Hidden Booby Trap: Is Your Lactation “Specialist” an Imposter?

Today, March 3rd 2010 is IBCLC Day as designated by ILCA–the International Lactation Consultant Association.  (IBCLC stands for International Board Certified Lactation Consultant.)  This year’s theme is “Experience You Can Trust.”  Best for Babes would like to congratulate ILCA on 25 years, and salute the thousands of incredible, dedicated lactation professionals who are helping moms and babies breastfeed every day.   While there are still not enough lactation consultants (IBCLCs) per capita in every region, the numbers are growing, as is the awareness of the critical role that IBCLCs play in the mother-baby breastfeeding relationship.    Given  breastfeeding’s power to reduce the risk of diseases in mother and baby, IBCLCs are truly helping to save two lives for the price of one.    If you were fortunate enough to have the help of a great lactation consultant, we hope you will stop right now, and send them a note and thank them.   Trust us, they don’t make nearly what they are worth (though we do think health insurance should covered the cost fully, based on reduced lifetime risk of disease and hospital visits).  As was beautifully described in the recent New York Times article, lactation consulting is a science and an art, and it is time we gave them their due.   We have had the wonderful opportunity to meet amazing IBCLCs (and even a few MD IBCLCs–fancy that!) and we worship the ground they walk on.  

We also thought IBCLC day was a great opportunity to talk about a hidden “booby trap” that moms need to know about and know how to navigate.  All too often, new parents are getting poor breastfeeding guidance from so-called hospital lactation experts, some of whom are not even experts at all!    How do we know?  It happened to us!

Bettina:  I was having a lot of trouble latching my first baby in the day after he was born.   I had seen what seemed like an endless parade of nurses on duty, all of whom had different advice for me and my newborn.  Finally I asked if there was a lactation consultant available to help me latch my son.   The so-called specialist on call marched in my room, and barely said hello before she yanked my boob and gruffly moved my baby so she could shove my breast into his wailing mouth.  “There you go,” she said, and marched back out.   I can not describe how offended and humiliated I felt, and how my already flailing confidence in my ability to learn to breastfeed was completely eroded.  

Remember indifferent Nurse Ratched in One Flew Over the Cuckoo's Nest?

Sound familiar?   We have heard far too many horror stories of moms like this one; stories of so-called lactation “specialists” who took one look at a vulnerable new mother’s exposed breasts, and shook their heads, non-chalantly crushing that new mother’s hopes and dreams.   Giving out nipple shields like they are candy, telling a mom that she will have difficulty breastfeeding because her nipples are too small, too large, or too flat, recommending nighttime formula-feeding so that mom doesn’t “wear herself out,” are just some examples of routine, non-evidence-based — i.e., bad — advice given out daily which can spoil breastfeeding, often for good.   To be sure, there are excellent, gifted lactation consultants (IBCLCs) and lactation counselors (CLCs) all over, both hospital-based and in private practice.   There are also many wonderful nurses who go above and beyond to help mothers succeed in achieving their breastfeeding goals.    Unfortunately,  however, the Centers for Disease Control found that most hospitals perform poorly on breastfeeding support.   It is a crying shame, but new parents can’t assume that every hospital with a maternity center–some 3,000 in the U.S.–will provide quality breastfeeding help.  Unless the institution itself has been designated “Baby-Friendly” (and only 3% are) or has a proven track record of high breastfeeding initiation and continuation rates, you will very likely find an awful lot of lip-service to “breast is best”, and along with it, imposters – nurses dubbed “lactation specialists” who have only received a few hours of uncredentialed breastfeeding education, or who have enhanced their paychecks and credentials by taking the IBCLC test but don’t display competency (or much compassion), and don’t seem to stay true to evidence-based breastfeeding management.  And  the real lactation “pros?”  There are many awesome, talented lactation consultants who are crushed under an impossible caseload and unable to deliver the care they are capable of.   And often they are like lone wolves running against a pack of nurses and physicians, and pushing against outdated hospital policies.  

The cost of this masquerade is very high, and those who are committed to delivering excellent breastfeeding care have known this for a long time:  Relying on poor quality lactation support and having a miserable breastfeeding experience, can be a bigger blow for moms personally, and for breastfeeding in general, than not having received help at all.  Moms who go down this road of getting quasi-help and failing will be absolutely convinced that they are fundamentally incapable of breastfeeding, and worse, even that it was their fault.  Their collective experiences also validates the common myth that large numbers of moms “can’t” breastfeed or that breastfeeding is always horrendously difficult.  Their destroyed confidence can affect how they feel about mothering this child, can carry over to their next newborn, can discourage their peers, and can provoke understandable defensiveness and anger against those who well-meaning friends, health care providers or advocates who harp on about breastfeeding.

So, what is an expecting or new mom to do?   We encourage you to educate yourself and to be empowered as you choose where you will deliver your baby, and as you go through the birth and new mother experience.   This doesn’t mean that we want you to be a nightmare patient; it is always a good idea to be pleasant and respectful as you advocate for yourself and your babe.   We have a great deal of respect and admiration for the thousands of health care professionals whose job is to take care of us when we are at our most vulnerable, and a little courtesy goes a long way.   That said, unless moms start asking questions and requesting that hospitals provide truly excellent breastfeeding support, nothing will change.

Here are some suggestions:

  • Rely on word of mouth.   If you haven’t joined a breastfeeding support group, do so now, and get the skinny on which birth centers and hospitals are best for breastfeeding support.    You may be lucky and have a Baby-Friendly Hospital nearby!  If you can’t find a breastfeeding group, tap into the doula and midwife community in your area:  these professionals are a wealth of information.   
  • Have a back-up plan:  bring the numbers of a few recommended, independent lactation consultants (IBCLCs) or proven excellent lactation counselors (CLCs) with you, even better, interview a few in advance and put the number of the one you are most comfortable with in your speed dial.   Again, it’s best to find qualified help by word of mouth through a breastfeeding support group, the birth community, or even a baby store.   You can also go to www.ilca.org and search for lactation consultants by zip code. 
  • Get to know your lactation consultant.


    Heather Kelly, IBCLC, teaches a breastfeeding class in NYC and gives workshops through BigCityMoms.com

    Read What to Look for In a Lactation Consultant by Heather Kelly, IBCLC.    Interview potential LCs by phone first; do they make housecalls? Do they take your insurance? How are fees structured?  Do they run a support group?  Most importantly, does their style mesh with your parenting philosophy?  

  • Know excellence.   Quality lactation counselors are highly trained, compassionate, and have your and your baby’s best interest at heart.    They are excellent listeners, will take your breastfeeding history, will be professional, and will always ask for permission before examining you or helping you with a breastfeeding position, hand expression, or the like.     They want to make sure you have all the information you need to make an informed decision so you can begin the parenting journey with confidence, no matter what your final decision is, whether to breastfeed, formula-feed or a combination of both.   (Like a good coach, though, they will want to help bring out your best, and are likely to encourage and motivate you to try breastfeeding for a while before you make a final decision.) 
  • Watch for red flags:  anyone who touches you without asking, judges you, or humiliates you is not acceptable.   You may want to take down their name and the details of what happened and consider further action.   Hospitals want to serve their patients and will want to know if the quality of their care in any arena is unacceptable. Wait until you’ve caught up on sleep to make sure you have a good perspective. 
  • Prepare for breastfeeding before birth.  Read our  Ultimate Breastfeeding Preparation Checklist, learn how to find your A-team (ob-gyn, hospital, pediatrician), read the Learning Curve, and How to Get Your Best Game On, for starters.   Pregnancy lasts nine months but the benefits of breastfeeding last a lifetime for you and your babe, babe!   Decorating the nursery is fun but knowing how to navigate booby traps is essential. 

How does excellent care look from the perspective of a lactation consultant?  Not to set the bar impossibly high, but here is the experience of Nikki Lee, RN, IBCLC, a wonderful lactation consultant (and my teacher during my CLC training), taken from her comment on our post about Healthy Children: 


Nikki Lee, RN, IBCLC: a great lactation consultant and educator

I loved my work as a hospital LC. My favorite thing was to invite the baby into the conversation and encourage the mother to put her baby skin to skin, then pull up a chair and sit and chat. Neither the mother nor I could see the baby because it was under a blanket on the mom’s chest.

Half the time, in the middle of our conversation, the mother would get an amazing surprised look on her face and say,”My baby is breastfeeding”. I LOVE THAT!!. No work on her part, we were having a good time together, and the baby showed the mother that breastfeeding could be very easy.

The stuff I didn’t like about the hospital experience was having to fight against the ignorance of some hospital staff who were suspicious of skin to skin and totally convinced that giving the baby a bottle of formula was the solution to most problems and challenges. I didn’t like that mothers and babies were never left alone to figure things out for themselves. I didn’t like the time presssure, that a baby would have to nurse by “X” number of minutes, or else.

I really didn’t like how mothers and babies were injured and disconnected from each other as a result of birth technology and surgery and induction. It was so difficult to get breastfeeding going when a mother was recovering from surgery and her baby was premature.

I also didn’t like that so many staff people wouldn’t want to know anything about breastfeeding even when invited to watch me and learn. They would just wait for me to come to work so that I could take care of all the mothers. Breastfeeding is everyone’s business, not only a LC’s!

Every once in a while, I would encounter a mother that didn’t want my visit. Sometimes it was because she’d nursed a bunch of other babies and felt confident. Sometimes it was because she’d heard bad things about LCs. That was hard to hear.

I loved to see the mothers that had chosen not to breastfeed. I wanted to be sure they knew how to be comfortable with their breasts that would have to dry up. I would sit down and chat with these mothers, and after some conversation, ask how she made her infant feeding decision. Half the time, the reason she’d made her choice was out of some misconception about breastfeeding. When that misconception was corrected, some mothers would change their minds. That was exciting. The other times, where the mothers were absolutely definite about their choice, I would ask them to tell me more so I could learn about their lives and the reasons for their choice. This was important and humbling.

Any strategies you have used to ensure you get excellent lactation care in the hospital or birth setting?

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