Lactation Consultants

By Tamar Mekredijian

Becoming a mother for the first time is overwhelming in so many ways. You endure pregnancy, labor and delivery, and suddenly your life is changed forever by a little bundle that completely depends on you. These days, many new moms are urged to breastfeed rather than give their babies formula. This is because studies have shown that breast milk carries nutrients that are beneficial to babies and conform to their specific needs. Breastfeeding is also beneficial for the mother. Studies show that breastfeeding mothers get more sleep than those who feed their babies formula, and more sleep means a decreased chance of developing post part-um depression. It’s become more and more common for mother to choose breastfeeding over formula feeding, but what they don’t realize is that in the midst of this huge life change called motherhood, breastfeeding can be challenging, both physically and emotionally.

When I gave birth to my daughter, the nurses brought her to me soon after and told me she was hungry. I was extremely nervous. After all, it was my first baby, and I didn’t know what to expect. My husband and I had both agreed that we wanted her to be breastfed. We thought our instincts as parents would take over, but what made it difficult was that we were extremely sleep deprived and also that we really didn’t know what to do. We practiced skin-to-skin time with our daughter, but ultimately, she was not latching well and the nurses were concerned. She was jaundiced and was losing weight fairly quickly. The word “formula” began being tossed around and I was very discouraged. Finally, one of the nurses informed us that there was a Lactation Consultant making her rounds. The nurse explained that she specialized in helping mothers learn how to breastfeed. We jumped at the chance to meet her. After spending just ten minutes with the Lactation Consultant, I already felt more confident and even more determined to continue breastfeeding. We asked to see a consultant each time I fed my daughter while I recovered at the hospital. When we left, we hired a consultant to come to our home when we faced a few problems with latch – without her help, we would not have been able to continue the breastfeeding relationship that we wanted.

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:

What is a Lactation Consultant? What are their specialties?

A Lactation Consultant is a health care professional who has the education, training, and experience to help mothers with a wide variety of breastfeeding challenges. In addition to a strong knowledge base that covers a wide spectrum of lactation problems, each consultant may also choose to specialize in various areas of interest, such as working with premature babies, assisting mothers with low milk production issues, resolving latch difficulties, and many more possibilities. There are several different types of specialists in the field of lactation, but usually the term “Lactation Consultant” is reserved for those who hold an international certification, or the title of IBCLC (International Board Certified Lactation Consultant.) As an example, I first became a Certified Lactation Educator in 1992, but advanced my practice to become an IBCLC by 1998.

Why did you choose this profession?

I was an RN (registered nurse) first. I was working in the postpartum unit of the hospital, and I realized very quickly that breastfeeding assistance was one of the most frequently requested aspects of patient care by new mothers. I wanted to be proficient in it, yet I had only received a short lecture on the subject in nursing school. So, I began to follow the Lactation Educator around as she visited with the patients, every chance I had, learning directly from her. It was a great way to see the techniques in action, and I picked up a lot of skills from her that I could use as a bedside nurse. About a year later, when that Lactation Educator was preparing to leave on her own maternity leave, I was asked to attend formal training in the field of lactation so that I could take her place while she was away. It was the start of a lifelong passion for me, and I realized that the more I learned, the more I wanted to know. That has never changed!

 Do you believe that breastfeeding is best? Please explain.

I absolutely do. Both the act of breastfeeding and the actual breast milk itself are worth all of the effort we put into them, in my opinion. But there’s more to it than what the studies have shown us. I mean, obviously, there have been countless health benefits demonstrated in research studies conducted all over the world, and it’s truly amazing how our milk is designed to protect our babies, as well as maintain our own health. But what seals the deal for me isn’t the science; it’s the relationship that is built through breastfeeding or even through providing breast milk. Through 22 years of clinical practice, I have seen that even when things don’t go as planned, and a mother must supplement, or must pump, or when she experiences some other limitation to the original plan, she can still capture an aspect of the breastfeeding relationship that is special and lasting. I’ve been privileged to witness the powerful connection between mother and baby that comes from giving a part of ourselves to our little ones, and I’ve seen that overcoming the bumps in the road provides a sense of personal accomplishment for the mother, so when there is some level of breastfeeding taking place, it all seems valuable to me. Therefore, yes, I believe it’s best, yet I have learned to see “success” in many different ways. It doesn’t have to be the textbook-version of success to be beneficial.

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.

What type of medical advice are you allowed or do you give to clients? What do you do if you encounter or discern a medical problem with the baby?

Much of what I do is observation and assessment, followed by suggestions for what may be causing the problems at hand, and possible solutions. I cannot, however, diagnose illness or provide medical treatments. When it appears that something medical may be interfering with the breastfeeding success, I can offer a mother suggestions on what types of questions to ask her physician, and I will encourage her to consult with the doctor immediately if it appears that a medical intervention is necessary. If I encounter a problem with the baby that needs medical attention, I can, with mother’s permission, call the doctor directly to discuss my concerns while I’m still with them. I have definitely done that before. For example, I recently arrived at a mother’s house and noticed immediately that the baby was not only very sleepy, but quite jaundiced as well. The mother had thought he looked a bit yellow, and was having trouble getting him to latch on (which was why she had called me), but she wasn’t sure how much of a concern it was. Judging by the baby’s sleepiness and poor output that day, I determined that his jaundice may have crossed the line into the abnormal realm. So, the mom allowed me to call the doctor directly, and the doctor offered to send the baby directly for a lab test. It was good that he did, because the baby was actually admitted to the hospital for phototherapy that afternoon. I had the mother start pumping, and we rescheduled our lactation consultation for a later date when he was feeling better and back at home. He went on to breastfeed well after his jaundice was resolved.

Have you come across new moms who are emotionally drained or unstable due to breastfeeding issues? How do you help them?

I definitely have. My heart really goes out to moms in this situation because, even though they desperately want to breastfeed, sometimes the stress of it all becomes overwhelming. It can be even more crippling if the mother is not getting any sleep. So occasionally, I have to encourage a mother to take a break from breastfeeding and get some sleep. If the baby is in need of feeding while mom catches up on sleep, there are breastfeeding-friendly ways to provide the necessary milk, such as finger-feeding with an SNS supplementer, or dropper-feeding. If sleep for mother still doesn’t help her emotional state, or if she is too anxious to even fall asleep, I contact her doctor for a medical evaluation. Sometimes, the priority must absolutely be to focus on mom’s health first–before trying to fix the breastfeeding, because all of the hands-on lactation help in the world won’t resolve anything if the mom ends up feeling broken. Once I have mom feeling more fortified, my focus on solving any breastfeeding issues can resume. In a situation like this, I often remind the mother that her breastfeeding relationship with her baby is a long-term one, not short-term, and therefore, there’s plenty of time to get back to the journey of cultivating it. If a few hours or days of self-care will keep a mother’s health intact, it will be worth a brief pause in the breastfeeding plan.

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.

Have you ever had to tell a mother that she needs to stop breastfeeding due to medical issues and/or medications she must take? Please explain.

I have, although this is very rare. Years ago, I took care of a mother who had a rare blood disorder, and her only hope for a safe recovery after the birth was to take powerful medications. At first, we hoped that she would eventually be able to wean off of the medications, so I set her up with a pumping and dumping plan to protect her milk supply. However, she eventually was told that her situation was not improving the way that it should have, and long-term drug therapy was going to be necessary; all of her medications were simply incompatible with breastfeeding. It was hard for her to accept, at first, but oddly enough, even though her milk wasn’t saved during the pumping phase, she said that the act of pumping gave her a little bit of comfort. Just seeing her body make milk, feeling the hormones respond to the stimulation from the pump, helped her bond with her baby somehow. She gradually weaned herself from pumping, and made a conscious effort to love her baby at every feeding, just as if she had been breastfeeding. So, again, success can come in many forms.

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. 

Please share your favorite success story with a client. What was the main issue? How did you help her overcome it?

I have so many favorites, it’s very hard to choose! Each mom inspires me. Each one makes me want to shout from the mountaintops when she finally achieves what she thought she could not do. But one who stands out in my mind occurred just a few years ago. The mother and father had a deep desire for their baby to be breastfed, yet I noticed immediately that Mom appeared to lack self-esteem. She had apparently struggled early in life, but she and her new little family were determined to make things work. It did not help matters when her baby, a late-preterm five-pounder, struggled to even latch on for a single moment. Rather, she fussed and cried at the breast every time her mother tried to feed her. Mom’s milk supply was low. Baby was underweight and low on fluids. Initially, even a nipple shield and an at-breast supplementer were not helpful, so mom had to resort to pumping for her, and the milk was given to the baby by cup or finger-feeder, oftentimes by the baby’s devoted dad. Despite the mother’s generally low self-esteem, she plugged on and didn’t give up. I did everything in my power to keep her feeling encouraged and hopeful, helping her to see even the smallest daily achievement as good reason to continue the next day. So she did. She pumped religiously, and continued to attempt feedings for several weeks. As is often the case with reluctant nursers, little by little, her baby began to latch on. First, using a nipple shield with the added flow of the supplementer, then later, once mother’s milk had developed more, she breastfed with the shield alone. Finally, there came a time when the baby’s weight gains were consistent, when she was no longer fighting the latch, and when her strong and patient mother was able to stop using a nipple shield! She was successfully breastfeeding, and the whole family was loving it. This mother even came to my Mom to Mom Support Group to inspire other moms to stick with their breastfeeding goals. Mom, Dad, and their sweet little baby remained in touch with me throughout the next couple of years, often sending pictures of a chubbier and more radiant baby every few months. Likewise, her mother now appeared confident and radiant, as well, as if she had discovered something in herself that she never knew had been there before. Breastfeeding can be a real self-esteem booster, and I’ll never forget that lovely little family.

Do you believe every mom should spend some time with a Lactation Consultant, whether while recovering from labor and delivery at the hospital or afterwards at home? Please explain.

I do recommend that every mother spend at least some time with a Lactation Consultant after giving birth, even if it is just a brief conversation about the mother’s general feelings about the early feedings, or to check the baby’s latch visually while still in the hospital. Regardless of the number of times a mom has nursed before, each new baby enters this world with his or her own set of strengths and weaknesses, so it can be expected that no two breastfeeding journeys will be exactly alike. Every mother, therefore, deserves the support and assessment skills that a Lactation Consultant can offer. Additionally, even a brief visit with a Lactation Consultant can serve as a reminder to the mother to seek further evaluation quickly if any problems surface. If no lactation services are offered in the facility where baby is born, then I would think it wise for mothers to seek a consultation soon after they have settled in at home.

 

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..