I have to agree with what Barbara Wilson-Clay has said here...regarding
the use of tools. I find that currently, there are many tools that are
misused when it comes to lactation management. Some professionals use
them appropriately, and with caution, while others use them because they
have neither the time nor the expertise to deal with the lactation issue
at hand, and have to do *something,* before discharge, before the person
walks out of the office, etc. There are practices that order nipple
shields by the reams...and hand them out. Latch is poorly taught in the
hospital, and also in some pediatric offices. I teach asymmetric latch,
a la Dr. Newman, Theresa Pitman, Anne Barnes (*I use that wonderful
illustration*), and when I do, I am often greeted with the comment "Oh,
that feels so much better. WHY didn't ANYONE teach me that before now?"
It's an art, trying to figure out which tool, if ANY, to use in any
situation. I avoid expensive tools when I can, since they are iffy and
can often be frustrating. I go simply, inexpensively, and mostly begin
with basics of breastfeeding. I rent pumps when necessary, and only when
necessary, and spend time talking mothers out of them usually. Some get
miffed with me, and that's ok. I did my job by giving her basic
information. I believe that most IBCLCs are ethical. In rural places it
is often hard to get pumps in evenings, on weekends, and that is why
many LCs have them available. It is also a source of income,
legitimately, although one must keep one's ethics and eyes on the prize
at all times. Protecting, supporting, and promoting breastfeeding is the
key, as Kathleen Auerbach wrote once in an earlier JHL editorial. No
tool is off bounds, or "evil," (*I think of nipple shields here*). It's
the misuse of the tool and lack of skill and professional judgement of
the care provider that should be frowned upon.
As one writer says, somehow, we need to give childbirth and bf back to
mothers. They need to TAKE it, however. That means taking the
responsibility for it, and for owning it, and that is a critical piece
that I am not sure how to get to. Our culture does everything it can to
take it and own it on an emotional and bureaucratic level...sweeping it
out of the hands of the mother. There has to be a revolution of some
sort.
I also think that we all need more hands on mentoring and sharing among
us, as IBCLCs. It is wonderful to talk about how we handle cases, etc,
but we also need to watch others work. It is the kinesthetic work that
we do that is so easily kept to ourselves. I and some colleagues of mine
are beginning a one day walkin breastfeeding clinic in our area,
actually just one morning. In it, the mothers will have a chance to work
with skilled IBCLCs, and the IBCLCs will have a chance to work and watch
each other work with mothers...so that learnin and sharing can be
working in many directions at one time. Support for mothers, a la Chloe
Fisher's and Sally Inch's clinic in Oxford, (which I visited this
summer, lucky me), and support for IBCLCs. We must pass our physical
skills on to others so that they will know what to do with their hands.
At least as valuable as straight conference lecture information, if not
more so.
Warmly, Kathleen
Kathleen Bruce RN IBCLC
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