues, longstanding habit, and lack of education and lack of trust in breastfeeding. They get formula without the understanding of the risks of "just a little bit".
What can you do to avoid unnecessary supplementation in the hospital? A few things:
1) Prepare yourself for breastfeeding - read, take a class, attend La Leche League meetings - boost both your knowledge and your confidence.
2) Choose a certified baby-friendly birthplace - this won't eliminate the possibility of unnecessary supplements, but it will greatly decrease them!
3) Make sure breastfeeding is going well - let the staff know you are committed to breastfeeding, ask for a lactation consult, and solicit outside help from La Leche League or a lactation professional if you need to. Yes, those people can come visit you in the hospital!
4) Surround yourself with family and friend support. Maybe the sister-in-law who keeps asking whether the baby is "too hungry" is not the person to spend the night with you!
5) Be ready to advocate for yourself if needed, and have all that knowledge, preparation, and support ready. I saw another mom a few months ago who confronted the same night-time pressure to supplement for hypoglycemia. She insisted that she get a chance to breastfeed first and, lo and behold, that baby's sugar came up too. Self-advocacy is not always easy (and unfortunately not always successful), but it is very important!
So that's my first dispatch from nights! I'm currently in recovery from the crazy schedule-shifting and ready to get back to regular sleep patterns for a few days. Any nurses out there have tips on shifting back and forth? I'm used to doula work where you can't plan it - you just power through and then sleep it off over the next couple of days. Tips for actually planning your night shifts would be greatly appreciated!
Tuesday, June 15, 2010
My final LC class exam
Our LC class met for the last time the day before graduation. It was sad as such a big percentage of people were getting ready to leave. We'll be taking the exam in July spread out across the country.
While said real exam is coming up frighteningly quickly, we had to do a bit of a pro forma exam at the end of class to make it all official. We wrote it out by hand (ouch! I haven't done much sustained fast handwriting since middle school, and after just a page and a half my hand started to cramp) and then the professor asked us to type it up. I was looking it over today, and I thought I would post my answers here as a little piece of reflection on my LC training this past year:
Question #1: What is the most important things you learned as an LC candidate?
That you can't learn everything you need to know to be a great LC in one year - or maybe not even two or three - and that you don't need to become a great LC before you sit the exam. You have to keep asking questions and learning, and believing that you don't know everything!
Question #2: What are 3 very specific things you'll do as an LC based on your answer to #1?
1) Not to be afraid to admit when I have reached the end of my skills and need help
2) Have more experienced LCs on speed dial
3) Continue educating myself and observing with different people when possible
Question #3: Make up an exam question based on this learning
(Note: We were supposed to try to format the answers just like the LC exam: two wrong answers, one "distractor" that is almost right, and one correct answer. We all complained we could have written a much better question given more time! I'll reproduce my original response faithfully here anyway.)
You have been working with a mother and baby for several weeks attempting to improve the baby's sucking skills, but there has been little change despite using all the techniques you have learned. Your next step should be:
a) Counsel the mother that there is likely nothing that can be done to improve her baby's suck
b) Plan to attend a training on sucking skills
c) Refer the mother to another LC or other specialist with more advanced knowledge
d) Suggest to the mother that she switch to bottle feeding expressed milk and give her baby time to mature before attempting breastfeeding again
This really does reflect a very important piece that I learned this year. I had visions of emerging from training ready to independently help the premature baby with cleft lip and oral aversion whose mother has a low milk supply. And they would be successful, too! At times I got impatient with training: how was I going to learn all this advanced stuff if we didn't move faster? Now I appreciate better that few, if any, LCs are ready to tackle the most advanced stuff when they become certified - at least not independently. More than one LC whom I respect has told me that she became as skilled as she is by admitting when she didn't know what to do next, finding someone who did, and learning from them as they helped that mom.
Back when I did tae kwon do, everyone emphasized that getting your black belt wasn't the end of your training: it was like starting all over again. Well, I start working nights at the hospital this week doing lactation support, and I'm ready to start all over again! This is going to be (I hope) a whole new learning experience.
While said real exam is coming up frighteningly quickly, we had to do a bit of a pro forma exam at the end of class to make it all official. We wrote it out by hand (ouch! I haven't done much sustained fast handwriting since middle school, and after just a page and a half my hand started to cramp) and then the professor asked us to type it up. I was looking it over today, and I thought I would post my answers here as a little piece of reflection on my LC training this past year:
Question #1: What is the most important things you learned as an LC candidate?
That you can't learn everything you need to know to be a great LC in one year - or maybe not even two or three - and that you don't need to become a great LC before you sit the exam. You have to keep asking questions and learning, and believing that you don't know everything!
Question #2: What are 3 very specific things you'll do as an LC based on your answer to #1?
1) Not to be afraid to admit when I have reached the end of my skills and need help
2) Have more experienced LCs on speed dial
3) Continue educating myself and observing with different people when possible
Question #3: Make up an exam question based on this learning
(Note: We were supposed to try to format the answers just like the LC exam: two wrong answers, one "distractor" that is almost right, and one correct answer. We all complained we could have written a much better question given more time! I'll reproduce my original response faithfully here anyway.)
You have been working with a mother and baby for several weeks attempting to improve the baby's sucking skills, but there has been little change despite using all the techniques you have learned. Your next step should be:
a) Counsel the mother that there is likely nothing that can be done to improve her baby's suck
b) Plan to attend a training on sucking skills
c) Refer the mother to another LC or other specialist with more advanced knowledge
d) Suggest to the mother that she switch to bottle feeding expressed milk and give her baby time to mature before attempting breastfeeding again
This really does reflect a very important piece that I learned this year. I had visions of emerging from training ready to independently help the premature baby with cleft lip and oral aversion whose mother has a low milk supply. And they would be successful, too! At times I got impatient with training: how was I going to learn all this advanced stuff if we didn't move faster? Now I appreciate better that few, if any, LCs are ready to tackle the most advanced stuff when they become certified - at least not independently. More than one LC whom I respect has told me that she became as skilled as she is by admitting when she didn't know what to do next, finding someone who did, and learning from them as they helped that mom.
Back when I did tae kwon do, everyone emphasized that getting your black belt wasn't the end of your training: it was like starting all over again. Well, I start working nights at the hospital this week doing lactation support, and I'm ready to start all over again! This is going to be (I hope) a whole new learning experience.
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