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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

 

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What is an IBCLC anyway?!?!

When someone asks me what I do for work, I usually say I am a Lactation Consultant.  But that is not the whole story.  I am actually an International Board Certified Lactation Consultant (IBCLC).  It’s faster to say it the first way, but I am proud of those letters, so I try to use it so people get used to hearing it (and knowing exactly what it means).

An IBCLC is the gold standard in lactation care.  The U.S. Surgeon General called IBCLCs “the only health care professionals certified in lactation care” and that we have the “specific expertise and training in the clinical management of complex problems with lactation.” (U.S. Department of Health and Human Services, 2011).

There are a few pathways to the IBCLC certification; a health professional (nurse, doctor, midwives and a number of others) can count their hours at  work and their education covers the 14 health science courses(Pathway 1).  They can do their 90 hours of lactation specific education and count the previous 1000 hours in their job that involved working with breastfeeding parents and babies.

Recognized breastfeeding peer supporters (including La Leche League )can also use their hours supporting families, they need 1000 as well (Pathway 1 as well). They also need the 14 health science pre-requisite courses and 90 hours of lactation specific education.

There are a number of post secondary institutions that provide the 90 hours of lactation specific education, the 14 health science courses and then students obtain 300 hours of mentored hours through these institutions(Pathway 2).  There are not many of these programs, and I believe most are in the U.S.

My path to the IBCLC was via Pathway 3. In this pathway I obtained the 90 hours of lactation specific education and the 14 health science courses (most of which I obtained with my General Arts and Science Bachelors Degree + my college diploma in Science Laboratory Technology).  I then obtained 500 hours directly mentored by IBCLCs. My pathway had to be approved before starting to accrue hours.  In this route I saw a range of babies at many different ages and breastfeeding stages.  I was also fortunate to work with more than one IBCLC, so I learned many different ways to approach supporting breastfeeding parents and the varied situations they are experiencing. I obtained the 90 hours of lactation specific education at The International Breastfeeding Centre and my clinical hours at the Newman Breastfeeding Clinic. In order to graduate from that program I actually obtained more than 500 hours and passed 3 clinical exams.  And then the written exam! 3 hours of questions on a topic that is hard to be tested on because there is no real person sitting in front of you, only pictures and sometimes cryptic questions.  I studied A LOT (ask my family!) and I passed (didn’t think I had, right after the exam!) and then 6 week wait to find out the results.

One of the aspects of this career I am passionate about is that all parents get in person help if they want it.  At the clinic I work at and in my private practice I spend between 1.5 and 2 hours in a first visit.  Due to the volume of patients, this is not often possible in the hospital.  I would like to see more IBCLCs in hospitals, not just the single one that is often there and trying to help everyone. Or only available Monday to Friday 9 to 5. Babies are born all times of the day and night.  Unfortunately this is often not the case, so families (if they are even aware that this service exists) call a private practice IBCLC (such as myself) and often have to pay out of pocket for this service.  A group of my colleagues and I are working on regulation so this service will be covered by extended health care (among other goals).  Please follow along at our facebook page Ontario Committee to Regulate Lactation Consultants.

 

References:

U.S. Department of Health and Human Services. (2011). “The Surgeon General´s Call to Action to Support Breastfeeding”. Washington, DC: U.S.: Office of the Surgeon General.

IBCLE website

International Breastfeeding Centre

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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

 

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How will my partner bond with my breastfed baby?

Many families I see in their homes or at the breastfeeding clinic where I work ask a similar question; when can they “safely” introduce a bottle so their partner can feed the baby.  There are a few aspects to think about here;

 

  1. Breastfeeding takes up a lot of your time in those early days – Feeds can be long (normal), frequent(normal) and occur around the clock (normal), however this frequent milk removal and stimulation is what makes milk.  This can be overwhelming (especially if things aren’t going as well as you’d like!) and often partners want to take this on for us.  They sometimes do this by “solving” the problem.  However, in order to give you a “break” by feeding the baby, you will need to pump your breasts so that there is something to give the baby and to protect your milk supply.  This doesn’t sound quite as easy as putting the baby to the breast, does it? Pumping, washing the bottles and pump parts and then getting back to sleep.  Have your lactation consultant show you the side lying position; this can help you get more rest and protect your milk supply without adding in extra work for you or your partner.  Obviously if your current situation is more complicated than this, please seek out additional support from a lactation consultant.

  2. Flow –Most of us have seen the bottles and artificial nipples (or teats) that are “just like the breast”.  This unfortunately is all about marketing (as are most things that are being sold), and no bottle or nipple is like the breast.  Better to save your money and if you do need to give your baby a bottle, use the slowest nipple and slow down the flow(by the way you hold the bottle).  This will never be “just like” the breast, however some babies can tolerate switching back and forth between the breast and the bottle this way. Some, however, will not. If you notice your baby getting fussier at the breast, this may be in some part to that preference for the faster/easier flow from the bottle.

     

  3. How else can my partner bond with the baby? – Partners all over the world and for millions of years have been bonding to their children without directly feeding them. I know it seems, especially in those early days, that all there is to babies is eating (and sleeping and pooping!). This WILL change and in the mean time, partners can bathe, read/talk, sing, hold, rock, cuddle, do skin to skin, change all the diapers.  To support the breastfeeding parent they can make snacks, do the laundry, clean up, call/email family and friends to update them, find the lactation consultant, pick up/heat up/make the breastfeeding parents favourite meals/snacks.  And if this isn’t your first time; play with, take care of, get out of the house with any older children.

  4. And this too will pass-  Literally before you know it you will be thinking about introducing solids around 6 months.  In the first few weeks postpartum you will be shocked if anyone says it will go fast (probably because you will have been awake for most of the first month!) but it will. And once solids are introduced you can leave your partner or caregiver with solids when you go out. Nurse before you leave and then when you get home.

  5. Follow your instincts- At the end of the day, the overwhelming part is that this is YOUR baby and YOUR decision. I want parents to have all the information; to know that if their goal is to breastfeed for the better part of a year, sometimes bottles can make that easier for you but harder for your baby.  A breastfed baby doesn’t HAVE to have bottles.  Sometimes families don’t even know that not using a bottle is an option – open cup, solids, nursing before and after leaving for a few hours are all options. If this is not an option for YOUR situation, that is okay too.

Please seek out the one on one help of a lactation consultant if you have questions about getting more rest while breastfeeding, returning to paid work or being away from your baby for an extended period of time.

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