I think Nikki makes some worthwhile points, and clearly, her warmth as a
counselor comforted the mother whose child was having such difficulty
breastfeeding. After 22 years working with mothers, I have another
perspective I'd like to toss out for consideration. It is the main point I
make when I teach breastfeeding assessment.
"Normal" is when a baby goes right to breast and breastfeeds without too
much fuss. That's how mammalian biology works when all is well. However,
birth can be perilous, and some mammals of all species will die during
birth. Many pups, kits and calves (esp. the runts) will die as the result
of birth trauma or because they are dysfunctional feeders. With skilled
birth attendants (good vets, good midwives, good OBs), more mammal mothers
survive birth. With skilled postpartum attendants, more mammal babies
survive the (usually temporary) feeding dysfunctions that would otherwise
prove fatal. The best birth and postpartum attendants all understand the
cardinal rule that should be followed while doing their jobs: Do not
frighten the mother!
But being soothing is not enough in the Not Normal situation. You have to be
soothing AND technically very expert in terms of assessing the problem. No
one with a normal breastfeeding baby requires an LC. Peer counselors, RNs
and other OB staff should all know how to facilitate latch and should ALL be
following the standards of care set out in the Ten Steps. That would
prevent most of the iatrogenic problems and will be enough for the normal
dyad. Hospitals are very wise to have LCs on all shifts to train staff in
Normal, and to be on hand to intervene in Not Normal situations.
Any mother who has a baby who can't go to breast after the kind of
interventions Nikki describes has a baby with real problems. She deserves
helpers who possess specialized skills. My concern is that the LCs she has
seen have perhaps been not quite "medicalized" enough. That is a huge issue
our profession must confront: we are differently and inefficiently and
inconsistently trained. If the LCs recognized this themselves and referred
the mother on to more specialized helpers, they have at least fulfilled
their obligation to not just throw up their hands. I would have spent
several hours with the mom, too, and done many of the same things the LCs in
the case tried. The fact that none of the tricks worked means either they
weren't the right tricks, that the LCs weren't very experienced, or that the
baby was indeed, very dysfunctional. I run across babies that are too
dysfunctional for me to help. In such circumstances, I wish I had more
expertise.
IBCLCs have the potential to evolve into real feeding specialists with real
depth of understanding about the bio-mechanics of breastfeeding. We can
also decide that what we mainly want to do as individuals is provide
mom-to-mom support. We are welcome to continue to do that valuable work in
any of a number of groups. But as professionals, we really need a 4 year
degree and post-grad education specific to bfg so that LCs are more
consistently trained in the science that should underpin all our efforts.
This would help our assessments be more precise and our interventions be
more effective. The genius of the founders of the IBLCE is that they always
identified that there should be a counseling component built into our
professional identity. If we maintain a commitment to balance technical
expertise with that counseling component we will serve a useful purpose.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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