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Attack of the Lactation Consultants

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Saturday, December 16, 2006

One of the complaints that I often hear from moms that had trouble breastfeeding is that they heard so much pressure from friends and family to "just quit and enjoy the baby." One of the things they often say is that in retrospect, they wish someone had simply said to them "you CAN do this, it will get better." To that end, we often push new moms to see lactation consultants "early and often" to make sure that breastfeeding gets well established.

But what happens when it's the lactation consultants that are the problem?

Picture this. You're the mother of a baby born six weeks premature. You're recovering from a difficult c-section with excessive blood loss. Your baby has spent several days in the NICU and you're swelled up like a Macy's balloon from the IV fluids that have been pumped into you since you were hospitalized several days before the birth. You desperately want to breastfeed and you're bound and determined to make it work. Unfortunately, since baby came early, you've not yet attended a breastfeeding class.

Starting within a few hours of the birth, you start to hear things like this...

"You MUST start pumping within six hours of the birth!"
"You need to pump, but you can wait until tomorrow..."
"You don't need to pump for a day or two, get some rest"
"If you don't start pumping within twelve hours, your milk might not come in"
"Pump early and often, as much as you can stand."
"Make sure you pump every two hours for the first few days"
"You can go up for four hours between pumping sessions if you're tired."

Now fast forward a day or two...

"Your baby was premature, she doesn't have the energy to nurse"
"Breastfeeding is the easiest way for a baby to eat, it takes less energy than a bottle"
"Your baby may not be able to nurse for a few weeks, until she's stronger"
"You've got to get that baby on the breast and do it now"
"You're supplementing? You need to stop so baby gets hungry enough to nurse"
"Don't worry about supplementing, we can wean baby off of it over time"
"Is baby latching? Is baby getting milk? You can't just nurse her if she's not getting enough milk"
"Try taking one bottle away at a time, see if she nurses better"
"Nurse her less so that she can focus on growing, then we'll work on the latch"

At this point, you're in an endless cycle of attempting to nurse, then bottle feeding, then pumping. You might get an hour of sleep here and there and oh yeah, you're still recovering from major surgery. Now it gets even more fun...

"If you don't get that baby on the breast soon, you may lose your milk supply"
"Don't worry, get some rest, you can build your supply up over time"
"You're still pumping? Baby should be nursing by now!"
"You're taking a four hour break at night from pumping? You can't do that, you must pump more often!"
"Get to a lactation consultant immediately!"
"You don't need to come in for a consultation until next week"
"Sounds like things are going fine, call me if you think you need a consultation"
"Why did you wait so long to call? You've got to get help pronto, as in yesterday"

You can sort of fill in the rest on your own...I'm sure it's happened to some of you. We tend to talk about how great lactation consultants are and how necessary they are to the process and I agree 100%. But how do you weed out the good LCs from the bad? How do you know who is giving you old information and who is giving you new information? How do you work around odd personalities that run the gamut from "squirrel on crack" shooting off rapid fire instructions in a dizzying daze to laid-back "things will be fiiiiiiine" lackadaisical attitudes? (And that's before you even add in the advice from well-meaning friends.)

It's enough to send any new mom running to a room with her baby and locking the door behind them so that they can just find a few minutes to enjoy each other's company.

And we wonder why breastfeeding rates are so low?

I think lactation consultants are amazing people. I know a few personally that I have an enormous amount of respect for. Unfortunately, LCs are like any profession...it's filled with good, qualified people and with people that have no business slapping those initials behind their names. It's further proof than an LC can, quite literally, make or break a mom's breastfeeding experience.

I saw my own breastfeeding relationship with Elnora tanked by an LC. I saw my breastfeeding relationship with Emmitt saved by one.

How do we fight this battle? How do we take women that are the first in generations to nurse and get them the guidance and the help that they need without making things so difficult that they call it quits simply to get a moment of peace with their child during those precious early days?


  1. Anonymous Anonymous | 10:20 AM |  

    Please help this woman get a clue:


  2. Anonymous Anonymous | 11:26 AM |  

    I remember with my first daughter's birth, I really couldn't stand the LC at the hospital. I requested that she come to my room b/c I was having trouble getting my daughter to latch on properly. I had done enough research on my own to know that if done correctly, it is not supposed to hurt (at least, not as much as it was hurting me). She walked in, and without a word to me, grabbed my breast and shoved my nipple in my daughter's mouth. It still hurt. When I told her that, she said, "Well you are just going to have to deal with it" and walked out.
    The second I got home I called a local LLL leader and she coached me into a good latch over the phone. My daughter nursed until she was 20 months old, where she self weaned due to my pregnancy. That LC had no business at all being a consultant.

  3. Anonymous Jax | 12:17 PM |  

    So is a lactaction consultant a paid role in the US? I'm not quite sure what the equivalent is over here. You get midwives who should know about breastfeeding, and certainly hand out a fair bit of advice, but often it's very conflicting, much in the way you've listed.

    Then there's breastfeeding counsellors, but they are volunteers (as far as I'm aware) and the different organisations that offer the training seem to have slightly different drives.

  4. Blogger Jennifer | 4:27 PM |  

    Well, let's see...

    "Officially" there are LCs, IBCLCs and LLLL.

    LC = Lactation consultant. A lot of hospitals will say that all of their L&D recovery nurses are "lactation consultants" and they usually mean this. It's a pretty easy certification to get though, you basically sit through a few classes and then they slap a label on you. There are good ones and bad ones. In terms of birthing, think of an LC as your friend that knows a lot about birth.

    IBCLC = International Board Certified Lactation Consultant...this is a TOUGH one to get. Lots of classes, tons of clinical hours required, etc... Think of it as being a certified, licensed midwife.

    LLLL = La Leche Leage Leader...this one requires quite a bit of time and effort including lots of reading, testing and recommendations. It also requires a certain amount and type of personal experience. Think of a LLLL as a doula.

    make more sense?

  5. Blogger Amy | 4:49 AM |  

    Oh girl. I agree completely. I'm a L&D RN and we have pts who do not want the LC to come back. "She made me feel guilty" and all sorts of things. BF Nazi is the other term that gets used. Women will have bleeding nipples and want to give their babies pacifiers. "NO! You will cause nipple confusion and they will never nurse again!" These poor women are in pain, in tears, etc. I've wondered the same things myself. Great post.

  6. Anonymous Anonymous | 10:48 AM |  

    On the definitions, LC is sometimes used interchangeably with IBCLC. IBCLC is the certification, LC is the job title of the people in the hospital who are IBCLCs.

    One other certification you might hear about is the CLC - certified lactation counselor. This is a title given to people who have completed a lactation counselor course. If they aren't also IBCLCs then they are not board certified lactation consultants (completed by passing the IBCLC exam).

    Confused yet?

    I'm going to write a post soon about how to know if you're working with a good lactation consultant...

  7. Anonymous Leslie | 12:12 AM |  

    Great post! I had a difficult time dealing with conflicting messages from the hospital staff when I had my daughter. One person would grill me about how long she nursed on each breast and tell me it wasn't enough time. Another would come in and say I was nursng her too long. Still another expressed concern about my daughter getting enough fluid and recommended that I allow her to finger-feed her formula.

    Luckily, my husband and I had attended a breastfeeding class, done a lot of reading and talked a lot about it, so we were pretty determined. My husband eventually found the head nurse/lactation consultant who, after speaking with him, came to see me after her shift. She sat with me for about an hour and gave me some much-needed encouragement and gentle advice. I was thankful for the help of the lactation consultant, but I never would have gotten it if my husband and I hadn't demanded it.

  8. Blogger Nora Dalasta | 9:09 PM |  

    Point well with all the conflicting advice you listed. I literally feel dizzy after reading it! I had a c-section and was super out of it after the birth of my son. The nurse looked at my nipples and said, "Oooh, those are really small" and then popped on a nipple shield. Turns out that nipple shield was the wrong size and hurt me in the long term. For my next birth, I am going to have a mid-wife who is also an LC. They don't leave your side until mom and baby are successfully nursing.
    I've dedicated a blog to breastfeeding called lactationconsultant.com

  9. Blogger La Leche in Marshall County | 1:57 AM |  

    I read your comments and I totally agree. I believe that lactation consultants are either gentle and nuturing or doing all the talking. I think mothers should not totally rely on LCs to give them what they need. I really think La Leche League has many mothers who can give great mothering advice...and best of all it is free. I wouldnt have succeeded in breastfeeding two children if it had not been for LLL.

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