Chapter 3 Preview: Lactation Consultants

By Tamar Mekredijian

Lactation Consultants are amazing resources for knowledge about breastfeeding and are trained to help educate new mothers about the benefits and the process of breastfeeding. They help with troubleshooting physically and support mothers emotionally through the process of learning how to breastfeed and overcoming obstacles along the way.

Here is a Q&A with International Board Certified Lactation Consultant, Tess Johnson, from Fresno, California:

When do you think a mother should look into hiring a Lactation Consultant? Why?

Due to the fact that there is a lot of natural instinct that leads moms and babies in the right direction, some new mothers settle into the breastfeeding relationship fairly easily with their babies, and that’s great! But virtually every mother can benefit from the reassurance that comes from having a trained pair of eyes watching a feeding, or from receiving a few pointers on how to establish a more comfortable and efficient latch. I just saw a mother this week who was lactating well, was not in any particular pain, but who just didn’t feel confident with her breastfeeding yet. So we spent a couple of hours together, working through her concerns, one by one. I weighed her baby, I listened to her worries, and I was able to show her in a tangible way that her baby was already thriving well. She expressed to me as I left that, more than anything, she felt relieved. She had anticipated that breastfeeding was going to be a problem, due to many stories that had been thrown her way by friends and family, but for her, breastfeeding seemed to be going well, and that was not what she had expected. She kept waiting for the “other shoe to drop,” but it never did, and her worry that trouble may be just around the next corner had been unsettling. After our visit, she was finally able to trust what she already suspected: her baby was breastfeeding well.

Certainly, if there are any significant problems occurring, such as very sore nipples, painful engorgement, poor weight gain by the baby, or other areas of concern, a Lactation Consultant can help the mom achieve comfort and confidence much more quickly than if she were to try to resolve the issues on her own. It’s pretty important to get help fast when the going is tough because little issues can turn to big ones in a very short time. Many women are tempted to give up when breastfeeding challenges arise in the beginning because, let’s face it, those first few weeks find us very tired and unsure of ourselves. A visit or two with a Lactation Consultant can really build the skills and confidence in a new mother, ensuring that she won’t give up on her goals too easily. So, whether or not there are significant problems at hand, there can be a tremendous benefit to sitting down with a skilled LC.

What should a mother expect during a session with a Lactation Consultant? Is it important to ask for a follow-up session?

At most sessions with a Lactation Consultant, there will be an assessment of the mother as well as the baby, and a direct observation of a feeding. The LC will be looking at the baby’s attachment to the breast, may take some weight checks to evaluate the baby’s milk intake, and will ask quite a number of questions about the mother’s birth history, her pain level, her baby’s diaper count and feeding behaviors, and many other specifics. A mom should expect to have plenty of opportunities to ask questions and voice her concerns during the visit. She may receive some hands-on help with positioning her baby, and hopefully, she’ll have a chance to also attempt the same techniques without the helping hands of the LC, so that she ends the session knowing that she can achieve the same success independently. If she feels that she is more confident at the end of the session than when it started, that’s a great thing. But she may still want to request a follow-up session just to ensure her continued success after that visit is over.

What is the most important piece of advice you give all mothers during their first session with you?

I like to remind new moms that breastfeeding really is a relationship: a very intimate and important one. So, like other very close relationships, there’s first a “getting to know you” phase, when there may be some awkwardness and uncertainty between the partners. That’s normal, and it’s okay for things to not feel perfect at first. Due to the strong commitment between mom and baby, though, these awkward feelings are gradually replaced by feelings of closeness and familiarity, and eventually everything will feel quite easy between you. So I think my best advice is to remember to give the relationship time to build, and not to expect perfection in the early days.

What is the most common breastfeeding problem you encounter? How do you help solve it?

Probably the most common problem is sore nipples in the first days after birth. Often, moms are worried that they’re “doing it wrong” when this happens, but I hate for moms to feel they’re doing things wrong. It’s just new for mom, as well as for baby. There’s not necessarily a right or a wrong; there’s more like just a time that it takes to adjust and build skills out of instincts. I like to show a new mom that her baby will be most coordinated and focused when held very close to her body, preferably in a skin-to-skin manner. Sometimes, this is all I have to suggest. The close skin-to-skin holding often brings out baby’s best instincts, and sometimes the latch just fixes itself! If not, I like to help mom find a few key points where she can stimulate the baby’s best feeding reflexes for the deepest latch, such as touching her nipple to the area right above the baby’s mouth. When a mom sees the baby open a little wider from this type of stimulus, she learns quickly how to get that deeper latch.

How do you deal with a situation in which a mother wants to give up breastfeeding? Do you push them to continue? How do you encourage them?

One of the most important things for me to remember as a Lactation Consultant is that I’m there to help a mom reach her goals. I’m not there to help her reach mine. So, if she truly feels that she wants to stop, I am not likely to talk her out of it. However, knowing that these decisions don’t come casually, I will gladly talk it over with her if she’s open to that. I like to make sure that she really feels secure in her decision, and that her feelings about her experience are generally healthy and positive. Sometimes, a mother who feels ready to give it up may not realize that there is a possibility of combining breastfeeding with formula-feeding. She may have been under the impression that if she is not exclusively breastfeeding, the whole experience will fail. However, as I mentioned earlier, there are many versions of “successful” breastfeeding, and one way is not always the only way. So there are times when just having the conversation about options is what keeps a mother from walking away. And there have been remarkable moments when, even months later, I’ll receive a text message photo of a beautiful, growing, glowing baby who is still enjoying some time at breast, when just a few months before, her mama thought she was finished.

How long do you believe a mother should breastfeed their baby? Why? Should they set a goal?

I usually suggest that a new mother have some general breastfeeding goals in mind, but to focus on short term goals first. It can be daunting to think about months or years when your nipples are sore or your breasts feel engorged, and you haven’t slept well for a while. So, it helps to think in terms of days or weeks at first. I have one mom that I’m working with right now who is literally working through her goals one day at a time. She knows that the American Academy of Pediatrics recommends at least a year of breastfeeding (with six months of that time being exclusive breastfeeding), but she cannot yet think in those terms. She had a hard time envisioning herself nursing a baby at all in the beginning, but she is doing it for the baby’s health and for her own recovery, and it’s slowly “growing on her.” I feel that most women should be encouraged to strive for at least the first six to eight weeks, knowing that during this time, most of the challenges are likely to get ironed out, and by that point, the breastfeeding relationship has had time to build strength. At this point, longer term goals may be easier to set.

How do you encourage mothers whose milk seems to be insufficient or seems to be drying up?

Firstly, it is most important that the baby is always properly fed, so my primary focus is to help the mother develop a plan that protects the baby’s needs while preserving her own goals of breastfeeding. Often, using an at-breast supplementer achieves this. By placing a feeding tube at the breast, attached to a supplemental milk source, we can allow the baby to keep growing as a breastfeeder while his mother works on improving her milk production. The at-breast supplementer has a bit of a learning curve associated with it, so I like to practice with mom and baby directly while they learn. However, after a couple of uses, it’s usually not bad at all, and it can keep both mother and baby “in the game” for much longer than if multiple bottle-feedings are done. 

Spending time with a Lactation Consultant during the first few weeks of motherhood can make all the difference in your confidence as a breastfeeding mother, equipping you with knowledge about positioning, how to achieve a deep latch to avoid nipple soreness, scheduling, when to introduce pacifiers and a bottle, etc..

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About Mary @ SmartMom

Mary is the Community Manager of SmartMom. She is a new mom to a bubbly little boy who has fire red hair and loves to smile. She loves to walk her dog, Bob, and watch Chicago sports with her husband. Go Cubs Go!