Regulation and Access

ocrlc

Access to qualified breastfeeding support can sometimes be difficult.  You have to know where to look for help and what types of help are out there.

There are many types of breastfeeding support; your health care provider (family doctor, midwife), clinics run by public health of your region, clinics that have pediatricians working with IBCLCs, support groups, clinics at the hospital and peer support.  Each type of support is helpful in it’s own way. But did you know? Some IBCLC’s will come to your home and help you there! This is known as private practice.

I’m going to talk about the private practice IBCLC (because that’s what I am!).  If you hire a private practice IBCLC, they will see you in your own home, develop a plan for you, send your health care provider a report(with your permission) and follow up with you on your breastfeeding journey. This investment needs to be paid out of pocket for the family.  But did you know that some insurance companies will cover this service? Manulife, Sun Life, Great West Life and Green Shield are all companies that recognize the IBCLC credential.  Your employer has to “opt-in” to this level of coverage, so please check with your insurance company and personal policy.

Even if you are not with the companies noted above, or you know your employer has not selected this coverage, it’s a good idea to submit the claim anyway. Why? Because the more people submitting this type of claim, the more likely they will be to enquire about the IBCLC credential.

Qualified lactation support should be available to all families that require it, however as it stands many families are not getting the care they need. Most breastfeeding parents are not reaching their goals; The Health at a Glance report for 2011-2012 from Statistics Canada indicated that 89% of mothers initiated breastfeeding; by 6 months only 26% of infants were still breastfeeding.  Common reasons cited for stopping breastfeeding were “not enough milk” and “difficulty with breastfeeding technique” (Gionet, 2013).  Early breastfeeding cessation is often the result of a lack of appropriate support and advice with respect to lactation.

A group of us, The Ontario Committee to Regulate Lactation Consultants (https://www.facebook.com/OCRLC/) would like to see our services covered by extended health care and the title Lactation Consultant protected.  Parents often seek help of non-IBCLCs who may use the title “lactation consultant” but who do not possess the expertise and professional certification of an IBCLC.  These parents may not realize that there is a very large difference in the training, skill-set, and expertise amongst the often confusing, overlapping, and unregulated use of titles carried by different lactation support personnel.  When seeking support from someone calling themselves a “lactation consultant”, parents and infants deserve that this title be exclusively limited to the gold standard professional in lactation support, the IBCLC.

I ask that if you have had an IBCLC help you on your breastfeeding journey, please follow our page on Facebook and support our efforts to provide this service to all families.

 

Gionet, L. (2013). Breastfeeding trends in Canada. Health at a Glance. Retrieved from http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11879-eng.pdf

 

Mommy Guilt……or is it Grief?

You plan to breastfeed, you hear it’s really great (for you and for the baby!) and its natural (sure to be easy!!). You see pictures of breastfeeding in those baby magazines, everyone looks so relaxed and fresh!  You take a prental class, and learn how to know it’s “go time” and also what your options are for pain relief.  You get one class on baby care and they mentioned breastfeeding but it was mostly about those first few hours (skin to skin!), no pacifiers, no bottles, baby’s cues.

THEN…………….

The baby arrives! The birth might not have been what you envisioned, you can’t believe how sore you are and while you recover they are letting you leave the hospital with this tiny human that you don’t feel very prepared to care for!   The breastfeeding in those early days is varying degrees of painful (not normal!), you are told your baby is jaundiced, or lost too much weight or will not latch at all, so you have to give your baby a bottle (not the plan) of formula (also not the plan)  Ummmm, where was this information in that class?!?!

No problem though, because you’ll just go to your doctor and get some help. Oh, wait, your doctor got even less training than you did in that prenatal class.  So you get help and a plan and still you are struggling.  You don’t know where else to go.  Topping up after feeds and/or  pumping after feeds leaves you feeling overwhelmed and even more tired.  Or it’s so painful you can’t even put the baby to your breast without crying or more damage. Or topping up with bottles of pumped milk seems like less work than even trying at the breast. Or no matter what all the “experts” say, no one can get your baby to latch.  And overtime it just gets more and more unsustainable.  So you end up, little by little changing your plan from breastfeeding to something else.  And you feel guilty.

WAIT.

But, is that what you are feeling? Did you do the best that you could with the information you had? Did you get informed choice from your health care providers? Did your breastfeeding support use evidence based information to help you meet your goals?  Often breastfeeding parents think they feel guilty for having to use formula.  There is no guilt in these situations; I believe what many are feeling is GRIEF.  They need to grieve their plan to breastfeed.  When that doesn’t work out, you need to give yourself time to understand what you are feeling.  When you see parents that did meet their goals, you might even feel ANGRY.  Are you angry at them? Are you being shamed by them for not breastfeeding? No.  Those feelings in the post partum period are big and complicated but there is never any need for guilt.  Every parent does the best that they can with the information and situation that they have at the time.

Personally, I figured I would breastfeed when I was pregnant with my first; it was free, always the right temperature and ready to feed at the drop of a hat, oh and all those health benefits for both the baby and I.  I didn’t have a plan, didn’t take any classes but I had a midwife, so I thought that was all I needed to do to prepare.  Then my baby wouldn’t latch.  No one panicked (except me!).  During those early days I finger fed my son formula.  Did that mean the end of our breastfeeding relationship? No.  Did I feel guilty; because I wasn’t giving him ONLY breastmilk? Never.  The number one rule of breastfeeding is feed the baby (this is a LOT different than Fed is Best.  See here  for a great discussion about that).  There are many different ways to do this, some protect the breastfeeding better than others.

My hope is that we all turn that grief into anger and passion; passion to change the current system that not all breastfeeding parents can afford the gold standard of lactation care; the International Board Certified Lactation Consultant (IBCLC).  Often we don’t know who is giving us breastfeeding information and advice. Anyone that calls themselves a Lactation Consultant should be an IBCLC but since it is not a protected title, anyone can.  There are also a few different ways to become an IBCLC, I’ll write more about that in another blog post.

Please follow along on the IBCLC journey in Ontario toward regulation; https://www.facebook.com/OCRLC

 

Getting Help with Breastfeeding from Facebook

In today’s fast paced culture, where many of us have no close friends or family nearby (or any that breastfeed) it can be so easy to type our questions into Google or Facebook, hoping for a miracle answer. Oh there it is, THAT’s why my baby is doing that!   This can be a great way to feel connected to your community, other parents and not feel so alone.  Until you work up the courage to get outside with your new baby (what if they poop! Or cry! Or want to feed!!!!!) it can be nice to have someone (anyone!) to talk to. Especially other parents who have experienced the newly postpartum worry and anxiety and lived to tell about it (or even have more kids!!). My concern with this way of getting advice or help for breastfeeding includes;

Experience – Parents have had (on average) 1-5 children. Maybe they know another 20 or so children (friends and families children).  In the training to be an IBCLC, I needed to spend a minimum of 500 hours with breastfeeding families, mentored by an IBCLC. If an average visit was 2 hours, then that is over 250 families! My point is advice from other parents is based on their goals, situation and advice they were given for their particular situation.  In this training I also see babies from birth until weaning so that is a wide range of ages, milestones and different techniques for different age children.

Questions -Then there is the history taking; an IBCLC asks LOTS of questions. Sometimes they are personal, and there is never judgement, we just need to know what is going on, what YOU feel comfortable with and what you can do at home. It doesn’t help anyone if I can latch the baby or get you pain-free, because I’m not coming home with you. My goal is to teach you how to get a pain-free latch, tell when the baby is getting milk and what to do when they are not.  The people responding on Facebook are often quick to give advice (from a place of wanting to help of course!) without asking questions. In regards to breastfeeding sometimes this can be outdated, not evidence based or even detrimental to breastfeeding.

In person – The computer and virtual world is great but it does lack the hands on help.  Often a full exam of the baby and assistance trying multiple positions can be helpful in person.  Finding comfortable ways to hold your baby, while enabling the baby to get milk effectively can take some time. I find it so helpful to see how families are coping with a new child, where they breastfeed, where the baby sleeps; all these pieces come together when I am making a plan for a family to help them reach their breastfeeding goals.

Cost- Facebook and online help is great because it’s free (other than what you paid for the computer and the internet connection).  There is other free breastfeeding help available too; through public health, in the hospital you delivered at, your midwives.  But sometimes that help is not enough.  They maybe familiar with babies of a certain age or experiencing certain difficulties but if the help you are getting right now is not getting you to your goals or it still hurts or you are having to feed the baby at the breast/pump/topping up with formula;look at the cost of not meeting those goals. Sometimes a short-term outlay of a larger amount seems like a lot, however if you look at the cost of the alternative for a year, the cost in the beginning is actually not that much.

So reach out, ask for help, ask why you are not reaching your goals, ask families not for advice but who has helped them reach their goals.

If you ever have any questions or comments, something you want me to write about? Feel free to contact me.