by Tiffany Jensen Gallagher, CLC
Have you ever tried to open a package, and instead of walking across the room to fetch the tool that would slice the package right open, you reach out for whatever is most convenient and spend 10 minutes tearing away at your child’s latest 1,000-piece toy monstrosity when you could have had it done faster, more efficiently, and with less mess if you had only taken the time to grab the right tool in the first place?
Getting the right help for breastfeeding is almost the same.
Doctors, nurses, midwives, and doulas can all be incredible sources of support during and after pregnancy, but unless they have received specific training in lactation and have kept up-to-date with the latest research and guidelines, they may not be the best source for information about breastfeeding and practical assistance with managing breastfeeding difficulties. The results of one survey published in the Journal of the Academy of Nutrition and Dietetics states that 51% of physicians surveyed reported little to no education about breastfeeding; only 9% reported that they felt they have received adequate education on the topic. A similar survey published in the Journal of Midwifery & Women’s Health showed that 70% of respondents considered themselves effective or very effective in meeting the needs of breastfeeding patients, but, still, they were less knowledgeable about specific management strategies. Birth and postpartum doulas who are certified by DONA are required to have approximately three hours of breastfeeding education, which—compared to the 1,000 hours of support some lactation consultants must obtain before they even sit for the certification exam—is not very much at all.
IBCLCs (usually known as “lactation consultants”) are the experts on breastfeeding. They’ve done hours upon hours of supervised clinical work with mothers and babies dealing with a wide variety of circumstances; taken various college-level and lactation-specific coursework; and have passed a rigorous exam. They must recertify every five years and, in the meantime, keep up-to-date on their knowledge about lactation by taking continuing education courses. IBCLCs can help with the most difficult breastfeeding problems, as well as provide support for moms in the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are IBCLCs, but unless someone has those letters after their name, they are not a lactation consultant.
CLCs (Certified Lactation Counselors) could be thought of as foot soldiers of the lactation-support world. CLCs have gone through a 45-hour course about lactation and have passed an exam. Recertification, which happens every three years, requires continuing education. For many, the education ends there, but there are others who make breastfeeding their passion. I’m one of those, and I spend a very large chunk of my time reading, writing, and learning about breastfeeding, in addition to helping families overcome problems and meet their breastfeeding goals. There are more CLCs out there than IBCLCs, and they are your go-to folks for helping with minor breastfeeding issues and helping families along the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are CLCs, but unless someone has those letters after their name, they are not a lactation counselor.
Why is it so important to use the right tool (in this case, the right person) for the job? Sometimes small, seemingly insignificant or innocent suggestions can have the potential to negatively impact breastfeeding.
For example, it’s not unusual for a mom to arrive at her baby’s first doctor’s appointment to find that a baby has lost a certain percentage of his birth weight. It is absolutely normal (and expected) for a baby to lose some weight after birth, especially if a mom has received IV fluids. Lactation professionals know to consider if fluids were received and to calculate weight gain from the baby’s lowest weight instead of a baby’s birth weight. However, since many doctors do not have a good understanding of how breastfeeding works or what is normal, the doctor may suggest a supplemental bottle, which, if not managed properly, is quite likely to lead to further problems down the road. The immediate issue—helping a baby gain weight—is fixed, but breastfeeding is not supported in the long term.
What a doctor, nurse, midwife, or doula should do—and what any professional, in any field, should do—is refer a patient or client to the best person for the job. As a CLC, there are some questions I cannot answer or issues I cannot resolve within my scope of practice, and I readily refer to IBCLCs, doctors, midwives, or other care providers. One of the signs of a professional who knows what she is doing is, in my opinion, whether or not she’s willing and able to refer clients to the best resources possible.
If you’re experiencing breastfeeding difficulties or have questions about breastfeeding, I do hope that your care provider is armed with good, evidence-based information and can help support you on your journey. If you feel that your needs are not being addressed, ask for a referral, or seek out a lactation professional on your own. You’ll thank yourself for taking the extra step to reach for the right tool.
Tiffany Gallagher, CLC is a Certified Lactation Counselor, WIC peer breastfeeding counselor, and postpartum doula serving families in and around the Twin Cities. Known as The Boob Geek, she’s a member of The Childbirth Collective and Pregnancy and Postpartum Support Minnesota, and loves to help families be the families they wish to be.