I want to thank Diane w. on her reply, as lactation consultants we need to
move are practice models more consistently to evidence based, and also
suppotive of what a family needs. I am sorry that the word nipple confusion
even exists, I receive too many phone calls from mothers that think they need
to quit breastfeeding because thier babies are "confused" when a little
identification of the real issue, education, and follow-up can fix the
situation. I work with the rule of "F'S" when working with families'
1. Most Breastfeeding issues are FIXABLE
If the infant is unable to breastfeed effectively, then FIND a method that
works for the FAMILY to provide adequate nurtrition for the infant. A
FRUSTRATED FAMILY, will not breastfeed or provide breastmilk to their
infant for very long. This means use what works for them-nipple shield (baby
is at breast and no one else needs to control baby), nursing supplementor,
bottle(slow flow, longer round nipple), finger, cup, spoon,drooper. Each
feeding method has pros&cons no one way has has been proven to be the one
answer for all babies.
2. If the infant is not cannot receive a A+ for breastfeeding than mom must
increase her milk FLOW, this means double pumping with a adequate breastpump
(M--- or AE/H---)(at least for US cultures) I realize that there are many
women who have hand expressed incredible amounts, (I even know some) but the
with demands that many new moms have on them, a 10 minute double pumping
session after each is least consuming of her time.
3. Keep FEEDINGS FRIENDLY, prolonging feeding duration past 45-50 minutes
when an infant does not breastfeed well becomes FRUSTRATING for most parents
When the baby can breastfeed well, I teach you do whatever you want.
4. Provide timely FOLLOWUP, the majority of issues are resolved within 1-2
weeks, with patient care planning, and can be done with weekly 1-2 hour
visits, and phone ad-lib
Yes I also have anecdotes of infants who never breastfeed
well,(confused-no!!!-there are always many issues and variables, I would
guess about <3% of the patients I have seen) but when a mother is worked with
in a way that meets her needs, she will look back on the breastfeeding
relationship positvely,(and will be more likely to breastfeed other children)
and will appreciate the role of an IBCLC with respect. We must move away from
preaching rights and wrongs, and develop methods that are FLEXIBLE FOR
FAMILIES, this means reasearch!!!! I encourge member to develop
relationships and network with various graduate schools, and channel ideas to
these students. It can and does help. I personnally know of 2 graduate
students that are looking into breastfeeding issues at Gonzaga U. in
Spokane., and received ideas for their topics after contacting IBCLC's here.
Karen Querna, RN, BSN, IBCLC
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