And the Word Breastfeeding Week blogs just keep rolling out…
I said in my last blog that the breastfeeding training midwives receive is sufficient to ensure that most mums can establish breastfeeding successfully (but other issues sometimes stop midwifery support from being as effective as it could be). As midwives are the main health care professional that mums see about breastfeeding, they are crucial to those first few weeks of breastfeeding. For the longest time, rather arrogantly, I assumed that what a midwife knew was the extent of breastfeeding knowledge. I used to believe that if a baby was unable to breastfeed with the help and support that we could give well, then, that was it. I knew that there was a wide range of activities midwives could do to promote breastfeeding, but I knew that there were areas where we fell short. Some of the niggling questions that went through my mind were:
What DO you do when a baby won’t latch on?
Why is it still hurting, even when the latch looks good?
Why isn’t this baby gaining weight adequately, even when the feeding looks right?
So while I knew that we weren’t able to solve every breastfeeding problem, I thought that we were the best source of help available to mums.
Then I had my own baby.
I got thrust into a world of very different breastfeeding knowledge. I discovered that there was so much more to breastfeeding than what I had learned as a midwife. I also discovered lactation consultants. The “gold standard” in breastfeeding knowledge is considered to be an International Board Certified Lactation Consultant (IBCLC), you have to undergo a rigorous course of study in order to qualify. I’ll not go into details in this blog, but if you want to read more about what an IBCLC is, you can read here.
At the start of this year I started to train to be an IBCLC. I have taken a 90 hour course (that’s just the lectures, additional reading and study is on top of that). My midwifery degree counts towards the health science requirements, but if you aren’t already on their list of approved health care professionals, there is further extensive study required. I also had to have a substantial number of hours actually helping women to breastfeed. That’s all before I could even apply for the exam. I’m lucky because I’m a midwife, so for me the requirements are easier to meet. For someone starting from scratch, it’ll take them years to reach the point where they can apply for the exam.
I’m no stranger to academia (I have a MSc in Midwifery as well as a BSc and a BA), so I was slightly concerned that the IBCLC course I took wouldn’t be sufficiently academic, but that wasn’t the case. There was quite a bit of overlap between my midwifery knowledge and the knowledge gained on the course (infant development, maternal and infant medical conditions, for example). There was however, a wealth of new information. I think what impressed me most about the course was the systematic and detailed approach to breastfeeding that lactation consultants need to have.
Why do I think this is important?
I said that midwives have sufficient training to ensure that most women can breastfeed. However, I don’t think that midwifery training really does address all of the breastfeeding issues that occur. As I mentioned in my last blog, many women complain about the conflicting advice they get from midwives. I think partly this comes down to each midwife’s perception of what breastfeeding should look like, but I also believe this is partly because we (midwives) are not breastfeeding experts. Just as I would say GP’s are not the experts in pregnancy and birth, but midwives are, I’d say that lactation consultants are the experts in breastfeeding, not midwives. As midwives, we have all gained experience and knowledge about breastfeeding beyond our initial training, and some midwives have a fantastic knowledge and range of practical skills. However, because it isn’t necessarily a complete and extensive knowledge base we might not be able to put all the pieces of the puzzle together, so one midwife suggests one thing and another midwife suggests another.
So for example, the baby that seems to be breastfeeding fine, but isn’t gaining weight. One midwife might suggest insufficient milk supply, another might suggest feeding more often, another might suggest expressing after each feed, another might say baby is just a “lazy feeder”. A lactation consultant on the other hand, would take a complete history, and assess both mother and baby, as breast development, breast surgery and medical conditions can all affect a woman’s ability to produce milk. Then the lactation consultant will assess a baby’s ability to breastfeed, which includes taking a history about the birth, assessing baby’s suck, checking for tongue ties and the ability to transfer milk efficiently before identifying the most likely cause for the baby’s slow weight gain. The lactation consultant will then implement a comprehensive plan of action, which will take into account the mother’s goals for breastfeeding. Possible interventions which the lactation consultant might suggest include suck training, supplementing at the breast using a supplemental nursing system, or even a tongue tie revision. See the difference between a midwife and lactation consultant?
So do I think every woman should see a lactation consultant? If you are determined to breastfeed, you may decide to see a lactation consultant antenatally to discuss your breastfeeding plan. Or you may just want to book a home visit for a few days after the baby is born. I don’t think an appointment with a lactation consultant is essential for every woman, though. I think that most women can breastfeed, provided they get the right help and support, be it from a midwife, knowledgeable friend, or breastfeeding support group. However, there is definitely a role for someone with an in-depth knowledge of breastfeeding, who has various skills and assessment tools at her disposal, to assess and evaluate a full feed properly, if things just don’t seem “right”. Furthermore, a lactation consultant possesses the additional skills to help babies that have physical issues (such as prematurity, birth injury, congenital malformation etc) that may make it difficult, but not impossible, to breastfeed. I would suggest that if you are really struggling with breastfeeding and you don’t get the answers you need from your friends and family, your breastfeeding group, or your midwife/health visitor/GP, you contact a lactation consultant, especially if you really want to breastfeed and no one else seems to be able to suggest a different course of action.
I would love to see the day when each hospital trust has at least one lactation consultant employed to help women with breastfeeding problems, or to give midwifery staff advice for helping women in their care, as there are in other parts of the world. Unfortunately, that isn’t the case (perhaps because breastfeeding really isn’t a priority for the NHS?).
14th February, 2017 edited to add: I am now an IBCLC offering private consults and breastfeeding workshops, you can contact me here: email@example.com. There are a few other IBCLC’s in practice also in N Ireland you can find details here.